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At least 469 records · Page 26Linked to original sources
PubMed2000

Midcarpal arthrodesis with complete scaphoid excision and interposition bone graft in the treatment of advanced carpal collapse (SNAC/SLAC wrist): operative technique and outcome assessment.

Thirty-six patients with stage II or III SNAC and SLAC wrists were treated by midcarpal arthrodesis and complete scaphoid excision. When assessed at a mean follow-up of 25 months, pain was significantly reduced both under resting and stress conditions. The active range of motion was 54% of the contralateral wrist and grip strength was 65% of the non-operated hand. The mean DASH score was 28 points, the Mayo wrist score was 63 points, and the Krimmer wrist score was 68. Correlation of the wrist scores with the DASH values demonstrated a significant correlation. Our data demonstrate that midcarpal fusion with complete excision of the scaphoid is a reliable procedure for treating advanced carpal collapse.

Arthralgia↗
PubMed1997

Scaphoid nonunion treated with bone graft and Herbert screw. 23 of 28 fractures healed.

We retrospectively reviewed 28 patients with symptomatic, established nonunion of the waist of the scaphoid who were treated with bone grafting and Herbert screw fixation. A volar approach was used in 20 patients, and a dorsal in 8. Grafting was performed with cancellous bone from the radius in 16 patients and a iliac wedge graft in 12 patients. At a mean follow-up of 3 (1-6) years. 5 of the 28 patients had not united. The surgical approach, the type of graft applied, and the duration of postoperative immobilization played a role for the final outcome. The volar approach appeared to be associated with a better outcome which may be attributed, in part, to the relatively better view of the nonunion achieved with this incision compared to the dorsal approach. The iliac wedge graft was more effective for reduction of the deformity and initial stabilization. We believe that the relatively long period, 3 months, of postoperative immobilization negatively effected the postoperative function because of stiffness.

Adolescent↗
PubMed1993

[The utility of three-phase bone scintigraphy in the assessment of fractured carpal scaphoid].

Thirty-seven joints in 36 patients with a fractured carpal scaphoid were evaluated by three-phase bone scintigraphy. They were classified into two groups according to their progress. Some were in good clinical condition and some in a non-union condition. Increased blood flow in the radial arteries and ample perfusion on and around the scaphoid bones on blood flow images suggested a good clinical course. The activity and the effectiveness of remodeling correlated well with the degree of scaphoid uptake on blood pool images taken more than seven days after the injury. Scaphoid uptake was more localized or there was almost none on blood pool images in cases with nearly complete recovery while it was amply visualized on static images. Blood pool images were indispensable for analyzing lesions and evaluating the clinical course. Two typical findings of scaphoid fractures were found on both blood pool and static images. One was diffusely increased scaphoid uptake seen in cases with a good clinical course, and the other was decreased uptake at proximal fragments seen in cases with non-union. It is concluded that three-phase bone scintigraphy provides useful information for evaluating the process of scaphoid fractures which cannot be obtained by means of conventional bone scintigraphy.

Adolescent↗
PubMed1984

Management of the fractured scaphoid using a new bone screw.

A new and simple operative technique has been developed to provide rigid internal fixation for all types of fractures of the scaphoid. This involves the use of a double-threaded bone screw which provides such good fixation that, after operation, a plaster cast is rarely required and most patients are able to return to work within a few weeks. A classification of scaphoid fractures is proposed. The indications for operation included not only acute unstable fractures, but also fractures with delayed healing and those with established non-union; screw fixation was combined with bone grafting to treat non-union. In a prospective trial, 158 operations using this technique were carried out between 1977 and 1981. The rate of union was 100 per cent for acute fractures and 83 per cent overall. This method of treatment appears to offer significant advantages over conventional techniques in the management of the fractured scaphoid.

Adolescent↗
PubMed1996

Revision of failed bone grafting for nonunion of the scaphoid. Treatment options and results.

Failure of bone grafting in scaphoid nonunion presents the hand surgeon a perplexing set of problems. Controversy remains as to the best course of treatment in this difficult situation. The authors have retrospectively reviewed during a 5-year period the patients treated at the Mayo Clinic who have gone on to a second nonunion after a failed initial bone grafting procedure. Twenty-five patients were identified, 19 of whom had a second bone grafting procedure. Depending on the preoperative evaluation, 4 types of bone grafting procedures were performed: conventional Russe procedure, 4; Maltese cross bone graft procedure, 6; interpositional wedge graft, 5; and vascularized pedicle bone graft, 4. Twenty-two of 25 united (88%). Average followup at 57 months (range, 25-90 months), shows satisfactory results (16% very satisfied and 8% moderately satisfied), but varying degrees of pain. Results using a modification of the Mayo Wrist Score are somewhat disappointing with 3 excellent, 5 good, 10 fair, and 7 poor. It must be remembered, however, these wrists have had at least 2 surgeries, multiple long periods of immobilization, and often a delay in treatment with a prolonged period of abnormal carpal mechanics. It is thought that a second bone grafting attempt should be strongly considered. The key to success is matching the type of bone graft procedure to the specific unique features of scaphoid shortening, carpal instability, and proximal pole vascularity that each patient's wrist displays. A treatment algorithm is presented to help decision making in this difficult problem.

Adolescent↗
PubMed2001

Scaphoid nonunion. Treatment with cancellous bone graft and Kirschner-wire fixation.

The wrist surgeon must be conversant with the many methods of treating scaphoid nonunions. Cancellous bone grafting combined with K-wire fixation is a relatively straightforward technique that has been shown in several studies to predictably produce healing of scaphoid nonunions. Although there may be a trend toward early use of vascularized bone grafts for the treatment of scaphoid nonunions, it would seem reasonable to reserve that procedure for cases in which the vascular supply to the scaphoid fragments is compromised, and for which there is little hope that a nonvascularized bone graft will succeed.

Bone Transplantation↗
PubMedDate not supplied

Treatment of scaphoid nonunions by Russe bone grafting--a retrospective analysis.

Forty-five patients with symptomatic established delayed union and nonunion of the scaphoid were operated between January 1983 and December 1997. The Russe anterior corticocancellous bone-grafting was performed in twenty-five cases. Using a grading system, we analyzed the suitability of this method, for three types of nonunion. We attained a 92% bony union rate of all nonunions grafted. Review of the relevant literature shows that there was same significant difference in union rates between the types of nonunion, the vascularity of the proximal fragment and the presence of dorsal intercalated segment instability (DISI). The aims of this procedure are to obtain a good functional wrist without pain and to prevent late arthritis.

Adult↗
PubMed2004

[MR imaging accuracy in the prediction of bone graft healing potential in scaphoid non-union].

PURPOSE: To determine the accuracy of MR imaging in predicting bone graft healing in patients with scaphoid non-union. MATERIAL AND METHODS: 21 patients with scaphoid non-union were examined with MR imaging prior to bone grafting (conventional bone graft in 14 cases and vascularized bone graft in 7 cases). The protocol included unenhanced and Gadolinium-enhanced sequences. Signal intensity and homogeneity of the proximal fragment was analysed by two independent radiologists. MRI findings were then correlated to the postoperative rate of union. RESULTS: Healing occurred in 17 cases and failed in 4 cases with a mean follow up of 14 months. Intraobserver agreement in MR reading was respectively 0.92 et 0.86. Interobserver agreement was 0.88. On Tl-wi, the proximal fragment was hyperintense in 1 case (with positive surgical result), heterogeneous low signal intensity in 7 cases (healing in n = 7) and homogeneous low signal intensity in 13 cases (healing in n = 9). On T2-wi, the proximal fragment was hypointense in 4 cases (healing in n = 3), homogeneous high signal in 5 cases (healing in n = 4) and heterogeneous high signal intensity in 12 cases (healing in n = 10). After Gadolinium injection, enhancement was homogeneous in 4 cases (healing in n = 4), heterogeneous in 8 cases (healing in n = 7) and absent in 9 cases (healing in n = 6). In the group with no enhancement, 5 patients were treated with vascularized bone graft (healing in n = 4) and 4 with conventional bone graft (healing in n = 2). CONCLUSION: The absence of enhancement of the proximal scaphoid fragment leads to poor surgical results except for vascularized bone graft.

Adolescent↗
PubMed1996

Magnetic resonance imaging versus bone scintigraphy in suspected scaphoid fracture.

Magnetic resonance imaging (MRI) has become increasingly useful in the evaluation of musculoskeletal problems, including those of the wrist. In patients with a wrist injury, MRI is used mainly to assess vascularity of scaphoid non-union. However, the use of MRI in patients in the acute phase following carpal injury is not common. Three-phase bone scintigraphy is routinely performed from at least 72 h after injury in patients with suspected scaphoid fracture and negative initial radiographs. We evaluated MRI in this patient group. The bone scan was used as the reference method. Nineteen patients were included. Bone scintigraphy was performed in all 19 patients, but MRI could be obtained in only 16 (in three patients, MRI was stopped owing to claustrophobia). In five patients, MRI confirmed a scintigraphically suspected scaphoid fracture. In one patient, a perilunar luxation, without a fracture, was seen on MRI, while bone scintigraphy showed a hot spot in the region of the lunate bone, suspected for fracture. This was confirmed by surgery. In two patients, a hot spot in the scaphoid region was suspected for scaphoid fracture, and immobilization and employed for a period of 12 weeks. MRI was negative in both cases; in one of them a scaphoid fracture was retrospectively proven on the initial X-ray series. In another two patients, a hot spot in the region of MCP I was found with a negative MRI. In both, the therapy was adjusted. In the remaining six patients, both modalities were negative. We conclude that in the diagnostic management of patients with suspected scaphoid fracture and negative initial radiographs, the use of MRI may be promising, but is not superior to three-phase bone scintigraphy.

Adult↗
PubMed2000

Free vascularized bone graft for nonunion of the scaphoid.

We used a free vascularized small periosteal bone graft to treat scaphoid nonunion. The graft consisted of periosteum, full-thickness cortex, and the underlying cancellous bone and was harvested from the supracondylar region of the femur. The graft was nourished by the articular branch of the descending geniculate artery and vein. Unlike the currently used vascularized bone grafts, this graft can be easily harvested and shaped to accommodate the bone defect of the scaphoid without disturbing its vascularity and can then be transferred with microvascular anastomosis of the nutrient vessels to the radial artery and its venae commitantes. Ten patients with longstanding nonunion of the scaphoid secondary to avascular necrosis, confirmed by radiologic and intraoperative findings, were treated with this vascularized bone graft. Union was achieved in all 10 patients at an average of 12 weeks after surgery. The average follow-up period for all fractures was 3.5 years. The scores for overall outcome, according to the Mayo wrist scoring system, were excellent in 4 patients, good in 4, and fair in 2. Two unsatisfied patients had preoperative signs of early periscaphoid osteoarthrosis. This free vascularized small bone graft from the supracondylar region of the femur is an attractive alternative to the conventional vascularized bone grafting procedures.

Adolescent↗
PubMedDate not supplied

Management of scaphoid nonunions.

Scaphoid nonunions result in a predictable pattern of wrist arthrosis. To minimize the incidence of arthrosis, the goal of treatment should be consolidation of the fracture with the scaphoid in anatomic alignment. Computed tomography and magnetic resonance imaging scans can aid evaluation of carpal collapse, scaphoid collapse, scaphoid nonunion, bone loss, and detection of osteonecrosis. Nonunion of the scaphoid waist may result in a humpback deformity, increasing the chances of further collapse and arthrosis. This collapse deformity must be approached volarly with an intercalary bone graft and internal fixation. A dorsal approach to proximal scaphoid nonunions allows easier access for removing the necrotic bone from the proximal pole and applying accurate screw or pin fixation. Vascularized bone graft is recommended to manage scaphoid nonunions with osteonecrosis.

Bone Transplantation↗
PubMed1989

Symptomatic non-union of the carpal scaphoid: Matti-Russe bone grafting versus Herbert screw fixation.

We have reviewed 19 patients who have had Matti-Russe bone grafting and 16 patients who have had Herbert screw fixation for symptomatic non-union of the carpal scaphoid. The success rate in both groups was similar, 74 per cent in the Matti-Russe group and 71 per cent in the Herbert screw group. Only five patients in the Herbert screw group had bone grafts. The advantages and disadvantages of both methods of treatment are discussed.

Adolescent↗
PubMed2002

A mechanical comparison of bone-ligament-bone autografts from the wrist for replacement of the scapholunate ligament.

A study was performed to compare the mechanical properties of two intracarpal ligaments with those of the dorsal component of the scapholunate interosseous ligament (SLIL). Trapezoid-to-second metacarpal, capitate-to-trapezoid ligaments, and the dorsal part of the SLIL were obtained as bone-ligament-bone grafts from fresh frozen cadavers. Their respective load to failure and stiffness were measured under uniaxial load on a servohydraulic machine and compared. The capitate-to-trapezoid ligament closely approximated the load to failure and stiffness of the dorsal SLIL, whereas the trapezoid-to-second metacarpal ligament was significantly stronger and stiffer than the dorsal SLIL. These 2 intracarpal bone-ligament-bone grafts share similar mechanical properties with the dorsal component of the scapholunate ligament and might be used clinically to replace it.

Aged↗
PubMed2005

Capsulodesis of the wrist for scapholunate dissociation.

We have had favorable results with our early experience using the Mayo modification of the dorsal intercarpal ligament capsulodesis. Our early experience with this technique has shown improvement in carpal alignment and pain relief with the tradeoff of a mild loss of wrist flexion. These results compare with reported results of the various capsulodesis techniques in evolution. Attention must also be paid as to the stage of dissociation at time of surgery. Dynamic dissociation has been treated with capsulodesis alone, whereas a combination of ligament repair in conjunction with dorsal intercarpal ligament capsulodesis is used to treat both dynamic and static variants. Many other investigators report improvements in scapholunate alignment and improvement in pain relief and function with a loss of wrist flexion as a tradeoff. However, despite technical advances in surgical technique and intraoperative improvement of alignment and gapping, these results may diminish by the 2- to 3-year postoperative period. Scapholunate interosseous injuries remain a challenging problem to even experienced hand and upper extremity surgeons. The Mayo modification of the modified dorsal intercarpal ligament capsulodesis is a technique that may be added to the armamentarium of treatment of this pathologic entity.

Humans↗