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PubMed1988

Scaphoid nonunion: role of anterior interpositional bone grafts.

Twenty-one cases of unstable fractures of the scaphoid were treated by open reduction, length restoration by interpositional anterior wedge grafting, and fixation with a Herbert screw to obtain union and restore carpal stability. There was primary union in 15 (71%) of 21 patients. Two failed cases were treated with a second anterior wedge graft and Herbert screw fixation; overall rate of union was 81%. Nonunions were related to improper screw placement, failure of compression at the nonunion, bone-graft resorption, or persistent avascular necrosis. In the united scaphoids, carpal instability was corrected, with improvement in the scapholunate angle (65 degrees to 54 degrees) and capitolunate angulations (35 degrees to 15 degrees). Scaphoid malalignment associated with nonunion was improved on biplanar tomographic measurement of the scaphoid angles.

Adolescent↗
PubMed1998

A comparison of bone scintigraphy and MRI in the early diagnosis of the occult scaphoid waist fracture.

OBJECTIVE: To determine the accuracy of MRI in the assessment of the radiographically occult scaphoid fracture. DESIGN: This prospective study compared the sensitivity and specificity of MRI for detection of radiographically occult scaphoid fractures with bone scintigraphy (BS), the currently accepted imaging modality of choice. Consecutive patients with clinical signs of a scaphoid injury but no evidence of fracture on plain radiographs at presentation and after 7-10 days were evaluated by MRI and BS. All images were reported in masked fashion and the sensitivities and specificities of the imaging modalities determined. All patients with a scaphoid fracture demonstrated by MRI or BS were followed for at least a year after injury. PATIENTS: Forty-three subjects (aged 12-74 years) had both MRI and BS carried out on average 19 days from the injury date. RESULTS AND CONCLUSIONS: Six patients (14%) had scaphoid waist fractures. There were other bony injuries in a further six. In 40 patients there was agreement between the BS and MRI findings. In three cases there was discrepancy between the imaging modalities; in all three MRI was found to be the more sensitive and specific. MRI could become the investigation of choice for this injury.

Adolescent↗
PubMed2002

[Intraligamentous suture of a scapholunar ligament lesion in a 9-year-old child].

Scapholunate dissociation is a well-known injury in adult patients. In pediatric patients, repair of this injury in the skeletally immature carpus has been previously reported. However, in none of these case studies is single ligamentous suture performed. We report a case of scapholunate dissociation in a 9-year-old boy after an initial Salter I injury of the distal radius. After 6 weeks of wrist immobilization, arthroscopy was performed due to persisting pain over the scapholunate gap, a positive Watson sign, and limited range of motion. This arthroscopy revealed intraligamentous rupture of the scapholunate ligament. Suture repair of the scapholunate ligament was performed. The suture was protected by a temporary K-wire arthrodesis for 8 weeks. One year after removal of the K-wire, the patient is completely free of symptoms and resumes all sport activities.

Arthroscopy↗
PubMed2001

[Scapho-lunate ligament reconstruction with Mitek suture anchors. Initial clinical results].

The scapholunate dissociation is an often misjudged lesion of carpal ligaments as clinical and radiological signs often don't allow a clear interpretation. Apart from chronical courses with increasing arthrosis the consequences are limited and more difficult operations. The application of Mitek suture anchors is a new and simple supplement to large-scale operative reconstructions of ligaments or partial arthrodesis. Of nine reconstructions of the scapholunate interosseous ligament using this anchor method so far only one relaps occurred.

Adult↗
PubMed2005

Scapholunate dislocation: a rare occupational hazard.

Dentists and their assistants are at risk of physical injuries during dental operations. The most common injuries are musculoskeletal. The need to work in a fixed working position using continuous repetitive movements can predispose dentists to wrist ache, lower backache, and neckache. We encountered a rare case of scapholunate dislocation with ligamentous injury, an unusual complication of extraction of teeth.

Accidents, Occupational↗
PubMed2004

Changes in radiocarpal loading characteristics after proximal row carpectomy.

PURPOSE: To document the changes in wrist loading that occur after proximal row carpectomy in a cadaver model. METHODS: The normal radioulnar carpal pressure distributions of 7 cadaver wrists were measured using super-low-pressure-sensitive film. Proximal row carpectomies were performed and the loading characteristics re-evaluated. RESULTS: In the lunate fossa the contact area increased 37%, the average contact pressure increased 57%, and the location of the contact moved radially 5.5 mm. With wrist motion between 40 degrees of extension and 20 degrees of flexion the volar/dorsal excursion of the lunate fossa contact point increased by 108%. CONCLUSIONS: Significant changes in radiocarpal loading occur after proximal row carpectomy. The increased radiocarpal excursion with wrist motion may explain the low incidence of radiocapitate arthritis in patients who have had proximal row carpectomy.

Biomechanical Phenomena↗
PubMed1997

Improved wrist fracture localization with digital overlay of bone scintigrams and radiographs.

UNLABELLED: The diagnosis of scaphoid fracture is often difficult and of interest in traumatology. Because of the low sensitivity of repeated scaphoid radiographs, a bone scintigram is advocated and considered the gold standard. In this study, we tried to simplify the interpretation of the bone scintigram of hand and wrist in localizing the hot spot by the digital overlay of the radiograph and the bone scintigram, using a simple device, in patients after wrist trauma. METHODS: Twenty-one consecutive patients (22 wrists) with clinically-suspected scaphoid fracture and negative initial radiographs were included. The PA view of the wrist was obtained with the hand of the patient placed in an acrylic device with three lead markers. For the bone scan, a similar device was used with 57Co markers at the same positions. We called this device the "hand-fix." The PA radiograph was digitized with a videocamera and overlaid on the bone scan. Each bone scan was interpreted twice by each of three observers, one nuclear physician and two residents in nuclear medicine. The first interpretation was made without the digital overlay, and the second was made with the digital overlay. RESULTS: The bone scintigrams were positive in the scaphoid, distal radius and in other carpal bones. Out of the 22 bone scans, Observer 1 judged 19 correctly, Observer 2 judged 16 correctly and Observer 3 judged 10 correctly without the digital overlay images. All three observers gave a correct localization in the 22 wrists using the digital overlay images. CONCLUSION: The digital overlay of a radiograph and a bone scintigram, using the hand-fix, simplifies and improves interpreting and localizing the hot spot on bone scintigrams in patients with wrist injuries.

Adult↗
PubMed2005

Assessment of four midcarpal radiologic determinations.

Several radiologic measurement methods have been described for determining static carpal alignment of the wrist. These include the scapholunate, radiolunate, and capitolunate angles. The triangulation method is an alternative radiologic measurement which we believe is easier to use and more reproducible and reliable than the above mentioned methods. The purpose of this study is to assess the intraobserver reproducibility and interobserver reliability of the triangulation method, scapholunate, radiolunate, and capitolunate angles. Twenty orthopaedic residents and staff at varying levels of training made four radiologic measurements including the scapholunate, radiolunate and capitolunate angles as well as the triangulation method on five different lateral, digitized radiographs of the wrist and forearm in neutral radioulnar deviation. Thirty days after the initial measurements, the participants repeated the four radiologic measurements using the same radiographs. The triangulation method had the best intra-and-interobserver agreement of the four methods tested. This agreement was significantly better than the capitolunate and radiolunate angles. The scapholunate angle had the next best intraobserver reproducibility and interobserver reliability. The triangulation method has the best overall observer agreement when compared to the scapholunate, radiolunate, and capitolunate angles in determining static midcarpal alignment. No comment can be made on the validity of the measurements since there is no radiographic gold standard in determining static carpal alignment.

Carpal Bones↗
PubMed2000

Bilateral transcapholunate dislocation.

An uncommon case has been reported of bilateral transscaphoid-perilunate dislocation fracture following trauma. A 35-year-old male with bilateral transscapholunate dislocation was treated by closed reduction and internal fixation. The case was examined in detail, and compared to the findings in the literature; observations regarding fracture prognosis were also made. Two years post-surgery, the patient remained asymptomatic.

Accidental Falls↗
PubMed2003

Blatt's capsulodesis for chronic scapholunate instability.

Nineteen patients underwent a scapholunate interosseous ligament repair combined with a Blatt's capsulodesis for scapholunate instability between 1994 and 1999. The diagnosis was based on clinical, radiographic and arthroscopic assessments. Mean follow-up was 22 months (range: 8 months to 5 years). Fifteen patients were available for follow-up. Most (13 of 15) of the patients presented with predynamic or dynamic instability. Results were analysed clinically and radiologically. Thirteen patients showed good or excellent clinical result. There was statistically significant improvement in pain relief (VAS scores) and grip strength (58% of the opposite side). Mean extension and ulnar deviation were significantly improved (62% and 53% of the opposite side respectively) and there was significant reduction in wrist flexion (49% of the opposite side). Thirteen patients returned to their original level of activity. There was no significant change in the mean scapholunate gap and angle after surgery. Thirteen patients would recommend this operation. We believe that this procedure can produce encouraging results in cases of predynamic and dynamic instability in a patient population with low-demand wrists. Larger caseloads and more complete follow-ups would be desirable to derive strong evidence-based conclusions.

Adult↗
PubMed2005

Obvious radiographic scapholunate dissociation: X-ray the other wrist.

Obvious radiographic scapholunate dissociation seen on plain radiographs may seem to establish the diagnosis in a patient who presents with wrist pain. This diagnosis, however, is based on the assumption that scapholunate dissociation is caused only by trauma. In questioning this assumption, we present 6 cases of obvious radiographic scapholunate dissociation with similar radiographic findings in both wrists. These cases illustrate the pitfalls of using unilateral wrist radiographs to diagnose traumatic scapholunate dissociation. We chose these cases as representative of more than 75 bilateral cases we are studying. We describe medical histories, physical findings, radiographs, other diagnoses, treatments, and outcomes. These patients' injury histories and clinical presentations were not necessarily suggestive of wrist instability. All the patients were asymptomatic in the contralateral, uninjured wrist, despite similarity in radiographic findings. Traumatic scapholunate dissociation cannot be diagnosed with unilateral radiographs, no matter how obvious the findings or suggestive the history of trauma.

Accidental Falls↗
PubMed2006

Most scaphoid non-unions heal with bone chip grafting and Kirschner-wire fixation. Thirty-nine patients reviewed 10 years after operation.

BACKGROUND: Many recommend to operate scaphoid pseudarthroses with wedge grafts and screw fixation. These are difficult operations. We have employed a simpler procedure and wished to review our results with regard to healing and long-term clinical results. PATIENTS AND METHODS: We reviewed 39 unselected scaphoid pseudarthroses which had been operated with Kirschner-wire fixation and bone chip transplantation 10 (3.5-12) years previously. Postoperative cast treatment was 15 (11-30) weeks. RESULTS: Four pseudarthroses failed to unite, one of which was after a trans-scaphoid perilunar dislocation. In another the pins were dislocated by an injury while the arm was in plaster. There were no other complications. All 14 proximal pseudarthroses united. There was no loss of grip strength but some loss of key-pinch strength and wrist mobility. Most patients reported no or little pain and none used analgesics because of wrist pain. The disability of the arm, shoulder and hand (DASH) score was 2 (0-33). Very few cases of mild arthrosis had arisen after operation. Three patients would not have consented to operation if they had known the outcome in advance. CONCLUSIONS: Kirschner-wire fixation and bone chip grafting of scaphoid pseudarthroses is an undemanding operation with few complications that produces good long-term results. Results are excellent also for proximal pole pseudarthroses.

Adolescent↗