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At least 685 records · Page 38Linked to original sources
PubMed2001

Orthopedic pitfalls in the ED: scaphoid fracture.

Wrist injuries are frequently encountered in the emergency department. When a patient presents with such an injury, the possibility of scaphoid fracture must be at the top of the differential for the emergency practitioner. Unfortunately, these injuries can be missed on first presentation, as they are frequently radiographically occult. When left unrecognized and untreated, these injuries lead to a high incidence of long-term functional disability and chronic pain. The emergency physician needs to be vigilant for scaphoid fracture and be aggressive in both its diagnosis and treatment to avoid this practice pitfall. This review examines the clinical presentation, diagnostic techniques, and management options applicable to the emergency physician.

Accidental Falls↗
PubMed2001

Magnetic resonance imaging of suspected scaphoid fractures using a low field dedicated extremity MR system.

AIM: To determine whether magnetic resonance imaging (MRI) using a dedicated extremity system could be utilized for the routine assessment of patients with a clinically suspected scaphoid fracture, and to determine the most cost-effective timing of MRI for these patients. MATERIALS AND METHODS: MRI of the wrist using a 0.2T extremity MR system was performed in two groups of patients. Fifty-six patients were examined within 4 days of injury and 53 with persistent symptoms at 10 days to 6 weeks following injury. A scaphoid series of radiographs was negative in both groups. RESULTS: The early MR group had seven scaphoid, six radial and four other fractures. Management was altered in 89%. The late MR group had 14 scaphoid, nine radial and three other fractures. Management was altered in 69%. A cost model showed that overall costs are less with early rather than late scanning. CONCLUSION: MRI of the wrist when scaphoid fracture is suspected can be undertaken in all patients with negative radiographs and could be performed in most departments with an MRI machine. There are significant patient benefits and overall costs would change little from conventional practice.

Cost-Benefit Analysis↗
PubMed2002

Scaphoid kinematics in vivo.

The purpose of this study was to quantify 3-dimensional (3-D) in vivo scaphoid kinematics during flexion-extension motion (FEM) and radial-ulnar deviation (RUD) of the hand. The right wrists of 11 healthy volunteers were imaged by spiral computed tomography during RUD and 5 of those wrists also during FEM. With a matching technique, relative translations and rotations of the scaphoids were traced. Our results showed a broad spectrum of kinematic patterns of the scaphoid during RUD, with small intercarpal motions within the proximal carpal row. Some scaphoids rotated basically around the flexion-extension axis only whereas others rotated almost entirely around the deviation axis during RUD. During FEM we found highly uniform scaphoid motion patterns with large intercarpal motions within the proximal carpal row. These findings suggest that current theories cannot sufficiently explain wrist kinematics and stress the need for more in vivo studies on 3-D carpal kinematics.

Adult↗
PubMed2001

Wrist position affects loading of the dorsal scaphoid: possible effect on extrinsic scaphoid blood flow.

Cadaver studies using radial artery injection techniques were used to study the vascular supply along the dorsal ridge of the scaphoid. These revealed an intraarticular membrane between the wrist capsule and the dorsal ridge of the scaphoid through which arteriolar vessels (25-100 microm internal diameter) passed. Biomechanical tests revealed that the extensor carpi radialis brevis may apply significant pressure to the dorsal ridge of the scaphoid when the wrist is flexed. The highest pressures occurred with the wrist flexed at 60 degrees or 90 degrees and in slight (15 degrees ) ulnar deviation. The authors suggest that these vascular and biomechanical factors may contribute to the aetiology for idiopathic osteonecrosis of the scaphoid.

Aged↗
PubMed2001

[Primary arthroscopic treatment of TFCC tears in fractures of the distal radius].

The primary simultaneous diagnosis and therapy of TFCC tears in distal radius fractures is still the exception. We present our results of arthroscopic treatment of these injuries. From January 1998 until September 1999, we treated 21 patients with a type C fracture (AO classification) of the distal radius and one patient with a scaphoid fracture and TFCC tears. The Palmer 1A (n = 5) and 1 C (n = 4) tears have been arthroscopically shaved as well as the meniscal tear (n = 1). The Palmer 1B tears were refixed either in an outside-inside technique (n = 6) or in a new all-inside technique (n = 6). Palmer 1D tears were refixed in the Fellinger technique (n = 5). In the clinical follow-up examination six to fifteen months later, we saw symptoms of ulnar-sided wrist pain only in one case of a Palmer 1B tear treated in an outside-inside technique. Especially the patients treated by the new all-inside technique were free from symptoms of TFCC instability. We conclude, that arthroscopic treatment of TFCC tears in acute radius fractures is possible with good results. The new technique of all-inside repair is minimally invasive and shows good results.

Adolescent↗
PubMed2002

[Scapholunate ligament tears in MR arthrography compared with wrist arthroscopy].

In a blinded study from January to July 2000, 125 patients suffering from specific complaints of the wrist were prospectively examined with direct MR arthrography. Within 24 hours an arthroscopy of the wrist was performed. With MR arthrography in 21 patients or 17 % of all patients, injury of the scapho-lunate ligament was diagnosed. In all patients this could be verified arthroscopically. In the remaining 104 patients, no SL-ligament lesions were diagnosed with the MR arthrography. However, partial lesions were found via arthroscopy in seven cases and complete lesions of the ligament were found in one case, where MRI findings expected an intact SL ligament. In the remaining 96 cases, the MRI could correctly exclude a lesion of the SL-ligament. The diagnosis of a SL-ligament lesion by means of MRI was correct in 100 % of the cases (specificity), the exclusion of such lesions in 72 % (sensitivity). Positive or negative predictive values of 100 % or 92 % were achieved. Since a sensitivity of 100 % cannot be reached at the moment, MR arthrography cannot replace arthroscopy. However, it could be a potent additional tool for wrist diagnosis if intraarticular contrast is used. It can facilitate the diagnostics and the indication for surgery of the wrist and help to reduce arthroscopic interventions for purely diagnostic purposes and without any therapeutic consequences. With improvement of the technique of magnet resonance tomography we can expect a further increase of accuracy in the clinical use of the MR arthrography in the diagnostic workup of the wrist.

Adult↗
PubMed2003

[The posttraumatic carpal collapse--long-term results after midcarpal fusion].

PURPOSE: Midcarpal fusion is a reliable treatment for posttraumatic carpal collapse in the short or midlong term. The long-term results remain, however, unclear. The objective of this study was to assess the long-term clinical outcome but also the incidence of an arthrosis of the radiolunate joint or an ulnar translocation after excision of the scaphoid. METHOD AND MATERIAL: 37 patients after midcarpal fusion were reexamined after an average follow-up of 97 months clinically and radiologically. RESULTS: The average range of motion from extension to flexion was 62 degrees, the average grip strength changed from 69 % of the opposite side before surgery to 80 % after surgery. Pain in the verbal analogue scale improved from 2.7 preoperatively to 1.7 postoperatively. The Krimmer wrist score was 72, whereas 28 patients (76 %) reached a good or excellent result. The mean DASH score was 24 points. At the X-rays, ten patients (27 %) showed an arthrosis of the radiolunate joint and/or an ulnar translocation. Differences in clinical results between the groups with or without X-ray pathology were not statistically significant. From 107 patients with a midcarpal fusion in the time of interest, seven (6.5 %) had to be converted into wrist arthrodesis because of ongoing pain. CONCLUSION: Also in the long-term the motion-sparing midcarpal fusion offers a functional advantage over wrist arthrodesis.

Adult↗
PubMed2004

Treatment of dynamic scaphoid instability.

BACKGROUND: Chronic wrist pain attributable to scaphoid instability without fixed deformity (dynamic instability) presents a treatment dilemma. The diagnosis usually is delayed, missing the opportunity for direct repair. The intercarpal fusion, tenodesis, and capsulodesis procedures create a fixed deformity. This report presents an outcome study of a new treatment for dynamic scaphoid instability that spanned more than 5 years. METHODS: Arthroscopic evaluation was used to confirm the diagnosis for 105 wrists of 102 patients who had experienced wrist pain for an average of 24.4 months. The treatment for these patients involved transferring two thirds of the extensor carpi radialis longus through the distal pole of the reduced scaphoid volarly to the intact flexor carpi radialis. The postoperative follow-up period averaged 63 months. RESULTS: The average grip strength increased by 65%. The average active wrist extension-flexion increased by 9%, with an average radial deviation loss of 6 degrees. The overall results, as measured by the modified Green and O'Brien clinical wrist scale, were as follows: excellent (49%), good (24%), and fair (26%). Good to excellent results were reported by 85% of the patients. Pain relief was reported by 94% of the patients, and 93% of the patients would recommend the procedure to others. CONCLUSIONS: Scaphoid instability without fixed deformity is a complex problem. Conventional treatments have drawbacks. The new technique produced positive results that are quite promising for the management of dynamic scaphoid instability.

Arthroscopy↗
PubMed2006

Foreign body giant cell reaction to polytetrafluoroethylene used as interposition material in scaphoid-trapezium arthroplasty.

We present the case of a 54-year-old woman who presented with a one and a half-year history of persistent pain at the base of her right thumb. A scaphoid-trapezium interposition arthroplasty with polytetrafluoroethylene was carried out in an effort to improve function and decrease the patient's persistent pain. Approximately 7 years after surgery, she began to complain of increasing pain and radiographs showed extensive osteolytic changes, consistent with a foreign body giant cell reaction.

Arthroplasty↗
PubMed2003

Acute carpal tunnel syndrome caused by anomalous muscle bellies: a case report.

We reported on an acute carpal tunnel syndrome that occurred two hours after the internal fixation of scaphoid. Operative exploration showed median nerve compression caused by flexor digitorum superficialis muscle bellies within the carpal tunnel. Symptoms were relieved immediately after the carpal tunnel release. This case was very rare because acute carpal tunnel syndrome was caused by swollen muscle bellies within the carpal tunnel after the initial operation for the trans-scaphoid perilunate dislocation. This clinical situation should be distinguished from compartment syndrome of forearm.

Acute Disease↗
PubMed2003

A morphological study of the scaphoid using a mathematical technique and comparative study of the three-dimensional measurements of the scaphoid.

To guide reconstruction of scaphoid non-union, we attempted to create full-scale models of the scaphoid by three-dimensional computed tomography (3D CT) of the healthy side. In this study, we obtained 3D scans of 51 cadaveric hands and studied the difference in morphology between genders and between the left and right sides. The major axis length on a fixed plane and Fourier transformation curve were examined. Ten scaphoid images were also obtained with 3D CT before and after removal from the cadaveric hands. Our findings suggest good correlation between models produced using 3D CT images of the scaphoid alone, and this could serve as an accurate model if the magnification is corrected using the regression line. However, the model using 3D CT images of the intact wrist joint has a large margin of error and its use will not be practical.

Aged↗
PubMed2001

Scaphoid blood flow and acute fracture healing. A dynamic MRI study with enhancement with gadolinium.

We have investigated whether assessment of blood flow to the proximal scaphoid can be used to predict nonunion in acute fractures of the scaphoid. We studied 32 fractures of the scaphoid one to two weeks after injury, by dynamic fat-suppressed T1-weighted gradient-echo MRI after the intravenous administration of gadopentetate dimeglumine (0.1 mmol/kg body-weight). Steepest slope values (SSV) and percentage enhancement values (%E) were calculated for the distal and proximal fragments and poles. All the fractures were treated by immobilisation in a cast, and union was assessed by CT at 12 weeks. Nonunion occurred in four fractures (12%), and there was no statistically significant difference between the proximal fragment SSV and %E values for the fractures which united and those with nonunion. The difference between the proximal pole SSV and %E values for the union and nonunion groups reached statistical significance (p < 0.05), but with higher enhancement parameters for the nonunion group. Our results suggest that poor proximal vascularity is not an important determinant of union in fractures of the scaphoid.

Adolescent↗