[Treatment results with the first plater cast in 41 fresh fractures of the scaphoid bone of the hand].
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The authors have treated a case of bilateral fracture of the scaphoid bone in a young man who had complete and bilateral lunato-triquetral synostosis, without any other associated congenital condition. Consolidation was obtained by orthopedic treatment on one side, but a Matti-Russe operation was necessary on the other. The authors emphasize but then rule out the hypothesis of a congenital bipartite scaphoid associated with the synostosis. A review of the literature on lunato-triquetral synostoses sums up the main points. The condition is rare in whites and occurs more frequently in blacks. It is sometimes associated with other congenital conditions. Four anatomic and radiologic types have been described. The pathogenic hypotheses, based on embryology, are summarized.
A combination of forces makes the scaphoid bone susceptible to fracture. The common mechanism of trauma is a force applied to the palmar aspect of the wrist while it is in extreme dorsiflexion. Because early fracture diagnosis by x-ray study is difficult, all patients with a suspicious wrist injury and tenderness in the scaphoid region should be treated as if they have a fracture until radiographs at two and four weeks are normal. Treatment usually consists of immobilization using a long or short plaster arm cast. Various treatment methods, including electrical stimulation, are used when nonunion occurs. It is important to remember that patients are mainly concerned with results, not means, as long as such means are fast, safe, and minimally disabling.
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MR examination was performed in 20 patients clinically suspected of having a fracture of the scaphoid bone. The patients also followed the normal routine with conventional radiographs in the acute fase and after 10-12 days. The MR was in most cases performed within a day after the trauma. All fractures seen on conventional radiographs were depicted on MR. MR further showed four fractures, five bone contusions (bone bruise) and lesions of the soft tissues in 75% of the patients. In patients with suspected fracture of the scaphoid, MR seems to be the best primary imaging method and displays a wide range of lesions.
The conservative treatment and results obtained in the treatment of 30 scaphoid bone fractures in soldiers aging from 18 to 22 years are reported. The immobilization was performed after acute posttraumatic edema, the latest 4 days after injury, first using the plaster splint and then the "plaster gloves." The immobilization lasted two months. The complete healing was achieved in 29 injured and pseudoarthrosis occurred in one case only.
In 1911 Preiser described the avascular necrosis of the scaphoid bone, which is regarded as a relatively rare clinical and radiological condition. The diagnosis is not established easily, and a small, avascular proximal fragment, e.g. in a scaphoid pseudarthrosis, should not be confused with Preiser's disease. Two histologically diagnosed cases are described: one of thema at operation 42-year old woman received a scaphoid Swanson implant in 1980. At follow-up eight years later, she presented with very satisfying clinical and radiological findings.
The aim of the study was to investigate the effect of smoking on the operative treatment of established non-union of the carpal scaphoid. Case notes and radiographs of patients undergoing bone grafting and screw fixation of scaphoid non-unions were reviewed. There were 34 patients that had undergone 37 operations for established non-union of the carpal scaphoid bone. There were two female patients, and the average age was 26.8 years (range 13.4 years to 52.9 years). The median delay to operation was 11.9 months. The overall success rate of the operation (internal fixation and autologous bone grafting) was 59.5% (22/37), but there was a significant association between non-union and smoking (P=0.02 for Fisher's exact test). In non-smokers (n=17) the success rate was 82.4%, but this dropped to 40.0% among smokers (P<0.01). We concluded that smoking was significantly associated with failure of operative treatment of established non-union of the scaphoid bone.
Eighty-nine late results (five to twelve years follow-up) of prosthetic replacement of the scaphoid bone with a silastic spacer are presented. In 76% the clinical course was uncomplicated; 24% needed secondary surgical procedures including two arthrodeses of the wrist joint. Flexion and extension of the wrist improved by 10.9%, radial and ulnar deviation by 15.0% on average. The first carpometacarpal joint showed minor restriction in 24.0%. The power grip was diminished by 32.0%, the lateral pinch by 25.0% on average. In 43.0% of the cases development or increase of intraosseous cysts was noticed, most of the patients being free of symptoms. Potential underlying factors were investigated. The silastic material seems not to have had any influence. Only slight advancement of the osteoarthritis was found and in some cases the process was arrested. The prostheses were adequately centered in 77.0%, slightly displaced in 16.0%, and dislocated in 7.0%. Change of intracarpal angles is largely complete by the fifth year. In the majority of cases signs of dorsal instability are obvious. The angle between the scaphoid and lunate is generally increased. The height of the carpus is diminished by 1.7 mm, and the distance between the trapezium and the lunate by 3.7 mm in average. A new score is presented which puts more stress on objective results and the clinical course than on complaints of the patient. Because of the predominantly good results (65%) the prosthetic replacement with a silastic spacer is favoured against other palliative techniques.