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At least 793 records · Page 44Linked to original sources
PubMed1985

Treatment of scaphoid nonunion by volar inlay distal radius bone graft.

Volar inlay corticocancellous bone grafting is an accepted method of treatment for symptomatic nonunion of the carpal scaphoid. Performance of this procedure with a radial graft without styloidectomy yields results comparable to those obtained with iliac grafting. This permits the operation to be performed through a single incision. The elimination of the need for iliac dissection avoids morbidity associated with the iliac exposure.

Adolescent↗
PubMed2002

Management of scaphoid nonunion with avascular necrosis using 1, 2 intercompartmental supraretinacular arterial bone grafts.

BACKGROUND: Poor reduction or neglect of an unstable carpal scaphoid fracture may lead to scaphoid nonunion or avascular necrosis. When pre-operative suggestion of avascular necrosis of the proximal pole is confirmed by intra-operative evaluation, conventional bone graft is not enough and a vascularized bone graft is strongly recommended. METHODS: Five patients with nonunion of scaphoid fractures associated with avascular necrosis based on results of radiography and further confirmed by magnetic resonance images and intra-operative findings were operatively managed with 1, 2 intercompartmental supraretinacular arterial (1, 2 ICSRA) vascularized bone graft combined with supplemental cancellous bone grafts from the radius. Follow-up periods were at least 18 months. The functional outcomes and radiographs were analyzed. RESULTS: In four of the five patients, the nonunion sites united within 4 months after surgery. The other patient had a superficial pin tract infection and bone healing was complete 6 months after the operation. The functional results were good in all five patients. CONCLUSION: 1, 2 ICSRA is superficial to the retinaculum and runs directly into the bony tubercle. It is a proper pedicle of vascularized bone graft due to the ease of visibility and dissection. The functional results and union rates were satisfactory in our study.

Adult↗
PubMed2000

[Antelunar dislocation of the wrist. Apropos of 3 cases].

Volar perilunar dislocation of the carpus is rare. We report three cases here. The patients were 18, 23 and 31 years of age. The etiology was a traffic accident in all cases and palmar hyperflexion of the wrist was noted in all three. Palmar dislocation was associated with a scaphoid fracture in two cases. In the third case, there was an associated fracture of the radial styloid and capitate. The patients were operated on after a delay of 48 h in two cases and four weeks in one. The dorsal approach was used in two cases and the palmar approach in the other. Reduction, fracture osteosynthesis and intracarpal temporary arthrodesis were the main lines of treatment. The functional result evaluated after a minimum of eight months' follow-up was good in two cases, and acceptable in one (Green and O'Brien score). Volar perilunar dislocation is often associated with fracture of a carpal bone, mainly the scaphoid. It occurs in young men, after a violent injury. Polytrauma is often associated. Closed reduction is attempted first but open reduction is often needed because of instability of the lesion. The functional result is good if the treatment restores carpal bone congruence.

Adolescent↗
PubMed1988

99Tcm-MDP bone scanning of injuries of the carpal scaphoid.

Clinical injuries of the carpal scaphoid are frequently seen at accident and emergency departments. Some exhibit delayed radiographic visualization of a fracture. The radioisotope bone scan is a sensitive test and increased uptake is observed in healing fractures. Twenty-three patients with an initial diagnosis of clinical fractures of the scaphoid were studied clinically, radiologically and independently by 99Tcm-MDP isotope scans. Three-quarters of the patients required only 1 month's management. Their corresponding bone scans were normal or not suggestive of a fracture. The remaining 25 per cent, who clinically required a more prolonged treatment (greater than or equal to 5 weeks' immobilization), were noted independently to have positive scans whether a fracture was observed or not. It is concluded that there is a stronger correlation between clinical examination and a bone scan than with a standard radiographic examination. It is proposed that patients still tender at 3 weeks should have a carpal isotope bone scan to identify if there is an important wrist injury and appropriate treatment commenced.

Adolescent↗
PubMed1994

Scintigraphy in the evaluation of the "clinical" scaphoid fracture.

In a prospective study we performed bone scans on 84 patients who had sustained a wrist injury and in whom a scaphoid fracture was clinically suspected but could not be confirmed on the original set of five routine "scaphoid view" radiographs. In 40 patients the bone scan was normal and in 25 there was increased uptake in areas other than the scaphoid. In 19 there was localized increased uptake in the scaphoid bone. In seven of these a scaphoid fracture was subsequently demonstrated on repeat radiographs (five cases) or a CT scan (two cases). In the remaining 12 no fracture could be demonstrated.

Carpal Bones↗
PubMed1990

Anterior bone grafting and conventional lag screw fixation to treat scaphoid nonunions.

The results of 20 established nonunions of the scaphoid treated with resection of the pseudoarthrosis, anterior cortic-cancellous iliac bone grafting, and conventional lag screw fixation with the ASIF 2.7 mm cortical screw are presented. Union rate was 95% and the average time off work was 8.9 weeks. Review of the relevant literature uniformly shows that the most common reasons for failure are improper internal fixation techniques and/or the absence of bone grafting. Successful treatment of scaphoid nonunions with screw fixation and cast-free after-treatment does not depend on the implant used but rather on careful case selection and precise surgical technique.

Adolescent↗
PubMed2005

Trans-scaphoid perilunate fracture dislocations: results of screw fixation of the scaphoid and lunotriquetral repair with a dorsal approach.

PURPOSE: To review the clinical and radiographic outcome of dorsal trans-scaphoid perilunate fracture-dislocations treated with screw fixation of the scaphoid and repair of the lunotriquetral ligament with bone anchors. METHODS: Twenty-five patients treated over an 11-year period for dorsal trans-scaphoid perilunate fracture-dislocations were reviewed retrospectively at a mean of 44.3 months. The mean age of the patients was 28.6 years, and 22 patients were men. Delay to surgery was 3.5 days. Five scaphoids had bone grafting from the distal radius. Six patients developed carpal tunnel syndrome requiring release. The functional outcome was determined by comparing the range of motion of the injured extremity with the uninjured extremity, grip strength, ability to return to pre-injury employment, and overall patient satisfaction. Radiographic evaluation comprised time to scaphoid union, any changes in the lunotriquetral interval, development of a volar intercalated segmental instability pattern, and any development of arthritis over time. RESULTS: Total range of motion achieved was 91% of the uninjured wrist and grip strength was 80%. Average extension was 54 degrees with an average flexion of 60 degrees . Ulnar deviation was 23 degrees with radial deviation averaging 18 degrees . The average supination was 76 degrees and the average pronation was 76 degrees . All scaphoids united primarily. The average time to union of the scaphoid was 16 weeks. For those scaphoids with bone grafting the union time was an average of 18.4 weeks. The average postreduction lunotriquetral gap was 1.8 +/- 0.4 mm. The average lunotriquetral gap at the last follow-up evaluation was 1.9 +/- 0.6 mm. None of the patients developed a volar intercalated segmental instability deformity. All but 2 patients returned to their pre-injury occupation. All patients, however, returned to some type of employment. Complications included 1 superficial pin track infection that resolved with removal of the pin and a short course of oral antibiotics. CONCLUSIONS: A dorsal approach to the wrist provides adequate exposure for reduction of carpal bones, internal fixation of the scaphoid, and lunotriquetral repair. Although perilunate fracture-dislocations are challenging problems to treat, all of the patients had acceptable pain relief and achieved sufficient range of motion and strength to return to gainful employment.

Adolescent↗
PubMed2006

Screw fixation of scaphoid fractures: a biomechanical assessment of screw length and screw augmentation.

PURPOSE: To assess the biomechanical stability relative to screw length and K-wire augmentation in scaphoid fracture fixation using a flexibility testing protocol and cadaver scaphoids whose soft tissue attachments remained undisturbed. Our hypothesis was 2-fold: increasing screw length and augmenting fixation with a K-wire would improve fracture fragment stability, individually and in combination. METHODS: Flexion and extension loading applied through wrist tendons was performed on 10 cadaveric wrists after volar wedge scaphoid osteotomy and internal fixation. Each wrist participated in 3 experimental groups: short screw, long screw, and long screw augmented with a K-wire transfixing the distal pole to the capitate. Interfragmentary displacements were measured. RESULTS: Analysis of variance showed significantly less fracture fragment motion with longer screws than with short screws in 4 of the 6 displacement axes. The flexion/extension axis rotations for the short, long, and augmented long-screw groups were 8.2 degrees +/- 4.8 degrees, 3.9 degrees +/- 1.6 degrees, and 1.8 degrees +/- 1.3 degrees, respectively. Although K-wire augmentation reduced displacement of the fracture fragments it did not decrease interfragmentary motion significantly when compared with the long-screw group. CONCLUSIONS: Under physiologically applied loading of cadaveric wrists with unstable scaphoid waist fractures the long screw provided significantly greater stability than the short screw. Although K-wire augmentation in the long-screw group did improve stability the improvements were not significant. Based in part on the biomechanical data from this study it is our recommendation that the optimally placed screw for scaphoid fracture fixation stability is a long screw positioned down the central axis of the scaphoid deep into subchondral bone.

Aged↗
PubMed2005

Radioscapholunate arthrodesis.

Although RSL fusion is a viable option for isolated radiocarpal arthritis, the enthusiasm for this procedure should be tempered with the reality that kinematics of the wrist is not entirely suited for independent midcarpal flexion and extension [10]. Limited wrist flexion and extension is expected following a successful RSL arthrodesis. The effects of imposed abnormal kinematics are further shown by the high incidence of RSL nonunions, occurrence of scaphoid fractures, and postoperative deterioration of the midcarpal joint [15,22]. In a young patient with posttraumatic arthritis or rheumatoid arthritis limited to the radiocarpal joint, however, RSL arthrodesis remains a viable alternative to complete wrist arthrodesis if the midcarpal joint is normal. Internal fixation with plates and screws and distal scaphoid excision are technical alternatives to consider when an RSL arthrodesis is performed.

Arthritis↗
PubMed1990

Experimental corrective scaphoid osteotomy for scaphoid malunion with abnormal wrist mechanics.

Two cases of painful posttraumatic scaphoid malunion (hump-back deformity) associated with dorsal intercalated segmental instability deformity and limitation of wrist motion are presented. Carpal alignment and wrist motion improved after an experimental opening wedge scaphoid osteotomy with iliac bone graft and Herbert screw fixation. The scaphoid deformities (angulation and shortening) were effectively corrected.

Adult↗