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At least 811 records · Page 45Linked to original sources
PubMed2000

The treatment of scaphoid nonunion. A review of a novel technique using precision bone grafting compared with Herbert screw fixation and bone graft.

We have retrospectively reviewed the results of 40 consecutive patients with nonunion of the scaphoid treated by the senior author (PG) between 1993 and 1996. These comprised two groups of patients. Group 1 comprised 20 patients treated between 1993 and 1994, with a Herbert screw and autograft, and Group 2, which also comprised 20 patients treated with the precision bone grafting technique which we describe. The precision bone grafting technique employs simple instrumentation to harvest bone percutaneously from the iliac crest and then insert it at the scaphoid nonunion site. The evaluation consisted of a clinical and radiological assessment of union and wrist function. Our review demonstrates a higher rate of union with the precision bone grafting technique than by the Herbert screw fixation with bone grafting.

Adult↗
PubMed1995

Nonunion of the scaphoid in children treated by Herbert screw fixation and bone grafting. A report of five cases.

In children, nonunion of fractures of the waist of the scaphoid is uncommon. Treatment has included bone grafting without internal fixation, bone grafting with Kirschner-wire fixation, and screw fixation without bone grafting. We report the successful use of Herbert screw fixation and iliac-crest bone grafting in five cases, all of which healed without further surgery. At an average follow-up of 3.3 years, the range of motion, grip strength, carpal stability, and radiological appearances were all excellent.

Adolescent↗
PubMed1986

[Fractures and dislocation fractures of the wrist joint].

Most carpal fractures are based on the same injury mechanism. In most cases the injury is caused by a fall on the dorsiflexed hand, which is raised as a protective measure, and less frequently by a fall on the clenched fist. The latter leads to passive palmar flexion, pronation and radial inclination of the hand; in the former, the hand is passively superextended by the impact, supinated, and brought into ulnar inclination. The instability caused by injury to various articular structures has four developmental stages. The bones or syndesmoses that are involved depend on the stage and quantitative relationship between the three above-mentioned moments of force. If the lateral ligament of the wrist is slack, scaphoid fractures occur; in the last stage of superextension, fractures of the capitate bone occur. With increasing ulnar inclination, perilunar dislocations or fracture-dislocations and triquetrum fractures occur in the third stage and dislocations of the semilunar bone in the fourth stage. In addition, compression and avulsion of the 1st, 4th or 5th metacarpal bones cause fractures of the trapezium and the hamate bone. To avoid unpleasant late sequels, scaphoid fractures with diastasis due to soft tissue interposition or non-reducible dislocated scaphoid fractures must be treated surgically. Vertical oblique fractures and scaphoid fractures with small proximal fragments are relatively good indications for operation. Perilunar instability and dislocations, particularly De Quervain's fracture-dislocations, must be treated operatively because reduction of the scaphoid bone requires a different approach than correcting alignment in the carpus and because soft tissue interpositions are always present, even though they may not be evident in the X-ray pictures. Fracture-dislocations in the distal carpal row also require operation, preferably percutaneous internal fixation using K-wire and fluoroscopy. Immobilization is accomplished by a below-elbow cast with a dorsal plaster splint up to the interdigital webs and from the palmar to the proximal crease. The thumb is only embedded in trapezium fractures; fractures requiring fist or above-elbow casts are indications for operation.

Adolescent↗
PubMed2002

Vascularized bone grafting and herbert screw fixation of scaphoid nonunions with avascular proximal poles.

Nonunion of the fractured scaphoid can present a difficult surgical problem, especially in fractures near the proximal pole. The incidence of nonunion is greater in this region, in which the vascularity of the proximal fracture segment is compromised and the proximal fragment is small and resists rigid fixation. Recent development of better vascularized bone grafting techniques has provided a tool with which to address this vexing problem. Because many authors had previously shown the advantage of rigid fixation in obtaining scaphoid union, it seemed advantageous to us to combine these two methods-rigid fixation and improved vascularity. In this article, we present in detail our technique for treating patients with very small proximal pole fractures in which the proximal fragment makes up less than 20% of the scaphoid. For practical purposes, all of these fractures have a proximal fragment that is avascular. We use a vascularized bone graft as described by Zaidemberg et al. in combination with more rigid fixation of proximal pole fractures using the Herbert mini screw. Although the technique presented requires the surgeon to use precise surgical technique, early results have been encouraging, and patients with very small fracture fragments can be treated successfully.

Journal Article↗
PubMed2006

Diagnosis of scaphoid fracture displacement with radiography and computed tomography.

BACKGROUND: Displacement is an important risk factor for nonunion of scaphoid wrist fractures. We compared computed tomography with radiographs with regard to their ability to detect displacement. METHODS: Six blinded observers rated thirty scaphoid fractures (ten displaced and twenty nondisplaced) with use of radiographs and computed tomography. The radiographs were evaluated separately from the computed tomography scans and then, in a third evaluation, the two imaging studies were reviewed simultaneously. The evaluations were repeated four weeks later. Observers were asked to evaluate specific measures of fracture displacement and then to judge the fracture as being displaced or nondisplaced. RESULTS: Intraobserver reliability was better for computed tomography alone and the combination of radiographs and computed tomography than it was for radiographs alone (kappa values, 0.65, 0.63, and 0.54, respectively; all p<0.001). The interobserver reliability was also better for computed tomography alone and the combination of radiographs and computed tomography than it was for radiographs alone (kappa values, 0.43, 0.48, and 0.27, respectively; all p<0.001). The average sensitivity was 75% for radiographs alone, 72% for computed tomography alone, and 80% for both; the average specificity was 64%, 80%, and 73%, respectively; the average accuracy was 68%, 77%, and 75%, respectively. The positive predictive values (assuming a 5% prevalence of fracture displacement) were low (0.10, 0.13, and 0.16) and the negative predictive values were high (0.97, 0.98, and 0.99) for the radiographs, computed tomography, and combined modality. CONCLUSIONS: Computed tomography improves the reliability of detecting scaphoid fracture displacement but has a more limited effect on accuracy, which remains <80%. The utility of computed tomography scans for diagnosing scaphoid fracture displacement is affected by the low prevalence of fracture displacement. This study suggests that computed tomography scans are useful for ruling out displacement but not for diagnosing it. We recommend that all scaphoid fractures be evaluated with computed tomography in order to rule out displacement.

Fractures, Bone↗
PubMed2006

Development of a clinical decision tool for suspected scaphoid fractures.

Scaphoid fractures are the most common carpal fractures; their overall incidence is however low. Missing a scaphoid fracture may lead to a non-union with a possible disastrous outcome for the patient; for this reason, treatment of a suspected scaphoid fracture, even without a proven fracture on the first radiograph, has been conservative with plaster treatment. There are many clinical tests developed to diagnose a scaphoid fracture. However not all tests are equally practical, and their sensitivity and specificity are not always known, or are very low. In this study 18 clinical tests were evaluated and a subset of 7 tests remained, which were found to be practical and/or had a high enough sensitivity. A clinical decision protocol was developed using a combination of these seven tests, in order to improve diagnostic accuracy and at the same time reduce unnecessary plaster cast treatment of patients with a suspected scaphoid, who turn out to only have a sprained wrist.

Decision Making↗
PubMed2004

[Anatomical and biomechanical study on scaphoid ring sign of advanced Kienbock's disease].

OBJECTIVE: To demonstrate the anatomical and biomechanical basis of scaphoid ring sign in advanced Kienbock's disease. METHODS: The study consisted of two sections. The ligaments stabilizing the proximal pole of the scaphoid were observed in 5 specimens. Under 12 kg dead weight load through the tendons of the flexion carpal radial, the flexion carpal ulnar, the extension carpal radial, and the extension carpal ulnar for 5 minutes, the stresses of the scaphoid fossa and lunate fossa were measured in the case of neutral, flexion, extension, radial deviation and ulnar deviation of the wrist joint under normal and rupture conditions respectively by FUJI prescale film and FPD-305E,306E. RESULTS: Based on anatomical study, the ligaments stabilizing the proximal pole of the scaphoid consisted of the radioscaphocapitate ligament, long radiolunate ligament and scapholunate interosseous ligament; and the latter two ligaments restricted dorsal subluxation of the proximal pole of the scaphoid. When compared rupture condition with normal condition, the scaphoid fassa stress of radial subregion was not significantly different (0.90 +/- 0. 43 vs 0.85 +/- 0.15), and the ones of palmar, ulnar and dorsal subregions decreased (0.59 +/- 0.20, 0.52 +/- 0.05 and 0.58 +/- 0. 23 vs 0.77 +/- 0.13, 0.75 +/- 0.08 and 0.68 +/- 0.09) in the case of extension; the scaphoid fassa stresses of all subregions increased or had no difference in the case of neural, flexion, radial deviation and ulnar deviation. The lunate fossa stresses of all subregions increased in the case of neural, and the ones of all subregions decreased or had no difference in the case of flexion, extension, radial deviation and ulnar deviation. CONCLUSION: Rotary scaphoid subluxation should be treated operatively at III B stage of Kienbock's disease to avoid traumatic arthritis of the radioscaphoid joint.

Biomechanical Phenomena↗
PubMed1999

Results of Herbert-screw fixation with bone-grafting for the treatment of nonunion of the scaphoid.

We examined twenty-one patients in whom an established nonunion of the scaphoid had been treated with Herbert-screw fixation with bone-grafting; our purpose was to determine the long-term morbidity of the procedure (at an average of forty-eight months; range, seventeen to fifty-five months). According to the modified scaphoid outcome scoring system, eighteen patients had a good or excellent result. No patient had failure of the hardware. Radial deviation was significantly decreased (an average of 17 degrees; 55 percent) compared with that of the contralateral wrist (p = 0.02). The other ranges of motion and the grip strength were also decreased, although the difference was not found to be significant with the numbers available. Three patients had a persistent nonunion, and two of them also had loosening of the hardware. Three patients had a tender hypertrophic scar. On the basis of our data, we concluded that Herbert-screw fixation with bone-grafting is effective for the treatment of nonunion of the scaphoid.

Adult↗
PubMed2004

Volar scaphotrapezial dislocation.

We present a case of volar luxation of the scaphotrapezial bone, in which radiographs suggested luxation of the scaphoid, but unclear relations to the other carpal bones. Computer tomographic reconstruction showed an isolated scaphotrapezial luxation. This was treated by closed reduction and a plaster cast, after which the patient regained normal function of her wrist.

Adolescent↗
PubMed2003

Palmar divergent dislocation of scaphoid and lunate.

A 28-year-old man presented with a palmar divergent dislocation of the scaphoid and lunate. He was treated with an open reduction and an internal fixation with two Kirschner's wires after the 25th day of trauma due to a neurological injury. The results were satisfactory after 18 months follow up without any evidence of avascular necrosis and traumatic arthritis of the scaphoid and lunate. The patient had no limitation in motion or intermittent wrist pain. We reported this case with a brief review of relevant literatures.

Adult↗
PubMed1991

Computed analyses of the pathomechanics of scaphoid waist nonunions.

The computed tomography scans of both the injured and the normal wrists of nine patients with a scaphoid nonunion of 5 to 120 months' duration were used to create three-dimensional computer models. When the computer images of the normal and the contralateral fractured scaphoids were superimposed, it was possible to calculate the volume of bone that was lost as a result of the injury and its failure to heal, as well as the angular relationship of the fracture components to one another. The amount of the scaphoid bone that was lost varied from 6% to 15% of bone volume and did not show a linear correlation with the duration of the nonunion. The configuration of the missing bone was consistent and exhibited a prismatic shape whose base is quadrilateral and faces palmarly. The proximal scaphoid fracture component is extended, radially deviated, and supinated in relation to its distal fracture component. The consistent fracture deformity and the configuration of the bony defect in the scaphoid waist nonunions should be helpful in the understanding and treatment of the condition.

Adult↗
PubMed2006

Simultaneous fractures of distal and proximal phalanges of the thumb, trapezium and carpal scaphoid of the ipsilateral hand: a case of very unusual combination of fractures.

Simultaneous multiple injuries of the thumb ray are rare. An unusual case of a simultaneous fracture of proximal and distal phalanges, trapezium and scaphoid is reported. The patient had an acceptable result six months after injury. This type of injury of the thumb ray may be a specific form of injury pattern caused by the mobile phone.

Adult↗