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PubMedDate not supplied

[Scaphoid percutaneous osteosynthesis by screw using computer assisted surgery: an experimental study].

Scaphoid fractures are sometimes difficult to diagnose and even more difficult to fix. Recent progress such as miniaturization of osteosynthesis material, adoption of the percutaneous route, and widening of the indications to include undisplaced fractures has still not abolished complications. In this context, computer assisted surgery (CAS) may be useful and deserves further study. To apply it to the scaphoid, it is initially necessary to immobilize the "wrist hand fingers" unit in a device adapted to make it a rigid unit. It is then necessary to choose the correct configuration of CAS system. The pedicular fluoroscopic navigation system, which is apparently similar to scaphoid screw insertion, was chosen for this study. The goal of this study is to define the osteosynthesis bases of the scaphoid with CAS. A fresh anatomical subject divided at the elbow joint was prepared at the DETERCA laboratory of the university Bordeaux 2. The solid "wrist hand fingers" unit was immobilized in extension and ulnar deviation of the wrist by a malleable, stable and radio transparent device. The first stage consisted of a calibration of the surgical instruments and the "wrist hand fingers" unit, with a three-dimensional optical localization system. The guide wire was simulated by a gauged stylet. When the axis and the length of the screw had been determined virtually, insertion of the guide wire was carried out under guidance of the virtual images of the computer's screen, without the assistance of the fluoroscopy. Finally the canulated screw was inserted over the guide wire. Insertion was stopped when the screw reached the intra osseous virtually predetermined length. A check using conventional fluoroscopy made it possible to ensure the correct positioning of the screw. Our results show that it is possible to insert a screw into a scaphoid without conventional fluoroscopy, by using the fluoroscopic navigation system. The procedure was performed without difficulty, apart from the need for calibration of the navigation tools one by one. The solid immobilization device, although having the potential for micromovement, did not lead to any misdirection of the guide wire or screw. Our technique cannot be employed at the moment in live human surgery. Its limits are of a geometrical nature "two images available in two planes", data processing "non-specific software dedicated", instrumental "instrument calibration, micromobility of the immobilisation device" and live surgery "no current validation on a fractured scaphoid". Meantime, the development of a percutaneous scaphoid osteosynthesis procedure by CAS can only bring advantages: reduction in the learning curve, widening of the indications, comfort in the technique, reduction in the errors of ostesynthesis and, reduction in the exposure to x-rays. In the current state of knowledge, the method would only be applicable to undisplaced fractures.

Bone Screws↗
PubMed2004

Central screw placement in percutaneous screw scaphoid fixation: a cadaveric comparison of proximal and distal techniques.

PURPOSE: Percutaneous screw fixation of acute minimally displaced scaphoid fractures is an attractive treatment alternative compared with cast immobilization and can be performed with either a distal/volar or proximal/dorsal approach. Central screw placement within the scaphoid appears to be an important factor for successful fixation. The purpose of this cadaveric study is to investigate whether the proximal or distal approach for percutaneous screw scaphoid fixation allows for more central placement of the screw. METHODS: Twelve fresh frozen cadaveric upper limbs were studied, with 6 specimens assigned to scaphoid screw placement with a proximal approach and 6 matched specimens assigned to scaphoid screw placement with a distal approach. After screw placement, the scaphoid was sectioned evenly into quarters along the longitudinal proximal-distal axis. For each section, the distance from the center of the screw hole to the edges of the dorsal/volar/radial/ulnar axes was measured, and the means of the 2 groups were compared with a Hotelling's T(2) test to determine statistically significant central screw placement. RESULTS: A statistically significant difference was found between the mean location of the distal fixation group and the center of the scaphoid in the midwaist and distal pole of the scaphoid (p =.007 and.012, respectively) and between the mean location of the proximal and distal fixation groups in the distal pole of the scaphoid (p =.045). CONCLUSIONS: We find that the proximal/dorsal approach to the percutaneous screw fixation of scaphoid waist fractures allows for a more central placement in the distal pole, but there is no significant difference when it is used in the proximal or waist region. It remains unclear whether the more central screw placement afforded by the proximal approach might translate into an improved clinical outcome.

Bone Screws↗
PubMedDate not supplied

Femoral neck stress fractures and metabolic bone disease.

OBJECTIVE: To determine whether metabolic bone disease plays a role in the cause of femoral neck stress fractures. STUDY DESIGN: Twenty-three patients with femoral neck stress fractures were enrolled prospectively in the study. Examination included computed tomography bone densitometry, trace mineral analysis, and histomorphometric analysis of the iliac crest in thirteen patients who underwent surgical treatment of their stress fractures. A control group of fifteen patients undergoing iliac crest bone grafting for scaphoid nonunions underwent similar examinations. SETTING: Tertiary military medical center. RESULTS: Patients with femoral neck stress fractures had lower bone mineral density than did control patients (p = 0.010), but no trace mineral deficiencies or consistent histomorphometric differences were noted. CONCLUSIONS: Bone mineral density is decreased in patients with femoral neck stress fractures. Despite observations of decreased bone mineral density in the stress fracture group, osteoporosis, as determined by histomorphometry, is not a consistent finding.

Absorptiometry, Photon↗
PubMed2004

Dorsal wrist ligament insertions stabilize the scapholunate interval: cadaver study.

This study examined sequential arthroscopic sectioning of volar, interosseous, and dorsal ligaments about the scapholunate complex in cadaver wrists. We attempted to clarify the contributions of the dorsal ligamentous complex to scapholunate instability and carpal collapse. We found that after sequential sectioning of volar ligaments and the scapholunate interosseous ligament, no scapholunate diastasis or excessive scaphoid flexion occurred. After dividing the dorsal intercarpal ligament, scapholunate instability occurred without carpal collapse. With sectioning of the dorsal radiocarpal ligament from the lunate, a dorsal intercalated scapholunate instability deformity ensued. This information may be of value in comprehending the pathogenesis of scapholunate instability and carpal collapse and in devising the rationales for conservative measures and surgical intervention.

Arthroscopy↗
PubMed2002

Percutaneous cannulated screw fixation of acute scaphoid fractures.

Percutaneous cannulated screw fixation (PCSF) of acute scaphoid fractures has been shown to consistently produce good results. It is less invasive and avoids damage to the radiocarpal ligaments. The scar is good. The procedure could be performed under Bier's block anaesthesia. No cast is required after the operation and the range of wrist motion is regained early. Most recently reported series achieved more than 95% primary radiological fracture union. The functional results were good. The surgical technique of PCSF is described in detail and special tricks for difficult problems are highlighted.

Acute Disease↗
PubMed1997

Repeat screw stabilization with bone grafting after a failed Herbert screw fixation for acute scaphoid fractures and nonunions.

Eight patients with persistent nonunions after failure of a Herbert screw fixation for both acute scaphoid fractures and nonunions underwent repeat screw internal fixation and bone grafting. They were followed for at least 1 year (average, 19 months) after their last surgical procedure. In 6 patients, union was achieved following the second surgery. These patients were pain free and resumed their previous occupations. The average range of wrist mobility was 87% of that of the uninvolved wrist, and grip strength averaged 93% of that of the uninvolved wrist. In 1 of the 2 patients with an unsuccessful outcome after the second procedure, union was achieved after a third procedure was performed that involved an inlay bone graft and internal fixation using a Kirschner wire. The remaining patient had relief of pain following denervation of the wrist joint. These 2 patients did not show marked clinical improvement and required a change of employment of light work. On the basis of study findings, it appears that revision with a repeat Herbert screw fixation and bone grafting is the treatment of choice for patients with persistent scaphoid nonunions following an unsuccessful Herbert screw procedure in which the screw is not correctly placed.

Acute Disease↗
PubMed1993

[Abductor pollicis longus-repair in treating basal thumb joint arthrosis].

Between 1987 and 1990, we operated 32 hands of 30 patients for basal joint arthrosis. After extirpation of the trapezium, a part of the abductor pollicis longus is pulled through and wrapped around the flexor carpi radialis, similar to the Lundborg method. This creates a tendinous web, which supports the first metacarpal bone. Patient assessment revealed good to very good results with only one dissatisfied patient; the objective evaluation showed two thirds good and one third poor results, comparable to those of alternative methods of creation of a tendon web with the flexor carpi radialis (Weilby) or the extensor carpi radialis longus (Necking and Eiken). The essential point is a permanent distance between the base of the first metacarpal bone and both the scaphoid and the base of the second metacarpal bone under normal conditions as well as under loading.

Adult↗
PubMed1992

Scaphoid enchondroma.

Enchondromas are rarely found in carpal bones. This paper reports a case with scaphoid enchondroma and reviews three cases from previous literature. Three of the patients with scaphoid enchondromas presented with pathologic fractures after traumatic events. Each enchondroma had characteristic histopathologic findings. It is important to realize that although enchondroma is usually a painless lesion, it weakens the cortex of the involved bone, facilitating fracture. Thus, when cystic scaphoid fractures are encountered, enchondroma must be part of the differential diagnosis.

Adult↗
PubMed1975

[The tendon interposition plastic with partly necrosised scaphoid pseudarthrosis (author's transl)].

We have seen in 4 cases of 46 operated scaphoid pseudarthrosis aseptic bone necrosis of a fragment. According to the tendon interposition plastic of Froimson for the substitute arthrose of the saddlepoint of the thumb. We exstirpated the bionecrotic fragment of the scaphoid, splitted the tendon of the flexor carpi radialis muscle, removed a part of the tendon from the belly of the muscle, rolled it in and fixed it in the excavated cavity of the bone. After an observation time of 6 months to 1.5 years all 4 patients have not developed complications.

Arthroplasty↗
PubMed1997

Fractures of the carpal bones.

Fractures of the carpal bones, excluding the scaphoid, are less common and are often missed on standard, plain radiographs. The diagnosis requires knowledge of the anatomy and common fracture patterns of the bones and the specialized radiographic views necessary to image them. Although the hamate hook, trapezial ridge, and pisiform often fracture from direct trauma, other fractures of the carpus may indicate more widespread injury and require a detailed evaluation to rule out associated perilunate or carpometacarpal fracture-subluxations. Fortunately, if treated appropriately, the vast majority of these fractures heal uneventfully and allow recovery of motion and function of the wrist and hand.

Carpal Bones↗
PubMed1999

[Scaphoid pseudarthrosis of the proximal third--results of treatment with the Herbert screw].

Purpose of this study was to assess the value of the Herbert screw used with iliac crest cancellous bone graft for treatment of scaphoid nonunion in the proximal third. From 1986 to 1996, 75 patients underwent this procedure. We followed-up on 67 of them using the Martini score, which covers pain, grip strength and social activities, range of motion, X-ray results, individual, clinical and overall assessment. We found 57 patients (85.1%) with a good to excellent outcome, eight patients (11.9%) with satisfactory results and two patients with a poor result. We conclude that the Herbert screw with or without cancellous bone graft should be the first choice for surgical treatment of non-union located in the proximal third of the scaphoid bone.

Adult↗
PubMed1986

[Pseudarthroses of the scaphoid and its surgical treatment].

Sclerotic bone ends and failure of union have quite often resulted from scaphoid fractures due to relatively insufficient blood supply to the proximal fragment. Clearly manifest scaphoid pseudarthrosis can be repaired only by surgery. Transplantation of cancellous or corticocancellous bone in combination with freshening of the sclerotic bone ends are priorities on which emphasis is laid in such surgical intervention. 38 patients with scaphoid pseudoarthrosis received surgical treatment in the casualty ward of Linz, between 1976 and 1982. The shortest follow-up interval for 30 patients was twelve months. 4 surgical methods were used, the technique of Streli in 16 cases, that of Matti-Russe in 9 instances, the Matti technique in 3 cases, and the Russe-II approach in 2 cases. Bony union was achieved in 90 per cent of the above patients. The technique of Streli was used in most cases for postoperative immobilisation, that is forearm cast for six weeks, which differed from other methods in which axilla to palm cast is applied up to twelve weeks. This paper has been prepared, with the view to describing results obtainable from various surgical approaches to scaphoid pseudoarthrosis.

Adult↗
PubMed2006

Anatomical comparative study of two vascularized bone grafts for the wrist.

Atrophic scaphoid non-union and lunate necrosis can be treated with vascularized bone grafting; through a posterior approach as described by Zaidemberg, based on a supraretinacular artery, or through an anterior approach, based on the volar carpal artery, according to Kuhlmann's procedure. The aim of our study was to determine the area covered by each of these two grafts and their respective future applications. Fifteen hands from eight adult human cadavers, free of any scar, were dissected after injection of colored fluid latex, through dorso-radial approach for Zaidemberg's graft and through volar approach for Kuhlmann's. We observed the morphological parameters of the pedicles and the arc of rotation of each flap. The volar vascularized graft had a constant origin and it could be transferred to the scaphoid, the lunate and the scapholunate joint. The posterior graft of Zaidemberg was technically more difficult to harvest because of the anatomical variations. It made it possible to reach the scaphoid, the trapezium and the scaphotrapeziotrapezoid joint line. Both these two vascularized bone grafts represent interesting procedures for treatment of scaphoid non-union or lunate necrosis, or intracarpal bones arthrodesis. They bring various possibilities of bone covering, related to specific area of mobilization and are not opposite procedures, but have different targeted indications. One must better define the respective places of the vascularized bone grafts, compared with the traditional free (non-vascularized) graft.

Adult↗
PubMed1994

[Combined arthrosis manifestation of the radial wrist joint].

In the following study, the basal joint of the thumb and its neighboring joints of 100 anatomical specimens were inspected radiologically and macroscopically for arthrotic alterations. The comparison of the radiological and macroscopic findings showed that early arthrotic joint alterations cannot be diagnosed by radiograms. Virtually half of the specimens examined demonstrated arthrotic lesions of the basal joint of the thumb, whereas the trapezio-scaphoidal and trapezoido-scaphoidal joints were only affected in one-third of the specimens. Two-thirds of the cases with manifest arthrosis of the metacarpophalangeal joint of the thumb demonstrated additional arthrotic changes in the joints between the scaphoid, trapezium, and trapezoideum. No macroscopic evidence of arthrotic alterations in the remaining radial carpal bones were observed. The architecture of the capsular and ligamentous apparatus as well as the individual variations in the scaphoid bone have both been discussed as possible causes of these phenomena, as were polyarthrotic or secondary arthrotic processes.

Adult↗