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PubMed2005

A technical note on percutaneous scaphoid fixation using a hybrid technique.

This article describes a percutaneous fixation technique for a midwaist scaphoid fracture using an antegrade (dorsal) guidewire and a retrograde (volar) cannulated screw placement. This simplified hybrid technique allows for accurate dorsal central wire placement and stable internal fixation with minimal violation of the articular cartilage of the proximal pole of the scaphoid.

Adult↗
PubMed2006

The distribution of bone islands and juxta-articular bone cysts in the growing hand.

Bone islands and juxta-articular bone cysts are relatively common incidental findings when X-rays are taken for other purposes. We have identified that the incidence of bone islands in the hands of asymptomatic children between the ages of 5 and 13 years is 3.8% and the incidence of cysts in the same population is 2.8%. Bone islands were most common in the scaphoid, whilst juxta-articular bone cysts were most common in the capitate. The age at which they appear has not been reported previously. This study first identifies their presence in the hands of children of age 10 years and 2 months (bone islands) and 10 years 0 months (juxta-articular bone cysts). Most of the lesions were already present on the first radiograph taken. New bone islands appeared in five cases between the ages of 13 years and 1 month and 15 years and 3 months. New juxta-articular bone cysts were observed to appear in five cases between the ages of 10 years 10 months and 15 years 0 months. No island or cyst changed in size during the review period.

Adult↗
PubMed1988

Diagnosis of acute bone pain using isotope bone imaging.

Twenty-one patients with acute bone pain in areas other than the scaphoid were referred for isotope bone imaging directly from the A&E department. Of these scans 61% were positive. The various pathologies seen included stress fractures, osteomyelitis and bony metastases. Implications of the findings are discussed.

Acute Disease↗
PubMed1989

Occult fractures of the carpals and metacarpals: demonstration by CT.

Occult fractures of the carpals and metacarpals occur frequently and are associated with major disability. The cross-sectional display and superior resolution of CT are well suited to the demonstration of these fractures. Sixteen patients with pain and negative conventional radiographs were chosen for further evaluation by CT. Imaging was performed in two planes and showed 21 fractures. The transaxial plane was the most revealing imaging plane. Coronal imaging was equal or superior to the transaxial plane in most fractures of the scaphoid, lunate, capitate, and pisiform bones and of the bases of the metacarpal bones. The direct sagittal plane was the best imaging plane in one patient with fractures of the scaphoid and lunate bones. After discovery of the fracture on CT, surgical removal of the avulsed fracture fragment was recommended in seven patients and fusion was recommended in three. Eight patients had a marked decrease in pain after the surgical procedure. The accuracy of CT for the demonstration of occult fractures may result in earlier recognition of these fractures and a reduction in the associated disability.

Carpal Bones↗
PubMed2005

Your diagnosis? Scaphoid fracture.

Fractures of the scaphoid are the most common carpal bone fracture. With careful management, prognosis is excellent. Imaging is critical, not only for early diagnosis, but also for monitoring patients after initial treatment to detect unstable fractures, the common complications of nonunion and avascular necrosis, and the need for surgical treatment.

Adult↗
PubMed1984

Surgical treatment of scaphoid pseudarthrosis: evaluation of the results after soft tissue arthroplasty and inlay bone grafting.

A retrospective study of the results after surgical treatment of scaphoid nonunion in two orthopedic centers is described. One center used Bentzon 's soft tissue-arthroplasty method in 15 cases, and the other center used Matti - Russe bone grafting procedure in 32 cases. Of these 47 cases, 46 had established pseudarthroses. The clinical results were similar in both methods (average follow-up time: 61.4 and 44.0 months, respectively). Soft tissue arthroplasty permitted an earlier return to work, but the risk of long-term degenerative changes developing cannot yet be excluded.

Adolescent↗
PubMed1997

Experience with scaphoid grafting.

Over a period of 24 years, the author has used five different methods of bone-grafting for ununited scaphoid fractures. The clinical and radiological results have been reviewed, with a minimum follow-up of 1 year. Radiologically the best results (78% definite union) were obtained with a "wedge" graft and Herbert screw, while the worst results followed the original Russe operation. The clinical result often did not coincide with the radiological outcome. All methods led to a decrease in pain in most cases, but little or no pain was achieved most often by the modified Russe graft. With proximal pole fractures, bony union was only achieved in 54% but the symptoms were always lessened.

Bone Screws↗
PubMed1992

Transscapho-transcapitate fracture dislocation of the carpus.

Transscapho-transcapitate fracture dislocation of the carpus is a rare form of perilunate dislocation. It occurs after acute high-energy hyperdorsiflexion trauma and longitudinal compression of the wrist, with concurrent fractures of the scaphoid and capitate neck and rotation of the proximal fragment of the capitate up to 180 degrees. Four cases and their treatments are described, and the literature is reviewed. A possible explanation of the mechanism underlying this condition is offered, and methods of treatment are discussed. If a stable anatomic situation is not obtained with closed reduction, surgical reduction and internal fixation of the scaphoid and capitate bones are recommended to prevent loss of function.

Adult↗
PubMed1996

The gross and histologic anatomy of the scapholunate interosseous ligament.

The scapholunate interosseous ligament, which connects the carpal scaphoid and lunate bones, was evaluated by gross dissection and serial histologic sections in transverse, sagittal, and coronal planes in 21 fresh and 16 fixed adult cadaver wrists. The scapholunate interosseous ligament is consistently divisible into three anatomic regions: dorsal, proximal, and palmar. The dorsal region is thick and composed of short, transversely oriented collagen fibers. The proximal region is principally composed of fibrocartilage, with a few superficial, longitudinally oriented collagen fibers. The proximal region may extend distally a few millimeters into the scapholunate joint space, thus resembling a knee meniscus. The radioscapholunate ligament separates the proximal and palmar regions of the scapholunate interosseous ligament, often extending distally to cover the dorsal surface of the palmar region of the scapholunate interosseous ligament. The palmar region is thin and composed of obliquely oriented collagen fascicles, just dorsal to and separate from the long radiolunate ligament.

Adult↗
PubMed1995

Intraosseous ganglion cyst of the scaphoid.

Intraosseous ganglion cysts are rare causes of hand and wrist pain. Differential diagnosis of painful cystic radiolucent carpal lesions includes osteoid osteoma and osteoblastoma. Isolated cases of ganglion cysts occurring in the lunate, scaphoid, pisiform, hamate, triquetrum, capitate, metacarpal, and phalanx have been reported. A case of intra-articular intraosseous ganglion cyst of the scaphoid is presented. A 49-year-old right-handed woman presented with a 3- to 4-month history of progressive left-wrist pain. No history of trauma was reported. Conservative treatment with anti-inflammatory medications before referral was unsuccessful. Examination revealed marked tenderness in the region of the volar scaphoid proximal pole as well as tenderness overlying the dorsal radial styloid. No palpable masses were present. Wrist motion was not limited. Grip strength was symmetric. Radiographic studies revealed a cystic lesion eroding the radial-volar surface of the scaphoid waist. Magnetic resonance imaging studies demonstrated the cystic lesion to be of the penetrating type, originating from the radiocarpal joint and eroding into the scaphoid. The patient underwent radial styloidectomy, excision of the ganglion cyst, curettage of the scaphoid lesion, and bone grafting with radial styloid bone. Intraosseous carpal ganglion cysts, although rare, present with chronic wrist pain and should be included in the differential diagnosis.

Bone Cysts↗
PubMed2006

Expression of extracellular matrix molecules typical of articular cartilage in the human scapholunate interosseous ligament.

The scapholunate interosseous ligament (SLIL) connects the scaphoid and lunate bones and plays a crucial role in carpal kinematics. Its rupture leads to carpal instability and impairment of radiocarpal joint function. As the ligament is one of the first structures affected in rheumatoid arthritis, we conducted an immunohistochemical study of cadaveric tissue to determine whether it contains known autoantigens for rheumatoid arthritis. We immunolabelled the ligament from one hand in 12 cadavers with monoclonal antibodies directed against a wide range of extracellular matrix (ECM) molecules associated with both fibrous and cartilaginous tissues. The labelling profile has also enabled us to comment on how the molecular composition of the ligament relates to its mechanical function. All regions of the ligament labelled for types I, III and VI collagens, chondroitin 4 and 6 sulphates, keratan sulphate, dermatan sulphate, versican, tenascin and cartilage oligomeric matrix protein (COMP). However, both entheses labelled strongly for type II collagen, aggrecan and link protein and were distinctly fibrocartilaginous. In some regions, the ligament attached to bone via a region of hyaline cartilage that was continuous with articular cartilage. Labelling for cartilage molecules in the midsubstance was most evident dorsally. We conclude that the SLIL has an ECM which is typical of other highly fibrocartilaginous ligaments that experience both tensile load and shear. The presence of aggrecan, link protein, COMP and type II collagen could explain why the ligament may be a target for autoantigenic destruction in some forms of rheumatoid arthritis.

Aged↗
PubMed1994

Scapholunate interosseous ligament of the wrist: MR appearances in asymptomatic volunteers and arthrographically normal wrists.

PURPOSE: To determine if the carpal scapholunate ligament (SLL) can be consistently visualized with commercial magnetic resonance (MR) imaging techniques and to establish the normal range of MR appearances of the SLL as a basis for comparison with SLL tears. MATERIALS AND METHODS: MR imaging helped identify and characterize the appearance of the SLL in 80 wrists with presumably normal SLLs (54 wrists in 27 asymptomatic volunteers and 26 patients with normal arthrograms). A dual-echo, gradient-echo technique was used. RESULTS: The SLL was visible in all 80 wrists and was seen on an average of almost four sections. It was delta-shaped in 72 wrists and linear in eight; there was absent signal intensity in 63% or intermediate signal intensity traversing all or part of the SLL in 37%. Distribution and extent of hyaline cartilage signal intensity at the insertion sites into the scaphoid and lunate bones were variable but related to the location within the SLL. CONCLUSION: The SLL can be consistently identified, but the normal variation in the MR appearance of the lunotriquetral ligament must be appreciated when evaluating wrists with suspected SLL tears.

Adolescent↗
PubMed2002

Sonography of the scapholunate ligament in four cadaveric wrists: correlation with MR arthrography and anatomy.

OBJECTIVE: The objective of our study was to sonographically characterize the dorsal aspect of the scapholunate ligament in cadaveric wrists using arthrography, MR arthrography, and anatomic correlation as the gold standard. MATERIALS AND METHODS: The dorsal aspect of the scapholunate ligament in four cadaveric wrists was evaluated on sonography without knowledge of the findings from standard arthrography, MR arthrography, and anatomic sectioning. The sonographic findings were compared with the findings from other modalities. The criteria for an abnormal scapholunate ligament included an abnormal contrast communication between the radiocarpal and midcarpal joints on arthrography and a discontinuity of the dorsal aspect of the scapholunate ligament that was documented both on MR arthrography and at anatomic sectioning. RESULTS: Arthrography, MR arthrography, and anatomic sectioning showed the dorsal aspect of the scapholunate ligament to be normal in one specimen and abnormal in three specimens. On sonography, the normal scapholunate ligament was hyperechoic between the scaphoid and lunate bones. In the three cases of abnormality, a normal scapholunate ligament was not visualized, and an abnormal hypoechogenicity was present. CONCLUSION: The dorsal aspect of the scapholunate ligament can be depicted on sonography; abnormality is present in patients in whom the normally hyperechoic fibrillar ligament is hypoechoic or absent.

Aged↗