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At least 883 records · Page 49Linked to original sources
PubMed1986

[Long-term results after the surgical treatment of saddle joint arthrosis with Swanson's silastic prosthesis].

The use of a silastic implant in resection arthroplasty of the carpometacarpal joint of the thumb allows the joint space to be preserved. With the Swanson type arthroplasty relief of pain, good function, as well as stability and improved pinch force can be obtained, avoiding the consequence of carpal instability by narrowing of the joint space associated with resection of the trapezium alone or in combination with tendon interposition arthroplasty. The two main problems associated with Swanson arthroplasty are prosthetic dislocation and longterm stability of the prosthesis itself. The joint surface of the prosthesis wears out asymmetrically, and mild to severe foreign body reactions can be seen in the carpal bones, mainly the scaphoid. Clinical and radiological results of a series of 77 operations in 65 patients from 1975-1981 are presented and discussed.

Adult↗
PubMed1986

Erosive silicone synovitis.

Although erosive silicone synovitis is an unusual complication of implant arthroplasty, its recognition is important. The authors describe three patients in whom this complication occurred after Silastic replacements of the carpal scaphoid and trapezium bones. Intercarpal arthrodesis is suggested as a form of stress shielding for the implants. Regular, long-term follow-up of patients with these Silastic implants is recommended.

Adult↗
PubMed1978

[Perilunar, transscaphoid, transcapital, transstyloid fracture-dislocation of the wrist. Operative reconstruction].

Report of a new type of fracture dislocation of the wrist and the intercarpal joints, which has not been published until now. A perilunar dislocation was associated with fractures of the scaphoid and capitate bones as well as a fracture of the radialstyloid. Open reduction and internal fixation was followed by fracture healing and slight posttraumatic arthritis. Loss of function was minimal and working capacity not reduced.

Bone Screws↗
PubMed1992

Detecting fractures of the scaphoid: the value of comparative X-rays of the uninjured wrist.

Pain or tenderness in the anatomical snuff-box following trauma suggests an injury to the scaphoid or surrounding soft tissues. It is often difficult to make a definite diagnosis since normal bone markings across the scaphoid can be misinterpreted as a fracture. To clarify whether a fracture is present or not, an X-ray of the uninjured scaphoid is taken in a comparable position to the most suspicious view. If bone markings are similar on both views, then a fracture can be excluded. Conversely, if the bone markings differ, then suspicion of a fracture may be confirmed. In combination with the clinical features, a more accurate diagnosis can be made and unnecessary out-patient and X-ray reviews can be avoided.

Adolescent↗
PubMed2005

Cannulated variable pitch compression screw fixation of scaphoid fractures using a limited dorsal approach.

Scaphoid fractures are common in the young, active patient. Treatment is challenging because of the complex three-dimensional anatomy of the scaphoid and the tenuous blood supply. Traditionally, cast immobilization has been used for the management of non-displaced fractures with satisfactory outcomes reported in the literature. However, non-surgical treatment may result in a delayed union or nonunion particularly if the fracture is unstable, displaced, or involves the proximal pole. Recently there has been increased interest in the fixation of non-displaced scaphoid fractures. The proposed advantages for operative treatment include avoiding the morbidity and inconvenience of prolonged cast immobilization and a lower incidence of delayed union or nonunion. A variety of surgical approaches for fixation of an acute scaphoid fracture have been described. The most common techniques include percutaneous fixation, arthroscopically assisted reduction and fixation, or open reduction and internal fixation via a volar approach. The senior author favors a limited dorsal approach with compression screw fixation of all proximal pole fractures as well as displaced and non-displaced fractures of the waist region. The technique is simple permitting accurate screw placement in the central axis of the scaphoid, which is biomechanically advantageous and important for achieving union.

Bone Screws↗
PubMed1999

Magnetic resonance imaging of the humpback scaphoid: the technique and a mathematical performance evaluation.

Surgical treatment of scaphoid nonunion and malunion with excessive intrascaphoid angulation (humpback deformity) usually involves a bone graft that is intended to correct the deformity. The volar bone graft length determines the degree of angular correction and scaphoid elongation. It is recommended that the length of the graft be determined by careful preoperative measurement of the deformity. Previous imaging techniques are inherently limited. The present paper describes a technique using three-dimensional magnetic resonance imaging. Scaphoid fracture angulation is calculated from measurements of comparable sagittal slices of the patient's fractured and normal scaphoid. Optimal bone graft length is determined by using simple trigonometric principles. Magnetic resonance imaging provides additional important information regarding vascularity of the proximal pole and the status of the periscaphoid ligaments and hyaline cartilage. Mathematical performance evaluation indicates that this technique is a promising method for planning reconstructive surgery of the scaphoid.

Bone Transplantation↗
PubMed1995

Non-union of the scaphoid. Revascularization of the proximal pole with implantation of a vascular bundle and bone-grafting.

Eleven patients who had an ununited fracture of the scaphoid associated with loss of the blood supply to the proximal fragment were managed operatively with a combination of an inlay corticocancellous bone graft from the iliac crest and implantation of the second dorsal intermetacarpal artery, its accompanying venae comitantes, and a thin cuff of perivascular tissue. The absence of the blood supply to the proximal pole was evidenced both by radiographic changes--which included increased bone density, absence of normal trabeculae, and cystic changes--and by failure to observe bleeding bone during the operation. There were ten men and one woman. The average duration of non-union was fourteen months (range, six to thirty-three months). Six patients had had previous unsuccessful operative attempts to obtain union. Eight non-unions were in the proximal one-third and three, at the waist of the scaphoid. Union was achieved in ten patients at an average of ten weeks postoperatively. According to the wrist-scoring system of the Mayo Clinic, at an average of five years (range, 2.5 to eleven years), three patients had a grade of excellent; three, good; three, fair; and two, poor. Four patients had subsequent reconstructive procedures; radial styloidectomy, styloidectomy and resection of osteophytes, radioscapholunate arthrodesis, and total wrist arthrodesis were performed in one patient each.

Adult↗
PubMed1990

Avascular necrosis after scaphoid fracture: a correlation of magnetic resonance imaging and histology.

In this study 12 male patients with fractures of the middle third of the scaphoid had an magnetic resonance imaging study before open reduction and internal fixation in conjunction with bone grafting of the scaphoid. The patients' average age was 27 years (range, 17 to 37 years). At the time of surgery biopsy specimens were obtained from both the proximal and distal poles of the scaphoid. The length of time before surgery ranged from a minimum of 1 1/2 months in recently displaced fractures to a maximum of 10 years in established nonunions. Results of the biopsy showed that six patients had avascular necrosis noted in the proximal pole fragment. In three of these six patients avascular necrosis was confirmed by the absence of tetracycline labeling despite positive uptake noted in biopsy specimens from the bone graft site; the other three patients did not receive tetracycline labeling. Magnetic resonance imaging showed that all six of the patients with biopsy specimens of the proximal poles showing avascular necrosis demonstrated decreased signal intensity in the proximal pole fragment, whereas the plain radiographs demonstrated changes in the proximal pole in only three of the six patients. A decreased signal intensity from the proximal pole of the scaphoid may indicate a poor prognosis inasmuch as only three of the six patients had healing of the fracture even with bone grafting and internal fixation.

Adolescent↗
PubMed2004

Diagnosis and management of scaphoid fractures.

Scaphoid fracture is a common injury encountered in family medicine. To avoid missing this diagnosis, a high index of suspicion and a thorough history and physical examination are necessary, because early imaging often is unrevealing. Anatomic snuffbox tenderness is a highly sensitive test for scaphoid fracture, whereas scaphoid compression pain and tenderness of the scaphoid tubercle tend to be more specific. Initial radiographs in patients suspected of having a scaphoid fracture should include anteroposterior, lateral, oblique, and scaphoid wrist views. Magnetic resonance imaging or bone scintigraphy may be useful if the diagnosis remains unclear after an initial period of immobilization. Nondisplaced distal fractures generally heal well with a well-molded short arm cast. Although inclusion of the thumb is the standard of care, it may not be necessary. Nondisplaced proximal, medial, and displaced fractures warrant referral to an orthopedic subspecialist.

Adolescent↗
PubMed1987

Dorsal dislocation of the triquetrum with rotary subluxation of the scaphoid.

Dislocations of the carpal bones are common, but dorsal dislocation of the triquetrum is rare and has only recently been reported in the English-language literature. This case report describes such an injury associated with rotary subluxation of the scaphoid that was successfully treated with closed reduction and cast immobilization for 8 weeks.

Adult↗
PubMed2006

[Scaphoid fracture and nonunion: current status of radiological diagnostics].

Scaphoid fractures, which involve approximately two-thirds of all wrist injuries, are often not detected during initial radiographic examination. By using high-resolution CT and dedicated MRI, it is possible to recognize scaphoid fractures soon at the first diagnostic approach and to assess fragment stability. CT imaging provides all the relevant information of the fracture extent and of the fracture healing in the follow-up. MRI is most sensitive in the detection of scaphoid fractures; however, fracture signs must be differentiated from those of a bone bruise. Both the initially overseen scaphoid fracture and the unsuccessful healing can lead to the natural history of scaphoid nonunion. In the injured scaphoid, CT imaging is essential for depicting the osseous morphology, whereas contrast-enhanced MRI is crucial for assessing the viability of the proximal fragment.

Fractures, Bone↗
PubMed1994

Compression forces generated by the Huene alignment guide alone.

To enhance the fixation of scaphoid fractures by providing precise alignment and compression at the fracture site, the Huene alignment guide has been used in conjunction with bone screws. In an effort to predict the compressive force generated by the Huene guide alone, these forces were measured with a calibrated, strain-gauge, instrumented device. Three orthopedic surgeons each tested the guide 10 times on one cadaver scaphoid bone specimen. The magnitude of the compressive forces generated ranged from 9.0 to 67.0 N (mean 36.0 +/- 15.0 N). Comparisons of the force measurements among the individuals revealed no significant differences. This wide range of measurements could be attributed to the variability of the ratchet mechanism on the device. Because the Huene alignment guide is used to generate transcaphoid compressive forces, these results demonstrate that it does not yield consistent compression.

Bone Screws↗
PubMed2005

In scaphoid non-union, does the source of graft affect outcome? Iliac crest versus distal end of radius bone graft.

Iliac crest bone grafts are sometimes preferred to other bone grafts for the treatment of non-unions of fractures of the scaphoid as they are claimed to have better osteogenic potential and biomechanical properties. We retrospectively studied a consecutive cohort of 68 symptomatic established scaphoid non-unions treated by bone grafting. An iliac crest graft was used in 44 cases and a distal radius graft in the other 24. The two treatment groups were comparable in terms of location of the fracture, duration of the non-union and the fixation implants used. Overall union was achieved in 45 of the 68 patients (66%) and the union rate was not influenced by the type of bone graft used. Twenty-nine of the 44 treated with iliac crest bone graft (66%) and 16 of the 24 (67%) treated with distal radial graft united. Donor site pain over the iliac crest was present in nine of the 44 patients in this group.

Adult↗
PubMed2001

Traumatic and reconstructive problems of the scaphoid.

The management of acute scaphoid fractures should be oriented on the concept of fracture stability, ease of reduction, associated ligamentous injury, and risk of impaired blood supply, rather than the direction of the fracture line or location of the fracture within the scaphoid. The lack of predictability of successful fracture union and prognostic discrepancies of historic and contemporary classifications may be related to subtle differences of the internal vascular architecture of each scaphoid. Because the possibility of impaired vascularity is greater with fractures located in the proximal third, stable internal fixation is indicated to provide mechanical stability and fracture surface contact to enhance revascularization. Improved healing rates in a shorter time and earlier rehabilitation with percutaneous techniques of internal fixation have produced a clear shift from classic conservative treatment to internal skeletal fixation. Although the rates of union of well-vascularized nonunions have not been dramatically improved with the use of internal fixation as compared with inlay bone grafting, the restoration of scaphoid anatomy and prevention of malunion and associated carpal collapse with interpositional bone grafting techniques will reduce the risk of osteoarthritis.

Bone Transplantation↗