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At least 1,027 records · Page 57Linked to original sources
PubMed1996

The effect of workers' or third-party compensation on return to work after hand surgery.

OBJECTIVES: To investigate the role of compensation in recovery from scaphoid internal fixation. DESIGN: Retrospective review of patients who had had scaphoid internal fixations performed by one surgeon between 1 September 1981 and 31 December 1994 with a minimum follow-up of six months. SETTING: Private practice of a specialist hand surgeon. PATIENTS: 202 patients who attended for the minimum of six months' follow-up, and for whom accurate details of return-to-work time were available. INTERVENTION: Internal fixation of scaphoid fractures using the Herbert bone screw without postoperative immobilisation. MAIN OUTCOME MEASURES: Return-to-work time and compensation status. RESULTS: Overall, patients receiving compensation took more than twice as long as privately insured individuals to return to work after scaphoid internal fixation (7.3 v. 3.3 weeks). There was no difference for clerical workers, but for manual workers compensable individuals took significantly longer (P < 0.001) to return to work. Compensation status did not affect bony union, postoperative wrist function, pain or patient satisfaction. CONCLUSIONS: Compensation encourages a slower return to work after surgery. The current compensation system could save millions of dollars each year by incorporating incentives to return to work without sacrificing good surgical results.

Adult↗
PubMed2005

Reconstruction of the distal radius facet by a free vascularized osteochondral autograft: anatomic study and report of a patient.

PURPOSE: Large chondral defects of the distal radius after fractures present a reconstructive challenge. The purpose of this study was to present the anatomic findings from a cadaver of a vascularized osteochondral autograft taken from the third metatarsal appropriate for reconstructing the distal radius articular facet. A patient is presented in whom 70% of the scaphoid fossa was reconstructed with this technique. METHODS: The base of the third metatarsal was studied in the feet of 20 cadavers. The size and shape of the cartilage were measured. Additionally vessel distribution was recorded and the diameters of vascular foramina were measured with Juch's method. RESULTS: The base of the third metatarsal is pear shaped and is wider dorsally than plantarly. It averages 19.2 mm long on its main axis. Its cartilaginous surface is minimally concave or flat and it is slanted slightly proximal-dorsal to distal-plantar and proximal-peroneal to distal-tibial. Nutrient foramina were found in every case in the dorsum and on both sides of the proximal shaft. At least 1 nutrient vessel could be tracked back to the dorsalis pedis in every dissected specimen. CONCLUSIONS: The anatomic features of the base of the third metatarsal make it a potential vascularized autograft to consider for osteochondral defects of the distal radius.

Adult↗
PubMed2004

Scaphoid and lunate motion during a wrist dart throw motion.

PURPOSE: The primary purpose of this study was to measure the in vitro scaphoid and lunate motion during 9 different variations of a wrist dart throw motion. Another goal was to determine the specific dart throw motion that minimized scaphoid and lunate motion. METHODS: Scaphoid and lunate motion were recorded in 7 cadaver forearms during various combinations of wrist dart throw motions caused by a wrist joint motion simulator. RESULTS: During wrist flexion and extension the scaphoid and lunate motions follow the wrist motion. During wrist radial and ulnar deviation the scaphoid and lunate correspondingly flex and extend. During intermediate motions the scaphoid and lunate move as little as 26% of the total third metacarpal motion and do not necessarily follow a planar motion. CONCLUSIONS: These findings suggest that there may be a dart throw motion during which there may be minimal scaphoid and lunate motion. If a subject's wrist motion could be clinically restricted to this dart throw motion, early hand mobility might be possible after surgery on the scaphoid and lunate.

Aged↗
PubMed2007

Scaphoid fractures: variation in radiographic views - a survey of current practice in the West of Scotland region.

BACKGROUND: A variation seems to exist between hospitals with regard to the initial radiographic assessment of suspected scaphoid fractures. MATERIALS AND METHODS: A survey of all acute hospitals in the West of Scotland was carried out to ascertain the current practice in the assessment of acute scaphoid fractures. Consultant radiologists and consultant orthopaedic surgeons from the same hospitals were requested to suggest the minimum number and type of views to be ideally performed for a routine scaphoid series. RESULTS: Fourteen hospitals, 85 consultant orthopaedic surgeons and 60 consultant radiologists were contacted. Among the hospitals, 64.3% performed four views and 28.5% performed three views for a suspected scaphoid fracture. The commonly performed radiographs were lateral with the wrist neutral (85.7%) and postero-anterior oblique in ulnar deviation (78.5%). Of the consultant orthopaedic surgeons, 57.5% suggested four views, while 33.3% suggested three views. A lateral view with the wrist neutral (87.8%) and a postero-anterior view in ulnar deviation (51.5%) were considered most useful. Of the consultant radiologists, 68.4% suggested four views and 15.8% suggested three views. A lateral view with the wrist neutral (84.2%) and a postero-anterior view in ulnar deviation (52.6%) were considered most useful. DISCUSSION: A lack of uniformity is found among orthopaedic consultants who request scaphoid views, radiographers who perform the views and radiology consultants who report on these. We feel a uniform system of radiographic evaluation of scaphoid fractures should be introduced, with a standardized number and type of views, in all hospitals to increase the familiarity of both terminology and visualization.

Data Collection↗
PubMed2005

Biomechanical evaluation of a new composite bioresorbable screw.

A new bioresorbable composite cannulated screw has been developed for small bone fracture fixation. The LG ("Little Grafter") screw is manufactured from Biosteon, which is a composite of poly L-lactic acid and hydroxyapatite. This study aimed to compare interfragmentary compression generated by this new screw with conventional metal screws commonly used in scaphoid fracture fixation. Four small metallic screws were compared with the LG screw, using a bone model produced from rigid polyurethane foam. The screws included the Acutrak, Asnis III, Herbert and Herbert-Whipple screws. The mean maximum compression forces for the LG screw, the Asnis and the Acutrak were comparable (LG 32.3 N, Asnis 32.8 N, Acutrak 38.3 N), whereas those using the Herbert and the Herbert-Whipple screw were significantly lower (Herbert 21.8 N, Herbert-Whipple 19.9 N). The bioresorbable LG screw has been shown to have good compressive properties compared to commonly used small bone fragment compression screws.

Absorbable Implants↗
PubMed2004

Dorsal transscaphoid-transtriquetral perilunate dislocation in pseudarthrosis of the scaphoid.

A patient reported that he sustained a minor fall on the outstretched hand in hyperextension, pronation, and in ulnar deviation. Initial radiographs suggested dorsal transscaphoid-transtriquetral perilunate dislocation. Traditionally, however, this injury is the result of a high-energy impact. A CT scan obtained after closed reduction of the dislocation revealed not only a fresh fracture of the triquetrum but also two corticalized fragments of the scaphoid. A former major fall on this hand and a normal scaphoid of the other hand made pseudarthrosis more likely than scaphoid bipartition. Arthrography revealed intact lunotriquetral and scapholunate ligaments, precluding the possibility of preexisting ligamentous instability. Pseudarthrosis of the scaphoid with a loss of scaphoid function as a mechanical tie-rod of the carpus is most likely responsible for this complex injury. This is the first clinical study that shows that single scaphoid discontinuity without preexisting ligamentous carpal instability may lead to complex perilunar dislocation in minor trauma.

Adult↗
PubMed2000

Calcium pyrophosphate dihydrate crystal deposition disease of the wrist: trapezioscaphoid joint abnormality.

OBJECTIVE: To determine whether trapezioscaphoid (TS) joint alterations are associated with calcium pyrophosphate dihydrate (CPPD) crystal deposition disease and, if so, to determine the nature of these alterations. METHODS: Radiographs of 160 wrists with evidence of chondrocalcinosis were evaluated with regard to TS joint abnormalities, and findings were compared with a similar number of radiographs in an age and sex matched control population in whom no evidence of chondrocalcinosis or other calcification in the wrist was seen. Two radiologists in consensus recorded radiographic findings in both groups, and a third radiologist blinded to the presence or absence of chondrocalcinosis reviewed wrist radiographs in both groups in a random order. Correlation of TS joint abnormalities with other changes in the wrist was also accomplished. RESULTS; TS arthropathy was found in 43.7% of CPPD wrists and in 14.4% of control wrists in the consensus evaluation. In the blind evaluation, 30% of CPPD wrists and 12.5% of control wrists had TS arthropathy. The degree of arthropathy was more extensive in the CPPD group than in the control group. Features associated with TS arthropathy in the patient population were first carpometacarpal arthropathy and subchondral cysts in the scaphoid or trapezium, or both bones. CONCLUSION: CPPD patients, compared to a control population, reveal frequent and significant radiographic abnormalities of the TS joint that may be suggestive of the diagnosis, even in patients in whom chondrocalcinosis is obscured or absent. The features associated with TS arthropathy are first carpometacarpal arthropathy and subchondral cysts in the scaphoid and trapezium.

Adult↗
PubMed1977

[Carpal bones of the Chiroptera in the comparative-anatomical and functional aspects].

Data on investigation of hand sceletal bones carried out in eight genera of three families of bats were subjected to comparative-anatomical and functional analysis. Quantitatively, the hand sceletal bones of Chiroptera preserve constructive pattern general for the hand of terrestrial mammalians Pentadactilus. It has rudiments of the prefirst (Pp) and the seventh (Pm) rays. The latter is situated on the volar surface of the base Mc5. Scaphoid, semilunar and central carnal bones of Chiroptera, like those of Mototremata, some Marsupialia, Insectivorona and Carnivora merge together into one large bone--os lunatum. At the same time, the hand of Chiropter is a highly specialized structure, that is evident from the presence of articular restricotrs of anterior sagging of the wrist, crests and grooves directing movements in a strictly definite plane, from fan-like spreading and bringing together the rays, from very long metacarpal bones and proximal phalanges, from reduction of distal phalangs of the 3d and 5th fingers. Thus, the hand of Chiroptera is a unique example of combination of primitive, initial for pentadactule plantigrades wrist with signs of narrow specialization resembling, to some extent, those of Ungulata; only in Ungulata those signs developed on the base of digitigrades wrist.

Anatomy, Comparative↗
PubMed1994

Os centrale carpi simulating a scaphoid waist fracture.

The os centrale carpi is a relatively rare accessory carpal bone, and its presence may be confused with a scaphoid fracture. A case is presented which simulated an un-united scaphoid fracture on the plain X-ray film. However, CT in the sagittal plane showed two rounded fragments on the dorsum of the scaphoid with smooth, regular cortical margins differing from an acute scaphoid fracture. Their volume combined with the volume of the scaphoid is more than that of a completely normal scaphoid. There is no evidence of degeneration in the two rounded fragments and scaphoid. Because of these features, the diagnosis of soft tissue injury with an incidental finding of an os centrale carpi was suggested.

Aged↗
PubMed1986

A longitudinal study of carpal bone development in Perthes' disease: its significance for both radiologic standstill and bilateral disease.

This paper reports a longitudinal study of carpal bone development in 125 children (98 boys, 27 girls) attending a clinic for Perthes' disease. The age at appearance of ossification in each carpal bone was estimated by studying consecutive radiographs obtained at six-months intervals. The results were compared with the findings for normal children published by Stuart et al. Three radiologic groups of carpal bone maturation are defined: not delayed (capitate and hamate); markedly delayed (triquetral and lunate); and slightly delayed (scaphoid, trapezium, and trapezoid). Overall, the bone age delay is severely abnormal at three to five years of chronologic age and indicates the time in development when general abnormalities occur. The mean age at diagnosis (and standard deviation) for 34 boys with skeletal standstill was 4.49 +/- 1.07 years, compared with 7.28 +/- 2.40 years for 51 boys without such standstill; the mean age at appearance of carpal bones was not significantly different between these two groups, suggesting an equally profound delay of carpal maturation in the group of later-diagnosed boys. Boys with bilateral hip disease show a significant delay in age at ossification of the trapezoid compared with boys who have unilateral disease. The immaturity of bone age may be present during a latent period and be of etiologic significance in the onset of the hip disease, but at present the evidence links it only with bilateral disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Carpal Bones↗
PubMed2003

Minimal invasive percutaneous Herbert screw fixation in acute unstable scaphoid fracture.

The purpose of this study is to document the percutaneous Herbert screw fixation technique with free-hand method to stabilise acute unstable scaphoid fractures and evaluated the clinical results. Thirteen patients with less than 14 day-old fractures were fixed by percutaneous Herbert screw and reviewed retrospectively for a minimum of 24 months (average, 37 months). All were men with an average age of 22 years. According to Herbert's classification, all fractures were classified as of the acute unstable (B2). Fracture union was achieved in all cases at a mean of 9.2 weeks (eight to 12 weeks). Return to work or school ranged from one day to three weeks according to their occupation. This percutaneous fixation technique using Herbert screw is a reliable and effective alternative for acute scaphoid fractures, which enables the patient to use the hand earlier with high satisfaction and minimum complication.

Adolescent↗
PubMed2002

Rotatory subluxation of the scaphoid in Kienböck's disease is not a cause of scapholunate advanced collapse (SLAC) in the wrist.

We have examined whether the rotatory subluxation of the scaphoid which is seen in patients with advanced Kienböck's disease is associated with scapholunate advanced collapse (SLAC) wrist. We studied 16 patients (11 men, 5 women) who had stage-IV Kienböck's disease with chronic subluxation of the scaphoid. All had received conservative treatment. The mean period of affection with Kienböck's disease was 30 years (14 to 49). No wrist had SLAC. In eight patients, 24 years or more after the onset of the disease, the articular surface of the radius had been remodelled by the subluxed scaphoid with maintenance of the joint space. The wrists of six patients were considered to be excellent, nine good, and one fair according to the clinical criteria of Dornan. Our findings have shown that rotatory subluxation of the scaphoid in Kienböck's disease is not a cause of SLAC wrist and therefore that scaphotrapeziotrapezoid arthrodesis is not required for the management of these patients.

Adolescent↗
PubMed2005

Management of clinical fractures of the scaphoid: results of an audit and literature review.

OBJECTIVES: Two to 5% of scaphoid fractures are missed on initial presentation. The failure of early recognition and treatment are considered to contribute to delayed union and non-union. Despite advances in diagnostic imaging, a dogmatic approach has persisted in the management of patients with clinical suspicion but no radiographic evidence of scaphoid fracture. A critical analysis of the current treatment protocol of indiscriminate cast immobilization and serial clinical and radiographic follow-up is presented. METHODS: A prospective study involving 90 patients with clinical signs suggestive of scaphoid injury, followed up until a definite boney injury was demonstrated or the patient was discharged. A review of the literature was conducted to question the need for immobilization in these patients and the potential use of other forms of diagnostic imaging in screening for occult scaphoid fractures. RESULTS: The incidence of true fractures of the scaphoid was 6.66% (5/75). Ten patients (13.33%) had other injuries around the wrist unrelated to the scaphoid. Eighty per cent of the patients had no definite boney injury and were needlessly immobilized, and followed up. A total of 128 scaphoid casts, 135 sets of scaphoid X-rays, 135 clinic appointments and a cumulative 148 weeks of cast immobilization involved patients with normal wrists. CONCLUSION: The incidence of radiologically inapparent fractures of the scaphoid is low. The use of a tender anatomical snuff box as the only clinical sign in the diagnosis of scaphoid injury is unsatisfactory. Other injuries around the wrist must be carefully excluded. There is insufficient evidence to support immobilizing all patients with clinical scaphoid fractures. For suspected fractures with no radiological evidence, symptomatic treatment is probably sufficient. Most occult fractures are visible at 2 weeks. Both magnetic resonance imaging and bone scintigraphy are accurate and cost effective and should be performed earlier rather than later.

Adolescent↗
PubMedDate not supplied

Palmar lunate transscaphoid fracture-dislocation caused by palmar flexion injury.

The authors report a rare case of palmar lunate transscaphoid fracture-dislocation resulting from a palmar flexion injury. After performing an open reduction of the lunate, they used a dorsal approach to fix the fractured scaphoid with a Herbert screw. A Kirschner wire fixation was also performed to stabilize the lunotriquetral joint.

Adult↗
PubMed1990

[Roentgenological follow-up studies of silicone joint surface replacement in hand surgery as exemplified by scaphoid total and partial prosthesis].

Frequently, the clinical evaluation of a silicon prosthesis does not correspond to radiologic findings. Therefore, an extensive examination of 52 patients (total 85 patients) following a partial or total prosthetic replacement of the scaphoid or any other carpal bone, was performed. To obtain comparable information as to mobility, 12 wrists of "normal" persons and 17 wrists of volleyball players were exactly measured. Interestingly, in flexion the volleyball players demonstrated a considerably larger range of motion than the normal group. These findings applied for the total as well as for the partial prostheses. It could be shown that total scaphoid prosthesis lead to the best mobility. Subjectively however, these excellent results are surpassed by the proximal partial prosthesis. The most unfavorable results were found in distal prostheses of the scaphoid fixed within the proximal scaphoid alone. The best results are obtained by the distally and proximally fixed distal prosthesis of the scaphoid. Altogether, the results are encouraging. They indicate that radiological findings do not correlate to clinical findings. The reasons for this are presented in detail.

Adult↗
PubMed2002

Percutaneous cannulated screw fixation of acute scaphoid waist fracture.

This prospective study assessed the outcome of percutaneous cannulated screw fixation in 49 of 60 acute scaphoid fractures. The union rate was 100% (mean time for radiological union at 12 weeks). There were no early or mid-term complications and all achieved an excellent functional recovery.

Adolescent↗
PubMed2001

Dorsal open repair of proximal pole scaphoid fractures.

Proximal pole fractures of the scaphoid are well suited for comprehension screw fixation. A dorsal approach allows for direct visualization of the fracture site, accurate reduction, and internal fixation. Bone grafting can also be achieved through the same incision without additional significant dissection. Successful uncomplicated union in the majority of cases with a considerably shortened period of immobilization has lead to a growing interest in this surgical procedure.

Bone Transplantation↗
PubMed2006

[Dynamic mesh of carpal scaphoid].

Despite the use of cannulated compression screws, it is still difficult to screw non-displaced fractures of the scaphoid percutaneously. That is due in particular to the difficulty in assessing the correct position for the guide pin from the 2D fluoroscopic images. This work is designed to enable 3D visualisation of the scaphoid during surgical operations by using the technique of dynamic meshing and having the image appearing on a computer screen rather than as a mental image. In this context, the MEFP3C software includes applications for converting a generic scaphoid into a virtual scaphoid, based on the fluoroscopic 2D images of a given scaphoid. These applications include a module for acquiring a cloud of points, a modeller, a dynamic meshing system, an animation module, a texture module and a multi-resolution meshing system. The result of this process, the virtual scaphoid, in spite of the imperfections, enables images to be obtained comparable with those from tomodensitometric reconstruction of the same scaphoid specimen. The virtual scaphoid can be moved over the computer screen in the three spatial planes in translation, rotation and scaling. In conclusion, we think that dynamic meshing is a powerful, simple and ergonomic method of viewing a scaphoid in 3D, which could, in future, be routinely integrated into the fluroroscopic monitor.

Computer Simulation↗