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PubMed1994

Mechanical evaluation of the scaphoid shift test.

Manipulative examination of the carpal bones is an important facet of the examination of the wrist. Abnormal translation of portions of the carpus in response to applied force is a commonly used clinical indicator of ligament injury. Unilateral scaphoid hypermobility during the so-called scaphoid shift test is felt to represent traumatic instability, especially in the context of wrist injury. The test, however, is subjective, and requires considerable experience to correlate the degree of scaphoid mobility with pathologic significance. We used an instrument that quantifies the load-displacement behavior of the scaphoid and its supporting ligaments during application of a dorsally directed load at the scaphoid tubercle. We evaluated 18 uninjured (normal) wrists with clinical ligament examination and with mechanical testing. Subjects who exhibited a positive scaphoid shift had significantly increased displacement and significantly decreased stiffness when compared with subjects who did not have a shift.

Adult↗
PubMedDate not supplied

Scaphoid fractures in children: problems and treatment.

From 1984 to 1999, the authors treated 64 cases of fracture of the scaphoid in children. Causes of injury were sports (n = 27), punching game machines or fighting (n = 22), and traffic accident or other trauma (n = 15). Most (46 cases) were nonunion cases. Eighteen cases were acute. Cast immobilization was performed in 10 acute cases and two nonunion cases. Screw fixation was performed in 52 cases, including 35 cases of bone graft. In 10 of these operated cases, freehand screw insertion was used. Ultimately, good bony fusion was achieved in all cases, but in two nonunion cases a secondary bone graft was necessary. Functional results in all cases were acceptable. A major problem is that children are not brought to clinics immediately after injury, so the percentage of nonunion is high.

Adolescent↗
PubMed1993

Radiography and scintigraphy of suspected scaphoid fracture. A long-term study in 160 patients.

Radiographs of the scaphoid after injury are difficult to interpret, and bone scintigraphy is widely used to increase the accuracy of diagnosis, though many fractures suspected on scintigraphy cannot be confirmed radiologically. We have reviewed the clinical consequences, after one year, of managing suspected scaphoid fractures according to the bone-scan results. We studied 160 patients, 35 of whom had initially positive radiographs and were treated in a cast for 12 weeks. The other 125 had bone scintigraphy and were managed according to the result. After a minimum of one year 119 patients were reviewed. Scintigraphically suspected scaphoid fracture could not be confirmed radiologically in 25%. There were no cases of nonunion. The long period of immobilisation in patients with positive radiographs or positive bone scans did not influence the frequency or severity of late symptoms compared with those with a normal bone scan.

Adolescent↗
PubMed2004

In vivo motion of the scaphotrapezio-trapezoidal (STT) joint.

It has previously been shown that the articulation of the scaphotrapezio-trapezoidal (STT) joint can be modeled such that the trapezoid and trapezium are tightly linked and move together on a single path relative to the scaphoid during all directions of wrist motion. The simplicity of such a model is fascinating, but it leaves unanswered why two distinct carpal bones would have a mutually articulating surface if there were no motion between them, and how such a simplistic model of STT joint motion translates into the more complex global carpal motion. We performed an in vivo analysis of the trapezoids and trapeziums of 10 subjects (20 wrists) using a markerless bone registration technique. In particular, we analyzed the centroid spacing, centroid displacements, kinematics, and postures of the trapezoid and trapezium relative to the scaphoid. We found that, on a gross level, the in vivo STT motion was consistent with that reported in vitro. In addition, we found that the magnitude of trapezoid and trapezium motion was dependent upon the direction of wrist motion. However, we also found that when small rotations and displacements are considered there were small but statistically significant relative motions between the trapezoid and trapezium (0.4 mm in maximum flexion, 0.3 mm in radial deviation and at least 10 degrees in flexion extension and ulnar deviation) as well as slight off-path rotations. The results of this study indicate that the STT joint should be considered a mobile joint with motions more complex than previously appreciated.

Adult↗
PubMed2006

What is the implication of scaphoid ring sign in advanced Kienböck's disease? Is it a sign of advanced carpal collapse or rotary scaphoid subluxation?

OBJECTIVE: To discuss the clinical implication of scaphoid ring sign in Lichtman's X-ray IIIB stage of the lunate avascular necrosis. METHODS: In a series of 17 cases of advanced Kienböck's diseases, carpal height (CH) and carpal height ratio (CHO) were measured in posteroanterior X-ray view (PA) preoperatively, which included seven cases in stage IIIA and 10 cases in stage IIIB. Radioscaphoid angles were also measured in the lateral X-ray view. All these measurements above were to study what were the differences between stages IIIA and IIIB. In addition, five fresh normal wrist specimens were dissected to observe the ligaments stabilizing the proximal pole of scaphoid. RESULTS: The results of CH and CHR between stages IIIA and IIIB were similar, which illustrated no significant difference in carpal collapse between two substages, however, the results of RSA were significantly different between two substages, which implied the position of the proximal pole of scaphoid changed in two substages. Based on the results of anatomical observation, three ligaments were important to stabilize the proximal pole of scaphoid, namely the radioscaphocapitate (RSC) ligament, long radiolunate (LRL) ligament and scapholunate interosseous ligament (SLIL). The function of RSC ligament was to restrict palmar subluxation of the proximal pole of scaphoid; LRL and SLIL were to restrict dorsal transposition of the proximal pole of scaphoid. CONCLUSION: Based on the results, we suppose the scaphoid ring sign is the implication of rotary scaphoid subluxation in stage IIIB, which was caused by destructions of LRL and SLIL ligaments. All procedures aimed at stage IIIB must account for this important factor.

Adolescent↗
PubMed2006

In vivo elongation of the palmar and dorsal scapholunate interosseous ligament.

PURPOSE: To investigate the elongation of the palmar and dorsal subregions of the scapholunate interosseous ligament (SLIL) in healthy human subjects throughout a complete range of wrist motion. METHODS: The 3-dimensional in vivo kinematics of the scaphoid and lunate were determined in both wrists of 13 female and 13 male volunteers from computed tomography volume images. For each wrist the palmar and dorsal insertions of the SLIL were identified on reconstructed surface models of the scaphoid and lunate. The interbone distances between the palmar and dorsal sites were calculated for the neutral wrist position. Elongations were then calculated after applying the 3-dimensional kinematics to the scaphoid and lunate. A multiple linear regression model was used to determine if elongations varied significantly as a function of wrist flexion/extension and radioulnar deviation. RESULTS: From pure wrist extension to pure wrist flexion, the fibers of the SLIL at the palmar insertion site increased significantly, from 29% shortening to 27% elongation, and the dorsal insertion decreased from 26% to 4% shortening with respect to the fiber lengths in the neutral position. From pure radial deviation to pure ulnar deviation, the elongation of the palmar insertion significantly decreased from 9% elongation to 21% shortening. There was no notable change in dorsal elongation with wrist radioulnar deviation. The multiple linear regression model predicted that there would be minimal elongation of the palmar and dorsal fibers at the wrist position along the dart thrower's path from radial extension to ulnar flexion. CONCLUSIONS: In vivo elongation of the palmar and dorsal fibers of the SLIL varied with wrist position. The palmar fibers lengthened and the dorsal fibers shortened with wrist flexion and the opposite occurred with wrist extension. Scapholunate interosseous ligament elongation was minimal as the wrist was positioned along the dart thrower's path.

Adult↗
PubMed2002

[Comparison between fixation with Herbert screws and Kirschner wires in the treatment of scaphoid pseudoarthrosis].

OBJECTIVES: To compare the treatment results of patients with scaphoid pseudoarthrosis, who were treated by autogenous cancellous bone grafting followed by fixation with Herbert screws or Kirschner wires. METHODS: The study included 19 men (mean age 28 years, range 20 to 41 years) who were treated for scaphoid pseudoarthrosis and had a minimum follow-up of 12 months. Treatment was comprised of autogenous cancellous bone grafting and fixation with Herbert screws (n=10) or Kirschner wires (n=9). Fifteen right and four left hands were affected. The mean duration between the traumatic event and surgery was 20 months (range 3 to 72 months). Fractures were localized in the proximal pole (n=4, 21%), waist (n=13, 68%), and in the distal pole (n=2, 11%). The mean follow-up was 16 months for Herbert screws, and 21 months for Kirschner wires. RESULTS: None of the patients exhibited a loss in range of motion of 10 degrees or more. The mean time to union was six months (range 3 to 20 months) with Herbert screws and eight months (range 4 to 22 months) with Kirschner wires. All patients had union with Kirschner wires, whereas non-union occurred in three patients with Herbert screws, two of whom had had proximal pole fractures. Radiologic outcome was significantly different between the two groups (p<0.01). CONCLUSION: Because of good vascularity and union potential, scaphoid pseudoarthrosis can be successfully treated by an appropriate surgical technique using autogenous cancellous grafting independent of fixation materials.

Adult↗
PubMed2003

Scaphoid kinematic behavior after division of the transverse carpal ligament.

PURPOSE: The effect that carpal tunnel release (CTR) has on scaphoid motion has not been reported. Accordingly the purpose of this study was to determine the flexion/extension behavior of the scaphoid during global wrist radial/ulnar deviation before and after division of the transverse carpal ligament (TCL). METHOD: In this study we examined the in vitro kinematics of the scaphoid during wrist deviation in 6 cadaver forearms both before and after the division of the TCL using a computerized camera monitoring system. The specimens were evaluated in 13 different positions, from 20 degrees of radial deviation to 40 degrees of ulnar deviation at increments of 5 degrees. RESULTS: The data indicate that the difference in scaphoid position after TCL division is statistically significant when the wrist is in ulnar deviation of 15 degrees or greater. In addition a significant difference in scaphoid extension between pre- and post-TCL division conditions was found at 5 degrees of radial deviation as well as at 5 degrees or more of ulnar deviation and increased with increasing ulnar deviation. CONCLUSIONS: Scaphoid kinematics are altered considerably in radial-ulnar deviation after division of the TCL. This alteration may have long-term consequences and contribute to commonly seen post-CTR symptoms.

Analysis of Variance↗
PubMed2006

The influence of wire positioning upon the initial stability of scaphoid fractures fixed using Kirschner wires A finite element study.

A finite element model of the carpal scaphoid and its joints was developed to study how wire positioning affects the initial stability of the fixation of scaphoid waist fractures using Kirschner wires. A transverse fracture of the scaphoid waist was simulated along with its fixation using five different two-wire configurations. The resulting models were subjected to a load simulating a 200N force passing through the wrist. Friction between bony fragments was taken into account; as the friction coefficient of cancellous bone is unknown, three different values were analysed. For each of these friction coefficient values, the smallest transverse interfragmentary displacements, and consequently maximum initial stability, were obtained for the model that simulated the maximum gap between wires in the plane of fracture. Results also show that for a similar gap in the plane of fracture, more stable fixation can be achieved when wires cross each other not only in the frontal plane of the hand, but also perpendicularly to it.

Bone Wires↗
PubMed2006

Scaphoid fracture detection in a military population: a standardized approach for medical referral.

OBJECTIVE: The objective was to test, refine, and implement an algorithm for early detection and referral of clinical scaphoid fractures by U.S. Army medical personnel. Our goal was to reduce complications resulting from delayed diagnosis and to improve outcomes affecting soldier health and unit readiness. METHODS: Data on scaphoid fractures treated in the orthopedic department at Tripler Army Medical Center were collected from January 1, 2001, through December 31, 2003. Demographic variables included gender, age, and military rank. RESULTS: The incidence of scaphoid fractures in our population was 43 cases per 100,000 personnel per year. An algorithm to guide nonorthopedic providers was developed after review of the medical literature. CONCLUSION: We present an algorithm-based approach to soldiers presenting with post-traumatic wrist pain. The algorithm was fashioned with the aim of reducing complications and poor outcomes associated with delayed diagnosis of scaphoid fractures, affecting soldier health and unit readiness. A prospective study of the algorithm is underway.

Adolescent↗
PubMed2001

Scapho-capitate fracture syndrome. A case report.

A rare injury of the wrist, scapho-capitate fracture syndrome, in a young patient is reported. Despite early recognition of the injury and surgical intervention, the scaphoid fracture did not unite and another attempt to achieve union with bone grafting and internal fixation also failed. The wrist continued to be painful and stiff. Radiographs of the wrist, 18 months after the injury, showed nonunion of the scaphoid, avascular necrosis of the scaphoid and the lunate and carpal collapse with midcarpal joint arthritis. Due to persistent and disabling symptoms arthrodesis of the wrist had to be carried out. Possible causes for the bad outcome after this injury are discussed. We recommend open reduction for the fracture of the capitate and open reduction and internal fixation with primary bone grafting for a displaced comminuted scaphoid fracture.

Adult↗
PubMed2000

Degenerative changes at the scaphotrapezial joint following Herbert screw insertion: a radiographic study comparing patients with scaphoid fracture and primary hand arthritis.

One method of Herbert screw insertion is to mobilize the scaphotrapezial joint and insert the screw through the articular surface of the distal scaphoid. Because of concern that this might predispose to osteoarthritis in the scaphotrapezial joint, we have investigated joint space width and the presence of osteophytes adjacent to the scaphotrapezial joint using high definition macroradiography.Twenty-eight patients with symptomatic primary osteoarthritis of their hands, 23 with a scaphoid fracture successfully treated conservatively and 18 treated with a Herbert screw were studied. The patients with primary osteoarthritis of their hands had more narrowing of the scaphotrapezial joint compared with the other two groups, but patients treated with a Herbert screw had a significantly higher incidence of osteophytosis on the distal scaphoid than the other two groups. With Herbert screw fixation, osteophytosis on the distal scaphoid may cause impingement and pain, and be a predictor of further degenerative joint changes.

Adult↗