[Fracture-dislocations of the scaphoid].
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Carpal Bones↗
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[Conclusions on recent injuries of the scaphoid].
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Carpal Bones↗
Fractures of the carpal scaphoid.
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Adolescent↗
The Herbert screw for fractures of the scaphoid.
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Bone Screws↗
Scaphoid fracture in the young athlete--therapeutic outcome of internal fixation using the Herbert screw.
BACKGROUND: A fractured scaphoid is a common disabling injury occurring in contact sports. This study was designed to evaluate the therapeutic outcome of Herbert screw fixation for scaphoid fracture in young athletes. METHODS: Thirty athletes with 30 scaphoid fractures were treated. According to the Herbert classification, 10 were classified as acute fracture (group I), 6 as fibrous union (group II) and 14 as pseudoarthrosis (group III). Twenty scaphoid non-unions were due to missed diagnosis or unsuccessful immobilisation. RESULTS: Bony union was evident at an average of 9.2, 8.0 and 11.9 weeks postoperatively in groups I, II and III, respectively, and times for returning to sports were 10.7, 14.0 and 22.9 weeks. The clinical outcome assessed using the Mayo wrist score was excellent in groups I (97.5 points) and II (93.3) and good in group III (85.4). CONCLUSION: Early definitive diagnosis and treatment can allow early return to sports in young athletes. The Herbert screw technique produces an excellent clinical result for scaphoid fracture.
Adolescent↗
A cadaveric anatomic study of radial artery pedicle grafts to the scaphoid and lunate.
This study was designed to determine the frequency of available radial styloid and metacarpal vascularized bone pedicle grafts and to determine the potential clinical availability (ie, sufficient length) of each pedicle graft for revascularization procedures to the dorsal and palmar scaphoid and dorsal lunate. Five vascularized bone pedicles (radial styloid 1, radial styloid 2, first metacarpal, second metacarpal, and third metacarpal) were evaluated in 20 fresh-frozen unpaired cadaveric forearms after methylene blue injection. For the dorsal approach to the scaphoid, radial styloid 2 bone graft was most reliable; for a palmar approach to the scaphoid, the first metacarpal graft was the most reliable; and for the dorsal approach to the lunate, the third metacarpal was the most reliable. Not all pedicles were available in all specimens; thus, versatility in using all five pedicles is recommended.
Bone Transplantation↗
[Carpal scaphoid chondroma complicated by fracture: a case report].
The carpal scaphoid is an uncommon localization for chondroma. Ten cases have been reported in the literature. We report a new case of right carpal scaphoid chondroma complicated by fracture in a 30 year-old man. The diagnosis was strongly suggested by the computed tomography scan and confirmed at pathology examination of the operative specimen. Treatment consisted in tumor enucleation and a cortico-cancellous graft to fill the gap followed by plaster case immobilization. Clinical and radiological outcome was favorable.
Adult↗
Frequency and timing of scaphoid-centrale fusion in hominoids.
Fusion between the os centrale and the scaphoid has played a central role in many functional and phylogenetic interpretations of hominoid evolution. In particular, scaphoid-centrale fusion shared among African apes and humans has been interpreted as an adaptation in knuckle-walkers, an exaptation in hominins, and has been offered as evidence for a knuckle-walking origin of bipedalism. However, discrepancies in the literature concerning the taxa in which this scaphoid-centrale fusion occurs, as well as the timing and/or frequency of this fusion, have confounded the significance of this trait. This study provides an historical review of the literature on scaphoid-centrale fusion in primates and the first formal investigation into the timing and frequency of this character among primates, with a focus on extant hominoids. Results indicate that there is a significant difference in the timing and frequency of scaphoid-centrale fusion in African apes and humans compared to Asian apes, suggesting that prenatal or early postnatal fusion among hominines is a synapomorphy. Scaphoid-centrale fusion does not occur randomly within primates. Instead, only Homininae and some members of Lemuroidea show consistent and ontogenetically early fusion of these carpals. The consistent occurrence of this trait within only two primate clades and a clear heterochronic trend in timing and frequency of scaphoid-centrale fusion among hominines suggest that this character is primarily phylogenetically controlled. We could not falsify the hypothesis that scaphoid-centrale fusion in African apes is indeed related to midcarpal stability in knuckle-walking, but neither were we able to find direct biomechanical or kinematic evidence to support this hypothesis. A more definitive answer to the question of the functional significance of scaphoid-centrale fusion will have to await more detailed analyses of great ape wrist kinematics.
Africa↗
The incidence of simultaneous fractures of the scaphoid and radial head.
In a 2-year period 181 scaphoid fractures were seen at our institution, of which 11 (6%) had a simultaneous fracture of the radial head. In four of these cases the scaphoid fracture was diagnosed late.
Adolescent↗
Management of acute scaphoid fractures.
Scaphoid fractures in the athlete present a dilemma to the treating clinician. Diagnosis of scaphoid fractures should be suspected in any athlete, especially those participating in contact sports, presenting with radial wrist pain. Appropriate imaging studies should be obtained to make a timely and complete diagnosis. Treatment alternatives for acute scaphoid fractures in the athlete include casting and staying out of sports, casting with use of a playing cast, and internal fixation. Displaced unstable fractures and proximal pole fractures should be treated by open reduction and internal fixation. Nondisplaced mid-third fractures are the most common type seen in the athlete. Alternatives of treatment should be carefully explained to the patients and family and the most appropriate treatment employed.
Athletic Injuries↗
Scapholunate ligament injury occurring with scaphoid fracture--a rare coincidence?
In a retrospective study the results of a series 34 wrist arthroscopies in 189 acute scaphoid fractures were analysed. Scapholunate ligament tears were found in 13 cases. In 10 cases there was complete disruption of scapholunate interosseous ligament causing dynamic instability. Partial ligament tears without instability were seen in three cases. Despite the limitations of this series we conclude that occurrence of scapholunate ligament injury with a scaphoid fracture may be more common than generally thought.
Adolescent↗
The presentation of scaphoid non-union.
A retrospective study of 30 patients presenting with scaphoid non-union was performed. The results showed that eight had been treated in plaster for a mean of 6 weeks and discharged from follow-up. They presented with established non-union at a mean of 60.3 months after the original fracture. Three of these cases have resulted in litigation against the surgeon. A total of 27 patients underwent bone grafting and Herbert's screw fixation achieving in union in 24. The natural history of scaphoid non-union has been examined in some detail in the literature. These studies have shown that scaphoid non-union is inevitably associated with arthritic changes that become worse with time and that freedom from symptoms is not protective from these changes. Therefore, prompt diagnosis and treatment of scaphoid non-union is vital, whether symptomatic or not, to prevent osteoarthritis developing in the future. Inadequate follow-up of treated scaphoid fractures will result in delayed diagnosis and treatment of non-union with a potentially impaired outcome and even litigation against the surgeon. It is the authors' advice that all scaphoid fractures treated in a plaster cast are reassessed clinically and radiologically 6 months post-injury.
Adolescent↗
Isolated dislocation of the scaphoid.
Isolated dislocation of the carpal scaphoid is an extremely rare injury. The authors report herein a case of a 28-year-old man managed with open reduction and Kirschner wire fixation. The aim of this study is to comprehensively present this unusual injury along with its treatment and to attempt to merge the available experience in the literature in a suggested algorithm that will guide the surgeon confronted with this rare problem to treat it promptly and effectively.
Adult↗
In vivo scaphoid, lunate, and capitate kinematics in flexion and in extension.
Carpal kinematics have been previously limited to in vitro models with cadaveric specimens. Using a newly developed markerless bone registration algorithm, we noninvasively studied the in vivo kinematics of the capitate, scaphoid, and lunate during wrist extension and flexion in both wrists of 5 men and 5 women. Computed tomography volume images were acquired in neutral and in 2 positions in both extension and flexion. The 3-dimensional kinematics of the capitate, scaphoid, and lunate relative to the radius were the determined. Scaphoid and lunate rotations differed for flexion and extension but were found to vary linearly with capitate rotation. In flexion the scaphoid contributed 73% of capitate motion and the lunate contributed 46%. In extension the scaphoid contributed 99% of capitate motion and the lunate contributed 68%. Contributions of the scaphoid and lunate to wrist extension were 15% greater than values reported in previous in vitro studies, while scaphoid and lunate contributions to wrist flexion were more similar to previous studies. The findings support a relative "engagement" of the scaphoid, capitate, and lunate during wrist extension. The only difference between male and female kinematics was a more distal location of the rotation axes; we believe this was due to a difference in carpal bone size, not gender. This study reports the 3-dimensional in vivo measurement of carpal motion using a noninvasive technology. This technique may prove useful in the study of more complex motions of the hand and wrist and of the abnormal kinematics that occur following ligamentous injury.
Adult↗
[Use of a cannulated 3.0 mm AO screw with an intraosseous support washer in osteosynthesis of the scaphoid: results and analysis of problems in 28 cases].
The cannulated 3.0 mm AO/ASIF screw with threaded washer is a new implant for scaphoid osteosynthesis. After insertion into the distal scaphoid pole, the washer serves as an intraosseous support for the head of the cannulated lag screw. From June 1997 to March 1998 the new implant was used in 28 male patients between 14 and 50 years of age. In fourteen patients, acute scaphoid fractures were operated on, including five transscaphoid perilunate fracture dislocations (Herbert type B2 and B4, respectively). Fourteen patients had scaphoid pseudarthroses, among those two re-pseudarthroses after prior surgery elsewhere. Using a palmar approach, the scaphoid was reduced. In pseudarthroses an iliac cortico-cancellous bone block was inserted, and the implants were inserted in a distal-to-proximal manner. In the fourteen acute fractures, follow-up assessment at a mean of 11 months revealed one pseudarthrosis (7%) and four screw removals (29%) for screw back-out after bony consolidation. In the fourteen pseudarthroses, follow-up assessment at a mean of ten months revealed one re-pseudarthrosis (7%) after a technical fault. It was treated by re-operation using the same implant, and healing was now uneventful. One screw removal became necessary after bony consolidation in another patient (7%). In conclusion, our preliminary results suggest that the new implant is suitable for stabilization of scaphoid pseudarthroses after insertion of an iliac crest bone graft. The complication rate in the treatment of acute fractures was inacceptably high.
Adolescent↗
[The anterior interosseous flap in wrist and hand surgery: a series of fifteen cases].
INTRODUCTION: Fifteen anterior interosseous flaps were used to reconstruct wrist and hand defects in fifteen patients (thirteen men and two women) with a mean of 38 years (27-42 years). PATIENTS AND METHODS: Seven anterior interosseous osteoperiosteal flaps and eight anterior interosseous osteocutaneous flaps were used. Seven island flaps and eight free flaps based on the anterior interosseous artery were raised. The indications were scaphoid non-union (4 cases), first metacarpal non-union (2 cases), proximal phalanx non-union (1 case), Kienböck's disease (2 cases), osteocutaneous phalangeal defects (3 cases), osseous capitatum defect (1 case) and intracarpal arthrodesis (2 cases). RESULTS: Postoperatively, one fracture of the distal end of the radius was noted because of a large osteoperiosteal corticotomy. Osseous reconstruction was usually consolidated at three months. One failure was noticed (Kienböck's disease). No significant deformity was noticed in the donor site. CONCLUSION: The anterior interosseous flap seems to be a useful alternative to reconstruct small or moderate defects in wrist and hand surgery.
Adult↗
[Isolated dislocation of the carpal scaphoid. A case report with review of the literature].
Isolated dislocation of the carpal scaphoid is an extremely rare injury, which is usually accompanied by significant ligamento-capsular lesions. A review of the literature found only 21 reported cases. The aim of this report is to present a single case of isolated radio-palmar dislocation of the scaphoid treated conservatively, which provided a good functional result at 10 years follow up.
Adult↗
[Treatment of old scaphoid fracture with Russe technique].
OBJECTIVE: To report the effect of Russe technique in treating old scaphoid fracture. METHODS: From January 1987 to February 1999, 11 cases of old scaphoid fractures were treated with Russe technique. The follow-up period averaged 5 years and 7 months. RESULTS: The fracture healing rate was 100%, and wrist pain was completely relieved in all cases. The ranges of motion averaged 41.2 degrees of flexion, 40.5 degrees of extension, 8.7 degrees of radial deviation, and 15.4 degrees of ulnar deviation. The grip strength reached 82.9% of the normal side. CONCLUSION: Russe technique is an effective and safe method of treatment for old scaphoid fracture.
Adult↗