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PubMed2003

[Occult scaphoid-lunate dissociation in distal radius fractures].

INTRODUCTION: The aim of this study was to investigate the clinical consequences of scapholunate dissociation associated with fractures of the distal radius and the impact on wrist function. Fractures of the distal radius and scapholunate dissociation overlap in pathomechanics. The diagnosis however is frequently missed initially. PATIENTS AND METHODS: We reviewed 45 consecutive patients with closed distal radius fractures with a mean follow up of 48 months. Ten patients underwent surgery and 35 patients were treated by fracture reduction and cast immobilization during 4.5 (range 3 to 8) weeks. All patients were re-examined clinically and radiographs of both wrists were compared. RESULTS: Four patients showed evidence of SLD in the scapholunate joint region based on specific criteria (scapholunate gaps > 2 mm on anterior-posterior radiograph and the scapholunate angle > 60 degrees on lateral radiograph). All patients with SLD showed a poor radioulnar deviation. Three patients reported mild to moderate pain. DISCUSSION: The difficulties in management of SLD may be avoided by early detection and treatment. In all investigated patients the diagnosis was missed after the initial trauma. Untreated SLD can lead to carpal collapse and arthrosis of the wrist, and ultimately to scapholunate advanced collapse.

Adolescent↗
PubMed1994

Long-term results following proximal row carpectomy.

The functional outcome, patient satisfaction, and x-ray film status for 23 wrists were examined an average of 6 years following proximal row carpectomy. Surgery was performed for Kienbock's disease, scapholunate dissociation with periscaphoid arthritis, and scaphoid nonunion not suitable for bone grafting. Twenty patients were satisfied with functional performance and pain relief. Wrist flexion-extension arc averaged 74 degrees, or 61%, of the opposite wrist at a later examination. Grip strength, corrected dor dominance, averaged 79% of the opposite side, reflecting an average improvement of 15 kg force. Radiocarpal arthritis developed in three wrists, but only one required arthrodesis for pain relief. The majority of patients experienced satisfactory pain relief, functional wrist motion, and effective grip strength following proximal row carpectomy. The results did not decline at an average of 6 years after surgery.

Adolescent↗
PubMed2003

Radiocarpal fusion.

Limited wrist fusion is a common and often effective method of treatment for many painful wrist conditions. When post-traumatic, inflammatory and noninflammatory arthritis affects only the articular surfaces of the proximal carpal joint, a limited radiocarpal fusion can be considered. Specific indications are painful arthritis following distal radial fractures, rheumatoid arthritis with ulnar shift of the carpus, scapholunate instability with radioscaphoid arthritis, and stage IV Kienbock's disease. It is necessary for the midcarpal joint surfaces to be essentially normal. Either a radioscapholunate or radiolunate fusion can be performed, depending on the underlying condition. Up to 70 degrees of wrist flexion-extension can be obtained after a radioscapholunate fusion. Keys to a successful postoperative result are proper alignment of the scaphoid and lunate, use of bone graft or bone graft substitute and careful positioning of internal fixation devices. Evidence of radiographic union is usually seen by eight weeks. Nonunion rates are quoted to be from 10 to 20%.

Journal Article↗
PubMed2000

Severely displaced scaphoid fracture treated by arthroscopic assisted reduction and osteosynthesis.

The severely displaced scaphoid fracture, when combined with a scapholunate dissociation, is a very rare condition that commonly is treated by open surgery. The authors present a case treated by arthroscopic-assisted closed reduction, using percutaneous pinning for the scapholunate dissociation and a Herbert/Whipple screw insertion for the scaphoid fracture. The patient was able to return to work four months after surgery. At twenty-seven months after surgery, both the patient's grip power and range of motion in the wrist were acceptable. The authors recommend this procedure as a minimally invasive operation.

Adult↗
PubMed2001

[Rollerblading and skateboarding injuries among children in Bergen, Norway].

BACKGROUND: The popularity of rollerblading and skateboarding activities in Norway is reflected in the number of injuries seen at our casualty centres and hospitals. MATERIAL AND METHODS: During 1998, we made a prospective registration of 7,041 new injuries involving children below the age of 16 treated at the Accident and Emergency Department and at Haukeland University Hospital in Bergen. RESULTS: Rollerblading and skateboarding injuries accounted for 113 cases, representing 1.6% of all injuries. Three quarters were boys, nine out of ten were 10 to 15-year-olds, and arms/hands were injured in two thirds of the cases. Almost two thirds of the injuries were fractures (n = 67), representing a higher fraction than seen in other activities. Most of them were distal radial fractures (n = 39), but scaphoid fractures, an otherwise seldom child fracture, were seen in one tenth (n = 6) of all fractures. INTERPRETATION: Scaphoid fractures can, when untreated, cause pseudarthrosis; this should be borne in mind when treating children with hand pain after fall on their rollerblades or skateboards. As fractures of the hand root and wrist accounted for 40% of all injuries, hand and wrist protection seem to be the best preventive measure in terms of number of injuries.

Child↗
PubMed2001

[Rollerblading and skateboarding injuries among children in Bergen].

BACKGROUND: The popularity of rollerblading and skateboarding activities in Norway is reflected in the number of injuries seen at our casualty centres and hospitals. MATERIAL AND METHODS: During 1998, we made a prospective registration of 7,041 new injuries involving children below the age of 16 treated at the Accident and Emergency Department and at Haukeland University Hospital in Bergen. RESULTS: Rollerblading and skateboarding injuries accounted for 113 cases, representing 1.6% of all injuries. Three quarters were boys, nine out of ten were 10 to 15-year-olds, and arms/hands were injured in two thirds of the cases. Almost two thirds of the injuries were fractures (n = 67), representing a higher fraction than seen in other activities. Most of them were distal radial fractures (n = 39), but scaphoid fractures, an otherwise seldom child fracture, were seen in one tenth (n = 6) of all fractures. INTERPRETATION: Scaphoid fractures can, when untreated, cause pseudarthrosis; this should be borne in mind when treating children with hand pain after fall on their rollerblades or skateboards. As fractures of the hand root and wrist accounted for 40% of all injuries, hand and wrist protection seem to be the best preventive measure in terms of number of injuries.

Adolescent↗
PubMed2005

Results of arthroscopic reduction and percutaneous fixation for acute displaced scaphoid fractures.

PURPOSE: This study used percutaneous techniques augmented by simultaneous wrist arthroscopy to visualize the fracture and thus confirm the fracture alignment and reduction and also to assesses the concurrent associated ligament injuries. TYPE OF STUDY: Retrospective study. METHODS: Arthroscopy was used to help to reduce scaphoid fractures and assess soft-tissue injuries in 15 acute cases (13 male and 2 female patients). The fractures were treated by reduction under arthroscopic control and percutaneous fixation with the cannulated interosseous compression screw. Soft-tissue lesions were also treated at the same time using debridement, suture repair, or K-wire transfixation. The average age of the patients was 29.2 years (range, 19 to 48 years). RESULTS: Two patients (13.3%) had scapholunate (SL) ligament injuries, and both exhibited partial tear of the SL ligament. Four patients (26.7%) suffered lunotriquetral (LT) ligament injuries and received ligament debridement, K-wire fixation of the LT joint, and splinting. Six patients (40%) had chondral fractures. Additionally, the triangular fibrocartilage complex (TFCC) was torn in 5 patients (33%). Finally, 5 patients (33%) suffered radioscaphocapitate ligament or long radiolunate ligament injuries. All fractures healed without malunion or nonunion and, at follow-up of 24 to 28 months, 11 patients had excellent results and 4 had good results based on Mayo Modified Wrist Scores. CONCLUSIONS: We believe that arthroscopic reduction may be considered for scaphoid fractures because this approach can use a single procedure to achieve acceptable restoration of fractures as well as assessment and management of soft-tissue lesions. LEVEL OF EVIDENCE: Level IV Therapeutic Study, case series with no, or historical, control group.

Adult↗
PubMed1992

The Herbert bone screw: a ten year perspective.

It is now over ten years since the Herbert bone screw was first released in Australia. In 1984, Herbert and Fisher first published their experience with the use of this new bone screw in the management of scaphoid fractures. Since that time, there has been a growing interest in the technique and over 60 articles have appeared in the English literature. The purpose of this paper is to review and comment on the relevant publications as they relate to the biomechanical properties of the screw, to its use in the management of scaphoid fractures and to other applications in surgery of the hand.

Biomechanical Phenomena↗
PubMed2002

[Primary fixation of displaced carpal scaphoid fractures with the Herbert-Whipple screw].

OBJECTIVES: We evaluated the results of primary open reduction and internal fixation with the Herbert-Whipple screw in acute displaced carpal scaphoid fractures. METHODS: The study included 10 patients with acute displaced carpal scaphoid fractures and one patient with transscaphoid perilunate fracture dislocation. All the patients were males (mean age 34 years; range 23 to 44 years) and underwent primary open reduction and internal fixation with the Herbert-Whipple screw. The fractures were in the right and left wrists in nine and two patients, respectively. The mean follow-up period was 30 months (range 13 to 58 months). RESULTS: No early or late complications were encountered. All fractures healed in a mean of 11 weeks (range 9 to 15 weeks). All patients returned to their previous employment between four and 14 weeks postoperatively, being a mean of five weeks (range 4 to 7 weeks) for those employed in office-work and 10 weeks (range 9 to 14 weeks) for others. CONCLUSION: Primary open reduction and internal fixation with the Herbert-Whipple screw of acute displaced and unstable scaphoid fractures is an easy and reliable method leading to an uneventful union. Early operative intervention may avoid malunion, carpal instability, and radiocarpal osteoarthrosis that are often associated with closed treatment of these complex fractures.

Adult↗
PubMed2006

[Injury of the scapholunate interosseal ligament--scapholunate dissociation].

Scapholunate interosseal ligament tears manifested with pain, a popping, weakness of the wrist, or limited wrist motion, are probably the most frequent cause of carpal instability. Insufficiency of the injured scapholunate ligament results in pathologic scaphoid and lunate position with wrist kinematics changes that cause irreversible degenerative arthrotic changes. The timely diagnosis combined with proper treatment is required for successful therapy and carpal collapse prevention.

Carpal Bones↗
PubMed2003

Osteoid osteoma of scaphoid.

Osteoid osteoma is infrequently localized to the hand. Initially the lesion may cause nonspecific symptoms. A 14-year-old boy presented with spontaneous onset swelling and pain wrist for 2 months. Initially he was suspected of having tuberculosis, but radiographs revealed a sclerotic lesion of the scaphoid and the sedimentation rate was not high. CT scan of the wrist showed a double-ring sign, indicating osteoid osteoma. Lesion was curetted and the nidus excised. This resulted in rapid resolution of the symptoms.

Adolescent↗
PubMed1986

The role of carpal instability in scaphoid nonunion: casual or causal?

We studied twenty consecutive scaphoid nonunions in twenty patients between the ages of eighteen and thirty-eight years. There were nineteen males and one female. The mean age was 25.2 years. Factors evaluated were fracture displacement, delay in treatment, and carpal instability. Fracture displacement and carpal instability were documented in patients by abnormal x-rays showing fragment displacement, abnormal scapholunate and radiolunate angles, etc., or by fluoroscopically controlled arthrography. We concluded that intercarpal ligamentous instability is consistently present and, therefore, the critical factor in wrists with ununited scaphoid fractures. Thirteen patients have been treated surgically; ligamentous disruption was confirmed at surgical exploration. In twelve patients, treatment of the nonunion included intercarpal ligamentous reconstruction. A satisfactory outcome was achieved in all twelve of these patients. One patient's treatment did not include ligament reconstruction. Although the scaphoid fracture united after a Russe bone graft, he remains symptomatic with persistent intercarpal instability. The remaining seven patients are being evaluated or awaiting surgery. Since ligamentous injury is so common in nonunion, we believe it is causal and that surgical care of nonunion involves ligamentous repair or other stabilization procedure. Prevention of nonunion involves early attention to the therapy of carpal instability when associated with scaphoid fracture.

Adolescent↗
PubMed2003

[Development of a arthroscopic severity score for scapholunate instability].

INTRODUCTION: We report the development of an arthroscopic severity score for scapholunate instability based on dynamic testing of the scapholunate joint. METHOD: Seventy patients who had a scapholunate instability diagnosed by arthroscopy were reviewed. There were 21 static instabilities, 19 dynamic instabilities and 30 preradiographic instabilities. The arthroscopic finding was systematized. In the radiocarpal space the scapholunate interosseous ligament was seen and palpated. In the midcarpal space, the dynamic manoeuvre of dissociation was done using the examining hook. RESULTS: An arthroscopic classification was developed: in stage 0, it is impossible to put the tip of the hook between the scaphoid and the lunate; in stage 1, it is possible to put the tip of the hook between the scaphoid and the lunate; in stage 2, it is possible to create a scapholunate diastasis with the use of a twisting motion applied to the hook; in the stage 3, the 2.7-mm arthroscope passes between the scaphoid and lunate from the midcarpal to the radiocarpal space. We found 4 stage 1, 43 stage 2 and 23 stage 3. DISCUSSION: Even if other diagnostic tools such as the arthroscanner or MRI are able to diagnose scapholunate interosseous ligament tears, wrist arthroscopy is for us the Gold Standard to quantify and directly explore the scapholunate joint. The goal of the score of severity presented here is to guide the different therapeutic indications.

Adolescent↗
PubMed1988

Scaphoid nonunion.

Scaphoid nonunion is common, but the exact pathophysiology of this complication is unclear. Explanations include lack of treatment, poor initial treatment, delay in diagnosis, synovial fluid dynamics, precarious vascularity, fracture displacement, and carpal instability. Currently, the diagnosis is best confirmed by classic changes on plain radiographs, instability testing, arthrography, and arthroscopy in selected cases. Nine carpal bones are not benign. The natural history of scaphoid nonunion is one of progressive arthritis. Attempts at obtaining bony healing are therefore recommended. In treating established nonunions without arthritis, the Russe bone graft technique is the mainstay of treatment. A union rate of 90 per cent is to be expected. Electrical stimulation is an alternative when there is no synovial pseudarthrosis or scaphoid collapse deformity, or if a previous Russe graft has failed. If a significant humpback scaphoid or collapse deformity is present, internal fixation with the Herbert screw and scaphoid reconstruction with a bone graft are our choices. Healing rates are less than those with the Russe graft, but one may achieve improved motion of the wrist and earlier return to function. When scaphoid nonunion is accompanied by degenerative arthritis, salvage procedures are recommended. Radial styloidectomy is a simple procedure that will preserve motion and buy time. Soft tissue interposition with excision of a small proximal pole is useful, particularly if no collapse deformity is present. Silicone replacement alone has fallen into increasing disfavor because of the high incidence of subluxation and silicone synovitis. Combining silicone replacement with intercarpal fusion (the SLAC procedure) may lessen these complications. Proximal row carpectomy is another procedure that may preserve motion, though often at the expense of weakness, particularly in the younger patient requiring significant grip strength. In these cases, standard wrist fusion seems the most predictable alternative.

Arthroplasty↗
PubMed1997

Management of trans-scaphoid perilunate dislocations. Herbert screw fixation, ligamentous repair and early wrist mobilization.

A retrospective review of 28 patients with 29 trans-scaphoid perilunate dislocations who underwent open reduction and Herbert screw fixation is presented. The majority of the patients had satisfactory results at 24 months of follow-up. A significantly better range of wrist motion was obtained in postoperative patients treated with cast immobilization for 4 weeks compared with those treated for longer than 5 weeks. The scaphoid fractures united well, with proper alignment of the carpal bones, regardless of the length of cast immobilization. We recommend open reduction, internal scaphoid fixation using a Herbert screw, carpal ligament repair and early cast removal in the management of trans-scaphoid perilunate dislocations.

Adolescent↗
PubMed2005

Results of four-corner arthrodesis using dorsal circular plate fixation.

PURPOSE: Four-corner arthrodesis with scaphoid excision has been used to reduce pain and preserve functional range of motion for patients with radioscaphoid arthritis. Early results of 4-corner arthrodesis with scaphoid excision using dorsal circular plate fixation are compared with reported results in the literature. METHODS: We reviewed retrospectively the first 18 four-corner arthrodeses performed with this system by 4 hand surgeons. Two patients had revision surgery for nonunions before the study that were considered failures. Eight patients returned for final radiographs, objective examination, and functional questionnaire. The average follow-up period was 20 months (range, 13-33 mo). These results were compared with reported results in the literature using alternate fixation methods. RESULTS: Radiographic union was achieved in only 3 wrists. Range of motion was 46% that of the opposite normal wrist and grip strength compared with the opposite wrist was 56%. Five patients would have the procedure again and 6 of 8 have returned to their original employment. CONCLUSIONS: Four-corner arthrodesis with scaphoid excision using a circular internal fixation plate produced a high number of nonunions. Grip strength and range of motion results also were inferior to those reported in the literature.

Adult↗
PubMed2001

Percutaneous screw fixation or cast immobilization for nondisplaced scaphoid fractures.

BACKGROUND: Nondisplaced scaphoid fractures treated with prolonged cast immobilization may result in temporary joint stiffness and muscle weakness in addition to a delay in return to sports or work. Fixation of scaphoid fractures with a percutaneous cannulated screw has resulted in a shorter time to union and to return to work or sports. The purpose of this prospective, randomized study was to compare cast immobilization with percutaneous cannulated screw fixation of nondisplaced scaphoid fractures with respect to time to radiographic union and to return to work. METHODS: Twenty-five full-time military personnel with an acute nondisplaced fracture of the scaphoid waist consented to be randomized to either cast immobilization or fixation with a percutaneous cannulated Acutrak screw (Acumed, Beaverton, Oregon) for the purpose of this study. Time to fracture union, wrist motion, grip strength, and return to work as well as overall patient satisfaction at the time of a two-year follow-up were evaluated. RESULTS: Eleven patients were randomized to percutaneous cannulated screw fixation, and fourteen were randomized to cast immobilization. The average time to fracture union in the screw fixation group was seven weeks compared with twelve weeks in the cast immobilization group (p = 0.0003). The average time until the patients returned to work was eight weeks compared with fifteen weeks in the cast immobilization group (p = 0.0001). There was no significant difference in the range of motion of the wrist or in grip strength at the two-year follow-up evaluation. Overall patient satisfaction was high in both groups. CONCLUSIONS: Percutaneous cannulated screw fixation of nondisplaced scaphoid fractures resulted in faster radiographic union and return to military duty compared with cast immobilization. The specific indications for and the risks and benefits of percutaneous screw fixation of such fractures must be determined in larger randomized, prospective studies.

Adult↗