[Follow-up study results of 22 cases of operated old fractures and pseudarthroses of the scaphoid bone of the hand].
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[Treatment of pseudoarthrosis of the scaphoid bone by bone transplantation (modified Matti-Russe operation)].
Author reviews possibilities in the treatment of nonunited scaphoid fractures. Different techniques with cancellous bone grafting are described and his own function-stable grafting osteosynthesis presented. Indications for his operation are well delineated and with regards to good results their accurate application is emphasized. 352 cases were treated using his grafting method in 94 per cent good results was obtained passing by 14 per cent the average results of 80 per cent with other grafting techniques.
Bone Transplantation↗
[Treatment results in fractures and pseudarthrosis of the scaphoid bone].
In 258 patients with fractures and pseudarthroses of the carpal scaphoid the cause and type are given and the results of treatment are presented. It is verified that the majority of fresh fractures are united by plaster immobilisation. In fractures with delayed healing and in cases with non-union the best results are achieved by autologous bone grafting.
Adolescent↗
[Dislocation of the scaphoid bone of the hand].
After presentation of the kinematic of the scaphoid and the mechanism of the luxation of the scaphoid, the importance of the correct diagnosis of a wrist instability, after this injury, is demonstrated. After closed reduction a lateral, anteroposterior and a stress-radiography in ulnar-and radialstress has to be done. If the gap between the scaphoid and lunate is widened, a wrist instability exists. Another sign for a wrist instability is a scapholunate angle with more than 70 degrees and a wrong position between radius, scaphoid, lunate and capitate. The problems of conservative treatment are presented and primary repair of a wrist instability with suture of the ruptured ligaments and temporary Kirschner-wire fixation is recommended.
Arthrodesis↗
Management of fractured scaphoid bone. A prospective study of 100 fractures.
One hundred fractured carpal scaphoids were immobilised alternatively in above-elbow and below-elbow casts. Preventing the pronation and supination of the forearm did not reduce the immobilisation time, which, with either type of cast, averaged 7 weeks, after exclusion of the fractures with delayed union. These eight fractures, which did not unite in 3 months, were operated on using a lag screw fixation, whereafter consolidation was achieved.
Adolescent↗
[Pseudarthrosis of the scaphoid bone. Experiences in 240 cases].
The results after treatment of 197 non-union of scaphoid fractures are reported. The operative technique of Matti-Russe, called also Russe I, has proved successful in cases in which the fracture is located in the middle or distal third of the scaphoid or where there is a viable small proximal fragment. Bone healing depends more on the age of the pseudarthrosis than on the age of the patient. In 86% of 83 cases the technique of Russe I was successful and in this group the period between accident and treatment was no longer than two years. After a period of more than four years after the accident the success rate is only 54%. The combination of the technique of Russe I with styloidectomy of the radius diminishes the number of good results. The operative technique known as Russe II assumes a good blood supply of the distal fragment of the scaphoid. In 15 cases, after resection of the necrotic small proximal fragment of the scaphoid, a fungiform bonegraft from the iliac crest was placed in the cavity and the success rate was 80%. The findings after palliative treatment of 43 non-unions of the scaphoid are based on subjective criticisms by the patients. The denervation of the wrist and the wrist arthrodesis were done in 28 cases. After resection of the necrotic proximal fragment, a tendon interposition arthroplasty was performed in nine cases, and in six cases a prosthesis for the proximal part of the scaphoid was implanted.
Bone Transplantation↗
18-F scintimetric diagnosis of osteoid osteoma of the carpal scaphoid bone.
In a patient with symptoms suggestive of osteoid osteoma of the carpal scaphoid, 18-F scintimetry supported the diagnosis in the absence of clear cut roentgenographic signs. High concentration of 18-F in the area of the lesion allowed direct surgical approach and extirpation. The diagnosis was proven by histology.
Adult↗
[Alternative surgical procedure in pseudarthrosis of the scaphoid bone with a small proximal fragment].
The management of non-union of the scaphoid with a Herbert screw assumes a specific size of the proximal pole fragment. In cases of extremely small proximal pole fragments the length of the leading thread of the screw can cause blockage of the proximal pole fragment. In these instances a dorsal approach is used and the Herbert screw is inserted in a proximal-to-distal direction rather than the usual distal-to-proximal insertion. The advantages are a stable internal fixation and an abbreviated period of immobilization in plaster; however, the small number of cases reported does not permit us to draw conclusions regarding indications for use of this technique.
Bone Screws↗
MRI diagnosis of fracture of the scaphoid bone: impact of a new practice where the images are read by radiographers.
RATIONALE AND OBJECTIVES: To investigate whether magnetic resonance imaging (MRI) radiographers are able to evaluate MRI examinations with regard to scaphoid fractures to save patients unnecessary immobilization and clinical and radiographic examinations, and to reduce the costs for the hospital as well as society in general. MATERIALS AND METHODS: Over a 1-year period 224 consecutive patients with a suspected clinical scaphoid fracture but negative radiography were referred for MRI and examined within 11 hours. The MR images were primarily evaluated by the MRI radiographer on duty. Other fractures and bone edema were not reported because these were not part of the work-up protocol agreed upon by the radiology and the orthopedic departments. The following weekday a final report was provided by a radiologist. For the economical analysis the official price-list for Danish hospital service was used. RESULTS: The MRI radiographers reported 43 scaphoid fractures, whereas the radiologist ultimately diagnosed only 36 scaphoid fractures (16.1% of patients) (sensitivity, 100%; specificity, 96.3%). Six of the seven false-positive fractures occurred in patients with edema of the scaphoid. The seventh false-positive was a fracture of the capitate. The hospital saved at least 20,000 and the social care system 70.000. CONCLUSION: It is possible to provide an acute MRI service to patients with clinically suspected fracture of the scaphoid and a normal plain radiograph. The MR images can be primarily read by sufficiently trained MR radiographers. This new work-up protocol reduces the cost for society.
Adolescent↗
[Conservative treatment of fractures of the scaphoid bone--indications].
Healing-up of the bone is achieved by immobilization in 96 to 98% of all recent scaphoid fractures. The average immobilization period is eleven weeks. Different methods of immobilization are used. The majority of authors apply an upper arm plaster cast including the thumb for a period of six weeks and then a forearm plaster cast. Even fractures showing a delayed healingup of the bone can be cured in more than two thirds of the cases by prolonged immobilization. In case of dislocated and not reducible fractures as well as fractures with great fragment diastases, conservative treatment with a fist plaster cast should only be performed exceptionally, for example if there is an increased anesthesia risk. In case of negative X-ray findings (four planes) and only clinical suspicion of scaphoid fracture, an initial fracture therapy is recommended with repeated X-ray examination 14 days later. Most of the fractures which have not healed up are vertical oblique fractures within the proximal third, fractures with great diastases, or fractures which have not been immobilized long enough.
Carpal Bones↗
[Treatment of pseudarthrosis of the carpal scaphoid bone by percutaneous pinning. Apropos of 74 cases].
From 1985 to 1997, 74 patients was operated of scaphoid non union at the Kassab Institute by a percutaneous pinning as described by Galluccio. The average age is 30 years with an extreme from 17 to 48 years. Union was obtained after an average of two years and six months. In 12 cases the delay was superior than three years. Functionally, pain is a constant cause of consultations and the majority of patients presented a reduction of the mobility sector (80%) and the strength of grasp (70%). Anatomically, it is particularly a pseudarthrosis stage II a of Alnot, and type I b of our classification. An immobilisation post-operative during one month is the rule. The analysis of results at an average of four years, revealed 91% of clinical recovery. Radiographically, the union is obtained in 89% of cases. Our fails (11%), are explained by an inadequate mounting and particularly by the length of pseudarthrosis. Compared to other means of synthesis, the percutaneous pinning of Galluccio, is an inexpensive technique, easily and rapid, which permit to obtain an interesting results particularly in the recent pseudarthrosis (evolution delay below three years).
Adolescent↗
[Management of proximal scaphoid bone pseudarthroses and fractures with the mini-Herbert screw via a dorsal approach].
32 patients, aged 16 to 49 years, were treated by osteosynthesis using the Herbert mini screw. The indications were five fractures (type B3, Herbert classification), two delayed unions (type C) and 25 nonunions (type D1 to D3, Filan and Herbert classification). Six patients received no bone grafts, 19 received cancellous bone graft from the radius. An interpositional iliac crest bone graft was used in four, and a vascularized bone graft from the distal radius in three cases respectively. The average postoperative immobilisation in a forearm splint was nine weeks. 26 patients could be recruited for clinical follow-up at an average of 14.5 months. The radiological results were assessed in 30 cases (94%). Bony consolidation was achieved in 26 cases (100% of the fractures, 84% of the nonunions). In three cases a loosening of the screw, and in three further cases a dislocation into the radiocarpal joint were observed. A humpback deformity was present in four cases. Three patients showed a persisting nonunion, one patient a fibrous union. Early degenerative changes of the radiocarpal joint were observed in six cases. The clinical follow up examination showed an average grip strength of 91% (JAMAR II), 94% for the three finger, and 95% for the pinch grip compared to the contralateral side. The mean postoperative pain score on the visual analog scale was one for resting conditions, eleven for motion and 33 under stress. The range of motion was 79% of the opposite side for extension/flexion and 83% for radial/ulnar deviation. The average DASH-score reached 15 points. The Herbert mini screw has proven to be a reliable implant for reconstruction of proximal pole fractures and nonunions of the scaphoid.
Adolescent↗
[Surgery for pseudarthrosis of the scaphoid bone performed in Hungary 1988].
Authors analyse, based on an all-round inquiry, the operations performed for pseudarthrosis of the scaphoid in 1988. It was found that 344 of 472 operations were reconstructive, 128 palliative. The single types of operation are briefly described. They hint at the fact that the operative treatment of scaphoid pseudarthrosis in Hungary is carried out mostly in Centers.
Carpal Bones↗
[Bilateral bipartite carpal scaphoid bone: a congenital disease or unrecognized pseudarthrosis? Discussion a propos of a clinical case].
PURPOSE OF THE STUDY: Bipartite scaphoid has long been debated, and is of traumatic origin for some authors or congenital for others. The aim of the study is to distinguish clinical and radiographic criteria for the diagnosis of congenital bipartite scaphoid. MATERIAL AND METHOD: A case of bilateral bipartite scaphoid is presented. To distinguish pseudarthrosis from congenital bipartite scaphoid we used, the revised carpal height ratio of Nattrass, the CT, and magnetic resonance imaging. RESULTS: These examinations showed no collapse and they revealed evidence of articular cartilage around the fragments with the same thickness in all the carpus. CONCLUSION: We believe that congenital origin is more probable but we recommend to follow the patient, with yearly standard wrist radiograph and use, the revised carpal height ratio of Nattrass to research a carpal shift or collapse.
Adult↗
[Fractures of the proximal pole of the scaphoid bone. Anatomo-clinical and therapeutic entity].
The authors present their anatomical and clinical findings concerning fractures and nonunions of the carpal scaphoid. They stress the proximal pole type I et II of the Schernberg (type C of Herbert) classification, and they suggest isolation of an anatomical entity, by the study of blood vessels, the ligament connections, and especially the pathomechanics as well as a clinical entity, by the mechanism of fracture and the surgical treatment, emphasizing the proximo-distal screwing, with excellent results. They present a series of 29 patients, with type I or II proximal fractures, either fresh or non-unions.
Adolescent↗
[Immobilization of the scaphoid bone (alterative between upper and forearm plaster)].
As a result of the lengthy rehabilitation of the non-injured but fixed elbow in the treatment of scaphoid fractures or pseudarthroses in a longarm plaster cast, a modification has been developed, which inhibits supination and pronation of the forearm while the flexion-extension movement of the elbow is permitted by the incorporation of a hinge.
Carpal Bones↗
Fractures and non unions of the proximal pole of the carpal scaphoid bone. Internal fixation by a proximal to distal screw.
We report a new proximal to distal screw fixation technique for proximal pole fractures and non unions of the carpal scaphoid (type I of the Schernberg, Elzein and Gerard classification). Seven cases of non union with a live proximal polar fragment were operated from 1984 to 1986 with 4 excellent and 2 fair results and one failure. Three recent displaced fractures were also treated this way, with 3 excellent results. This useful technique is worth knowing and deserves a place in the treatment of scaphoid fractures, especially type I proximal pole fractures which represent a challenging problem, and are in no way comparable to other locations.
Bone Screws↗
[Osteosynthesis in pseudoarthrosis of the scaphoid bone with simultaneous denervation of the wrist joint].
Authors describe the results of the partial selective denervation from radio-volar exposure of the wrist, simultaneously with the osteosynthesis of the pseudoarthrosis of the scaphoid with Ender plates. After a 1-8 years follow up, 3/4 of the patients whose scaphoid pseudoarthrosis was 6.5 years old in average, and had at the operation middle or severe arthrosis of the wrist became symptomless or had only mild symptoms. It is stated that the denervation may be a good supplement of the scaphoid pseudoarthrosis operations and of sanative character performed in the arthrotic stage already.
Adult↗