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At least 19 recordsLinked to original sources
PubMed1995

[Percutaneous Herbert screw osteosynthesis of the scaphoid bone].

Scaphoid fractures are the most common carpal fractures. Conservative treatment is long, and non-union is frequent after immobilization in a cast. The Herbert procedure is an improvement, but access to the scaphoid is through an extensive open exposure that damages the blood vessels and the anterior radiocarpal ligaments. In order to solve this problem we used the Herbert screw for percutaneous internal fixation resulting in minimal operative trauma. This procedure requires intraoperative x ray guidance and the use of the accessories of the Herbert set except the "Jick". We operated 23 patients for acute fracture (19 cases) or nonunion (4 cases) of the waist of the scaphoid. In this study, the average follow-up was 16 months and the average age was 32 years. There were 18 men and 5 women. In 18 cases the fracture occurred on the right side. The average immobilization was 15.5 days. Union was obtained in all patients. Postoperative range of motion was 95% of the unaffected side. Key pinch was 6% better than on the unaffected side (the dominant hand was affected in 81% cases). Patients returned to work after an average of 7 weeks.

Adolescent↗
PubMed1988

Simultaneous fractures of the distal end of the radius and the scaphoid bone.

Simultaneous fracture of the scaphoid bone occurred in 26 (4%) of the 650 injuries of the distal end of the radius seen at our institution. These injuries occur after a fall on the outstretched hand with a pronated wrist joint and extended hand. In a 4-year period (1983-1987), 26 simultaneous fractures of the distal end of the radius and the scaphoid bone were seen. Typically, the fracture of the radius had minimal or slight displacement, and the fracture of the scaphoid bone occurred always as a transverse thin line without displacement. The simultaneous fracture of the scaphoid bone was often very difficult to recognize radiographically and could very easily be overlooked. Discovery of the simultaneous fracture is important for adequate immobilization. Inadequate treatment, due to an overlooked fracture of the scaphoid bone, can result in a painful wrist joint and, possibly, Sudeck's atrophy.

Adolescent↗
PubMed1992

[Scaphoid bone].

The scaphoid is the most important carpal bone due to the frequency of its pathological involvement. Two points of radiological anatomy are stressed: the presence of the scaphoid tubercle whose projection gives rise to the scaphoid ring, the solid radio-capitatum ligament which bridges the scaphoid. Scaphoid fracture represents 70% of all carpal bone fractures and its presence must therefore be meticulously investigated on appropriate x-rays or on tomographies or CT scans, rather than by the classical repeat examination a fortnight later. CT provides good analysis of scaphoid fragments when consolidation is delayed (pseudarthrosis), allowing earlier and more justified indications for surgery. The wrist ligaments are poorly visualised by MRI at the present time; but it allows study of the cartilage and, most importantly, is a decisive examination when there is a doubt about bone vitality.

Arthrography↗
PubMed1991

[The ligaments of the scaphoid bone].

The scaphoid has three separately directed ligamentous connections, directed 1. proximally, toward the distal radius, 2. distally, toward the distal carpal row, and 3. ulnarly, toward the adjacent lunate. The palmar radiocarpal ligament consists of three distinct fiber complexes. Two of them, the radiocapitate and deep radioscapholunate, insert on the scaphoid, whereas the collateral ligament courses to the distal pole of the scaphoid. Dorsally, the dorsal radiocarpal ligament passes the proximal pole of the scaphoid without direct attachment. The dorsal arcuate ligament spans the midcarpal joint, from the scaphoid tubercle to the triquetrum. The well developed interosseous scapholunate ligament connects the proximal pole of the scaphoid with the lunate in a distally concave semicircular fashion. Short ligaments extend between the distal pole of the scaphoid and the trapezium palmarly, dorsally and radially, and between the distal pole of the scaphoid and the trapezoid palmarly and radially.

Carpal Bones↗
PubMed1983

Bone scintigraphy in the evaluation of fracture of the carpal scaphoid bone.

The purpose of the present prospective study was to assess the value of 99m-Tc-MDP wrist scintigraphy performed as a routine examination in excluding or detecting carpal scaphoid bone fracture. The following conclusions are drawn: 99m-Tc-MDP wrist scintigraphy is of high sensitivity, but low specificity in the detection of scaphoid bone fractures. The scintigraphy is expedient to exclude scaphoid bone fracture, if performed after secondary clinical and radiographic assessment, and guided by negative scintigrams a reduction of clinical examinations, radiographies and superfluous casting days is achieved.

Adolescent↗
PubMed1989

[Conservative treatment of scaphoid bone fracture of the wrist].

The status of fractures of the scaphoid bone in clinical statistics on fractures depends on the age of the patients, the population treated in a particular clinic, and the number of nearby sports fields. Most frequently, fractures of the scaphoid bone occur as a result of falling on an outstretched hand while playing soccer. This kind of injury is typical of people between 15 and 45 years of age. Of the scaphoid bone fractures treated in our outpatient clinic, 77.4% were in this age group. Younger people with this injury mainly suffer from fractures distant from the body of the radius (or from forearm fractures near the wrist). In comparison, for people over 45 years of age, fractures of the radius due to over-extension are more typical. Since most injuries took place during sports activities, mainly males had fractures of the scaphoid bone (according to our statistics, 86.2% of these men were between 15 and 45 years of age). In the future, the distribution among sexes will probably be different due to the increasing number of girls and women who now play soccer. According to the literature, a fresh fracture of the scaphoid should first be treated conservatively. However, the type and duration of immobilization vary widely. The results published indicate that a rate of 4% - 5% can be expected. We have checked the therapy results of the surgical outpatient clinic in Bergmannsheil for 1960-1983. Of the 214 patients with fresh scaphoid bone fractures and conservative treatment, 138 had a follow-up examination. Among them were two instances of pseudoarthrosis (1.45%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2000

Accumulation of calcium and phosphorus in the mitral valve in comparison with the abdominal aorta and the scaphoid bone.

To clarify why calcification of the mitral valve occurred, the authors chose the abdominal aorta and the scaphoid bone among many arteries and bones, and they studied both relationships in element contents between the mitral valve and the abdominal aorta and between the mitral valve and the scaphoid bone. The subjects consisted of 11 men and 8 women, ranging in age from 52 to 96 yr. The accumulation of calcium and phosphorus occurred progressively with aging in the mitral valve, whereas it became the highest in the sixties in the abdominal aorta and did not increase thereafter. The accumulation of calcium and phosphorus occurred in the abdominal aorta earlier than the thoracic aorta, in which it became remarkable in the seventies. It should be noted that in regard to the accumulation of calcium and phosphorus, no significant correlations were found between the mitral valve and the abdominal aorta. It is suggested that calcification of the abdominal aorta is not essentially accompanied by calcification of the mitral valve. The scaphoid bone was chosen among many bones consisting mainly of spongy bone and the relationship was examined between the calcium content in the mitral valve and the bone mineral density of the scaphoid bone. It was found that there was a low relationship between them. Therefore, it is suggested that a part of the surplus calcium released from bones is deposited in the mitral valve.

Aged↗
PubMed1988

[Clinical problems in fracture of the scaphoid bone].

UNLABELLED: The following specific characteristics of injury cause the problems that occur in scaphoid bone fractures: 1. Mechanisms of accident: There are only a few typical circumstances that cause the injury: as there are false winding of a shrankshaft handle or a fall on the extended hand. In all the other cases the accident is neither realized by the injured person himself or by the physician. As a consequence the possibility of injury of the scaphoid bone is not taken into consideration. 2. SYMPTOMS: In a stable fracture the symptoms do not appear directly but may be clearly delayed or they may disappear very quickly after a short period of intensity, so that the accident is no longer taken any notice of. 3. Radiodiagnostics: Because of the anatomic position of the scaphoid bone any X-raying from a lateral view is difficult because the scaphoid is covered by other carpal bones. In case of an undisplaced fracture you often only see very fine fracture lines, which are only to be seen from a direct orthograde view. It is necessary to X-ray the carpus in different positions. 4. THERAPY: If there is the slightest chance of a scaphoid bone fracture an intensive therapy must be directly started. An immobilisation for a too short period may lead to a delayed union and end in a pseudarthrosis. This is also the case if you start the therapy too late. Then the fracture line is already filled up by fibrous tissue. The latest period of time to begin a conservative treatment is six to eight weeks after the day of the accident.(ABSTRACT TRUNCATED AT 250 WORDS)

Carpal Bones↗
PubMed1988

[Fracture of the scaphoid bone--surgical treatment, indications, method and results].

In fractures of the scaphoid bone, conservative treatment leads to an osseous consolidation in 95% of all cases. A primary surgical treatment seems justified in case of instability by torsion, tilting, or shifting of the fragments, associated fractures of the same arm, as well as de Quervain dislocation fracture. The different surgical possibilities are described and the complications are compiled in a special study. The question if a recent fracture of the scaphoid bone should be managed by conservative or surgical treatment ist not justified considering the rate of 14.5% of complications, i.e. formation of pseudarthroses, observed after surgery of recent fractures of the scaphoid bone.

Carpal Bones↗
PubMedDate not supplied

[Role of wrist instability in the onset of pseudoarthrosis of the scaphoid bone].

INTRODUCTION: The most common fracture involving the wrist is a fracture of the scaphoid bone. Fracture of the scaphoid most frequently occurs in young adult male and usually involves the wrist of the scaphoid. There is a universal agreement that the majority of these fractures will heal if immobilized property and for a long period of time [1, 2]. In the treatment of these fractures much attention has been payed to bone damage and not to associated ligament injury. It is reported that the incidence of nonunion of scaphoid fractures is ten per cent and that the frequency of this complication remains essentially unchanged [3, 4]. Failure to improve the outcome suggests that the mechanisms and causes of this complication are poorly understood. Explanations of nonunion or delayed union of scaphoid bone are: poor initial treatment or even no treatment [3], delayed diagnosis [5], fragments displacement [5-8], improper immobilization [9], site and direction of the fracture [3] and wrist instability [8, 10]. AIM: The study was undertaken to analyse the influence of carpal instability on the development of scaphoid nonunion. METHOD: The study concerned 40 patients with painful nonunions of the scaphoid bone. Duration of nonunion was 1.43 year. There were 37 (92%) male and 3 (8%) female patients. Site and direction of the fracture, initial treatment and carpal collaps were analysed. Data processing was done for all examined patients (Table 1). RESULTS: Dominant hand was involved in 24 (60%) patients and nondominant hand in 16 (40%) subjects. Carpal collaps was present in 68% of patients. There were 14 (35%) untreated patients (Graph 1). Untreated fractures were statistically insignificant regarding the intensity of carpal collaps (p = 0.101; p > 0.05). The physical examination usually revealed focal tenderness, a palpable click with ulnar deviation, abnormal antero-posterior mobility with passive range of motion or a combination of these findings. Standard X-rays evaluated fracture location and carpal instability or collaps. There were 14 (35%) proximal third located fractures and 26 (65%) in the middle third of wrist (Graph 2). There was no statistically significant correlation between location of the fracture and presence of carpal collaps (p = 0.081; p > 0.05). DISCUSSION: There were 35 per cent overlooked fractures. Delay in diagnosis of a scaphoid fracture has been suggested as a significant factor in the development of nonunion [5, 7]. However, in our series of nonunions, non treatment does not occur frequently enough to be the critical factor. Most series report about 2/3 of nonunions occurring at the wrist [7, 9]. Our series shows a similar distribution, arguing against site as a critical factor. There appears to be a nearly uniform rate of nonunion in most of the reported series [7, 15, 16], regardless of the position of the wrist, whether or not the thumb was immobilized. Evidence of ligamentous injury in our series led us to conclude that scaphoid nonunion is consistently associated with carpal instability pattern. In our series 68% of nonunions associated with carpal collaps were present. We found no statistically significant correlation between carpal collaps and nontreated fractures or location of fracture site. Therefore, we concluded that carpal collaps was consistently present and, thus the critical factor in wrists with ununited scaphoid fractures.

Adolescent↗
PubMed1992

Aseptic necrosis of unilateral scaphoid bone in systemic lupus erythematosus.

An SLE patient developed aseptic necrosis of the right scaphoid bone 4 years after an episode of aseptic necrosis of bilateral femoral heads caused by corticosteroid treatment. Since the aseptic necrosis of the right scaphoid bone was preceded by the insidious exacerbation of SLE as evidenced by facial erythema, it was considered to be a result of vasculopathy due to active SLE. It took 14 months to make a correct diagnosis of the aseptic necrosis of the scaphoid bone by a chanced roentgenogram for the routine evaluation for osteoporosis. Therefore, the importance of an awareness of this possibility and repeated radiographic examinations is emphasized for the correct diagnosis of joint manifestations in SLE.

Adult↗
PubMed1990

Biomechanical measurements on scaphoid bone screws in an experimental model.

A number of screws commonly used for internal fixation in scaphoid bone fractures and nonunions are compared regarding biomechanical properties and clinical applicability. The experiments were carried out on models made of ash-wood, representing a reconstruction and fixation as is performed in a cortico-cancellous inlay bone graft for scaphoid non-union. For fixation use was made of 2.7 and 3.5 AO/ASIF cortical screws respectively, 4.0 AO/ASIF cancellous screws, Herbert screws, and a newly designed screw called the three components screw (D.K.S.). The models with implanted screws were tested for bending strength, tensile strength and torsion stability. No large differences between the various screws were found regarding the measured parameters, so that a small intra-osteal implant such as the Herbert screw and the D.K.S., which can be inserted easily and which gives a certain amount of interfragmentary compression, will be sufficient for osteosynthesis of the scaphoid bone. In case an intra-osteal implant is not available a single 3.5 AO/ASIF cortical screw, inserted following lag-screw principles, is recommended.

Alloys↗
PubMed1983

[Alloplastic partial replacement of the scaphoid bone].

Operative treatment for non-union of the carpal scaphoid bone with a small proximal fragment often presents some difficulties. A complete Silastic carpal scaphoid replacement does not always fit well because the shape and dimensions of the implant differ from the natural carpal scaphoid bone. The proximal fragment looks more like the lunate bone and so a Silastic carpal lunate implant may be used to replace the proximal fragment of the scaphoid while the well preserved distal fragment remains in place. This prevents disturbance of the intercarpal joint composition and improves stability of the base of the thumb. Five patients have been treated in this manner. The procedure is described in detail.

Arthroplasty↗
PubMed1999

[The Matti-Russe method of treatment of ununited fractures of the scaphoid bone].

The authors present their experience with treatment of scaphoid non-unions by the operation according to Matti-Russe. They compare their results with those of other authors and present a relatively high number of successfully treated patients with stable non-unions localized in the midline of the scaphoid bone as well as a high patient satisfaction rate with this method of treatment. The disadvantage of this treatment is long-term cast immobilization of the wrist and poor results in treatment of unstable non-unions and those localized in the proximal portion of the scaphoid bone. They conclude, that at present, it is more effective to support the surgery by osteosynthesis with an adequate implant and thus shorten the immobilization period in a cast.

Adolescent↗
PubMedDate not supplied

[Incidence and severity of degenerative changes in the wrist in pseudoarthrosis of the scaphoid bone]].

INTRODUCTION: In patients with symptomatic scaphoid nonunion there was an increased evidence of progressive osteoarthrosis expressed as instability of the wrist [1, 2]; it is defined as a scapholunate angle of more than 70 degrees or a radiolunate angle of more than 10 degrees. Intercarpal instability causes unnatural joint movement of the wrist. This disorganization of the wrist mechanism associated with hypermobility of the schapoid bone induces degenerative changes [3]. Arthritic changes begin at the distal scaphoid-radial styloid joint and later progress to the capitolunate joint. A similarity was noted with rotatory instability of the scaphoid bone associated without fracture [2]. If mid-carpal joint exists the joint becomes unstable, the lunate rotates backwards and carpal bones show the so-called concertina deformity [4] or dorsal intercalated segment instability pattern [5]. AIM: We tried to determine the factors of risk and prognostic indicators of degenerative arthritis. METHOD: In this study 40 patients with painful nonunion of the scaphoid bone were analysed. Duration of nonunion was 1.43 year (range from 8 months to 15 years). Roentgenograms of the hand were done in anteroposterior, lateral and oblique projections. Fracture location and configuration were determined as described by Russe. Instability was determined by measuring the scapholunate and radiolunate angle in the lateral roentgenogram. Scapholunate angle more than 70 degrees and radiolunate angle more than 10 degrees were considered abnormal. To asses the amount of carpal collapse the carpal index was determined as described by Youm [6]. Abnormal value was 0.50 or less (normal value: 0.54 +/- 0.03). Four roentgenographic groups were established based on the extent of degenerative changes [7]. Group I showed no sign of degenerative changes. Group II had sclerotic lesions in fracture margins with or without a cystic formation. Group III showed lesions of radioscaphoid arthritis, including joint-space narrowing and pointing the radial styloid. Group IV had lesions of generalized arthritis of the wrist. RESULTS: Duration of nonunion was not in correlation with development of osteoarthritic changes (p = 0.644, p > 0.05) (Table 1). Progressive degenerative changes correlated well with radiolunate angle (p = 0.398, p < 0.05), capitolunate angle (p = 0.381, p < 0.05) and carpal index (p = 0.392, p < 0.05) (Table 2). The average values of intercarpal angles increased with progression of osteoarthritic changes (Table 3). There were 14 (35%) proximal third located fractures and 26 (65%) in the middle third or waist. There was a statistically strong correlation between location of the fracture in proximal third and presence of degenerative changes (p = 0.341, p < 0.01) (Table 4). Intensity of arthritic changes showed no statistically significant correlation regarding untreated fractures (p = 0.665, p > 0.05). DISCUSSION: In our study the most significant factors associated with arthritis were instability of the wrist and fracture location at the proximal third of the scaphoid bone. Mack [7] reviewed forty-seven symptomatic nonunions of the scaphoid and found a correlation between the presence of arthritis and the duration of nonunion. Also, he concluded that instability of the wrist can occur as late phenomenon in previously stable nonunion. Similar results were noted by Ruby [8] in his series. Conclusion of these authors was that the incidence of degenerative changes increased with the time after fracture of the scaphoid bone occurred [8-12]. We demonstrated that in untreated fractures associated with carpal instability, arthritis developed much earlier. Fourteen (35%) patients in our study were not treated and 92.8% belonged to Group II and Group III, with average time of nonunion duration of 27.2 months. Lunate dorsiflexion is a useful guide to carpal instability. In our experience the lunate silhouette is easily visualized on a lateral roentgenogram even in the presence of degenerative arthritis. There is a high probability that degenerative changes will occur. We recommend that a scaphoid nonunion associated with carpal instability should be operated before degenerative changes develop.

Disease Progression↗