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Benjamin F Plucknette, Peter C Rhee
BACKGROUND: "Floating forearm" injuries, perilunate injuries, with an elbow dislocation, are rare and challenging to treat. METHODS: We present the case of an unusual variant of a floating forearm injury, trans-scaphoid perilunate fracture dislocation and elbow dislocation, with a concomitant open both-bone forearm fracture after a fall from a ladder. Treatment involved irrigation and debridement of the forearm wound, open reduction and internal fixation of the forearm and perilunate injury, and closed reduction of the elbow...
July 1, 2018: Hand: Official Journal of the American Association for Hand Surgery
Ashley Davis, Mark P Wilhelm, Timothy J Pendergrass, Dawndra M Sechrist, Jean-Michel Brismée, Phillip S Sizer, Kerry K Gilbert
STUDY DESIGN: Descriptive in situ cadaveric study. INTRODUCTION: Performing accurately directed examination and treatment to the wrist requires clinicians to orient to carpal bone structures. PURPOSE OF THE STUDY: To examine the anatomical relationships that exist within the wrist-hand complex and identify the accuracy of surface anatomy mapping strategies for localizing anatomical landmarks using a palmar approach. METHODS: Twenty-three embalmed cadavers were dissected using standardized procedures...
July 13, 2018: Journal of Hand Therapy: Official Journal of the American Society of Hand Therapists
Gernot Schmidle, Hannes Leonhard Ebner, Andrea Sabine Klauser, Josef Fritz, Rohit Arora, Markus Gabl
INTRODUCTION: For the treatment of scaphoid non-unions (SNU), different surgical techniques, including vascularized and non-vascularized bone grafts, are applied. Besides stability, vascularity, and the biological situation at the non-union site are important for healing and the appropriate choice of treatment. We assessed the healing potential of SNUs by histological parameters and compared it to CT parameters of bone structure and fracture location. Based on the results, we developed a CT classification and a treatment algorithm to impact graft selection in SNU surgery...
July 13, 2018: Archives of Orthopaedic and Trauma Surgery
Ryan Sefcik, Kyle Andrews, Jacob Stirton, Justin Lea, Mina Tanios, Martin Skie
Isolated dislocations of the scaphoid are extremely uncommon injuries and are often associated with significant ligamentous failures. Since scaphoid dislocations typically present with associated carpal fractures, few cases of isolated dislocations of the scaphoid exist in the literature. The proposed treatment options in the literature range from closed reduction and casting to open reduction and internal fixation. We present the case of a 41-year-old male with an isolated scaphoid dislocation in whom open reduction and internal fixation was performed with K-wires...
2018: Case Reports in Orthopedics
Adil Turan, Ozkan Kose, Cemil Aktan, Melih Unal, Baver Acar, Muzaffer Sindel
AIM: The purpose of this study was to investigate the role of anatomic variations in distal radius radiographic indices in patients with or without scaphoid fractures. MATERIALS AND METHODS: Radial inclination (RI), volar tilt (VT), radial height (RH) and ulnar variance (UV) were measured on wrist radiographs of 320 patients with (Group I, n = 167) or without (Group II, n = 153) scaphoid fracture, fall on outstretched hand (FOOSH). Receiver operating characteristics (ROC) curve analysis was used to assess the diagnostic performance for each variable...
June 30, 2018: Clinical Imaging
Jill G Putnam, Sean M Mitchell, Ryan M DiGiovanni, Erin L Stockwell, Scott G Edwards
PURPOSE: Treatment of scaphoid nonunion with a segmental defect presents a challenging clinical problem. Various techniques have been proposed, often involving structural grafting with vascularized and nonvascularized bone. The authors hypothesize that satisfactory clinical and radiographic outcomes are possible with a relatively simplified technique of volar plate fixation with autogenous, purely cancellous graft. METHODS: The authors performed a retrospective review of 34 patients with scaphoid nonunions with segmental defects, treated with plate fixation and purely cancellous bone grafting...
June 27, 2018: Journal of Hand Surgery
Graeme Matthewson, Samuel Larrivee, Tod Clark
Perilunate fracture dislocations are a rare but devastating injury, which is often missed on initial presentation leading to significant delays in treatment. With the delay in treatment and a high energy mechanism of injury, patients are at increased risk of developing complex regional pain syndrome following trauma. In this report, we review the case of a 57-year-old left-hand dominant female who presented to a clinic with a five-and-a-half-week-old transtriquetral, perilunate fracture dislocation with comminution of the scaphoid facet...
2018: Case Reports in Orthopedics
Hongfang Zhao, Siyu Tian, Lingde Kong, Jiangbo Bai, Jian Lu, Bing Zhang, Dehu Tian
Background: The aim of this study was to investigate the union time of acute middle-third scaphoid fractures following treatments and to analyze the effect of different factors on late union. Patients and methods: We retrospectively reviewed patients with acute middle-third scaphoid fracture at our institution between January 2013 and December 2017. Patient demographics, fracture characteristics, and treatment strategy, such as age, gender, body mass index, habit of smoking, sides of injury, dominant hand, ulnar variance, multiple fractures, and treatment methods, were investigated...
2018: Therapeutics and Clinical Risk Management
Nishant Gupta, Ian Karol, Yogesh Kumar, Brian Rapillo, Neetu Soni, Daichi Hayashi
OBJECTIVE: It is challenging to image extremely obese and claustrophobic patients using a standard, non-open, magnetic resonance imaging (MRI) scanner. On the other hand, installing an additional upright or open MRI scanner may not be cost-effective for most practices. Our technique with a patient in a sitting or standing position behind the standard MRI scanner may be helpful in the MR examination of the wrist/elbow in these patients using a standard wrist/elbow coil. MATERIAL AND METHODS: We performed wrist and elbow MRI of extremely obese and claustrophobic patients by using our modified technique with the patient sitting or standing outside the standard non-open MRI scanner...
June 12, 2018: Skeletal Radiology
Stephen Michael Crowe Ernst, David P Green, James M Saucedo
Scaphoid fracture nonunion can often lead to pain, arthrosis, and disability. While typically the result of delayed diagnosis or inadequate treatment, it can sometimes occur even if the initial care was timely and appropriate. Whereas early recognition of acute fractures allows for nonoperative management, nonunions frequently require surgical treatment. Traditionally, this has involved open debridement and bone grafting. However, some publications suggest that certain stable nonunions may be amenable to percutaneous debridement and fixation without formal bone grafting...
June 19, 2018: Journal of Hand Surgery
Kitty Wu, Clare Padmore, Emily Lalone, Nina Suh
PURPOSE: Fragmentation of the scaphoid proximal pole secondary to avascular necrosis presents a difficult reconstructive problem. This anthropometric study assesses the utility of the ipsilateral proximal hamate for complete osteochondral scaphoid proximal pole reconstruction. METHODS: Twenty-nine cadaveric specimens underwent computed tomography scanning and 3-dimensional reconstruction of the carpus and distal radius. Scaphoid height was measured and a third of its height was used to simulate resection of the proximal scaphoid pole and extent of hamate autograft required...
June 19, 2018: Journal of Hand Surgery
João Torrinha Jorge, Ana Ferrão, Sandra Alves, Ruben Caetano, Frederico Teixeira
Background  The treatment of chronic scapholunate instability is yet a controversial topic. Arthroscopic reduction-association scapholunate technique is a minimally invasive option in which a stable pseudoarthrosis at the scapholunate joint is obtained, allowing some degree of movement while maintaining the normal alignment of the wrist. The purpose of this study was to review the results of arthroscopic reduction-association scapholunate with an absorbable screw. Methods  We retrospectively evaluated patients with dynamic or static, but reducible, chronic scapholunate instability who underwent arthroscopic reduction-association scapholunate between 2012 and 2015...
July 2018: Journal of Wrist Surgery
Adnan N Cheema, Paul J Niziolek, David Steinberg, Bruce Kneeland, Nikolas H Kazmers, David Bozentka
PURPOSE: Reformatting computed tomography (CT) scans along the scaphoid longitudinal axis improves the ability to detect scaphoid fractures compared with reformats along the wrist axis. However, it remains unclear whether scaphoid axis reformats affect measurements of displacement or deformity, which are factors that drive the clinical decision to perform open reduction internal fixation. Our null hypothesis was that reformatting CT scans along the scaphoid axis does not affect measurements of fracture displacement and deformity...
June 13, 2018: Journal of Hand Surgery
Antônio Lourenço Severo, Rodrigo Cattani, Filipe Nogueira Schmid, Haiana Lopes Cavalheiro, Deodato Narciso de Castro Neto, Marcelo Barreto de Lemos
Objective: Analyze the percutaneous fixation technique for scaphoid fractures in the waist of the scaphoid and the proximal pole, and demonstrate its result. Methods: A retrospective cross-cohort study conducted from January 2005 to April 2015, aiming at the consolidation time, epidemiological profile, level of function, return to work, and complications. Results: Twenty-eight patients were selected, with a mean of eight weeks of follow-up...
May 2018: Revista Brasileira de Ortopedia
Xin Zhang, Qiang Wei, Fang Ji, Da-Ke Tong, Hao Tang, Hao Zhang, Jin-Guo Yu, Ji-Dong Yang, Rui Cui, Ning-Ning Huo
OBJECTIVE: To investigate the efficacy and complications of manual reduction and external fixation for the treatment of scaphoid fractures and perilunate dislocations. METHODS: From January 2009 to January 2013, 43 patients suffered from scaphoid fractures and perilunate dislocations were retrospective analyzed. Among them, 17 cases were treated with manipulative reduction and plaster external fixation as conservation group including 10 males and 7 females, the other 26 cases were treated with application of surgical as operation group including 15 males and 11 females...
May 25, 2018: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
Olivia Sharp, Kai Yuen Wong, Phillip Johnston
We present a rare case of segmental fracture of the scaphoid. This case highlights the importance of using appropriate imaging modalities to assess the presence and morphology of fractures.
June 8, 2018: BMJ Case Reports
Simon S M Chan, Sheena Sikora, Jason N Harvey, Stephen K Y Tham
The purpose of this study was to compare the outcome of scaphoid excision with capitolunate and triquetrohamate arthrodesis (bicolumnar arthrodesis) to radioscapholunate arthrodesis in patients with scapholunate advanced collapse (SLAC) II wrist arthritis. Twelve patients with symptomatic SLAC II arthritis were recruited and randomized to receive either bicolumnar arthrodesis or radioscapholunate arthrodesis. The primary outcome was wrist function as assessed by the patient rated wrist evaluation. Secondary outcomes included range of motion, grip strength and the Mayo wrist score...
January 1, 2018: Journal of Hand Surgery, European Volume
David Bustamante Suárez de Puga, Román Cebrián Gómez, Javier Sanz-Reig, Jesús Más Martínez, Manuel Morales Santías, Carmen Verdú Román, Enrique Martínez Giménez
The arthroscopic technique most frequently used in acute scapholunate instability is reduction and fixation with Kirschner wires. To repair the injured ligament, open surgery and dorsal capsular plication are recommended, but this procedure has the risk of damaging secondary dorsal stabilizers, the dorsal blood supply, and the proprioceptive innervation of the posterior interosseous nerve. In this report, we present an all-arthroscopic technique of a dorsal reconstruction of the scapholunate interosseous ligament for scapholunate instability using a tape by tethering the scaphoid to the lunate...
May 2018: Arthroscopy Techniques
Lone Kirkeby, Poul Frost, Torben Bæk Hansen, Susanne Wulff Svendsen
OBJECTIVES: We aimed to determine the prognosis after early MRI on clinical suspicion of scaphoid fracture, hypothesising that MRI pathology is associated with more disability and that MRI pathology and high occupational mechanical hand-arm exposures are associated with slower return to work (RTW). METHODS: We conducted a follow-up study of a cohort of 469 patients, who were scanned in the period 2006 to 2010. The respondents constituted our cohort for disability analysis and the subset that was in the labour market at the time of the trauma constituted our sub-cohort for RTW analysis...
2018: PloS One
L García-Lamas, M Á Porras-Moreno, V Jiménez-Díaz
Carpal coalitions are relatively frequent between bones in the same carpal row. Coalitions between bones of different rows, however, are very uncommon. We present a case of bilateral intercarpal coalition between the trapezium and scaphoid as an incidental finding, confirming its hereditary origin since a parent has the same bilateral coalition.
May 21, 2018: Revista Española de Cirugía Ortopédica y Traumatología
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