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Pickrell BB, Dowlatshahi AS, Kim PS. Update on Management of Scaphoid Fractures. Plast Reconstr Surg 2024; 154:1020e-1036e. [PMID: 39480260 DOI: 10.1097/prs.0000000000011558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2024]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Accurately diagnose scaphoid fractures through examination and appropriate imaging selection. 2. Recognize those fractures that can be treated with nonoperative management. 3. Outline the different surgical approaches for scaphoid fractures. 4. Appreciate the surgical options for management of scaphoid nonunion. SUMMARY This article includes the most up-to-date information on the diagnosis, work-up, and treatment of scaphoid fractures.
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Affiliation(s)
- Brent B Pickrell
- From Beth Israel Deaconess Medical Center, Harvard Medical School
| | | | - Peter S Kim
- From Beth Israel Deaconess Medical Center, Harvard Medical School
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Sharma M, Choudhury SR, Prakash M, Sinha A, Sheth R, Sandhu MS. MDCT evaluation of distal radius fractures and their association with carpal and distal ulnar fractures. Emerg Radiol 2023; 30:629-635. [PMID: 37656265 DOI: 10.1007/s10140-023-02169-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/25/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the characteristics of distal radius fractures (DRFs) in patients undergoing multi-detector computed tomography (MDCT) and their association with carpal and distal ulnar fractures. METHODS This retrospective study analyzed 120 patients, who underwent MDCT for evaluation of DRFs. Two radiologists independently evaluated the data for various fracture characteristics and for associated carpal and distal ulnar fractures. RESULTS Out of 120 DRFs, 74 were complete articular, 40 were partial articular and only 6 were extra-articular. Displacement was present in 99 fractures and intra-articular step off was present in 73 fractures. A total of 81 carpal bone fractures were identified in 46 (38.3%) patients, with more than one carpal bone fracture in 21 patients. Distal ulnar fractures were detected in 79 patients (65.8%), out of which 67 involved the ulnar styloid. DRFs with intra-articular step off were more frequently associated with carpal bone fracture (p value: 0.021), while displaced DRFs were more frequently associated with distal ulnar fracture (p value <0.001). Interobserver agreement for detection of carpal bone fractures (κ = 0.807) and distal ulnar fractures (κ = 0.923) was excellent. CONCLUSION Majority of DRFs in patients referred for MDCT were complete articular with high incidence of displacement and intra-articular step off. Associated carpal bone and distal ulna fractures were not uncommon.
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Affiliation(s)
- Madhurima Sharma
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Shayeri Roy Choudhury
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mahesh Prakash
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Anindita Sinha
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rishabh Sheth
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Manavjit Singh Sandhu
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Tandioy-Delgado FA, Marcovici LL, Luchetti R, Atzei A. Arthroscopic Assisted Treatment of Combined Trapezium and Bennett Fracture-Dislocation. Tech Hand Up Extrem Surg 2023; 27:30-37. [PMID: 35997265 DOI: 10.1097/bth.0000000000000406] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Trapezium fractures are unusual; however, they represent the third most frequent fracture of the carpal bones. As they usually follow a high-energy trauma, they are associated with distal radius, Bennett, or Rolando fractures in 80% of cases. Traditional treatment options include, closed reduction and percutaneous pinning, or open reduction and internal fixation. To minimize the additional surgical trauma, an arthroscopic technique has been developed for safe, minimally invasive management of complex injuries of the first carpo-metacarpal joint. Intra-articular dislocated fracture fragments are reduced under direct visualization and fixed through small incisions. Limiting additional surgical damage on the carpo-metacarpal joint ligaments, capsule, and other soft tissues around the fracture preserves the blood supply to fracture fragments and also the proprioceptive system, which is key for the dynamic stability of such a hypermobile joint. This report confirms that the procedure is feasible, and a complete functional recovery can be expected with reduced postoperative rehabilitation.
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Affiliation(s)
| | | | | | - Andrea Atzei
- Pro-Mano, Hand Surgery and Rehabilitation, Treviso, Italy
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Chang MTK, Price M, Furness J, Kemp-Smith K, Simas V, Pickering R, Lenaghan D. The current management of scaphoid fractures in the emergency department across an Australian metropolitan public health service: A retrospective cohort study. Medicine (Baltimore) 2022; 101:e29659. [PMID: 35839014 PMCID: PMC11132340 DOI: 10.1097/md.0000000000029659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 04/22/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Scaphoid fractures are commonly present to emergency departments (EDs), challenging medical practitioners to achieve accurate diagnosis and management. This is because of the prevalence of radiographically occult scaphoid fractures and complications associated with missed diagnoses. Clinical Guidelines are limited for treatment of suspected scaphoid fractures, and heterogeneity in the literature further complicates management. This study aimed to explore the differences in management between practitioners in the ED and determine if immobilizing clinically suspected scaphoid fractures is supported by current evidence. This study also aimed to establish if there are predictors to assist in the diagnosis of a scaphoid fracture in the ED. METHODS A retrospective cohort study analyzed clinical data from patient's charts who attended the ED for a scaphoid fracture in 2019. Using retrospective patient chart audits and a Data Extraction Form, the clinical data regarding the assessment, treatment, diagnosis, and follow-up outcomes were collected. Descriptive analysis and multivariable logistic regression were performed to assess current management and find out predictors of a scaphoid fracture. RESULTS There was significance between practitioners performing physical assessments and providing treatment (P < .001). Physiotherapists performed assessment and education combined treatment more frequently than nurse practitioners and doctors. Thirty-four cases (11.7%) were negative for fracture in ED and positive in follow-up at the orthopedic clinic. There was an estimated loss of income of $327,433.60 (Australian dollar) for 221 patients who missed work due to overtreatment with immobilization. The strongest predictors for a confirmed scaphoid fracture were of male gender (odds ratio, 3.2; 95% confidence interval, 2.1-5.0; P < .001) and a positive x-ray in ED (odds ratio, 36.6; 95% confidence interval, 17.4-77.0; P < .001). CONCLUSION Management of scaphoid fractures across the Gold Coast Hospital Health Service ED followed commonly accepted practices involving x-ray and immobilization; however, this conservative approach to management is associated with increased health costs and low rates of conversion to a confirmed scaphoid fracture. Male gender was the only significant predictor associated with a scaphoid fracture.
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Affiliation(s)
- Margaret Ting-Kwei Chang
- Faculty of Health Science, Physiotherapy Department, Bond University, Robina, Queensland, Australia
| | - Maggie Price
- Faculty of Health Science, Physiotherapy Department, Bond University, Robina, Queensland, Australia
| | - James Furness
- Faculty of Health Science, Physiotherapy Department, Bond University, Robina, Queensland, Australia
| | - Kevin Kemp-Smith
- Faculty of Health Science, Physiotherapy Department, Bond University, Robina, Queensland, Australia
| | - Vini Simas
- Faculty of Health Science, Physiotherapy Department, Bond University, Robina, Queensland, Australia
| | - Rowan Pickering
- Gold Coast Hospital Health Services, Queensland Health, Gold Coast, Queensland, Australia
| | - Deborah Lenaghan
- Gold Coast Hospital Health Services, Queensland Health, Gold Coast, Queensland, Australia
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Snaith B, Harris M, Hughes J, Spencer N, Shinkins B, Tachibana A, Bessant G, Robertshaw S. Evaluating the potential for cone beam CT to improve the suspected scaphoid fracture pathway: InSPECTED - A single-centre feasibility study. J Med Imaging Radiat Sci 2021; 53:35-40. [PMID: 34802964 DOI: 10.1016/j.jmir.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/07/2021] [Accepted: 10/18/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The suspected scaphoid fracture remains a diagnostic conundrum with over-treatment a common risk-averse strategy. Cross-sectional imaging remains the gold standard with MRI recommended but CT used by some because of easier access or limited MRI availability. The aim of this feasibility study was to evaluate whether cone beam computed tomography (CBCT) could support early diagnosis, or exclusion, of scaphoid fractures. METHODS Patients with a suspected scaphoid were recruited fracture between March and July 2020. All underwent a 4-view X-ray. If this examination was normal, they were immediately referred for a CBCT scan of the wrist. Those with a normal scan were discharged to research follow-up at 2 and 6-weeks. RESULTS 68 participants were recruited, 55 had a normal or equivocal X-ray and underwent CBCT. Nine additional radiocarpal fractures (16.2%) were demonstrated on CBCT, the remainder were discharged to research follow-up. Based on the 2-week and 6-week follow up three patients (4.4%) were referred for MRI to investigate persistent symptoms with no bony injuries identified. CONCLUSIONS CBCT scans enabled a rapid pathway for the diagnosis or exclusion of scaphoid fractures, identifying other fractures and facilitating early treatment. The rapid pathway also enabled those with no bony injury to start rehabilitation, suggesting that patients can be safely discharged with safety-net advice following a CBCT scan.
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Affiliation(s)
- Beverly Snaith
- Radiology, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK; Faculty of Health Studies, University of Bradford, Richmond Road, Bradford, BD7 1DP, UK.
| | - Martine Harris
- Radiology, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - James Hughes
- Radiology, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | | | - Bethany Shinkins
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | | | - Gareth Bessant
- Emergency Department, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Sarah Robertshaw
- Emergency Department, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
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Abstract
Fractures of the carpus can be debilitating injuries and often lead to chronic pain and dysfunction when not properly treated. Although scaphoid fractures are more common, fractures of the other carpal bones account for nearly half of all injuries of the carpus. Often missed on initial presentation, a focused physical examination with imaging tailored to the suspected injury is needed to identify these fractures. In addition to plain radiographs, advanced imaging such as CT and MRI are helpful in diagnosis and management. Treatment of carpal fractures is based on the degree of displacement, stability of the fracture, and associated injuries. Those that require surgical fixation often affect the congruency of the articular surfaces, are unstable, are at risk for symptomatic nonunion, are associated with notable ligamentous injury, or are causing nerve or tendon entrapment. Surgical strategies involve percutaneous Kirschner wires, external fixation, screws and/or plates, excision, or fusion for salvage. Owing to the intimate articulations in the hand, small size of the carpal bones, and complex vascular supply, carpal fracture complications include symptomatic nonunion, osteonecrosis, and posttraumatic arthritis.
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Beekhuizen SR, Quispel CR, Jasper J, Deijkers RLM. The Uncommon Trapezium Fracture: A Case Series. J Wrist Surg 2020; 9:63-70. [PMID: 32025357 PMCID: PMC7000256 DOI: 10.1055/s-0039-1683846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/06/2019] [Indexed: 10/27/2022]
Abstract
Background Isolated trapezium fractures are rare and account for only 1 to 5% of all carpal fractures but are still the third most common carpal fracture. Trapezium fractures are hard to detect and easily missed on standard radiographs. Trapezium fractures can be treated conservatively, as well as operatively, the best treatment is still debatable. Damage of the joint surface between the trapezium and the base of the first metacarpal or scaphoid could cause pain and restriction of movements. Therefore, it is important to diagnose and treat the fracture at early stage, so that articular congruence is guaranteed. Case description We present four cases of the uncommon trapezium fracture. All four cases are conservatively treated with good results, there was no need for operative treatment in all the cases. Literature review The literature describes the possibility to use fixation techniques, only when it is not possible to reduce the displaced fracture or the residual articular step-off is too high a fixation technique should be used. Clinical relevance Primarily, we would recommend navicular cast immobilization for 4 to 6 weeks as initial treatment.
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Affiliation(s)
- S. R. Beekhuizen
- Department of Orthopaedic Surgery, HagaZiekenhuis, The Hague, The Netherlands
| | - C. R. Quispel
- Department of Orthopaedic Surgery, HagaZiekenhuis, The Hague, The Netherlands
| | - J. Jasper
- Department of Orthopaedic Surgery, HagaZiekenhuis, The Hague, The Netherlands
| | - R. L. M. Deijkers
- Department of Orthopaedic Surgery, HagaZiekenhuis, The Hague, The Netherlands
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Bouya A, Rhounimi M, Azirar A. Trapezium nonunion: A rare case report. HAND SURGERY & REHABILITATION 2019; 38:135-138. [PMID: 30665871 DOI: 10.1016/j.hansur.2018.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 11/27/2018] [Accepted: 12/25/2018] [Indexed: 11/17/2022]
Abstract
Trapezium fracture is a rare clinical situation that several authors have described through clinical case reports. Nevertheless, there is currently no consensus on the best treatment. We report a case of trapezium nonunion, a situation which, to our knowledge, has never been described before.
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Affiliation(s)
- A Bouya
- Service de traumatologie orthopédie, CHU de Avicenne, avenue Ahmed Balafrej, 10000 Rabat, Morocco; Service de traumatologie orthopédie I, hôpital militaire d'instruction Mohamed V, Hay Ryad (avenue des FAR), 10000 Rabat, Morocco.
| | - M Rhounimi
- Service de traumatologie orthopédie, CHU de Avicenne, avenue Ahmed Balafrej, 10000 Rabat, Morocco
| | - A Azirar
- Service de traumatologie orthopédie, CHU de Avicenne, avenue Ahmed Balafrej, 10000 Rabat, Morocco
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APSI scaphoid hemiarthroplasty – long-term results. REVISTA BRASILEIRA DE ORTOPEDIA (ENGLISH EDITION) 2018; 53:582-588. [PMID: 30245998 PMCID: PMC6148075 DOI: 10.1016/j.rboe.2018.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 06/08/2017] [Indexed: 11/29/2022]
Abstract
Objective This study is aimed at evaluating the long-term results of proximal scaphoid hemiarthroplasty for post-traumatic avascular necrosis at this institution. Methods Twelve patients who underwent this procedure were identified, and the mean follow-up time was 6.5 years (range: 5–8 years). All patients were male, with a mean age of 39 years (range: 28–55 years). In eight patients, the non-dominant limb was affected. The procedure was carried out through a dorsal approach and all patients underwent the same rehabilitation protocol. Cases were evaluated regarding complications, pain, range of motion, functional status (Mayo Wrist Score), and disability (QuickDASH Score). Results No immediate post-operative complications, such as infection or dislocation of the implant, were observed. All patients presented with peri-implant osteolysis at follow-up, on a radiograph study. None of the patients was forced to abandon their previous professional activity, although about 50% required some type of adaptation at their workplace. The mean functional capacity was, according to the Mayo Wrist Score, of 67.5 points (range: 50–80), corresponding to a satisfactory degree of function. The QuickDASH disability score presented a mean of 25 (range: 3–47.7). Conclusion The results of this series are in line with previously published studies about this technique. Hemiarthroplasty with a pyrocarbon implant is a safe technique for the treatment of post-fracture avascular necrosis of the scaphoid proximal pole. This technique allowed for satisfactory functional results at a mean follow-up of 6.5 years.
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Trapezium Fracture Associated with Thumb Carpometacarpal Joint Dislocation: A Report of Three Cases and Literature Review. Case Rep Orthop 2018; 2018:2408708. [PMID: 29682377 PMCID: PMC5841103 DOI: 10.1155/2018/2408708] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/22/2018] [Indexed: 11/26/2022] Open
Abstract
Isolated trapezium fracture in combination with thumb carpometacarpal (CMC) joint dislocation is extremely rare, and no treatment consensus exists. Herein, we report 3 successfully treated cases of isolated trapezium fracture with thumb CMC joint dislocation. While good short-term results have been reported in the literature, the possibility of substantial ligament injuries that can lead to future instability of the thumb CMC joint must be noted. In order to obtain an excellent long-term clinical result, we propose the consideration of the anatomical repair of the CMC joint in terms of both bony and ligamentous structures in cases where instability remains after fracture fixation.
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Goyal T. Bennett’s fracture associated with fracture of Trapezium - A rare injury of first carpo-metacarpal joint. World J Orthop 2017; 8:656-659. [PMID: 28875133 PMCID: PMC5565499 DOI: 10.5312/wjo.v8.i8.656] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 01/22/2017] [Accepted: 02/20/2017] [Indexed: 02/06/2023] Open
Abstract
Association of fracture of trapezium with Bennett’s fracture is very rare and makes reduction and stabilisation more difficult. We are reporting a rare case of Bennett’s fracture with fracture of the trapezium and subluxation of the carpo-metacarpal joint (CMC) joint. The patient was a 47-year-old school teacher who fell from his motorbike on his outstretched right dominant hand. Radiographs and computed tomography showed fracture of the trapezium with subluxation of the CMC joint, associated with Bennett’s fracture. Open reduction and internal fixation was carried out. Trapezium was reduced first and secured with a 2 mm diameter screw. Bennett’s fracture was then reduced and fixed with two per-cutaneously placed Kirchner’s wires. CMC was stabilised with per-cutaneous Kirchner’s wires. Latest follow up at 12 mo showed a healed fracture with good reduction of the CMC joint. Clinically patient had no pain and normal extension, abduction and opposition of the thumb. QuickDASH score was 3.9/100. Thus, fracture of trapezium associated with a Bennett’s fracture is a rare injury and if ignored it may lead to poor results. This injury is more challenging to manage than an isolated Bennett’s fracture as anatomical reduction of the trapezium with reduction of the first CMC is needed. Fracture of the trapezium should be fixed first as this will provide a stable base for reduction of the Bennett’s fracture.
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Single-incision open reduction and internal fixation of comminuted trapezium fractures with distal radius cancellous autograft. Tech Hand Up Extrem Surg 2015; 19:40-5. [PMID: 25706149 DOI: 10.1097/bth.0000000000000073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Trapezium fractures comprise approximately 3% to 5% of all hand fractures. Although operative management of intra-articular trapezium fractures can result in good functional outcomes, there is very little literature addressing specific operative techniques. We describe a technique for open reduction and internal fixation of severely comminuted, intra-articular trapezium fractures, utilizing autogenous cancellous bone graft from the distal radius.
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Burnett SE, Stojanowski CM, Mahakkanukrauh P. Six new examples of the bipartite trapezoid bone: morphology, significant population variation, and an examination of pre-existing criteria to identify bipartition of individual carpal bones. Ann Anat 2015; 198:58-65. [PMID: 25556074 DOI: 10.1016/j.aanat.2014.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 11/07/2014] [Accepted: 11/20/2014] [Indexed: 10/24/2022]
Abstract
Carpal bone bipartition is a developmental variant resulting in the division of a normally singular carpal into two distinct segments. Cases involving the scaphoid are best known, though many other carpals can be affected, including the trapezoid. Six new examples of bipartite trapezoids, identified in African and Asian anatomical and archeological samples, are reported here and compared with the eight previously known. While the site of bipartition is consistent, the resulting segments exhibit variability in their articulations with neighboring carpals. Five of the six affected trapezoids were identified in African or African-derived samples, yielding a significantly higher frequency (0.323%) of bipartite trapezoid than seen in anatomical or archeological series of European origin. Bilateral bipartite trapezoids in archeological remains from the Mid Holocene site of Gobero (Niger) are potentially the oldest bipartite carpals yet identified in humans. Their discovery may indicate that trapezoid bipartition is a condition that has been present in African populations since prehistoric times, though more data are needed. Because bipartite carpals may be symptomatic and can occur as part of syndromes, the significant population variation in frequency identified here has potential utility in both anatomical and clinical contexts. However, a comparison of the morphological appearance of bipartite trapezoids with the suggested criteria for bipartite scaphoid diagnosis indicates that these criteria are not equally applicable to other carpals. Fortunately, due to the rarity of fracture, identification of the bipartite trapezoid and separating it from pathological conditions is considerably easier than diagnosing a bipartite scaphoid.
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Affiliation(s)
- Scott E Burnett
- Comparative Cultures Collegium, Eckerd College, 4200 54th Avenue South, St Petersburg, FL 33711, USA.
| | | | - Pasuk Mahakkanukrauh
- Department of Anatomy, Faculty of Medicine, Chiang Mai University, 50120, Thailand
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15
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Raghupathi AK, Kumar P. Nonscaphoid carpal injuries - Incidence and associated injuries. J Orthop 2014; 11:91-5. [PMID: 25104893 DOI: 10.1016/j.jor.2014.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 02/02/2014] [Indexed: 10/25/2022] Open
Abstract
AIMS Nonscaphoid fractures comprise approximately 40% of all carpal fractures. But the exact incidence of these rare injuries is still not clear. Missed or late diagnosis can lead to serious ligamentous disruption and permanent wrist dysfunction. METHODS A retrospective analysis of wrist X-rays and CT scans were carried out for a period of 3 years. Incidence and associated injuries from this study was compared with literature. A total of 33 patients were included in our study. Both wrist X-rays and CT scans were reviewed individually by two authors. DASH scores were recorded for each patient. RESULTS There were 26 male and 7 female patients. Out of 33 patients 13 (35%) were Triquetral fractures, 10 (27%) were Hamate fractures, 5 (14%) were Capitate fractures, 4 (11%) were Lunate fractures, 3 (8%) were Trapezium fractures and 2 (5%) were Pisiform fractures. There were no Trapezoid fractures in our study. CONCLUSION Incidence of nonscaphoid carpal fractures in our study is considerably higher when compared to literature. We propose that high index of suspicion should always be borne in mind when dealing with carpal fractures and detailed examination of wrist should be conducted even when X-rays does not show any obvious bony injuries. CT scans and other specialized images should be judiciously used in areas of suspicion for early diagnosis, to initiate immediate treatment, for early mobilisation and good functional recovery.
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Affiliation(s)
| | - Prathap Kumar
- Department of Trauma & Orthopaedics, Darlington Memorial Hospital, Darlington, United Kingdom
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Carpenter CR, Pines JM, Schuur JD, Muir M, Calfee RP, Raja AS. Adult scaphoid fracture. Acad Emerg Med 2014; 21:101-21. [PMID: 24673666 DOI: 10.1111/acem.12317] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 07/03/2013] [Accepted: 08/18/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Scaphoid fractures are the most common carpal fracture, representing 70% of carpal bone fractures. The diagnostic accuracy of physical examination findings and emergency medicine (EM) imaging studies for scaphoid fracture has not been previously described in the EM literature. Plain x-rays are insufficient to rule out scaphoid fractures in a patient with a suggestive mechanism and radial-sided tenderness on physical examination. This study was a meta-analysis of historical features, physical examination findings, and imaging studies for scaphoid fractures not visualized on plain x-ray in adult emergency department (ED) patients, specifically to address which types of imaging tests should be recommended in patients with persistent concern for acute fracture after ED discharge. METHODS A medical librarian and two emergency physicians (EPs) conducted a medical literature search of PUBMED and EMBASE. The original studies' bibliographies were reviewed for additional references and unpublished manuscripts were located via a hand search of EM research abstracts from national meetings. All abstracts were independently reviewed by the two physicians, and Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2) was used to assess individual study quality. When two or more qualitatively similar studies were identified, meta-analysis was conducted using Meta-DiSc software. Primary outcomes were sensitivity, specificity, and likelihood ratios (LRs) for predictors of scaphoid fracture detected on follow-up in patients with normal ED x-rays. RESULTS A total of 957 unique citations were identified, yielding 75 studies eligible for inclusion in this systematic review. Studies were significantly heterogeneous in design, study population, and criterion standard. The majority of studies were conducted in non-ED settings (e.g., orthopedic clinics). No studies used accepted diagnostic research publishing guidelines, and the overall QUADAS-2 methodologic quality was low, indicating an increased risk of bias in the estimates of diagnostic accuracy. The prevalence of scaphoid fractures ranged from 12% to 57% with the point estimate of 25% pretest probability for adult ED patients with concern for scaphoid injuries, nondiagnostic index x-rays, and scaphoid fractures on later imaging studies. Except for the absence of snuffbox tenderness (LR- = 0.15), physical examination findings lack accuracy to rule in or rule out scaphoid fractures, and no validated clinical decision rules exist. In patients with persistent concern for injury, magnetic resonance imaging (MRI) is superior to bone scan, computed tomography (CT), or ultrasound (US) to both rule in and rule out scaphoid fractures. Both MRI and CT share the added benefit of identifying alternative etiologies for posttraumatic wrist pain. CONCLUSIONS Except for the absence of snuffbox tenderness, which can significantly reduce the probability of scaphoid fracture, history and physical examination alone are inadequate to rule in or rule out scaphoid fracture. MRI is the most accurate imaging test to diagnose scaphoid fractures in ED patients with no evidence of fracture on initial x-rays. If MRI is unavailable, CT is adequate to rule in scaphoid fractures, but inadequate for ruling out scaphoid fractures.
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Affiliation(s)
- Christopher R. Carpenter
- Division of Emergency Medicine; Washington University in St. Louis; School of Medicine; St. Louis MO
| | - Jesse M. Pines
- Department of Emergency Medicine; George Washington University; Washington DC
| | - Jeremiah D. Schuur
- Department of Emergency Medicine; Brigham and Women's Hospital; Boston MA
| | - Meaghan Muir
- Medical Library; Brigham and Women's Hospital; Boston MA
| | - Ryan P. Calfee
- Orthopedic Surgery; Washington University in St. Louis; School of Medicine; St. Louis MO
| | - Ali S. Raja
- Department of Emergency Medicine; University of Cincinnati; Cincinnati OH
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Dana C, Doursounian L, Nourissat G. Arthroscopic treatment of a fresh lunate bone fracture detaching the scapholunate ligament. CHIRURGIE DE LA MAIN 2010; 29:114-7. [PMID: 20299263 DOI: 10.1016/j.main.2010.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2009] [Revised: 11/11/2009] [Accepted: 01/31/2010] [Indexed: 10/19/2022]
Abstract
Fractures of the lunate bone are rare and usually treated by prolonged immobilization. We report a fracture of the dorsal pole of the lunate bone detaching the scapholunate ligament. The clinical presentation was equivalent to an acute disruption of this ligament. Percutaneous screw repair of the bone fragment was performed under wrist arthroscopy. The patient kept an analgesic splint for five days and early mobilization was provided. After 6 weeks, the patient had returned to his previous level of activity with normal wrist motion and full strength. Screw fixation under arthroscopy is minimally invasive and provides accurate restoration of the lunar anatomy, yielding good functional results after a short recovery period. This treatment offers a satisfactory alternative to prolonged immobilization and ensures good reduction and compression of the fracture. We present a detailed description of the surgical technique and its results.
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Affiliation(s)
- C Dana
- Unité de chirurgie du membre supérieur, service de chirurgie orthopédique, hôpital universitaire Saint-Antoine, AP-HP, université Pierre-et-Marie-Curie-Paris 6, Paris, France.
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18
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Trapezium fracture - a common technique to fix a rare injury: a case report. CASES JOURNAL 2009; 2:8304. [PMID: 19918416 PMCID: PMC2769426 DOI: 10.4076/1757-1626-2-8304] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 08/25/2009] [Indexed: 11/21/2022]
Abstract
Trapezium fractures are rare injuries which should not be missed. We report a case of a 27-year-old right hand dominant man who sustained a closed vertical trapezium fracture and first carpometacarpal joint dislocation which was treated with closed reduction and percutaneous Kirschner-wire fixation, a technique familiar to all orthopaedic surgeons. Satisfactory functional outcome was achieved at final follow-up.
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19
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Trapezium fracture - a common technique to fix a rare injury: a case report. CASES JOURNAL 2009. [PMID: 19918416 DOI: 10.4076/1757-16262-8304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Trapezium fractures are rare injuries which should not be missed. We report a case of a 27-year-old right hand dominant man who sustained a closed vertical trapezium fracture and first carpometacarpal joint dislocation which was treated with closed reduction and percutaneous Kirschner-wire fixation, a technique familiar to all orthopaedic surgeons. Satisfactory functional outcome was achieved at final follow-up.
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20
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Abstract
Hand and wrist injuries are common in most athletic events and sports. Carpal fractures and ligamentous injuries are common in athletes and require physicians, trainers, and therapists who treat and diagnosis these injuries to have an understanding of the carpal bone anatomy and vascularity along with the potential for progression to instability. Research is still needed to further investigate the optimal treatments of all carpal injuries in athletes along with designing new means to prevent these injuries.
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Affiliation(s)
- Joseph F Slade
- Department of Orthopeadics and Rehabilitation, Yale University School of Medicine, PO Box 208071, New Haven, CT 060-8071, USA.
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21
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Arora R, Gschwentner M, Krappinger D, Lutz M, Blauth M, Gabl M. Fixation of nondisplaced scaphoid fractures: making treatment cost effective. Prospective controlled trial. Arch Orthop Trauma Surg 2007; 127:39-46. [PMID: 17004075 DOI: 10.1007/s00402-006-0229-z] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2006] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Nondisplaced scaphoid waist fractures treated with prolonged plaster immobilisation often lead in transient joint stiffness and to a delay in return to sport and work activity. The long time off work increases the work off compensation costs. Internal fixation of scaphoid fractures has resulted in a shorter time to union and to return to work and sports. This prospective study compares cast immobilisation with screw fixation and the direct cost with indirect cost of conservative and minimally invasive treatment of undisplaced scaphoid fractures. MATERIALS AND METHODS Forty-seven patients with an acute nondisplaced waist fracture of the scaphoid were allocated into either cast immobilisation or internal screw fixation for this study. Cost data concerning the groups of nonoperated and operated patients were analysed. Range of wrist motion, grip strength, DASH-score, time to fracture union, return to work time and the needed physiotherapy at the final follow-up at 6 months were evaluated. RESULTS Twenty-one patients were included in the group of screw fixation and 23 patients were included in the group of cast immobilisation. At final follow-up there was no significant difference in the range of motion of the wrist or in grip strength. The operatively treated group had a better mean DASH-score than the conservative group. Fracture union was seen in the screw fixation group at a mean of 43 days and in the cast immobilisation group at a mean of 74 days (P < 0.5). The average time of return to work was 8 days for patients who had an internal screw fixation, while those treated with a cast returned to work at a mean of 55 days (P < 0.5). In total the internal fixation of undisplaced scaphoid fractures is less expensive than conservative treatment. CONCLUSION Internal screw fixation of nondisplaced scaphoid fractures had a shorter time to bony union and the patients returned earlier to work compared with cast immobilisation. Although it is assumed that operative treatment is more expensive, in this study the cost was not found to be higher.
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Affiliation(s)
- R Arora
- Department of Trauma Surgery and Sports Medicine, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
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22
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Abstract
Although carpal fractures other than of the scaphoid are uncommon, vigilance in diagnosing these potentially serious fractures is paramount to early and effective treatment. Physical examination and standard plain radiographs may reveal only subtle findings. Use of special radiographic views and computed tomography may help elucidate the diagnosis. Treatment is particular to each fracture. Nondisplaced fractures should be treated nonoperatively. For intra-articular carpal bone fractures, virtually any amount of displacement is unacceptable and requires reduction and fixation. This article organizes current knowledge of these potentially difficult fractures, with a table of diagnosis and treatment guidelines.
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Affiliation(s)
- Mordechai Vigler
- Hand Surgery Service, New York University Hospital for Joint Diseases Orthopaedic Institute, Department of Orthopaedic Surgery, The New York University School of Medicine, New York, NY 10003, USA
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23
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Abstract
Traumatic fractures of the lunate are rare. This article presents two patients who had displaced oblique lunate fractures and distal radius fractures. Both fractures achieved union; however, transient avascular necrosis occurred in the proximal healing of one patient.
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Affiliation(s)
- Alan E Freeland
- Department of Orthopedic Surgery and Rehabilitation, University of Mississippi Medical Center, Jackson, Miss 39216, USA
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24
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Abstract
This article reviews the appropriate management of common carpal fractures. The fundamental principles used by clinicians to choose appropriate stabilization and length of immobilization for these various injuries are discussed. The principles behind the progression of therapeutic intervention and the relation of progression to the stages of healing are emphasized.
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Affiliation(s)
- Paul Brach
- Centers for Rehab Services, Department of Hand and Upper Extremity Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA
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25
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Abstract
Eleven patients with intra-articular fractures of the trapezium were evaluated after surgical treatment with a mean follow-up time of 47 months (range, 25-80 mo). There were 6 vertical split and 5 comminuted fractures. All fractures involved high-energy trauma in men. Five resulted from motorcycle accidents. An associated Bennett's fracture occurred in 4 patients. Three fractures went undiagnosed at the time of initial evaluation. At late follow-up evaluation, 8 of 11 patients experienced some pain, mainly at the trapeziometacarpal articulation. There was no statistical difference in thumb motion, wrist motion, or grip and pinch strength between the affected and unaffected extremity. Radiographs revealed degenerative changes at the trapeziometacarpal articulation in 5 of 11 fractures. No patient was disabled and no patient changed occupation as a result of the hand injury. Based on the good results obtained with surgical intervention we advocate open reduction and internal fixation for fractures with either articular displacement >2 mm or carpometacarpal subluxation.
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Affiliation(s)
- Francis X McGuigan
- Department of Orthopaedic Pathology, Armed Forces Institute of Pathology, 6825 Sixteenth Street NW, Washington, DC 20306-6000, USA
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26
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Abstract
A review of the literature shows that 3% to 9% of all athletic injuries occur to the hand or wrist. Also, hand and wrist injuries are more common in pubescent and adolescent athletes than adults. Although knee and shoulder injuries are more common athletic injuries, an injury to the hand or wrist significantly can impair the athlete's ability to throw or catch a ball, or swing a bat or racquet. A college football player trains year round for just 11 or 12 hours of playing time. An athletic injury that occurs during the season can have profound consequences for the athlete's career and emotions. When defining a management plan for a particular wrist athletic injury, the time to heal the injury and the time to rehabilitate fully must be considered. The athlete must be informed fully of the length of recovery. The continued advancement of fixation methods and techniques are diminishing fracture morbidity considerably. Small-cannulated compression screws that provide rigid fixation can be inserted with decreased surgical dissection, thus preserving critical vascular supply and promoting accelerated healing and earlier rehabilitation. The arthroscope as a valuable adjunct in the management of wrist fractures was virtually unheard of years ago, but is now common. The ability to arthroscopically guide a cannulated compression screw to stabilize a scaphoid fracture without a formal open volar approach can reduce surgical morbidity significantly and allow the athlete to return to competition more quickly. Mechanisms of injury that cause osseous fractures of the wrist are fairly high energy. A high index of suspicion for associated soft tissue injuries should be kept in mind when fractures of the wrist are identified. The wrist is composed of eight carpal bones tightly interwoven with each other by intrinsic and extrinsic wrist ligaments. The management of carpal fractures depends on prompt diagnosis, stable and anatomic alignment of the involved carpal bone, protective immobilization of the injury, and thorough rehabilitation. Displaced fractures of the hook of the hamate, trapezial ridge fractures, and comminuted pisiform fractures are managed best by early excision to promote uncomplicated recovery and early return to sport. For most athletes, return to competition can be expedited safely with the use of padded gloves and custom playing splints or casts. The sports medicine physician always must put the athlete's safety first when deciding the appropriate time for return to competition.
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Affiliation(s)
- W B Geissler
- Department of Orthopaedic Surgery, Division of Hand and Upper Extremity Surgery, University of Missisippi Medical Center, Jackson, Mississippi, USA.
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27
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Fortis AP, Panagiotopoulos E, Kostopoulos V, Tsantzalis S, Boudouris T. Strain development in carpal scaphoid for various wrist positions: a cadaveric study using strain gauges. Injury 2000; 31:529-35. [PMID: 10908746 DOI: 10.1016/s0020-1383(00)00048-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In order to investigate the ideal position in which the wrist should be immobilized during scaphoid fracture, treatment the strains which are developed in the carpal scaphoid for various wrist positions has been recorded in cadaveric wrists, using strain gauges. The data obtained shows that during radial deviation with neutral or slight palmar flexion of the wrist the waist of the scaphoid tends to compress because of the development of strong compressive strains, while the strain development parallel to the fracture site that tends to shift the scaphoid waist is minimum. This position seems to be the best for stable scaphoid fracture immobilization.
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Affiliation(s)
- A P Fortis
- Orthopedic Department, General Hospital of Tripolis, Tripolis, Greece.
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28
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Hove LM. Epidemiology of scaphoid fractures in Bergen, Norway. SCANDINAVIAN JOURNAL OF PLASTIC AND RECONSTRUCTIVE SURGERY AND HAND SURGERY 1999; 33:423-6. [PMID: 10614752 DOI: 10.1080/02844319950159145] [Citation(s) in RCA: 172] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
During a three-year period, 330 fractures of the scaphoid were diagnosed, 273 of these in subjects resident in Bergen, Norway. The population at risk was 211719, and 82% of the fractures occurred in male subjects. The mean (range) age was 25 (11-79) years. The annual incidence was 4.3/10000 people. The age-specific incidence for men was highest between the ages of 20-30 years followed by a rapid decrease. The age-specific incidence for men was significantly higher than the corresponding rates for women up to about 50 years of age, whereas the rates for men and women over 60 were similar. Fractures of the scaphoid accounted for about 2% of the total number of fractures in our area, 11% of the hand fractures, and 60% of the carpal fractures.
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Affiliation(s)
- L M Hove
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
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29
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Fritsche EA, Hort C, Noever G. Simultaneous fractures of the waist and tuberosity of the scaphoid. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 1997; 22:814-6. [PMID: 9457596 DOI: 10.1016/s0266-7681(97)80456-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We present a case of a double fracture of the scaphoid. A non-displaced transverse fracture of the waist was associated with a displaced fracture of the tuberosity in the same scaphoid. To our knowledge this combination in an acutely fractured scaphoid has been described in only six previous cases.
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Affiliation(s)
- E A Fritsche
- Division of Plastic and Reconstructive Surgery, Kantonsspital Aarau, Switzerland
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30
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Tang JB, Ryu J, Han JS, Omokawa S, Kish V, Wearden S. Biomechanical changes of the wrist flexor and extensor tendons following loss of scaphoid integrity. J Orthop Res 1997; 15:69-75. [PMID: 9066529 DOI: 10.1002/jor.1100150111] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Loss of integrity of the scaphoid may change the motion center of the entire carpus, and deformities from scaphoid fractures may alter the location of motor tendons of the wrist, thus altering their biomechanics. The goal of this study was to clarify biomechanical changes in these tendons following loss of scaphoid integrity. Excursions and moment arms of the principal flexor and extensor tendons of the wrist were investigated in seven cadaveric upper extremities in intact wrists after simulation of scaphoid waist fracture and after removal of the proximal scaphoid. Excursions of the flexor carpi radialis and ulnaris, extensor carpi radialis longus and brevis, and extensor carpi ulnaris tendons were measured with rotary potentiometers during wrist flexion-extension and radioulnar deviation. Simultaneously, wrist joint angulation was recorded. Moment arms of the tendons were derived from tendon excursions and joint motion. After scaphoid fracture, the moment arms of the flexor carpi radialis and extensor carpi ulnaris tendons increased significantly during wrist flexion-extension, whereas the moment arms of the extensor carpi radialis longus and brevis tendons decreased significantly. After proximal scaphoid excision, the moment arms of the extensor carpi radialis longus and brevis tendons again decreased significantly during wrist flexion-extension. The moment arms of the flexor carpi radialis and extensor carpi radialis brevis tendons increased significantly during radioulnar deviation, whereas those of the wrist motors on the ulnar side decreased. These findings indicate the importance of the integrity of the scaphoid in maintaining normal biomechanics of motor tendons of the wrist. An increase in the moment arm of the radial wrist flexor along with a decrease in moment arms of the radial extensors constitutes as etiology for persistent angulation of the scaphoid and the humpback deformity. In addition, disturbing the biomechanics of the wrist motor tendons predisposes the carpal joints to abnormal loading, potentially contributing to the development of carpal joint degeneration.
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Affiliation(s)
- J B Tang
- Department of Orthopedics, West Virginia University, Robert C. Byrd Health Sciences Center, Morgantown 26506, USA
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31
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32
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Hove LM. Simultaneous scaphoid and distal radial fractures. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 1994; 19:384-8. [PMID: 8077834 DOI: 10.1016/0266-7681(94)90095-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Simultaneous fractures of the distal radius and scaphoid are uncommon. In a prospective 3-year study we registered 2,330 distal radial fractures and 390 scaphoid fractures, and 12 were combined. Ten of these had high energy trauma; six were styloid fractures, four Colles' fractures, one was a greenstick fracture and one Salter-Harris Type 2 epiphyseal fracture. All but one of the 12 scaphoid fractures were stable and healed without problems, and one was a trans-scaphoid, trans-styloid peri-lunate fracture-dislocation. The study supports the opinion that the distal radial fracture constitutes the principal injury that determines the outcome and hence the treatment. If the scaphoid fracture is unstable or dislocated, we recommend internal fixation of the scaphoid. Only a small proportion of these injuries represent a more serious disruption with carpal instability.
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Affiliation(s)
- L M Hove
- Bergen Accident and Emergency Department, Bergen Legevakt, Norway
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33
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Brøndum V, Larsen CF, Skov O. Fracture of the carpal scaphoid: frequency and distribution in a well-defined population. Eur J Radiol 1992; 15:118-22. [PMID: 1425745 DOI: 10.1016/0720-048x(92)90135-v] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The incidence, location, and type of scaphoid fractures found in a well-defined population is described. Fractures of the carpal scaphoid (n = 442) were identified during an eight-year period, of which 19 (5%) were nonunions. At the initial radiographic examination the fractures were visible on PA views in 70% of the cases (true lateral 10%, scaphoid view neutral 77%, scaphoid view ulnar deviated 73%, and scaphoid view with the X-ray tube tilted 30 degrees distally 71%). Among inhabitants living in the Odense Municipality (population at risk 170648 in 1983 to 174948 in 1989) 222 males and 51 females (age range 9-87 year) sustaining scaphoid fractures during a seven-year were period used for computation of incidences. During the survey, there was an average annual incidence of scaphoid fracture of 8 per 100000 females, and 38 per 100000 males. All patients (except a 9-year-old male) were aged 10 years or over. In the age-group 10-14 years there was an average annual incidence of 3 per 100000 females, and 39 per 100000 males. Average annual incidence per 100000 inhabitants of carpal scaphoid fractures according to the location was proximal 6, middle 15, and distal (fractures of the tuberosity included) 2. Average annual incidence per 100000 inhabitants of carpal scaphoid fractures according to type was transverse 7, horizontal oblique 9, vertical oblique 1, avulsion/fracture of the tuberosity 5, and not stated 1.
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Affiliation(s)
- V Brøndum
- Department of Diagnostic Radiology, Odense University Hospital, Denmark
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34
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35
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Abstract
Five fresh cadaver upper extremities were studied with use of a static positioning frame, pressure-sensitive film, a microcomputer-based videodigitizing system, and a Sun station image analysis system to assess the load bearing characteristics of the scaphoid in the proximal carpal joint. Specimens were studied in their normal condition, after a proximal pole osteotomy of the scaphoid, and after resection of the proximal pole of the scaphoid. The amount of contact area born through the scaphoid fossa was essentially the same whether the scaphoid was intact, or after a simulated scaphoid fracture of its proximal pole, or after resection of the proximal pole. The scaphoid contact area and pressure, although overall relatively constant, was redistributed after osteotomy, resulting in increased contact area under the distal fragment and no change or a slight decrease in the contact area under the proximal fragment of the scaphoid. After resection of the proximal fragment, all scaphoid contact area and pressure was born by the distal scaphoid fragment. The contact area and pressure characteristics of the lunate remained unchanged in all conditions compared with the normal condition. There were no significant changes in the locations of the centroids of the scaphoid segments and the lunate in any of the conditions tested.
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Affiliation(s)
- S F Viegas
- Division of Orthopaedic Surgery, University of Texas Medical School, University of Texas Medical Branch, Galveston 77551
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36
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Mehta M, Brautigan MW. Fracture of the carpal navicular--efficacy of clinical findings and improved diagnosis with six-view radiography. Ann Emerg Med 1990; 19:255-7. [PMID: 2178500 DOI: 10.1016/s0196-0644(05)82039-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A prospective study was conducted to determine the usefulness of clinical findings and 25-degree pronation and supination radiologic views to diagnose carpal navicular fractures. All patients presenting to the emergency department during a two-year period who fell on their outstretched hand and had pain and/or swelling in the anatomic snuffbox were evaluated initially and at two weeks. All patients received at least the standard four-view wrist radiography. If a fracture was not detected, two additional views were obtained. Ninety patients were enrolled; 54 fractures of the navicular were evident on initial four-view radiography. Thirty-six patients with a negative initial four-view radiograph had two additional views; 11 of the 36 were found to have a fracture. The other 25 patients failed to show fracture. In this series; no fractures were missed when six-view radiography was used. Anatomic snuffbox tenderness was 100% sensitive and 76% specific and had a 92% positive predictive value for carpal navicular fracture. We conclude that patients clinically suspected of carpal navicular fracture should undergo additional radiologic views if the standard four views of the wrist are negative.
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Affiliation(s)
- M Mehta
- Department of Emergency Medicine, Mount Carmel Mercy Hospital, Detroit, Michigan
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37
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Kaulesar Sukul DM, Johannes EJ, Marti RK, Klopper PJ. Biomechanical measurements on scaphoid bone screws in an experimental model. J Biomech 1990; 23:1115-21. [PMID: 2277046 DOI: 10.1016/0021-9290(90)90004-m] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
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.
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Affiliation(s)
- D M Kaulesar Sukul
- Department of Traumatology, University Hospital Rotterdam Dijkzigt, Rotterdam, The Netherlands
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38
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Teisen H, Hjarbaek J. Classification of fresh fractures of the lunate. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 1988; 13:458-62. [PMID: 3249151 DOI: 10.1016/0266-7681_88_90180-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The X-rays of 17 patients with fresh fractures of the lunate bone have been reviewed. The fractures were classified according to their radiological appearances and according to the vascular anatomy of the lunate. A long term X-ray follow-up examination was performed.
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Affiliation(s)
- H Teisen
- Department of Diagnostic Radiology, Odense University Hospital, Denmark
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39
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Ruijters R, Kortmann J. A case of translunate luxation of the carpus. ACTA ORTHOPAEDICA SCANDINAVICA 1988; 59:461-3. [PMID: 3421086 DOI: 10.3109/17453678809149405] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A rare case of carpal injury is presented in which a longitudinal fracture of the lunate bone was associated with a volar dislocation of the capitate bone. The injury was treated closed. Ten months after the trauma, there was nonunion of the lunate fracture and an instability of the capitate-lunate joint.
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Affiliation(s)
- R Ruijters
- Department of Orthopedics, Catharina Hospital, Eindhoven, The Netherlands
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40
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Abstract
The dorsoulnar tubercle of the trapezium may fracture, and this fracture may be missed without precise physical examination and correct radiographic studies. If there is persistent localized pain and tenderness in this region and the results of routine wrist radiographic examination are normal, a bone scan should be performed. If there is localized uptake in the area of the trapezium, additional radiographic studies may be necessary to confirm or exclude this fracture. Four patients with this previously unreported fracture and a method for its detection are presented.
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Affiliation(s)
- A C Griffin
- Department of Radiology, Mallinckrodt Institute of Radiology, St. Louis, Mo. 63110
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41
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42
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Abstract
The progressively ossifying scaphoid of the child is well protected but is not immune to injury. The diagnosis of scaphoid fracture may be difficult when the fracture occurs through the osteochondral interface. Nonunion and ischemic necrosis of the proximal pole fragment--complications more often seen in adults sustaining scaphoid fracture--may occur in children, as shown by the young patient presented here.
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43
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44
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Abstract
Aseptic necrosis of the capitate bone is a rare disease, except in the scaphoid bone and the lunate bone. This report describes an aseptic necrosis of the bone in two gymnasts. In both cases, the necrosis probably resulted from dorsiflexion compression injury in gymnastics. In an attempt to enable these patients to continue athletics, partial resection and drilling were performed to give successful results.
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45
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The lunate bone: a weak link in the articular column of the wrist. Surg Radiol Anat 1983. [DOI: 10.1007/bf01798873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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46
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47
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Abstract
The pathomechanics, ligamentous damage, and degree of carpal instability in perilunate and lunate dislocations were analyzed by experimentally loading 32 cadaver wrists to failure. Thirteen perilunate and two lunate dislocations were produced. The mechanism of injury was extension, ulnar deviation, and intercarpal supination. These dislocations occurred in a sequential fashion due to progressive and specific ligamentous disruptions and were classified according to the degree of perilunar instability (PLI). Stage I perilunar instability (scapholunate diastasis) had the least degree of carpal instability. Lunate dislocations (stage IV PLI) had the highest degree of carpal instability. Radial styloid fractures were produced in seven as a result of avulsion. Scaphoid rotation was created in eight and was due to rupture of the radioscaphoid and scapholunate ligaments. Reduction was accomplished by reversing the mechanism of injury--that is, intercarpal pronation, radial deviation, and palmar flexion. Stress roentgenograms employing longitudinal carpal compression in radial and ulnar deviation were helpful in determining the degree of associated carpal instability.
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49
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Abstract
Three cases of simultaneous Colles' and scaphoid fractures, one bilateral, occurring in a series of 422 Colles' fractures are presented. The factors necessary for the occurrence of such injuries are discussed.
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