Avascular Necrosis Of The Scaphoid Research Articles

Four bone versus capito-lunate limited carpal fusion. Report of 40 cases

Fourty patients with limited carpal fusion have been retrospectively reviewed. The aim of this study was to compare the results of four bone fusions (30 wrists) versus capitolunate fusion (11 wrists). Follow-up averaged 30 months with a range of 15-96 months. Twelve patients presented SLAC-wrist (scapho-lunate advanced collapse) and fourteen with SNAC-wrist (sapho-non union advanced collapse). There were seven cases of primitive wrist arthritis, one mid-carpal instability, one sequella of Fenton's syndrome, one Preiser's disease and two Kienbock's disease. All 40 patients were evaluated by the same observer. In terms of range of motion, the capito-lunate fusion led to better results than the four bone fusions with a gain of 10 degrees in volar flexion and 12 degrees in radial deviation. Results in term of post operative pain are similar in the two groups of patients with 90% painless wrist in four bone fusion and 81% with capito-lunate fusion. Results for strength were equivalent. Radiological bone fusion was obtained within nine weeks. Absence of fusion was observed in two patients with capito-lunate fusion. Our result in terms of joint motion and strength are similar to those found in the literature. Correction or not of the DISI deformity during the procedure did not affect the results (on 19 patients). The Four bone fusion procedure is still a good treatment in SLAC or SNAC wrist. Capito-lunate fusion remains a good choice, despite the risk of non-fusion.

Idiopathic avascular necrosis of the scaphoid in a child demonstrated by bone scintigraphy.

Idiopathic avascular necrosis of the scaphoid in a child demonstrated by bone scintigraphy.

Avascular nontraumatic necrosis of the scaphoid. Preiser's disease?

Twenty-two cases of nontraumatic avascular necrosis of the scaphoid are reported. In ten cases a metabolic cause could be revealed; for the other 12 cases no etiology could be established. Twelve were treated with a proximal row carpectomy, ten had a very satisfactory result, one was not satisfied and had to be converted into a wrist arthrodesis and one is in doubt.

Preiser's disease: Arthroscopic treatment of avascular necrosis of the scaphoid

We report the case of a 50-year-old female patient with Preiser's disease (avascular necrosis of the scaphoid), who after a 2-year history of wrist pain, underwent arthroscopic debridement of the necrotic scaphoid using a standard technique. Osteoarthritic changes of the articular cartilage, partial rupture of the scapholunate ligament, local synovitis, and loose fragments were documented. The patient reported significant improvement in pain relief and complete relief of mechanical symptoms at 31-month follow-up examination. Radiographs demonstrated no progression of collapse of the scaphoid or acceleration of degenerative changes in the wrist. Arthroscopy in Preiser's disease allows direct visualization and assessment of the exact pathology of the radiocarpal and midcarpal joint and the scaphoid cartilage. Arthroscopic debridement of the necrotic scaphoid increased wrist functional range of motion, provided excellent pain relief, and improved health-related quality of life.

Idiopathic avascular necrosis of the scaphoid

Idiopathic avascular necrosis of the scaphoid is a rare condition. A review of the literature shows a variety of conditions labelled as spontaneous avascular necrosis or Preiser's disease. In this paper we report on a study of eight patients with idiopathic avascular necrosis affecting only the proximal pole of the scaphoid. Seven of these patients had positive ulnar variance. The possible aetiology is discussed and the natural history has been studied. A staging system is proposed, as this helps to determine the prognosis and appropriate management. Two of our patients were managed conservatively; the others were treated successfully by partial silastic replacement of the scaphoid.

両手根骨に無腐性壊死をきたした一症例

Idiopathic avascular necrosis of the carpal scaphoid, so called Preiser's disease, was first reported in the German literature in 1910 by Preiser. It is an exceedingly rare condition, the etiology of which is still unlnown, and the treatment is controversial. Recently, we treated a 68-year-old housewife who had avascular necrosis in the carpal scaphoid of her right hand and avascular necrosis of the lunate in her left hand. The plane X-ray, tomograms, bone scintigraphy and MRI, were useful in making the diagnosis of avascular necrosis of the catpal bones. The more symptomatic right hand was operated on by scapho-luno-capitate fusion, with a satisfactory postoperative course.

Preiser's disease

Nine patients with the diagnosis of unilateral Preiser's disease were seen between 1970 and 1987. The mean age of four male and five female patients was 37 years (range, 20 to 70 years). The diagnosis was based on radiographic evidence of sclerosis, fragmentation, erosion, and collapse of the proximal pole of the scaphoid. Onset was usually insidious but two had a preexisting radial hypoplasia, a third had a modest scaphoid malunion, and a fourth had a recent fall. Treatment consisted of scaphoid excision and silicone rubber prosthetic replacement in three, debridement of necrotic bone fragments in one, and different periods of cast support and observation in the remaining five. No relationship to ulnar variance was seen. Mean follow-up was 6.9 years. Of the scaphoid implants, two had subluxated, but only one was painful. In the more conservatively treated group, pain and function were only modestly limiting in four, who returned to their original occupations as did the one treated by curettage of necrotic bone in the proximal pole. One patient (case 4) was severely incapacitated because of associated severe congenital anomalies of the lower extremities. Polyaxial tomography permitted a better assessment of the degree of involvement and carpal alignment. Preiser's disease is a rare affliction of the carpal scaphoid which may involve the entire bone in avascular changes but primarily leads to fragmentation and collapse of the proximal pole. A conservative approach to treatment is favored based on this experience.

Idiopathic avascular necrosis of the scaphoid: Preiser's disease?

Although avascular necrosis after fracture of the scaphoid is common, it rarely develops without apparent trauma. Preiser's disease is commonly associated with avascular necrosis of the scaphoid without fracture or trauma. A critical review of Preiser's original article reveals that all of his cases, as well as three of seven additional cases in the literature, were associated with fracture or trauma. Preiser's disease, therefore, should be traumatic avascular necrosis and differentiated from truly nontraumatic avascular necrosis. Five additional cases in four patients with nontraumatic avascular necrosis of the scaphoid are presented.

Replacement of the proximal portion of the scaphoid with spherical implant for post-traumatic carporadial arthritis

Nineteen spherical prosthetic replacements have been performed in eighteen non service patients for osteonecrosis of the proximal scaphoid-with carporadial arthritis. One period of observation postoperative was for seven weeks only. Two procedures failed in the same patient. The patient with Preiser's disease is too recent to permit definitive conclusions on follow-up. Each of the other fifteen patients followed for an acceptable period are considered to have a good or satisfactory result.

The natural history of scaphoid non-union. A review of fifty-five cases.

We reviewed the cases of fifty-six scaphoid non-unions in fifty-five patients, none of whom had received treatment of any kind before examination. In the thirty-two patients who had been injured five years or more earlier, arthritis developed in thirty-one (97 per cent). The one patient in whom osteoarthritis developed less than four years after injury also had avascular necrosis of the scaphoid. The incidence of osteoarthritis increased with time after injury. We concluded that patients with established scaphoid non-union should be advised that osteoarthritis will most likely develop.

Preiser's disease: A case report

Preiser's disease, or avascular necrosis of the scaphoid, is an exceedingly rare although debilitating pathologic process. A case of progressive avascular necrosis of the carpal scaphoid is presented together with a review of the possible etiology of this rare syndrome. Histologic evaluations of resected specimens have demonstrated a localized sequestrum of necrotic bone, leading to the belief that disruption of blood supply is a major predisposing factor. The diagnosis of Preiser's disease or avascular necrosis of the carpal scaphoid should be exclusively reserved to those cases that demonstrate a progressive clinical and radiographic sequence of osteosclerosis and subsequent fragmentation of the scaphoid.

Blood vessel transplantation to bone

In dogs an artery, a vein, and a vascular bundle were transplanted into intact bone, isolated bone segments, necrotized bone, and homografts of bone. Active proliferation of new blood vessels and formation of new bone occurred in all instances where the vascular bundle was used, when the vein was implanted into the intact bone and isolated bone, and only when the artery was implanted into intact bone. As a result of these experiments, vascular bundle transplantation has been performed in patients with Kienboeck's disease, and avascular necrosis of the scaphoid, the femoral head, the talus, and other conditions.