Carpal Scaphoid Bone Research Articles

Intercarpal Degenerative Arthritis in Adulthood as a Late Consequence of Unilateral Congenital Aplasia of the Scaphoid: A Case Report

We report a case of unilateral congenital aplasia of the carpal scaphoid bone discovered in adulthood, which probably caused a severe painful intercarpal degenerative arthritis. This case was not associated with hypoplasia or aplasia of thenar and forearm muscles, abnormality of the skeleton of the thumb ray, absence of the sesamoid bones, hypoplasia of the forearm bones, as in cases reported in the literature; the only additional anatomic abnormality was a mild hypoplasia of the radial styloid. A surgical treatment (4-bone arthrodesis) has been performed to treat the advanced carpal collapse and the arthritis.

Smoking increases failure rate of operation for established non-union of the scaphoid bone

The aim of the study was to investigate the effect of smoking on the operative treatment of established non-union of the carpal scaphoid. Case notes and radiographs of patients undergoing bone grafting and screw fixation of scaphoid non-unions were reviewed. There were 34 patients that had undergone 37 operations for established non-union of the carpal scaphoid bone. There were two female patients, and the average age was 26.8 years (range 13.4 years to 52.9 years). The median delay to operation was 11.9 months. The overall success rate of the operation (internal fixation and autologous bone grafting) was 59.5% (22/37), but there was a significant association between non-union and smoking (P=0.02 for Fisher's exact test). In non-smokers (n=17) the success rate was 82.4%, but this dropped to 40.0% among smokers (P<0.01). We concluded that smoking was significantly associated with failure of operative treatment of established non-union of the scaphoid bone.

Ostéotomie d’horizontalisation de la glène radiale dans les pseudarthroses du scaphoïde carpien

Purpose of the study We propose a different management scheme for painful post-traumatic osteoarthritis of the wrist resulting from pseudarthrosis of the carpal scaphoid bone. We report a prospective series with a maximum follow-up of 16 years. Material and methods From 1973 to 1990, we performed 100 first-intention wedge osteotomies of the distal radius in patients with painful pseudarthrosis of the carpal scaphoid bone. Inclusion criteria were painful wrists with established pseudarthrosis. The operation consisted in the removal of a small lateral wedge (base ≤ 0.5 cm) without affecting the length of the radius nor the function of the distal radio-ulnar joint. Twenty patients were lost to follow-up and follow-up was less than two years for two. The present series corresponds to 77 patients (all male manual laborers) followed for at least two years. Mean follow-up was 4 years (range 216 years). To evaluate outcome, we developed a devoted scoring system, the Scaphoid Pseudarthosis Hand Score, (SPHS, max 60 points) with items for pain, range of motion, grasping strength, work capacity, wrist function and post-traumatic arthritis. Results At last follow-up, the SPHS was 45.66 points versus 19.98 before surgery. The pain score was 8.51 versus 3.19: 67 patients (86%) were pain free or experienced mild pain for heavy work. Bone fusion or fibrous union was observed in 49 patients (64%) who were free of post-traumatic osteoarthritis; some improvement of which was observed in 11 other patients (14%) with less sclerotic bone. All patients but two resumed their occupational activities. Discussion Wedge osteotomy relieves pain and improves hand function by reducing the pressure applied to the radial and scaphoid joint surfaces. It acts positively in the event of post-traumatic arthritis, altering the dynamics of the wrist and producing the beneficial effects of styloidectomy. Although it was not the target, sound union of the pseudarthrosis observed in 25 patients at last follow-up was attributed to the applied treatment.

Bilateral congenital aplasia of the scaphoid

A case of bilateral congenital aplasia of the carpal scaphoid bone is presented. In contrast to previously reported cases of congenital hypoplasia of the scaphoid, this case was not associated with hypoplasia or absence of thenar and forearm muscles, absence of the sesamoid bones of the thumb, abnormalities of the skeleton of the thumb ray or hypoplasia of the forearm bones.

Ｈｅｒｂｅｒｔ ｂｏｎｅ ｓｃｒｅｗの種々の骨折への応用

The Herbert bone screw was originally developed for internal fixation of fractures of the carpal scaphoid bone but has proved to be so effective its use has now expanded to include fixation of other fractures. We used the cannulated Herbert bone screw for treatment of fractures (ankle ten, foot eight, knee seven, elbow five, shoulder three, distal radial bone one, hand one). The mean age of patients at the time of the injury was 38 years and 11 months, ranging from 17 to 73-years. Good bone union and clinical results were obtained in all cases. Advantages of this procedure are;(1) Lack of a protrusive head allowing it to be positioned in thin soft tissue parts (Malleolar, Olecranon).(2) Surgical technique is easier using the guide pin.(3) Screw threads which are at both ends have different pithces so that during insertion rigid compression is produced across the fracture line.

Scaphoid fracture: A new method of assessment

The value of colour flow Doppler ultrasound scanning in patients with suspected acute carpal scaphoid fracture has been examined. A prospective study of 78 patients with signs and symptoms of carpal scaphoid injury was undertaken over a period of 6 months. Both wrists of all patients were scanned within 12-72 h of injury. The radial artery and carpal scaphoid bone contours are visible using this type of imaging technique. The distance between the medial wall of the radial artery and the outer cortex of the scaphoid waist was measured. The scaphoid index is described and was calculated from this measurement. Patients were managed without knowledge of the ultrasound imaging result, using plain radiographs and clinical examination as the standard for determining the presence of a scaphoid fracture. All patients were followed to the resolution of symptoms. All 12 patients who were subsequently considered to have scaphoid fractures were identified using this imaging technique within 12-72 h after injury. We conclude that this imaging may be useful in the assessment of patients with carpal scaphoid fracture. It can be used early, as a supplementary investigation, in patients with suspected carpal scaphoid fracture in whom the initial plain radiographs are normal.

Clinical fracture of the carpal scaphoid???An illusionary diagnosis

The management of patients with clinical evidence of a fracture of the carpal scaphoid bone but without radiological evidence of a fracture is based on dogma emphasizing the need to immobilize the wrist in all cases. Because of the apparently high proportion of patients who spend up to six weeks in a plaster cast and in whom no fracture is ever demonstrated radiologically, a study was undertaken to determine the fate of those wrist injuries diagnosed as clinical fractures of the scaphoid. All patients who presented with clinical or radiological evidence of fractures of the scaphoid over a one year period were reviewed. Of the 108 patients in whom the diagnosis of clinical fracture of the scaphoid was made at the time of presentation none was proved radiologically to have a fracture of the scaphoid subsequently after a period of mobilization. These patients spent an average time of 21.9 days in a plaster cast which represents a significant loss of productivity to the community and inconvenience to the patient.

Retrograde Herbert screw fixation for treatment of proximal pole scaphoid nonunions

Most nonunions of the carpal scaphoid bone can be treated with a high rate of success by use of conventional bone grafting techniques. However, fractures with a small proximal pole fragment may be difficult to treat by use of these techniques. Nine patients with nonunion and three patients with unstable proximal pole fractures were treated with retrograde dorsal Herbert screw fixation and adjunctive bone grafting. Follow-up averaged 25 months. Of the 12 patients, the fracture healed in 11 and one fracture remained ununited. This technique has been successful in our practice and should be considered in the treatment of small proximal pole nonunions and displaced proximal pole fractures.

Wedge Osteotomy of the Lower End of the Radius in the Treatment of Painful Pseudarthrosis of the Carpal Scaphoid Bone

The present authors have had encouraging results in the treatment of painful pseudarthrosis of the carpal scaphoid bone using wedge osteotomy on the lower end of the radius. After the operation, patients experienced restoration of joint movement, less painful or pain-free joints, and, in a few cases, sound union of the established pseudarthrosis of the carpal scaphoid bone. Osteotomy is a simple procedure of short duration and is without complications. In addition, in cases of failure, osteotomy does not exclude other forms of therapy.

Bilateral congenital hypoplasia of the carpal scaphoid bone

A case of bilateral congenital scaphoid hypoplasia, with wasting of the thenar muscles and absence of certain muscles of the forearm is presented. The patient had additional congenital disorders of the vertebrae, skull and elbow.

What's new in the new editions?

Gone is the subheading "Purity of the Dressers and Surgeons" as is the picture of Professor Lister's carbolic spray and the use of leeches (choose the thinnest and most lively) for treating local congestion. Readers will have guessed that I am looking at the original edition and that purity refers to clean hands and dress and not to holiness. It was so full of practical help (much applicable today) with 233 illustrations that its achievement in reaching the centenary and becoming the oldest surgical textbook in the English language is understandable. Walter Pye, a surgeon at St Mary's Hospital, died young and it is a tribute to subsequent editors that its standard has been kept up and purpose maintained: practical help for senior students, young doctors in hospital, and for lone practitioners working in underdeveloped countries. This centenary edition is a worthy tribute and has a new look; the editor has been assisted by John Smith of Sheffield and 25 other contributors. Since 1977 the section on brain death and care of the dying has been expanded and much other material rewritten and brought up to date. The pictures are better, especially the halftones on matt paper; the fracture in the carpal scaphoid bone (page 273) can even be seen. The preface by James Kyle is a masterly statement about the principles of good medical practice? a modern Hippocratic oath.

What's new in the new editions?

Gone is the subheading Purity of the Dressers and Surgeons as is the picture of Professor Lister's carbolic spray and the use of leeches (choose the thinnest and most lively) for treating local congestion. Readers will have guessed that I am looking at the original edition and that purity refers to clean hands and dress and not to holiness. It was so full of practical help (much applicable today) with 233 illustrations that its achievement in reaching the centenary and becoming the oldest surgical textbook in the English language is understandable. Walter Pye, a surgeon at St Mary's Hospital, died young and it is a tribute to subsequent editors that its standard has been kept up and purpose maintained: practical help for senior students, young doctors in hospital, and for lone practitioners working in underdeveloped countries. This centenary edition is a worthy tribute and has a new look; the editor has been assisted by John Smith of Sheffield and 25 other contributors. Since 1977 the section on brain death and care of the dying has been expanded and much other material rewritten and brought up to date. The pictures are better, especially the halftones on matt paper; the fracture in the carpal scaphoid bone (page 273) can even be seen. The preface by James Kyle is a masterly statement about the principles of good medical practice? a modern Hippocratic oath.

Treatment of Carpal Scaphoid Fracture

Fracture of the carpal scaphoid bone is the most common fracture of the carpus. Unfortunately. nonunion are common since the symptoms do not alert patients to seek early medical treatment and the diagnosis is easily missed. Fracture of the scaphoid is a common condition whose management remains controversial. The conservative treatment has many complications, these include inability to work while in plaster, stiffness of the wrist afterwards, muscle wasting, weakness and malunion. So various operative treatments of scaphoid fracture have been developed. Open reduction by use of screws suggested by Maclaughlin first in 1954. In 1984 a new and simple operative technique has been developed to provide rigid internal fixation for all types of fractures of the scaphoid by T.J. Herbert. This involves the use of a double-treaded bone screw which provides good fixation that, after operation, a plaster cast is rarely required and most patients are able to return to work within a few weeks. Authors have experienced 10 cases of scaphoid fracture and accomplished good result in all cases by internal fixation using Herbert screw. The results are as follows : Of these 10 fractures, 2 were fresh fractures and 8 were non unions of scaphoid fracture. In nonunion cases, the time interval between fracture and operation was from 5 months to 5 years. The postoperative immobilization period was average of 4 weeks. Short period of immobilization achieved early functional recovery of the wrist. The bony unions in roentgenogram were seen from 3 months to 9 months after operation. In 2 cases the fracture gap was seen after 9 months. But in these cases the symptoms such as pain and range of motion of wrist were improved.

Clinical fracture of the carpal scaphoid—An illusionary diagnosis

The management of patients with clinical evidence of a fracture of the carpal scaphoid bone but without radiological evidence of a fracture is based on dogma emphasizing the need to immobilize the wrist in all cases. Because of the apparently high proportion of patients who spend up to six weeks in a plaster cast and in whom no fracture is ever demonstrated radiologically, a study was undertaken to determine the fate of those wrist injuries diagnosed as clinical fractures of the scaphoid. All patients who presented with clinical or radiological evidence of fractures of the scaphoid over a one year period were reviewed. Of the 108 patients in whom the diagnosis of clinical fracture of the scaphoid was made at the time of presentation none was proved radiologically to have a fracture of the scaphoid subsequently after a period of mobilization. These patients spent an average time of 21.9 days in a plaster cast which represents a significant loss of productivity to the community and inconvenience to the patient.

Clinical Fracture of the Carpal Scaphoid— An Illusionary Diagnosis

The management of patients with clinical evidence of a fracture of the carpal scaphoid bone but without radiological evidence of a fracture is based on dogma emphasizing the need to immobilize the wrist in all cases. Because of the apparently high proportion of patients who spend up to six weeks in a plaster cast and in whom no fracture is ever demonstrated radiologically, a study was undertaken to determine the fate of those wrist injuries diagnosed as clinical fractures of the scaphoid. All patients who presented with clinical or radiological evidence of fractures of the scaphoid over a one year period were reviewed. Of the 108 patients in whom the diagnosis of clinical fracture of the scaphoid was made at the time of presentation none was proved radiologically to have a fracture of the scaphoid subsequently after a period of mobilization. These patients spent an average time of 21.9 days in a plaster cast which represents a significant loss of productivity to the community and inconvenience to the patient.

Bone scanning of fractures of the scaphoid

The value of isotope scanning in patients with clinical signs of fracture of the carpal scaphoid bone and negative or non-diagnostic initial radiographs was examined. 30 patients were examined using both radiography and isotope scanning. A normal scan excludes a fracture. Increased activity localized to the scaphoid bone indicates a fracture. 9 patients had fracture of the scaphoid evident on bone scans within 2 weeks of the injury. It took 2-6 weeks before these fractures showed up on radiographs.

Failure of treatment of ununited fractures of the carpal scaphoid. The role of non-compliance.

We studied the results in thirty patients who had grafting of an ununited fracture of the carpal scaphoid bone. Psychiatric evaluations revealed that the thirteen patients who had a non-union of the initial scaphoid bone graft had significant psychiatric problems, whereas the seventeen patients in whom the non-union had healed after initial bone-grafting of the scaphoid did not have psychiatric abnormalities. Technically successful surgical revisions in the first group of patients did not result in significant clinical improvement. We concluded that most failures of the bone grafts were related to non-compliance on the part of the patient and that some of the operations could have been avoided if the underlying psychiatric problems had been recognized preoperatively.

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

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

Regional scintimetry in scaphoid fractures.

A quantitative scintigraphic method was introduced to examine the proximal, middle and distal third of the carpal scaphoid bone. 99mTc-Sn-pyrophosphate scintimetry was obtained by the use of a gamma camera equipped with a pinhole collimator. Of six patients in whom a unilateral fresh fracture of the scaphoid was clinically suspected, radiology showed a fracture of the scaphoid in four and no fractures in two. The method may be suitable in early diagnosis and further localization of clinically suspected fractures with initially non-diagnostic radiographs.

The early diagnosis of fractures of the carpal scaphoid bone.

Fractures of the navicular bone are the most common carpal injuries (O'Donoghue, 1976; Thomaidis, 1973). Young males are especially prone to this fracture when falling on the outstretched hand. Various sporting activities are associated with this type of injury, these include football, basketball, rugby, skating, skate-boarding, hang-gliding, etc. (Dobyns, 1978). The vast majority of fractured scaphoids unite without complications. However, some unite slowly; in others, pseudoarthrosis occurs and in some, aseptic necrosis of the proximal fragment (Alho, 1975). Failure to recognise this fracture with resultant delayed immobilisation of the wrist is partially blamed for these complications.