Carpal Scaphoid Fracture Research Articles

Fijación percutánea en fracturas de escafoides carpiano agudas no desplazadas.

Introduction: The treatment of nondisplaced carpal scaphoid fractures is controversial. The objective is to present a series of patients treated surgically. Material and Methods: Data of 42 consecutive patients with Herbert type B1 and B2 fractures treated with percutaneous volar screw fixation were reviewed. Function was assessed using the quick-DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire. Radiologically, the fracture union and the scapholunate (AEL) and capitolunar (ACL) angles were evaluated. Results: The mean follow-up time was 7.1 months (range, 5-12). The mean quick-DASH score at the final evaluation was 2.3 points (range, 0-27.3), which is consistent with an excellent outcome. Union was achieved in all cases, except one that presented nonunion, in a mean time of 5.7 weeks. The final mean AEL and ACL angles were satisfactory. There were no cases of scapholunate instability. All the patients, except one, returned to their previous activities in a mean time of 6.4 weeks. There was one case of pseudarthrosis, which required reintervention. Two patients reported discomfort from the screw after consolidation, with excellent outcomes after removed. Conclusion: Percutaneous screw fixation is an effective and safe method for nondisplaced or minimally displaced carpal scaphoid fractures, favoring rapid recovery and return to previous activities.

Delayed diagnosis of carpal scaphoid fracture in a young boy.

Carpal scaphoid fracture is rare in children and is important to recognize early because of an increased risk for serious complications including non-union, avascular necrosis, and osteoarthritis. In the skeletally immature patient, a scaphoid fracture can easily escape detection due to clinical and diagnostic imaging interpretation errors. We report complete healing of a pediatric scaphoid non-union fracture after a remarkable delay in diagnosis and emphasize the considerable biological potential of the immature skeleton, coupled with proper stabilization, for good clinical outcomes.

Mini-locking titanium plate system fixation in the treatment of carpal scaphoid fracture

Mini-locking titanium plate system fixation in the treatment of carpal scaphoid fracture

Evaluation of the mechanical properties and clinical application of nickel-titanium shape memory alloy scaphoid arc nail.

To investigate the mechanical and biomechanical properties of nickel–titanium (Ni–Ti) shape memory alloy scaphoid arc nail (NT‐SAN) fixator as well as study the surgical method of treating carpal scaphoid fractures and evaluate its clinical efficacy. (1) Static and dynamic bending tests with embedded axial bending fixture were conducted to study the mechanical properties. (2) To evaluate biomechanical strength and fatigue, 32 scaphoid samples were classified into four groups to perform the fixation rigidity test: intramedullary Kirschner fixation (group A), Kirschner straddle nail fixation (group B), screw nail fixation (group C), and NT‐SAN fixation (group D). Next, 24 scaphoid waist fracture models were classified to conduct fatigue experiments as follows: Kirschner straddle nail fixation (group E), screw nail fixation (group F), and NT‐SAN fixation (group G). (3) The Krimmer score chart was used for clinical evaluations. (1) NT‐SAN showed excellent mechanical performance and a long lifespan. (2) NT‐SAN was fixated with a strong intensity and an anti‐fatigue outcome. (3) Ninety‐eight interviewed patients were satisfied with the therapeutic effects of the arc nail (satisfaction rate: 95.92%). The designed strength and hardness of NT‐SAN corresponded with the anatomical characteristics of the scaphoid, and the designed mechanical properties met the biomechanical requirements of a scaphoid fracture. The fatigue strength can meet the requirements of bone healing after the scaphoid fracture. Clinical trials on NT‐SAN scaphoid fracture treatment have shown that the surgery is simple and the clinical results are satisfactory. The therapeutic level of NT‐SAN is III; thus, it is worth promoting.

WITHDRAWN

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Scaphoid waist fractures fixation with staple. Retrospective study of a not widespread procedure.

IntroductionIn carpal scaphoid fractures, the surgical treatment with screw is considered the gold standard; shape memory staple however presents substantial advantages.The authors report a study on unstable fractures of the scaphoid waist (type B1, B2, B5, according to Herbert classification) treated with shape memory staple on a large sample of patients, with the aim to confirm the usefulness of this method, the quality of reduction and fixation, the functional results, the time of union and the possible complications. Materials and methodsA retrospective analysis of 131 patients with scaphoid waist fractures with minimum follow-up 1 year was performed. Staples were used in all cases; technical details are discussed. Outcome measures were: postoperative pain, flexion-extension wrist range, hand grip strength, radiographic consolidation, work absence. Herbert and Fisher Grading System was used to assess subjective, objective and radiographic results. ResultsConsolidation was achieved in all cases of primary fractures (0–30 days) within three months after surgery, and within eight months in all but two cases of delayed unions (operated within 6 months of the injury). Pain was absent at follow-up in 79% of cases, never severe or unbearable, the average flexion-extension range achieved was 112°. Handgrip strength values were comparable to those of contralateral wrist in 75% of cases. Mean time lost at work was 7.4 weeks. No algo-distrophy or malunion were observed.Discussion ConclusionsScaphoid waist fractures’ treatment with shape memory staple should be considered as an excellent alternative to screw fixation.

Pseudarthrosis of the Carpal Scaphoid Treated with Non-Vascularized Corticocancellous Bone Graft

Objectives: To carry out an epidemiological study and to assess the evolutionary profile of patients with scaphoid non-union treated by anterior non-vascularized corticocancellous bone graft.
 Introduction: The non-union is a serious complication of carpal scaphoid fractures. Untreated, it leads to instability and osteoarthritis of the carp. The most used technique is that of Matti-Russe employing a corticocancellous graft.
 Materials and methods: We report in this retrospective study the experience of the department of Orthopaedic Surgery & Traumatology II, Mohamed V Military Hospital, Rabat, in the treatment of non-unions of the carpal scaphoid by anterior non-vascularized corticocancellous graft in nine cases collected between January 2012 and March 2016. We identified six cases of stage IIA and three cases of stage IIB. All our patients were operated by the Matti-Russian technique followed by an immobilization by plaster cast cuff on three months.
 Results: All our patients achieved a union within an average of three months. The Mayo Wrist score was excellent in 66.6% of cases. Our results were very satisfying in 90% of cases, satisfying in 10%.
 Conclusion: The treatment of non-unions of the carpal scaphoid without necrosis or osteoarthritis, using anterior non-vascularized bone graft remains the most widely used technique. The presence of initial instability is a factor of poor prognosis, its correction reduces the risk of arthritis.

Ultrasound-guided percutaneous Herbert screw for the treatment of fresh nondisplaced carpal scaphoid fracture

To explore the effectiveness of ultrasound-guided percutaneous Herbert screw for the treatment of fresh nondisplaced carpal scaphoid fracture. Between May 2013 and August 2015, 15 patients with fresh nondisplaced carpal scaphoid fractures (Krimmer type A2) were treated with ultrasound-guided Herbert screw fixation. There were 12 males and 3 females with an average age of 33.4 years (range, 18-51 years). The causes of injury included 9 cases of falls, 3 cases of training injuries, and 3 cases of machine injuries. The interval from injury to surgery was 2-15 days (mean, 5 days). No other complication was found. The operation time, intraoperative blood loss, intraoperative fluoroscopy times, and the fracture healing time were recorded. The wrist function was assessed by the modified Mayo wrist score standard. The operation time was 28-53 minutes (mean, 33.9 minutes); the intraoperative blood loss was 5-30 mL (mean, 10.5 mL); the intraoperative fluoroscopy was 2-6 times (mean, 2.6 times). All 15 patients were followed up 6-18 months (mean, 10.5 months). One patient developed pain and soreness in the skin of the nail entrance, and gradually relieved after fumigation. No complication such as infection occurred. All fractures healed clinically, and the healing time was 8-16 weeks (mean, 11.6 weeks). At last follow-up, the modified Mayo wrist score was 76-99 (mean, 92.5). Among them, 12 cases were excellent, 2 cases were good, and 1 case was fair, and the excellent and good rate was 93.3%. Ultrasound-guided fixation with Herbert screw is a reliable treatment method for fresh nondisplaced carpal scaphoid fractures with small invasion, less bleeding, and small radiation damage.

The use of pedicled vascularized bone graft from the dorsum of distal radius for the treatment of scaphoid nonunion

Background The use of vascularized bone grafts from the dorsum of the distal radius for the treatment of scaphoid nonunion. Poor reduction or neglect of an unstable carpal scaphoid fracture may lead to scaphoid nonunion with or without avascular necrosis. When preoperative suggestion of avascular necrosis of the proximal pole is confirmed with intraoperative evaluation, conventional bone graft is not enough and a vascularized bone graft is strongly recommended. Patients and methods From May 2011 to September 2014, 12 patients with nonunited fracture of the scaphoid were treated with pedicled vascularized bone graft from the dorsum of the distal radius using of the 1,2 intercompartmental supraretinacular artery. Presurgical and postsurgical clinical evaluation included pain, range of motion, and grip strength. Radiographic evaluation included plain radiographs and MRI. The average follow-up period was 26 months (range = 12-40 months). Results At a mean follow-up period of 26 months, all patients clinically improved. Nine patients (75%) reported the absence of any discomfort, two patients (16%) reported slight discomfort after hard work, and only one case (8%) reported pain with light work. The wrist range of motion improved significantly, and the hand grip strength also improved. According to the modified Mayo wrist scoring chart, clinical results were rated as excellent in eight cases, good in three cases, and fair in one case. Radiographically, in eight of the 12 patients, union was achieved within 12 weeks after surgery, and in the other four patients trabecular bridging of the scaphoid fracture was achieved 16 weeks after the procedure. Conclusion 1,2 Intercompartmental supraretinacular artery is superficial to the extensor retinaculum and is a proper pedicle of vascularized bone graft due to the ease of visibility and dissection. The functional results and union rates were satisfactory in our study.

A new approach in the miniminvasive treatment of fractures

The use of biological cement with provisory closed percutaneous Kirschner wire (K-wire) fixation enabled the treatment of 12 patients with fractures. Within the period November 2010—February 2011, we have treated at Saint Pantelimon Emergency Orthopaedics Clinic 12 patients using this specific method, namely: 8 humeral fractures, 1 distal radial fracture, 1 distal radial fracture associated with carpal scaphoid fracture, 1 ankle fracture, and a delayed union of distal tibial fracture. In the specialized literature, the use of bone substitutes or of biological bone cement has never been described in the treatment of fractures without the opening of the fracture site. Some bone fillers for bone defects have been injected before, together with osteosynthesis means, plates and screws, respectively. The assessment of the results has to take into account the consolidation range of each type of fracture, and the cast fixation must be extended accordingly. The recovery shall depend upon the fracture’s callus biology, the fracture’s type and location as well as the age of the patient. We evaluate the results after clinical and radiological criteria. Consolidation was achieved in all cases. We will present also the complications related to first use of this new method. The use of Kryptonite-X injected under fluoroscopic control in the conservative treatment of the fractures is a novelty. Thus, it is introduced the perspective of an innovative way of treating the fractures. Consolidation was achieved in all cases.

Arthroscopically Assisted Use of Injectable Bone Graft Substitutes for Management of Scaphoid Nonunions

The purpose of this study was to analyze the clinical follow-up results (minimum, 2 years) in patients with nonunions of the scaphoid with minimal sclerosis treated with arthroscopically assisted percutaneous internal fixation augmented by injection of a bone graft substitute. From January 2006 through November 2007, a consecutive series of 15 patients with fibrous union or nonunion of a carpal scaphoid fracture with minimal sclerosis or resorption at the nonunion site were treated with arthroscopically assisted percutaneous internal fixation combined with the use of injectable bone graft substitute. Preoperative and postoperative evaluations included measurement of clinical (grip strength and range of motion), radiographic, and functional (Mayo Modified Wrist Score) parameters, as well as satisfaction. The sample included 13 men and 2 women with a mean age of 31 years (range, 20 to 45 years). We recorded union and return to activity and analyzed data with regular clinical follow-up at a mean of 33 months (range, 24 to 46 months). We confirmed union in 14 of 15 patients (93%) at a mean of 15.4 weeks according to clinical examinations and standard radiography. For the Mayo Modified Wrist Score, there were 10 excellent and 4 good results. A total of 14 of 15 patients (93%) returned to work or sports activities at their preinjury level. Arthroscopically assisted treatment with percutaneous internal fixation with injectable bone graft substitute is a reliable and minimally invasive method to achieve union and scaphoid healing. Level IV, therapeutic case series.

Scaphoid fractures treated by means of volar percutaneous fixation

Purpose To analyze the functional and radiological results as well as the complications of carpal scaphoid fractures treated by means of volar percutaneous fixation. Materials and Methods A retrospective study was carried out of 41 patients with a mean follow-up of 15 months (range: 12-54). Fractures included in the study correspond to those classified as types B1 and B2 on Herbert's scale further to a detailed radiographic study for the carpal scaphoid. Fractures of the tubercle and the proximal pole were excluded from the study. Demographic data were collected on the mechanism of injury, postoperative complications and any associated lesions. Clinical and radiological evaluations were performed. The adapted DASH questionnaire was used for the functional assessment. Results Fracture healing occurred at 7-and-a-half weeks. All patients started using their hand in the first 2 weeks. Mean wrist range of motion one year into follow-up was 70° of extension and 65° of flexion. The final score on the adapted DASH scale was 44 points when there were no associated lesions and 80 when the fracture was associated with other injuries. The complications rate was 5.8% intraoperatively (2 instances of guide wire breakage) and 5.8% during follow-up. All cases went on to heal, except for one which developed pseudoarthrosis. OR time was of 20 min on average. Conclusions Volar percutaneous fixation is a simple, rapid technique characterized by low morbidity rates and scarce significant complications, which accelerates the patients’ functional recovery.

Fracturas del escafoides tratadas mediante osteosíntesis percutánea volar

Purpose To analyze the functional and radiological results as well as the complications of carpal scaphoid fractures treated by means of volar percutaneous fixation. Materials and Methods A retrospective study was carried out of 41 patients with a mean follow-up of 15 months (range: 12–54). Fractures included in the study correspond to those classified as types B1 and B2 on Herbert's scale further to a detailed radiographic study for the carpal scaphoid. Fractures of the tubercle and the proximal pole were excluded from the study. Demographic data were collected on the mechanism of injury, postoperative complications and any associated lesions. Clinical and radiological evaluations were performed. The adapted DASH questionnaire was used for the functional assessment. Results Fracture healing occurred at 7-and-a-half weeks. All patients started using their hand in the first 2 weeks. Mean wrist range of motion one year into follow-up was 70° of extension and 65° of flexion. The final score on the adapted DASH scale was 44 points when there were no associated lesions and 80 when the fracture was associated with other injuries. The complications rate was 5.8% intraoperatively (2 instances of guide wire breakage) and 5.8% during follow-up. All cases went on to heal, except for one which developed pseudoarthrosis. OR time was of 20 min on average. Conclusions Volar percutaneous fixation is a simple, rapid technique characterized by low morbidity rates and scarce significant complications, which accelerates the patients’ functional recovery.

Pediatric Fractures of the Carpal Scaphoid

A retrospective study was undertaken of 22 carpal scaphoid fracture patients younger than 18 years. Of these, 17 patients received conservative treatment, and 5 received treatment involving screw fixation with or without a bone graft from the iliac crest. Clinical outcomes were evaluated using the Cooney score. Radiographs were analyzed with respect to the site of the fracture, the course of the fracture gap, displacement, and time to union. According to the Cooney score, in 94% of patients, good or excellent results were obtained. A total of 94% of patients considered their result as good or excellent. All fractures healed. Malunion was evident in 1 case.

Apport de la radioscintigraphie quantitative dans les traumatismes du poignet avec radiographies initiales normales: Étude prospective de 154 cas

Purpose of the study Fractures of the scaphoid must be diagnosed quickly to avoid persistent nonunion and the risk of osteoarthritis. Despite meticulous physical examination and adequate x-ray detection, numerous occult fractures still go unrecognized. The aim of this prospective study was to analyze the pertinence of quantitative radio-scintigraphy (QRS) presently used for the diagnosis of occult wrist fractures. Material and methods Quantitative radio-scintigraphy (QRS) is a new imaging technique associating quantitative bone scan and numerical fusion between bone scan images and x-ray images. We conducted a prospective study between November 1994 and March 1999 to evaluate the pertinence of this examination technique for the diagnosis of occult wrist fractures in patients presenting clinical symptoms suggestive of wrist fracture but whose plain x-rays were initially considered normal. Further some patients had several series of plain x-rays performed at several week intervals in order to search for fractures becoming progressively visible on plain x-rays. After the QRS data was acquired, these patients’ x-rays were reviewed again. We also compared the cost of QRS, repeated x-rays, bone scan and MRI at the Besançon University Hospital. Results QRS was performed in all 154 patients and revealed 61 fractures (56 single-line and 5 multiple-line fractures). Thus 43.5% of these patients had occult wrist fractures (41% of which involved the carpal scaphoid). Discussion Occult fracture of the wrist, particularly the carpal scaphoid, is frequent. Repeated x-ray examination does not increase the rate of detection of these fractures. Bone scans may also fail to reveal occult fractures. MRI is a key examination in the assessment of wrist fracture symptoms, but is presently not available in all institutions. Bone scan is classically insufficiently precise. QRS is a rapidly available low-cost examination which we have found to be indispensable for the diagnosis of occult wrist fractures. With early QRS diagnosis, the risk of neglected carpal scaphoid fracture and subsequent nonunion and osteoarthritis together with the personal, social, and medicolegal consequences can be avoided.

Athletic injuries of the wrist and hand. Part I: traumatic injuries of the wrist.

Hand and wrist injuries in sports are some of the most common injuries reported. This review discusses briefly the causes of hand and wrist injuries in sports and discusses pertinent biomechanical findings regarding the range of motion required in different sports activities. The bulk of the review discusses specific traumatic and overuse injuries to the hand and wrist commonly seen in the athlete. Emphasis is placed on problematic traumatic injuries such as carpal scaphoid fractures and hook of the hamate fractures, as well as ligament injuries to the wrist with regard to diagnosis, treatment, and return to athletic competition.

Percutaneous internal fixation of selected scaphoid nonunions with an arthroscopically assisted dorsal approach.

Preliminary reports have indicated that selected scaphoid nonunions-i.e., those that are well aligned and without extensive sclerosis or bone resorption at the nonunion site-can be treated effectively with internal fixation alone. We examined the feasibility of percutaneous fixation in a series of such nonunions. A consecutive series of fifteen patients with fibrous union or nonunion of a carpal scaphoid fracture with minimal sclerosis or resorption at the nonunion site were treated with rigid fixation alone (without bone graft) with a headless compression screw inserted with a dorsal percutaneous technique. Clinical examination, standard radiographs, and computed tomography scans confirmed union in all patients at an average of fourteen weeks. Nonunions treated less than six months after the injury healed faster than those treated later (p < 0.02). According to the Mayo modified wrist score, there were twelve excellent and three good results. The results in our series were due to careful examination and grading of the scaphoid nonunions preoperatively. The findings in this small series support the observation in earlier reports that percutaneous repair of selected scaphoid nonunions requires only rigid fixation to achieve healing.

Diagnosis of Occult Carpal Scaphoid Fracture: A Comparison of Magnetic Resonance Imaging and Computed Tomography Techniques

We investigated 52 consecutive patients (53 wrists) with suspected scaphoid fracture using MRI (0.2 T) within 7 days after the injury. We performed two sequences for the wrist: (1) coronal T1-weighted spin-echo and (2) T2-weighted turbo spin-echo. We also performed four sequences specific for the scaphoid with the plane parallel to the longitudinal axis of the scaphoid: (1) coronal T1-weighted, (2) coronal T2-weighted, (3) sagittal T1-weighted, and (4) sagittal T2-weighted images. In these projections, only one section is enough to cover the scaphoid fracture that definitely eased the diagnosis. In 18 (33%) wrists, the scaphoid fracture was detected on MRI. Computed tomograms (CT) were also taken with angled sagittal and coronal projections in 16 of the 18 wrists in which the scaphoid fracture was detected on MRI. CT revealed ten nondisplaced fractures, three displaced fractures, and three occult fractures. Bone contusion was found in no patients. MRI is a useful modality as a screening for occult scaphoid fracture.

Carpal Scaphoid Fracture Nonunion in Children

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Carpal scaphoid fracture nonunion in children.

Four new cases of carpal scaphoid nonunion in children are presented. This rare injury is characterized by delay in treatment of the scaphoid fracture or incorrect immobilization. The Matti-Russe procedure was performed with autograft harvested from the proximal cubitus, achieving complete consolidation in every patient. No complications occurred and there was no significantly limited mobility. The author speculates about the posibility of partial or complete consolidation of the scaphoid fracture without treatment as a part of the natural history of this fracture in children.