Trans-scaphoid Fracture Dislocation Research Articles

Open reduction and internal and external fixation combined with anchor repair of intercarpal ligament for the treatment of peripheral injury of lunate bone

To evaluate the feasibility of internal and external fixation after open reduction combined with suture anchors to repair the intercarpal ligaments for the treatment of perilunate injury, and to explore its operative techniques and therapeutic efficacy. From September 2012 to September 2016, 11 patients with perilunate injury were surgically treated with Kirschner wires in intercarpal articulations, 3.0 mm cannulated screws for scaphoid fracture, absorbable anchor for intercarpal ligament repair, together with fixators at intercarpal joints, among whom 6 suffered from perilunate dislocations and 5 from trans-scaphoid fracture dislocations. There were 7 males and 4 females with an average age of 43.6 years old ranging from 29 to 68 years old. Scapho-lunate angle, radio-lunate angle, index of carpal height and ROM of the wrist were observed. All wounds were healed at stage I. All patients were followed up from 12 to 24 months. The height of the carpal was maintained well with a mean scapho-lunate angle of 51°(35° to 65°), mean radio-lunate angle of 7°(-10° to 15°), and mean index of carpal height being 0.51(0.50 to 0.53), 5 patients of scaphoid fracture obtained bone union. Necrosis of lunate and scaphoid was not observed. The ROM of the wrist averages about 91.5°. The grip strength was recovered and amounted to 78.5% of that of the contralateral side. Among them, 6 cases reported no feeling of pain, 3 mild feeling of pain, and 2 medium level of pain. According to Cooney wrist score, 8 cases were considered excellent, 2 good and 1 fair. The wrist functions can be obtained satisfactorily by intervening in the early stage through internal and external fixation after open reduction combined with suture anchors to repair intercarpal ligaments for the treatment of perilunate injury. It has advantages of shorter operation time, smaller invasive trauma, less blood loss and etc. Therefore, this technique is safe and practicable, yielding satisfying clinic effects.

Comparison of Fracture Location and Extent of Comminution in Isolated Scaphoid Fractures Versus Transscaphoid Fracture-Dislocations

Background: Isolated scaphoid fractures (ISFs) are common, whereas transscaphoid fracture-dislocations (TSFDs) are not. Scaphoid fracture location and the extent of comminution are factors that affect treatment and outcome. The purpose of this study is to compare the radiographic characteristics of ISFs with TSFDs associated with greater arc injury. Methods: This study is a retrospective review of all ISFs and TSFDs that presented to our institution during a 5-year period. Fracture location (along the long axis of the scaphoid) was calculated by dividing the distance from the proximal pole to the fracture by the entire length of the scaphoid. The extent of comminution was measured in millimeters along the mid-axis of the scaphoid and divided by the entire length of the scaphoid. Results: One-hundred thirty-eight scaphoid fractures in 137 patients were identified. One-hundred twelve fractures (81%) were ISFs, and 26 (19%) were associated with a TSFD. The mean fracture location was more proximal in TSFDs than in ISFs. However, fractures occurred in the distal third of the scaphoid in 12% of ISFs compared with 0% of TSFDs. Nine percent of ISFs demonstrated comminution as compared with 12% of TSFDs. Extent of comminution was 16% and 28% for ISFs and TSFDs, respectively. Conclusion: Scaphoid fractures associated with greater arc injuries are located more proximally and are more comminuted than ISFs, and distal pole fractures rarely occur in the setting of TSFDs. The increased incidence and extent of comminution in TSFDs may be suggestive of a higher energy injury mechanism.

Mid-term Outcomes in Perilunate Dislocations

Introduction: Perilunate dislocations and fracture-dislocations are often related to fair or poor results. The goal of this study is to analyze radiographic and functional outcomes of surgically treated patients with perilunate injuries. Methods: We assessed a retrospective series of 37 patients (36 male), mean age 36 (range, 17-71), with a mean follow-up of 4 years (range, 1-10.1). All were subject to worker’s compensation. All patients had dorsal perilunate dislocations; there were 13 cases of perilunate dislocation and 24 cases of perilunate fracture-dislocations. Seventeen patients had a scaphoid fracture and 7 presented other fractures (radial styloid, triquetrum, etc.). All patients had surgical treatment with k wire carpus stabilization, open ligamentous repair (24 cases), scaphoid fixation (9 k wire, 8 headless screws), and other bone fixation when indicated. The Mayo wrist score (MWS) was used for functional evaluation. Radiographic examination was focused in osteoarthritis and instability, according to Herzberg classification. We defined poor results patients with at least one of the following: MWS < 60 points, advanced osteoarthritis, scapholunate instability (SL gap > 5 mm or SL angle > 70°), scaphoid nonunion, or major surgery: proximal row carpectomy (PRC), wrist arthrodesis, or nonunion surgery. Results: Patients had a mean flexion of 44.8° (SD 15.2) and mean extension of 46.8° (SD 16.7). Two cases had severe stiffness (less than 30° arc of motion). Mean grip strength was 66% of contralateral (SD 19.2). According to MWS, 1 patient had excellent results, 7 good (19%), 18 fair (49%), and 11 patients poor results (30%). According to our definition of poor results, 24 of 37 (65%) patients had an unsatisfactory outcome. Radiographic evaluation showed 10% of advanced osteoarthritis and 45% of instability signs. Six patients were classified as Herzberg A (normal alignment without osteoarthritis) and 11 patients as A1 (normal alignment with osteoarthritis). One patient showed instability without osteoarthritis (B) and 11 patients showed instability with osteoarthritis (B1). Seven patients had x-rays modified by the treatment (C). Five patients with trans-scaphoid fracture dislocation had nonunion, 4 of them went to bone graft and only 2 of these get union. One scaphoid nonunion went directly to PRC. There were 3 total wrist arthrodesis (2 due to arthritis and 1 due to instability) and 4 PRC, 3 in context of failed nonunion treatment and 1 in a severe and complex instability. Discussion: Perilunate dislocations and fracture-dislocations are complex injuries with a high rate of unsatisfactory outcomes. Our series showed poor clinical outcomes in 65% which correlate with the poor and fair results in the MWS. We observed a high rate of nonunion in trans-scaphoid dislocations, carpal instability, and articular degenerative changes. These factors would be independent of patient functional performance.

RADIAL AND VOLAR PERILUNATE TRANS-SCAPHOID FRACTURE DISLOCATION: A CASE REPORT

A case of radial and volar perilunate trans-scaphoid fracture dislocation in which the proximal fragment of the scaphoid was dislocated dorsally is presented.

Open reduction and internal fixation combined with intercarpal ligament repair for the treatment of acute perilunate transscaphoid fracture dislocations of perilunate dislocations

Objective To evaluate the results of Open reducdon and internal fixation combined with repairing of the intercarpal ligaments using suture anchors for the treatment of perilunate fracture dislocations or perilunate dislocations. Methods From February 2004 to August 2006,12 cases of perilunate fracture dislocations or perilunate dislocations were treated operatively,in which 8 cases were transscaphoid fracture dislocations and 4 cases were perilunate dislocations.All the fractures were fixed with AO 3.0 mm cannulated screws or 3.0 mm Bold screws,with the scapholunate or lunotriquertral ligaments sutured by Mitek mini suture anchors. Results All cases were followed up for a mean period of 37 months(from 33 to 48 months).All the scaphoid healed primarily,the height of the carpal was maintained well with a mean scapho-lunate angle of 50°(35°to 65°),mean radio-lunate angle of 5°(-10°to 15°),the mean index of carpal height was 0.51(0.50 to 0.53),the ROM of the wrist iS about 92.5°,The grip strength was 76.7% of the contralateral side.The modified Nayo wrist score revealed 1 excellent,4 good,4 fair and 3 poor results.The average score was 72(50to 95). Collclusion The wrist function can be obtained satisfactorily by early open reduction and internal fixation for perilunate fracture disloeations or perilunate dislocations.Carpal instability or carpal collapse can be avoided by Intercarpal fixation and ligaments rear in short term. Key words: Scaphoid bone; Fracture fixation,internal; Reconstruction surgical procedures; Perilunate dislocation

Scaphoid Nonunion Treated With Vascular Bone Grafts Pedicled on the Dorsal Supra-retinacular Artery of the Distal Radius

Nonunion and avascular necrosis (AVN) are frequent complications of scaphoid fractures. We describe the operative technique and long-term results of treatment with pedicle vascularized bone grafts (VBGs) of the distal radius in patients with scaphoid fractures in whom nonunion and AVN developed. During a 4-year period (1997-2000), VBGs pedicled on either the first and second or second and third compartments of the supraretinacular artery of the distal radius were in our hospital used to treat 11 patients with symptomatic scaphoid nonunion involving AVN of the proximal fragment (one with perilunate transscaphoid fracture dislocation and 10 with displaced scaphoid fractures with nonunion). Nine of these 11 patients received fixation with divergent K-wires fixation and two received Herbert screws fixation. Osseous union was achieved in all 11 patients treated with VBGs within an average period of 13 weeks. Functional results of treatment, which were measured using the modified Mayo Wrist Score, were encouraging in all patients in this series (four excellent, six good, and one fair). The deformity of ununited scaphoid was well corrected. The index study suggests that this treatment can be used not only to revascularize necrotic scaphoid, but also to correct humpback deformity and the resulting carpal instability.

Anterior dislocation of the proximal fragment of a scaphoid fracture: A case report

A case of irreducible anterior dislocation of the proximal fragment of a scaphoid fracture without perilunate or lunate dislocation is described. This case is a subtle variation of transscaphoid fracture dislocation. The mechanism of injury of this entity is also discussed. Case Report

Radial and volar perilunate transscaphoid fracture dislocation.

An unusual volar and radial perilunate transscaphoid fracture dislocation is reported. Treatment of perilunate transscaphoid fracture dislocations by closed reduction often produces a poor result. Early open reduction may be followed by a good result, but if open reduction is impossible, proximal row carpectomy is advised.