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PurposeTo determine the effect of simulated radioscapholunate fusion with distal scaphoid excision (RSLF+DSE), 4-corner fusion with scaphoidectomy (4-CF), and proximal row carpectomy (PRC) on the wrist's range of motion (ROM), contact pressure, and contact force in a cadaveric model.MethodsTen freshly frozen cadaveric wrists were tested under 4 sequential conditions: native wrist, RSLF+DSE, 4-CF, and PRC. The simulated fusions were performed using two 1.6-mm Kirschner wires. The ROM in the flexion-extension and radioulnar deviation planes was evaluated. Contact area, contact pressure, and contact force were measured at the scaphocapitolunate joint for the RSLF+DSE simulation and radiocarpal joint for the 4-CF and PRC simulations. Mechanical testing was performed using a 35-N uniaxial load and pressure-sensitive film.ResultsThe RSLF+DSE and 4-CF groups had a decreased wrist arc ROM compared with the native wrist. The PRC group had a greater wrist arc ROM compared with the RSLF+DSE and 4-CF groups, but compared to the native wrist, it demonstrated a mildly decreased wrist arc ROM. The carpal pressure and contact force were significantly increased in the RSLF+DSE, 4-CF, and PRC groups compared with those in the native wrist. The RSLF+DSE group had the smallest increase in the carpal pressure and contact force, whereas the PRC group had the greatest increase.ConclusionsOur study validates previous findings that PRC is motion-conserving but has the greatest contact force, whereas RSLF-DSE and 4-CF may cause a decrease in the ROM but have lower contact forces.Clinical relevanceUnderstanding the underlying native wrist biomechanics and alterations following different surgical treatments may assist hand surgeons in their clinical decision making for the treatment of stage II scapholunate advanced collapse.

Purpose: High bone density and quality is associated with improved screw fixation in fracture fixation. The objective of this study was to assess bone density and quality in the proximal and distal scaphoid to determine optimum sites for placement of 2 screws in scaphoid fracture fixation. Method(s): Twenty-nine cadaveric human scaphoid specimens were harvested and scanned using micro-computed tomography. Bone density (bone volume fraction) and bone quality (relative bone surface area, trabecular number, and trabecular thickness) were evaluated in 4 quadrants within each of the proximal and distal scaphoid. Result(s): The proximal radial quadrant of the scaphoid had significantly greater bone volume than the distal ulnar (mean difference, 33.2%) and distal volar quadrants (mean difference, 32.3%). There was a significantly greater trabecular number in the proximal radial quadrant than in the distal ulnar (mean difference, 16.7%) and in the distal volar quadrants (mean difference, 15.9%) and between the proximal ulnar and the distal ulnar quadrants (mean difference, 12%). There was a significantly greater bone surface area in the proximal radial and distal radial quadrants than in the distal ulnar and distal volar quadrants. There were no significant differences in trabecular thickness between the 8 analyzed quadrants Conclusion(s): Although there are differences in bone volume, trabecular number, and bone surface area between the proximal pole of the scaphoid and that of the distal pole, there were no significant differences in the bone quality (trabecular thickness, trabecular number, and relative bone surface area) and density (bone volume fraction) between the 4 quadrants of the proximal or distal pole of the cadaveric scaphoids studied. Clinical relevance: Insertion of 2 headless compression screws can be determined by ease of surgical access and ease of screw positioning and not by differences in bone quality or density of the proximal or distal scaphoid.Copyri

Purpose: High bone density and quality is associated with improved screw fixation in fracture fixation. The objective of this study was to assess bone density and quality in the proximal and distal scaphoid to determine optimum sites for placement of 2 screws in scaphoid fracture fixation. Method(s): Twenty-nine cadaveric human scaphoid specimens were harvested and scanned using micro-computed tomography. Bone density (bone volume fraction) and bone quality (relative bone surface area, trabecular number, and trabecular thickness) were evaluated in 4 quadrants within each of the proximal and distal scaphoid. Result(s): The proximal radial quadrant of the scaphoid had significantly greater bone volume than the distal ulnar (mean difference, 33.2%) and distal volar quadrants (mean difference, 32.3%). There was a significantly greater trabecular number in the proximal radial quadrant than in the distal ulnar (mean difference, 16.7%) and in the distal volar quadrants (mean difference, 15.9%) and between the proximal ulnar and the distal ulnar quadrants (mean difference, 12%). There was a significantly greater bone surface area in the proximal radial and distal radial quadrants than in the distal ulnar and distal volar quadrants. There were no significant differences in trabecular thickness between the 8 analyzed quadrants Conclusion(s): Although there are differences in bone volume, trabecular number, and bone surface area between the proximal pole of the scaphoid and that of the distal pole, there were no significant differences in the bone quality (trabecular thickness, trabecular number, and relative bone surface area) and density (bone volume fraction) between the 4 quadrants of the proximal or distal pole of the cadaveric scaphoids studied. Clinical relevance: Insertion of 2 headless compression screws can be determined by ease of surgical access and ease of screw positioning and not by differences in bone quality or density of the proximal or distal scaphoid.Copyri

Scaphoid fractures are common and have an increasing incidence. High clinical suspicion and complementary studies are required to reach the diagnosis, where the physical examination has high sensitivity but low specificity. Radiographs have a low negative predictive value and a high false negative rate, whereas magnetic resonance imaging is the study of choice due to its high sensitivity and effectiveness, in addition to detecting ligament injuries and presenting a favorable cost-benefit ratio. Computerized tomography has a similar sensibility, and has great utility in surgical planning. Herbert's classification is the most widely used and has great utility in defining treatment, which depends on the time to diagnosis, location and stability of the fracture. As surgical indications, instability, displacement greater than 1mm, proximal and oblique pole fractures stand out. Surgical management can be both volar and dorsal, with open or percutaneous technique depending on the characteristics of each case. In general terms, consolidation occurs in the vast majority of cases, being less in: displaced fractures, proximal pole fractures, delayed diagnosis fractures and smoking patients. Surgical management leads to a higher rate of complications, however they are considered minor. The case of a patient with a history of wrist trauma is presented. In the initial evaluation he presented little specific clinical data, a wrist x-ray was performed and no bone lesion was evident. However, the patient persisted with pain, so computed axial tomography was performed, and a fracture of the proximal pole of the scaphoid was diagnosed. Surgical management of the fracture was performed., Las fracturas del escafoides son comunes y presentan una incidencia que viene en aumento. Se requiere de una alta sospecha clínica y de estudios complementarios para llegar al diagnóstico, donde el examen físico tiene alta sensibilidad pero baja especificidad. Las radiografías presentan un bajo valor predictivo negativo y una alta tasa de falsos negativos, mientras que la resonancia magnética es el estudio de elección por su alta sensibilidad y efectividad, además de que detecta lesiones ligamentarias y presenta una relación costo-beneficio favorable. La sensibilidad de la tomografía axial computarizada es similar, y tiene gran utilidad en el planeamiento quirúrgico. La clasificación de Herbert es la más utilizada y tiene utilidad para definir el tratamiento, el cual depende del momento del diagnóstico, la localización y la estabilidad de la fractura. Como indicaciones quirúrgicas destacan la inestabilidad, el desplazamiento mayor a 1mm, las fracturas del polo proximal y las oblicuas. El manejo quirúrgico puede ser tanto volar como dorsal, con técnica abierta o percutánea dependiendo de las características de cada caso. En términos generales, se presenta consolidación en la gran mayoría de los casos; siendo menor en: aquellas fracturas desplazadas, en fracturas del polo proximal, en fracturas de diagnóstico tardío y en pacientes fumadores. El manejo quirúrgico condiciona mayor tasa de complicaciones, sin embargo las mismas se consideran menores. Se expone el caso de un paciente con antecedente de trauma de muñeca. En la valoración inicial, presentó datos clínicos poco específicos, se realizó una radiografía de muñeca y no se evidenció ninguna lesión ósea. Sin embargo, el paciente persistió con dolor, por lo que se realizó una tomografía axial computarizada, y se diagnosticó una fractura del polo proximal del escafoides. Se procedió con un manejo quirúrgico.

BackgroundThe anatomy of the scapholunate interosseous ligament (SLIL) has been described qualitatively in great detail, with recognition of the dorsal component's importance for carpal stability. The purpose of this study was to define the quantitative anatomy of the dorsal SLIL and to assess the use of high-frequency ultrasound to image the dorsal SLIL.MethodsWe used high-frequency ultrasound imaging to evaluate 40 wrists in 20 volunteers and recorded the radial-ulnar (length) and dorsal-volar (thickness) dimensions of the dorsal SLIL and the dimensions of the scapholunate interval. We assessed the use of high-frequency ultrasound by comparing the length and thickness of the dorsal SLIL on ultrasound evaluation and open dissection of 12 cadaveric wrists. Student's t test was used to assess the relationship between measurements obtained on cadaver ultrasound and open dissection.ResultsIn the volunteer wrists, the mean dorsal SLIL length was 7.5 ± 1.4 mm and thickness was 1.8 ± 0.4 mm; the mean scapholunate interval was 5.0 mm dorsally and 2.5 mm centrally. In the cadaver wrists, there was no difference in dorsal SLIL length or thickness between ultrasound and open dissection.ConclusionsThe dorsal SLIL is approximately 7.5 mm long and 1.8 mm thick. These parameters may be useful in treatment of SLIL injuries to restore the native anatomy. High-frequency ultrasound is a useful imaging technique to assess the dorsal SLIL, although further study is needed to assess the use of high-frequency ultrasound in detection of SLIL pathology.

INTRODUCTION: To compare the cost-effectiveness and patient impact between acute magnetic resonance imaging (MRI) management and conventional management in the diagnosis of occult scaphoid fractures in a rural setting. METHODS: Consecutive patients presenting to a rural emergency department (ED) with a suspected scaphoid fracture were randomly assigned to either conventional management (6) or acute MRI management (10) (3 patients were excluded from the study analysis). All healthcare costs were compared between the two management groups and potential impacts on the patients' pain, mobility and lifestyle were also measured. RESULTS: There were no significant differences between the two groups at baseline. There was one (10%) scaphoid fracture in the MRI group and none in the conventional group (P = 0.42). A larger proportion of other fractures were diagnosed in the MRI group (20% (2) vs. 16.7% (1), P = 0.87), as well as less clinic attendances (1 (0-2.25) vs. 4 (2.25-5)) and diagnostic services (1 (1-1.25) vs. 2 (1-3)). Median management costs were $485.05 (AUD) (MRI) and $486.90 (AUD) (conventional). The MRI group had better pain and satisfaction scores as well as less time of immobilisation, treatment and time off work. CONCLUSION: MRI dramatically reduces the amount of unnecessary immobilisation, time of treatment and healthcare usage in a rural setting. The two protocols are suggested to be equivalent financially. When potential societal costs, the amount of unnecessary immobilisation, low prevalence of true fractures and patient satisfaction are considered, acute MRI should be the management technique of choice. Further studies are still required to assess the best method for managing bone bruise within the scaphoid.

Scaphoid fracture is most common in young individuals of working age. Without adequate diagnosis and treatment, long-term results are poor. Operative treatment is being recommended increasingly often instead of a long time in cast, although there is no evidence-based support for its superiority. The present thesis focuses on diagnostic problems and therapeutic consequences of acute scaphoid fractures and of scaphoid reconstruction when other treatments have failed. Simultaneous plain radiographs and computed tomography were done in 97 injured wrists. Structural assessments of plain radiography images were highly predictive with respect to the risk of having a displaced or comminute fracture as diagnosed on computed tomography. Any finding of a gap or step-off > 0.5 mm, the presence of an intermediate fragment or a dorsal lunate tilt of ≥ 15° identified 81 % of fractures that were displaced or comminuted when investigated with computed tomography. Eighty-three patients were randomly allocated to and received either nonoperative treatment in cast or operative treatment with the aim of assessing long-term outcome of the two treatment options. Fifty-two of the patients were occupationally active. From an occupational perspective with an early return to work, surgical treatment was superior in individuals with manual employment, and from a health economic perspective conservative treatment was superior in non-manual workers. Patients treated for scaphoid fractures generally do well up to 13 years after the injury based on limb-specific outcome scores. No benefits were identified with operative treatment compared to non-operative treatment in cast. On the contrary, there was an increased risk for osteoarthritis in the scaphotrapezial joint in those who were operated. The patient-rated long-term results of silicone implant arthroplasty were good, with pain relief and reasonable hand function in many patients up to 20 years after surgery.

Scaphoid fracture is most common in young individuals of working age. Without adequate diagnosis and treatment, long-term results are poor. Operative treatment is being recommended increasingly often instead of a long time in cast, although there is no evidence-based support for its superiority. The present thesis focuses on diagnostic problems and therapeutic consequences of acute scaphoid fractures and of scaphoid reconstruction when other treatments have failed. Simultaneous plain radiographs and computed tomography were done in 97 injured wrists. Structural assessments of plain radiography images were highly predictive with respect to the risk of having a displaced or comminute fracture as diagnosed on computed tomography. Any finding of a gap or step-off > 0.5 mm, the presence of an intermediate fragment or a dorsal lunate tilt of ≥ 15° identified 81 % of fractures that were displaced or comminuted when investigated with computed tomography. Eighty-three patients were randomly allocated to and received either nonoperative treatment in cast or operative treatment with the aim of assessing long-term outcome of the two treatment options. Fifty-two of the patients were occupationally active. From an occupational perspective with an early return to work, surgical treatment was superior in individuals with manual employment, and from a health economic perspective conservative treatment was superior in non-manual workers. Patients treated for scaphoid fractures generally do well up to 13 years after the injury based on limb-specific outcome scores. No benefits were identified with operative treatment compared to non-operative treatment in cast. On the contrary, there was an increased risk for osteoarthritis in the scaphotrapezial joint in those who were operated. The patient-rated long-term results of silicone implant arthroplasty were good, with pain relief and reasonable hand function in many patients up to 20 years after surgery.

Scaphoid fracture is most common in young individuals of working age. Without adequate diagnosis and treatment, long-term results are poor. Operative treatment is being recommended increasingly often instead of a long time in cast, although there is no evidence-based support for its superiority. The present thesis focuses on diagnostic problems and therapeutic consequences of acute scaphoid fractures and of scaphoid reconstruction when other treatments have failed. Simultaneous plain radiographs and computed tomography were done in 97 injured wrists. Structural assessments of plain radiography images were highly predictive with respect to the risk of having a displaced or comminute fracture as diagnosed on computed tomography. Any finding of a gap or step-off > 0.5 mm, the presence of an intermediate fragment or a dorsal lunate tilt of ≥ 15° identified 81 % of fractures that were displaced or comminuted when investigated with computed tomography. Eighty-three patients were randomly allocated to and received either nonoperative treatment in cast or operative treatment with the aim of assessing long-term outcome of the two treatment options. Fifty-two of the patients were occupationally active. From an occupational perspective with an early return to work, surgical treatment was superior in individuals with manual employment, and from a health economic perspective conservative treatment was superior in non-manual workers. Patients treated for scaphoid fractures generally do well up to 13 years after the injury based on limb-specific outcome scores. No benefits were identified with operative treatment compared to non-operative treatment in cast. On the contrary, there was an increased risk for osteoarthritis in the scaphotrapezial joint in those who were operated. The patient-rated long-term results of silicone implant arthroplasty were good, with pain relief and reasonable hand function in many patients up to 20 years after surgery.

Scaphoid fracture is most common in young individuals of working age. Without adequate diagnosis and treatment, long-term results are poor. Operative treatment is being recommended increasingly often instead of a long time in cast, although there is no evidence-based support for its superiority. The present thesis focuses on diagnostic problems and therapeutic consequences of acute scaphoid fractures and of scaphoid reconstruction when other treatments have failed. Simultaneous plain radiographs and computed tomography were done in 97 injured wrists. Structural assessments of plain radiography images were highly predictive with respect to the risk of having a displaced or comminute fracture as diagnosed on computed tomography. Any finding of a gap or step-off > 0.5 mm, the presence of an intermediate fragment or a dorsal lunate tilt of ≥ 15° identified 81 % of fractures that were displaced or comminuted when investigated with computed tomography. Eighty-three patients were randomly allocated to and received either nonoperative treatment in cast or operative treatment with the aim of assessing long-term outcome of the two treatment options. Fifty-two of the patients were occupationally active. From an occupational perspective with an early return to work, surgical treatment was superior in individuals with manual employment, and from a health economic perspective conservative treatment was superior in non-manual workers. Patients treated for scaphoid fractures generally do well up to 13 years after the injury based on limb-specific outcome scores. No benefits were identified with operative treatment compared to non-operative treatment in cast. On the contrary, there was an increased risk for osteoarthritis in the scaphotrapezial joint in those who were operated. The patient-rated long-term results of silicone implant arthroplasty were good, with pain relief and reasonable hand function in many patients up to 20 years after surgery.

Background. The fracture of scaphoid continues being a challenge for orthopedist and hand surgeons. Objective. To show the anatomical details of the bony strip from the second metacarpal in corpses injected with green latex and the results of the chirurgical technique in a series of patients with scaphoid speudartrosis. Materials and methods. We carry out an initial anatomical analysis before employing the chirurgical technique in clinical setting, and then we did a descriptive study of patients with pseudarthrosis of scaphoid, treated with vascularized bony graft by the first metacarpal artery. Results. All patients consolidated and improved in the pain scale, they did not have mobility deterioration or residual carpus instability, after ten years of observations. Conclusions. The vascularized graft is a useful option in the management of the speudartrosis of the scaphoid., Antecedentes. La fractura de escafoides sigue siendo un reto para el ortopedista y para los cirujanos de mano. Objetivo. Mostrar los detalles anatómicos del colgajo óseo del segundo metacarpiano en cadáveres inyectados con látex coloreado de verde y los resultados de la técnica empleada en una serie de pacientes con seudoartrosis de escafoides. Material y métodos. Describimos detalles anatómicos. Todos nuestros pacientes consolidaron, mejoraron en la escala de dolor, no tuvieron deterioro de la movilidad y no presentaron inestabilidad de carpo residual. Resultado. El injerto vascularizado es una opción útil en el manejo de la pseudoatrosis del escafoides. Conclusión. Estudio descriptivo de una serie de casos de pacientes con seudoartrosis de escafoides, tratados con injerto óseo vascularizado por la primera arteria metacarpiana dorsal. Un estudio anatómico inicial antes de emplear la técnica en nuestros pacientes.

Background. The fracture of scaphoid continues being a challenge for orthopedist and hand surgeons. Objective. To show the anatomical details of the bony strip from the second metacarpal in corpses injected with green latex and the results of the chirurgical technique in a series of patients with scaphoid speudartrosis. Materials and methods. We carry out an initial anatomical analysis before employing the chirurgical technique in clinical setting, and then we did a descriptive study of patients with pseudarthrosis of scaphoid, treated with vascularized bony graft by the first metacarpal artery. Results. All patients consolidated and improved in the pain scale, they did not have mobility deterioration or residual carpus instability, after ten years of observations. Conclusions. The vascularized graft is a useful option in the management of the speudartrosis of the scaphoid., Antecedentes. La fractura de escafoides sigue siendo un reto para el ortopedista y para los cirujanos de mano. Objetivo. Mostrar los detalles anatómicos del colgajo óseo del segundo metacarpiano en cadáveres inyectados con látex coloreado de verde y los resultados de la técnica empleada en una serie de pacientes con seudoartrosis de escafoides. Material y métodos. Describimos detalles anatómicos. Todos nuestros pacientes consolidaron, mejoraron en la escala de dolor, no tuvieron deterioro de la movilidad y no presentaron inestabilidad de carpo residual. Resultado. El injerto vascularizado es una opción útil en el manejo de la pseudoatrosis del escafoides. Conclusión. Estudio descriptivo de una serie de casos de pacientes con seudoartrosis de escafoides, tratados con injerto óseo vascularizado por la primera arteria metacarpiana dorsal. Un estudio anatómico inicial antes de emplear la técnica en nuestros pacientes.