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Background: The scaphoid is an important mechanical stabilizer for both the proximal and distal carpal columns. The precise estimation of the complete scaphoid bone based on partial bone geometric information is a crucial factor in the effective management of scaphoid nonunion. Statistical shape model (SSM) could be utilized to predict the complete scaphoid shape based on the defective scaphoid. However, traditional principal component analysis (PCA) based SSM is limited by its linearity and the inability to adjust the number of modes used for prediction. Purpose: This study proposes an iterative kernel principal polynomial shape analysis (iKPPSA)‐based SSM to predict the pre‐morbid shape of the scaphoid, aiming at enhancing the accuracy as well as the robustness of the model. Methods: Sixty‐five sets of scaphoid images were used to train SSM and nine sets of scaphoid images were used for validation. For each validation image set, three defect types (tubercle, proximal pole, and avascular necrosis) were virtually created. The predicted shapes of the scaphoid by PCA, PPSA, KPCA, and iKPPSA‐based SSM were evaluated against the original shape in terms of mean error, Hausdorff distance error, and Dice coefficient. Results: The proposed iKPPSA‐based scaphoid SSM demonstrates significant robustness, with a generality of 0.264 mm and a specificity of 0.260 mm. It accounts for 99% of variability with the first seven principal modes of variation. Compared to the traditional PCA‐based model, the iKPPSA‐based scaphoid model prediction demonstrated superior performance for the proximal pole type fracture, with significant reductions of 25.2%, 24.7%, and 24.6% in mean error, Hausdorff distance, and root mean square error (RMSE), respectively, and a 0.35% improvement in Dice coefficient. Conclusion: This study showed that the iKPPSA‐based SSM exploits the nonlinearity of data features and delivers high reconstruction accuracy. It can be effectively integrated into preoperative planning for scaphoid fracture management or morphology‐based biomechanical modeling of the scaphoid. [ABSTRACT FROM AUTHOR]

Objectives: Scaphoid fractures are usually diagnosed using X-rays, a low-sensitivity modality. Artificial intelligence (AI) using Convolutional Neural Networks (CNNs) has been explored for diagnosing scaphoid fractures in X-rays. The aim of this systematic review and meta-analysis is to evaluate the use of AI for detecting scaphoid fractures on X-rays and analyze its accuracy and usefulness. Materials and methods: This study followed the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and PRISMA-Diagnostic Test Accuracy. A literature search was conducted in the PubMed database for original articles published until July 2023. The risk of bias and applicability were evaluated using the QUADAS-2 tool. A bivariate diagnostic random-effects meta-analysis was conducted, and the results were analyzed using the Summary Receiver Operating Characteristic (SROC) curve. Results: Ten studies met the inclusion criteria and were all retrospective. The AI's diagnostic performance for detecting scaphoid fractures ranged from AUC 0.77 to 0.96. Seven studies were included in the meta-analysis, with a total of 3373 images. The meta-analysis pooled sensitivity and specificity were 0.80 and 0.89, respectively. The meta-analysis overall AUC was 0.88. The QUADAS-2 tool found high risk of bias and concerns about applicability in 9 out of 10 studies. Conclusions: The current results of AI's diagnostic performance for detecting scaphoid fractures in X-rays show promise. The results show high overall sensitivity and specificity and a high SROC result. Further research is needed to compare AI's diagnostic performance to human diagnostic performance in a clinical setting. Clinical relevance statement: Scaphoid fractures are prone to be missed secondary to assessment with a low sensitivity modality and a high occult fracture rate. AI systems can be beneficial for clinicians and radiologists to facilitate early diagnosis, and avoid missed injuries. Key Points: • Scaphoid fractures are common and some can be easily missed in X-rays. • Artificial intelligence (AI) systems demonstrate high diagnostic performance for the diagnosis of scaphoid fractures in X-rays. • AI systems can be beneficial in diagnosing both obvious and occult scaphoid fractures. [ABSTRACT FROM AUTHOR]

Variability in the topography of the arteries of the upper extremity is associated with fetal development. Determination of individual anatomical variants of the upper extremity blood supply at different stages of ontogeny, especially in human fetuses, is of great practical importance in vascular surgery. Aim of the study. To study the individual anatomical variability of the ulnar and radial arteries in human fetuses of different ages. Material and methods. The study of variants of the topography of the branches of the radial and ulnar arteries, the peculiarities of the formation of the superficial palmar arterial arch was carried out on 46 preparations of the upper extremities of 23 human fetuses 81. 0-375, 0 mm parieto-coccygeal length using macromicroscopic dissection, vascular injection and morphometry without external signs of anatomical abnormalities or congenital malformations of skeletal, fascial-muscular and vascular-nerve structures of the upper extremities. Results and discussion. Our study demonstrated fetal anatomical variability and bilateral asymmetry of the right and left upper extremity arteries in human fetuses. Thus, in a fetus with a PCL of 210.0 mm, the right brachiocephalic artery was found to originate from the right axillary artery. It should be noted that the initial portion of the right brachiocephalic artery passed anteriorly, not posteriorly, to the median nerve, and at the level of the middle third of the anterior shoulder region, the artery occupied a superficial position relative to the median nerve, which is located in the lateral bicuspid groove of the shoulder. The brachiocephalic artery was then directed in an oblique lateral direction to the lateral surface of the forearm. In this fetus, a high origin of the right ulnar artery was found, which originated from the trunk of the brachiocephalic artery in the upper third of the right anterior shoulder region. At the border of the middle and lower thirds of the anterior shoulder region, the ulnar artery crossed the ulnar nerve anteriorly and passed with it in the median biceps groove of the shoulder. 3.0 mm below the beginning of the ulnar artery, the superior circumflex ulnar artery bifurcated from the brachiocephalic artery, and in the lower third of the anterior shoulder region, a common trunk bifurcated from the brachiocephalic artery and bifurcated into the middle and inferior circumflex ulnar arteries. We found arterial anastomoses between the latter and branches of the ulnar artery. The immediate continuation of the right brachiocephalic artery in the palm was the brachiocephalic artery of the thumb. At the level of the base of the proximal phalanx of the thumb, the brachiocephalic artery branched into three palmar finger arteries, which were directed to both edges of the palmar surface of the first finger and the radial edge of the palmar surface of the second finger. The superficial palmar arch was formed by the superficial palmar branch of the brachial radial artery, the terminal ulnar artery, and the anterior interosseous artery. Four common palmar arteries originated from the superficial palmar arch and were directed to the ulnar edge of the palmar surface of the second finger and the palmar surfaces of the adjacent edges of the third through fifth fingers. The left superficial palmar arch had an atypical structure located under the palmar aponeurosis at the level of the middle of the metacarpals and formed by the terminal parts of the ulnar and anterior interosseous arteries. Because the radial artery in this fetus was traced to the distal part of the forearm (to the scaphoid bone), we did not find branches of this artery in the palm area, especially the superficial palmar branch of the radial artery. The ulnar artery was directed caudally to the palmar region, curving slightly in an arc to the radial side of the hand. From the terminal portion of the ulnar artery, three common palmar finger arteries bifurcated, which in turn bifurcated into five palmar finger arteries of their own. The latter supplied the ulnar edge of the third finger and the palmar areas of the fourth and fifth fingers. The radial edge of the third finger and the palmar areas of the II-I fingers were supplied by five separate palmar arteries originating from the terminal portion of the anterior interosseous artery. Anastomoses were found between the palmar arteries, mainly in the middle and terminal phalanges. In the area of the palm, numerous muscular branches bifurcated from the anterior interosseous and ulnar arteries, providing blood supply to the palm muscles. Conclusions. In the majority of the studied fetuses (82.61 %) the superficial palmar arch was closed, in 17.39 % of the observations it was not closed. In 10.5 % of cases, the superficial palmar arch was formed by the trunk of the ulnar artery and the median forearm artery, and in 5.2 % - with the participation of the ulnar and anterior interosseous arteries. The ulnar artery is predominantly involved in the formation of the superficial palmar arch. In a fetus with a PCL of 210.0 mm, the right brachiocephalic artery was found, as well as a high origin of the right ulnar artery from it and an atypical branching of other branches. In particular, the superficial palmar arch was formed by the superficial palmar branch of the brachial radial artery, the terminal ulnar artery, and the anterior interosseous artery, while the left superficial palmar arch was formed by the terminal ulnar and anterior interosseous arteries. [ABSTRACT FROM AUTHOR]

This study describes the age and sex distribution, trauma mechanism, treatment and influence of patient-reported outcomes of 6542 carpal fractures from the Swedish Fracture Registry (SFR). The most commonly fractured carpal bone was the scaphoid (60%), followed by the triquetrum (25%), hamate (5%) and trapezium (4%). The mean age at injury was 41 years, and 69% of patients were male. The age and sex distribution of carpal fractures differed substantially between the different carpal bones. Men were more likely to sustain a carpal fracture after high-energy trauma and were more likely to be treated surgically. Carpal fractures had a small negative effect on the Short Musculoskeletal Function Assessment Hand/Arm Index and EQ-5D scores 1 year after the injury. Level of evidence: IV [ABSTRACT FROM AUTHOR]

BACKGROUND: Abnormal scaphoid alignment after fracture is used as an indication for fixation. Acceptable alignment after reduction and fixation of scaphoid fractures is not well defined. We systematically reviewed the literature to identify how scaphoid malunion is currently defined and by what parameters. METHODS: A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Multiple databases were searched for studies published in the English language that reported on outcomes after scaphoid malunion and included measurements to define malunions. Radiographic scaphoid measurement parameters were collected. Clinical outcome measures recorded included grip strength, wrist range of motion, and patient-reported outcome measures. Study quality was analyzed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Descriptive summaries of the studies are presented. RESULTS: The initial search yielded 1600 articles. Ten articles (161 participants, 93% males, mean age = 28.3 + 6.3 years, mean MINORS score = 10.2 + 1.6) were included and analyzed. Scaphoid malunion was defined if the lateral intrascaphoid angle (LISA) was >45° (3 articles), LISA >35° (1 article), and height to length ratio >0.6 (3 articles). Four out of 5 studies found no significant associations between patient outcomes and degree of scaphoid malunion measured on imaging. CONCLUSIONS: There is a lack of consensus for defining scaphoid malunion on imaging and absence of correlation between findings on imaging and patient outcomes. Future studies defining scaphoid malunion should be appropriately powered, incorporate measures of intrarater and interrater reliabilities for all reported imaging measurements, and utilize validated patient-reported outcome measures to reflect that malunion is associated with inferior outcomes meaningful to patients.

Objective: Rare disease Background: Scaphocapitate syndrome is a rare clinical entity consisting of a combined scaphoid and capitate fracture along with a 90- or 180-degrees rotation of the proximal capitate fragment. The syndrome is scarcely described in the literature, with proximal migration of the capitate fragment being reported only by Mudgal et al in 1995. Concurrent compression of the median nerve is a highly unfortunate event, suggesting a unique case presented here. Case Report: We present a unique case of scaphocapitate fracture-dislocation in a 25-year-old man with volar dislocation of the capitate's fragment deep to the median nerve. X-rays and CT scan were performed and the patient was treated few hours after the injury by a hand specialist, in order to prevent median neuropathy and avascular necrosis of the fragment. Open reduction and internal fixation utilizing a Herbert screw for the scaphoid fracture and 3 additional K-wires was performed. Immediately post-operatively, the acute neurological symptoms had subsided and good reduction was acquired radiologically. One year post-operatively the patient had regained good hand and wrist functionality, with no extension or flexion ROM deficits. Conclusions: Immediate intervention in a specialized center with reduction and fixation utilizing a Herbert screw and K-wires showed favorable 1-year results in our case of scaphocapitate syndrome. The impending complications of median neuropathy and capitate avascular necrosis were avoided despite the high-risk injury pattern. [ABSTRACT FROM AUTHOR]

Purpose: Cancellous bone harvested from the distal radius has been used in various hand surgeries, but studies on its use in scaphoid waist nonunions are insufficient. We investigated the usefulness of cancellous bone graft from the distal radius and headless screw fixation in unstable scaphoid waist nonunion. Methods: Thirty-one patients who underwent cancellous bone graft from the distal radius and headless screw fixation for unstable scaphoid waist nonunion with follow-up for at least 1 year were included. Bone union time, the number of patients with bone union at six and 12 weeks, total number of patients with bone union at last follow-up, and bone union on the computed tomography (CT) image at postoperative six weeks were evaluated. Further, pre- and postoperative radiological measurements, such as scaphoid length and height, lateral intra-scaphoid angle, and height-to-length ratio, and functional outcomes were compared. Additionally, inter-observer reliability of radiologic parameters was checked. Results: Bone union was achieved in 29 patients. There were two nonunions (6.5%). Bone union time was 10.7 (range, 6–26) weeks. Eighteen (58%) and 25 patients (80.6%) were diagnosed with bone union on the plain radiographs at six and 12 weeks, respectively. Twenty-two patients (71%) were diagnosed with bone union on CT performed at six weeks. Radiological measurements and functional outcomes improved postoperatively. The scaphoid length showed good inter-observer agreement. Conclusions: In treating unstable scaphoid waist nonunion, cancellous bone graft from the distal radius and headless screw fixation achieved 93.5% union and improved radiological measurements as well as functional outcomes. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the outcomes of fixing scapholunate with pins and screws in parallel,convergent, and divergent orientations.Methods: In this computer simulation study, the CT scan images of a healthy subject wereused to construct a 3D model of the wrist joint using MIMICS software. The imposed force to scaphoid and3D model lunate bones, as well as the scapholunate angle and distance, were compared in different surgicaltechniques using parallel, divergent, and convergent pins and screws.Results: In the absence of external force, the imposed stress applied to the scaphoid and lunate bones in casesof parallel pins and screws were 7.5MPa, 5.08MPa (pins), 1.134MPa, and 1.151MPa (screws), and 10.90MPa,10.90MPa (pins), 9.7MPa, and 34.1MPa (screws) for 50N flexion force. The imposed stress in this approach issignificantly lower compared to other interventions. Better outcomes were seen regarding scapholunate angleand scapholunate distance in using parallel pins or screws as well.Conclusion: In conclusion, implementing parallel pins and screws for scapholunate fixation had better resultsin terms of achieving carpal stability in scapholunate dissociation. However, fixation with pins and screwsshowed a statistically significant difference. Furthermore, a wide range of motion exercises with no additionalforces can be used in the rehabilitation of patients undergoing this surgery.

PURPOSE OF THE STUDY The basic aim of the treatment of cystic nonunion is to provide stable fixation and mechanical compression to increase union, but there is no consensus on whether to perform bone grafting in the cystic area or not. The aim of this study was to compare the clinical and radiological results of patients with cystic scaphoid non-union who received open grafting, and internal fixation and those treated with percutaneous fixation without grafting. MATERIAL AND METHODS A retrospective evaluation was made of patients included those determined radiologically with Slade and Dodds grade IV scaphoid cystic non-union. Two different surgical procedures were performed. Percutaneous screw fixation was carried out on the patients in group 1. Open curettage–grafting and screw fixation were performed on the patients in group 2. Group 1 was comprised of 16 patients treated with percutaneous screw fixation, and group 2 was comprised of 17 patients who had open curettage–grafting and screw fixation. RESULTS In the radiological evaluation at the final follow-up examination, union was determined in 12 of the 16 (75%) patients in group 1 and 15 of the 17 (88%) patients in group 2. There was no statistically significant difference between the two groups in terms of union, functional outcomes and complication rates. DISCUSSION In the current study, the union rate was higher in the patients who had open curettage–grafting and fixation with a headless screw (88%) than in those with percutaneous screw without grafting (75%), but the difference was not determined to be statistically significant. The union rate of the group that received grafting was similar to the rates reported in the literature. CONCLUSIONS We think that both of these techniques may be successfully used for cystic scaphoid nonunions but percutaneous technique should be preferred as it is minimally invasive. Nevertheless, there is a need for further prospective, randomised studies with larger series to have better comparisons. [ABSTRACT FROM AUTHOR]

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.

ABSTRACT Objective: To evaluate the effectiveness of the dorsal fixation technique with a cannulated compression screw (CCS) for transverse scaphoid neck fractures. Methods: A case series study was carried out with patients treated with a CSS between April 2014 and May 2021. The main outcome was the healing of the fracture, verified by radiographic evaluation that used images of the wrist in anteroposterior, lateral, radial deviation, ulnar deviation and oblique views, obtained in the postoperative period. Results: Fifty-two patients aged between 15 and 65 years were analyzed, of which 43 (83%) were male. Of the 52 patients, 19 (36.53%) had a right-hand injury and 33 (63.46%) had a left-hand injury. Results were excellent in 47 patients (90.38%); good in 4 patients (7.69%), with reduced mobility compared to contralateral and poor in 1 patient (1.92%), with failure of consolidation and breakage of the synthesis material. In 51 cases (99%) there was bone consolidation at the end of six months. Conclusion: Osteosynthesis with a cannulated compression screw is a safe, effective and promising method for the treatment of scaphoid neck fractures. Level of Evidence IV, Case Series.

Most carpal bone fractures occur in the scaphoid. The most suitable size of NiTi shape memory alloy (nitinol) staples to heal scaphoid fractures was found by comparing two commercially available compression staples (DynaClip™ Bone Fixation System, 10×10 and 14×14 mm). The scaphoid bone was selected for simulating a model in SolidWorks software. To accurately investigate the effect of staple size on the bone the scaphoid was assumed to be a three-layer composite structure consisting of collagen and mineral crystals. The stress distributions along a path located at the waist of the scaphoid were assessed. The finite element analysis was carried out in ABAQUS software based on the nitinol staple shape memory effect and super-elasticity behavior. The results indicated that the smaller size of staples induced a more significant stress on the central zone of the scaphoid, whereas the larger size of staples showed a peak stress concentration on the peripheral zones with a reduced stress concentration at the center. Hence, it is suggested to utilize the two of these staples in different orientations or in parallel with each other to improve the biomechanical behavior of the regenerated bone. [ABSTRACT FROM AUTHOR]

In this clinical trial, patients were randomized to receive a pedicled vascularized bone graft, based on the 1,2-intercompartmental supraretinacular artery, or a non-vascularized iliac crest graft. Fixation was done with K-wires. Union and time to union were assessed using CT scans at regular intervals. Twenty-three patients received a vascularized graft, and 22 received a non-vascularized graft. Thirty-eight patients were available for union assessment and 23 for clinical measurements. There were no significant differences in union incidence, time to union, incidence of complications, patient-reported outcome scores, or wrist mobility and grip strength at final follow-up between the treatment groups. Smokers were 60% less likely to achieve union, independent of graft type. When controlling for smoking, patients receiving a vascularized graft were 72% more likely to achieve union. Given our small sample size, results should be interpreted with caution. Level of evidence: I [ABSTRACT FROM AUTHOR]

Percutaneous screw fixation has recently gained popularity as an alternative to conservative treatment to avoid prolonged immobilization. The placement of a screw in the central axis of the scaphoid has been shown to be biomechanically superior to its eccentricity. Still, it poses difficulties in performing percutaneous screw fixation via both palmar and dorsal approaches. We describe a palmar percutaneous screwing of corporal fractures of the scaphoid by a simple palmar transtrapezial approach allowing an optimal centering of the screw. We selected patients operated on by the same surgeon using the palmar transtrapezial approach between January 2015 and January 2019 based on the coding used for these fractures and the operative reports. In addition, pre- and postoperative data were collected from the patient's computer and paper records and by telephone contact with the patients. Thirty-three patients were included. Percutaneous screw fixation of the scaphoid was performed under locoregional anesthesia in the operating room with one arm in the supine position on the arm table. No hyper-extension of the wrist was performed. The Kirchner guidewire passed through the anterior horn of the trapezium and then into the trapezium-scaphoid joint. A screw replaced it after satisfactory centering in the axis of the scaphoid. Management took place on average within 12 days after the trauma. 75.8% were A2 fractures, according to Herbert's classification. The average operating time was 16.63 minutes, and in 91% of the cases, the patient was hospitalized for one day. The variation of the scapholunate angle on the preoperative profile radiographs with the angle defined by the axis of the scaphoid screw and the lunate postoperatively was on average 2.94°. One patient presented nonunion, and four showed an undersized screw with a screw overhang requiring revision surgery. The transtrapezial approach to fixation of acute scaphoid fractures facilitates precise percutaneous screw placement in the central axis of the scaphoid. A study of long-term complications, including the degenerative impact on the scaphotrapezial joint, is needed to assess the safety of passage through the anterior horn of the trapezium. [ABSTRACT FROM AUTHOR]

Background: Scaphoid non-union results in pain and decreased hand function. Untreated, almost all cases develop degenerative changes. Despite advances in surgical techniques, the treatment is challenging and often results in a long period with a supportive bandage until the union is established. Open, corticocancellous (CC) or cancellous (C) graft reconstruction and internal fixation are often preferred. Arthroscopic assisted reconstruction with C chips and internal fixation provides minimal trauma to the ligament structures, joint capsule, and extrinsic vascularization with similar union rates. Correction of deformity after operative treatment is debated with some studies favouring CC, and others found no difference. No studies have compared time to union and functional outcomes in arthroscopic vs. open C graft reconstruction. We hypothesize that arthroscopic assisted C chips graft reconstruction of scaphoid delayed/non-union provides faster time to union, by at least a mean 3 weeks difference. Methods: Single site, prospective, observer-blinded randomized controlled trial. Eighty-eight patients aged 18–68 years with scaphoid delayed/non-union will be randomized, 1:1, to either open iliac crest C graft reconstruction or arthroscopic assisted distal radius C chips graft reconstruction. Patients are stratified for smoking habits, proximal pole involvement and displacement of > / < 2 mm. The primary outcome is time to union, measured with repeated CT scans at 2-week intervals from 6 to 16 weeks postoperatively. Secondary outcomes are Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH), visual analogue scale (VAS), donor site morbidity, union rate, restoration of scaphoid deformity, range of motion, key-pinch, grip strength, EQ5D-5L, patient satisfaction, complications and revision surgery. Discussion: The results of this study will contribute to the treatment algorithm of scaphoid delayed/non-union and assist hand surgeons and patients in making treatment decisions. Eventually, improving time to union will benefit patients in earlier return to normal daily activity and reduce society costs by shortening sick leave. Trial registration: ClinicalTrials.gov NCT05574582. Date first registered: September 30, 2022. Items from the WHO trial registry are found within the protocol. [ABSTRACT FROM AUTHOR]

Introduction: Scaphoid fractures represent 5–10% of nonunion rate and the treatment options consist of an open reduction with correction of deformity, restoration of the scaphoid length with autologous wedge grafting and fixation. However, there is still no consensus in the literature on the best fixation method. Therefore, the purpose of the study is to compare plate fixation and screw fixation in treating scaphoid nonunion with humpback deformity and carpal instability. Methods: Prospective, non-randomised study comparing the treatment of two groups of patients with scaphoid nonunion. A total of 19 patients were included in the study, the first ten patients were included in group 1 (plate fixation), subsequently nine patients were included in group 2 (screw fixation). The nonunion duration was longer than 6 months and patients did not present type III Scaphoid Nonunion Advanced Collapse (SNAC). Clinical evaluations included pain intensity, range of motion, grip strength, pinch test and functional scales Disabilities of the Arm, Shoulder and Hand (DASH) and Mayo Wrist Score. Radiographic evaluations consisted of radiographs of both wrists in AP, AP with ulnar deviation, lateral and oblique views. Patients further underwent a tomography of the affected wrist for bone deformity, carpal collapse and later consolidation evaluation. Results: According to post-operative measurements, group 1 showed a significant improvement in the scapholunate angle (p = 0.011) and in the intrascaphoid angle (p = 0.002). Group 2 only showed an improvement in the scapholunate angle (p = 0.011). All patients in group 1 achieved consolidation in 8 weeks, while group 2 patients had a slower consolidation, with a mean of 14 weeks and standard deviation (SD) of 4.2, with statistical significance (p = 0.006). Conclusion: Our prospective study, despite the limitations, contributes to the literature for demonstrating a better fixation using plate, with a better correction of humpback deformity and Dorsal Intercalated Segment Instability (DISI) and a faster consolidation. Level of evidence: II, therapeutics studies; prospective comparative study. [ABSTRACT FROM AUTHOR]

Scaphoid fractures are a common wrist injury accounting for 2-7% of all adult fractures. Nonunion is described in 5-12% of cases leading to osteoarthritis. Several classifications have been developed focused on this pathology and its complication. We present a case of a 28 years old male patient with a scaphoid fracture and nonunion who spontaneously consolidates without treatment. We performed a literature review to recognize this pathology, its common evolution and possible treatment options. [ABSTRACT FROM AUTHOR]

Objectives: To assess how an artificial intelligence (AI) algorithm performs against five experienced musculoskeletal radiologists in diagnosing scaphoid fractures and whether it aids their diagnosis on conventional multi-view radiographs. Methods: Four datasets of conventional hand, wrist, and scaphoid radiographs were retrospectively acquired at two hospitals (hospitals A and B). Dataset 1 (12,990 radiographs from 3353 patients, hospital A) and dataset 2 (1117 radiographs from 394 patients, hospital B) were used for training and testing a scaphoid localization and laterality classification component. Dataset 3 (4316 radiographs from 840 patients, hospital A) and dataset 4 (688 radiographs from 209 patients, hospital B) were used for training and testing the fracture detector. The algorithm was compared with the radiologists in an observer study. Evaluation metrics included sensitivity, specificity, positive predictive value (PPV), area under the characteristic operating curve (AUC), Cohen's kappa coefficient (κ), fracture localization precision, and reading time. Results: The algorithm detected scaphoid fractures with a sensitivity of 72%, specificity of 93%, PPV of 81%, and AUC of 0.88. The AUC of the algorithm did not differ from each radiologist (0.87 [radiologists' mean], p ≥.05). AI assistance improved five out of ten pairs of inter-observer Cohen's κ agreements (p <.05) and reduced reading time in four radiologists (p <.001), but did not improve other metrics in the majority of radiologists (p ≥.05). Conclusions: The AI algorithm detects scaphoid fractures on conventional multi-view radiographs at the level of five experienced musculoskeletal radiologists and could significantly shorten their reading time. Key Points: • An artificial intelligence algorithm automatically detects scaphoid fractures on conventional multi-view radiographs at the same level of five experienced musculoskeletal radiologists. • There is preliminary evidence that automated scaphoid fracture detection can significantly shorten the reading time of musculoskeletal radiologists. [ABSTRACT FROM AUTHOR]

Purpose: Three-dimensional planning in corrective surgeries in the hand and wrist has become popular throughout the last 20 years. Imaging technologies and software have improved since their first description in the late 1980s. New imaging technologies, such as distance mapping (DM), improve the safety of virtual surgical planning (VSP) and help to avoid mistakes. We describe the effective use of DM in two representative and frequently performed surgical interventions (radius malunion and scaphoid pseudoarthrosis). Methods: We simulated surgical intervention in both cases using DM. Joint spaces were quantitatively and qualitatively displayed in a colour-coded fashion, which allowed the estimation of cartilage thickness and joint space congruency. These parameters are presented in the virtual surgical planning pre- and postoperatively as well as in the actual situation in our cases. Results: DM had a high impact on the VSP, especially in radius corrective osteotomy, where we changed the surgical plan due to the visualization of the planned postoperative situation. The actual postoperative situation was also documented using DM, which allowed for comparison of the VSP and the achieved postoperative situation. Both patients were successfully treated, and bone healing and clinical improvement were achieved. Conclusion: The use of colour-coded static or dynamic distance mapping is useful for virtual surgical planning of corrective osteotomies of the hand, wrist and forearm. It also allows confirmation of the correct patient treatment and assessment of the follow-up radiological documentation. [ABSTRACT FROM AUTHOR]

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Background: Allograft bone screws are rarely described for the fixation of the scaphoid. When fresh fractures are treated, metal screws are mainly used; when pseudarthrosis is the indication, plates in combination with vascularized or non-vascularized bone grafts are mainly used. The necessity of metallic screw removal is under debate, but it is mandatory for plates because of movement restrictions due to the plate. The use of biomaterials in scaphoid fracture fixation was described as leading to union rates of between 64 and 100%. Brcic showed the incorporation of an allogeneic cortical bone screw at 10 weeks postoperative, along with revascularization and stable osteosynthesis with primary bone healing, without any signs of immunological rejection. The purpose of this retrospective study was to explore the results obtained using an allogenic cortical bone screw (Shark Screw®) in patients with fresh scaphoid fracture fixation and pseudarthroses with respect to union rates and time to union. Patients and methods: We retrospectively analyzed 75 patients: 31 with fresh fractures and 44 pseudarthrosis patients. The Shark Screw® was used for the fixation of the scaphoid in the fresh-fracture and pseudarthrosis patients. We evaluated the union rate, complication rate and time to union. Results: Using the human allogeneic cortical bone screw for scaphoid fracture fixation led to a high union rate (94–96%). There were two nonunions in the fresh fracture group and two nonunions in the pseudarthrosis group. The complication rate was 1.3% (1 patient). Median time to union was 16, 18 and 29 weeks for the fresh-fracture, pseudarthrosis and delayed-union patients, respectively. The treatment of fresh scaphoid fractures and pseudarthroses showed similar union rates to those described in the literature, uses a shorter and less invasive surgical method with no need for hardware removal, and has a low complication rate. Conclusion: Using the human allogenic cortical bone screw (Shark Screw®) led to similar union rates in fresh fractures—but better union rates in pseudarthrosis patients—compared to those presented in the literature for other scaphoid fracture fixation techniques, and it enabled a short and low-invasive procedure without any donor site morbidity and without the necessity to remove the hardware in a second surgery. The pseudarthrosis patient group showed a particularly strong benefit from this new procedure. The physiological bone metabolism remodels the cortical bone screw without scars. Level of evidence: III: retrospective cohort study, therapeutic investigation of a treatment. [ABSTRACT FROM AUTHOR]

Cast selection for conservatively treated acute scaphoid fractures remains controversial. Cast options include short arm versus long arm, and those that include the thumb or leave it free. We sought to investigate the role of how cast choice affects nonunion rates after conservative management of scaphoid fractures. We searched PubMed, Embase, and Google Scholar from inception through July 14, 2020, according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. We extracted information of interest, including cast type, and non-union rates at the end of the treatment period. We then performed a meta-analysis using the random-effects model. We identified seven relevant studies. Non-union was observed in 15 out of 156 (9.6%) with short-arm cast and 13 out of the 124 (10.5%) with long-arm cast (OR = 0.79, 95% CI [0.19, 3.26], p = 0.74). Non-union was observed in 18 out of 174 (10.3%) with thumb immobilization cast and 18 out of the 179 (10.1%) without thumb immobilization (OR = 0.97, 95% CI [0.49, 1.94], p = 0.69). In our study, short arm casting was proven non-inferior to long arm casting. Similarly, casts without thumb immobilization were equally as effective as casts with thumb immobilization in terms of non-union rates for acute scaphoid fractures treated non-operatively. [ABSTRACT FROM AUTHOR]

Purpose: Most patients with a clinically suspected scaphoid fracture and normal initial radiograph are unnecessarily treated. Previously developed prediction rules using demographic and clinical risk are unable to accurately predict occult fractures. Adding other risk factors could enhance this. Therefore, we aim to explore if there are morphological risk factors of the wrist for sustaining a scaphoid fracture. Methods: We retrospectively included adult patients with a clinically suspected scaphoid fracture between 2013 and 2019 in our case–control study. There were 82 patients with a scaphoid fracture and 158 patients with a wrist contusion. Morphological risk factors were identified using statistical shape modelling (SSM) and linear measurements. Independent wrist shape variations on posteroanterior and lateral radiographs were captured in modes using SSM. Associations between outcomes and a scaphoid fracture were explored using logistic regression and the reliability was assessed. Results: Of the 15 posteroanterior modes and 8 lateral modes identified and linear measurements performed, 1 PA mode was associated with a scaphoid fracture (PA mode 4; OR 1.40, CI 1.04–1.93, p = 0.031). We described this mode as an ulna plus and narrower distal radius with more volar tilt and radial inclination. The reliability of the posteroanterior modes and linear measurements was mostly good/excellent and moderate/poor for the lateral modes. Conclusion: There was one complex wrist shape significantly associated with a scaphoid fracture. Since the association was weak and the shape is difficult to identify radiographs, we believe this morphological risk factor would not enhance identifying occult scaphoid fractures in the future. [ABSTRACT FROM AUTHOR]

Background: Suspected scaphoid fracture (SF) after a fall on an outstretched hand is a common presentation in the emergency department. Magnetic resonance imaging (MRI) or computed tomography (CT) has been suggested to assist in the diagnosis or exclusion of SF. Purpose: To compare MRI and CT at diagnosing occult SFs. Material and Methods: We routinely perform CT scans in patients with clinically suspected occult SF, after 7–10 days of injury following two negative radiographs. All eligible patients with a clinically suspected SF, but negative radiographs and a negative CT, underwent an MRI scan to assess further for evidence of occult fracture. Results: A total of 100 patients were included in our study. MRI showed fractures in 16% of the time (in 15 patients) when plain radiographs and CT did not. Of these fractures, 8% were SFs. In addition to fractures, 10% had bone bruising. A total of 25% of patients with fractures and bone bruising were referred to the hand surgery team for further follow-up. Conclusion: The study demonstrated that MRI would identify a radiographically occult SF more often than CT. This supports NICE guidelines which recommend MRI as the best early diagnostic tool for occult SFs. [ABSTRACT FROM AUTHOR]

BACKGROUND: Early evaluation and appropriate management of pediatric scaphoid fractures are necessary to avoid complications. To date, current management of pediatric fractures varies among providers. The objective of this study was to compare clinical outcomes following different treatment modalities. METHODS: A PubMed literature search identified studies involving acute scaphoid fractures in children. Studies were evaluated for treatment provided and their respective effects on union rate, wrist range of motion, and wrist pain. Data were pooled across studies, and quantitative statistical analysis was conducted to compare outcomes. RESULTS: Seventeen studies representing 812 acute pediatric scaphoid fractures were included in the current analysis. We found 93.5% of scaphoid fractures were treated with cast immobilization vs 6.5% treated surgically as 13 of 17 authors treated all fractures with immobilization vs 4 of 17 studies who offered surgical intervention. We found pediatric scaphoid fractures had excellent bone union rates (96.2%) with no difference between the cast immobilization and surgery groups ( P value NS). Long- and short-arm thumb spica immobilization protocols were commonly employed; however, we found no difference in the rates of union ( P value NS). At follow-up, 99.0% of patients treated nonoperatively had normal wrist range of motion and 96.8% were pain free. CONCLUSIONS: Pediatric scaphoid fractures have excellent outcomes. Nonoperative treatment results in a high rate of union with few posttreatment wrist symptoms. Nonsurgical treatment represents an adequate treatment modality in a majority of acute pediatric scaphoid fractures, wherein the role for surgery needs to be better defined.

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.

CLINICAL SCENARIO Scaphoid injuries are common in high impact or high collision sports with 11% of all hand injuries and 60%-70% of all carpal injuries being attributed to the scaphoid bone. Athletes at the highest risk include males ages 20-24 years of age and those who participate in football, basketball, or ice hockey. Fracture of the scaphoid are often misdiagnosed which increase the chance of a nonunion fracture. Currently most scaphoid fractures are treated either conservatively or with surgical interventions. The increasing knowledge of this injury leads us to question the best treatment options for future football athletes. FOCUSED CLINICAL QUESTION In Football Players with Scaphoid Fractures, how does surgical intervention compare to a conservative intervention for the outcomes of repair? SUMMARY OF KEY FINDINGS Scaphoid fractures are more commonly seen in football lineman and defensive backs who have to repetitively block during competition. Scaphoid fractures have a lower incidence rate but have a high surgical and season ending rate. Both conservative and surgical treatment for scaphoid fractures have long term consequences including but not limited to loss of range of motion, decreased grip strength, nonunion fractures, and arthritic changes. Return to play rate is higher when treated surgically versus conservatively; operative union rate is higher than a non-operative union rate; cast with surgical intervention has a faster return than a cast with a conservative intervention. Overall, patients who undergo surgery have a better return to sport rate. STRENGTH of RECOMMENDATION Articles used in this review were graded at a IIa level. This level was reached from the inclusion of a systematic review, prognostic study, two descriptive epidemiological studies, and two literature reviews. The Center for Evidence-Based Medicine (CEBM) Criteria was used to assess each article. The systematic review was rated a 1a level due to the fact that it includes different levels of studies and is able to be generalized to multiple populations. The prognostic study was graded 2b because of the fact that it was a single population, and the athletes were untreated in the study. Both descriptive epidemiological studies were graded at 2b levels because they used the NCAA Injury Surveillance Program to gather data on a single untreated population. Finally, the two literature reviews were graded 2c levels because they would fall under the umbrella of “outcome research” looking at the overall effects of interventions on public health. [ABSTRACT FROM AUTHOR]

Background: As a flexible and elastic structure, the dynamic morphometry of medial longitudinal arch remains to be an unresolved Issue for clinic. Here we introduce a new measurement named arch volume to describe the morphological changes of the medial longitudinal arch during weight-bearing and compare with present method for measuring MLA.Methods: 64 healthy participants were enrolled. And the dynamic arch morphology was measured under four weight bearing status with navicular height, arch area and arch volume, respectively.Results: With the increase of weight loading, the flattening or slightly deformation of medial longitudinal arch was observed by all method (p<0.05). However, as a 3D indicator, arch volume not only showed higher sensitivity than other method, but also provide visualization of MLA during loading changing.Conclusions: Compared with navicular height and arch area, arch volume has a significant advantage in describing arch morphological changes under different weight bearing status. [ABSTRACT FROM AUTHOR]

Abstract Objective The aim of the present article is a clinical and radiographic evaluation of scaphoid nonunion with humpback deformity using an iliac graft and a volar plate. Methods Eight patients were followed-up prospectively, all male, with a mean age of 39.6 years old, with scaphoid waist nonunion, with an average of 19 months of trauma without previous surgery. The patients were treated with a graft removed from the iliac crest and a 1.5 mm blocked volar scaphoid plate (Medarthis AG, Basel, Switzerland). The patients were followed-up with radiographic evaluations and computed tomography (CT) scans in the preoperative period and 1 month, 3 months, 6 months and 1 year after the operation. The carpal height and the scaphosemilunar and intrascaphoid angles were measured preoperatively, 3 months, and 1 year postoperatively. The function was assessed preoperatively and repeated 1 year postoperatively using the Disabilities of the Arm, Shoulder, and Hand (DASH) and Patient-related Wrist Evaluation (PWRE scores), as well as by measurement of forceps clamp and wrist and thumb range of motion. Results All cases were consolidated, with an average time of 3.38 months. Two complications were observed: an infection of the iliac surgical wound and a plaque element placed in the scapholunate space. Two patients opted to remove the implant because they had a painful click at maximum wrist flexion. There was improvement in the parameters of wrist and thumb range of motion and pinch strength in all measurements, with statistical significance for the PRWE and the scapholunate angle. Conclusion Although our sample was small, we achieved consolidation in all cases; the complications were expected in the literature and there were improvements in the radiographic patterns, in the functional assessment, and in the pain scale of our patients.

Scaphocaptiate fracture syndrome is a unique condition and is challenging to manage. This rare fracture develops after high-energy wrist trauma. We reported a patient with a history of falling on an outstretched hand. A 15-year-old boy had scaphocapitate fracture syndrome, which included a displaced fracture of the capitate, an avulsion fracture at the distal tubercle of the scaphoid bone with an extension to the articular surface, and a perilunate fracture. A few months after open reduction and internal fixation were performed, the patient had a satisfying outcome. In addition, we have conducted a review of the literature regarding the mechanism of injury, diagnosis and outcome of published cases in correlation to our discussed case. [ABSTRACT FROM AUTHOR]

Abstract Objective The aim of our study is to analyze the clinical and functional results obtained using autologous chondrocytes embedded in a fibrin scaffold in knee joint injuries. Methods We included 56 patients, 36 men and 20 women, with a mean age 36 years. Six of the patients were professional athletes, with single knee injuries that were either chondral or osteochondral (43 chondral, 9 osteochondral, 2 cases of osteochondritis dissecans and 2 osteochondral fractures), 2 to 10 cm2 in size and ≤ 10 mm deep, with no signs of osteoarthritis. The location of the injury was in the patella (8), the medial femoral condyle (40) and lateral femoral condyle (7) and one in the trochlea. The mean follow-up was 3 (range: 1–6) years. The clinical course was assessed using the Cincinnati and Knee Injury and Osteoarthritis Outcome (KOOS) scores, 6 and 12 months after surgery. The paired Student t-test was used to compare pre-and postoperative results. Results Six months after the implant, patients resumed their everyday activities. On the assessment scores, their condition was improving in comparison with their presurgical state (p < 0.05). They were also able to carry out their sporting activities more easily than prior to surgery (p < 0.05). Conclusion The seeding of chondrocytes in fibrin may provide a favorable microenvironment for the synthesis of extracellular matrix and improved the clinical condition and activity of the patients 1 year after surgery.

Objective: The scaphoid bone is the most frequently fractured carpal bone following wrist injuries. Although fractures are often treated conservatively, internal fixation is increasingly being used because it allows early physical activity and is associated with high satisfaction of patient. In addition, avascular necrosis of bone is common after fracture and surgical treatment. Knowledge of the location of vascular foramina is important for understanding bone nutrition and assessing the risk of avascular necrosis. The aim of this study was to define various morphological and morphometric features of the scaphoid for appropriate implant selection and to evaluate the risk of avascular necrosis. Methods: This study evaluated eighteen scaphoids using twenty-three parameters. The scaphoid's maximum length, longitudinal axis length, and narrowest part of the neck width were measured. The number of vascular foramina was also recorded. The distances of the closest and farthest foramina to the tubercle were recorded. The safe angle range for screwing and the thickness of the proximal and distal part of the tubercle were measured. Results: The maximum length, longitudinal axis length, and neck width of scaphoids were 26.12±2.78 mm, 11.07±1.65 mm and 24.16±2.6 mm, respectively. The numbers of vascular foramina on the palmar and dorsal surface were 0-9 and 2-25, respectively. No vascular foramen was found on the palmar surface of five bones. In addition, foramen located proximal to the neck was not detected in six of the bones. Conclusion: Location of fracture is thought to be associated with the development of avascular necrosis and nonunion. Understanding the features of the scaphoid is crucial for accurate screw selection and placement. [ABSTRACT FROM AUTHOR]

Nicholas Barton, the former editor of the Journal of Hand Surgery, European volume, passed away in 2023. He was a prominent figure in British hand surgery and had an international reputation. Barton was born in London in 1935 and attended Westminster School. He studied medicine at Cambridge and the Middlesex Hospital in London. Throughout his career, Barton made significant contributions to the field of hand surgery, particularly in scaphoid fractures. He was also involved in various professional organizations and received numerous recognitions for his work. Outside of medicine, Barton had diverse interests, including cricket and history. He was remembered as a curious and respected individual who left a positive impact on the world. [Extracted from the article]

Background: Scaphoid fractures correspond to 60% of all carpal fractures, with a risk of 10% to progress towards non-union. Furthermore, ~3% present avascular necrosis (AVN) of the proximal pole, which is one of the main complications related to the peculiar vascularization of the bone. Scaphoid non-union can be treated with vascularized and non-vascularized bone grafting. The aim of the study is to evaluate the rates of consolidation of scaphoid non-union treated using two types of grafts. Methods: A systematic review of two electronic medical databases was carried out by two independent authors, using the following inclusion criteria: non-union of the proximal pole of the scaphoid bone, treated with vascular bone grafting (VBG) or non-vascular bone grafting (NVBG), with or without the use of internal fixation, patients aged ≥ 10 years old, and a minimum of 12 months follow-up. Research of any level of evidence that reports clinical results and regarding non-union scaphoid, either using vascularized or non-vascularized bone grafting, has been included. Results: A total of 271 articles were identified. At the end of the first screening, 104 eligible articles were selected for the whole reading of the text. Finally, after reading the text and the control of the reference list, we selected 26 articles following the criteria described above. Conclusions: The choice of the VBG depends mainly on the defect of the scaphoid and on the surgeon's knowledge of the different techniques. Free vascular graft with medial femoral condyle (MFC) seems to be a promising alternative to local vascularized bone grafts in difficult cases. [ABSTRACT FROM AUTHOR]

Scaphoid fractures frequently appear in injury radiograph, but approximately 20% are occult. While there are few studies in the fracture detection of X-ray scaphoid images, their effectiveness is insignificant in detecting the scaphoid fractures. Traditional image processing technology had been applied to segment interesting areas of X-ray images, but it always suffered from the requirements of manual intervention and a large amount of computational time. To date, the models of convolutional neural networks have been widely applied to medical image recognition; thus, this study proposed a two-stage convolutional neural network to detect scaphoid fractures. In the first stage, the scaphoid bone is separated from the X-ray image using the Faster R-CNN network. The second stage uses the ResNet model as the backbone for feature extraction, and uses the feature pyramid network and the convolutional block attention module to develop the detection and classification models for scaphoid fractures. Various metrics such as recall, precision, sensitivity, specificity, accuracy, and the area under the receiver operating characteristic curve (AUC) are used to evaluate our proposed method's performance. The scaphoid bone detection achieved an accuracy of 99.70%. The results of scaphoid fracture detection with the rotational bounding box revealed a recall of 0.789, precision of 0.894, accuracy of 0.853, sensitivity of 0.789, specificity of 0.90, and AUC of 0.920. The resulting scaphoid fracture classification had the following performances: recall of 0.735, precision of 0.898, accuracy of 0.829, sensitivity of 0.735, specificity of 0.920, and AUC of 0.917. According to the experimental results, we found that the proposed method can provide effective references for measuring scaphoid fractures. It has a high potential to consider the solution of detection of scaphoid fractures. In the future, the integration of images of the anterior–posterior and lateral views of each participant to develop more powerful convolutional neural networks for fracture detection by X-ray radiograph is probably important to research. [ABSTRACT FROM AUTHOR]

Teaching Point: Palmar dislocation of the scaphoid and lunate is an extremely uncommon injury that warrants early diagnosis and treatment to avoid complications such as median nerve dysfunction, avascular necrosis, and premature osteoarthritis. [ABSTRACT FROM AUTHOR]

No abstract is available.

Abstract Objective To describe the clinical and radiographic outcomes of patients submitted to percutaneous fixation without bone graft for scaphoid nonunion, with a minimum follow-up of six months. Methods A case series study of a convenience sample of hand surgeons with prospective evaluation. Patients with scaphoid (waist or proximal pole) nonunion and the following features were included: more than six months of history; X-rays showing sclerosis of the edges of the nonunion, with resorption of the nonunion focus measuring less than 4 mm (Slade & Gleissler I, II, III and IV) and no angular deformity; and no proximal pole necrosis on magnetic resonance imaging (MRI). Results After six months of follow-up, all nonunion were consolidated, with no major complications. The functional outcomes revealed good scores on the disabilities of the arm, shoulder and hand (DASH; n = 12; mean: 6.9; standard deviation [SD]: 2.1) and patient-rated wrist evaluation (PRWE; n = 12; mean: 7.97, SD: 1.5) questionnaires. The results of the visual analog scale (VAS) showed little residual pain (n = 12; mean: 0.71; SD: 0.2). Slight decreases in flexion (69 versus 59.1; p = 0.007), extension (62.4 versus 48.7; p = 0.001) and radial deviation (29.6 versus 24.6; p = 0.014) were detected in comparison to the contralateral side. Conclusions All cases in the series presented consolidation and good functional scores at the six-month evaluation. This is a promising option (with lower technical demand and morbidity) for the treatment of scaphoid nonunion. Comparative studies are required to assess the effectiveness of this technique in comparison with other options.

• Anatomically pre-contoured volar locking-plate fixation with autologous bone graft provides satisfactory outcomes. • Pure cancellous bone grafts from iliac crest achieve comparable outcomes to corticocancellous grafts from iliac crest in scaphoid nonunion with deformity, supported by a plate. • Volar locking-plates offer mechanical stability and space for bone grafts, explaining the success of pure cancellous grafts. Bone grafts for scaphoid nonunion with deformity include cortcicocancellous or pure cancellous bone grafts. This study compared the outcomes between two types of bone grafts when employing a volar locking-plate in patients with scaphoid nonunion with dorsal intercalated segmental instability (DISI). This retrospective study included 34 patients with scaphoid nonunion and DISI due to humpback deformity treated between March 2017 and January 2022. Two types of bone grafts were obtained from iliac crest. Twenty of the corticocancellous (CC) group underwent a wedge-shaped graft, while 14 patients of the pure cancellous (C-only) group received graft chips. In both groups, a 1.5-mm anatomically pre-contoured locking plate was used for fixation. Radiographic evaluations included the union rate and carpal alignment including scapholunate angle (SLA), radiolunate angle (RLA), intrascaphoid angle (ISA) and scaphoid height to length ratio (HLR). Clinical assessments encompassed wrist range-of-motion, grip strength, and patient-reported outcomes. Nineteen of the 20 patients in the CC group and 12 of the 14 patients in the C-only group respectively, achieving osseous union. The mean follow-up period in CC group was 14.7 (range, 12 ∼ 24) months and that in C-only group was 12.6 (range, 12 ∼ 15) months. Postoperatively, there were no significant intergroup differences of radiographic parameters including SLA (CC; 49.9° ± 6.7° vs. C-only; 48.9° ± 3.5°, P = 0.676), RLA (1.7° ± 6.4° vs. 2.4° ± 3.3°, P = 0.74), ISA (36° ± 7.5° vs. 36.6° ± 12.2°, P = 0.881), and HLR (0.54 ± 0.09 vs. 0.53 ± 0.05, P = 0.587). Clinical outcomes, including the flexion–extension arc (137° ± 30° vs. 158° ± 33°, P = 0.122), grip strength (93.4 % ± 15.4% vs. 99.5 % ± 16.7 %, P = 0.39), Quick Disabilities of the Arm, Shoulder, and Hand scores (11.2 ± 8.3 vs. 12.5 ± 7.7, P = 0.74) and Mayo Wrist Scores (81.2 ± 13.1 vs. 89 ± 11.4, P = 0.242) also showed no significant intergroup differences. Volar locking-plate fixation with pure cancellous bone grafts achieved outcomes comparable to those achieved with corticocancellous bone grafts in scaphoid nonunion with deformity, possibly due to the biomechanical advantages of the volar plate to provide structural supports. [ABSTRACT FROM AUTHOR]

Background: Consensus about Management of scaphoid nonunion is controversial, many procedures have been described. This study compares between 2 modalities for management of scaphoid nonunion either arthroscopic scaphoid bone grafting from iliac bone combined with percutaneous fixation versus open scaphoid fixation and non-vascularized bone graft from iliac bone in management of scaphoid nonunion to identify if one technique is better as regards union rate, time to union and functional outcome. Patients and Methods: A prospective randomized control trial held to recruit the patients between September 2019 and December 2020 between open grafting group (group O) for scaphoid non union (15 patient) and arthroscopic group (group A) (15 patients), randomization was done by using computerized random allocation. The mean follow up was 17.2 months (12-24 months). We evaluated the results as regards union rate, time to union, complications, grip strength functional outcome according to disability of arm, shoulder and hand questionnaire (DASH) score and modified mayo wrist score (MMWS). We analyzed the results by using Statistical Package for the Social Sciences software (SPSS) version 25. Results: union rate for group A was 100 % with time to union mean of 9.73 weeks (±2.4 weeks), union rate for group O was 93.33% with time to union mean of 11.64 weeks (±1.82 weeks) which was significantly faster to union for group A (p value< 0.05). The open group showed significantly less operative time, the mean operative time was 59.2 min ±11.01, 90.6min ±11.77 for group O and group A respectively. Grip strength, range of motion, VAS, MMWS and DASH score improved post operative for both groups with no statistical difference between them with comparable complication rate. Conclusion: arthroscopic grafting technique for scaphoid non unions showed comparable results as regard union rate, complications, range of motion and functional outcomes with significantly faster time to union however, significantly longer operative time. [ABSTRACT FROM AUTHOR]

Background: The pathology of Preiser disease remains controversial, and treatment for Preiser disease has not yet been standardised. Preiser disease itself is rare, and although it can be found in children, its presentation is even rarer; therefore, the treatment of paediatric patients with Preiser disease is more unclear than adult cases. Case presentation: A 10-year-old boy who complained of left wrist pain was diagnosed with Preiser disease from osteosclerosis and segmentation on plain radiography and computed tomography, and low signal intensity on both T1- and T2-weighted images on magnetic resonance imaging. Because the patient was a child whose scaphoid was immature and pre-ossified, we chose a conservative immobilisation treatment with a thumb spica cast followed by an orthosis. After 3 months of immobilisation, the distal pole of the scaphoid showed remodelling. One year after the initial visit, plain radiography showed remodelling of the whole scaphoid, although magnetic resonance T1-weighted image showed that the recovery of intensity change was only observed in the distal pole. Two years after the initial visit, both plain radiography and magnetic resonance imaging showed a normal appearance and 5 years after the initial visit; the scaphoid bone showed normal development. Conclusions: This is the first case report of Preiser disease before complete ossification of the scaphoid; therefore, we cannot say anything definitive about the treatment strategy. However, our experience suggests that conservative treatment may provide a cure for Preiser disease in children with immature ossification of the scaphoid without carpal collapse. [ABSTRACT FROM AUTHOR]

The morphology of the proximal carpals (scaphoid, lunate, triquetrum) are linked to the range of motion (ROM) at the radiocarpal and midcarpal joints. While the relationship between ROM and habitual locomotor mode is well established, it has yet to be investigated whether relative patterns of internal bone architecture reflect the kinematics and kinetics at the proximal row. As internal bone is known to model its structure to habitually incurred forces, internal architecture has the potential to provide insight into how joints have been loaded during the lifetime of an individual. Using a broad sample of extant great apes and humans (n = 177 total bones), this study investigates whether relative differences in the bone volume to total volume (BV/TV) and degree of anisotropy (DA) across the scaphoid, lunate and triquetrum correlate with the presumed force transfer and biomechanics of the hominoid wrist. Results reveal that broad patterns in BV/TV and DA differentiate hominoids by their predominant locomotor mode. The human pattern suggests the lunate may be the most highly strained bone within the proximal row. Both knuckle‐walking taxa (Gorilla, Pan) exhibited similar architectural patterns suggesting they are adapted to resist similar forces in this region of the wrist. The relatively high DA across all Pongo carpals suggests it may have more stereotypical wrist loading than commonly assumed. Finally, the distinctly low DA in the triquetrum across all taxa suggests force transfer via the synapomorphic triangular fibrocartilage complex may leave a distinctive signature in the internal bone architecture that requires further investigation. Objectives: Functional adaptation in the trabecular and cortical bone of individual wrist bones has been investigated across hominoid species but functional conclusions remain limited. This study examines whether relative patterns in internal bone architecture across multiple carpal bones can be correlated to the known or assumed kinetics and kinematics of the wrist joint in extant hominoids. Materials and Methods: This study applied a whole‐bone methodology to quantify the internal architecture (cortical and trabecular bone) of the scaphoid, lunate, and triquetrum of suspensory (Pongo sp.), knuckle‐walking (Pan paniscus, Pan troglodytes, Gorilla sp.) and bipedal (Homo sapiens) hominoids (n = 177 total bones). Results: H. sapiens showed unique patterns in both measured parameters: a decrease in degree of anisotropy (DA) from the scaphoid to the triquetrum with higher bone volume to total volume (BV/TV) in the lunate relative to the other bones. Knuckle‐walking taxa had similar patterns in both parameters: highest mean DA in the lunate and lowest in the triquetrum while significantly higher BV/TV was recorded the triquetrum. Pongo exhibited the same DA pattern as knuckle‐walking taxa but a distinct pattern of continual decrease in BV/TV from scaphoid to triquetrum. Discussion Relative differences in the internal bone structure across multiple carpals differentiated locomotor modes in extant hominoids. The triquetrum and lunate are particularly understudied but their importance to differentiating locomotor mode indicates further research is warranted. Establishing patterns across more carpal joints in primates should be a research priority as they will provide critical context to interpreting fossil species represented by single or few carpal elements. [ABSTRACT FROM AUTHOR]

Background: Scaphoid fracture is the most common wrist injury with a high rate of misdiagnosis and subsequent complications. As the morphology of the distal radius affects the load transmission through the carpal bones, radiographic wrist indices may help prevent missing occult fractures. Objectives: The current retrospective case-control study compared the distal radius radiographic indices of patients with a scaphoid fracture with a control group. Methods: Wrist X-rays of 129 patients with scaphoid fractures (case group) and the contralateral uninjured side of 101 patients with distal radius fractures (control group) were assessed by two orthopedic surgeons. Anteroposterior and lateral radiographs were evaluated to measure the radial height (RH), radial inclination (RI), ulnar variance (UV), and volar tilt (VT). Results: The student t-test was used to compare the distal radius radiographic indices between the two groups. The average RI was 27.14 in the scaphoid fracture group and 24.35 in the control group (P<0.05). Mean VT, RH, and UV of the case group were, 12.32, 15.01, and - 0.73, respectively; this is while in the control group, the above measures were 10.76, 13.52, and - 0.11, respectively (P<0.05). Conclusion: High values of RH, RI, and VT, and negative amount of UV are significantly correlated with scaphoid fracture after a Fall Onto an Outstretched Hand (FOOSH) injury. [ABSTRACT FROM AUTHOR]

BACKGROUND: The foot is an important part of the human body. Its functions are mainly walking and load-bearing. It also keeps the human body stable and absorbs ground vibrations to protect important human organs. OBJECTIVE: Many researchers use finite element methods to study the biomechanics of the foot. However, current studies on the finite element of the foot are based on the stress and displacement response analysis of the foot under static or quasi-static conditions, ignoring the movement process of the foot and the impact of vibration. Moreover, the joint application of energy method and finite element analysis in foot biomechanics is rarely reported. METHODS: In this paper, to obtain the foot energy transfer process, the transient response of the foot under neutral position is analyzed based on the energy method. RESULTS: The results show that: (1) In this model, the energy analysis follows the conservation of energy, which indicates that the transient response analysis has obtained a reasonable response. (2) When the foot touches the ground, the strain energy of the calcaneus, second metatarsal and third metatarsal is relatively large, which is consistent with the main stress concentration area of the plantar. (3) The gravity of the human body is mainly transmitted through the talus to the calcaneus, while the effect of transmittal through the scaphoid to the cuneiform bone and metatarsal is weak. CONCLUSION: This study can not only more clearly and intuitively reflect the energy transfer and source of various skeletal foreheads in the foot, but also provide a new research idea for the study of foot biomechanics. [ABSTRACT FROM AUTHOR]

Recent technical and technological developments in wrist arthroscopic surgery allow for advanced treatments of difficult wrist disorders. In this review, world leaders of wrist arthroscopy describe bone graft for scaphoid nonunion, transosseous repair for triangular fibrocartilage fovea avulsion, palmaris longus reconstruction of the triangular fibrocartilage, and arthroscopic reconstruction of the scapholunate and lunotriquetral ligaments. [ABSTRACT FROM AUTHOR]

Abstract Background There are some difficulties in treating proximal scaphoid nonunion, mainly including poor vascularity of the proximal scaphoid fragment and limited space for a stable fixation in the proximal scaphoid fragment. This study reports the outcomes of treating proximal scaphoid nonunion with arthroscopic assist for reduction, bone grafting and screw fixation across the scapholunate (SL) joint. Methods Between 2008 and 2017, 21 patients were enrolled. Fracture healing and change in the lateral SL angle and SL gap were evaluated. Functional outcomes were evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH) score, wrist range of motion, grip strength, and the Visual Analog Scale (VAS) for pain. Results Nineteen patients achieved fracture healing and their mean follow-up duration was 31.3 months (24–120 months). The average fracture healing time was 16.3 weeks (10 to 28 weeks). From the preoperative to the postoperative final evaluation, there was some significant improvement in wrist function, including wrist flexion from 54.5o to 67.4o, wrist extension from 62.3o to 71.7o, DASH scores from 52.4 to 21.4, VAS during activity from 4.6 to 2.1, and grip strength from 9.6 kg to 24.7 kg. The lateral SL angle also improved significantly, from 82o to 66o. Seventeen patients requested screw removal after fracture healing because of their cultural belief in not leaving hardware in the body. No significant SL gap widening was noted after screw removal in the sequential follow-ups. Conclusions Using arthroscopic-assisted reduction, bone grafting and screw fixation across the SL joint in proximal scaphoid nonunion treatment, satisfactory functional and radiographic outcomes can be achieved.

Background: The purpose of this retrospective study was to report outcomes of arthroscopic bone grafting and K-wire fixation to treat scaphoid non-union. Methods: We included in at two healthcare facilities, 42 consecutive patients (34 men, 8 women) with a mean age of 25 years (range 15–56 years) with scaphoid non-union of the proximal and middle third without intracarpal deformity or SNAC osteoarthritis. All patients were evaluated (pain, range of motion, strength, function, X-rays) by an independent examiner. Results: At the mean follow-up of 18 months (range 12–56), pain was significantly reduced from 7 to 1 on a visual analogue scale (out of 10). The scores on the Quick Disabilities of the Arm, Shoulder and Hand questionnaire and Patient Rated Wrist Evaluation were improved significantly. At the last review, grip strength was 83% of the contralateral side, the average wrist flexion-extension was 125° and the radioulnar deviation was 58°. Bone union was achieved in 37 cases (88%). The mean time of checking the bone union was 3 months (range, 2–8). Four patients required revision surgery because of failed union. Conclusions: Based on our findings, we found that this procedure can be used as a surgical treatment for scaphoid non-union of the proximal and middle third without intracarpal deformity or osteoarthritis. The arthroscopic bone grafting is a reliable, effective, and minimally invasive procedure. [ABSTRACT FROM AUTHOR]

Rupture of the scapholunate interosseous ligament can cause the dissociation of scaphoid and lunate bones, resulting in impaired wrist function. Current treatments (e.g., tendon-based surgical reconstruction, screw-based fixation, fusion, or carpectomy) may restore wrist stability, but do not address regeneration of the ruptured ligament, and may result in wrist functional limitations and osteoarthritis. Recently a novel multiphasic bone-ligament-bone scaffold was proposed, which aims to reconstruct the ruptured ligament, and which can be 3D-printed using medical-grade polycaprolactone. This scaffold is composed of a central ligament-scaffold section and features a bone attachment terminal at either end. Since the ligament-scaffold is the primary load bearing structure during physiological wrist motion, its geometry, mechanical properties, and the surgical placement of the scaffold are critical for performance optimisation. This study presents a patient-specific computational biomechanical evaluation of the effect of scaffold length, and positioning of the bone attachment sites. Through segmentation and image processing of medical image data for natural wrist motion, detailed 3D geometries as well as patient-specific physiological wrist motion could be derived. This data formed the input for detailed finite element analysis, enabling computational of scaffold stress and strain distributions, which are key predictors of scaffold structural integrity. The computational analysis demonstrated that longer scaffolds present reduced peak scaffold stresses and a more homogeneous stress state compared to shorter scaffolds. Furthermore, it was found that scaffolds attached at proximal sites experience lower stresses than those attached at distal sites. However, scaffold length, rather than bone terminal location, most strongly influences peak stress. For each scaffold terminal placement configuration, a basic metric was computed indicative of bone fracture risk. This metric was the minimum distance from the bone surface to the internal scaffold bone terminal. Analysis of this minimum bone thickness data confirmed further optimisation of terminal locations is warranted. [ABSTRACT FROM AUTHOR]