Scaphoid fractures,particularly those that occur more proximally,are unreliable in achieving union due to the retrograde blood supply of the scaphoid bone.Vascular compromise is associated with the development of nonu...Scaphoid fractures,particularly those that occur more proximally,are unreliable in achieving union due to the retrograde blood supply of the scaphoid bone.Vascular compromise is associated with the development of nonunions and avascular necrosis of the proximal pole.Due to the tenuous blood supply of the scaphoid,it is imperative that the vascularity be assessed when creating diagnostic and treatment strategies.Early detection of vascular compromise via imaging may signal impending nonunion and allow clinicians to perform interventions that aid in restoring perfusion to the scaphoid.Vascular compromise in the scaphoid presents a diagnostic challenge,in part due to the non-specific findings on plain radiographs and computed tomography.Magnetic resonance imaging techniques have dramatically improved our ability to assess the blood supply to the scaphoid and improve time to intervention.This review aims to summarize these advances and highlights the importance of imaging in assessing vascular compromise in scaphoid nonunion and in reperfusion following surgical intervention.展开更多
AIM: To analyse bone remodeling in regard to the age of scaphoid non-unions(SNU) with immunohistochemistry.METHODS: Thirty-six patients with symptomatic SNU underwent surgery with resection of the pseudarthrosis. The ...AIM: To analyse bone remodeling in regard to the age of scaphoid non-unions(SNU) with immunohistochemistry.METHODS: Thirty-six patients with symptomatic SNU underwent surgery with resection of the pseudarthrosis. The resected material was evaluated histologically after staining with hematoxylin-eosin(HE), tartrate resistant acid phosphatase(TRAP), CD 68, osteocalcin(OC) and osteopontin(OP). Histological examination was performed in a blinded fashion.RESULTS: The number of multinuclear osteoclasts in the TRAP-staining correlated with the age of the SNU and was significantly higher in younger SNU(P = 0.034; r = 0.75). A higher number of OP-immunoreactive osteoblasts significantly correlated with a higher number of OC-immunoreactive osteoblasts(P = 0.001; r = 0.55). Furthermore, a greater number of OP-immunoreactive osteoblasts correlated significantly with a higher number of OP-immunoreactive multinuclear osteoclasts(P = 0.008; r = 0.43). SNU older than 6 mo showed a signifi-cant decrease of the number of fibroblasts(P = 0.04). Smoking and the age of the patients had no influence on bone remodeling in SNU.CONCLUSION: Multinuclear osteoclasts showed a significant decrease in relation to the age of SNU. However, most of the immunhistochemical findings of bone remodeling do not correlate with the age of the SNU. This indicates a permanent imbalance of bone formation and resorption as indicated by a concurrent increase in both osteoblast and osteoclast numbers. A clear histological differentiation into phases of bone remodeling in SNU is not possible.展开更多
Purpose: This study evaluated the functional outcome after conservative treatment of non-displaced scaphoid fractures using an international validated outcome scale (DASH). Methods and materials: Between 2005 and 2010...Purpose: This study evaluated the functional outcome after conservative treatment of non-displaced scaphoid fractures using an international validated outcome scale (DASH). Methods and materials: Between 2005 and 2010, 60 patients with a non-displaced scaphoid fracture were included. When a patient visited the emergency department and was clinically suspected of a scaphoid fracture radiography was performed. If no fracture was diagnosed with this modality a CT or MRI-scan both in combination with bonescintigraphy was performed. Patients with scaphoid fractures diagnosed with CT/MRI and bonescintigraphy were treated with a six-week scaphoid forearm cast. Within 1 year after cast removal patients filled in the DASH questionnaire. Results: Sixty (80%) patients returned the DASH questionnaire at 12 months after treatment. Thirty-eight (63.3%) were male and the mean age was 35 (range 11 - 83). Forty-four (73.3%) patients had a mid-waist fracture of the scaphoid, 13 (21.7%) had a fracture of the distal pole and three (0.05%) had a proximal fracture. Median DASH score at one year after the trauma was 6 (range 3 - 15) for patients with a distal pole fracture and 5 (range 0 - 21.5) for mid-waist fractures (p = 0.7, table 2). For the three patients with a proximal scaphoid fracture the DASH scores appeared higher and were 83, 82 and 30 respectively. Conclusion: Conservative treatment for six weeks with a below the elbow cast is sufficient for the majority of patients with an occult distal or mid-waist scaphoid fracture and results in a good functional outcome according to the DASH questionnaire.展开更多
This study explored the feasibility of employing computer-aided design(CAD)and 3 dimensional(3D)-printed personalized guide plate for the mini-invasive percutaneous internal screw fixation of fractured scaphoid.The st...This study explored the feasibility of employing computer-aided design(CAD)and 3 dimensional(3D)-printed personalized guide plate for the mini-invasive percutaneous internal screw fixation of fractured scaphoid.The study consisted of two parts:(1)experimentation on upper limbs from corpses and(2)preliminary clinical application.Corpse experiments involved upper limbs of 6 adult corpses.The specimens of upper limbs were subjected to plain CT scan.Then the CT data were input into computer to conduct 3D reconstruction of wrist region.The direction and depth of the guide wire and screw were designed on the basis of the principle that screw should lie at the center of scaphoid and the long axis of the screw should be aligned with that of the scaphoid.The carpal bone model and the guide plate were designed and 3D-printed.By using the guide plates,the guide wire was placed and the cannulated compression screw was inserted.The wrist region was examined by X-ray and CT to observe the location of the screw in the scaphoid.The scaphoid was longitudinally excised to grossly observe the location and evaluate the result of screw insertion.For clinical application,the guide plate was employed in 4 patients with fresh scaphoid fracture using the aforementioned operative technique.Our results showed that,in the 6 corpse limbs,the guide plate well fitted the skin surface and the guide wire and screw were accurately put in place in one session.X-ray examination and gross observation confirmed that the screw was satisfactorily positioned and the result met the requirements of the preoperative design.For 4 patients,the guide wire and screw were all precisely inserted into place in one session.The operation time and X-ray exposure times were apparently reduced.The imaging examination exhibited satisfactory results and the hand functioned well.It was concluded that the operative guide plate used for the miniinvasive percutaneous internal screw fixation of fractured scaphoid not only can assist in accurate placement of screw but also shorten operation time and reduce insertion and X-ray exposure times,thereby reducing the radiation injury and damage to the substance and the blood circulation of carpal bone.Its use can also improve the learning curve of surgeons.展开更多
The computer-assisted surgery (CAS)has significantly improved the accuracy, reliability and outcomes of traumatic,spinal,nerve surgery and many other operations with a less invasive way.The application of CAS for scap...The computer-assisted surgery (CAS)has significantly improved the accuracy, reliability and outcomes of traumatic,spinal,nerve surgery and many other operations with a less invasive way.The application of CAS for scaphoid fractures remains experimental.The related studies are scanty and most of them are cadaver researches.Some intrinsic defects from the registration procedure,scan and immobilization of limbs may inevitably result in deviations. Some deviations become more obvious with operations of small bones (such as scaphoid)although they are acceptable for spine and other orthopedic surgeries.We reviewed the current literatures on the applications of CAS for scaphoid operation and summarized technical principles,scan and registration methods,immobilization of limbs and their outcomes.On the basis of the data,we analyzed the limitations of this technique and envisioned its future development.展开更多
AIM: To determine the diagnostic accuracy and radiation dose of conventional radiography and multidetector computed tomography(MDCT) in suspected scaphoid fractures.METHODS: One hundred twenty-four consecutive patient...AIM: To determine the diagnostic accuracy and radiation dose of conventional radiography and multidetector computed tomography(MDCT) in suspected scaphoid fractures.METHODS: One hundred twenty-four consecutive patients were enrolled in our study who had suffered from a wrist trauma and showed typical clinical symptoms suspicious of an acute scaphoid fracture. All patients had initially undergone conventional radiography. Subsequent MDCT was performed within 10 d because of persisting clinical symptoms. Using the MDCT data as the reference standard, a fourfold table was used to classify the test results. The effective dose and impaired energy were assessed in order to compare the radiation burden of the two techniques. The Wilcoxon test was performed to compare the two diagnostic modalities.RESULTS: Conventional radiography showed 34 acute fractures of the scaphoid in 124 patients(42.2%). Subsequent MDCT revealed a total of 42 scaphoid fractures. The sensitivity of conventional radiography for scaphoid fracture detection was 42.8% and its specificity was 80% resulting in an overall accuracy of 59.6%. Conventional radiography was significantly inferior to MDCT(P < 0.01) concerning scaphoidfracture detection. The mean effective dose of MDCT was 0.1 m Sv compared to 0.002 m Sv of conventional radiography.CONCLUSION: Conventional radiography is insufficient for accurate scaphoid fracture detection. Regarding the almost negligible effective dose, MDCT should serve as the first imaging modality in wrist trauma.展开更多
BACKGROUND Scaphoid fracture is the most commonly fractured carpal bone in the athletic patient,accounting for over 85%of all sport-related carpal bone fractures,and is particularly common in sports involving high imp...BACKGROUND Scaphoid fracture is the most commonly fractured carpal bone in the athletic patient,accounting for over 85%of all sport-related carpal bone fractures,and is particularly common in sports involving high impact injuries to the wrist.The management of such injuries comprises both conservative and surgical techniques,as guided by fracture location and type.Athletes demonstrate a unique challenge with regards to the management of scaphoid fractures due to their requirement to return to sport,as soon as able.AIM To review systemically all studies recording return to sport following scaphoid fractures,to collate information on return rates to sport(RRS)and mean return times(RTS)to sport and to determine differences in sporting outcome for the various treatment methods.METHODS A systematic search of MEDLINE,EMBASE,CINAHAL,Cochrane,Google Scholar,Physiotherapy Evidence Database,SPORTDiscus,Web of Science and Scopus was performed in August 2018 using the keywords"scaphoid","fracture","acute","carpal","athletes","sports","non-operative","conservative","operative"and"return to sport".All studies that recorded RRS and RTS following scaphoid fractures were included.RTS was recorded as the length of time from commencement of either primary conservative management or primary surgical procedure to return to sport.RESULTS Eleven studies were included:Two randomised controlled trials,six retrospective cohort studies and three case series.Seven studies reported on conservative management(n=77),and eight studies reported on surgical management(n=83).For conservative management,RRS was 90%(69/77),and the mean RTS was9.6 wk.Three studies allowed to return to sport in cast[RRS 89%(25/28);RTS 1.9 wk],and four studies required completion of cast treatment prior to returning to sport[RRS 90%(44/49);RTS 13.9 wk].Four studies recorded fracture union data:Union rate 85%(47/55);mean time to union 14.0 wk.For surgical management,RRS was 98%(81/83),and RTS was 7.3 wk.Three studies reported on Percutaneous Screw Fixation[RRS 97%(32/33);RTS 6.5 wk],and five studies reported on Open Reduction Internal Fixation[RRS 98%(49/50);RTS 7.9 wk].Six studies recorded fracture union data:Union rate 97%(69/71);mean time to union9.8 wk.On meta-analysis,RRS(RR=1.09;95%confidence interval(CI):1.00-1.18;P<0.045),RTS(MD 2.3 wk;95%CI:0.79-3.87;P<0.002),union rates(RR=1.14;95%CI:1.01-1.28;P<0.030)and mean times to union(MD 4.2 wk;95%CI:3.94-4.36;P<0.001)were all significantly better for the surgical cohort compared to the conservative cohort.CONCLUSION Surgical management of scaphoid fractures can provide significantly improved RRS and RTS to sport compared to conservative management.Both treatments,however,remain acceptable options,and athletes should be fully informed of the benefits and risks of both prior to deciding treatment plans.Immediate return to sport in a cast should be avoided due to the significant risk of non-union.展开更多
Background: While plain radiography is commonly used to assess scaphoid fracture, this imaging modality may not accurately demonstrate early bone healing. This investigation evaluates the utility of 64-slice CT in the...Background: While plain radiography is commonly used to assess scaphoid fracture, this imaging modality may not accurately demonstrate early bone healing. This investigation evaluates the utility of 64-slice CT in the detection of early fracture healing compared to plain radiographs and magnetic resonance imaging (MRI). Methods: Outpatients attending follow-up visits for scaphoid fractures at Hamilton General Hospital were included in this investigation. Inclusion criteria included outpatients over age of 18 who consented to attend a follow-up visit for the scaphoid fracture at 6 weeks for X-Ray, 64-slice CT and MRI scan to monitor fracture healing. Assessment of healing was independently interpreted by two radiologists specialized in musculoskeletal imaging. A total of 7 adult outpatients were accrued, with each case classified as healing, not healing, or equivocal for plain radiography and 64-slice CT scan. Results: For plain radiographs, the level of interrater agreement for evidence of healing was 57% (4/7) cases. When comparing this to CT scans, there was no discrepancy between radiologists as 100% (7/7) were found to have evidence of healing. The 64-slice CT scan demonstrated evidence of early trabecular continuity in all cases, including radiographs that were interpreted as equivocal. Conclusion: This study can be considered a pilot project for the efficacy of 64-slice CT in the assessment of early healing of scaphoid fractures. For clinicians, the multiplanar reconstruction images allows for more accurate assessment of fractures than plain radiography. CT scans are able to penetrate through bony callus that may obscure visualization of healing in plain radiography, demonstrate trabecular continuity better than plain radiographs, are readily accessible and provide faster imaging acquisition. The observations from this study may have implications in terms of duration and type of casting applied, timing of strengthening exercises, and avoiding unnecessary surgery which affect patient morbidity and cost of care.展开更多
The clinical results of the application of pedicled vascularized bone graft （VBG） from Lister＇s tubercle vs. traditional bone graft （TBG） were evaluated and compared. Thirteen cases of symptomatic scaphoid nonuni...The clinical results of the application of pedicled vascularized bone graft （VBG） from Lister＇s tubercle vs. traditional bone graft （TBG） were evaluated and compared. Thirteen cases of symptomatic scaphoid nonunion were treated between January 2011 and December 2012, including 7 cases subject to VBG and the rest 6 cases to TBG, respectively. Outcomes were assessed by modified Mayo wrist score system. All cases were followed up for an average period of 3.5 months after opera- tion. The results showed that total scores in VBG group were 86.4i9.4 after operation with excellent result in 4 cases, good in 2 and acceptable in one, and those in TBG group were 71.7±9.3 after operation with good result in 2 cases, acceptable in 3 and disappointing in one. Total score of wrist function was significantly improved in VBG group as compared with TBG group （P〈0.05）. Our study suggests that VBG method is more effective for treating scaphoid nonunion than TBG method.展开更多
BACKGROUND Isolated dislocations of the scaphoid are extremely rare types of injuries,commonly associated with severe ligament disruptions,and are occasionally misdiagnosed.Treatment options for dislocations of the sc...BACKGROUND Isolated dislocations of the scaphoid are extremely rare types of injuries,commonly associated with severe ligament disruptions,and are occasionally misdiagnosed.Treatment options for dislocations of the scaphoid mainly include closed reduction,with or without internal fixation,and open reduction with ligament repair.CASE SUMMARY A 59-year-old male worker sustained a twisting trauma of his right wrist,caused by a moving belt while he was operating a machine.When he presented at our emergency department,the patient complained of swelling,tenderness,and restriction of movement of the right wrist.Radiographs confirmed a primary complex partial radial dislocation of the scaphoid and some chip fractures of the capitate and hamate.Closed reduction with K-wire internal fixation was performed with the assistance of arthroscopy,and an excellent prognosis was achieved.CONCLUSION Arthroscopy-assisted reduction is a minimally invasive method to reduce the dislocated scaphoid and maintain the blood supply.展开更多
A rare combination of an ulnar fracture with posterior dislocation of the head of the radius and fracture of the radius shaft concomitant with an ipsilateral scaphoid fracture is presented. To the best of our knowledg...A rare combination of an ulnar fracture with posterior dislocation of the head of the radius and fracture of the radius shaft concomitant with an ipsilateral scaphoid fracture is presented. To the best of our knowledge, no such case has been reported. The mechanism of this fracture combination is discussed with respect to its role in producing the Monteggia type II fracture. Treatment consisted of a combination of closed and open reduction with external fixation.展开更多
BACKGROUND Metastatic tumors of the hand are very rare.They are usually late manifestations of massive advanced malignancies.However,a small portion of acrometastases are indications of occult primary cancer.Here,we r...BACKGROUND Metastatic tumors of the hand are very rare.They are usually late manifestations of massive advanced malignancies.However,a small portion of acrometastases are indications of occult primary cancer.Here,we report an extremely rare case in which a scaphoid bone lesion was the initial manifestation and was found to be a metastasis from gastroesophageal junction(GEJ)cancer.CASE SUMMARY A 57-year-old male patient presented with ongoing left wrist pain and swelling after trauma.He was initially misdiagnosed with infection of the scaphoid bone and treated with antibiotics and anti-inflammatory drugs.Further radiographic investigations showed a scaphoid pathological fracture,indicating a metastatic tumor derived from the GEJ and/or right lung malignancies.Gastroscopy failed to identify the pathology of the mass at the GEJ,which grew in an exophytic pattern.A lung puncture biopsy was not performed because the patient refused the procedure.To relieve his wrist pain and obtain a definite pathology,we resected the scaphoid lesion.Based on the clinical and pathological results,the patient was finally diagnosed with multiple metastases of advanced GEJ adenocarcinoma.He underwent chemotherapy and died 6 mo after his initial presentation.CONCLUSION Despite the rareness of the disease,orthopedic surgeons should consider the possibility of metastasis to the bones of the hand when patients complain of persistent and progressive pain in the hand.展开更多
Concomitant fractures of the hook of hamate and scaphoid are rare injuries to the wrist. Whenever these fractures cannot be effectively managed, nonunion or osteonecrosis is encountered. Subsequent treatment is thus m...Concomitant fractures of the hook of hamate and scaphoid are rare injuries to the wrist. Whenever these fractures cannot be effectively managed, nonunion or osteonecrosis is encountered. Subsequent treatment is thus much more challenging for a hand surgeon or orthopedist. Minimally invasive percutaneous internal fixation is an optimal treatment with the potential to minimize injury and reduce fractures. However, the control of iatrogenic injuries, including possible damage to the adjacent vital tissue, is a challenge that needs to be addressed. Herein,we describe the case of a 26-year-old man who presented with fractures to the scaphoid and hook of hamate in his left wrist. Minimally invasive treatment-with closed reduction and percutaneous fixation of the scaphoid, wrist arthroscopy, and closed reduction and percutaneous fixation of the hook of hamate-was performed at our institution. The Mayo score of the wrist, visual analog scale(VAS) for pain, grip strength, pinch strength, and wrist motion in radial/ulnar and flexion/extension deviation were recorded. Primary healing was achieved in both fractures. At the final follow-up, the Mayo score of the wrist was 100(excellent), the VAS score was 0(no pain),and the grip and pinch strength of his injured hand were 90.9% and 83.3%, respectively, compared with the contralateral hand(grip strength: left, 50 kg;right, 55 kg. Pinch strength: left, 20 kg;right, 24 kg). The radialulnar, flexion-extension, and forearm pronation-supination directions were 30°, 140°, and 90°, respectively.Minimally invasive closed reduction with percutaneous internal fixation is an optimal technique with satisfactory outcomes for simultaneous fractures of the hook of hamate and scaphoid. Provided in this paper are details of the technique and technical suggestions for performing the procedure.展开更多
Isolated dislocation of the carpal scaphoid is a rare injury. Such dislocation is extremely rare. In this article the authors report a twenty-eight-year-old man with isolated dislocation of the scaphoid with associati...Isolated dislocation of the carpal scaphoid is a rare injury. Such dislocation is extremely rare. In this article the authors report a twenty-eight-year-old man with isolated dislocation of the scaphoid with associating radial styloid fracture. We manage the patient with open reduction and Kirschner wire fixation. One year later there is a good functional and radiographic result.展开更多
Objective To introduce a new procedure for treatment of rotatory subluxation of the scaphoid. Methods Eighteen patients with rotatory subluxation of the scaphoid were divided into five types according to clinical mani...Objective To introduce a new procedure for treatment of rotatory subluxation of the scaphoid. Methods Eighteen patients with rotatory subluxation of the scaphoid were divided into five types according to clinical manifestation and cause: type Ⅰ (predynamic) 1 case,type Ⅱ (dynamic) 2 cases, type Ⅲ (static) 7 cases, type Ⅳ (degenerative) 3 cases, type Ⅴ( secondary) 5 cases. All cases underwent scapho-trapezio-trapezoid limited wrist arthrodesis. Results The follow-up ranged from 6 months to 3 years. The results showed that the all rotatory subluxatiopn of scaphoid in the study had been corrected with satisfactory fusion and painless wrist. The average grip strength was 90% of the normal wrist, and the average range of motion was 62% of the opposite side. Conclusion Scapho-trapezio-trapezoid limited arthrodesis is a reliable and useful procedure for treatment of chronic andChina Medical Abstracts(Surgery) static rotatory subluxation of the scaphoid. 15 refs,2 figs.展开更多
Purpose： Wrist has a complex anatomy and undergoes complex injuries, Scaphoid fracture is one of such injuries. It is the most common fracture in carpal bone. Most of the scaphoid fractures are missed on initial X-ra...Purpose： Wrist has a complex anatomy and undergoes complex injuries, Scaphoid fracture is one of such injuries. It is the most common fracture in carpal bone. Most of the scaphoid fractures are missed on initial X-rays. Magnetic resonance imaging （MRI） is considered as a gold standard for diagnosing scaphoid fractures. Ultrasonography （USG） is emerging as a good alternative to make an early diagnosis of scaphoid fractures. Our aim is to throw light upon the role of USG in detection of scaphoid flactures. Methods： The study was centered upon 114 patients in the age range 10-65 years, with traumatic wrist injury and were clinically suspected to have scaphoid fractures. Patient with non-traumatic history, bilateral wrist injury and late presentation were excluded. X-rays, USG using high frequency probe and MRI were done for all patients. MRI was considered to be the gold standard test. Patients were followed up at 6 weeks. Results： Of the 114 patients, X-ray could diagnose scaphoid fractures in 48 patients, 30 of which were confirmed by MRI. USG results were positive in 74 patients, of which MRI was positive in 67 patients. The accuracy of scaphoid fracture detection with USG was 98.04% in comparison to X-ray （20.58%）, which was statistically significant. Conclusion： USG provides a more accurate and reliable method of making an early diagnosis of scaphoid fracture than X-rays. It is non-invasive, non-expensive and allows better visualisation of cortical disruption.展开更多
Scaphoid dislocation is a rare injury. Traditionally it has been classified into isolated dislocation and dislocation associated with axial carpal disruption. We present a unique case of scaphoid dislocation associate...Scaphoid dislocation is a rare injury. Traditionally it has been classified into isolated dislocation and dislocation associated with axial carpal disruption. We present a unique case of scaphoid dislocation associated with proximal migration of the entire distal carpal row as a single unit and hamate fracture with no axial carpal disruption. This injury complex has not been previously described in the literature. The purpose of this case reportis to emphasize that in absence of axial carpal dissociation with scaphoid dislocation, a careful evaluation of injury to other bones should be done and treated accordingly to maximize the chances of favourable outcome with recon- structive surgery.展开更多
文摘Scaphoid fractures,particularly those that occur more proximally,are unreliable in achieving union due to the retrograde blood supply of the scaphoid bone.Vascular compromise is associated with the development of nonunions and avascular necrosis of the proximal pole.Due to the tenuous blood supply of the scaphoid,it is imperative that the vascularity be assessed when creating diagnostic and treatment strategies.Early detection of vascular compromise via imaging may signal impending nonunion and allow clinicians to perform interventions that aid in restoring perfusion to the scaphoid.Vascular compromise in the scaphoid presents a diagnostic challenge,in part due to the non-specific findings on plain radiographs and computed tomography.Magnetic resonance imaging techniques have dramatically improved our ability to assess the blood supply to the scaphoid and improve time to intervention.This review aims to summarize these advances and highlights the importance of imaging in assessing vascular compromise in scaphoid nonunion and in reperfusion following surgical intervention.
文摘AIM: To analyse bone remodeling in regard to the age of scaphoid non-unions(SNU) with immunohistochemistry.METHODS: Thirty-six patients with symptomatic SNU underwent surgery with resection of the pseudarthrosis. The resected material was evaluated histologically after staining with hematoxylin-eosin(HE), tartrate resistant acid phosphatase(TRAP), CD 68, osteocalcin(OC) and osteopontin(OP). Histological examination was performed in a blinded fashion.RESULTS: The number of multinuclear osteoclasts in the TRAP-staining correlated with the age of the SNU and was significantly higher in younger SNU(P = 0.034; r = 0.75). A higher number of OP-immunoreactive osteoblasts significantly correlated with a higher number of OC-immunoreactive osteoblasts(P = 0.001; r = 0.55). Furthermore, a greater number of OP-immunoreactive osteoblasts correlated significantly with a higher number of OP-immunoreactive multinuclear osteoclasts(P = 0.008; r = 0.43). SNU older than 6 mo showed a signifi-cant decrease of the number of fibroblasts(P = 0.04). Smoking and the age of the patients had no influence on bone remodeling in SNU.CONCLUSION: Multinuclear osteoclasts showed a significant decrease in relation to the age of SNU. However, most of the immunhistochemical findings of bone remodeling do not correlate with the age of the SNU. This indicates a permanent imbalance of bone formation and resorption as indicated by a concurrent increase in both osteoblast and osteoclast numbers. A clear histological differentiation into phases of bone remodeling in SNU is not possible.
文摘Purpose: This study evaluated the functional outcome after conservative treatment of non-displaced scaphoid fractures using an international validated outcome scale (DASH). Methods and materials: Between 2005 and 2010, 60 patients with a non-displaced scaphoid fracture were included. When a patient visited the emergency department and was clinically suspected of a scaphoid fracture radiography was performed. If no fracture was diagnosed with this modality a CT or MRI-scan both in combination with bonescintigraphy was performed. Patients with scaphoid fractures diagnosed with CT/MRI and bonescintigraphy were treated with a six-week scaphoid forearm cast. Within 1 year after cast removal patients filled in the DASH questionnaire. Results: Sixty (80%) patients returned the DASH questionnaire at 12 months after treatment. Thirty-eight (63.3%) were male and the mean age was 35 (range 11 - 83). Forty-four (73.3%) patients had a mid-waist fracture of the scaphoid, 13 (21.7%) had a fracture of the distal pole and three (0.05%) had a proximal fracture. Median DASH score at one year after the trauma was 6 (range 3 - 15) for patients with a distal pole fracture and 5 (range 0 - 21.5) for mid-waist fractures (p = 0.7, table 2). For the three patients with a proximal scaphoid fracture the DASH scores appeared higher and were 83, 82 and 30 respectively. Conclusion: Conservative treatment for six weeks with a below the elbow cast is sufficient for the majority of patients with an occult distal or mid-waist scaphoid fracture and results in a good functional outcome according to the DASH questionnaire.
文摘This study explored the feasibility of employing computer-aided design(CAD)and 3 dimensional(3D)-printed personalized guide plate for the mini-invasive percutaneous internal screw fixation of fractured scaphoid.The study consisted of two parts:(1)experimentation on upper limbs from corpses and(2)preliminary clinical application.Corpse experiments involved upper limbs of 6 adult corpses.The specimens of upper limbs were subjected to plain CT scan.Then the CT data were input into computer to conduct 3D reconstruction of wrist region.The direction and depth of the guide wire and screw were designed on the basis of the principle that screw should lie at the center of scaphoid and the long axis of the screw should be aligned with that of the scaphoid.The carpal bone model and the guide plate were designed and 3D-printed.By using the guide plates,the guide wire was placed and the cannulated compression screw was inserted.The wrist region was examined by X-ray and CT to observe the location of the screw in the scaphoid.The scaphoid was longitudinally excised to grossly observe the location and evaluate the result of screw insertion.For clinical application,the guide plate was employed in 4 patients with fresh scaphoid fracture using the aforementioned operative technique.Our results showed that,in the 6 corpse limbs,the guide plate well fitted the skin surface and the guide wire and screw were accurately put in place in one session.X-ray examination and gross observation confirmed that the screw was satisfactorily positioned and the result met the requirements of the preoperative design.For 4 patients,the guide wire and screw were all precisely inserted into place in one session.The operation time and X-ray exposure times were apparently reduced.The imaging examination exhibited satisfactory results and the hand functioned well.It was concluded that the operative guide plate used for the miniinvasive percutaneous internal screw fixation of fractured scaphoid not only can assist in accurate placement of screw but also shorten operation time and reduce insertion and X-ray exposure times,thereby reducing the radiation injury and damage to the substance and the blood circulation of carpal bone.Its use can also improve the learning curve of surgeons.
基金the National Natural Science Foundation of China(No.51675036)the Innovation and Development Project of Intelligent Manufacturing Technique from Beijing Municipal Science and Technology Commission(No.Z161100001516012).
文摘The computer-assisted surgery (CAS)has significantly improved the accuracy, reliability and outcomes of traumatic,spinal,nerve surgery and many other operations with a less invasive way.The application of CAS for scaphoid fractures remains experimental.The related studies are scanty and most of them are cadaver researches.Some intrinsic defects from the registration procedure,scan and immobilization of limbs may inevitably result in deviations. Some deviations become more obvious with operations of small bones (such as scaphoid)although they are acceptable for spine and other orthopedic surgeries.We reviewed the current literatures on the applications of CAS for scaphoid operation and summarized technical principles,scan and registration methods,immobilization of limbs and their outcomes.On the basis of the data,we analyzed the limitations of this technique and envisioned its future development.
文摘AIM: To determine the diagnostic accuracy and radiation dose of conventional radiography and multidetector computed tomography(MDCT) in suspected scaphoid fractures.METHODS: One hundred twenty-four consecutive patients were enrolled in our study who had suffered from a wrist trauma and showed typical clinical symptoms suspicious of an acute scaphoid fracture. All patients had initially undergone conventional radiography. Subsequent MDCT was performed within 10 d because of persisting clinical symptoms. Using the MDCT data as the reference standard, a fourfold table was used to classify the test results. The effective dose and impaired energy were assessed in order to compare the radiation burden of the two techniques. The Wilcoxon test was performed to compare the two diagnostic modalities.RESULTS: Conventional radiography showed 34 acute fractures of the scaphoid in 124 patients(42.2%). Subsequent MDCT revealed a total of 42 scaphoid fractures. The sensitivity of conventional radiography for scaphoid fracture detection was 42.8% and its specificity was 80% resulting in an overall accuracy of 59.6%. Conventional radiography was significantly inferior to MDCT(P < 0.01) concerning scaphoidfracture detection. The mean effective dose of MDCT was 0.1 m Sv compared to 0.002 m Sv of conventional radiography.CONCLUSION: Conventional radiography is insufficient for accurate scaphoid fracture detection. Regarding the almost negligible effective dose, MDCT should serve as the first imaging modality in wrist trauma.
文摘BACKGROUND Scaphoid fracture is the most commonly fractured carpal bone in the athletic patient,accounting for over 85%of all sport-related carpal bone fractures,and is particularly common in sports involving high impact injuries to the wrist.The management of such injuries comprises both conservative and surgical techniques,as guided by fracture location and type.Athletes demonstrate a unique challenge with regards to the management of scaphoid fractures due to their requirement to return to sport,as soon as able.AIM To review systemically all studies recording return to sport following scaphoid fractures,to collate information on return rates to sport(RRS)and mean return times(RTS)to sport and to determine differences in sporting outcome for the various treatment methods.METHODS A systematic search of MEDLINE,EMBASE,CINAHAL,Cochrane,Google Scholar,Physiotherapy Evidence Database,SPORTDiscus,Web of Science and Scopus was performed in August 2018 using the keywords"scaphoid","fracture","acute","carpal","athletes","sports","non-operative","conservative","operative"and"return to sport".All studies that recorded RRS and RTS following scaphoid fractures were included.RTS was recorded as the length of time from commencement of either primary conservative management or primary surgical procedure to return to sport.RESULTS Eleven studies were included:Two randomised controlled trials,six retrospective cohort studies and three case series.Seven studies reported on conservative management(n=77),and eight studies reported on surgical management(n=83).For conservative management,RRS was 90%(69/77),and the mean RTS was9.6 wk.Three studies allowed to return to sport in cast[RRS 89%(25/28);RTS 1.9 wk],and four studies required completion of cast treatment prior to returning to sport[RRS 90%(44/49);RTS 13.9 wk].Four studies recorded fracture union data:Union rate 85%(47/55);mean time to union 14.0 wk.For surgical management,RRS was 98%(81/83),and RTS was 7.3 wk.Three studies reported on Percutaneous Screw Fixation[RRS 97%(32/33);RTS 6.5 wk],and five studies reported on Open Reduction Internal Fixation[RRS 98%(49/50);RTS 7.9 wk].Six studies recorded fracture union data:Union rate 97%(69/71);mean time to union9.8 wk.On meta-analysis,RRS(RR=1.09;95%confidence interval(CI):1.00-1.18;P<0.045),RTS(MD 2.3 wk;95%CI:0.79-3.87;P<0.002),union rates(RR=1.14;95%CI:1.01-1.28;P<0.030)and mean times to union(MD 4.2 wk;95%CI:3.94-4.36;P<0.001)were all significantly better for the surgical cohort compared to the conservative cohort.CONCLUSION Surgical management of scaphoid fractures can provide significantly improved RRS and RTS to sport compared to conservative management.Both treatments,however,remain acceptable options,and athletes should be fully informed of the benefits and risks of both prior to deciding treatment plans.Immediate return to sport in a cast should be avoided due to the significant risk of non-union.
文摘Background: While plain radiography is commonly used to assess scaphoid fracture, this imaging modality may not accurately demonstrate early bone healing. This investigation evaluates the utility of 64-slice CT in the detection of early fracture healing compared to plain radiographs and magnetic resonance imaging (MRI). Methods: Outpatients attending follow-up visits for scaphoid fractures at Hamilton General Hospital were included in this investigation. Inclusion criteria included outpatients over age of 18 who consented to attend a follow-up visit for the scaphoid fracture at 6 weeks for X-Ray, 64-slice CT and MRI scan to monitor fracture healing. Assessment of healing was independently interpreted by two radiologists specialized in musculoskeletal imaging. A total of 7 adult outpatients were accrued, with each case classified as healing, not healing, or equivocal for plain radiography and 64-slice CT scan. Results: For plain radiographs, the level of interrater agreement for evidence of healing was 57% (4/7) cases. When comparing this to CT scans, there was no discrepancy between radiologists as 100% (7/7) were found to have evidence of healing. The 64-slice CT scan demonstrated evidence of early trabecular continuity in all cases, including radiographs that were interpreted as equivocal. Conclusion: This study can be considered a pilot project for the efficacy of 64-slice CT in the assessment of early healing of scaphoid fractures. For clinicians, the multiplanar reconstruction images allows for more accurate assessment of fractures than plain radiography. CT scans are able to penetrate through bony callus that may obscure visualization of healing in plain radiography, demonstrate trabecular continuity better than plain radiographs, are readily accessible and provide faster imaging acquisition. The observations from this study may have implications in terms of duration and type of casting applied, timing of strengthening exercises, and avoiding unnecessary surgery which affect patient morbidity and cost of care.
文摘The clinical results of the application of pedicled vascularized bone graft （VBG） from Lister＇s tubercle vs. traditional bone graft （TBG） were evaluated and compared. Thirteen cases of symptomatic scaphoid nonunion were treated between January 2011 and December 2012, including 7 cases subject to VBG and the rest 6 cases to TBG, respectively. Outcomes were assessed by modified Mayo wrist score system. All cases were followed up for an average period of 3.5 months after opera- tion. The results showed that total scores in VBG group were 86.4i9.4 after operation with excellent result in 4 cases, good in 2 and acceptable in one, and those in TBG group were 71.7±9.3 after operation with good result in 2 cases, acceptable in 3 and disappointing in one. Total score of wrist function was significantly improved in VBG group as compared with TBG group （P〈0.05）. Our study suggests that VBG method is more effective for treating scaphoid nonunion than TBG method.
文摘BACKGROUND Isolated dislocations of the scaphoid are extremely rare types of injuries,commonly associated with severe ligament disruptions,and are occasionally misdiagnosed.Treatment options for dislocations of the scaphoid mainly include closed reduction,with or without internal fixation,and open reduction with ligament repair.CASE SUMMARY A 59-year-old male worker sustained a twisting trauma of his right wrist,caused by a moving belt while he was operating a machine.When he presented at our emergency department,the patient complained of swelling,tenderness,and restriction of movement of the right wrist.Radiographs confirmed a primary complex partial radial dislocation of the scaphoid and some chip fractures of the capitate and hamate.Closed reduction with K-wire internal fixation was performed with the assistance of arthroscopy,and an excellent prognosis was achieved.CONCLUSION Arthroscopy-assisted reduction is a minimally invasive method to reduce the dislocated scaphoid and maintain the blood supply.
文摘A rare combination of an ulnar fracture with posterior dislocation of the head of the radius and fracture of the radius shaft concomitant with an ipsilateral scaphoid fracture is presented. To the best of our knowledge, no such case has been reported. The mechanism of this fracture combination is discussed with respect to its role in producing the Monteggia type II fracture. Treatment consisted of a combination of closed and open reduction with external fixation.
基金Natural Science Foundation of Zhejiang Province,No.LQ19H060002 and No.LQ19H160041Medical and Health Science and Technology Project of Zhejiang Province,No.2018KY089.
文摘BACKGROUND Metastatic tumors of the hand are very rare.They are usually late manifestations of massive advanced malignancies.However,a small portion of acrometastases are indications of occult primary cancer.Here,we report an extremely rare case in which a scaphoid bone lesion was the initial manifestation and was found to be a metastasis from gastroesophageal junction(GEJ)cancer.CASE SUMMARY A 57-year-old male patient presented with ongoing left wrist pain and swelling after trauma.He was initially misdiagnosed with infection of the scaphoid bone and treated with antibiotics and anti-inflammatory drugs.Further radiographic investigations showed a scaphoid pathological fracture,indicating a metastatic tumor derived from the GEJ and/or right lung malignancies.Gastroscopy failed to identify the pathology of the mass at the GEJ,which grew in an exophytic pattern.A lung puncture biopsy was not performed because the patient refused the procedure.To relieve his wrist pain and obtain a definite pathology,we resected the scaphoid lesion.Based on the clinical and pathological results,the patient was finally diagnosed with multiple metastases of advanced GEJ adenocarcinoma.He underwent chemotherapy and died 6 mo after his initial presentation.CONCLUSION Despite the rareness of the disease,orthopedic surgeons should consider the possibility of metastasis to the bones of the hand when patients complain of persistent and progressive pain in the hand.
文摘Concomitant fractures of the hook of hamate and scaphoid are rare injuries to the wrist. Whenever these fractures cannot be effectively managed, nonunion or osteonecrosis is encountered. Subsequent treatment is thus much more challenging for a hand surgeon or orthopedist. Minimally invasive percutaneous internal fixation is an optimal treatment with the potential to minimize injury and reduce fractures. However, the control of iatrogenic injuries, including possible damage to the adjacent vital tissue, is a challenge that needs to be addressed. Herein,we describe the case of a 26-year-old man who presented with fractures to the scaphoid and hook of hamate in his left wrist. Minimally invasive treatment-with closed reduction and percutaneous fixation of the scaphoid, wrist arthroscopy, and closed reduction and percutaneous fixation of the hook of hamate-was performed at our institution. The Mayo score of the wrist, visual analog scale(VAS) for pain, grip strength, pinch strength, and wrist motion in radial/ulnar and flexion/extension deviation were recorded. Primary healing was achieved in both fractures. At the final follow-up, the Mayo score of the wrist was 100(excellent), the VAS score was 0(no pain),and the grip and pinch strength of his injured hand were 90.9% and 83.3%, respectively, compared with the contralateral hand(grip strength: left, 50 kg;right, 55 kg. Pinch strength: left, 20 kg;right, 24 kg). The radialulnar, flexion-extension, and forearm pronation-supination directions were 30°, 140°, and 90°, respectively.Minimally invasive closed reduction with percutaneous internal fixation is an optimal technique with satisfactory outcomes for simultaneous fractures of the hook of hamate and scaphoid. Provided in this paper are details of the technique and technical suggestions for performing the procedure.
文摘Isolated dislocation of the carpal scaphoid is a rare injury. Such dislocation is extremely rare. In this article the authors report a twenty-eight-year-old man with isolated dislocation of the scaphoid with associating radial styloid fracture. We manage the patient with open reduction and Kirschner wire fixation. One year later there is a good functional and radiographic result.
文摘Objective To introduce a new procedure for treatment of rotatory subluxation of the scaphoid. Methods Eighteen patients with rotatory subluxation of the scaphoid were divided into five types according to clinical manifestation and cause: type Ⅰ (predynamic) 1 case,type Ⅱ (dynamic) 2 cases, type Ⅲ (static) 7 cases, type Ⅳ (degenerative) 3 cases, type Ⅴ( secondary) 5 cases. All cases underwent scapho-trapezio-trapezoid limited wrist arthrodesis. Results The follow-up ranged from 6 months to 3 years. The results showed that the all rotatory subluxatiopn of scaphoid in the study had been corrected with satisfactory fusion and painless wrist. The average grip strength was 90% of the normal wrist, and the average range of motion was 62% of the opposite side. Conclusion Scapho-trapezio-trapezoid limited arthrodesis is a reliable and useful procedure for treatment of chronic andChina Medical Abstracts(Surgery) static rotatory subluxation of the scaphoid. 15 refs,2 figs.
文摘Purpose： Wrist has a complex anatomy and undergoes complex injuries, Scaphoid fracture is one of such injuries. It is the most common fracture in carpal bone. Most of the scaphoid fractures are missed on initial X-rays. Magnetic resonance imaging （MRI） is considered as a gold standard for diagnosing scaphoid fractures. Ultrasonography （USG） is emerging as a good alternative to make an early diagnosis of scaphoid fractures. Our aim is to throw light upon the role of USG in detection of scaphoid flactures. Methods： The study was centered upon 114 patients in the age range 10-65 years, with traumatic wrist injury and were clinically suspected to have scaphoid fractures. Patient with non-traumatic history, bilateral wrist injury and late presentation were excluded. X-rays, USG using high frequency probe and MRI were done for all patients. MRI was considered to be the gold standard test. Patients were followed up at 6 weeks. Results： Of the 114 patients, X-ray could diagnose scaphoid fractures in 48 patients, 30 of which were confirmed by MRI. USG results were positive in 74 patients, of which MRI was positive in 67 patients. The accuracy of scaphoid fracture detection with USG was 98.04% in comparison to X-ray （20.58%）, which was statistically significant. Conclusion： USG provides a more accurate and reliable method of making an early diagnosis of scaphoid fracture than X-rays. It is non-invasive, non-expensive and allows better visualisation of cortical disruption.
文摘Scaphoid dislocation is a rare injury. Traditionally it has been classified into isolated dislocation and dislocation associated with axial carpal disruption. We present a unique case of scaphoid dislocation associated with proximal migration of the entire distal carpal row as a single unit and hamate fracture with no axial carpal disruption. This injury complex has not been previously described in the literature. The purpose of this case reportis to emphasize that in absence of axial carpal dissociation with scaphoid dislocation, a careful evaluation of injury to other bones should be done and treated accordingly to maximize the chances of favourable outcome with recon- structive surgery.
