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Adaş M. Treatment of AVN-Induced Proximal Pole Scaphoid Nonunion Using a Fifth and Fourth Extensor Compartmental Artery as a Vascularized Pedicle Bone Graft: A Retrospective Case Series. Med Sci Monit 2024; 30:e944553. [PMID: 38762751 PMCID: PMC11113082 DOI: 10.12659/msm.944553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/01/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND Scaphoid nonunion (SN) is a challenging condition in wrist pathology, often resulting in severe consequences if left untreated. Surgical intervention, particularly using vascularized bone grafts (VBGs), is a promising but uncertain approach. The 4+5 extensor compartment artery (ECA) pedicled graft, less commonly used for SN, has potential benefits due to its vascular supply and accessibility to the scaphoid. This study aimed to evaluate the effectiveness of the 4+5 ECA pedicled graft combined with headless compression screw fixation in treating avascular necrosis (AVN)-induced proximal pole SN. Radiological results, functional outcomes, and complications related to this method were assessed. MATERIAL AND METHODS This was a retrospective analysis of 19 proximal pole SN cases with AVN treated using the 4+5 ECA-VBG technique from 2016 to 2022. Patients underwent preoperative evaluation and postoperative follow-up for at least 1 year. Data on surgery, demographics, radiological assessments, and functional outcomes were recorded and analyzed statistically. RESULTS All patients achieved radiographic union within 8.5 weeks postoperatively, with revascularization of proximal pole necrosis. Significant improvements in functional outcomes were observed, including pain reduction, increased wrist range of motion, improved grip and pinch strength, and enhanced wrist scores. No major complications were reported. CONCLUSIONS The 4+5 ECA-VBG technique, with headless compression screw fixation, showed high success rates in treating AVN-induced proximal pole SN. This method offers comprehensive restoration of wrist function and minimal complications, making it a viable option for SN management, especially in AVN cases. Further research is needed to confirm these results and establish standardized protocols for SN treatment.
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Seth I, Lim B, Xie Y, Hunter-Smith DJ, Rozen WM. Exploring the role of artificial intelligence chatbot on the management of scaphoid fractures. J Hand Surg Eur Vol 2023; 48:814-818. [PMID: 37177798 DOI: 10.1177/17531934231169858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Affiliation(s)
- Ishith Seth
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria, 3004, Australia
| | - Bryan Lim
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria, 3004, Australia
- Faculty of Medicine, Monash University, Melbourne, Victoria, 3002, Australia
| | - Yi Xie
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria, 3004, Australia
| | - David J Hunter-Smith
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria, 3004, Australia
| | - Warren M Rozen
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria, 3004, Australia
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Singh CM, Prasad M, Thakur K, Vig V. Osteopenia in Scaphoid Fracture: An Indicator of Good Prognosis or Is it Cause for Concern?: A Case Report. JBJS Case Connect 2022; 12:01709767-202203000-00015. [PMID: 35050934 DOI: 10.2106/jbjs.cc.21.00161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
CASE A 32-year-old man sustained a scaphoid waist fracture and was managed nonoperatively in a short-arm cast. Radiographic follow-up at 6 weeks showed marked loss of radiodensity of the whole scaphoid, although the fracture was clinically united. Patchy ossification at 3 months was followed by the complete restoration of radiodensity and trabecular pattern by 20 weeks. The patient had an uneventful and full functional recovery. CONCLUSION This, perhaps unreported, finding seems to be an indicator of preserved vascularity in scaphoid fractures. Further research/reporting of this radiological pattern in these fractures will help improve their understanding and management.
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Hermena S, Khan RK, El-Bouni T, McFarlane J. How to manage scaphoid waist fractures? Introduction of pragmatic imaging efficient pathway and literature review of the recent evidence. J Med Imaging Radiat Sci 2021; 52:511-518. [PMID: 34479830 DOI: 10.1016/j.jmir.2021.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/30/2021] [Accepted: 08/07/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION AND OBJECTIVE The scaphoid bone sustains about 90 % of carpal bone fractures and is the second-highest bone at risk of post-traumatic osteonecrosis. Delayed diagnosis and treatment could lead to non-union and advanced carpal bones collapse. This study aimed to introduce an imaging efficient and practical scaphoid waist fracture management pathway (SWFMP) and measure its efficacy in clinical practice. MATERIALS AND METHODS The SWFMP was introduced in January 2020. Suspected occult fractures were approached by early orthopaedic clinical assessment and subsequent urgent MRI scan without repeating scaphoid X-rays. Scaphoid waist fractures displaced < 2 mm were treated with 8 weeks below elbow cast immobilization followed by CT scan if delayed union was suspected. Waist fractures displaced > 2 mm were managed with surgical fixation. Adult patients referred from the emergency department (ED) to the Virtual Fracture Clinic (VFC) with acute scaphoid injury from January 2019 to October 2019 (Pre SWFMP, n = 29), were identified and compared to those managed from January 2020 to October 2020 (Post SWFMP, n = 33). RESULTS Mean age was 37.9 (SD = 20.61) and 36.2 (SD = 17.06) years in the pre-SWFMP and post-SWFMP cohorts respectively. Fiften patients (51.7%) had the right side affected in the pre-SWFMP cohort and twenty-three patients (69.7%) in the post-SWFMP cohort. Scaphoid X-rays requested by ED have increased from 19 (65.5%) to 31 (94%) and repeated X-rays reduced from 17 (58.6%) to 10 (30.3%) after the introduction of the SWFMP. Mean wrist cast immobilization for patients without scaphoid fractures dropped from 16.9 days (SD = 5.57) to 3.6 days (SD = 6.24) after the SWFMP (p = 0.001). In the pre-SWFMP cohort, 24 patients had no fracture, 4 achieved full healing and 1 developed non-union. In the post-SWFMP cohort, 29 patients had no fracture, 1 achieved full union and delayed union was detected in 3 patients at 8 weeks. CONCLUSIONS The SWFMP has improved the clinical practice by reducing unnecessary ionizing radiation, unnecessary cast immobilization, and by using a timely fracture fixation intervention.
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Affiliation(s)
- Shady Hermena
- Trauma and Orthopaedic department, Yeovil District Hospital NHS foundation Trust. Higher Kingston, Yeovil BA21 4AT, UK.
| | - Raafay Kamal Khan
- Trauma and Orthopaedic department, Yeovil District Hospital NHS foundation Trust. Higher Kingston, Yeovil BA21 4AT, UK
| | - Tarek El-Bouni
- Trauma and Orthopaedic department, Yeovil District Hospital NHS foundation Trust. Higher Kingston, Yeovil BA21 4AT, UK
| | - John McFarlane
- Trauma and Orthopaedic department, Yeovil District Hospital NHS foundation Trust. Higher Kingston, Yeovil BA21 4AT, UK
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Stirling PHC, Broll RD, Molyneux SG, Oliver CW, McQueen MM, Duckworth AD. Percutaneous fixation of acute scaphoid waist fractures: Long-term patient-reported functional outcomes and satisfaction at a mean of 11 years following surgery. HAND SURGERY & REHABILITATION 2021; 40:293-298. [PMID: 33652139 DOI: 10.1016/j.hansur.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/14/2021] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
The aim of this study was to report the long-term functional outcomes and complication rates following early percutaneous fixation of acute fractures of the scaphoid. A trauma database was searched to identify all skeletally-mature patients with an undisplaced or minimally-displaced scaphoid waist fracture managed with early percutaneous retrograde screw fixation over a thirteen-year period from 1997-2010. Medical records were retrospectively reviewed, and complications documented. Long-term follow-up was by a questionnaire-based review. The Patient-Rated Wrist Evaluation (PRWE) was the primary outcome measure. Secondary outcomes included the Quick version of the Disability of the Arm, Shoulder and Hand score (QuickDASH), the EuroQol 5-dimensions score (EQ-5D-5L), and complications. During the study period 114 patients underwent this procedure. The mean age was 28 years (range 17-62) and 97 patients (85%) were male. The median time from injury to surgery was nine days (range 1-27). Twelve patients (11%) reported a complication, all of whom required repeat surgical intervention (six revision ORIF for non-union, five elective removal of hardware, one early revision fixation due to screw impingement). Long-term outcome data was available for 77 patients (68%) at mean follow-up of 11.4 years (range 6.4-19.8). The median PRWE was 0 (IQR 0-7.5), median QuickDASH 0 (IQR 0-4.5) and median EQ-5D-5L 1.0 (IQR 0.837-1.0). There were 97% (n = 74) patients satisfied with their outcome. Early percutaneous fixation of acute non-displaced or minimally displaced scaphoid fractures results in good long-term patient reported outcomes and health-related quality of life. Although comparable with previous studies, the overall surgical reintervention rate is notable and can result in inferior outcomes. LEVEL OF EVIDENCE: Therapeutic level III (Retrospective Cohort Study).
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Affiliation(s)
- P H C Stirling
- Edinburgh Orthopaedics - Trauma, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh EH16 4SA, United Kingdom
| | - R D Broll
- Edinburgh Orthopaedics - Trauma, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh EH16 4SA, United Kingdom
| | - S G Molyneux
- Edinburgh Orthopaedics - Trauma, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh EH16 4SA, United Kingdom
| | - C W Oliver
- Edinburgh Orthopaedics - Trauma, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh EH16 4SA, United Kingdom
| | - M M McQueen
- Edinburgh Orthopaedics - Trauma, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh EH16 4SA, United Kingdom
| | - A D Duckworth
- Edinburgh Orthopaedics - Trauma, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh EH16 4SA, United Kingdom; Usher Institute, University of Edinburgh, NINE Edinburgh BioQuarter, Edinburgh.
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Ek ET, Johnson PR, Bohan CM, Padmasekara G. Clinical Outcomes of Double-Screw Fixation with Autologous Bone Grafting for Unstable Scaphoid Delayed or Nonunions with Cavitary Bone Loss. J Wrist Surg 2021; 10:9-16. [PMID: 33552688 PMCID: PMC7850798 DOI: 10.1055/s-0040-1714252] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/03/2020] [Indexed: 10/23/2022]
Abstract
Objective This study reports on the clinical outcomes of double screw fixation with autologous cancellous bone grafting and early active range of motion for delayed and nonunited scaphoid waist fractures with cavitary segmental bone loss. Patients and Methods Twenty-one consecutive patients underwent fixation using two 2.2 mm antegrade headless compression screws with autologous distal radius cancellous bone graft. Postoperatively, patients were allowed early active motion with a resting splint until union was achieved. Patients were reviewed radiologically and clinically to assess for fracture union, complications, residual pain, wrist function, and return to work and recreational activities. Results All but one patient was male, and the mean age was 23 years (range, 15-38 years). The average time from initial injury was 16 months (range, 3-144 months). Nineteen of 21 (90.5%) patients achieved union at a mean of 2.8 months (range, 1.4-9.2 months). Of the patients who failed, one underwent revision surgery with vascularized bone grafting at 10.6 months. The other patient refused further intervention as he was asymptomatic. Conclusion Double-screw fixation with bone grafting and early active range of motion is a safe and effective technique for management of delayed and nonunited unstable scaphoid fractures with cavitary bone loss. This potentially allows for earlier return to function, without compromise to union rates. Level of Evidence This is a Level IV, retrospective case series study.
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Affiliation(s)
- Eugene T. Ek
- Melbourne Orthopaedic Group, Windsor, Melbourne, Victoria, Australia
- Division of Hand Surgery, Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Dandenong, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Monash Medical Centre, Clayton, Melbourne, Victoria, Australia
| | - Paul R. Johnson
- Melbourne Orthopaedic Group, Windsor, Melbourne, Victoria, Australia
| | - Carmel M. Bohan
- Melbourne Orthopaedic Group, Windsor, Melbourne, Victoria, Australia
| | - Gayan Padmasekara
- Melbourne Orthopaedic Group, Windsor, Melbourne, Victoria, Australia
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Ek ET, Johnson PR, Bohan CM, Padmasekara G. Autologous bone grafting and double screw fixation for unstable scaphoid nonunions with cavitary bone loss. J Hand Surg Eur Vol 2021; 46:205-206. [PMID: 32746686 DOI: 10.1177/1753193420946656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Eugene T Ek
- Melbourne Orthopaedic Group, Windsor, VIC, Australia.,Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash University, Melbourne, VIC, Australia.,Department of Surgery, Monash Medical Centre, Monash University, Melbourne, VIC, Australia
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Liu EH, Schulz PD, Ek ET. Periprosthetic fracture of the scaphoid after successful headless compression screw fixation: report of two cases. J Hand Surg Eur Vol 2020; 45:1093-1095. [PMID: 32536297 DOI: 10.1177/1753193420930593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Edward H Liu
- Division of Hand Surgery, Monash University, Melbourne, VIC, Australia
| | | | - Eugene T Ek
- Division of Hand Surgery, Monash University, Melbourne, VIC, Australia.,Department of Surgery, Monash University, Melbourne, VIC, Australia.,Melbourne Orthopaedic Group, Melbourne, VIC, Australia
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Polo Simón F, García Medrano B, Delgado Serrano PJ. Diagnostic and Therapeutic Approach to Acute Scaphoid Fractures. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2020. [DOI: 10.1055/s-0040-1718457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
AbstractThe scaphoid is the carpal bone that most often fractures, accounting for up to 70% of carpal fractures and 11% of hand fractures. It is the second most common arm fracture, only surpassed by fractures of the distal radius. Despite being so common, these fractures can be difficult to diagnose and treat due to the anatomic and physiological particularities of the bone, including its precarious vascularization, its complex three-dimensional structure, and its ligament connections, which greatly contribute to the risk of complications such as malunion, pseudoarthrosis and avascular necrosis. Although there are many published studies on the treatment of these injuries, there is still controversy over what is the most suitable one for certain fracture types. The present article is a comprehensive and updated review of the literature. Combining strategies for clinical and radiological diagnosis, we propose a complete algorithm for the diagnosis of scaphoid fractures based on the varying availability of resources, and we also describe the most appropriate therapeutic approach for the different types of acute fractures of this bone.
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Affiliation(s)
- Fernando Polo Simón
- Hand Surgery and Microsurgery Unit, Hospital Universitario HM Montepríncipe, Boadilla del Monte, Madrid, Spain
- Mutua Universal, Madrid, Spain
- Orthopedic Surgery and Traumatology Service, Hospital Universitario HM Montepríncipe, Boadilla del Monte, Madrid, Spain
| | - Belén García Medrano
- Hand Surgery and Microsurgery Unit, Hospital Universitario HM Montepríncipe, Boadilla del Monte, Madrid, Spain
- Orthopedic Surgery and Traumatology Service, Hospital Universitario HM Montepríncipe, Boadilla del Monte, Madrid, Spain
| | - Pedro J. Delgado Serrano
- Hand Surgery and Microsurgery Unit, Hospital Universitario HM Montepríncipe, Boadilla del Monte, Madrid, Spain
- Orthopedic Surgery and Traumatology Service, Hospital Universitario HM Montepríncipe, Boadilla del Monte, Madrid, Spain
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Haugstvedt JR, Wong CWY. Arthroscopic treatment for nonunion of the scaphoid. HANDCHIR MIKROCHIR P 2020; 52:413-418. [DOI: 10.1055/a-1242-4415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
AbstractScaphoid nonunion has traditionally been treated by open surgery where the pseudarthrosis has been cleaned while either a structural wedged bone graft, or chips of cancellous bone has been used to fill the defect. K-wires or a screw has been used to stabilize the bone. Using the arthroscopic technique for treatment of nonunion of the scaphoid gives us small exposure to the joint, however with an excellent view of the bones, the articular surfaces and the intraarticular ligaments. The results from arthroscopic treatment for scaphoid nonunion with bone grafting using chips of cancellous bone are as good as from the open technique. The arthroscopic treatment, though, helps us to diagnose and treat concomitant lesions. There is less damage of blood supply, nerves and capsule, which might lead to a faster recovery and rehabilitation. The technique will be described and discussed.
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Affiliation(s)
| | - Clara Wing-yee Wong
- Department of Orthopedics & Traumatology, The Chinese University of Hong Kong
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Ansari SA, Kennedy JA, Younis F. Postoperative Outcomes of Volar Plate Fixation in Cases of Scaphoid Deformity or Nonunion: A Case Series. J Wrist Surg 2020; 9:304-311. [PMID: 32760609 PMCID: PMC7395847 DOI: 10.1055/s-0040-1710383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
Background Fractures through the waist of scaphoid are a common injury, resulting in deformity or nonunion. Recently, a locking plate has been shown to fix deformity or nonunion of scaphoid, with limited observation of functional postoperative outcomes. Objectives We present a case series of 16 patients, with the disabilities of the arm, shoulder, and hand (DASH) score evaluation in primary fixation of scaphoid fractures with humpback deformity ( n = 11) and revision open reduction internal fixation (ORIF) for nonunion ( n = 5), using the Medartis TriLock 1.5 scaphoid plate and bone grafting. Patients and Methods DASH scores were obtained preoperatively and postoperatively at 3, 6, and 12 (if required) months. Patient demographics, smoking status, employment type, and grip strengths were recorded. Results Thirteen patients attended follow-up. Union was clinically and radiologically assessed with 13 achieving union. The mean preoperative DASH score was 34.0 ( n = 16) and at treatment completion (discharge or DNA) was 11.5 ( n = 13), with mean reduction of 18.5 ( p = 0.03). At treatment completion, mean reduction in DASH score of revision ORIF was 13.7 ( p = 0.27; n = 4), compared with 20.7 ( p < 0.01; n = 9) in primary fixation with plate. Conclusions Deformity correction, reduction in DASH score, and rate of union make the plate system useful in the management of scaphoid fractures with humpback deformity and revision for nonunion. Level of Evidence This is a Level IV study.
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Affiliation(s)
- Saif A. Ansari
- School of Medicine, University of Central Lancashire, Lancashire, United Kingdom
| | - James A. Kennedy
- Department of Trauma and Orthopaedics, Health Education North West ST6 Trauma and Orthopaedics, Health Education North West, Lancashire, United Kingdom
| | - Fizan Younis
- School of Medicine, University of Central Lancashire, Lancashire, United Kingdom
- Department of Hand Surgery, University of Central Lancashire, East Lancashire Hospitals National Health Service Trust, Lancashire, United Kingdom
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Abstract
Acute scaphoid fractures are common wrist injuries that continue to elicit debate from surgeons regarding the most appropriate diagnostic and management algorithms. This review will examine the current literature and trends, in an attempt to provide the reader with an evidence-based discussion regarding current controversies of interest to clinicians. In addition, an attempt will be made to provide recommendations for the best treatment practices for acute scaphoid fractures.
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Affiliation(s)
- Nina Suh
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, University of Western Ontario, London, Ontario, Canada
| | - Ruby Grewal
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, University of Western Ontario, London, Ontario, Canada
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Tourdias D. Pseudarthrose du scaphoïde. ANNALES FRANCAISES DE MEDECINE D URGENCE 2016. [DOI: 10.1007/s13341-016-0645-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
The patient was a 21-year-old male cadet at a military academy who was evaluated by a physical therapist in a direct-access capacity for a chief complaint of left wrist pain that began 1 day after injuring his wrist while performing a bench-press exercise. Due to concern for a scaphoid fracture and because radiographic imaging was not immediately available, a physical therapist credentialed to utilize fluoroscopy evaluated the left wrist. Radiographs were subsequently ordered, which confirmed a mid-waist, nondisplaced scaphoid fracture.
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