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Srivastav A, Behera P, Dwivedi RK, Santoshi JA. Finite Element Analysis of Postoperative Stability of Transverse Scaphoid Waist Fracture. Indian J Orthop 2024; 58:785-793. [PMID: 38812856 PMCID: PMC11130101 DOI: 10.1007/s43465-024-01156-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/12/2024] [Indexed: 05/31/2024]
Abstract
Background and Purpose Scaphoid waist fractures are often stabilised with compression screws, Kirschner wires (K-wires), or a combination of both. While clinical and bio-mechanical studies evaluating their utility are available, the ideal configuration of implant that would provide adequate stability to permit early use of the hand is debatable. We examined configurations of a single screw, one screw along with a K-wire, and two K-wires used for a transverse scaphoid waist fracture fixation aiming to assess the stability provided by each in the immediate postoperative period. Methods Computer-aided design (CAD) models of the scaphoid, K-wire, and headless compression screw were created. A transverse fracture was created at the scaphoid waist, and the CAD models of the screw and K-wire were used to fix the fracture in different configurations in a distal to proximal direction. Finite Element Analysis (FEA) was used to examine the strength of configurations when they were subjected to compression and distraction forces. The total maximum deformation (TDef) and factor of safety (FoS) for each configuration were calculated and used as indirect indicators of postoperative stability. Results When a single screw was used, the configurations with the screw directed posteriorly from either centre or anterior had the best combined TDef and FoS values. For one screw and one K-wire, the configuration with screw and K-wire parallel to each other with the screw located along the long axis in the AP projection and anterior to the K-wire in the lateral projection had the best combined TDef and FoS values. When using two K-wires, configurations with the two wires diverging proximally on the lateral projection had the best combined TDef and FoS values. Conclusions When fixing a transverse scaphoid waist fracture with a single screw, the screw directed posteriorly from either the centre or anterior aspect of the distal pole has the best stability, a parallel configuration has the best stability when fixing it using a screw and a K-wire, and divergent configuration has the best stability when fixing it with two K-wires only.
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Affiliation(s)
- Ayush Srivastav
- Department of Mechanical Engineering, Maulana Azad National Institute of Technology, Bhopal, India
| | - Prateek Behera
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, India
| | - Ravi Kumar Dwivedi
- Department of Mechanical Engineering, Maulana Azad National Institute of Technology, Bhopal, India
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2
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Mickley JP, Lynch DJ, Gordon AM, Roebke AJ, Goyal KS. Fracture Gap Closure and Reduction Are Affected by the Orientation of the Headless Compression Screw. Hand (N Y) 2024; 19:656-663. [PMID: 36692082 PMCID: PMC11141410 DOI: 10.1177/15589447221150504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND We evaluated the impact of a variable-pitch headless screw's angle of insertion relative to the fracture plane on fracture gap closure and reduction. METHODS Variable-pitch, fully threaded headless screws were inserted into polyurethane blocks of "normal" bone model density using a custom jig. Separate trials were completed with a 28-mm screw placed perpendicular and oblique/longitudinal to varying fracture planes (0°, 15°, 30°, 45°, and 60°). Fluoroscopic images were taken after each turn during screw insertion and analyzed. Initial screw push-off, residual fracture gap at optimal fracture gap reduction, and malreduction were determined in each trial. Statistical analysis was performed via a 1-way analysis of variance followed by Student t tests. RESULTS Malreduction was found to be significantly different between the perpendicular (1.88 mm ± 1.38) and the oblique/longitudinal (0.58 mm ± 0.23) screws. The malreduction increased for the perpendicular screw as the fracture angle increased (60° > 45°=30° > 15° > 0°). Residual fracture gap at optimal fracture gap reduction was also found to be significantly different between the perpendicular (0.97 ± 0.42) and oblique/longitudinal (1.43 ± 1.14) screws. The residual fracture gap increased for the oblique/longitudinal screw as the fracture angle increased, although the oblique/longitudinal screw with a 60° fracture angle was the only configuration significantly larger than all the other configurations. Screw push-off was not found to be significantly different between the oblique/longitudinal screw and perpendicular screw trials. CONCLUSIONS The perpendicular screw had a larger malreduction that increased with fracture angle, whereas the oblique/longitudinal screw had a larger residual fracture gap that increased with fracture angle.
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Affiliation(s)
- John P. Mickley
- The Ohio State University College of Medicine, Columbus, USA
| | - Daniel J. Lynch
- The Ohio State University College of Medicine, Columbus, USA
| | - Adam M. Gordon
- The Ohio State University Wexner Medical Center, Columbus, USA
| | | | - Kanu S. Goyal
- The Ohio State University Wexner Medical Center, Columbus, USA
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Santoshi JA, Behera P, Dwivedi RK, Srivastav A. Mechanism of scaphoid waist fracture: finite element analysis. J Hand Surg Eur Vol 2022; 48:426-434. [PMID: 36562119 DOI: 10.1177/17531934221145516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The mechanism of scaphoid waist fracture is not completely understood. We used finite element analysis to study the formation of scaphoid waist fractures. Clinical computed tomography scans of 12 wrists were used to create models for finite element analysis. The points of application of load were at different sites along the scaphotrapeziotrapezoid joint distally, and the scaphoid fossa plus the area underlying the radioscaphocapitate ligament was regarded as the fixed proximal support. A fracture was produced at the scaphoid waist in all cases. The location of failure of bone at its anterior or dorsal cortex, either in tension or in compression, was determined by the site of application of the load. The anterior cortex failed in compression when the point of impact was located along the trapezium facet or the entire distal pole, whereas it failed in tension when the point of impact was along the trapezoid facet.
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Affiliation(s)
- John Ashutosh Santoshi
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Prateek Behera
- Department of Orthopaedics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Ravi Kumar Dwivedi
- Department of Mechanical Engineering, Maulana Azad National Institute of Technology Bhopal, Madhya Pradesh, India
| | - Ayush Srivastav
- Department of Mechanical Engineering, Maulana Azad National Institute of Technology Bhopal, Madhya Pradesh, India
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4
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Dean BJF, Berridge A, Berkowitz Y, Little C, Sheehan W, Riley N, Costa M, Sellon E. The reliability and clinical utility of a simple MRI based classification tool for acute scaphoid injuries: the OxSMART. Bone Jt Open 2022; 3:913-920. [DOI: 10.1302/2633-1462.311.bjo-2022-0129.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Aims The evidence demonstrating the superiority of early MRI has led to increased use of MRI in clinical pathways for acute wrist trauma. The aim of this study was to describe the radiological characteristics and the inter-observer reliability of a new MRI based classification system for scaphoid injuries in a consecutive series of patients. Methods We identified 80 consecutive patients with acute scaphoid injuries at one centre who had presented within four weeks of injury. The radiographs and MRI scans were assessed by four observers, two radiologists, and two hand surgeons, using both pre-existing classifications and a new MRI based classification tool, the Oxford Scaphoid MRI Assessment Rating Tool (OxSMART). The OxSMART was used to categorize scaphoid injuries into three grades: contusion (grade 1); unicortical fracture (grade 2); and complete bicortical fracture (grade 3). Results In total there were 13 grade 1 injuries, 11 grade 2 injuries, and 56 grade 3 injuries in the 80 consecutive patients. The inter-observer reliability of the OxSMART was substantial (Kappa = 0.711). The inter-observer reliability of detecting an obvious fracture was moderate for radiographs (Kappa = 0.436) and MRI (Kappa = 0.543). Only 52% (29 of 56) of the grade 3 injuries were detected on plain radiographs. There were two complications of delayed union, both of which occurred in patients with grade 3 injuries, who were promptly treated with cast immobilization. There were no complications in the patients with grade 1 and 2 injuries and the majority of these patients were treated with early mobilization as pain allowed. Conclusion This MRI based classification tool, the OxSMART, is reliable and clinically useful in managing patients with acute scaphoid injuries. Cite this article: Bone Jt Open 2022;3(11):913–920.
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Affiliation(s)
- Benjamin J. F. Dean
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, Oxford, UK
| | - Anna Berridge
- East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | | | | | - Warren Sheehan
- Emergency Department, John Radcliffe Hospital, Oxford, UK
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Li C, Peng Z, Zhou Y, Ruan M, Su YY, Liu S, Meng XH, Xu YQ. The progress in the classification and treatment of scaphoid nonunion. Surgeon 2022; 20:e231-e235. [PMID: 35750549 DOI: 10.1016/j.surge.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 05/26/2022] [Indexed: 10/17/2022]
Abstract
Scaphoid fracture is the most common carpal fracture, accounting for 50%-80% of all carpal fractures in the Youngers and manual workers. The nonunion rate of scaphoid fractures was approximately 10-15%. Scaphoid nonunion can lead to wrist deformity, wrist collapse, ischemic necrosis, and traumatic osteoarthritis resulting in the loss of wrist function and seriously influence the patients' lives. Achieving bony union is essential for the treatment of scaphoid nonunion. Although many surgical procedures including various forms of bone grafting have been developed to improve bony union, there is no conclusion about which method is the most effective and optimal. In this review, we provide an overview of the diagnostic, classification and progress in the treatments of scaphoid nonunion fractures.
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Affiliation(s)
- Chuan Li
- Department of Orthopaedic, Kunming Medical University, Kunming 650500, China; Department of Orthopaedic, 920th Hospital of Joint Logistics Support Force, Kunming 650032, China
| | - Zhi Peng
- Department of Orthopaedic, Kunming Medical University, Kunming 650500, China
| | - You Zhou
- Department of Orthopaedic, Children's Hospital of Kunming Medical University, Yunnan 650228, China
| | - Mo Ruan
- Department of Orthopaedic, 920th Hospital of Joint Logistics Support Force, Kunming 650032, China
| | - Yong-Yue Su
- Department of Orthopaedic, 920th Hospital of Joint Logistics Support Force, Kunming 650032, China
| | - Shuai Liu
- Department of Orthopaedic Surgery, Sheng-Jing Hospital, China Medical University, Shenyang 110004, China
| | - Xu-Han Meng
- Department of Orthopaedic, 920th Hospital of Joint Logistics Support Force, Kunming 650032, China
| | - Yong-Qing Xu
- Department of Orthopaedic, 920th Hospital of Joint Logistics Support Force, Kunming 650032, China.
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Abstract
Acute and subacute wrist trauma predominantly consist of fractures of the distal radius in elderly patients and most frequently carpal fractures (scaphoid, followed by triquetrum and hamatum) and avulsion fractures of the ulnar styloid in younger patients, especially in sports-related injuries but also in work activities. The initial radiographs may miss the fractures and result when untreated in complications as nonunion, osteonecrosis, and degenerative osteoarthritis. Fractures of the distal radius and of the scaphoid may be associated with ligament injuries, most frequently the scapholunate complex, which are often overlooked at the emergency department. Patients without osseous injuries may present intrinsic and extrinsic ligament tears that may lead to carpal instability when they are clinically and/or radiologically missed. Therefore, in acute and subacute setting, computed tomography may be helpful for the detection of subtle fractures, and magnetic resonance imaging, for the early diagnosis of occult fractures and ligament injuries.
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Chong HH, Kulkarni K, Shah R, Hau MYT, Athanatos L, Singh HP. A meta-analysis of union rate after proximal scaphoid fractures: terminology matters. J Plast Surg Hand Surg 2021; 56:298-309. [PMID: 34550858 DOI: 10.1080/2000656x.2021.1979016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Heterogeneity in the anatomical definition of 'proximal' affects the comparison of outcomes of these scaphoid fractures. This study aims to review published outcomes of all variants to determine both, differences in terminology, and union rate based upon definition. A literature search was conducted to identify articles that reported descriptions and union rate of all acute (<8 weeks of injury) proximal scaphoid fractures in adult patients (>16 years old). Proximal fractures were grouped as reported ('third', 'pole', 'fifth' or 'undefined'). The data were pooled using a fixed-effects method, and a meta-analysis was conducted to compare relative risk (RR) of non-union against non-proximal fractures. Qualitative analysis of 12 articles included three main definitions: 'proximal' (1 article), 'proximal third' (3 articles), and 'proximal pole' (8 articles). Only 6 articles adopted a specific anatomical or ratio description. In a pooled meta-analysis of union rates (15 articles), 'proximal third' and 'proximal pole' fractures demonstrated a relative risk (RR) of non-union of 2.3 and 3.4 in comparison to non-proximal fractures, respectively. Operative management yielded lower non-union rates than non-operative for all fracture types (6% vs. 18%). In conclusion, non-union risk varies depending on definition, with non-standardised classifications adding heterogeneity to reported outcomes. We recommend an approach utilizing fixed anatomical landmarks on plain radiographs (referencing scaphoid length and scapho-capitate joint) to standardise reporting of proximal fracture union in future studies. Abbreviations: CI: confidence intervals; CT: computer tomography; Df: degrees of freedom; DL: dersimonian and laird estimator; MRI: magnetic resonance imaging; NICE: national institute for health and care excellence; OTA: orthopaedic trauma association; PA: posterior-anterior; PRISMA: preferred reporting items for systematic reviews and meta analyses; RCT: randomised controlled trial; RR: relative risk; SNAC: scaphoid non-union advanced collapse; UK: United Kingdom.
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Affiliation(s)
- Han Hong Chong
- University Hospital of Leicester NHS Trust, Leicester, United Kingdom
| | - Kunal Kulkarni
- Pulvertaft Hand Centre, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Rohi Shah
- University Hospital of Leicester NHS Trust, Leicester, United Kingdom
| | - Melinda Y T Hau
- University Hospital of Leicester NHS Trust, Leicester, United Kingdom
| | - Lambros Athanatos
- University Hospital of Leicester NHS Trust, Leicester, United Kingdom
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Chaves C, Asmar G, Billac F, Falcone MO. Volar rerouting of the 1,2 intercompartmental supraretinacular artery vascularized bone graft for middle and distal scaphoid nonunions. Orthop Traumatol Surg Res 2021; 107:102972. [PMID: 34052511 DOI: 10.1016/j.otsr.2021.102972] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/27/2020] [Accepted: 12/09/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND The bone graft vascularized by the 1,2 intercompartmental supraretinacular artery (1,2 ICSRA) placed on the scaphoid by a dorsal approach is a technique used to treat scaphoid nonunions with avascular necrosis of the proximal pole and without significant bone loss or carpus collapse. We present the results of patients treated with a volar rerouting of the 1,2 ICSRA graft under the tendons of the first extensor compartment to treat more distal scaphoid nonunions than the proximal pole. The aim of this study was to assess the clinical and radiological outcomes of patients operated with this technique with the hypothesis that it would allow to treat more distal nonunions than those of the proximal pole. PATIENTS AND METHODS This retrospective study involved patients treated by a volar rerouting of the 1,2 ICSRA graft for nonunions of the middle and distal thirds of the scaphoid. Assessments included clinical outcomes and radiological bone consolidation. QuickDASH and Mayo Wrist scores were computed. Range of motion and grip strength were evaluated for both the operated and the contralateral sides. RESULTS Nineteen patients were followed-up for 33 months (range: 6-75). Mean postoperative QuickDASH score was 10 (range: 0-45), and mean Mayo wrist score was 85 (range: 50-100). Flexion and extension, ulnar and radial deviations were statistically different between the affected and healthy sides (p<0,05). Consolidation was achieved in 17 patients (89%). DISCUSSION This technical modification allowed good functional outcomes and scaphoid consolidation. It expands the classic indications of the vascularized 1,2 ICSRA bone graft to more distal nonunions than the proximal pole. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Camilo Chaves
- Ramsay Générale de Santé-Capio-Hôpital Privé Paul d'Égine, 4, avenue Marx Dormoy, 94500 Champigny-sur-Marne, France; Institut de la Main Nantes Atlantique, boulevard Charles-Gautier, 44800 Saint-Herblain, France
| | - Ghada Asmar
- Ramsay Générale de Santé-Capio-Hôpital Privé Paul d'Égine, 4, avenue Marx Dormoy, 94500 Champigny-sur-Marne, France
| | - Fanny Billac
- Université Paris Descartes, 15, rue de l'École de Médecine, 75006 Paris, France
| | - Marc-Olivier Falcone
- Ramsay Générale de Santé-Capio-Hôpital Privé Paul d'Égine, 4, avenue Marx Dormoy, 94500 Champigny-sur-Marne, France; Clinique Internationale du Parc Monceau, 21, rue de Chazelles, 75017 Paris, France.
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9
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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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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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11
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Turow A, Bulstra AE, Oldhoff M, Hayat B, Doornberg J, White J, Jaarsma RL, Bain GI. 3D mapping of scaphoid fractures and comminution. Skeletal Radiol 2020; 49:1633-1647. [PMID: 32417943 DOI: 10.1007/s00256-020-03457-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 04/19/2020] [Accepted: 04/26/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Acute and subacute scaphoid fractures were assessed using 3D computer tomography (CT). The aims were to describe fracture morphology, to map fractures onto a 3D scaphoid model and to correlate this to scaphoid anatomy. MATERIALS AND METHODS A retrospective, multicentre database search was performed to identify CT studies of acute and subacute scaphoid fractures. CT scans of scaphoid fractures less than 6 weeks from time of injury were included in this retrospective, multicentre study. CTs were segmented and converted into three-dimensional models. Following virtual fracture reduction, fractures were mapped onto a three-dimensional scaphoid model. RESULTS Seventy-five CT scans were included. The median delay from injury to CT was 29 days. Most studies were in male patients (89%). Most fractures were comminuted (52%) or displaced (64%). A total of 73% of displaced fractures had concomitant comminution. Waist fractures had higher rates of comminution and displacement when compared with all other fractures. Comminution was located along the dorsal ridge and the volar scaphoid waist. CONCLUSION Our study is the first to describe acute fracture morphology using 3D CT and to correlate comminution and displacement to fracture types. The dorsal ridge and volar waist need prudent assessment, especially in waist fractures.
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Affiliation(s)
- Arthur Turow
- Flinders University, Sturt Road, Bedford Park, 5042, South Australia, Australia. .,Department of Orthopaedic Surgery, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, 5042, Australia.
| | - Anne Eva Bulstra
- Flinders University, Sturt Road, Bedford Park, 5042, South Australia, Australia.,Department of Orthopaedic Surgery, University of Amsterdam, location Academic Medical Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Miriam Oldhoff
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, the Netherlands
| | - Batur Hayat
- Flinders University, Sturt Road, Bedford Park, 5042, South Australia, Australia.,Department of Orthopaedic Surgery, University of Amsterdam, location Academic Medical Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Job Doornberg
- Flinders University, Sturt Road, Bedford Park, 5042, South Australia, Australia.,Department of Orthopaedic Surgery, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, 5042, Australia.,Department of Orthopaedic Surgery, University of Amsterdam, location Academic Medical Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - John White
- Flinders University, Sturt Road, Bedford Park, 5042, South Australia, Australia.,Department of Orthopaedic Surgery, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, 5042, Australia
| | - Ruurd L Jaarsma
- Flinders University, Sturt Road, Bedford Park, 5042, South Australia, Australia.,Department of Orthopaedic Surgery, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, 5042, Australia
| | - Gregory I Bain
- Flinders University, Sturt Road, Bedford Park, 5042, South Australia, Australia.,Department of Orthopaedic Surgery, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, 5042, Australia
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12
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Farracho LC, Moutinot B, Neroladaki A, Hamard M, Gorican K, Poletti PA, Beaulieu JY, Bouvet C, Boudabbous S. Determining diagnosis of scaphoid healing: Comparison of cone beam CT and X-ray after six weeks of immobilization. Eur J Radiol Open 2020; 7:100251. [PMID: 32944592 PMCID: PMC7481520 DOI: 10.1016/j.ejro.2020.100251] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/24/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To assess the accuracy and reliability of using cone beam computed tomography (CBCT) compared to X-ray six weeks after injury for predicting scaphoid union. MATERIALS AND METHODS Overall; 52 patients with scaphoid fractures between April 2018 and March 2019 were prospectively included in this study. The mean age was 34.52 (13-88) years, and the gender ratio male/female 43/9. Of the fractures, 26 had occurred on the right side, and 26 on the left side. In total, 28 % of patients were manual workers. All patients underwent X-ray and CBCT six weeks after injury. Four readers, two radiologists, and two hand surgeons analyzed the findings using double-blinded X-ray and CBCT and categorized fractures as consolidated based on a 50 % visibility threshold concerning trabecular bridges. Proximal pole sclerosis, communition, cyst formation, and humpback deformity were similarly analyzed for all cases. Agreement between readers was calculated using Kappa, and sensitivity, specificity, and accuracy using RStudio software. The gold standard was the radiologic and clinical follow-up for all patients at two months. RESULTS Inter-reader agreement between the four readers was moderate concerning X-ray (0.543) but substantial concerning CBCT (0.641). It was almost perfect between seniors regarding CBCT (Kappa = 0.862). Sensitivity, specificity, and accuracy were 0.75-0.78, 0.4, and 0.61-0.64, respectively, for two readers regarding CBCT. The X-ray values were 0.65-0.71, 0.35-0.4, and 0.53-0.59, respectively. CONCLUSION CBCT proves more accurate and reliable than X-ray for diagnosing scaphoid union at an early follow-up and prevents longer immobilization and interruption of activity or work.
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Affiliation(s)
- Lucia Calisto Farracho
- Division of Radiology, Department of Diagnosis, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Berenice Moutinot
- Hand Surgery Unit, Orthopedic and Traumatology Division, Surgery Department, HUG, Switzerland
| | - Angeliki Neroladaki
- Division of Radiology, Department of Diagnosis, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Marion Hamard
- Division of Radiology, Department of Diagnosis, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Karel Gorican
- Division of Radiology, Department of Diagnosis, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Pierre Alexandre Poletti
- Division of Radiology, Department of Diagnosis, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Jean Yves Beaulieu
- Hand Surgery Unit, Orthopedic and Traumatology Division, Surgery Department, HUG, Switzerland
| | - Cindy Bouvet
- Hand Surgery Unit, Orthopedic and Traumatology Division, Surgery Department, HUG, Switzerland
| | - Sana Boudabbous
- Division of Radiology, Department of Diagnosis, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
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Braun S, Yelinek A. Conservatively Managed, Displaced Scaphoid Fracture in a Young, Female Collegiate Basketball Player. Cureus 2020; 12:e9793. [PMID: 32953308 PMCID: PMC7491689 DOI: 10.7759/cureus.9793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Fractures of the scaphoid bone occur in 60-70% of wrist bone fractures. It most often occurs after a fall onto outstretched hand injury. Many times, the diagnosis of a scaphoid fracture is missed due to the unique anatomy and positioning of this carpal bone. Treatment options vary depending on the type of fracture and degree of displacement. We present the case of a 19-year-old female patient. She reported to the urgent care facility after a fall on an outstretched hand while playing basketball. She was diagnosed with a wrist sprain. After having continued pain she sought care at the sports medicine clinic where she was diagnosed with a displaced scaphoid fracture. She was managed conservatively with thumb-spica casting and later adjuvant therapy treatments with low-intensity pulsed ultrasound (LIPUS) technology.
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Affiliation(s)
- Samantha Braun
- Physical Medicine and Rehabilitation, Sports Medicine, West Virginia School of Osteopathic Medicine, Clarksburg, USA
| | - Ashley Yelinek
- Sports Medicine, United Hospital Center, Clarksburg, USA
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Eng K, Gill S, Hoy S, Shridar V, Van Zyl N, Page R. Volar Scaphoid Plating for Nonunion: A Multicenter Case Series Study. J Wrist Surg 2020; 9:225-229. [PMID: 32509427 PMCID: PMC7263855 DOI: 10.1055/s-0040-1702199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/07/2020] [Indexed: 10/24/2022]
Abstract
Background The volar scaphoid plate from Medartis (Medartis AG, Austrasse, Basel, Switzerland) is a variable angle titanium locking plate, preformed for the volar aspect of the scaphoid. It does not have compressive capability, and may act as a bridging device. It may provide an advantage over a compression screw where the pathoanatomy is less favorable to such a device with increased rotational stability. It may act as a buttress plate for correction of humpback deformity for example. It has been used in nonunions and with vascularized grafts. Questions Our study aims to assess the results of our patients with scaphoid nonunion treated with scaphoid volar plating over a larger number of patients. We aim to identify techniques to increase the success of plating. Methods Patients from our cohort were retrospectively reviewed. Operations were performed by three hand fellowship trained surgeons and in two centers. Inclusion involved a scaphoid plate procedure for a nonunion of the scaphoid with a minimum of 6 months of follow-up. Exclusions were those who had less than 6 months of follow-up. Data included demographics, patient-rated wrist evaluation (PRWE), a quick disabilities of the arm, shoulder, and hand (qDASH), visual analogue score, and range and grip. Radiology was reviewed. Results Thirty-two eligible patients were assessed. The mean age was 25 years (range 13-46), 2 were female and 15 were smokers. Mean follow-up postsurgery was 18 months. Twenty-nine of 32 patients united (90.6%) on computed tomography scan. Clinical assessment was performed in the 25 patients. The mean qDASH score was 12.5 (range 0-42) and mean PRWE was 11 (range 0-54). The mean arc of motion was 115 degrees. The mean grip strength was 39 kg compared with 41 kg on the nonoperated side. Conclusion We postulate that the plate acts like an internal bridging device, acting over a small distance, and inherent stability of the construct with structural graft and accurate reduction prior to plating is advantageous. Potential problems include plate impingement on the volar lip of the radius, particularly when trying to plate more proximal fractures. Ideally, it is utilized for mid to distal waist fractures.
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Affiliation(s)
- Kevin Eng
- Department of Orthopaedic Surgery, Barwon Health, Geelong, Australia
- Deakin University, Waurn Ponds, Australia
| | - Stephen Gill
- Department of Orthopaedic Surgery, Barwon Health, Geelong, Australia
- Deakin University, Waurn Ponds, Australia
| | - Simon Hoy
- Department of Orthopaedic Surgery, Barwon Health, Geelong, Australia
- Deakin University, Waurn Ponds, Australia
| | - Vivek Shridar
- Department of Orthopaedic Surgery, Toowoomba Hospital, South Toowoomba, QLD, Australia
| | - Natasha Van Zyl
- Department of Orthopaedic Surgery, Toowoomba Hospital, South Toowoomba, QLD, Australia
| | - Richard Page
- Department of Orthopaedic Surgery, Barwon Health, Geelong, Australia
- Deakin University, Waurn Ponds, Australia
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15
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Abstract
In cases of suspected scaphoid fracture where the initial radiographs are negative, a supplementary MRI, or alternatively CT, should be carried out within three to five days. Fracture classification, assessment of dislocation as well as evaluation of fracture healing is best done on CT with reconstructions in the coronal and sagittal planes, following the longitudinal axis of the scaphoid. After adequate conservative management, union is achieved at six weeks for approximately 90% of non-displaced or minimally displaced (≤ 0.5 mm) scaphoid waist fractures. Scaphoid waist fractures with moderate displacement (0.5–1.5 mm) can be treated conservatively, but require prolonged cast immobilization for approximately eight to ten weeks. Internal fixation is recommended for all scaphoid waist fractures with dislocation ≥ 1.5 mm. Distal scaphoid fractures can be treated conservatively. The majority heal uneventfully after four to six weeks of immobilization, depending on fracture type. In general, proximal scaphoid fractures should be treated with internal fixation.
Cite this article: EFORT Open Rev 2020;5:96-103. DOI: 10.1302/2058-5241.5.190025
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Affiliation(s)
- Martin Clementson
- Department of Hand Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Anders Björkman
- Department of Hand Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Niels O B Thomsen
- Department of Hand Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
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16
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Drijkoningen T, Mohamadi A, Luria S, Buijze GA. Scaphoid Fracture Patterns-Part One: Three-Dimensional Computed Tomography Analysis. J Wrist Surg 2019; 8:441-445. [PMID: 31815056 PMCID: PMC6892660 DOI: 10.1055/s-0039-1693050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 05/18/2019] [Indexed: 10/26/2022]
Abstract
Objective Using three-dimensional (3D) computed tomography models of acute scaphoid fractures, we looked for differences between volumetric size of the fracture fragments, recognizable groups, or a shared common fracture area. Methods We studied 51 patients with an adequate computed tomography scan of an acute scaphoid fracture using 3D modeling. Fracture surfaces were identified and fragment volumetric size of the fracture fragments was measured. A principal component analysis was used to find groups. Density mapping was used to image probable common fracture areas in the scaphoid. Results Forty-nine of 51 fractures had a similar pattern. It was not possible to identify subgroups based on fracture pattern. The mean volumetric size of the fracture fragments of the proximal (1.45 cm 3 ± 0.49 cm 3 standard deviation [SD]) and distal fracture fragments (1.53 cm 3 ± 0.48 cm 3 SD) was similar. There was a single common fracture area in the middle third of the bone. In the distal third, there were no horizontal fractures through-but only directly proximal to-the tubercle suggesting that these would be best classified as distal waist fractures. Conclusion Acute scaphoid fractures mainly occur in the middle third of the bone and tend to divide the scaphoid in half by volumetric size of the fracture fragments. There were two distinct grouping patterns: fractures through the proximal and middle third were horizontal oblique, whereas fractures of the distal third were vertical oblique. It seems that scaphoid fractures might be classified into proximal pole fractures, a range of waist fractures, and tubercle avulsion fractures. Level of evidence This is a Level IV study.
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Affiliation(s)
- Tessa Drijkoningen
- Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amin Mohamadi
- Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shai Luria
- Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Geert A. Buijze
- Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands
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17
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Drijkoningen T, Mohamadi A, van Leeuwen WF, Schwarcz Y, Ring D, Buijze GA. Scaphoid Fracture Patterns-Part Two: Reproducibility and Demographics of a Simplified Scaphoid Fracture Classification. J Wrist Surg 2019; 8:446-451. [PMID: 31815057 PMCID: PMC6892654 DOI: 10.1055/s-0039-1692470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 05/03/2019] [Indexed: 10/26/2022]
Abstract
Objective To analyze the reproducibility, reliability, and demographics of a simplified anatomical scaphoid fracture classification based on posteroanterior radiographs using a large database of scaphoid fractures. Methods The study consisted of a retrospective review of electronic medical records of 871 consecutive patients. All patients presented between 2003 and 2014 at two centers. Patient- and surgeon-related factors were analyzed. Additionally, interobserver reliability of the Herbert and simplified scaphoid fracture classifications were tested. Results Proximal pole fractures were defined as fractures in which the center of the fracture line was proximal to the distal scapholunate interval (n = 30), waist fractures (n = 802) were defined as fractures involving the scaphocapitate interval, and distal tubercle fractures (n = 39) were defined as fractures involving the scaphotrapeziotrapezoid (STT) interval. The interobserver reliability of the simplified classification was fair (κ = 0.37) as for the Herbert classification (κ = 0.31). The average doubt of the answers of the observers was 2.1 on a scale from 0 to 10 for the simplified classification and 3.6 for the Herbert classification ( P < 0.05). Conclusions All complete fractures across the entire scaphoid distal to the scapholunate articulation and proximal to the STT joint can be classified as waist fractures; nonwaist scaphoid fractures are uncommon (6%) and have somewhat different presentations compared to waist fractures. Simplifying the fracture classification slightly improves interobserver reliability, although remaining fair, and significantly reduces doubt. Level of Evidence This is a Level III, prognostic study.
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Affiliation(s)
- Tessa Drijkoningen
- Hand and Arm Center, Department of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amin Mohamadi
- Hand and Arm Center, Department of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Wouter F. van Leeuwen
- Hand and Arm Center, Department of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yonatan Schwarcz
- Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas, Austin, Texas
| | - Geert A. Buijze
- Hand and Upper Extremity Surgery Unit, Lapeyronie University Hospital, Montpellier, France
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18
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Vannabouathong C, Ayeni OR, Bhandari M. A Narrative Review on Avulsion Fractures of the Upper and Lower Limbs. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2018; 11:1179544118809050. [PMID: 30450008 PMCID: PMC6236480 DOI: 10.1177/1179544118809050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 09/16/2018] [Indexed: 11/15/2022]
Abstract
Avulsion fractures compromise function and movement at the affected joint. If
left untreated, it can lead to deformity, nonunion, malunion, pain, and
disability. The purpose of this review was to identify and describe the
epidemiology and available treatment options for common avulsion fractures of
the upper and lower extremities. Current evidence suggests that optimal
treatment is dependent on the severity of the fracture. Conservative efforts
generally include casting or splinting with a period of immobilization. Surgery
is typically indicated for more severe cases or if nonoperative treatments fail;
patient demographics or preferences and surgeon experience may also play a role
in decision making. Some avulsion fractures can be surgically managed with any
one of various techniques, each with their own pros and cons, and often there is
no clear consensus on choosing one technique over another; however, there is
some research suggesting that screw fixation, when possible, may offer the best
stability and compression at the fracture site and earlier mobilization and
return to function. Physicians should be mindful of the potential complications
associated with each intervention.
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Affiliation(s)
| | - Olufemi R Ayeni
- Department of Surgery, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Mohit Bhandari
- Department of Surgery, McMaster University, Hamilton, ON, Canada
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19
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Beks RB, Drijkoningen T, Claessen F, Guitton TG, Ring D. Interobserver Variability of the Diagnosis of Scaphoid Proximal Pole Fractures. J Wrist Surg 2018; 7:350-354. [PMID: 30174995 PMCID: PMC6117179 DOI: 10.1055/s-0038-1641716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 03/06/2018] [Indexed: 10/17/2022]
Abstract
Purpose Fractures of the proximal pole of the scaphoid are prone to adverse outcomes such as nonunion and avascular necrosis. Distinction of scaphoid proximal pole fractures from waist fractures is important for management but it is unclear if the distinction is reliable. Methods A consecutive series of 29 scaphoid fractures from one tertiary hospital was collected consisting of 5 scaphoid proximal pole and 24 scaphoid waist fractures. Fifty-seven members of the Science of Variation Group (SOVG) were randomized to diagnose fracture location and displacement by using radiographs alone or radiographs and a computed tomography (CT) scan. Results Observers reviewing radiographs alone and observers reviewing radiographs and CT scans both had substantial agreement on fracture location (κ = 0.82 and κ = 0.80, respectively; p = 0.54). Both groups had only fair agreement on fracture displacement (κ = 0.28 and κ = 0.35, respectively; p = 0.029). Conclusion Proximal pole fractures are sufficiently distinct from proximal waist fractures that CT does not improve reliability of diagnosis. Level of Evidence Level IV interobserver reliability case-control study.
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Affiliation(s)
- Reinier B. Beks
- Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tessa Drijkoningen
- Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Femke Claessen
- Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Thierry G. Guitton
- Department of Plastic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - David Ring
- Department of Comprehensive Care, Dell Medical School, The University of Texas at Austin, Austin, Texas
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20
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Fowler TP, Fitzpatrick E. Simultaneous Fractures of the Ipsilateral Scaphoid and Distal Radius. J Wrist Surg 2018; 7:303-311. [PMID: 30174987 PMCID: PMC6117171 DOI: 10.1055/s-0038-1641719] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 03/06/2018] [Indexed: 10/17/2022]
Abstract
Background Ipsilateral fractures of the distal radius and scaphoid are rare, with few reports describing mechanisms of injury, fracture patterns, and treatment approaches. Purpose This article describes the clinical and radiographic features of ipsilateral distal radius and scaphoid fractures occurring simultaneously. Materials and Methods Electronic databases from 2007 to 2017 at a single Level 1 trauma center were reviewed for patients with concurrent fractures of the distal radius and scaphoid. Patient demographics, injury mechanism, scaphoid and distal radius fracture pattern, treatment approach, and radiographic healing were studied. Results Twenty-three patients were identified. Nineteen of the 23 (83%) were males, and 19 of 23 (83%) of the injury mechanisms were considered high energy. Twenty-two of the 23 (96%) scaphoid fractures were nondisplaced, all treated with screw fixation. Most distal radius fractures were displaced and comminuted, 17 of 23 (74%) were intra-articular. All distal radius fractures were treated surgically with internal and/or external fixation. Three patients were lost to follow-up. Average follow-up of the remaining 20 was to 19.8 weeks. Nineteen of the 20 (95%) scaphoids healed, one scaphoid went on to nonunion with avascular necrosis. All 20 radius fractures healed, 16 of 20 (80%) in anatomic alignment. Conclusion Ipsilateral fractures of the distal radius and scaphoid are rare and are usually result of high-energy mechanisms. The scaphoid fracture is usually a nondisplaced fracture at the waist. The distal radius fracture pattern varies but most are displaced and comminuted. The union rate of the scaphoid is high, even if subjected to radiocarpal distraction required for distal radius management. Level of Evidence Therapeutic level IV study.
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Affiliation(s)
- Timothy P. Fowler
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Elizabeth Fitzpatrick
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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21
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Dean BJF, Riley ND, McCulloch ER, Lane JCE, Touzell AB, Graham AJ. A new acute scaphoid fracture assessment method: a reliability study of the 'long axis' measurement. BMC Musculoskelet Disord 2018; 19:310. [PMID: 30157835 PMCID: PMC6116451 DOI: 10.1186/s12891-018-2236-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 08/16/2018] [Indexed: 01/14/2023] Open
Abstract
Background The aim of this study was to assess the inter observer and intra observer reliability of acute scaphoid fracture classification methods including a novel ‘long axis’ measurement, a simple method which we have developed with the aim of improving agreement when describing acute fractures. Methods We identified sixty patients with acute scaphoid fractures at two centres who had been investigated with both plain radiographs and a CT (Computed Tomography) scan within 4 weeks of injury. The fractures were assessed by three observers at each centre using three commonly used classification systems and the ‘long axis’ method. Results Inter observer reliability: based on X-rays the ‘long axis’ measurement demonstrated substantial agreement (Intraclass Correlation Coefficient (ICC) =0.76) and was significantly more reliable than the Mayo (p < 0.01), the most reliable of the established classification systems with moderate levels of agreement (kappa = 0.56). Intra observer reliability: the long axis measurement demonstrated almost perfect agreement whether based on X-ray (ICC = 0.905) or CT (ICC = 0.900). Conclusions This study describes a novel pragmatic ‘long axis’ method for the assessment of acute scaphoid fractures which demonstrates substantial inter and intra observer reliability. The ‘long axis’ measurement has clear potential benefits over traditional classification systems which should be explored in future clinical research.
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Affiliation(s)
- Benjamin J F Dean
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Botnar Research Centre, Windmill road, Oxford, OX3 7LD, UK. .,Nuffield Orthopaedic Centre, Windmill road, Oxford, OX3 7LD, UK.
| | | | | | - Jennifer C E Lane
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Botnar Research Centre, Windmill road, Oxford, OX3 7LD, UK.,Nuffield Orthopaedic Centre, Windmill road, Oxford, OX3 7LD, UK
| | | | - Alastair J Graham
- Buckinghamshire Hospitals NHS Trust, High Wycombe Hospital, High Wycombe, Amersham, HP11 2TT, UK
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22
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de Roo MGA, Dobbe JGG, Ridderikhof ML, Goslings JC, van der Horst CMAM, Beenen LFM, Streekstra GJ, Strackee SD. Analysis of instability patterns in acute scaphoid fractures by 4-dimensional computed tomographic imaging - A prospective cohort pilot study protocol. Int J Surg Protoc 2018; 9:1-5. [PMID: 31851745 PMCID: PMC6913558 DOI: 10.1016/j.isjp.2018.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/16/2018] [Accepted: 04/18/2018] [Indexed: 11/16/2022] Open
Abstract
Introduction A scaphoid fracture is the most common carpal fracture. When healing of the fracture fails (nonunion), a specific pattern of osteoarthrosis occurs, resulting in pain, restricted wrist motion and disability. Scaphoid fracture classification systems recognize fragment displacement as an important cause of nonunion. The fracture is considered unstable if the fragments are displaced. However, whether and how displaced bone fragments move with respect to one another has not yet been investigated in vivo. With a four-dimensional (4D) computed tomographic (CT) imaging technique we aim to analyze the interfragmentary motion patterns of displaced and non-displaced scaphoid fragments. Furthermore, the correlation between fragment motion and the development of a scaphoid nonunion is investigated. We hypothesize that fragment displacement is not correlated to fragment instability; and concurrent nonunion is related to fragment instability and not to interfragmentary displacement. Methods In a prospective single-center cohort pilot study, patients with a one-sided acute scaphoid fracture and no history of trauma to the contralateral wrist are illegible for inclusion. Twelve patients with a non-displaced scaphoid fracture and 12 patients with a displaced scaphoid fracture are evaluated. Both wrists are scanned with 4D-CT imaging during active flexion-extension and radio-ulnar deviation motion. The contralateral wrist serves as kinematic reference. Relative displacement of the distal scaphoid fragment with respect to the proximal scaphoid fragment, is described by translations and rotations (the kinematic parameters), as a function of the position of the capitate. Non-displaced scaphoid fractures are treated conservatively, displaced scaphoid fractures receive intraoperative screw fixation. Follow-up with CT scans is conducted until consolidation at 1½, 3 and 6 months. This trial is registered in the Dutch Toetsingonline trial registration system, number: NL60680.018.17. Ethics This study is approved by the Medical Ethics Committee of the Academic Medical Center, Amsterdam.
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Affiliation(s)
- M G A de Roo
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - J G G Dobbe
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - M L Ridderikhof
- Department of Emergency Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J C Goslings
- Trauma Unit, Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - C M A M van der Horst
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - L F M Beenen
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - G J Streekstra
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - S D Strackee
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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23
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Abstract
LEARNING OBJECTIVES After reading this article, the participant should be able to: 1. Understand the epidemiology, classification, and anatomy pertinent to the scaphoid. 2. Appropriately evaluate a patient with suspected scaphoid fracture, including appropriate imaging. 3. Understand the indications for operative treatment of scaphoid fractures, and be familiar with the various surgical approaches. 4. Describe the treatment options for scaphoid nonunion and avascular necrosis of the proximal pole. SUMMARY The goal of this continuing medical education module is to present the preoperative assessment and the formation and execution of a surgical treatment plan for acute fractures of the scaphoid. In addition, secondary surgical options for treatment of scaphoid nonunion and avascular necrosis are discussed.
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24
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Abstract
Fractures of the carpal bones are uncommon. On standard radiographs fractures are often not recognized and a computed tomography (CT) scan is the diagnostic method of choice. The aim of treatment is to restore pain-free and full functioning of the hand. A distinction is made between stable and unstable carpal fractures. Stable non-displaced fractures can be treated conservatively. Unstable and displaced fractures have an increased risk of arthritis and non-union and should be stabilized by screws or k‑wires. If treated adequately, fractures of the carpal bones have a good prognosis. Unstable and dislocated fractures have an increased risk for non-union. The subsequent development of carpal collapse with arthrosis is a severe consequence of non-union, which has a heterogeneous prognosis.
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Affiliation(s)
- T Lögters
- Klinik für Unfall- und Handchirurgie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland.
| | - J Windolf
- Klinik für Unfall- und Handchirurgie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland
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