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Kunc V, Shrestha S, Benes M. Fracture of an aberrant os styloideum: a unique case report. Skeletal Radiol 2024; 53:1205-1209. [PMID: 37903997 DOI: 10.1007/s00256-023-04494-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/03/2023] [Accepted: 10/19/2023] [Indexed: 11/01/2023]
Abstract
Several accessory bones can be found around the wrist, which may pose a diagnostic challenge. Hereby, we report a unique case of a traumatic fracture of an aberrant os styloideum in a 66-year-old male. The patient presented with a swollen dominant right hand and a hematoma on its anterior and posterior aspects, as a result of a fall on an outstretched hand. The diagnosis was based on a CT scan, which showed a fractured accessory bone between the distal portion of the capitate bone and the base of the third metacarpus. Due to its typical location, the ossicle was identified as os styloideum. The patient was treated conservatively and the symptoms subsided on a short forearm cast after 2 weeks. At a 12-month follow-up, no other episodes were declared. Strong anatomical knowledge and sharing of such cases is essential for proper diagnosis and treatment of this very rare condition.
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Affiliation(s)
- Vojtech Kunc
- Clinic of Trauma Surgery, Masaryk Hospital, Socialni pece 3316/12A, 400 111, Usti nad Labem, Czech Republic.
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
- Research Centre, Faculty of Health Studies, Jan Evangelista Purkyne University in Usti nad Labem, Ústí nad Labem, Czech Republic.
| | - Shilu Shrestha
- Orthopaedic and Hand Surgery Unit, National Trauma Center & National Academy of Medical Sciences, Kathmandu, Nepal
| | - Michal Benes
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
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Almigdad A, Al-Zoubi A, Mustafa A, Al-Qasaimeh M, Azzam E, Mestarihi S, Khair Y, Almanasier G. A review of scaphoid fracture, treatment outcomes, and consequences. Int Orthop 2024; 48:529-536. [PMID: 37880341 DOI: 10.1007/s00264-023-06014-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/15/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE Scaphoid fractures are the most common carpal fracture and can lead to severe complications like carpal collapse and osteoarthritis. This study reviewed scaphoid fracture patterns, outcomes, and consequences in conservative and surgical management. METHODS Sixty-four patients with scaphoid fracture who attended the hand clinic at King Hussein Medical City from January 2022 to December 2022 were included and reviewed regarding the anatomical fracture site, the associated injury, the treatment modality (conservative versus surgical), the healing time, and fracture sequelae such as nonunion and scaphoid nonunion advanced collapse. RESULTS Most patients were males (62 patients, 96.9%), and most (47, 73.4%) fell within 25 to 40 years. Scaphoid waist fracture was the most common location (40, 52.5%). Most patients (47, 73.4%) received conservative treatment and 17 (26.6%) were fixed acutely. However, nonunion complicated 53 fractures (82.8%). Notably, there were no differences in the union rate or time between cases of scaphoid nonunion treated with vascularized or nonvascularized grafts. Furthermore, there were no variations in union rates among genders, extremities, age, fracture locations, or among smokers. However, a higher union rate was noted in office workers and those who received conservative treatment. CONCLUSION Nonunions were higher in our study than in the literature, as our department is a referral center for established nonunion cases. For conservative treatment, we recommend aggressive management and follow-up with a clinical and CT scan at three months and early referral of non-united fractures to the hand clinic to avoid the advanced collapse of the scaphoid.
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Affiliation(s)
- Ahmad Almigdad
- Department of Hand and Upper Limb Surgery, Department of Orthopedic, King Hussein Medical City, King Abdullah II St, Amman, 230, Jordan.
| | - Ahmad Al-Zoubi
- Department of Hand and Upper Limb Surgery, Department of Orthopedic, King Hussein Medical City, King Abdullah II St, Amman, 230, Jordan
| | - Ayman Mustafa
- Department of Hand and Upper Limb Surgery, Department of Orthopedic, King Hussein Medical City, King Abdullah II St, Amman, 230, Jordan
| | - Motaz Al-Qasaimeh
- Department of Hand and Upper Limb Surgery, Department of Orthopedic, King Hussein Medical City, King Abdullah II St, Amman, 230, Jordan
| | - Ehab Azzam
- Department of Hand and Upper Limb Surgery, Department of Orthopedic, King Hussein Medical City, King Abdullah II St, Amman, 230, Jordan
| | - Saab Mestarihi
- Department of Hand and Upper Limb Surgery, Department of Orthopedic, King Hussein Medical City, King Abdullah II St, Amman, 230, Jordan
| | - Yousef Khair
- Department of Hand and Upper Limb Surgery, Department of Orthopedic, King Hussein Medical City, King Abdullah II St, Amman, 230, Jordan
| | - Ghandi Almanasier
- Department of Hand and Upper Limb Surgery, Department of Orthopedic, King Hussein Medical City, King Abdullah II St, Amman, 230, Jordan
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Aldeeb M, Aminake GN, Khalil IA, Hayton M, Ksantini OEK, Hagert E. Isolated Trapezoid Fracture in Adolescent Goalkeepers: A Scoping Review of the Literature and a Report of Two Cases. J Hand Surg Glob Online 2024; 6:46-52. [PMID: 38313604 PMCID: PMC10837293 DOI: 10.1016/j.jhsg.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/03/2023] [Indexed: 02/06/2024] Open
Abstract
Purpose Isolated trapezoid fractures are rare injuries, particularly among adolescents, constituting only 0.4% of all carpal bone fractures. This study aims to present two cases of isolated trapezoid fracture in adolescent goalkeepers and a scoping review of the literature to provide guidelines for the management of this injury. Methods Following PRISMA-ScR guidelines, a scoping review of reported cases was conducted. Two hundred and twenty articles were found using PubMed and Google Scholar. After full-text review, a total of 30 cases from 22 articles along with our 2 cases were analyzed based on demographics, injury mechanism, method/timing of diagnosis, prognosis, and time to recovery. Results Thirty-two reported cases of trapezoid fractures with a mean age of 26.7 years (75% male) were found, with pain as the most common presenting symptom. A majority (78%) had initial negative findings on radiography, and the diagnosis was primarily established through computed tomography (59%; n = 19) or magnetic resonance imaging (50%; n = 16). There was a substantial delay in diagnosis (mean 26 days), primarily because computed tomography/magnetic resonance imaging was frequently ordered late. The majority of cases (78%) were managed conservatively, with immobilization periods ranging from 4 to 12 weeks. The average duration for full recovery was 4.5 months, with operative management taking 7.3 months and conservative management taking 3.5 months. Conclusion Trapezoid fractures, though rare, are often not promptly diagnosed on initial plain radiographs, leading to a potential underreporting of cases. Because of the risk of complications associated with this type of injury, clinicians should maintain a high level of vigilance and consider trapezoid fracture as a possible differential diagnosis when presented with carpal pain, swelling, or limited movement, particularly after axial load incidents. Further research and guidelines are needed to enhance our understanding and management of this uncommon injury in the future. Type of study/level of evidence Differential diagnosis/symptom prevalence IIIb.
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Affiliation(s)
- Maya Aldeeb
- Department of Medical Education, Family Medicine Residency Program, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Mike Hayton
- Department of Orthopedic Surgery, Upper Limb Unit, Wrightington Hospital, Wrightington, UK
| | | | - Elisabet Hagert
- Aspetar Orthopedic and Sport Medicine Hospital, Doha, Qatar
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
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Öncül A, Ergün T. WITHDRAWN: Long-term follow-up results of a dorsal approach to complex dorsal metacarpophalangeal dislocation. Hand Surg Rehabil 2023:S2468-1229(23)00024-5. [PMID: 36690298 DOI: 10.1016/j.hansur.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/05/2023] [Accepted: 01/14/2023] [Indexed: 01/22/2023]
Abstract
PURPOSE The present study aimed to examine the dorsal approach to complex MCP joint dislocation and to compare our clinical results with others reported in the literature. This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/policies/article-withdrawal
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Affiliation(s)
- Ahmet Öncül
- Ege University Faculty of Medicine, Department of Orthopedics and Traumatology, İzmir, Turkey.
| | - Tuğrul Ergün
- Istinye University Bahçeşehir Liv Hospital, Department of Orthopedics and Traumatology, Istanbul, Turkey.
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Rodriguez-Alejandro OE, Olivella G, Torres-Lugo NJ, Echegaray GJ, Ramirez N, Foy-Parrilla CA. Non-union in a hook of hamate fracture of a skeletally immature baseball player. Trauma Case Rep 2021; 35:100523. [PMID: 34485665 PMCID: PMC8405909 DOI: 10.1016/j.tcr.2021.100523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 11/16/2022] Open
Abstract
An isolated hook of hamate fracture is an extremely rare condition in skeletally immature patients. Early diagnosis and treatment are vital for the functional outcome of athletes such as baseball players. The hook of hamate fracture may be missed at initial presentation due to nonspecific symptoms and false-negative radiographs, which may eventually lead to a nonunion. Currently, there is no clear indication of surgical intervention for nonunion of the hook of hamate in a skeletally immature patient. This report presents the case of a twelve-year-old skeletally immature male with a hook of hamate fracture who underwent surgical bone fragment excision three months after initial injury due to a nonunion of the hamate bone. At the two-year postoperative visit, excellent results were obtained, and patient was able to continue his sports activity without any functional impairment.
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Affiliation(s)
- Omar E Rodriguez-Alejandro
- Orthopedic Surgery Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Gerardo Olivella
- Orthopedic Surgery Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Norberto J Torres-Lugo
- Orthopedic Surgery Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Gabriel J Echegaray
- Orthopedic Surgery Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Norman Ramirez
- Pediatric Orthopedic Surgery Department, Mayagüez Medical Center, Mayagüez, Puerto Rico
| | - Christian A Foy-Parrilla
- Orthopedic Surgery Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
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Abstract
In 2016, our primary modality for radiological examination of wrist trauma, was changed from radiography to cone-beam computed tomography (CBCT). This is a retrospective survey of carpal bone fractures detected by CBCT during 6 months in 2016/2017, compared with those found on conventional radiographs during 6 months in 2013/2014. The incidence of carpal fractures was three times higher during the CBCT period (92/100,000 per year) compared with the radiography period (29/100,000 per year) and the spectrum of anatomical locations was different between the two periods, with fractures of the lunate (n = 6), trapezium (n = 9), trapezoid (n = 4) and capitate (n = 1) detected by CBCT, in contrast to no fractures of these bones diagnosed during the 6 months radiography period. We suggest a more liberal use of CBCT for examination of wrist trauma considering the benefits of being able to give patients a correct primary diagnosis, treatment and prognosis.Level of evidence: III.
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Affiliation(s)
- Mamoun Krayem
- Department of Radiology, Norrköping,
Sweden,Department of Health, Medicine and Caring
Sciences, Linköping University, Norrköping, Sweden,Lotta Fornander, Department of Orthopedic Surgery,
Vrinnevi Hospital, Gamla Övägen 25, 603 79 Norrköping, Sweden.
| | - Claudia Weber Lensing
- Department of Radiology, Norrköping,
Sweden,Department of Health, Medicine and Caring
Sciences, Linköping University, Norrköping, Sweden
| | - Lotta Fornander
- Department of Orthopedic Surgery, Norrköping,
Sweden,Department of Biomedical and Clinical
Sciences, Linköping University, Norrköping, Sweden
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Ogut E, Yildirim FB, Urguden M, Oruc F, Oguz N. Abnormal type III fusion between lunate and triquetrum: A case report. Int J Surg Case Rep 2020; 77:930-933. [PMID: 33221137 PMCID: PMC7775965 DOI: 10.1016/j.ijscr.2020.10.108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/22/2020] [Indexed: 11/25/2022] Open
Abstract
Knowledge of type III complete fusion is essential to the proper diagnosis and management of this variation. Imaging modalities can easily diagnose in type III complete lunotriquetral coalition without pathological evidence. The lunotriquetral coalition provides an enhanced understanding of unexplained carpal wrist pain or trauma. Surgical treatment of fusion has revealed pain relief, restored mobility, and acceptable postoperative wrist motion effects. Comprehensive postoperative rehabilitation is required to ensure optimal improvement.
Introduction The lunotriquetral coalition is the fusion of the lunate and triquetral bones of the wrist and is the most frequent carpal coalition type. It is frequently asymptomatic and discovered as an incidental due to chronic wrist pain, trauma, or fracture. This case aims to present an unusual unilateral lunotriquetral coalition and clinical significance for diagnosis and treatment. Presentation of case In this case, we presented a 37-year-old male who exhibited with right-sided trauma and wrist pain. He was diagnosed to had a type III complete osseous lunotriquetral coalition on the right side and detected by plain radiography and CT without lytic, destructive, and sclerotic lesions. Discussion An avulsion fracture was recognized in the distal end of the right radius. A fragmented fracture was identified in the scaphoid bone, and an internal fixator extending from scaphoid bone to lunate bone. The internal fixators were observed among the lunate, capitate, and distal end of the radius bones. The plain anteroposterior, lateral radiograph and CT of the right wrist exhibited a right-sided unilateral type III osseous coalition between the lunate and triquetrum bones. Conclusion Knowledge of type III complete fusion is essential to the proper diagnosis and management of this variation when a subject exhibits unexplained wrist pain, trauma, or fracture. It should be noted that plain radiographs and CT can provide an accurate diagnosis in type III complete lunotriquetral coalition without pathological evidence.
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Affiliation(s)
- E Ogut
- Department of Anatomy, Bahçeşehir University, Faculty of Medicine, 34734, İstanbul, Turkey.
| | - F B Yildirim
- Department of Anatomy, Akdeniz University School of Medicine, 07070, Antalya, Turkey.
| | - M Urguden
- Department of Orthopaedics and Traumatology, School of Medicine, Akdeniz University, 07070, Antalya, Turkey.
| | - F Oruc
- Department of Orthopaedics and Traumatology, Medical Park Hospital, 07070, Antalya, Turkey.
| | - N Oguz
- Department of Anatomy, Akdeniz University School of Medicine, 07070, Antalya, Turkey.
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Kiran M, Persaud I, Jariwala A, Wigderowitz C. Factors Influencing Outcome in the Management of Scaphoid Non-union and Comparison of Matti Russe and Interpositional Grafting Techniques. J Hand Surg Asian Pac Vol 2017; 22:286-291. [PMID: 28774245 DOI: 10.1142/s0218810417500319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Scaphoid non-union is often caused due to missed fractures, inadequate or inappropriate management. Matti-Russe and interpositional grafting techniques are used in the treatment of non-union. There are very few studies in literature that compare the outcomes of these techniques. The aim of our study was to analyse the factors influencing outcome in the management of scaphoid non-union and to compare the results of the Matti Russe procedure with interpositional grafting techniques. METHODS Fifty scaphoid non-unions with a mean follow-up of 39.9 ± 5.5 months were included in this retrospective study. Demographic parameters, treatment, functional and radiological outcomes were recorded. The influence of demographic and treatment factors on union in this cohort was statistically analysed. RESULTS Union was achieved in 76% of cases. Good to excellent results were achieved in 84% of patients. There was no significant difference in union rates, deformity correction achieved and period of immobilisation between the MR and IG techniques. The occurrence of arthritic changes correlated with the time interval between injury and surgery (p = 0.002). CONCLUSIONS The most important factor that influences the outcome is the time period between the occurrence of the fracture and surgery for non-union. The Matti-Russe procedure can achieve comparable results to interpositional grafting techniques with a shorter period of immobilisation than previously thought to be required. We believe that the presence of a deformity is not a contraindication for the procedure.
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Affiliation(s)
- Manish Kiran
- 1 Department of Orthopaedics and Trauma Surgery, University of Dundee, TORT Centre, Ninewells Hospital, Dundee, Scotland
| | - Ian Persaud
- 1 Department of Orthopaedics and Trauma Surgery, University of Dundee, TORT Centre, Ninewells Hospital, Dundee, Scotland
| | - Arpit Jariwala
- 1 Department of Orthopaedics and Trauma Surgery, University of Dundee, TORT Centre, Ninewells Hospital, Dundee, Scotland
| | - Carlos Wigderowitz
- 1 Department of Orthopaedics and Trauma Surgery, University of Dundee, TORT Centre, Ninewells Hospital, Dundee, Scotland
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Abstract
Correct diagnosis of wrist injuries is critical in preventing prolonged pain and dysfunction. Radiographs cannot diagnose a large percentage of injuries. Wrist sprain is considered one of the most common yet most treacherous emergency department (ED) diagnoses because radiographs do not always rule out all acute injuries. Knowledge of the anatomy, normal physical examination findings, and physical examination abnormalities associated with different pathological conditions, is paramount in making the correct diagnosis. This article focuses on the anatomy, diagnosis, and ED management of acute wrist injuries, including fractures and dislocations.
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Affiliation(s)
- Alina Tsyrulnik
- Department of Emergency Medicine, Yale University School of Medicine, 464 Congress Ave, New Haven, CT 06519, USA.
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Sharma S, Mishra V, Kulshreshtha V. Radiographical study showing asymmetry in the surface area of carpal bones in malnourished children. J Clin Diagn Res 2014; 8:AC08-10. [PMID: 25120963 DOI: 10.7860/jcdr/2014/8993.4505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 05/02/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Protein energy malnutrition, a major health and nutritional problem in India, leads to retardation in bone maturity and eventually physical growth. Many studies have been done on ossification centers of hand bones for estimation of skeletal maturation and to diagnose malnutrition but very few studies have been done so far to see effect of protein energy malnutrition on surface area of carpal bones. AIMS AND OBJECTIVES The surface areas of carpal bones on radiographs on both sides were calculated, analysed and compared in protein energy malnutrition (PEM) cases and healthy controls upto five years of age to see the variability among study groups. MATERIALS AND METHODS The study was conducted in Department of Paediatrics, Radiodiagnosis and Anatomy of S.N. Medical College, Agra, India consisting of 68 PEM cases and 68 controls of either sex upto five years of age. Radiography of wrist done and surface areas of carpal bones were calculated by using millimeter Graph Transparency paper by Hit method and data were evaluated for significance by using t-test. RESULT The surface areas of capitate, hamate and triquetral bones of both hands were reduced in PEM children of all grades as compared to healthy controls. The surface areas of these carpal bones were much reduced in grade 2 and grade 3 PEM cases as compared to healthy controls and grade 1 PEM cases. Asymmetry in surface areas of capitate and hamate bones were ascertained in healthy controls and grade 1 PEM cases but due to delay in appearance of ossification centers and reduced surface areas of these bones, asymmetry could not be ascertained in grade 2 and grade 3 malnutrition children. CONCLUSION The surface areas of capitate, hamate and triquetral bones on both sides were reduced in grade 2 and grade 3 PEM cases as compared to controls. Asymmetry in surface area of carpal bones was ascertained in healthy controls and grade 1 PEM cases.
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Affiliation(s)
- Shelja Sharma
- Assistant Professor, Department of Anatomy, Mahatma Gandhi Medical College and Hospital , Jaipur, Rajasthan, India
| | - Vivek Mishra
- Assistant Professor, Department of Anatomy, AIIMS , Rishikesh, Uttarakhand, India
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Heo YM, Kim SB, Yi JW, Lee JB, Park CY, Yoon JY, Kim DH. Evaluation of associated carpal bone fractures in distal radial fractures. Clin Orthop Surg 2013; 5:98-104. [PMID: 23730472 PMCID: PMC3664678 DOI: 10.4055/cios.2013.5.2.98] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 11/20/2012] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study was to investigate the frequency and distribution of associated carpal bone fractures (CBFs) in distal radial fractures (DRFs). Methods Three hundred and thirteen patients who underwent surgical treatment for DRFs between March 2007 and January 2010 were reviewed retrospectively. In this study, 223 patients who had preoperative computed tomography (CT) were included. We investigated the frequency and distribution of associated CBFs on CT scans. The relationship between the frequency of associated CBFs and patient factors such as age, gender, body mass index, and the mechanism of injury was assessed. Results CBFs were complicated in 46 of 223 DRFs (20.9%). The distribution of CBFs was 23 cases in the triquetrum, 16 in the lunate, 12 in the scaphoid, five in the hamate, and four in the pisiform. Among the 46 cases, a fracture of one carpal bone occurred in 36 cases, two in seven cases, three in two cases, and four in one case. In 10 of the 46 cases, associated CBFs occurred in more than two carpal bones. No significant differences were observed for age, sex, body mass index, or the mechanism of injury between patients with DRFs and CBFs and those without CBFs. Conclusions Because CBFs that mainly occur in the proximal carpal row are complicated in DRFs at a relatively high frequency, assessment of carpal bones using CT scans is beneficial.
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Affiliation(s)
- Youn Moo Heo
- Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Korea
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