Arthroscopic Treatment of Stable Scaphoid Nonunion
|
|
- Poppy Garrison
- 6 years ago
- Views:
Transcription
1 J Orthop Spine Trauma September; 1(1):e1774. Published online 2015 September 23. Brief Report Arthroscopic Treatment of Stable Scaphoid Nonunion Yousef Fallah, 1,* Reza Shahriar Kamrani, 1,2 and Leila Oryadi Zanjani 1 1 Department of Orthopedic Surgery, Joint Reconstruction Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, IR Iran 2 Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, IR Iran *Corresponding author: Yousef Fallah, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: , Fax: , fallah2us@yahoo.com Received: March 18, 2015; Revised: April 26, 2015; Accepted: April 28, 2015 Background: Open bone grafting has been the standard procedure for treatment of scaphoid nonunion. Arthroscopic bone grafting and fixation is a minimally invasive method, which is effective as open procedure with minimal complications. Objectives: The purpose of this study was to assess the results of arthroscopic treatment by refreshing and bone grafting on clinical wrist function and radiographic outcome in patients with stable scaphoid nonunion. Patients and Methods: Between June 2012 and May 2014, 17 patients received arthroscopic refreshing and bone grafting for treatment of stable waist scaphoid nonunion. The mean follow-up was 13 months (ranged 6-18 months). Results: The mean flexion/extension of the wrist was 72 degrees (ranged degrees) compared with the pre-operation 53 degrees (ranged degrees) (P < 0.04). Grip strength at final follow-up averaged 28 kg (ranged kg) indicating a significant improvement from 21kg (ranged 5-41 kg) before the operation (P < 0.026). The mean Quick DASH scores showed a significant improvement from 48 (ranged 27-90) preoperatively to 84 (ranged ) postoperatively (P < 0.05). The mean VAS score showed a significant improvement from 4.3 (ranged 2-7) preoperatively to 1.03 (ranged 0-4) postoperatively (P < 0.04). Conclusions: Arthroscopic treatment of stable scaphoid nonunion is an effective alternative to the conventional treatment of stable Scaphoid nonunion. Keywords: Hand Bones; Carpal Bones; Scaphoid Bone 1. Background The natural history of untreated scaphoid nonunion is progression to carpal collapse resulting to carpal arthritis and chronic painful disability. For these reasons, bony union and restoring the normal anatomy of scaphoid have been emphasized. The procedure may need cancellous bone graft and fixation with either screws or k-wire (1-7). Several recent studies have shown that arthroscopic technique for the treatment of stable scaphoid nonunion is effective as conventional bone graft (8-11). The advantages of this approach are less morbidity, less stiffness and better functional outcomes. This method is limited to early stage of nonunion or stable fibrous union with minimal sclerosis (12-14). To evaluate the results of this approach and to find its advantages and disadvantages in our patients, we reviewed our patients who underwent arthroscopic treatment of stable scaphoid nonunion. 2. Objectives The purpose of this study was to assess the results of arthroscopic treatment by refreshing and bone grafting on clinical wrist function and radiographic outcome in patients with stable scaphoid nonunion. 3. Patients and Methods Between June 2012 and May 2014, 19 patients received arthroscopic refreshing and bone grafting for stable scaphoid waist nonunion at our institution. The inclusion criteria were scaphoid waist nonunion and minimal sclerosis without malalignment. Exclusion criteria were: 1) unstable scaphoid nonunion, 2) carpal arthritis and carpal collapse sign, 3) severe sclerosis, 4) plain radiographies signs of avascular necrosis, 5) humpback deformity, and 6) follow-up less than six months. All surgical procedures were performed by the same surgeon (k.rs) after informed consent was obtained from all patients Clinical and Radiographic Evaluation Clinical outcomes were investigated by an independent observer who did not participate in the surgical procedure. Range of motion was measured using a hand-held goniometer. Grip strength was measured using a Jamar hydraulic hand dynamometer. Shoulder and Hand (Quick DASH) and VAS questionnaire were used. All the measurements were performed preoperative and at the last follow-up. Intraoperative complications like cartilage injury, tendon tearing, and cutaneous nerve injury and postoperative complications like algoneurodystrophy and failure were documented. Radiographic evaluation included union in augmented posteroanterior and lateral views and degenerative changes. Copyright 2015, Persian Orthopedic Trauma Association. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non- Commercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
2 3.2. Surgical Technique An arthroscopic procedure was performed with tourniquet on upper arm, holding the hand in 5 kg of traction under general anesthesia. Standard radial and ulnar midcarpal portals were used. Once the location and alignment of the fracture were seen through radial portal using a probe, we made a working portal through the ulnar portal (Figure 1). If any doubt existed about nonunion site, we used operative fluoroscopy with a guide to find the fibrous nonunion site. The ulnar portal was useful for removing sclerotic or devitalized tissue from nonunion site with a motorized 2 mm burr under wet arthroscopy (Figure 2). Sometimes we had to change the working portal and debride the proximal segment with better access. Cancellous bone graft was removed from the ipsilateral iliac crest and pushed to the nonunion site through the working portal through an arthroscopic sheath. It was then packed into the gap with increasing firmness using a probe without escape out into the joint. The hand released from traction and put on a radiolucent hand table. Two 1.2 mm K-wires were inserted percutaneously from distal to proximal segment of scaphoid under fluoroscopy control (Figure 3). The wrist was immobilized in a short-arm thumb Spica splint. After one week, it changed to a short thumb Spica cast. After twelve weeks of operation, the cast and the pins were removed and digital posteroanterior and lateral radiography were obtained. If bridging bone was not identified by 12 weeks, a rigid short-arm thumb Spica splint was applied for an additional six weeks. If bridging bone was not identified by 18 weeks, we considered the treatment as failure. Patients with union were visited every three months and wrist range of motion and grip strength and plain radiographs were evaluated at the final follow up. Figure 2. Cp, Capitate; Sc-D, Distal Segment of Scaphoid; and Sc-P, Proximal Segment of Scaphoid Figure 3. Scaphoid Nonunion Was Fixed With K-Wires Figure 1. MCR, Mid Carpal Radial Portal; and MCU, Mid Carpal Ulnar Portal 4. Results This study assessed finally 17 of 19 patients who underwent arthroscopic treatment for stable scaphoid nonunion because 2 patients were excluded due to incomplete follow-up. There were six women and 11 men at the final evaluation with a mean age of 27.5 years (ranged years). The mean follow-up was 13 months (ranged 6-18 Months). The mean flexion/extension of the wrist was 72 degrees (ranged degrees) in comparison with the pre-operation 53 degrees (ranged degrees) (P < 0.04). Grip strength at final follow-up averaged 28 kg (ranged kg) indicating a significant improvement from 21 kg (ranged 5-41 kg) before the operation (P < 0.026). The mean Quick DASH scores showed a significant improvement from 48 (ranged 27-90) preoperatively to 84 (ranged ) postopera- 22
3 tively (P < 0.05). The VAS score showed a significant improvement from 4.3 (ranged 2-7) preoperatively to 1.03 (ranged 0-4) postoperatively (P < 0.04). All patients achieved a successful bony union by a mean 3.3 months (ranged months). We had a complication of escaped out of the bone graft in one patient who showed degenerative changes at follow-up radiography and underwent styloidectomy one year after index operation with relief of the pain (Figure 4). Three patients showed symptoms of algoneurodystrophy treated by prolonged physical therapy. All of them healed without complication at the final follow-up. We had not any cutaneous nerve injury, tendon injury or intraoperative cartilage injury. Figure 4. A 37-Year-Old Man Treated With an Arthroscopic Technique for Scaphoid Nonunion (A) That complicated with escaped out of the graft resulted in degenerative changes (B) at follow-up radiography and underwent styloidectomy (C And D) 23
4 5. Discussion The development of arthroscopies brings a significant breakthrough in the history of wrist surgeries like scaphoid nonunion. It provides a thorough wrist biological environment for the union and minimal surgical trauma to the ligamentous architecture and vascularity. The present study showed a significant improvement with arthroscopic management of the stable nonunion of scaphoid in Grip strength and flexion/extension of the wrist. The overall functional outcomes for patients who achieved bony union were excellent or good like Kim et al. (15) report. We had a union rate of 100% like vascular bone graft that produced a 90% - 100% union rate, which may be due to relatively small number of patients (7). Arthroscopic management of scaphoid nonunion techniques continues to evolve. The present study showed the advantage of this method to achieve a more probably bone union (100%) with no delay union. The overall complication rate was 23.5%, which was higher than other studies; this may be due to the duration of the procedure or due to low skills. Kim et al. (15) reported a 7% complication rate in their study (arthroscopic surgery) and Slade and Gillon (16) reported a 9% complication rate and 96% union rate of nonunion group by nine months and 9% delay union. In another study performed by Kolodziej et al. (17), nonunion rate after the Matti-Russe surgery method was 28% after a long-term follow-up of 2-27 years (mean: 8.8 years) and no complication reported. Our procedure also can preserve cartilage and tendon and sensory cutaneous nerve, which consequently preserves wrist motion and gripe and patient satisfaction (Figure 5). Figure 5. A 24-Year-old man Treated With an Arthroscopic Technique for Scaphoid Nonunion (And B) that Treated Completely Without any Complication and Had Full Wrist Motion (C and D) 24
5 Shaving of bony sclerosis is probably the main step in treating stable scaphoid nonunion and usually performed with cortical window at the nonunion site (1). Therefore, our procedure includes removing bony sclerosis until normal cancellous bone with punctate bleeding is seen. For a fixation device in providing rigid fixation of stable scaphoid nonunion, it must be able to resist complex forces during normal functional loading (shearing or translation forces) (18, 19). The mechanical effectiveness of internal fixation is determined by five independent variables: bony quality, fragment geometry, reduction, implant and implant placement. While all the five variables are of importance, bone quality and fragment geometry depend on the patient. Reduction, implant placement and implant selection are the variables which the surgeon can manipulate. Implant placement in the biomechanically ideal position for the biomechanically ideal position for patient is probably the single most important one of the five variables (20). In this study, we used two k-wire for nonunion fixation and found it sufficient in stable scaphoid nonunion. Arthroscopic refreshing and bone grafting and osteosynthesis of stable scaphoid nonunion have positive effects on the recovery of clinical wrist function and can be an effective alternative to the conventional method with few complication Limitation This study had several limitations. It was a retrospective case study with no control group, the number of cases was relatively small. CT scan was not performed for assessing union of scaphoid as CT provides better accuracy than the plain radiographs. References 1. Buijze GA, Ochtman L, Ring D. Management of scaphoid nonunion. J Hand Surg Am. 2012;37(5): Woon Tan JS, Tu YK. 2,3 intercompartmental supraretinacular artery pedicled vascularized bone graft for scaphoid nonunions. Tech Hand Up Extrem Surg. 2013;17(2): Reigstad O, Thorkildsen R, Grimsgaard C, Reigstad A, Rokkum M. Excellent results after bone grafting and K-wire fixation for scaphoid nonunion surgery in skeletally immature patients: a midterm follow-up study of 11 adolescents after 6.9 years. J Orthop Trauma. 2013;27(5): Cohen MS, Jupiter JB, Fallahi K, Shukla SK. Scaphoid waist nonunion with humpback deformity treated without structural bone graft. J Hand Surg Am. 2013;38(4): Ong HS, Tan G, Chew WY. Treatment of scaphoid non-union with 1,2 intercompartmental supraretinacular artery (1,2 ICSRA) vascularised graft. Singapore Med J. 2011;52(9): Huang YC, Liu Y, Chen TH. Long-term results of scaphoid nonunion treated by intercalated bone grafting and Herbert's screw fixation--a study of 49 patients for at least five years. Int Orthop. 2009;33(5): Braga-Silva J, Peruchi FM, Moschen GM, Gehlen D, Padoin AV. A comparison of the use of distal radius vascularised bone graft and non-vascularised iliac crest bone graft in the treatment of non-union of scaphoid fractures. J Hand Surg Eur Vol. 2008;33(5): Slutsky DJ, Trevare J. Use of arthroscopy for the treatment of scaphoid fractures. Hand Clin. 2014;30(1): Chu PJ, Shih JT. Arthroscopically assisted use of injectable bone graft substitutes for management of scaphoid nonunions. Arthroscopy. 2011;27(1): Wong WY, Ho PC. Minimal invasive management of scaphoid fractures: from fresh to nonunion. Hand Clin. 2011;27(3): Slade J3, Dodds SD. Minimally invasive management of scaphoid nonunions. Clin Orthop Relat Res. 2006;445: Shahabpour M, De Maeseneer M, Pouders C, Van Overstraeten L, Ceuterick P, Fierens Y, et al. MR imaging of normal extrinsic wrist ligaments using thin slices with clinical and surgical correlation. Eur J Radiol. 2011;77(2): Mayfield JK. Wrist ligamentous anatomy and pathogenesis of carpal instability. Orthop Clin North Am. 1984;15(2): Rainbow MJ, Kamal RN, Leventhal E, Akelman E, Moore DC, Wolfe SW, et al. In vivo kinematics of the scaphoid, lunate, capitate, and third metacarpal in extreme wrist flexion and extension. J Hand Surg Am. 2013;38(2): Kim JP, Seo JB, Yoo JY, Lee JY. Arthroscopic management of chronic unstable scaphoid nonunions: effects on restoration of carpal alignment and recovery of wrist function. Arthroscopy. 2015;31(3): Slade J3, Gillon T. Retrospective review of 234 scaphoid fractures and nonunions treated with arthroscopy for union and complications. Scand J Surg. 2008;97(4): Kolodziej RK, Blacha J, Bogacz A, Mazurkiewicz T. Long-term outcome of scaphoid nonunion treated by the Matti-Russe operation. Ortop Traumatol Rehabil. 2006;8(5): Kaneshiro SA, Failla JM, Tashman S. Scaphoid fracture displacement with forearm rotation in a short-arm thumb spica cast. J Hand Surg Am. 1999;24(5): McAdams TR, Spisak S, Beaulieu CF, Ladd AL. The effect of pronation and supination on the minimally displaced scaphoid fracture. Clin Orthop Relat Res. 2003;(411): Kaufer H. Mechanics of the treatment of hip injuries. Clin Orthop Relat Res. 1980;(146):
Chapter 19. Arthroscopic Bone Grafting for Scaphoid Nonunion. Introduction. Operative Technique. Radiocarpal and Midcarpal Exploration
Chapter 19 Arthroscopic Bone Grafting for Scaphoid Nonunion Introduction Scaphoid fractures are often initially missed and then diagnosed only once nonunion manifests. Because the natural history of these
More informationCASE REPORT. Distal radius nonunion after volar locking plate fixation of a distal radius fracture: a case report
Nagoya J. Med. Sci. 79. 551 ~ 557, 2017 doi:10.18999/nagjms.79.4.551 CASE REPORT Distal radius nonunion after volar locking plate fixation of a distal radius fracture: a case report Takaaki Shinohara 1
More informationUnion rate: Union: Stable 94% All fracture 90% Union after surgery for nonunion with surgery 80% OA in healed scaphoid: 9%
Complications Incidence of Non-union 1 cm displacement of fracture caused 55% Non-union It takes 5-20 yrs to develop SNAC. SNAC appears to be more common with waist fracture than a proximal pole. However
More informationVascularized pedicle dorsal distal radius graft in management of scaphoid nonunion Osama M Essawy MD, Mohamed S Singer MD, Ahmed Shawkat Rizk MD
Vascularized pedicle dorsal distal radius graft in management of scaphoid nonunion Osama M Essawy MD, Mohamed S Singer MD, Ahmed Shawkat Rizk MD Orthopaedic Department, Faculty of Medicine, Benha University,
More informationIndex. Note: Page numbers of article titles are in boldface type. Hand Clin 21 (2005)
Hand Clin 21 (2005) 501 505 Index Note: Page numbers of article titles are in boldface type. A Antibiotics, following distal radius fracture treatment, 295, 296 Arthritis, following malunion of distal
More informationScaphoid Fracture of the Wrist
A Patient s Guide to Scaphoid Fracture of the Wrist 651 Old Country Road Plainview, NY 11803 Phone: 5166818822 Fax: 5166813332 p.lettieri@aol.com DISCLAIMER: The information in this booklet is compiled
More informationCarpal rows injuries!
Carpal rows injuries! Michael Papaloïzos! Center for Hand Surgery and Therapy Geneva, Switzerland no conflict of interest to declare Fractures of carpal bones! The fractured scaphoid! Fracture-dislocations
More informationChapter 13. Arthroscopic Lunotriquetral Arthrodesis and Head of the Hamate Resection. Introduction. Operative Technique (Fontes) Midcarpal Exploration
Chapter 13 Arthroscopic Lunotriquetral Arthrodesis and Head of the Hamate Resection Introduction Lunotriquetral arthrodesis is a controversial procedure but is sometimes proposed as a last resort for lunotriquetral
More informationScaphoid Fractures. Mohammed Alasmari. Orthopaedic Surgery Demonstrator Majmaah University
Scaphoid Fractures Mohammed Alasmari Orthopaedic Surgery Demonstrator Majmaah University 1 2 Scaphoid Fractures Introduction Anatomy History Clinical examination Radiographic evaluation Classification
More informationThe Kienböck disease and scaphoid fractures. Mariusz Bonczar
The Kienböck disease and scaphoid fractures Mariusz Bonczar The Kienböck disease and scaphoid fractures Mariusz Bonczar Kienböck disease personal experience My special interest for almost 25 years Thesis
More information8 Recovering From HAND FRACTURE SURGERY
8 Recovering From HAND FRACTURE SURGERY Hand fractures are caused by trauma and result in breaking (fracturing) the phalanges or metacarpals. Surgery involves achieving acceptable alignment and providing
More informationA Patient s Guide to Adult Distal Radius (Wrist) Fractures
A Patient s Guide to Adult Distal Radius (Wrist) Fractures Suite 11-13/14/15 Mount Elizabeth Medical Center 3 Mount Elizabeth Singapore, 228510 Phone: (65) 6738 2628 Fax: (65) 6738 2629 1 DISCLAIMER: The
More informationScaphoid Non-Union Current Treatment Options
Scaphoid Non-Union Current Treatment Options Peter J. Evans, MD, PhD, FRCSC Director Upper Extremity Center, Peripheral Nerve Center, Cleveland Combined Hand Fellowship Cleveland Clinic Outline The Basics
More informationHand and wrist emergencies
Chapter1 Hand and wrist emergencies Carl A. Germann Distal radius and ulnar injuries PEARL: Fractures of the distal radius and ulna are the most common type of fractures in patients younger than 75 years.
More informationScaphoid nonunion with carpal ligament injury radiological, arthroscopical assessment and clinical results
Acta Orthop. Belg., 2016, 82, 210-215 ORIGINAL STUDY Scaphoid nonunion with carpal ligament injury radiological, arthroscopical assessment and clinical results Masahiro Tatebe, Hitoshi Hirata, Kenji Tanaka,
More informationSURGERY OF THE HAND. Results of Iliac Bone Graft with Kirschner Wire Fixation for Scaphoid Nonunions INTRODUCTION ORIGINAL ARTICLE
ORIGINAL ARTICLE pissn 1598-3889 eissn 2234-0998 J Korean Soc Surg Hand 2017;22(3):174-179. http://doi.org/10.12790/jkssh.2017.22.3.174 JOURNAL OF THE KOREAN SOCIETY FOR SURGERY OF THE HAND Results of
More informationPosterolateral elbow dislocation with entrapment of the medial epicondyle in children: a case report Juan Rodríguez Martín* and Juan Pretell Mazzini
Open Access Case report Posterolateral elbow dislocation with entrapment of the medial epicondyle in children: a case report Juan Rodríguez Martín* and Juan Pretell Mazzini Address: Department of Orthopaedic
More informationWrist Arthritis & Partial Wrist Fusion
Wrist Arthritis & Partial Wrist Fusion Mr Jason N Harvey MB.BS. FRACS (Orth) Hand,Wrist & Elbow Surgeon Clinical Symptoms Outline Physical Examination Diagnosis Differential Diagnosis Outline Non-operative
More informationRecurrent subluxation or dislocation after surgical
)263( COPYRIGHT 2017 BY THE ARCHIVES OF BONE AND JOINT SURGERY CASE REPORT Persistent Medial Subluxation of the Ulna with Radiotrochlear Articulation Amir R. Kachooei, MD; David Ring, MD, PhD Research
More informationArhtroscopy of the wrist joint: Setup, instrumentation, anatomy & indications
Arhtroscopy of the wrist joint: Setup, instrumentation, anatomy & indications Andreas Panagopoulos, MD, PhD Upper Limb and Sports Medicine Surgeon Assistant Professor in Orthopaedics Patras University
More informationMark VanDer Kaag 1, Ajmal Ikram 2. Hand Unit, Tygerberg Hospital University of Stellenbosch
A Prospective, Randomized Controlled Study To Determine The Radiological And Functional Outcomes Of IMN Fixation Of Distal Radius Fractures Using A Novel Device The Sonoma Wrx Distal Radius Nail Compared
More informationVolar Approach for Scaphoid Fractures Nader Paksima, DO, MPH Clinical Professor of Orthopaedic Surgery NYU/Hospital for Joint Diseases
Volar Approach for Scaphoid Fractures Nader Paksima, DO, MPH Clinical Professor of Orthopaedic Surgery NYU/Hospital for Joint Diseases Internal Fixation indicated for displacement >1mm Percutaneous fixation
More informationSCAPHOID FRACTURE. Relevant antomy
SCAPHOID FRACTURE Relevant antomy The proximal row consists of the scaphoid, the lunate, and the triquetrum. The proximal carpal row is regarded as an intercalated segment The keystone in the coordination
More informationCharacterizing scaphoid nonunion deformity using 2-D and 3-D imaging techniques ten Berg, P.W.L.
UvA-DARE (Digital Academic Repository) Characterizing scaphoid nonunion deformity using 2-D and 3-D imaging techniques ten Berg, P.W.L. Link to publication Citation for published version (APA): ten Berg,
More informationChpter 2 Nonoperative Management of Non-displaced Acute Scaphoid Fracture
Chpter 2 Nonoperative Management of Non-displaced Acute Scaphoid Fracture Megan Tomaino and Thomas B. Hughes Case Presentation The patient is a 15-year-old male with a history of left wrist pain following
More informationCOMMON CARPAL INJURIES IN ATHLETES Nicholas A. Bontempo, MD Orthopedic Associates of Hartford I HAVE NO CONFLICTS OR DISCLOSURES TO REPORT OUTLINE
COMMON CARPAL INJURIES IN ATHLETES Nicholas A. Bontempo, MD Orthopedic Associates of Hartford I HAVE NO CONFLICTS OR DISCLOSURES TO REPORT OUTLINE The carpus Scaphoid fracture Scapholunate ligament tear
More informationComparisonofUlnar-ShorteningOsteotomyWitha NewTrimedDynamicCompressionSystemVersusthe SynthesDynamicCompressionSystem:ClinicalStudy
SCIENTIFICARTICLE ComparisonofUlnar-ShorteningOsteotomyWitha NewTrimedDynamicCompressionSystemVersusthe SynthesDynamicCompressionSystem:ClinicalStudy ShaiLuria,MD,AnthonyJ.Lauder,MD,ThomasE.Trumble,MD
More informationSurgical Care at the District Hospital. EMERGENCY & ESSENTIAL SURGICAL CARE
Surgical Care at the District Hospital 1 18 Orthopedic Trauma Key Points 2 18.1 Upper Extremity Injuries Clavicle Fractures Diagnose fractures from the history and by physical examination Treat with a
More informationCarpal Injuries. AO Advanced Principles of Fracture Management Middelfart, april 2016
Carpal Injuries AO Advanced Principles of Fracture Management Middelfart, 11.-14. april 2016 Overlæge Marianne Vestergaard Lind Traumesektionen Ortopædkirurgisk Klinik Rigshospitalet AOT Advanced Principles
More informationA Patient s Guide to Adult Forearm Fractures
A Patient s Guide to Adult Forearm Fractures Orthopedic and Sports Medicine 825 South 8th Street, #550 Minneapolis, MN 55404 Phone: 612-333-5000 Fax: 612-333-6922 1 DISCLAIMER: The information in this
More informationPercutaneous Fixation And Bone Grafting Of Paediatrics Scaphoid Non-Unions
ISPUB.COM The Internet Journal of Orthopedic Surgery Volume 23 Number 1 Percutaneous Fixation And Bone Grafting Of Paediatrics Scaphoid Non-Unions M Saeed, I Aktselis, N Goddard Citation M Saeed, I Aktselis,
More informationThe Journal of the Korean Society of Fractures Vol.13, No.4, October, 2000
The Journal of the Korean Society of Fractures Vol13, No4, October, 2000,, 16, ) : 2 29-1 TEL : (02) 2210-3474 FAX : (02) 2217-1897 1004, 4 (16%), 18,, (72%), 3 ( 12 %),,, 15 1994 1 1998 1 2 - (scapholunate
More informationPure Cancellous Iliac Bone grafting for the Treatment of Scaphoid Waist Nonunions with Humpback Deformity
ORIGINAL ARTICLE pissn 1598-3889 eissn 2234-0998 J Korean Soc Surg Hand 2014;19(1):36-43. http://dx.doi.org/10.12790/jkssh.2014.19.1.36 JOURNAL OF THE KOREAN SOCIETY FOR SURGERY OF THE HAND Pure Cancellous
More informationOpen Reduction and Internal Fixation with Bone Grafting for Scaphoid non-union: an experience at a tertiary care hospital
ORIGINAL ARTICLE Open Reduction and Internal Fixation with Bone Grafting for Scaphoid non-union: an experience at a tertiary care hospital ADEEL HAMID, SAJJAD HUSSAIN ABSTRACT Background: Scaphoid fractures
More informationTechnique Guide. VA-Locking Intercarpal Fusion System. Variable angle locking technology for mediocarpal partial arthrodesis.
Technique Guide VA-Locking Intercarpal Fusion System. Variable angle locking technology for mediocarpal partial arthrodesis. Table of Contents Introduction VA-Locking Intercarpal Fusion System 2 Indications
More information2.4 mm Variable Angle LCP Intercarpal Fusion System. Variable angle locking technology for mediocarpal partial arthrodesis.
2.4 mm Variable Angle LCP Intercarpal Fusion System. Variable angle locking technology for mediocarpal partial arthrodesis. Technique Guide Instruments and implants approved by the AO Foundation Table
More informationIntroduction. The wrist contains eight small carpal bones, which as a group act as a flexible spacer between the forearm and hand.
Wrist Introduction The wrist contains eight small carpal bones, which as a group act as a flexible spacer between the forearm and hand. Distal forearm Distal forearm 4 Distal end of the radius A. anterior
More informationBilateral Trans-Scaphoid Perilunate Fracture Dislocation
CASE REPORT pissn 1598-3889 eissn 2234-0998 J Korean Soc Surg Hand 2015;20(3):127-132. http://dx.doi.org/10.12790/jkssh.2015.20.3.127 JOURNAL OF THE KOREAN SOCIETY FOR SURGERY OF THE HAND Bilateral Trans-Scaphoid
More information)244( COPYRIGHT 2015 BY THE ARCHIVES OF BONE AND JOINT SURGERY RESEARCH ARTICLE
)244( COPYRIGHT 2015 BY THE ARCHIVES OF BONE AND JOINT SURGERY RESEARCH ARTICLE Correlation of Reconstructed Scaphoid Morphology with Clinical Outcomes Ahmadreza Afshar, MD; Afshin Mohammadi, MD; Kian
More informationScapholunate Ligament Lesions Imaging Which and when?
Scapholunate Ligament Lesions Imaging Which and when? Kolo Frank Lesions to scapholunate ligament(sl) Most frequent cause of carpal instability Traumatic tears of SL ligament = most common ligament injury
More informationA Patient s Guide to Adult Radial Head (Elbow) Fractures
A Patient s Guide to Adult Radial Head (Elbow) Fractures 2321 Coronado Idaho Falls, ID 83404 Phone: 208-227-1100 jpond@summitortho.net 1 DISCLAIMER: The information in this booklet is compiled from a variety
More informationIntegra. Spider and Mini Spider Limited Wrist Fusion System SURGICAL TECHNIQUE
Integra Spider and Mini Spider Limited Wrist Fusion System SURGICAL TECHNIQUE Table of contents Description... 02 Indications... 02 Contraindications... 02 Surgical Technique... 03 Spider Introduction-Four
More informationAuthor Query Form. Journal Title : The Journal of Hand Surgery (JHS) Article Number :
Author Query Form Journal Title : The Journal of Hand Surgery (JHS) Article Number : 410154 Dear Author/Editor, Greetings, and thank you for publishing with SAGE. Your article has been copyedited and typeset,
More informationQUICK REFERENCE GUIDE. The Pennig Dynamic Wrist Fixator. Part A: Trans-articular application
10 The Pennig Dynamic Wrist Fixator Part A: Trans-articular application B1 B2 B3 III IV TRANS-ARTICULAR APPLICATION The fractures that can be treated with this technique include AO type B and C fractures,
More informationIsolated dislocation of the carpal scaphoid without the
)332( COPYRIGHT 2017 Y THE RCHIVES OF ONE ND JOINT SURGERY CSE REPORT Unusual Complete Isolated Scaphoid Dislocation, Report of a Case Efstathios G. allas, MD; Konstantinos Raptis, MD; Ioannis P. Stathopoulos,
More informationTotal distal radioulnar joint replacement for symptomatic joint instability or arthritis
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Interventional procedure consultation document Total distal radioulnar joint replacement for symptomatic joint instability or arthritis Instability of
More informationMEDIAL EPICONDYLE FRACTURES
MEDIAL EPICONDYLE FRACTURES Demographic 20% of elbow fractures 60% of which are associated with elbow dislocation. 75% in boys between 6-12 years 20% of elbow dislocation with ME fracture, the ME is incarcerated
More informationFractures and dislocations around elbow in adult
Lec: 3 Fractures and dislocations around elbow in adult These include fractures of distal humerus, fracture of the capitulum, fracture of the radial head, fracture of the olecranon & dislocation of the
More informationUniversity of Groningen. Fracture of the distal radius Oskam, Jacob
University of Groningen Fracture of the distal radius Oskam, Jacob IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document
More informationSYMPOSIUM ON ADVANCES IN THE MANAGEMENT OF SCAPHOID PROBLEMS Scaphoid malunion
Hong HKJOS Kong Journal of Orthopaedic Surgery 2002;6(2):104-108. SYMPOSIUM ON ADVANCES IN THE MANAGEMENT OF SCAPHOID PROBLEMS Scaphoid malunion Department of Orthopaedics and Traumatology, Prince of Wales
More informationIsolated Comminuted Fracture of the Trapezium: A Case Report and Review of the Literature
ISPUB.COM The Internet Journal of Orthopedic Surgery Volume 18 Number 2 Isolated Comminuted Fracture of the Trapezium: A Case Report and Review of the Literature M Suthersan, S Chan Citation M Suthersan,
More informationMANAGEMENT OF INTRAARTICULAR FRACTURES OF ELBOW JOINT. By Dr B. Anudeep M. S. orthopaedics Final yr pg
MANAGEMENT OF INTRAARTICULAR FRACTURES OF ELBOW JOINT By Dr B. Anudeep M. S. orthopaedics Final yr pg INTRAARTICULAR FRACTURES Intercondyar fracture Elbow dislocation Capitellum # Trochlea # Radial head
More informationAbd Ali Muhsin FICMS.
Comparative study between close reductions versus close reduction with K-Wire fixation in completely dorsally displaced distal radial metaphyseal fracture, in children and adolescent. Abd Ali Muhsin FICMS.
More informationManagement of Acute Trans Scaphoid Peri-Lunate Fracture Dislocation by Closed Reduction and Percutaneous Fixation
American Research Journal of Orthopedics and Traumatology (ARJOT) Volume 2016, 6 Pages Research Article Abstract: Management of Acute Trans Scaphoid Peri-Lunate Fracture Dislocation by Closed Reduction
More informationMayo Clinic Disorders of the Wrist
Mayo Clinic Disorders of the Wrist Thursday, May 19, 2016 Pre-Conference Laboratory Workshop Anatomy of the Wrist & Wrist Arthroscopy 6:30 a.m. Registration and Breakfast 7:30 a.m. Welcome and Introduction
More informationSean Walsh Orthopaedic Surgeon Dorset County Hospital
Sean Walsh Orthopaedic Surgeon Dorset County Hospital Shapes and orientation of articular surfaces Ligaments Oblique positioning of scaphoid Tendons surrounding the joints Other soft tissues Peripheral
More informationResults of pronator quadratus pedicle bone graft as primary procedure for treatment of scaphoid nonunion
2017; 3(3): 1008-1012 ISSN: 2395-1958 IJOS 2017; 3(3): 1008-1012 2017 IJOS www.orthopaper.com Received: 19-05-2017 Accepted: 20-06-2017 Dr. Manish Kumar Assistant Professor, Dr. Rakesh Kumar Dr. Rajesh
More informationThe Wrist Fusion Set. Stainless Steel and Titanium TECHNIQUE GUIDE. Instruments and implants approved by the AO Foundation
The Wrist Fusion Set Stainless Steel and Titanium TECHNIQUE GUIDE Instruments and implants approved by the AO Foundation Three Plate Options Stainless Steel or Titanium* Standard Bend Stainless Steel [242.510]
More informationWrist movements, apart from the distal radioulnar joint, take place in two planes:
The wrist consists of eight bones in two rows: the proximal and distal. The proximal row includes (starting from the radial bone): the scaphoid bone, the lunate bone, the triangular bone and the postulnar
More informationFRCS orth course Important papers in Orthopaedics
FRCS orth course Important papers in Orthopaedics Scaphoid, Distal radius Scaphoid fracture JBJS Am 2005 oct Should acute scaphoid fractures be fixed? A randomized controlled trial. Dias JJ, Wildin CJ,
More informationSCAHPO-LUNATE DISSOCIATION
SCAHPO-LUNATE DISSOCIATION Introduction Scapho-lunate dissociation is the most common significant ligamentous injury of the wrist. The condition is also sometimes referred to as rotary subluxation of the
More informationMINIMALLY INVASIVE PLATE OSTEOSYNTHESIS FOR DISTAL RADIUS FRACTURES: SURGICAL TECHNIQUE M. TOBE 1, K. MIZUTANI 1, Y. TSUBUKU 1, Y.
Riv Chir Mano - Vol. 43 (3) 2006 MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS FOR DISTAL RADIUS FRACTURES: SURGICAL TECHNIQUE M. TOBE 1, K. MIZUTANI 1, Y. TSUBUKU 1, Y. YANAGIHARA 2 1 Department of 2nd Orthopaedic
More informationSurgical Technique Carpal Fusion
Carpal Fusion Patent and Patent Pending CAUTION: Federal Law (USA) restricts this device to sale by or on the order of a physician. INDICATIONS FOR USE The Extremity Medical Lag Screw and X-Post System
More informationUvA-DARE (Digital Academic Repository) Scaphoid fractures: anatomy, diagnosis and treatment Buijze, G.A. Link to publication
UvA-DARE (Digital Academic Repository) Scaphoid fractures: anatomy, diagnosis and treatment Buijze, G.A. Link to publication Citation for published version (APA): Buijze, G. A. (2012). Scaphoid fractures:
More informationOperative Treatment of Intra-articular Distal Radius Fractures Using the Small AO External Fixation Device
ORIGINAL ARTICLE Operative Treatment of Intra-articular Distal Radius Fractures Using the Small AO External Fixation Device Teng-Le Huang 1,2 *, Ching-Kuei Huang 2,3, Jung-Kuang Yu 2,3, Fang-Yao Chiu 2,3,
More informationA Patient s Guide to Adult Olecranon (Elbow) Fractures
A Patient s Guide to Adult Olecranon (Elbow) Fractures 2350 Royal Boulevard Suite 200 Elgin, IL 60123 Phone: 847.931.5300 Fax: 847.931.9072 1 DISCLAIMER: The information in this booklet is compiled from
More informationA Patient s Guide to Adult Metacarpal Fractures of the Hand
A Patient s Guide to Adult Metacarpal Fractures of the Hand 651 Old Country Road Plainview, NY 11803 Phone: 5166818822 Fax: 5166813332 p.lettieri@aol.com 1 DISCLAIMER: The information in this booklet is
More informationNE Nebraska Trauma Conference Tristan Hartzell, MD November 8, 2017
NE Nebraska Trauma Conference 2017 Tristan Hartzell, MD November 8, 2017 Traumatic arm injuries in the elderly Fractures Hand Wrist Elbow Shoulder Soft tissue injuries Definitions Elderly? old or aging
More informationE ORIGINAL ARTICLE Low extra-articular (transcondylar) fractures of the distal humerus
Shoulder & Elbow. ISSN 1758-5732 E ORIGINAL ARTICLE Low extra-articular (transcondylar) fractures of the distal humerus Alexander A. Weening, Kim M. Brouwer, Margaritha Adams & David Ring Orthopaedic Hand
More informationFractures of the tibia shaft treated with locked intramedullary nail Retrospective clinical and radiographic assesment
ARS Medica Tomitana - 2013; 4(75): 197-201 DOI: 10.2478/arsm-2013-0035 Șerban Al., Botnaru V., Turcu R., Obadă B., Anderlik St. Fractures of the tibia shaft treated with locked intramedullary nail Retrospective
More informationORIGINAL PAPER. Department of Hand Surgery, Nagoya University School of Medicine ABSTRACT
Nagoya J. Med. Sci. 74. 167 ~ 171 2012 ORIGINAL PAPER TILT OF THE RADIUS FROM FOREARM ROTATIONAL AXIS RELIABLY PREDICTS ROTATIONAL IMPROVEMENT AFTER CORRECTIVE OSTEOTOMY FOR MALUNITED FOREARM FRACTURES
More informationVA-Locking Intercarpal Fusion System. Variable angle locking technology for mediocarpal partial arthrodesis.
VA-Locking Intercarpal Fusion System. Variable angle locking technology for mediocarpal partial arthrodesis. Surgical Technique This publication is not intended for distribution in the USA. Image intensifier
More informationThe Role of Lunate Morphology on Scapholunate Instability and Fracture Location in Patients Treated for Scaphoid Nonunion
Original Article Clinics in Orthopedic Surgery 2016;8:175-180 http://dx.doi.org/10.4055/cios.2016.8.2.175 The Role of Lunate Morphology on Scapholunate Instability and Fracture Location in Patients Treated
More informationCarpal Instability: Clarification of the Most Common Etiologies and Imaging Findings
Carpal Instability: Clarification of the Most Common Etiologies and Imaging Findings Corey Matthews DO, Nicholas Strle DO, Donald von Borstel DO Oklahoma State University Medical Center, Department of
More informationNursing Management: Musculoskeletal Trauma and Orthopedic Surgery. By: Aun Lauriz E. Macuja SAC_SN4
Nursing Management: Musculoskeletal Trauma and Orthopedic Surgery By: Aun Lauriz E. Macuja SAC_SN4 The most common cause of musculoskeletal injuries is a traumatic event resulting in fracture, dislocation,
More informationTriangular Fibrocartilage Complex Repair. The triangular fibrocartilage complex (TFCC) is one of the main stabilizers of the
Michelle Brandt and Megan Passarelle Surgical Assignment Due: 11/9/14 Triangular Fibrocartilage Complex Repair Abstract The triangular fibrocartilage complex (TFCC) is one of the main stabilizers of the
More informationA Patient s Guide to Elbow Dislocation
A Patient s Guide to Elbow Dislocation 2 Introduction When the joint surfaces of an elbow are forced apart, the elbow is dislocated. The elbow is the second most commonly dislocated joint in adults (after
More informationSPORTS INJURIES IN HAND
Grundkurs SGSM-SSMS Sion 2015 SPORTS INJURIES IN HAND Dr S. KŠmpfen EPIDEMIOLOGY Incidence of hand, finger and wrist injuries in sports : 3% Ð 9 % RADIAL-SIDED WRIST PAIN 1)! Distal Radius Fractures 2)!
More informationAcu-Loc Wrist Spanning Plate System. Surgical Technique
Acu-Loc Wrist Spanning Plate System Surgical Technique Acumed is a global leader of innovative orthopaedic and medical solutions. We are dedicated to developing products, service methods, and approaches
More informationDepartment of Orthopaedics and Rehabilitation
Rotation: Department of Orthopaedics and Rehabilitation Resident Year-In-Training: Attending Physicians Rotation-Specific Objectives for Resident Education 1. Robert Orfaly, M.D., FRCS(C) Orthopaedic Surgeon,
More informationDepartment of Surgery, Medical Centre Haaglanden, The Hague, the Netherlands 2. Department of Surgery, Gelre Hospitals, Apeldoorn, the Netherlands 3
Chapter 1 F.J.P. Beeres 1 S.J. Rhemrev 1 M. Hogervorst 2 P. den Hollander 3 G.N. Jukema 4 1 Department of Surgery, Medical Centre Haaglanden, The Hague, the Netherlands 2 Department of Surgery, Gelre Hospitals,
More information3. Ulno lunate, Ulno triquetral ligament. Poirier: Between RSC &LRL. 5. Dorsal intercarpal ligament
CARPAL INSTABILITY Ligaments Intrinsic Scapho lunate ligament: Dorsal component stronger than volar ligament Luno triquetral ligament: Volar component stronger than dorsal ligament Extrinsic Palmar 1 Radio
More informationTreatment of Scaphoid Waist Nonunions with an Avascular Proximal Pole and Carpal Collapse Surgical Technique
169 Copyright 2009 by The Journal of Bone and Joint Surgery, Incorporated Treatment of Scaphoid Waist Nonunions with an Avascular Proximal Pole and Carpal Collapse Surgical Technique By David B. Jones
More informationRehabilitation after Total Elbow Arthroplasty
Rehabilitation after Total Elbow Arthroplasty Total Elbow Atrthroplasty Total elbow arthroplasty (TEA) Replacement of the ulnohumeral articulation with a prosthetic device. Goal of TEA is to provide pain
More informationMicro Screw Fixation for Small Proximal Pole Scaphoid Fractures with Distal Radius Bone Graft
Scientific Article 319 Micro Screw Fixation for Small Proximal Pole Scaphoid Fractures with Distal Radius Bone Graft Joseph J. Schreiber, MD 1 Lana Kang, MD 1 Krystle A. Hearns, MA 1 Tracy Pickar, MSW
More informationDisclosures. Distal Radius Fractures 5/16/2017. Distal Radius Fractures: Complications & Limitations of the Volar Approach
Distal Radius Fractures: Complications & Limitations of the Volar Approach Frank R. Avilucea, MD Assistant Professor Department of Orthopaedic Surgery University of Cincinnati Medical Center Disclosures
More informationFocal Fibrocartilaginous Dysplasia in Distal Radius
Shafa Ortho J. 2015 August; 2(3):e2942. Published online 2015 August 24. DOI: 10.17795/soj-2942 Research Article Focal Fibrocartilaginous Dysplasia in Distal Radius Farid Najd Mazhar 1,* ; Hooman Shariatzadeh
More informationFibula bone grafting in infected gap non union: A prospective case series
2019; 3(1): 06-10 ISSN (P): 2521-3466 ISSN (E): 2521-3474 Clinical Orthopaedics www.orthoresearchjournal.com 2019; 3(1): 06-10 Received: 03-11-2018 Accepted: 06-12-2018 Dr. Mohammed Nazim M.S (Ortho),
More information7/23/2018 DESCRIBING THE FRACTURE. Pattern Open vs closed Location BASIC PRINCIPLES OF FRACTURE MANAGEMENT. Anjan R. Shah MD July 21, 2018.
BASIC PRINCIPLES OF FRACTURE MANAGEMENT Anjan R. Shah MD July 21, 2018 DESCRIBING THE FRACTURE Pattern Open vs closed Location POLL OPEN HOW WOULD YOU DESCRIBE THIS FRACTURE PATTERN? 1 Spiral 2 Transverse
More informationCLINICAL PRESENTATION AND RADIOLOGY QUIZ QUESTION
Donald L. Renfrew, MD Radiology Associates of the Fox Valley, 333 N. Commercial Street, Suite 100, Neenah, WI 54956 10/13/2012 Radiology Quiz of the Week # 94 Page 1 CLINICAL PRESENTATION AND RADIOLOGY
More informationSeven patients with nonunion of the scaphoid were
Treatment of nonunion of the scaphoid by a limited combined approach F. del Piñal The Hospital Mutua Montañesa, Santander, Spain Seven patients with nonunion of the scaphoid were treated by a limited approach
More informationUnstable elbow dislocations: a case report of a new surgical technique
SICOT J 2016, 2, 15 Ó The Authors, published by EDP Sciences, 2016 DOI: 10.1051/sicotj/2016010 Available online at: www.sicot-j.org CASE REPORT OPEN ACCESS Unstable elbow dislocations: a case report of
More informationChapter 12 Distal Ulnar Resection
Chapter 12 Distal Ulnar Resection Introduction Ulnar impaction syndrome is a common but often unrecognized cause of pain on the ulnar side of the wrist. Although it can be congenital (due to a long ulna),
More informationSpeedTip CCS 2.2, 3.0
PRODUCT INFORMATION SpeedTip CCS 2.2, 3.0 Cannulated Compression Screws APTUS 2 SpeedTip CCS 2.2, 3.0 Cannulated Compression Screws SpeedTip CCS * 2.2, 3.0 Cannulated Compression Screws A new generation
More informationA Patient s Guide to Adult Thumb Metacarpal Fractures
A Patient s Guide to Adult Thumb Metacarpal Fractures Suite 11-13/14/15 Mount Elizabeth Medical Center 3 Mount Elizabeth Singapore, 228510 Phone: (65) 6738 2628 Fax: (65) 6738 2629 1 DISCLAIMER: The information
More informationFOOSH It sounded like a fun thing at the time!
FOOSH It sounded like a fun thing at the time! Evaluating acute hand and wrist injuries Larry Collins, MPAS, PA-C, ATC, DFAAPA Assistant Professor, Physician Assistant Program Assistant Professor, Department
More informationAcutrak versus Herbert screw fixation for scaphoid non-union and delayed union.
Acutrak versus Herbert fixation for scaphoid non-union and delayed union. Item Type Article Authors Oduwole, Kayode O;Cichy, Benedikt;Dillon, John P;Wilson, Joan;O'Beirne, John Citation Acutrak versus
More informationComplications of Distal Radius Fractures. How to Treat a Distal Radius Fx 11/13/2017. Michael S. Bednar, M.D. Loyola University Chicago
Complications of Distal Radius Fractures Michael S. Bednar, M.D. Loyola University Chicago How to Treat a Distal Radius Fx Need to restore motion, begin with uninvolved parts Need to reduce an unreduced
More information