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Surgery of the Wrist
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Ramon Tahmassebi, Sirat Khan, Kalpesh R Vaghela
History and clinical examination will lead the surgeon to suspect a scaphoid fracture or non-union, but confirmation of the diagnosis will come from imaging. Scaphoid series X-rays are an essential starting point. However, CT and MRI can provide additional information. The surgical plan will be affected by several key factors.
Emergency medicine
Published in Roy Palmer, Diana Wetherill, Medicine for Lawyers, 2020
One of the most notorious missed fractures is that of the scaphoid. The scaphoid is a small bone in the wrist, the carpus, and it characteristically fractures in young men who sustain hyperextension injuries to their wrist, i.e. the wrist is forced backwards by, for instance, a fall onto the outstretched hand. The patient complains of pain in the wrist but there is often a paucity of physical signs, apart from the presence of tenderness in the ‘anatomical snuff box’ (in the wrist, near the base of the thumb).
Orthopaedic Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
The scaphoid has a critical role in the proximal carpal row and is important in maintaining radiocarpal stability. Orthopaedic review is essential to reduce complications and potential loss of function, as well as to exclude a missed injury such as: scapholunate dissociation with >4 mm space between these bones, radial styloid fracture, or even a Bennett's fracture of the base of the thumb metacarpal.Delayed complications of scaphoid fracture include avascular necrosis, non-union and osteoarthritis, which result in pain and loss of wrist function.
Patient-reported ‘treatment injuries’ after hand surgery. A review of 1321 claims submitted to the Norwegian system of patient injury compensation 2007–2017
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Sunniva Martine Kolstad Addison, Lisa Sofie Albrigtsen, Ida Rashida Khan Bukholm, Hebe Désirée Kvernmo
Of 45.5% of the 712 trauma claims were accepted, varying from 8 to 52.9% (Table 2). The proportion of men was much greater than women (63.6 vs. 36.4% p < .05). Mean age was 38.7 years (SD 15.5). Around 1/5 of the claims were falling into each of the age groups of 20–29, 30–39, 40–49 and 50–59 years. Diagnosis ‘S62 – Fracture at wrist and hand level’ dominated, accounting for almost half of the accepted trauma claims. Note that this diagnosis code does not include distal radius or ulna fractures. Almost ¼ of the claims for hand fractures were due to ‘S62.0 – Fracture of scaphoid bone of wrist’. Of 63% of these were accepted, which is almost 15% higher than for all hand fractures. The second-largest trauma diagnosis was ‘S63 – Dislocation, sprain and strain of joints and ligaments at wrist and hand level’ at 17% (Table 2). ‘S66 – Injury of muscle and tendon at wrist and hand level’ had the highest percentage of accepted claims (52.6%), accounting for 12.7% of accepted trauma claims. The grounds for acceptance were almost equally distributed between ‘treatment failure’ and ‘diagnostic failure’ (Figure 2). However, 2/3 of all accepted hand fracture claims were based on treatment failure, but more than 2/3 of accepted scaphoid fracture claims were based on diagnostic failure. The reasons for failure in treatment or diagnostics are shown in Figures 3 and 4.
Pain, impaired functioning, poor satisfaction and diminished health status eight years following perilunate (fracture) dislocations
Published in Disability and Rehabilitation, 2020
Charlotte M. Lameijer, Caren K. Niezen, Mostafa El Moumni, Corry K. van der Sluis
A total of 24 patients with PLD/PLFDs were retrieved from the hospital records. Three patients were excluded based on insufficient control of the Dutch language or dementia. Two patients could not be reached due to outdated contact information. Eight patients refused to participate. Finally, a total of 11 patients were included (9 males) with median age at injury of 38 years (IQR 33; 54). Median follow up time was 97 months (IQR 84–193) (Table 1). Five patients had sustained a fracture of the scaphoid. The capitate was fractured in one patient and the ulnar styloid was fractured in two patients. Six patients had transient median nerve neuropraxia. All PLD/PLFDs were surgically treated within five days following the injury. Four patients underwent secondary surgery because of re-dislocation, three within nine days after initial surgery, one at two years after initial surgery. Approximately two years after the injury, one patient underwent a four-corner arthrodesis and another patient underwent a complete wrist arthrodesis. Seven patients received specific rehabilitation programs for the PLD/PLFD, while four did not (Table 1).
A case of total scaphoid titanium custom-made 3D-printed prostheses with one-year follow-up
Published in Case Reports in Plastic Surgery and Hand Surgery, 2020
Sequelae of scaphoid fracture treatment include nonunion and necrosis of bone fragments. Carpal biomechanical changes can lead to scaphoid nonunion advanced collapse (SNAC) arthritis and severe degenerative osteoarthritis of radiocarpal and intercarpal joints. Surgical treatment options for the reconstruction of the scaphoid bone or, when that is impossible, for the prevention or treatment of late sequelae, include bone grafts (free or pedicled when the nonunion is isolated without collapse phenomena) [1–7], proximal row carpectomy [7,8], total or partial scaphoid removal in association with midcarpal arthrodesis, total wrist replacement, and total wrist arthrodesis [9]. However, no one method is considered to be the gold standard.