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Forearm and hand
Published in Pankaj Sharma, Nicola Maffulli, Practice Questions in Trauma and Orthopaedics for the FRCS, 2017
Pankaj Sharma, Nicola Maffulli
In the absence of a fracture, the most likely injury is to the scapholunate ligament. Clenched-fist radiographs should demonstrate the presence of scapholunate dissociation. However, if these are normal and clinical suspicion is still high, an MRI scan should be performed.
Injuries of the wrist
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
David Warwick, Adam Watts, Joanna Thomas
The wrist functions as a system of intercalated segments or links, stabilized by the scaphoid (which acts as a bridge between the proximal and distal rows of the carpus) and the ligaments either side of the lunate (the scapholunate ligament and the lunotriquetral ligament). Fractures and dislocations of the carpal bones, or even simple ligament tears and sprains, may seriously disturb this system so that the links collapse into one of several well-recognized patterns (see Chapter 16).
Carpal injuries
Published in Sebastian Dawson-Bowling, Pramod Achan, Timothy Briggs, Manoj Ramachandran, Stephen Key, Daud Chou, Orthopaedic Trauma, 2014
The tightened ligaments surrounding the scaphoid cause it to extend. This force is transmitted to the lunate, which is unable to rotate given its strong ligamentous attachment. This causes either scapholunate ligament rupture or scaphoid fracture.
Rib osteochondral graft for scaphoid proximal pole reconstruction
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Tomoyuki Koike, Naoki Kato, Kenta Saito, Kenichi Kokubo, Jiro Maegawa
Next, preservation or reconstruction of the scapholunate ligament is common. However, this still depends on the extent of osteonecrosis. There is no unified view on whether reconstruction should be performed. Using a cadaver model, Capito [12] reported that after complete dissection of the scapholunate ligament, the extension of the scaphoid with a 4-mm spacer restored alignment without ligament repair. This suggests that if the scaphoid can be reconstructed slightly longer, ligament reconstruction may not be necessary. Although it is possible to maintain the carpal alignment by reconstructing the scaphoid slightly longer, the progression of osteoarthritis due to the increased load remains a concern. However, in our cases, the alignments were maintained, and none had progression to osteoarthritis. Because of the thickness of the rib cartilage, shaving may not be a problem. Reconstruction of the scaphoid using rib osteochondral autografts may be a solution without ligament reconstruction.
The clinical significance of magnetic resonance imaging of the hand: an analysis of 318 hand and wrist images referred by hand surgeons
Published in Journal of Plastic Surgery and Hand Surgery, 2022
Maire Sofia Ratasvuori, Nina Charlotta Lindfors, Markus J. Sormaala
The highest correlation between clinical examination and MRI findings was found for the mass group and the lowest for the group with unspecific pain. Although there were second-look findings in 88 (27.8%) cases (24–33% in every diagnostic group), most of these were of minimal or no clinical significance. The most common second-look findings were extensor carpi ulnaris (ECU) tendinopathy (n = 28, 31.8%) and ganglions (n = 25, 28.4%). In 10 cases (11.4%) with a primary diagnosis on MRI, after a second look, the MRI was considered to be normal. However, the second-look finding would have changed the course of treatment in 13 cases, as in six of these cases the second-look opinion was that there were no pathological findings on MRI. Two of these included the scapholunate ligament.
Progressing arthrosis and a high conversion rate 11 (4–19) years after four corner fusion
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Ole Reigstad, Trygve Holm-Glad, Preben Dovland, Johanne Korslund, Christian Grimsgaard, Rasmus D. Thorkildsen, Magne Røkkum
Untreated scapholunate ligament injury or scaphoid non-union often lead to painful wrist arthrosis. Limited wrist arthrodesis or resections can reduce pain and preserve motion and function [1]. Four corner fusion (4CF), described by Watson and Ballet [2] or proximal row carpectomy (PRC), described by Stamm [3] are treatment alternatives. 4CF has a wider indication than PRC being a treatment option also in scaphoid non-union advanced collapse (SNAC 3) and scapho-lunate advanced collapse (SLAC 3) patients where the midcarpal joint is also affected. In Watson’s original description the scaphoid was replaced with a silicon implant, the implant was later abandoned due to complications [4]. Bone fusion in 4CF is achieved by different means including K-wire fixation, staples, headless compression screws and circular plates with screws [5]. The latter has demonstrated the highest non-union and hardware complication rate [6–8]. The clinical result after 4CFvaries considerably, ranging from no gain after surgery to satisfactory results; the majority report reduced motion, strength and pain scores [6,9]. Although numerous case series have demonstrated good clinical results, long-term follow is rarely reported. The aim of our study was to evaluate whether the good short to midterm results reported after 4CF surgery could be expected after longer term follow-up. We performed a retrospective follow-up of patients operated with 4CF due to SNAC and SLAC grade 2 or 3.