Visits abroad: the treatment of pseudarthrosis in the Soviet Union

Three British surgeons on a visit to Russia were impressed with the Russian technique known as ‘compression distraction’ used mainly in the treatment of infected pseudarthrosis of the tibia. Multiple thick Kirschner wires drilled through the tibia at a distance from the lesion were fixed in stirrups attached to steel rods and turnbuckles. By adjustment of the apparatus deformity was corrected at the time of application; shortening was overcome by gradual turnbuckling. The equipment was also used for leg lengthening and for complicated recent injuries.     

An unusual fracture of the scaphoid

A case of unusual displacement of the proximal pole of an acute scaphoid fracture is presented. The usual mechanism of scaphoid fracture, dorsiflexion of the wrist, probably did not pertain in this case. We believe that a palmar hyperflexion injury to the wrist drove the proximal pole through the dorsal capsule. On extension of the wrist, the dorsal lip of the radius sheared off the proximal pole.     

Ultrasonic assessment of fractures and its use in the diagnosis of the suspected scaphoid fracture

Ultrasound in the therapeutic range was found to produce pain or severe tingling when applied to 80 of 87 fractures of all types less than 2 weeks old. It appears that as the fracture unites the painful response subsides. It was a valuable supplementary test in the wrist suspected of having a scaphoid fracture when a positive result commonly indicated either fracture or a severe soft tissue injury.     

Scapho-capitate fracture syndrome. A case report

A rare injury of the wrist, scapho-capitate fracture syndrome, in a young patient is reported. Despite early recognition of the injury and surgical intervention, the scaphoid fracture did not unite and another attempt to achieve union with bone grafting and internal fixation also failed. The wrist continued to be painful and stiff. Radiographs of the wrist, 18 months after the injury, showed nonunion of the scaphoid, avascular necrosis of the scaphoid and the lunate and carpal collapse with midcarpal joint arthritis. Due to persistent and disabling symptoms arthrodesis of the wrist had to be carried out. Possible causes for the bad outcome after this injury are discussed. We recommend open reduction for the fracture of the capitate and open reduction and internal fixation with primary bone grafting for a displaced comminuted scaphoid fracture.     

Fractures of the hook of the hamate--a failure of clinical diagnosis

Two cases of a fracture of the hook of the hamate are described in which the diagnosis was clinically missed even though a fracture of the hook was considered. In one patient, the clinical diagnosis was thought to be ulnar wrist instability, and in the other, a pisiotriquetral injury. In one case, the diagnosis was confirmed only by a computerized tomography scan even though lateral tomograms were negative.     

Unusual case of isolated lunate fracture without ligamentous injury

Fractures of the lunate are rare injuries that usually result from high-energy trauma and are typically associated with other carpal and ligamentous injuries. The incidence of lunate fractures has been cited as 0.5% to 6.5% of all carpal fractures. These fractures are not frequently reported in the literature, and no consensus exists on the treatment of these injuries in the acute and chronic setting. The mechanism typically producing this fracture is a loading force applied to a dorsiflexed, ulnarly deviated wrist such that the capitate is driven downward into the lunate.No prior reports exist in the literature of an isolated fracture of the lunate without perilunate dislocation or ligament disruption. This article reports a case of an isolated displaced transverse shear fracture of the lunate seen 3 months after initial injury, which was successfully treated using a volar and dorsal combined approach and open reduction and internal fixation using microscrews. Bony union across the fracture site was obtained by 7-week follow-up and continued to show improved consolidation through 10-month follow-up. The patient had decreased pain, normal range of motion, and no radiographic evidence of lunate osteonecrosis on most recent follow-up despite the delayed presentation and degree of fracture displacement. This case demonstrates a previously unreported type of wrist injury.     

The effect of vigorous physical activity and risk of wrist fracture over 25 years in a low-risk survivor cohort

Recent studies have suggested that a high level of recent physical activity increases the risk of a wrist fracture in postmenopausal women. The relationship of more distant past physical activity to wrist fracture is less clear, and most studies have relied on recall of physical activity much earlier in life. The aim of this study was to assess the risk of wrist fracture in a subset of women who had completed a recent questionnaire and also had participated in a cohort study 25 years earlier, 1865 women who were perimenopausal and postmenopausal in 1976 and had completed the 1976 and 2002 Adventist Health Study lifestyle questionnaires. Data on risk factors including physical activity were collected from the 1976 survey. Subjects reported wrist fractures occurring since baseline, and the approximate time of fracture, in the 2002 questionnaire. Incidence of wrist fracture was 3.7/1000 person-years of follow up. There was a dose–response inverse relationship between level of physical activity and wrist fracture with a 37% reduction of risk for the highest level of physical activity with respect to the lowest level (HR, 0.63; 95% CI, 0.45, 0.89). The effect of physical activity changed little in the final multivariable model (HR, 0.61; 95% CI, 0.43, 0.87). In this cohort of women with a relatively low incidence of wrist fracture, higher levels of physical activity at baseline were protective against risk of fracture during 25 years of follow-up.     

Colles骨折与腕关节不稳定

目的探讨Colles骨折合并腕关节不稳定的发生机制和防治措施。方法对53例Colles骨折随访3～5年,测量其复位前、后和去除外固定后的腕关节正、侧位平片,并测定腕关节功能的主、客观指标。比较合并与不合并腕关节不稳定两组的功能恢复情况。结果伴有腕关节不稳定的发生率为41.5%(22/53),其中腕背不稳定（DISI）10例（45.5%）,舟月分离12例（54.5%）,多发生在严重骨折移位,高能量损伤的患者。骨折愈合后,合并腕关节不稳定的功能明显差于单纯Colles骨折患者。结论对骨折移位严重或高能量损伤的Colles骨折,要注意是否合并腕关节不稳定。对合并腕关节不稳定的Colles骨折,复位时应尽可能恢复掌倾角,如骨折稳定,腕关节固定在中立位或轻度背伸位（＜10°）为宜;如骨折不稳定,应固定在掌屈尺偏位,2周后改为固定于中立位或轻度背伸位（＜10°）,以防止远期出现腕关节不稳定。     

Radiographic assessment of soft tissue signs in clinically suspected scaphoid fractures: the incidence of false negative and false positive results

Radiographs of 127 patients who presented with suspected scaphoid fractures were reviewed to determine whether, as recent studies have suggested, an absence of dorsal soft tissue swelling of the wrist and a normal scaphoid fat stripe invariably excluded the possibility of such a fracture. Both false negative and false positive results were found to occur. False negative results (only approximately one in four patients with normal soft tissue signs had scaphoid fractures) might occur if the radiograph was obtained before the onset of edema. False positive results (only approximately a third of patients with abnormal soft tissue signs did not have any bony injury) might reflect soft tissue injury alone. Normal soft tissue signs do not exclude the possibility of a scaphoid fracture. Abnormal signs do not always indicate a scaphoid fracture.     

113例绝经后女性腕部骨折的危险因素分析

目的调查分析绝经后女性腕部骨折的危险因素。方法选取113例绝经后女性腕部骨折患者作为骨折组.80例体 检人员作为对照组，进行问卷调查。结果骨折组中体重指数明显高于对照组(P <0.01)。骨折组近1年内跌倒次数明显多 于对照组(P <0.01)。骨折组中服用钙盐比例明显低于对照组(P <0.01)。Logistic回归分析发现体重指数及1年内跌倒次 数对绝经后女性腕部骨折发生率有显著的影响。结论肥胖、跌倒及不了解骨质疏松为绝经后女性腕部骨折的高危险因素。     

腕关节镜下治疗尺骨茎突骨折

目的 探讨腕关节镜监视下治疗尺骨茎突骨折的方法,以获得更好的治疗效果.方法 对15例尺骨茎突骨折的患者,在C臂透视机及腕关节镜监视下先将合并的桡骨远端骨折进行复位,经皮穿针内固定或切开复位钢板内固定,然后在腕关节镜下检查三角纤维软骨复合体(triangular fibrocartilage complex,TFCC)是否损伤,并作修整、清理等相应的处理,在关节镜监视下将尺骨茎突骨折复位,经皮作钢丝张力带内固定.结果 11例合并有TFCC损伤,经平均15.4个月的临床随访,X线片检查显示尺骨茎突骨折全部骨性愈合,骨性愈合时间平均5.2个月.按照Green-O'Brien功能评定方法进行腕关节功能评定,优良率为93.3%,无腕关节尺侧疼痛及腕关节不稳等并发症发生.结论 腕关节镜下治疗尺骨茎突骨折既可以对骨折进行有效的复位及固定,有利于骨折的愈合;又可以了解腕关节内TFCC等结构的损伤程度,便于早期处理,以免遗留慢性腕痛或腕关节不稳定.     

Internal fixation of a capitate fracture with Herbert screws

A case of an isolated, displaced fracture of the capitate is described. This rare carpal injury was treated by internal fixation with two Herbert screws. The fracture united and the patient achieved an excellent range of wrist motion. The Herbert screw is useful in the treatment of displaced fractures of the capitate since the screw maintains reduction, compresses the fracture site, and allows early wrist motion.     

Unusual combined fracture dislocation of the wrist and metacarpophalangeal joints: a case report and review of the literature

Volar perilunate fracture dislocation is an extremely rare carpal injury, but associated with metacarpophalangeal joint dislocation of both the ipsilateral index and middle finger has never been reported. We report one case of a 28-year-old man following a high-energy trauma.After performing closed reduction of the metacarpophalangeal joint injury, open reduction of the wrist injury through volar approach was done, and a K-wire fixation was used to stabilize the scaphoid fracture and lunotriquetral joint. After a 16 months' follow-up period, the wrist regained a full range of motion without symptoms, and the fractured bone was strengthened in a good position.     

腕舟骨骨折关节镜检查的结果及其意义

目的　应用腕关节镜研究腕舟骨骨折后腕关节的反应、合并软组织、软骨损伤与腕骨排列的异常。方法　分析了 5 8例次腕舟骨骨折患者的关节镜检查结果 ,镜检中重点观察了腕关节滑膜、关节软骨、掌侧韧带、骨间韧带、三角纤维软骨和骨折线等内容。结果　舟骨骨折后滑膜增生开始于伤后 2周 ,并经历了波浪式的消涨过程 ,其增生与否与骨折移位无相关性 (P >0 .0 5 ) ;关节软骨的破坏最早在伤后 5周即有表现 ,并有较大比例的患者合并韧带和三角纤维软骨损伤。结论　腕关节镜检查能更清楚地观察腕关节的病变 ,并为完善诊断和制定治疗计划提供有力的依据。     

Proximal row transcarpal fracture from a punching injury

We describe an unusual case of a 31-year-old woman who injured the right dominant wrist when she punched an assailant's shoulder. She described a mechanism of direct compression, with the wrist in hyperextension, radial deviation and the forearm in pronation. She sustained an oblique transverse fracture of the proximal pole of the scaphoid and a coronal plane fracture of the lunate and the triquetrum. This unusual proximal row transcarpal fracture is in conflict with the Mayfield sequence and was caused by a low velocity injury.     

Does the term scaphocapitate syndrome need to be revised? A report of 6 cases

This is a retrospective study of six patients with displaced fractures of the neck of the capitate. In four of the six patients the diagnosis was delayed by at least 1 week. After open reduction and internal fixation the results were assessed as excellent (three cases), fair (two cases) or poor (one case). In all cases there was a concomitant injury to the radial side of the wrist: in four cases this was a fracture of the waist of the scaphoid. In five of the six cases there was also an injury to the ulnar side of the wrist. As a scaphoid fracture does not always occur with the fracture of the neck of the capitate, we consider the term "scaphocapitate syndrome" inappropriate for this injury.     

Patterns of union in fractures of the waist of the scaphoid

Eighty-two of 85 patients who had sustained a fracture of the waist of the scaphoid in 1985 were reviewed more than one year after injury. The incidence of nonunion, defined as a clear gap at the fracture site one year after injury, was 12.3%. This was much higher than expected. Most of the patients with nonunion had symptoms and had appreciable restriction of wrist movement. In a further 25% of the patients at review, the site of the fracture could be easily identified although it appeared to have healed. These patients were older and more of them were women. Three-quarters of these patients had symptoms but their wrist movement was essentially normal.     

Ligamentotaxis for comminuted fracture of capitate: a case report

We present the technical report for treatment of comminuted fracture of the capitate with ligamentotaxis.The base of third metacarpal was found to be fractured with comminution of the capitate.The decr...     

Type III Monteggia fracture with ipsilateral epiphyseal injury of the distal radius

Ipsilateral elbow and wrist injuries are uncommon in children. We present a case of Bado type III Monteggia fracture dislocation with ipsilateral Salter Harris type I epiphyseal injury of distal radius in a 10-year-old boy. A good result was achieved with early closed reduction and percutaneous K wire fixation. This case emphasizes that whenever a fracture is detected around wrist and elbow in children, early anatomical reduction is required for good functional outcome.