Nontraumatic osteonecrosis of the distal pole of the scaphoid

Post traumatic osteonecrosis of distal pole of scaphoid is very rare. We present a case of 34 years old male, drill operator by occupation with nontraumatic osteonecrosis of distal pole of the scaphoid. The patient was managed conservatively and was kept under regular follow-up every three months. The patient was also asked to change his profession. Two years later, the patient had no pain and had mild restriction of wrist movements (less than 15 degrees in either direction). The radiographs revealed normal density of the scaphoid suggesting revascularization.     

Neglected dorsal dislocation of the scaphoid

Isolated dislocation of the scaphoid is very rare. A 45-year old male, industrial worker reported two and half months after injury with wrist pain and swelling on the dorsum of left wrist. He was diagnosed as neglected dorsal dislocation of scaphoid. Proximal row carpectomy with capsular interposition was done stabilizing the distal carpus on the radius using Kirschner wires. At-12 months follow-up the patient had good wrist function and was satisfied with the outcome of the treatment. We hereby report this neglected dorsal dislocation of scaphoid in view of rarity and discuss the various options for management.     

Treatment of acute scaphoid fractures: a systematic review and meta-analysis

Background/Methods  

The purpose of this review was to assess the current evidence supporting operative fixation versus casting for acute scaphoid fractures through a systematic review and meta-analysis of the literature.     

Thumb metacarpal vascularized bone graft in long-standing scaphoid nonunion--a useful graft via dorsal or palmar approach: a cohort study of 24 patients

PURPOSE: Long-standing scaphoid nonunion preferentially is treated by using a vascularized bone graft because of its superiority in achieving bone healing. In the present study nonunion was repaired using a bone graft raised from the thumb metacarpal and vascularized by the first dorsal metacarpal artery. METHODS: Twenty-four patients with scaphoid nonunion for longer than 5 years, without ligament injuries and panarthrosis, had surgery. According to the location of the nonunion and presence of dorsal intercalated segment instability deformity, surgery was performed by either a dorsal or palmar approach. The patients had a final clinical and radiographic evaluation 12 months after surgery. RESULTS: Complete healing was shown in 21 patients but incomplete healing was observed in the remaining 3 patients. After surgery patients had marked pain relief, with an improved range of motion and grasping strength. Anatomic restoration of carpal angles and scaphoid length was observed. None of the patients required additional surgery. Before surgery 15 patients presented radiographic signs of wrist arthrosis. During surgery, however, cartilage erosion on the proximal pole or on the radius articular surface was not confirmed. Despite the presence of radiographic arthrosis, wrist symptoms, motion, and grasping strength improved after surgery. CONCLUSIONS: Long-standing scaphoid nonunion, even in the presence of limited arthrosis, can be treated with surgery and healing promoted by a vascularized bone graft. Because of its versatility for use by dorsal or palmar approach and reliability, the first dorsal metacarpal artery vascularized bone graft represents our method of choice.     

Carcinoma of the Lip: A Retrospective Study of 70 Patients

From 1966 to 1978, 70 patients with carcinoma of the lip were treated at the Division of Plastic Surgery, University Central Hospital, Helsinki. The lip tumour was a squamous cell carcinoma in 64 patients, and a basal cell carcinoma in 6 patients. Of these 70 patients, 24 had radiotherapy as the primary mode of therapy and 46 patients had been treated initially by surgery. The results of surgery were generally good. However, in the group of “simple wedge excision” and in patients who had had radiotherapy as the primary treatment there was a higher incidence of recurrences. In the former group the recurrences were considered to be due to a too narrow angle of excision. We recommend surgery as the primary method of treatment because of the availability of histologically accurate tumour margin assessment, the short rehabilitation period and the good functional results achieved.     

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。