Volar scaphotrapezial dislocation

We present a case of volar luxation of the scaphotrapezial bone, in which radiographs suggested luxation of the scaphoid, but unclear relations to the other carpal bones. Computer tomographic reconstruction showed an isolated scaphotrapezial luxation. This was treated by closed reduction and a plaster cast, after which the patient regained normal function of her wrist.     

The scaphotrapezial ligament complex: an anatomic and biomechanical study

An anatomic and biomechanical study of the ligamentous stabilizers of the scaphotrapezial trapezoidal joint was performed in 25 fresh cadaver specimens. A consistent scaphotrapezial ligament complex consisting of four entities was identified. This complex is comprised of a stout scaphotrapezial ligament on the radial and palmar aspects of the scaphotrapezial joint, weak palmar and dorsal capsules, and a scaphocapitate capsular ligament. A biomechanical study subsequently found that these structures were directly related to resisting diastasis of the scaphotrapezial trapezoidal joint. This information is helpful in understanding scaphoid tuberosity fractures, scaphotrapezial instability and arthrosis, scaphoid dislocations, and perhaps scapholunate disassociations.     

Long-term follow-up of trapeziometacarpal arthroplasty with coexisting scaphotrapezial disease.

Visualization of the scaphotrapezial joint during basal joint arthroplasty has been recommended to establish the stage of degeneration. This study attempts to clarify that recommendation and evaluate whether moderate wear of the joint precludes a good result of trapeziometacarpal hemiarthroplasty. To assess the need for inspection of the scaphotrapezial joint, x-ray films, tomograms, and operative findings in 23 cases of basal joint arthroplasty were reviewed. X-ray findings agreed with operative findings at the scaphotrapezial joint in only 76% of the cases. We also evaluated 18 thumbs in 15 patients who underwent interposition arthroplasty of the trapeziometacarpal joint and at surgery had moderate degenerative changes of the scaphotrapezial joint. The scaphotrapezial joints were left intact and the trapeziometacarpal joints were reconstructed. Follow-up averaged 8 years. In no case was there x-ray or symptomatic progression of the disease at the scaphotrapezial joint. Clinically, 78% were rated excellent, 17% good, and 5% fair.     

Biomechanical evaluation of the ligamentous stabilizers of the scaphoid and lunate: part III

PURPOSE: This study continued our previous investigations of the ligaments stabilizing the scaphoid and lunate in which we examined the scapholunate interosseous ligament, the radioscaphocapitate, and the scaphotrapezial ligament. In this current study, we examined the effects of sectioning the dorsal radiocarpal ligament, dorsal intercarpal ligament, scapholunate interosseous ligament, radioscaphocapitate, and scaphotrapezial ligaments. In the current study, the scapholunate interosseous ligament, radioscaphocapitate, and scaphotrapezial ligaments were sectioned in a different order than performed previously. METHODS: Three sets of 8 cadaver wrists were tested in a wrist joint motion simulator. In each set of wrists, only 3 of the 5 ligaments were cut in specific sequences. Each wrist was moved in continuous cycles of flexion-extension and radial-ulnar deviation. Kinematic data for the scaphoid and lunate were recorded for each wrist in the intact state, after the 3 ligaments were sectioned in various sequences and after the wrist was moved through 1,000 cycles of motion. RESULTS: Dividing the dorsal intercarpal or scaphotrapezial ligaments did not alter the motion of the scaphoid or lunate. Dividing the dorsal radiocarpal ligament alone caused a slight statistical increase in lunate radial deviation. Dividing the scapholunate interosseous ligament after first dividing the dorsal intercarpal, dorsal radiocarpal, or scaphotrapezial ligaments caused large increases in scaphoid flexion and lunate extension. CONCLUSIONS: Based on these findings, we concluded that the scapholunate interosseous ligament is the primary stabilizer and that the other ligaments are secondary stabilizers of the scapholunate articulation. Dividing the dorsal radiocarpal, dorsal intercarpal, or scaphotrapezial ligaments after cutting the scapholunate interosseous ligament produces further changes in scapholunate instability or results in changes in the kinematics for a larger portion of the wrist motion cycle.     

Biomechanical evaluation of ligamentous stabilizers of the scaphoid and lunate

This study evaluated the effects of sectioning the scapholunate interosseous ligament, radioscaphocapitate ligament, and scaphotrapezial ligament on the kinematics of the scaphoid and lunate. Eight cadaver upper extremities were placed in a wrist joint simulator and moved in continuous cycles of flexion-extension and radial-ulnar deviation. Positional data of the scaphoid and lunate were obtained in the intact state, after the scapholunate ligament was cut; after the scapholunate and scaphotrapezial ligaments were cut; after the scapholunate, scaphotrapezial, and radioscaphocapitate ligaments were cut; and after all 3 ligaments were cut and the specimen was placed through an additional 1,000 cycles of flexion-extension. Cutting the scapholunate ligament caused changes in scaphoid and lunate motion during flexion-extension, but not radial-ulnar deviation. Additional sectioning of the scaphotrapezial ligament followed by the radioscaphocapitate ligament caused further kinematic changes in these carpal bones. One thousand cycles of motion after all 3 ligaments were sectioned caused additional kinematic changes in the scaphoid and lunate. The scapholunate ligament appears to be the primary stabilizer between the scaphoid and lunate. The radioscaphocapitate and scaphotrapezial ligaments are secondary restraints. Repetitive cyclic motion after ligament sectioning appears to have additional deleterious effects on carpal kinematics.     

Degenerative changes at the scaphotrapezial joint following Herbert screw insertion: a radiographic study comparing patients with scaphoid fracture and primary hand arthritis

One method of Herbert screw insertion is to mobilize the scaphotrapezial joint and insert the screw through the articular surface of the distal scaphoid. Because of concern that this might predispose to osteoarthritis in the scaphotrapezial joint, we have investigated joint space width and the presence of osteophytes adjacent to the scaphotrapezial joint using high definition macroradiography.Twenty-eight patients with symptomatic primary osteoarthritis of their hands, 23 with a scaphoid fracture successfully treated conservatively and 18 treated with a Herbert screw were studied. The patients with primary osteoarthritis of their hands had more narrowing of the scaphotrapezial joint compared with the other two groups, but patients treated with a Herbert screw had a significantly higher incidence of osteophytosis on the distal scaphoid than the other two groups. With Herbert screw fixation, osteophytosis on the distal scaphoid may cause impingement and pain, and be a predictor of further degenerative joint changes.     

Percutaneous transtrapezial fixation of acute scaphoid fractures

Percutaneous screw fixation of undisplaced fractures of the scaphoid waist has gained popularity but remains technically demanding. This study describes a transtrapezial modification of the volar percutaneous technique and reports the results in 41 patients. The patients were evaluated at a mean of 36 months (range 14-68 months) after surgery. All fractures healed within 10 weeks (mean 6.4 weeks). Functional ranges of wrist motion and grip strength were achieved in all patients. Radiographs showed accurate central placement of the screw in all patients and no degenerative changes were seen at the scaphotrapezial joint. In three patients, the screw was removed because it was prominent at the scaphotrapezial joint.     

Silicone rubber implants for arthrosis of the scaphotrapezial joint.

Between 1980 and 1983, 10 patients received high performance silicone rubber condylar implants for the treatment of isolated degenerative changes of the scaphotrapezial joint. Early clinical and radiographic results (at a mean of 15 months) were excellent. Late follow up of these 10 together with a further 11 patients, however, showed migration of the implant and radiological signs of silicone particle synovitis in all but two. We no longer recommend this operation for treatment of isolated arthrosis of the scaphotrapezial joint.     

Scaphotrapezial arthritis after a carpometacarpal fusion in a patient with Marfan's Syndrome: case report

We report a case of scaphotrapezial arthritis that developed in a patient with Marfan's syndrome many years after a carpometacarpal fusion, which placed the thumb metacarpal in adduction. This problem was effectively treated with an abduction/opposition osteotomy, which both increased the patient's first web space and improved her arthritic symptoms.     

Anterior wrist ganglia from the scaphotrapezial joint.

In this series of 104 anterior wrist ganglia evaluated, 35 were found to arise from the scaphotrapezial joint, 1 from the metacarpotrapezial joint, and 68 from the radioscaphoid joint. After dissection of the cyst and identification of the joint of origin, the ganglion was removed and the joint was incised. Of the patients with scaphotrapezial ganglia, 29 were available for follow-up evaluation with a mean follow-up time of 67 months. Relief of symptoms was noted in 93%, wrist motion was maintained in all patients, and there were two recurrences.     

Scaphotrapezial dislocation: a case report

Traumatic dislocation of either trapezium or trapezoid is rare. We found less than 20 cases of each reported in the literature. We describe a case of traumatic dislocation of the scaphotrapezial joint associated with subluxation of the scaphotrapezoidal joint, which to our knowledge has not been reported.     

Radiography and visual pathology of the osteoarthritic scaphotrapezio-trapezoidal joint, and its relationship to trapeziometacarpal osteoarthritis

PURPOSE: To determine and quantify the relationship of osteoarthritis (OA) in the trapeziometacarpal, scaphotrapezial, and scaphotrapezoidal joints; to ascertain the dependability of radiographic assessment of trapeziometacarpal, scaphotrapezial, and scaphotrapezoidal OA; to determine the articular topography of the scaphotrapezio-trapezoidal (STT) joint (composed of the scaphotrapezial and scaphotrapezoidal articulations) using stereophotogrammetry; and to characterize the articular wear patterns of STT OA. METHODS: Sixty-nine fresh-frozen human cadaveric hands were staged radiographically and by gross visual examination for the presence of OA in the trapeziometacarpal and STT joints. Twenty randomly selected joints also were evaluated to determine the topography of the STT joint using stereophotogrammetry. RESULTS: Concomitant severe osteoarthritic degeneration was found in the trapeziometacarpal and STT joint in 60% of our specimens. A correlation was found in the severity of OA in the trapeziometacarpal and STT joints. Radiographic and gross visual evaluation of STT OA concurred in 39% of our specimens. CONCLUSIONS: The prevalence of concomitant trapeziometacarpal and STT OA, and the uncertainty of radiographic evaluation of STT OA, indicate the need to visualize the STT joint intraoperatively to determine the true degree of degenerative changes present.     

Ocular globe luxation under general anesthesia

We present a case of ocular globe luxation after general anesthesia. Upon completion of the surgery, the upper eyelid was retracted to examine for conjunctival edema, which resulted in globe luxation. The posterior aspect of the globe was visualized and a small tethering white structure ("check ligament") was observed. The upper lid was retracted, and the globe easily repositioned into the orbit. Ophthalmic sequelae would not be anticipated if the episode of globe luxation is brief. Anesthesiologists should be aware of the risk factors associated with globe luxation and know how to appropriately treat this complication.     

Interposition arthroplasty using trapezium tendon ball for osteoarthritis of the carpometacarpal joint of the thumb

Carpometacarpal (CM) joint arthroplasty of the thumb using a trapezium tendon ball was performed in 11 hands of 9 patients with osteoarthritis. After a total dissection of the trapezium, the palmaris longus was wrapped around the trapezium, with the surfaces of both the CM joint and the scaphotrapezial joint tightly covered. Grafted trapezium was repositioned, and a congruency of the CM joint was confirmed. All patients were relieved from pain, with the radial abduction angle, grip strength, and the pinch strength increased 5 years after surgery. Radiographically, the mean width of the CM joint space increased, and a central migration of the first metacarpal bone was not found. This procedure would be available for the osteoarthritis in both the CM joint and the scaphotrapezial joint.     

Complete dislocation of the polyethylene inlay after internal hemipelvectomy and individually fitted tumor endoprosthesis

We report about an exceptional complication after internal hemipelvectomy and replacement of the defect with a custom-made endoprosthesis. A complete luxation of the PE-inlay out of the metal cup occurred. Radiologically we assumed a luxation of the femoral head in dorsal direction. Revision after a failed attempt of closed reposition showed a complete luxation of the inlay, which was caused by deficient fixation in the acetabular component. The absence of a contrast wire in the PE-inlay delayed the right diagnosis and made it difficult to find the dislocated inlay in the large wound.     

Posttraumatic recurrent luxation of knee joint (author's transl)

A posttraumatic, recurrent luxation of the knee joint is presented. The cause for the first luxation was a severe trauma. As the treatment of the ligament and capsule ruptures of the first luxation was inadequate, the effect was a completely unstable knee joint. By hyperextension trauma or hyperextension following weakness of the muscles of the thigh recurrent luxations of the knee were caused. The importance of a sufficient treatment of ligament and capsule damage following a knee luxation is emphasized.     

Patellar dislocation. Diagnostic and forensic problems]

Very often, patellar luxation or subluxation after spontaneous setting is difficult to diagnose. Concomitant injuries can be highly misleading during diagnosis. Traumatic luxation almost always results from forces exerted on the knee indirectly and by way of the muscles, and must be differentiated from habitual luxation. When the constitution favors the occurrence of luxation it is not the clinical and radiological results that are relevant to the assessment. Only an exact analysis of the course of events can clarify whether the trauma can be recognized as a basic cause covered by insurance laws.     

Two cases of traumatic testicular luxation]

Two cases of traumatic testicular luxation are described. Patients were a 21 year-old man and a 19 year-old man who were involved in a traffic accident. They were admitted to our hospital with the complaint of right groin mass after the traffic accident. Surgical replacement of the testis, which was dislocated at the right inguinal region, was successfully carried out in both cases. These cases are the 57th and 58th cases of traumatic testicular luxation reported in the Japanese literature.     

Approaches to the semilunar bone and their indications]

The authors review incisions for exposure of the lunate bone and describe them in detail. They study the advantages and disadvantages of each approach, then consider their indications in peri-lunar luxation, scapholunar luxation and Kienboeck's disease. They emphasize the interest of the palmar routes in all cases, except for scapho-lunar luxation.