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Galal Hegazy 《Journal of hand and microsurgery》2015,7(2):250-255
The aim of the study was to evaluate results of volar percutaneous headless compression screw fixation without bone grafting in 21 patients with scaphoid waist nonunion fractures. The inclusion criteria in this series were scaphoid waist fracture nonunion with intact cartilaginous envelope, minimal fracture line at nonunion interface, no cyst or sclerosis, no avascular necrosis and normal scapholunate angle without humpback deformity. There were 17 male and 4 female patients with an average age of 23 years (range 16–45 years). All patients had radiographic examinations that included Posteroanterior, lateral, oblique and scaphoid views. Preoperative MRI to assess the cartilaginous shill and vascularity of scaphoid was done. CT scans were performed postoperatively to confirm scaphoid fracture healing. The average clinical follow-up was at 25 months (range 18–35) postoperatively. All fractures united successfully with no additional procedures. The average DASH score (disabilities of the arm, shoulder, and hand) at final follow-up was 8 (range 0–16). Percutaneous fixation for selected scaphoid nonunion can avoid the morbidity of an open approach and bone grafting. 相似文献
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Scaphoid nonunion followed by necrosis of bone segments is a common pathologic condition for the hand surgeon, and the difficulty
of its management is well known. The total titanium scaphoid replacement, although not well-described in the literature, in
our experience represents a reasonable choice in the treatment of this condition. Strict patient selection is necessary to
achieve good clinical results. The titanium avoids the silicone synovitis, a well-described complication of silastic implants.
Furthermore, this technique permits other surgical steps in case of failure. 相似文献
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Abstract Fractures of the carpus are frequent injuries and
typically result from of a fall onto the outstretched hand.
Scaphoid fractures are the second most frequent fracture type of
the hand (80%). 95% of the patients with acute scaphoid
fractures are male, and the average age is approximately 25
years. Conservative treatment of acute scaphoid fractures with
immobilization in a plaster cast was the therapy of choice for a
long time. Surgical treatment was reserved to severe dislocated
fractures only. A progress could be obtained by the principle of
intramedullary fixation, whose forerunner is represented by the
Herbert screw, and the introduction of cannulated screws
guaranteed a continuous improvement. The decision to treat the
fracture by surgery requires a clear definition of the fracture
type. Therefore, precise radiologic technique is mandatory to
detect the fracture and to analyze the pathomorphological
circumstances. In order to get an exact classification for the
decision on how to proceed, three standard X-ray projections
(posteroanterior [PA], lateral and Stecher projection) and a CT
scan have to be performed. The most well-known classification
has been defined by Herbert & Fisher which combines fracture
anatomy, stability and disease history in order to derive
prognostic and therapeutic criteria. Also, delayed healings and
nonunions are considered. To decide on the adequate treatment, a
prerequisite for conservative therapy of acute scaphoid
fractures is the anatomic position of the scaphoid. Conservative
therapy should be reserved to fracture types, which are stable
and heal reliably in the lower-arm plaster cast within 6 weeks.
All displaced and unstable acute scaphoid fractures should be
operated, and whenever possible, rigid internal fixation should
be achieved because of interfragmentary compression. Therefore,
several intramedullary implants are available for surgical
treatment of acute scaphoid fractures, e. g., Herbert screw,
Mini Herbert screw, AO screw (cannulated), Acutrac screw
(cannulated), or Twin-fix screw (cannulated). With improved
surgical and radiologic techniques, most scaphoid fractures are
amenable to minimally invasive fixation. The dorsal approach
guarantees a good overview in treating proximal pole fractures.
Yet, not all types of fractures can be treated in this way.
Severely displaced fractures require the classic open palmar
approach. In order to prevent the development of a scaphoid
nonunion or an advanced carpal collapse (SNAC-wrist), an early
and sufficient diagnostic algorithm is necessary. We recommend
internal fixation with a cannulated Herbert screw in B1 and B2
fractures and a Mini Herbert screw in fractures of the proximal
third (B3). A2 fractures can be treated conservatively. Early
diagnosis and operative treatment will shorten the time off
work, minimize the risk of nonunion, and reduce the costs of
health care in the long term. 相似文献
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Isolated fracture of the scaphoid with an associated anterosuperior dislocation of the proximal fragment is an extremely rare injury. We present two cases where open reduction and internal fixation through a palmar and dorsal approach was performed. No instances of non-union, necrosis of the proximal fragment of the scaphoid or scapholunate dissociation were noted during a mean follow-up period of 18 months. Clinical results (active motion, power grip, DASH) following such injury and intervention are presented. The aetiology of this rare injury is discussed. 相似文献
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