Avascular Necrosis of the Capitate and Dorsal Dorsi-Flexion Instability

HAND ◽  
1980 ◽  
Vol os-12 (2) ◽  
pp. 176-178 ◽  
Author(s):  
John H. Newman ◽  
Iain Watt
Keyword(s):  
Avascular Necrosis ◽  
Scaphoid Fracture ◽  
Proximal Part ◽  
Ligamentous Laxity

Avascular necrosis of the proximal part of the capitate is very rare and usually is secondary to a fracture of the waist in association with a scaphoid fracture — the naviculocapitate syndrome. A case is presented in which partial avascular necrosis of the capitate occurred in association with bilateral dorsal dorsi-flexion instability. The authors suggest that this phenomenon represents a form of the naviculocapitate syndrome in which ligamentous laxity altered the line of failure, thus sparing the scaphoid from fracture.

Avascular Necrosis of the Proximal Scaphoid after Fracture Union

1995 ◽  
Vol 20 (4) ◽  
pp. 551-556 ◽  
Author(s):  
S. L. FILAN ◽  
T. J. HERBERT
Keyword(s):  
Femoral Neck ◽  
Avascular Necrosis ◽  
Scaphoid Fracture ◽  
Proximal Part ◽  
Femoral Neck Fractures ◽  
The Other ◽  
Fracture Union ◽  
Scaphoid Fractures ◽  
Both Bones ◽  
Plaster Immobilization

We report four cases of late avascular necrosis (AVN) of the proximal part of the scaphoid following apparent healing of acute scaphoid fractures. One patient had been treated conservatively, by plaster immobilization, and the other three had undergone internal fixation of their acute fractures. The onset of symptoms associated with AVN varied, being as late as 2 years in one patient. Late AVN following healing of a scaphoid fracture does not appear to have been previously recognized, perhaps due to the fact that patients are seldom followed up for long enough. We feel that this condition is in many ways analogous to late AVN following femoral neck fractures and as such is a special complication related to the fact that both bones are intracapsular and have a precarious blood supply.

Scaphoid Fracture and Avascular Necrosis

2017 ◽  
pp. 129-133
Author(s):  
Trishla Reddy Kanthala ◽  
Anup H. Patel ◽  
Lyn Weiss
Keyword(s):  
Avascular Necrosis ◽  
Scaphoid Fracture

scholarly journals Avascular necrosis of both poles of a paediatric waist of scaphoid fracture

Injury Extra ◽  
2007 ◽  
Vol 38 (8) ◽  
pp. 247-249 ◽  
Author(s):  
Shehzad Iqbal ◽  
Gordon Higgins ◽  
P. Ratcliffe
Keyword(s):  
Avascular Necrosis ◽  
Scaphoid Fracture

scholarly journals Vascularized Bone Autoplasty with Graft from Medial Femoral Epicondyle in Scaphoid Pseudarthrosis

2014 ◽  
pp. 40-44 ◽  
Author(s):  
I. O. Golubev ◽  
R. V. Yulov ◽  
O. M. Bushuev ◽  
M. V. Merkulov ◽  
I. A. Kutepov ◽  
...  
Keyword(s):  
Avascular Necrosis ◽  
Scaphoid Fracture ◽  
Proximal Fragment ◽  
Average Force ◽  
Angle Correction ◽  
One Year ◽  
Dorsal Intercalated Segment Instability ◽  
Bone Autograft ◽  
Scaphoid Pseudarthrosis ◽  
Vascularized Bone

Nineteen patients (16 - 49 years) with scaphoid pseudarthrosis were treated using vascularized bone autograft from medial femoral epicondyle. Mean term since scaphoid fracture made up 30.5 ± 21.2 months. In all cases avascular necrosis of the proximal fragment, scaphoid humpbach deformity and dorsal intercalated segment instability (DISI) were present. In 16 (84.2%) consolidation in the zone of scaphoid pseudarthrosis was achieved at terms from 8 to 12 weeks after operation. In 3 (15.8%) unsatisfactory results were observed. Average scapholunate angle correction made up 13°. Average force of feast and pinch grasps increased on the average by 2.5 and 1.5 times, respectively. One year after surgery the average estimation by DASH scale decreased by 9.6 points at average, from 27 to 13.4 points.

scholarly journals Transosseous Suture Fixation of True 4-part Valgus Impacted Fractures of the Proximal Humerus: Clinical and Radiological Outcome in 49 Patients

2018 ◽  
Vol 12 (1) ◽  
pp. 41-52
Author(s):  
Andreas Panagopoulos ◽  
Irini Tatani ◽  
Seferlis Yannis ◽  
Bavelou Aikaterini ◽  
Antonis Kouzelis ◽  
...  
Keyword(s):  
Avascular Necrosis ◽  
Humeral Head ◽  
Proximal Humerus ◽  
Constant Score ◽  
Reverse Shoulder Arthroplasty ◽  
Proximal Part ◽  
Shoulder Function ◽  
Functional Score ◽  
Invasive Technique

Background: The valgus-impacted (VI) 4-part fractures are a subset of fractures of the proximal humerus with a unique anatomic configuration characterized by a relatively lower incidence of avascular necrosis after operative intervention. Objectives: The present study reports the midterm clinical and radiological results of a large series of consecutive patients with 4-part VI fractures treated with a minimal invasive technique of internal fixation. Methods: Over a ten-year period (2004-2014), we treated 56 patients with a true 4-part valgus impacted fracture of the proximal part of the humerus. Four patients were lost to follow-up and three died, leaving 49 patients (33 female, 16 males, average age 60,1 years) available for the study. Fracture fixation was achieved through the lateral transdeltoid approach with transosseous suturing of the tuberosities to each other, to the metaphysis and to the articular part of the humeral head avoiding gross disimpaction of the humeral head from the valgus position. Functional outcome assessment was performed using the parameters of the Constant-Murley score within a mean follow up period of 43,8 months (range, 24 to 115 months). Results: All fractures were united within the first 3 months except one that showed late displacement and finally nonunion. The median Constant score was 81,7 points and the functional score in comparison with the unaffected shoulder was 86.2%. There were three patients with total Avascular Necrosis (AVN) of the head revised to hemiarthroplasty. The nonunion case was revised to reverse shoulder arthroplasty 12 months after surgery. In five cases, absorption of the greater tuberosity was noted in the last radiographic control without any serious consequences to the shoulder function. Conclusion: Advantages of this minimally invasive technique can be summarized as shorter operative time, no use of hardware, minimal soft tissue damage, low incidence of avascular necrosis, stable osteosynthesis with “tension band effect” and adequate rotator cuff repair allowing for early joint motion.

scholarly journals Vascularized Bone Autoplasty with Graft from Medial Femoral Epicondyle in Scaphoid Pseudarthrosis

2014 ◽  
Vol 21 (3) ◽  
pp. 40-44
Author(s):  
I. O Golubev ◽  
R. V Yulov ◽  
O. M Bushuev ◽  
M. V Merkulov ◽  
I. A Kutepov ◽  
...  
Keyword(s):  
Avascular Necrosis ◽  
Scaphoid Fracture ◽  
Proximal Fragment ◽  
Average Force ◽  
Angle Correction ◽  
One Year ◽  
Dorsal Intercalated Segment Instability ◽  
Bone Autograft ◽  
Scaphoid Pseudarthrosis ◽  
Vascularized Bone

Nineteen patients (16 - 49 years) with scaphoid pseudarthrosis were treated using vascularized bone autograft from medial femoral epicondyle. Mean term since scaphoid fracture made up 30.5 ± 21.2 months. In all cases avascular necrosis of the proximal fragment, scaphoid humpbach deformity and dorsal intercalated segment instability (DISI) were present. In 16 (84.2%) consolidation in the zone of scaphoid pseudarthrosis was achieved at terms from 8 to 12 weeks after operation. In 3 (15.8%) unsatisfactory results were observed. Average scapholunate angle correction made up 13°. Average force of feast and pinch grasps increased on the average by 2.5 and 1.5 times, respectively. One year after surgery the average estimation by DASH scale decreased by 9.6 points at average, from 27 to 13.4 points.

scholarly journals Scaphocapitate fracture syndrome in a child

2021 ◽  
Vol 9 (4) ◽  
pp. 471-476
Author(s):  
Patrícia Wircker ◽  
Teresa Alves da Silva ◽  
Rafael Dias
Keyword(s):  
Avascular Necrosis ◽  
Open Reduction ◽  
Soft Tissues ◽  
Scaphoid Fracture ◽  
Proximal Fragment ◽  
Radiographic Appearance ◽  
Manual Pressure ◽  
Both Bones ◽  
K Wires ◽  
Scaphocapitate Fracture Syndrome

BACKGROUND: Scaphocapitate fracture syndrome involves transverse fracture of the scaphoid and capitate, with rotation of 90 or 180 of the proximal fragment of the capitate, commonly associated with other carpal lesions. It is a rare wrist injury, usually occurs in young men and is exceptional in children. The exact mechanism remains controversial. The injury is often misdiagnosed as a simple scaphoid fracture and there has been a controversy about the treatment of the capitate fracture in this syndrome. CLINICAL CASE: The authors report a rare case of a scaphocapitate syndrome in a 15-year-old boy. Early open reduction of both fractures was performed. It was obtained a good mobility, with a normal grip strength and the radiographs showed union of both bones without avascular necrosis. DISCUSSION: Most authors agree that regardless of the radiographic appearance of the injury, open reduction and internal fixation is the treatment of choice. The dorsal approach is the most used. The capitate fragment is usually devoid of any soft tissues and is reduced relatively easy with manual pressure, by applying traction to the hand. Reduction and fixation of the capitate must precede that of the scaphoid. K-wires or headless screws may be placed from the proximal to the distal side for the fixation of the scaphoid and capitate. The evolution is marked by the risk of occurrence of head capitate avascular necrosis CONCLUSIONS: This case report illustrates that the scaphocapitate syndrome can occur in children and is important an early diagnosis to initiate timely treatment. Our patient was successfully treated with open reduction and fixation using K-wires.

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