Scaphoid Waist Nonunion in an 8-Year-Old: A Rare Occurrence

Case. Historically, the most common pattern of pediatric scaphoid injury described is at the distal pole, which has a high rate of success with nonoperative management. Injury patterns have evolved as children are more commonly presenting with adult-type fracture patterns. We present the case of a scaphoid waist fracture in an 8-year-old male that resulted in nonunion and required surgical fixation. Conclusion. This case highlights the trend of adult pattern scaphoid fractures in the pediatric population and the utility of magnetic resonance imaging in patients who do not have complete carpal bone ossification at the time of initial radiographic evaluation.

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Pediatric Scaphoid Nonunions: A Case Series, Review of the Literature, and Evidence-Based Guidelines

Journal of Wrist Surgery ◽

10.1055/s-0039-3401035 ◽

2019 ◽

Vol 09 (01) ◽

pp. 002-012 ◽

Cited By ~ 1

Author(s):

Kerstin Oestreich ◽

Tatiana Umata Yoko Jacomel ◽

Sami Hassan ◽

Maxim David Horwitz ◽

Tommy Roger Lindau

Keyword(s):

Nonoperative Management ◽

Pediatric Population ◽

Scaphoid Fracture ◽

Case Series ◽

Fracture Site ◽

X Rays ◽

Review Of The Literature ◽

Level Of Evidence ◽

Scaphoid Fractures ◽

Magnetic Resonance Imaging Mri

Abstract Background Scaphoid fractures represent less than 3% of hand and wrist fractures in the pediatric population. Nonunions are very rare. We present a case series (n = 18) of nonunions in skeletally immature children and adolescents. We further present a review of the literature on pediatric scaphoid nonunions. Materials and Methods We reviewed the literature by searching the main databases on pediatric scaphoid nonunions, but to identify factors that lead to nonunion, we also searched for databases on scaphoid fractures. Seventy articles were found for the period between 1961 and 2019, all with level 4/5 evidence. Results The nonunion rate of pediatric scaphoid fractures in the literature is on average 1.5%, occurring mostly as a result of missed or underdiagnosed injuries, similar to our presented case series. Half (n = 9) of the injuries in our case series were missed initial injuries, leading to scaphoid nonunions and half developed nonunions after initial treatment. We found excellent outcomes and with surgical and nonoperative management, with few complications. Not surprisingly, the duration of immobilization is longer with nonoperative management. Conclusions Based on the literature, we recommend a period of nonoperative management before surgery in undisplaced nonunions. In displaced nonunions, open reduction and internal fixation ± bone grafting is necessary. In pediatric scaphoid fractures, similar to adult cases, we identified that suspicious scaphoid fractures should be considered for initial immobilization, and repeat X-rays and early magnetic resonance imaging (MRI) or computed tomography (CT) scans should be considered at follow-up. Immobilization time and type of plaster should be appropriate in relation to the fracture site, similar to the adult scaphoid fracture. Level of Evidence This is a Level IV study.

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Importance of Computed Tomography in Determining Displacement in Scaphoid Fractures

Journal of Wrist Surgery ◽

10.1055/s-0037-1604136 ◽

2017 ◽

Vol 07 (01) ◽

pp. 038-042 ◽

Cited By ~ 1

Author(s):

Emily Gilley ◽

Sameer Puri ◽

Krystle Hearns ◽

Andrew Weiland ◽

Michelle Carlson

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Interobserver Reliability ◽

Scaphoid Fracture ◽

High Rate ◽

Radiographic Evaluation ◽

Angular Deformity ◽

Level Of Evidence ◽

Scaphoid Fractures ◽

The Mean

Background Displaced scaphoid fractures have a relatively high rate of nonunion. Detection of displacement is vital in limiting the risk of nonunion when treating scaphoid fractures. Questions/Purpose We evaluated the ability to diagnose displacement on radiographs and computed tomography (CT), hypothesizing that displacement is underestimated in assessing scaphoid fracture by radiograph compared with CT. Materials and Methods Thirty-five preoperative radiographs and CT scans of acute scaphoid fractures were evaluated by two blinded observers. Displacement and angular deformity were measured, and the fracture was judged as displaced or nondisplaced. Scapholunate, radiolunate, and intrascaphoid angles were measured. Radiograph and CT measurements between nondisplaced and displaced fractures were compared. Intraobserver reliability was measured. Results Reader 1 identified 12 fractures as nondisplaced on radiograph, but displaced on CT (34%). Reader 2 identified 9 fractures as nondisplaced on radiograph, but displaced on CT (26%). For displaced fractures, the mean intrascaphoid angle was over three times greater when measured on CT than on radiograph (56 vs. 16 degrees). Scapholunate angle >65 degrees and radiolunate angle >16 degrees were significantly associated with displacement on CT. Interobserver reliability for diagnosing displacement was perfect on CT but less reliable on radiograph. Conclusion Scaphoid fracture displacement on CT was identified in 26 to 34% of fractures that were nondisplaced on radiograph, confirming that radiographic evaluation alone underestimates displacement. These results underscore the importance of CT scan in determining displacement and angular deformity when evaluating scaphoid fractures, as it may alter the decision on treatment and surgical approach to the fracture. We recommend considering CT scan to evaluate all scaphoid fractures. Level of Evidence Level III.

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Clinical and Radiologic Outcomes of the Matti-Russe Technique for Scaphoid Nonunions in Pediatric Patients

Hand ◽

10.1177/1558944718797340 ◽

2018 ◽

Vol 14 (1) ◽

pp. 73-79

Author(s):

Irshad Shakir ◽

Ugochi C. Okoroafor ◽

Joao Panattoni

Keyword(s):

Internal Fixation ◽

Pediatric Population ◽

Radiographic Evaluation ◽

Dash Score ◽

Scaphoid Nonunion ◽

Scaphoid Fractures ◽

Outcomes Measures ◽

Classic Technique

Background: Scaphoid fractures are a common injury, and a known complication is nonunion. One option to treat this nonunion is with the Matti-Russe technique, which takes a corticocancellous graft and fits it into the defect without internal fixation. The advent of modern methods of fixation has led the classic Matti-Russe technique to fall out of favor. In this study, we describe the classic technique and evaluate the results of the Matti-Russe method for treatment of scaphoid nonunions specifically for the pediatric population. Our purpose was to evaluate the long-term clinical and radiologic outcomes after surgery for scaphoid nonunion using the Matti-Russe technique in the pediatric population. Methods: A retrospective review was performed of patients less than 17 years of age, with a scaphoid nonunion that was treated with the Matti-Russe technique. This technique consisted of open reduction with intercalated bone graft and no internal fixation with hardware. Union was determined by radiographic evaluation. Computed tomography was obtained in 7 of 10 patients in this series and showed bony bridging in more than 50% of the scaphoid width in 3 different views. Intrascaphoid, scapholunate, and radiolunate angles were calculated. We reviewed wrist range of motion and complications. We obtained postoperative Mayo and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Results: There were 10 patients who underwent the Matti-Russe technique. The average age was 14.7 years old (±1.34, range: 13-17). All 10 of these patients had a scaphoid waist nonunion. There were 9 males and 1 female with an average follow-up of 13 months. The average amount of time to surgery from the date of injury was 12.3 months. All 10 patients went on to radiographic union at or before 6 months from surgery. Preoperative intrascaphoid, scapholunate, and radiolunate angles were 29° (±5.38), 62° (±18.28), and 20° (±9.22). Postoperative intrascaphoid, scapholunate, and radiolunate angles improved to 16° (±6.89), 38° (±8.50), and 10° (±4.69), which was significant. Seven out of 10 patients completed postoperative outcomes measures. The average postoperative Mayo wrist score was 87.9 (±14.10, range: 60-100). The average postoperative DASH score was 1.9 (±2.03, range: 0-4.5). There were no associated complications nor reoperations. Conclusion: The Matti-Russe technique is a safe and effective treatment for scaphoid nonunion in the pediatric population. It facilitates scaphoid union without the need for screw fixation and avoiding potential complications with hardware.

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Spontaneous Healing of a Pediatric Scaphoid Proximal Pole Fracture Nonunion

Journal of Wrist Surgery ◽

10.1055/s-0037-1602799 ◽

2017 ◽

Vol 07 (01) ◽

pp. 081-083

Author(s):

Nicholas Riley ◽

Ian McNab ◽

Neal Rupani

Keyword(s):

Nonoperative Management ◽

Pediatric Population ◽

Scaphoid Fracture ◽

Fracture Pattern ◽

Proximal Pole ◽

Unique Case ◽

Scaphoid Fractures ◽

Fractures In Children ◽

Increased Risk ◽

Fracture Nonunion

Background Scaphoid fractures in the pediatric population are rare. The majority of nondisplaced fractures tend to unite; however, there is an increased risk of nonunion in proximal pole fractures. Limited evidence exists in their outcomes, owing to the scarcity of the fracture pattern. Case Description A 13-year-old boy who presented late after developing a traumatic proximal pole scaphoid fracture developed nonunion. He was treated conservatively owing to it being asymptomatic and developed union at 18 months. Literature Review No previous case of proximal pole pediatric scaphoid fractures with established nonunion that has developed union with conservative management has been described. Clinical Relevance The authors highlight a unique case of an established proximal pole scaphoid nonunion in a child progressing to union with nonoperative intervention. Owing to its rarity and difficulty in obtaining research, we recommend consideration of nonoperative management of asymptomatic nondisplaced proximal pole fractures in children.

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Outcomes of Local Bone Graft and Fixation of Proximal Pole Scaphoid Nascent Nonunions and Nonunions

Journal of Wrist Surgery ◽

10.1055/s-0040-1701512 ◽

2020 ◽

Vol 09 (03) ◽

pp. 203-208

Author(s):

Kristin E. Shoji ◽

F. Joseph Simeone ◽

Sezai Ozkan ◽

Chaitanya S. Mudgal

Keyword(s):

Bone Graft ◽

Common Mechanism ◽

Study Cohort ◽

Proximal Pole ◽

Scaphoid Fractures ◽

Local Bone ◽

Case Series Study ◽

Increased Risk ◽

Surgical Fixation ◽

The Mean

Abstract Background Fractures of the proximal pole of the scaphoid have an increased risk of nonunion due to its tenuous blood supply. The optimal treatment of proximal pole scaphoid nonunions remains controversial. Objectives To review a single surgeon's experience with proximal pole scaphoid nascent nonunions (delayed unions) and nonunions that underwent surgical fixation with a cannulated headless compression screw and local autologous bone graft from the distal radius. Patients and Methods After obtaining Institutional Review Board approval, the electronic medical record of one tertiary care center was queried for patients with the diagnosis of “proximal pole scaphoid fractures” who underwent surgical fixation by a single surgeon over an 11-year period (2006–2017). Fifteen patients met initial query criteria; upon review of records, four patients were excluded due to the acute nature of the fracture, and one was excluded as surgical fixation included a vascularized bone graft. Results The final study cohort consisted of 10 patients with a total of 10 proximal pole scaphoid nonunions. Almost all of the patients in this study were male (9/10 [90%]), and sporting activities were the most common mechanism of injury (8/10 [80%]). Volumetric measurements of the scaphoid fractures on computed tomography (CT) revealed that the mean total volume of the scaphoid was 2.4 ± 0.48 cm3 and the mean volume of the proximal pole fragment was 0.38 ± 0.15 cm3. Postoperative CT scans were performed at a mean of 12.4 weeks (range: 8–16 weeks), with seven (7/10 [70%]) showing signs of complete union and three (3/10 [30%]) demonstrating partial union. None of the patients required additional procedures and there were no complications. Conclusions Our results suggest that proximal pole scaphoid fractures with delayed union and nonunion treated with surgical fixation and autologous local bone graft heal without the need for more complex vascularized procedures. The volume of the proximal pole fragment did not correlate with increased risk of ongoing nonunion after the index procedure. Level of Evidence This is a Level IV, case series study.

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Limited Bilateral Advancement of the Sternocostal Head of Pectoralis Major for Sternal Reconstruction: Preserving the Axillary Fold

International Surgery ◽

10.9738/intsurg-d-15-00029.1 ◽

2017 ◽

Vol 102 (3-4) ◽

pp. 189-195

Author(s):

Warren M. Rozen ◽

Ken G. W. Teo ◽

Gausihi Sivarajah ◽

Rafael Acosta

Keyword(s):

Pectoralis Major ◽

High Rate ◽

Pectoralis Major Flap ◽

Limited Sample ◽

Wound Coverage ◽

Caudal Portion ◽

Sternal Reconstruction ◽

The Right ◽

Good Cosmesis ◽

Rate Of Success

The introduction of well-vascularized flaps for infected sternotomy wound reconstruction has improved mortality rates dramatically. Multiple variations of the pectoralis major flap have been described in this context. However, unresolved limitations of this flap include poor cosmesis and problematic coverage of the inferior third of the sternotomy wound. We describe an approach to address these issues. The humeral attachments are preserved and bilateral muscles are advanced in a limited fashion. The left sternocostal head is advanced medially and rotated anticlockwise, using this portion to fill the upper half of the sternum while the caudal portion of the right pectoralis muscle is used as a turnover flap at the lower half of the wound. In all 25 patients, the anterior axillary fold was preserved bilaterally and the infection completely resolved. Complications included 3 cases of hematoma, 2 cases of coagulopathy, and 1 late bone sequestrum (aseptic). Although the study had a limited sample size, we had a high rate of success and few complications. With the preservation of bilateral axillary folds, good cosmesis, and adequate wound coverage, we recommend this modification of the pectoralis major flap in even complicated cases of mediastinitis.

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Radiographic evaluation of sclerosis of the third carpal bone associated with exercise and the development of lameness in Standardbred racehorses

Equine Veterinary Journal ◽

10.2746/0425164044868341 ◽

2010 ◽

Vol 36 (5) ◽

pp. 441-446 ◽

Cited By ~ 23

Author(s):

B. J. HOPPER ◽

C. STEEL ◽

J. L. RICHARDSON ◽

G. R. ALEXANDER ◽

I. D. ROBERTSON

Keyword(s):

Carpal Bone ◽

Radiographic Evaluation ◽

The Third ◽

Standardbred Racehorses

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Effects of 12-week treatment with Sovodak in patients infected by genotype 1 hepatitis C virus

Journal of Analytical Research in Clinical Medicine ◽

10.15171/jarcm.2019.001 ◽

2019 ◽

Vol 7 (1) ◽

pp. 1-6

Author(s):

Hosein Mehdipour ◽

Yaghoub Moaddab ◽

Khalil Azizian ◽

Morteza Ghojazadeh ◽

Mohammad Hossein Somi

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

High Rate ◽

Genotype 1 ◽

Hcv Genotype ◽

Definitive Evidence ◽

Single Pill ◽

Treatment Naïve ◽

Hcv Genotype 1 ◽

Rate Of Success

Introduction: It has been shown that the combination therapy of Sofosbuvir-Daclatasvir (Sof/Dac) has a high rate of success in the treatment of patients. For the first time, a single pill of Sof/Dac has been formulated in Iran (Sovodak). In this regard, the present study was carried out aiming to investigate the safety and efficacy of Sovodak for 12 weeks during treatment of patients infected by genotype 1 hepatitis C virus (HCV). Methods: In this study, 50 patients (25 and 25 treatment-naïve and treatment-experienced patients, respectively) infected by HCV genotype 1 received Sovodak (1pill per day) for 12 weeks. Ribavirin was added for patients who had definitive evidence of liver cirrhosis. The sustained virological response (SVR12) was investigated 12 weeks after the end of the therapy. Results: All 50 patients completed the treatment period. The mean age of patients was 54.40 ± 11.69 years, in addition, 60% and 90% of the patients were male and infected by HCV genotype 1b, respectively. After 4 and 12 weeks of treatment with Sovodak, the HCV ribonucleic acid (RNA) titer was undetectable in 82% and 100 % of the patients, respectively and 100% of them achieved SVR12. None of the subjects reported treatment discontinuation because of adverse events, however, 3 patients reported transient side effects including foot swelling, headache, and vomiting. Conclusion: The results of this study showed that once-daily Sovodak single-pill for 12 weeks is an effective and safe medicine for treating patients infected by HCV genotype 1

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Moulded supportive seating for the disabled

Prosthetics and Orthotics International ◽

10.3109/03093647809146295 ◽

1978 ◽

Vol 2 (1) ◽

pp. 30-34 ◽

Cited By ~ 13

Author(s):

N. D. Ring ◽

R. L. Nelham ◽

F. A. Pearson

Keyword(s):

Physical Disability ◽

Pressure Control ◽

High Rate ◽

Good Position ◽

Vacuum Consolidation ◽

Functional Activities ◽

Plaster Of Paris ◽

The Disabled ◽

Maximum Comfort ◽

Rate Of Success

In severe cases of physical disability intimate supportive seating may be required to provide maximum comfort, a good position for functional activities, improved respiration, relief of localized pressure, control of spasm, protection, or improved management. A service for providing such seating has been developed at Chailey Heritage. The seat is vacuum-formed from thermoplastic materials, having a soft non-absorbent foam for the liner and a hard semi-rigid outer shell. A mould is obtained by casting the patient using the vacuum consolidation technique and by recording the resulting impression using plaster-of-Paris. Nearly 200 seats have been made using the technique with a high rate of success.

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Mechanisms of Injury Among the Amish Population in Central Pennsylvania

The American Surgeon ◽

10.1177/00031348211050592 ◽

2021 ◽

pp. 000313482110505

Author(s):

Larissa Whitney ◽

Kelly Bonneville ◽

Madison Morgan ◽

Lindsey L. Perea

Keyword(s):

Pediatric Population ◽

Traumatic Injury ◽

Age Groups ◽

Geographic Location ◽

Future Research ◽

Common Mechanism ◽

Trauma Patients ◽

Trauma Centers ◽

Injury Patterns ◽

Level Of Evidence

Background Individuals presenting with traumatic injury in rural populations have significantly different injury patterns than those in urban environments. With an increasing Amish population, totaling over 33 000 in our catchment area, their unique way of life poses additional factors for injury. This study aims to evaluate differences in mechanism of injury, location of injury, and demographic patterns within the Amish population. We hypothesize that there will be an increased incidence of agriculture-related mechanisms of injury. Methods All Amish trauma patients presenting to our level I trauma center over 20 years (1/2000-4/2020) were retrospectively analyzed. Mechanism and geographic location of injury were collected. Demographic and clinical variables were compared between the age groups. Results There were 1740 patients included in the study with 36.4% (n = 634) ≤ 14 years. Only 10% (n = 174) were ≥ 65 years. The most common mechanism across all ages was falls. However, when separating out the pediatric population ( ≤ 14 years), 27.8% (n = 60) fell from a height on average > 8-10 feet. The most common geographic location of injury was at home in all age groups, except for the 15-24 year group, which was roadways. Discussion The Amish population poses a unique set of mechanisms of injury and thus injury patterns to rural trauma centers. We have found the most common injuries to be falls, buggy accidents, animal-related injuries, and farming accidents across all age groups. Future research and collaboration with other rural trauma centers treating large Amish populations would be beneficial to maximize injury prevention in this population. Level of Evidence Level 3a, epidemiological.

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