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

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.

10.29007/h9w1 ◽  
2018 ◽  
Author(s):  
Michael Chu-Kay Mak ◽  
Elvis Chun-Sing Chui ◽  
Wing-Lim Tse ◽  
Pak-Cheong Ho

IntroductionScaphoid non-union results the typical humpback deformity, pronation of the distal fragment, and a bone defect in the non-union site with shortening. Bone grafting, whether open or arthroscopic, relies on fluoroscopic and direct visual assessment of reduction. However, because of the bone defect and irregular geometry, it is difficult to determine the precise width of the bone gap and restore the original bone length, and to correct interfragmentary rotation. Correction of alignment can be performed by computer-assisted planning and intraoperative guidance. The use of computer navigation in guiding reduction in scaphoid non-unions and displaced fractures have not been reported.ObjectiveWe propose a method of anatomical reconstruction in scaphoid non-union by computer-assisted preoperative planning combined with intraoperative computer navigation. This could be done in conjunction with a minimally invasive, arthroscopic bone grafting technique.MethodsA model consisting of a scaphoid bone with a simulated fracture, a forearm model, and an attached patient tracker was used. 2 titanium K-wires were inserted into the distal scaphoid fragment. 3D images were acquired and matched to those from a computed tomography (CT) scan. In an image processing software, the non-union was reduced and pin tracts were planned into the proximal fragment. The K-wires were driven into the proximal fragment under computer navigation. Reduction was assessed by direct measurement.These steps were repeated in a cadaveric upper limb. A scaphoid fracture was created and a patient tracker was inserted into the radial shaft. A post-fixation CT was obtained to assess reduction.Results and DiscussionIn both models, satisfactory alignment was obtained. There were minimal displacement and articular stepping, and scaphoid length was restored with less than 1mm discrepancy. This study demonstrated that an accurate reduction of the scaphoid in non-unions and displaced fractures can be accurately performed using computed navigation and computer-assisted planning. It is the first report on the use of computer navigation in correction of alignment in the wrist.


Author(s):  
I. O. Golubev ◽  
R. V. Yulov ◽  
O. M. Bushuev ◽  
M. V. Merkulov ◽  
I. A. Kutepov ◽  
...  

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.


2014 ◽  
Vol 21 (3) ◽  
pp. 40-44
Author(s):  
I. O Golubev ◽  
R. V Yulov ◽  
O. M Bushuev ◽  
M. V Merkulov ◽  
I. A Kutepov ◽  
...  

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.


1995 ◽  
Vol 20 (4) ◽  
pp. 551-556 ◽  
Author(s):  
S. L. FILAN ◽  
T. J. HERBERT

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.


2018 ◽  
Vol 46 (1) ◽  
Author(s):  
Catarina Borges Cardoso ◽  
Sheila Canevese Rahal ◽  
Maria Jaqueline Mamprim ◽  
Hugo Salvador Oliveira ◽  
Alessandra Melchert ◽  
...  

Background: The avascular necrosis of the femoral head is a development disease caused by ischemic necrosis, which is mainly observed in young dogs. The etiology of the disease remains controversial. The diagnosis requires imaging exams such as MRI and radiographs. Thus, the aim of the current study was to retrospectively assess a population of dogs with avascular necrosis of the femoral head in order to feature the disease, as well as to analyze the radiographic appearance of the lesion at the moment of patient consultation.Materials, Methods & Results: The signalment factors of dogs (breed, gender, age and body mass), the affected hind limb, the radiographic appearance of the lesion, the clinical signs at the moment of patient consultation, the time of occurrence and the type of treatment were evaluated. The disease was radiographically classified according to the previously described items. Forty-three cases of avascular necrosis of the femoral head were identified, 97.67% presented lameness and pain during palpation of the hip joint; and 54.34%, were 1 week to 4 months old. Females represented 58.13% of the sample, and 65.11% of them weighed from 2.6 to 4.9 kg. Based on the radiographic classification, 4.34% were Grade 1; 32.60%, Grade 2; 8.69%, Grade 3; 19.56%, Grade 4; and 34.78%, Grade 5. The femoral head and neck ostectomy was performed in 42 hind limbs (91.30%); 42.85% of the dogs reached total functional recovery and 26.19% required physiotherapy and rehabilitation.Discussion: The present sample was composed of 25 dogs, which were 6-to-11-month old at the moment of patient consultation, but 17 dogs were 12-to-36-month old at this time; only one dog was older than 36 months. It may be associated with the non-recognition of clinical signs by the owners, rather than with the late-onset form of the disease. With respect to the breed, pinscher, Yorkshire, poodle, Lhasa apso, pug were most frequently observed. However, 7 dogs were crossbreed. Such group differed from that of a review involving 188 cases encompassing West Highland white terrier, Cairn terrier and poodle as the most commonly affected breeds. No sex predilection was found in a study comprising 188 cases, but in another study comprising 14 dogs, female predilection was observed. Likewise, the females represented 58.13% of cases in the present study; and 41.86% of the participants were male. The mean body mass of the dogs in the current study was 4.33 kg, which matches the small breed dogs, which are most affected by the disease. Clinical signs of non-weightbearing lameness or an intermittent subtle lameness are common in the avascular necrosis of the femoral head. Lameness of the affected hind limb was observed in 69.76% of the cases in the present study, but 2.32% showed no lameness. Occasionally, the avascular necrosis of the femoral head is bilaterally found in 12% to 16.5% of the cases. Only 3 out of the 43 cases assessed in the present study were bilateral. Since the lesions were more frequent in Grades 2 and 5, there is less chance of success through the conservative treatment. Thus, the femoral head and neck ostectomy was the surgical procedure performed in 42 hind limbs. The procedure is used to provide pain relief and to reduce the signs of lameness. In conclusion, the population assessed in the present study was composed of small size dogs, mean body mass 4.33 kg, no sex predilection, mostly presenting unilateral lesions and higher Grade 2 and Grade 5 radiographic lesion frequency.Keywords: radiographic, joint, canine, hip.


2020 ◽  
Vol 09 (02) ◽  
pp. 141-149
Author(s):  
Pooja Prabhakar ◽  
Lauren Wessel ◽  
Joseph Nguyen ◽  
Jeffrey Stepan ◽  
Michelle Carlson ◽  
...  

Abstract Background Nonunion after open reduction and internal fixation (ORIF) of scaphoid fractures is reported in 5 to 30% of cases; however, predictors of nonunion are not clearly defined. Objective The purpose of this study is to determine fracture characteristics and surgical factors which may influence progression to nonunion after scaphoid fracture ORIF. Patients and Methods We performed a retrospective case–control study of scaphoid fractures treated by early ORIF between 2003 and 2017. Inclusion criteria were surgical fixation within 6 months from date of injury and postoperative CT with minimum clinical follow-up of 6 months to evaluate healing. Forty-eight patients were included in this study. Nonunion cases were matched by age, sex, and fracture location to patients who progressed to fracture union in the 1:2 ratio. Results This series of 48 patients matched 16 nonunion cases with 32 cases that progressed to union. Fracture location was proximal pole in 15% (7/48) and waist in 85% (41/48). Multivariate regression demonstrated that shorter length of time from injury to initial ORIF and smaller percent of proximal fracture fragment volume were significantly associated with scaphoid nonunion after ORIF (63 vs. 27 days and 34 vs. 40%, respectively). Receiver operating curve analysis revealed that fracture volume below 38% and time from injury to surgery greater than 31 days were associated with nonunion. Conclusion Increased likelihood for nonunion was found when the fracture was treated greater than 31 days from injury and when fracture volume was less than 38% of the entire scaphoid. Level of Evidence This is a Level III, therapeutic study.


1985 ◽  
Vol 10 (3) ◽  
pp. 382-384
Author(s):  
P. TOFT ◽  
K. BERTHEUSSEN ◽  
S. OTKJAER

A case translunate, transmetacarpal, scapho-radial fracture with perilunate dislocation occurred as a young man drove his motorcycle into the side of a car. Closed reduction was performed initially. Open reduction was performed with a screw in the lunate. Eighteen months later the screw was removed and after two and a half years x-rays revealed no signs of avascular necrosis or arthrosis. The patient fully recovered. This case stresses the necessity of open reduction in cases of complicated carpal fracture dislocations.


2014 ◽  
Vol 4 (1) ◽  
pp. 3-7
Author(s):  
Selene G Parekh ◽  
Todd Bertrand ◽  
Robert Zura ◽  
Samuel Adams ◽  
Alan Yan

ABSTRACT Calcaneal tuberosity fractures comprise only 1 to 2% of all calcaneal fractures. Treatment of these injuries has traditionally included open reduction and internal fixation with various means including lag screws, suture anchors and K-wires. We report on a series of cases treated with excision of the tuberosity fragment with repair of the Achilles tendon supplemented by a flexor hallucis longus tendon transfer. Parekh S, Bertrand T, Zura R, Adams S, Yan A. Novel Techniques in Treating Calcaneal Tuberosity Fractures. The Duke Orthop J 2014;4(1):3-7.


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