Fracture Fixation ; Fractures, Bone ; surgery ; Humans ; Scaphoid Bone ; injuries ; surgery ; Wrist Injuries ; surgery

OBJECTIVETo evaluate the clinical and radiological outcome of anterior vascularized bone graft in the treatment of primitive nonunion of the scaphoid.

METHODSThis is a retrospective study of 26 scaphoid nonunion cases treated by this technique between 2004 and 2009. The mean age was 38 years. Nonunion was of types IIA and IIB according to the Alnot's classification and only one case showed a proximal pole necrosis (type IV). The fixation was ensured by K-wire. The mean immobilization period was 9 weeks.

RESULTSAt mean 19 months follow-up, the bone union rate was 88.5%. Failure was noted in three cases. No significant complications secondary to this technique were observed. The mobility in extension and flexion had an average recovery of 18 degree Nineteen patients (73%) were free of pain, and the others had occasional pain.

CONCLUSIONSIt is a meticulous surgical technique that provides better union rates than those of conventional scaphoid graft. This technique is first adopted in cases of failure of conventional grafts in the treatment of scaphoid nonunion but the encouraging results suggest expanding indications to primitive nonunion.

Bone Transplantation ; Bone Wires ; Fractures, Ununited ; surgery ; Humans ; Retrospective Studies ; Scaphoid Bone

Adult ; Fracture Fixation, Internal ; Fractures, Ununited ; surgery ; Humans ; Male ; Scaphoid Bone ; injuries ; surgery

Adult ; Fracture Fixation, Internal ; Humans ; Joint Dislocations ; surgery ; Male ; Scaphoid Bone ; injuries ; surgery

Scaphoid stress fracture is rare and occurs mainly in gymnasts. The current literature has only two reported cases: unilateral scaphoid stress fracture in a platform diver and bilateral scaphoid stress fracture in a gymnast. We herein report bilateral stress fracture of the scaphoid in a platform diver who presented with only one symptomatic side. Our patient was a 16-year-old competitive platform diver with an 18-month history of pain in the right wrist. Radiography revealed fracture of the right scaphoid at the waist. As part of our preoperative plan of measuring the scaphoid length to determine the appropriate screw, radiography of the contralateral side was performed, revealing an unexpected fracture of the left scaphoid. Due to the frequency of stress fractures in competitive sports, especially gymnastics, we recommend that bilateral scaphoid radiography be performed for athletes presenting with a unilateral scaphoid fracture, to avoid missing a fracture in the contralateral side.
Adolescent ; Diving ; injuries ; Fractures, Stress ; diagnostic imaging ; surgery ; Humans ; Male ; Radiography ; Scaphoid Bone ; injuries ; surgery

Fracture Fixation ; instrumentation ; methods ; Fractures, Bone ; surgery ; Humans ; Scaphoid Bone ; injuries ; surgery ; Wrist Injuries ; surgery ; Wrist Joint ; surgery

Adult ; Bone Screws ; Female ; Fracture Fixation, Internal ; instrumentation ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Scaphoid Bone ; injuries ; surgery ; Wrist Injuries ; surgery ; Young Adult

OBJECTIVETo investigate application of the bone flap pedicled on the retrograde branch of radial artery for treatment of old scaphoid bone fractures of type AO-B.

METHODSFrom October 2007 to October 2011,41 patients with old scaphoid bone fractures of type AO-B were treated by transplantation of the bone flap pedicled on the retrograde branch of radial artery including 26 males and 15 females with an average of (27.3±4.5) years old ranging from 16 to 43 years old. The courses before operation ranged from 6 to 22 months with an average of 11 months. All fractures belonged to the type B of AO classification, that is old wrist fracture of scaphoid bone. All patients' wrist function (pain, function, motion, grip strength) were evaluated by Cooney's modifiedwrist scoring system before and 6 months after operation,and the conditions of bone healing were observed during the follow-up time.

RESULTSAmong them, 36 patients were followed up from 4 to 15 months with an average of 8.3 months. The wounds were healed well without other complications as infection appearing. X-rays or CT confirmed that all fractures were healed completely. The Cooney wrist score was improved from preoperative 53.61±13.97 to postoperative 81.81±8.71 (P<0.01).

CONCLUSIONThe operation of transplantation of the bone flap pedicled on the retrograde branch of radial artery is an effective method to treat old scaphoid bone fractures,which is scientific and has curative effects, and valuable for clinical application.

Adolescent ; Adult ; Female ; Fractures, Bone ; surgery ; Humans ; Male ; Radial Artery ; injuries ; surgery ; Scaphoid Bone ; blood supply ; injuries ; surgery ; Surgical Flaps ; Wrist Injuries ; surgery ; Young Adult

OBJECTIVETo investigate the clinical efficacy of radial artery recurrent branch of the styloid process bone flap transfer for treatment of scaphoid nonunion.

METHODSFrom 2002 to 2007, 18 patients with scaphoid nonunion included 12 males and 16 females with an average age of 31.2 years old ranging from l8 to 51 years. Time from injury to operation was 8 to 26 months (averaged 12.5 months). Radial bone flap blood supply by radial artery recurrent branch of styloid process was embedded in retrograde scaphoid shift distance at both ends, Kirschner wire fixed on the bone flap and bone fractures, and the radial styloid process was resected. Cast gypsum immobilization in a neutral place of wrist were performed for 6 to 8 weeks, the rehabilitation of physical therapy and functional exercise were performed after removal. Kirschner wire were removed after X-ray showed fracture healing.

RESULTSAmong them, 15 cases were followed-up for from 8 to 25 months (means 13 months). All fractures healed. The healing time was 8 to 12 weeks. According to adult forearm fracture evaluation of Anderson the results were excellent in 14 cases, good in 1.

CONCLUSIONThe radial artery recurrent branch of styloid process bone flap has a wealth of blood circulation, can make free grafting of the creeping substitution process directly into the healing process.

Adolescent ; Adult ; Bone Transplantation ; methods ; Female ; Fracture Healing ; Fractures, Ununited ; surgery ; Humans ; Male ; Middle Aged ; Radial Artery ; Scaphoid Bone ; injuries ; surgery ; Surgical Flaps ; Temporal Bone

OBJECTIVETo discuss operative methods and effects for Müller-Weiss disease.

METHODSFrom March 2005 to May 2011, 15 patients were operated. There were 2 males and 13 females, with an average age of 51.8 years (range, 26 to 62 years). The preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was (42 ± 13) points. According to the Maceira Staging system, 1 foot was grade 2, 6 feet were grade 3, 4 feet were grade 4, and 4 feet were grade 5. The technique consisted of arthrodesis of the talonaviculocuneiform joints with plate, arthrodesis of the talonavicular joint and arthrorisis of naviculocuneiform joint with plate, or triple arthrodesis with screws, according to the preoperative evaluation.

RESULTSTen feet were treated with arthrodesis of the talonaviculocuneiform joints, 3 feet were treated with arthrodesis of the talonavicular joint and arthrorisis of naviculocuneiform joint and 2 feet were treated with triple arthrodesis. Two patients were lost to follow-up. The average follow-up after operation was 19.2 months (range, 9 to 38 months). All feet were solid fusion and the average duration of union was 13.3 weeks (range, 12-16 weeks). The AOFAS ankle-hindfoot score at the last follow-up was (83 ± 6) points. Two feet were excellent, 10 feet were good, and 1 foot was fair. The length of feet was (14.2 ± 1.0) cm before surgery and (15.7 ± 0.9) cm at the last follow-up (t = 11.570, P < 0.05). The Meary's angle was -6.1° ± 13.1°before surgery and 1.1° ± 3.0° at the last follow-up (t = 2.248, P < 0.05). The talocalcaneal angle was 4.5° ± 2.2° before surgery and 18.0° ± 4.0° at the last follow-up (t = 11.700, P < 0.05). One foot had breakage of the plate and screws at arthrorisis of naviculocuneiform joint and none had complications related to the incision.

CONCLUSIONOperations for Müller-Weiss disease, according to concrete conditions using different therapeutic program, may achieve a satisfactory outcome.

Adult ; Arthrodesis ; methods ; Bone Nails ; Bone Plates ; Female ; Follow-Up Studies ; Foot Diseases ; surgery ; Humans ; Male ; Middle Aged ; Scaphoid Bone ; surgery ; Treatment Outcome