Established non-union of an operatively managed trans-scaphoid perilunate fracture dislocation progressing to spontaneous union

Divecha, Hiren; Clarke, Jon; Barnes, Steven J.

doi:10.1007/s10195-011-0143-1

Cited by 4 publications

(4 citation statements)

References 8 publications

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“…Only limited case reports and case series of late spontaneous union of established pediatric scaphoid nonunion have been described. [5][6][7] However, these reports are isolated to waist and distal pole nonunions. Clarke et al and Manak et al have described cases of a 14-year-old and 11-yearold boys, both with a scaphoid waist nonunion that progressed to union at around 2 years following injury.…”

Section: Discussionmentioning

confidence: 95%

Spontaneous Healing of a Pediatric Scaphoid Proximal Pole Fracture Nonunion

2017

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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. 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. No previous case of proximal pole pediatric scaphoid fractures with established nonunion that has developed union with conservative management has been described. 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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Section: Discussionmentioning

confidence: 95%

Spontaneous Healing of a Pediatric Scaphoid Proximal Pole Fracture Nonunion

2017

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“…As already mentioned, it is difficult to diagnose the scaphoid fractures with plain radiographs and different studies have cited the sensitivity of plain radiography after injury 59 to 79 percent which is relatively low ( 13 , 19 , 20 ). MRI is a gold standard for the diagnosis of this type of fracture, but its cost is relatively high ( 19 , 21 , 22 , 23 , 24 , 25 ). Therefore, it is felt the need for other ways with less cost and in order to eliminate additional costs, such as immobilization, referring to the clinic, delayed radiographic examinations, patients’ downtime after casting.…”

Section: Discussionmentioning

confidence: 99%

The Accuracy of Pain Measurement in Diagnosis of Scaphoid Bone Fractures in Patients with Magnetic Resonance Imaging: Report of 175 Cases

Sharifi

Zakeri

et al. 2015

Med Arh

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Introduction:Scaphoid fracture is the most common fracture among the bones of the wrist. Plain radiography has a sensitivity of 59 to 79 percent for the diagnosis of scaphoid fracture after injury. Casting is done to avoid complications in patients with suspected fractures with normal radiography. Magnetic resonance imaging (MRI) has a sensitivity of 100% and a specificity of 99%. To avoid unnecessary casting and high costs, we decided to offer a way more efficient than radiography and less costly than MRI.Material and Methods:In the present study, 175 patients with suspected scaphoid fracture along with snuff box tenderness and normal radiography were enrolled in the study. On arrival, patients’ pain score were determined using visual analog scale method with anatomical snuffbox tenderness and then MRI was performed on the patients’ wrist and the results were recorded for patient in the check list. The data was then aggregated and analyzed.Results:The result of MRI for fracture was negative for 90.9% and positive for 9.1%. The mean pain score was 7.3 in negative MRI group and 8.75 in positive MRI group, considering a significant difference. ROC curve graph showed that the sensitivity and specificity will be 87% and 57%, respectively for scores 7.5 and higher and 75% and 72%, respectively for scores 8.5 and higher.Conclusion:It seems that although this method, beside other criteria in the diagnosis of fractures, can be useful in future studies, it would not be helpful in fracture detection.

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“…Prior studies identified nonunion of the scaphoid as the primary reason for reoperation. 11,12 It seems that, with current techniques and implants, scaphoid nonunion meriting additional surgery is uncommon. Among the factors associated with poor outcome in prior studies of PLDs (e.g., open injury, delayed treatment, osteochondral fracture of the capitate, and presence of persistent carpal malaligment), 1,21,22 only persistent carpal malalignment was associated with unplanned reoperation in the early recovery period.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Unplanned Reoperation in Perilunate Dislocations and Fracture Dislocations

et al. 2015

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Background Perilunate injuries are complex and uncommon injuries that are typically the result of a high-energy injury and are nearly always treated operatively. Little is known about factors associated with unplanned reoperations after surgery for perilunate injuries. Purpose To assess the rate and types of unplanned reoperation after operative treatment of a perilunate dislocation. Patients and Methods We reviewed 115 patients of all ages with unplanned reoperations after operative treatment of perilunate injuries at five hospitals. Planned removal of implants were not considered as unplanned reoperations. Results Sixteen patients had an unplanned reoperation, including four for compartment syndrome (three hand, one forearm); three for deep infection; three for malalignment or an errant screw; two for early salvage procedures; and four for other reasons. We considered seven unplanned reoperations necessary (forearm compartment syndrome, infection, loss of alignment, errant screw) and nine debatable or unnecessary (hand compartment syndrome, early salvage procedures, suspected malunion, etc.). Patients who had an unplanned reoperation were younger (median age 24 versus 34 years; p = 0.0034); had earlier surgery (median days to surgery 0 versus 3; p = 0.0068); and were more likely injured in a motor vehicle collision (50% versus 17%; p = 0.0070). Accounting for interaction among the variables using multivariable analysis, the factors independently associated with unplanned reoperation were young age (odds ratio 0.92) and motor vehicle collision accidents (odds ratio 4.1). Conclusion We conclude that higher-energy injuries may be at greater risk for unplanned reoperation, but more than half of the unplanned reoperations were for debatable indications. Level III Retrospective Cohort Review.

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Established non-union of an operatively managed trans-scaphoid perilunate fracture dislocation progressing to spontaneous union

Cited by 4 publications

References 8 publications

Spontaneous Healing of a Pediatric Scaphoid Proximal Pole Fracture Nonunion

Spontaneous Healing of a Pediatric Scaphoid Proximal Pole Fracture Nonunion

The Accuracy of Pain Measurement in Diagnosis of Scaphoid Bone Fractures in Patients with Magnetic Resonance Imaging: Report of 175 Cases

Factors Associated with Unplanned Reoperation in Perilunate Dislocations and Fracture Dislocations

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