The Vascular Anatomy of the Scaphoid: New Discoveries Using Micro–Computed Tomography Imaging

Morsy, Mohamed; Sabbagh, M. Diya; Alphen, Nick A. van; Laungani, Alexis; Kadar, Assaf; Moran, Steven L.

doi:10.1016/j.jhsa.2019.08.001

Cited by 51 publications

(29 citation statements)

References 26 publications

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“…Patients with acute scaphoid fractures have surgical therapy to achieve a high fracture union rate and an early resumption to daily activities [24].…”

Section: Discussionmentioning

confidence: 99%

Different modalities in management of acute scahphoid fracture

Khalil

Mostafa

Shoulah

et al. 2021

Benha Journal of Applied Sciences

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Background . Background Scaphoid fractures constitute around 2-3% of all fractures and about 10% of all the fractures in the hand. The indication of closed treatment of fractures with scaphoid is generally confined to stable fractures without displacements. Kirschner wires, screws and staples incorporate operational approaches. Both flying and dorsal methods have been documented as percutaneous methods (pins and cannulated screws). Purpose The objective of the research is to undertake a comprehensive analysis of previous available research on various ways of managing acute scaphoid fractures. Patients and procedures The search for literature was done using PubMed, SCOPUS, Web of Science, and the Cochrane Library. Search and filtering literature produced 7 full text publications (254 patients), randomised controlled trials were included. Results Surgical fixation on scaphoid fractures results in better rates of union and quick union times of 5 to 9 weeks. As for casting, the union usually takes around 7 to 16 weeks and the union rate is between 85 and 90%. ROM 90 percent -97 percent following conservative scaphoid fracture therapy, whereas surgical therapy was 88 percent -97 percent. Grip strength was 88%-98% improvement with conservative therapy and 84%-94% following surgical therapy. The return to work was surgery for 6-8 weeks before, but for those who were receiving conservative therapy it was 4-15,5 weeks. Conclusion Our analysis showed no statistically significant difference in overall complications between surgical and non-operative therapy. However, independent study demonstrated that surgical therapy had the benefit of delayed union, backed by time-to-fracture union analyses.

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“…Patients with acute scaphoid fractures have surgical therapy to achieve a high fracture union rate and an early resumption to daily activities [24].…”

Section: Discussionmentioning

confidence: 99%

Different modalities in management of acute scahphoid fracture

Khalil

Mostafa

Shoulah

et al. 2021

Benha Journal of Applied Sciences

View full text Add to dashboard Cite

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“…5 All attempts should be made to preserve the radial soft tissue attachments to the distal pole and dorsal ridge to maximize blood supply if surgery is to be performed. 10 If there is a partial dislocation then closed reduction with 4 to 6 weeks of immobilization has been performed. Cases of delayed diagnosis typically require operative treatment for reduction because of changes to the soft tissues.…”

Section: Discussionmentioning

confidence: 99%

Isolated Scaphoid Dislocation: A Case Report and Review of the Literature

2020

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Background Isolated scaphoid dislocation is an exceedingly rare event with only 55 cases described. Closed reduction followed by operative intervention with Kirschner's wires (K-wire) fixation and ligamentous reconstruction are the mainstays of treatment. Case Description We describe a patient with a solitary scaphoid dislocation treated with initial closed reduction and urgent open reduction with K-wire stabilization and ligamentous repair. The patient was immobilized for 6 weeks and on 24-month follow-up, the patient was doing well with no limitations in his daily living, no pain, and acceptable range of motion. Literature Review A literature review was performed on the 55 cases described in the English language. The majority of the patients were males, aged between 18 and 79 years, and presented with motor vehicle accidents as the most common mechanism. Historically, isolated scaphoid dislocations were treated with closed reduction. However, K-wire fixation and, now, K-wire fixation coupled with ligamentous injury repair remain the current treatments of choice. Avascular necrosis of the scaphoid remains a rare event with only one documented case. Overall, patients do well with only minor pain and limited wrist movements. Notably, only eight cases were associated with type-II lunates. Type-II lunates appear to be protective for carpal injury. Clinical Relevance Although isolated scaphoid dislocations remain a rare event, understanding the anatomy and the current ability to restore carpal anatomy is important. Type-II lunates appear to confer protection from carpal injuries.

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“…A centrally placed screw from the volar side can also be achieved by a lever trapezium approach or by drilling a portion of it; however, many surgeons prefer the dorsal approach because of the ease of access and the ability to place a screw closer to the central axis [ 39 , 40 ]. In addition, a study that has examined scaphoid intraosseous vascular anatomy also shows that the central axis and antegrade dorsal screw fixation cause less disruption of the scaphoid internal blood supply than that for the retrograde volar screw [ 41 ]. In our study, the headless screws were inserted through the dorsal mini-open approach instead of a purely dorsal percutaneous technique.…”

Section: Discussionmentioning

confidence: 99%

Wrist function recovery course in patients with scaphoid nonunion treated with combined volar bone grafting and a dorsal antegrade headless screw

et al. 2020

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Background Surgical treatment is necessary for scaphoid nonunion. Open surgery with a combined volar and dorsal approach is thought to have poor functional outcomes and a prolonged recovery course. However, the detailed recovery course for this approach is rarely reported. The aim of this study was to investigate the recovery course and radiographic outcome for patients with scaphoid nonunion who underwent a combined volar bone grafting and dorsal antegrade headless screw approach. Material and methods Eighteen patients with scaphoid nonunion who underwent combined volar bone grafting and dorsal antegrade headless screw fixation were enrolled in this retrospective study. Preoperative and serial postoperative wrist functional and radiographic outcomes were collected and analysed. Results All 18 patients achieved bone union at a mean time of 14.3 weeks. Compared to the preoperative status, the grip strength, wrist motion arc, and Mayo Wrist score were improved significantly 6 months after surgery, whilst the Disabilities of the Arm, Shoulder, and Hand (DASH) score did not recover until 12 months after surgery. Significant improvements were found in all scaphoid radiographic parameters. Conclusion The surgical outcomes for scaphoid nonunion treated with a combined volar bone grafting and dorsal antegrade headless screw achieved a high union rate, with great wrist functional and radiographic outcomes. The earliest recovered wrist functional parameters were grip strength, motion arc, Mayo Wrist score and finally the DASH score at postoperative 6 months and 12 months, respectively.

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The Vascular Anatomy of the Scaphoid: New Discoveries Using Micro–Computed Tomography Imaging

Cited by 51 publications

References 26 publications

Different modalities in management of acute scahphoid fracture

Different modalities in management of acute scahphoid fracture

Isolated Scaphoid Dislocation: A Case Report and Review of the Literature

Wrist function recovery course in patients with scaphoid nonunion treated with combined volar bone grafting and a dorsal antegrade headless screw

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