Search Our Scientific Publications & Authors

J Hand Surg Eur Vol 2019 Apr 15:1753193419841253. Epub 2019 Apr 15.

2 Upper Limb Unit, Wrightington Hospital, Wigan, UK.

This study reports outcomes of arthroscopy in the treatment of delayed or nonunions of 25 scaphoids (25 patients). The surgery was performed between 8 and 43 weeks after injury. Intraoperatively, 11 fractures were deemed stable to probing and underwent percutaneous screw fixation only; 14 were unstable and received arthroscopic bone grafting with percutaneous screw fixation. Read More

Clin Radiol 2019 Apr 3. Epub 2019 Apr 3.

Department of Radiology, Warrington Hospital, Lovely Lane, Warrington, WA5 1QG, UK. Electronic address:

Aim: To assess the current practice of scaphoid fracture imaging (where initial scaphoid radiographs are normal) in the UK.

Materials And Methods: A survey monkey questionnaire was sent to 140 eligible NHS trusts derived from the NHS England database following exclusion of all non-acute and specialist centres. Four questions were asked regarding the provision of magnetic resonance imaging (MRI) for radiographically occult scaphoid fractures, time to MRI, number of departmental MRI scanners, and alternative imaging offered. Read More

Semin Musculoskelet Radiol 2019 Apr 29;23(2):109-125. Epub 2019 Mar 29.

Weill Cornell Medical College, New York, New York.

The universal goals of upper limb fracture management are to restore anatomic alignment, establish stable fracture fixation (while preserving blood supply), and allow for early mobilization of the elbow, wrist, and digits. However, the indications for operative management and fixation constructs are specific to each fracture type. This article systematically reviews current classifications and treatment options for adult fractures of the distal humerus, radius, ulna, scaphoid, metacarpals, and phalanges. Read More

Clin Med Insights Arthritis Musculoskelet Disord 2019 18;12:1179544119836742. Epub 2019 Mar 18.

Department of Surgery, McMaster University, Hamilton, ON, Canada.

Vascular compromised fractures typically result in a high rate of healing complications, such as avascular necrosis, nonunion, delayed union, and arthritis, which severely affect a patient's function and quality of life. The purpose of this review was to identify and describe the epidemiology and available treatment options for the most well-known vascular compromised closed fractures. The injuries discussed in detail in this review were scaphoid, lunate, femoral neck, and talar fractures. Read More

Med Biol Eng Comput 2019 Mar 22. Epub 2019 Mar 22.

Orthopaedic Research Laboratory, Department of Biomedical Engineering, Virginia Commonwealth Universitymedica, P.O. Box 843067, Richmond, VA, 23284-3067, USA.

The scapholunate ligament stabilizes the scaphoid and lunate of the proximal row in the wrist which allows for proper force transmission with the radius and ulna. Damage to this structure degenerates into arthritis and disability. Controversy exists over the best technique to restore function and reduce pain. Read More

J Med Radiat Sci 2019 Mar;66(1):3-4

Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore, Singapore.

Radiographs are currently accepted as the first-line modality for the investigation of scaphoid fractures. Early use of magnetic resonance imaging (MRI) in patients with radio-occult scaphoid fractures has been shown to be beneficial in the management of such patients. Incorporation of early MRI into the management protocol for scaphoid fracture is recommended. Read More

J Hand Surg Asian Pac Vol 2019 Mar;24(1):13-16

* Clinic for Hand and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland.

Background: Literature provides little and controversial evidence regarding the influence of ulnar variance (UV) on the incidence of scaphoid fractures. The aim of this retrospective study was to assess UV in a large number of patients with acute scaphoid fracture in comparison to a control group of the same population.

Methods: During a two year period, 182 patients with acute scaphoid fractures (fracture group) and 182 ethnicity-, gender- and age-matched patients with wrist contusions (control group) were treated in three non-university hospitals. Read More

J Wrist Surg 2019 Feb 7;8(1):37-42. Epub 2018 Aug 7.

Mayo Clinic, Rochester, Minnesota.

 Management of scapholunate (SL) ligament disruption is a challenging problem. The reduction and association of the scaphoid and lunate (RASL) procedure has been described with varying results. This study assessed the outcomes of the RASL procedure. Read More

Curr Rheumatol Rev 2019 Jan 18. Epub 2019 Jan 18.

Centre for Orthopaedic and Trauma Research Department of Orthopaedics and Trauma University of Adelaide Orthopaedic Surgeon Wakefield Orthopaedic Clinic, 270 Wakefield Street, Adelaide 5000. Australia.

Background: The carpus is a complicated and functionally challenged mechanical system and advancements in the understanding have been compromised by the recognition that there is no standard carpal mechanical system and no typical wrist. This paper cover component of a larger project that seeks to develop a kinetic model of wrist mechanics to allow reverse analysis of the specific biomechanical controls or rule of a specific patient's carpus, and then use those to create a forward mathematical model to reproduce the unique individual's anatomical motion based on the extracted rules.

Objective And Methods: Based on previous observations, the carpus essentially moves with only 2 degrees of freedom - pitch (flexion / extension) and yaw (radial deviation / ulnar deviation), while largely preventing roll (pronation / supination). Read More

Ortop Traumatol Rehabil 2018 Oct;20(5):389-399

Klinika Chirurgii Ogólnej i Chirurgii Ręki, Pomorski Uniwersytet Medyczny w Szczecinie, Polska / Department of General and Hand Surgery, Pomeranian Medical University in Szczecin, Poland.

Background: Persistent, long-lasting pseudoarthrosis of the scaphoid or scapholunate dissociation results in arthrosis of the radio-scaphoid joint termed scaphoid non-union advanced collapse (SNAC) or scapholunate advanced collapse (SLAC), which causes pain, reduction in wrist movements and weakness of the hand grip. Scaphoid resection followed by "four-corner" midcarpal arthrodesis is a recognized treatment for this condition.

Material And Methods: The study evaluated the results of treatment of 27 patients with arthrosis of the wrist type SNAC (n = 15) and SLAC (n = 12) after an average of 4 years after surgery (range from 2 to 8 years) Results. Read More

Tech Hand Up Extrem Surg 2019 Mar;23(1):6-9

Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.

Scaphoid fractures typically occur in young, healthy males at the peak of their employment and productivity, and left untreated or inadequately treated will ultimately progress to nonunion and a "predictable" pattern of wrist arthritis and carpal collapse. Nonoperative treatment of these fractures requires prolonged cast immobilization, which can lead to wrist stiffness, loss of grip strength, muscle atrophy, and protracted loss of economic productivity. To prevent these devastating sequelae, percutaneous techniques for scaphoid fixation have been described and popularized; however, these techniques are technically demanding as optimal position of the compression screw is required to achieve bony union. Read More

Unfallchirurg 2019 Mar;122(3):170-181

Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstr. 1, 48149, Münster, Deutschland.

Among the carpal bones the scaphoid (Os scaphoideum) is the most important. The most frequent fracture of the carpus is a fracture of the scaphoid bone. The frequently occurring absence of healing of these fractures as well as unhealed ruptures of the ligament complex between the scaphoid and lunate, lead to the most severe biomechanical and thus the most severe clinical changes of the wrist. Read More

Arch Orthop Trauma Surg 2019 Feb 6;139(2):281-293. Epub 2018 Dec 6.

AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria.

Introduction: Scaphoid nonunion remains challenging for hand surgeons. Several treatment options are available such as: non-vascularized or vascularized bone grafting, with or without additional stabilization. In the last few decades, extracorporeal shockwave therapy (ESWT) has become an established procedure for treating delayed and nonunions. Read More

Curr Med Sci 2018 Dec 7;38(6):941-948. Epub 2018 Dec 7.

Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China.

The computer-assisted surgery (CAS) has significantly improved the accuracy, reliability and outcomes of traumatic, spinal, nerve surgery and many other operations with a less invasive way. The application of CAS for scaphoid fractures remains experimental. The related studies are scanty and most of them are cadaver researches. Read More

Curr Rheumatol Rev 2018 Dec 10. Epub 2018 Dec 10.

Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York. United States.

Background: Scapholunate interosseous ligament (SLIL) injury following a fall on an outstretched hand may lead to carpal instability and in some cases require long term rehabilitation following repair. Rehabilitation, especially in athletes, may include pushups, but little is known as to what type of pushup may be safer.

Objective: To determine biomechanical differences between two pushup position (neutral or extended). Read More

Med Arch 2018 Oct;72(4):253-256

Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy.

Introduction: The SNAC wrist (Scaphoid nonunion advanced collapse) is one of the complications following scaphoid fractures treated conservatively and one of the causes of wrist arthritis that the hand surgeon has to face most frequently. In these cases surgical management is usually warranted.

Materials And Methods: In the set time frame of 6 years we treated 15 SNAC wrist cases. Read More

Medicine (Baltimore) 2018 Nov;97(48):e13266

Hand & Foot Surgery and Reparative & Reconstruction Surgery Center, The Second, Hospital of Jilin University, Changchun, China.

Background: Surgical or nonsurgical treatment for scaphoid waist fracture with slight or no displacement is still controversial. This study compared the efficacy of the 2 methods through meta-analysis to provide a reference for the choice of clinical treatment options.

Methods: Two individuals independently searched for relevant RCTs and cohort studies from PubMed (1946-February 2018), Embase (1946-February 2018), and Cochrane library (1997-February 2018). Read More

J Hand Microsurg 2018 Dec 20;10(3):150-154. Epub 2018 Mar 20.

Department of Orthopaedics, Maulana Azad Medical College, New Delhi, India.

Divergent trapezium-trapezoid fracture dislocation is a rare and complex injury. The authors present an unusual case of dislocation of the trapezium-trapezoid complex with scaphoid fracture. A 25-year-old man suffered a road traffic accident leading to complex carpal injury due to axial and rotation forces (steer wheel injury) on the left wrist. Read More

J Hand Microsurg 2018 Dec 20;10(3):130-133. Epub 2018 Mar 20.

Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Harvard Medical School, Massachusetts General Hospital, Boston, United States.

Computed tomography (CT) is increasingly used not just to diagnose union but also to estimate the percentage of the fracture gap that is bridged by healing bone. This study tested the primary null hypothesis that there is no agreement between observers on the extent of union of a scaphoid waist fracture on CT. CT scans of 13 nondisplaced scaphoid waist fractures treated nonoperatively were rated by 145 observers. Read More

J Hand Surg Asian Pac Vol 2018 Dec;23(4):450-462

1 Department of Orthopaedic Surgery, Dongguk University College of Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.

Scaphoid fracture is the most common carpal fracture. Nonunion rate has been reported around 10 to 15% of scaphoid fractures. Risk factors for scaphoid nonunion are known as location, displacement, poor vascularity, time to treatment etc. Read More

Tech Hand Up Extrem Surg 2019 Mar;23(1):14-21

Department of Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, PA.

In this retrospective study, we report the preliminary results of a novel technique for volar vascularized strut grafting to treat avascular scaphoid nonunion by using the 1,2 intercompartmental supraretinacular artery through a single incision. Forty-three of 45 patients with avascular scaphoid nonunion healed at a mean of 13 weeks (range, 3 to 10 mo). Complications consisted of 1 pin tract infection that resolved with oral antibiotics and 4 cases of transient dysesthesia of the radial sensory nerve. Read More

Ulus Travma Acil Cerrahi Derg 2018 Sep;24(5):468-473

Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul-Turkey.

Background: There are conflicting results regarding the duration of the plaster treatment of nondisplaced scaphoid fractures. The aim of the present study was to evaluate the healing process and to determine the role of computed tomography (CT) on shortening the duration of plaster treatment of nondisplaced scaphoid fractures.

Methods: A total of 42 patients diagnosed with nondisplaced scaphoid fractures between January 2012 and January 2014 were investigated. Read More

Zhonghua Yi Xue Za Zhi 2018 Oct;98(39):3153-3157

To explore the MRI characteristics of injuries of scapholunate ligament (SLL), and provide imaging basis for the early diagnosis and treatment of the injuries. A total of 20 healthy volunteers without wrist injuries and 30 patients who complained dorsoradial-sided wrist pain and were highly suspected as the injury of SLL underwent the wrist magnetic resonance examination and X-ray examination in Beijing Jishuitan Hospital from January 2013 to September 2017.All subjects underwent anterior and lateral radiographs of the wrist joint and examination on coronal T(1)WI scan and PD-FS on 3 planes respectively in a prone position. Read More

Am Fam Physician 2018 Nov;98(10):570-576

West Virginia University School of Medicine-Eastern Campus, Harpers Ferry, WV, USA.

Braces and splints can immobilize and protect joints, reduce pain, decrease swelling, and facilitate healing of acute injuries. They are also used for injury prevention and chronic pain reduction, and to alter the function of a joint. The medial unloading (valgus) knee brace is an option for patients with medial knee osteoarthritis, but evidence of long-term benefit is limited. Read More

Zhongguo Gu Shang 2018 Sep;31(9):863-866

Department of Orthopaedics, the First People's Hospital of Neijiang City, Neijiang 641000, Sichuan, China.

Objective: To evaluate the feasibility of internal and external fixation after open reduction combined with suture anchors to repair the intercarpal ligaments for the treatment of perilunate injury, and to explore its operative techniques and therapeutic efficacy.

Methods: From September 2012 to September 2016, 11 patients with perilunate injury were surgically treated with Kirschner wires in intercarpal articulations, 3.0 mm cannulated screws for scaphoid fracture, absorbable anchor for intercarpal ligament repair, together with fixators at intercarpal joints, among whom 6 suffered from perilunate dislocations and 5 from trans-scaphoid fracture dislocations. Read More

J Bone Joint Surg Am 2018 Oct-Dec;8(4):e77

Department of Orthopaedic Surgery, University of Michigan Health System, Ann Arbor, Michigan.

Case: A 31-year-old Caucasian man presented with a greater arc perilunate variant injury after falling from a friend's shoulders onto an outstretched hand. Imaging revealed a minimally displaced scaphoid waist fracture and a nondisplaced transverse fracture through a previously unrecognized lunotriquetral coalition. A volar intercalated segmental instability (VISI) deformity was present. Read More

J Exerc Rehabil 2018 Aug 24;14(4):694-698. Epub 2018 Aug 24.

IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.

The main goal of this study was to determinate the extent of the relationship between shoulder pain and time of wrist and thumb immobilization required after injury. One hundred twenty-three consecutive subjects presenting to the practice of different Orthopedic Specialist hospitals with a diagnosis of distal radius or scaphoid fracture that required wrist and thumb immobilization were screened for eligibility criteria. Upper extremity pain and the need for shoulder rehabilitation were assessed using the visual analogue scale (VAS) at baseline after immobilization period (T0) 1- and 3-month follow-up (1-FU/2-FU). Read More

J Nippon Med Sch 2018 ;85(4):231-235

Department of Orthopedic Surgery, Nippon Medical School Hospital.

We report a case of trans-scaphoid perilunate fracture-dislocation with concomitant lunotriquetral ligament disruption of the right wrist in a 44-year-old man, sustained from a 10-m fall landing on his outstretched right hand. Open reduction was performed 1 day after injury; at first the palmar dislocation of the lunate was reduced with the palmar approach. Under direct view with the dorsal approach, the scaphoid was comminuted and then treated with open reduction and internal fixation with a double threshold screw using a dorsal approach and a bone graft from the distal radius. Read More

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2018 08;32(8):989-992

Department of Hand Microsurgery, Luoyang Orthopedic Hospital of Henan Province (Orthopedic Hospital of Henan Province), Luoyang Henan, 471002, P.R.China.

Objective: To explore the effectiveness of ultrasound-guided percutaneous Herbert screw for the treatment of fresh nondisplaced carpal scaphoid fracture.

Methods: Between May 2013 and August 2015, 15 patients with fresh nondisplaced carpal scaphoid fractures (Krimmer type A2) were treated with ultrasound-guided Herbert screw fixation. There were 12 males and 3 females with an average age of 33. Read More

Hand (N Y) 2018 11 12;13(6):NP39-NP45. Epub 2018 Sep 12.

2 NYU Langone Orthopedic Hospital, NYU Langone Health, New York City, USA.

Background: Scaphocapitate syndrome is a rare variety of perilunate instability, described as a trans-scaphoid, trans-capitate fracture, with rotation of the capitate head either 90° or 180°.

Methods: We present a unique case of scaphocapitate syndrome in which the rotated proximal capitate fragment expelled into the carpal canal.

Results: The capitate head was extricated from the carpal tunnel via the volar approach, and was anatomically aligned and fixed through the dorsal approach using two 2. Read More

Medicine (Baltimore) 2018 Sep;97(36):e12161

Pediatric Orthopaedic Surgery, Lenval University Children's Hospital.

Rationale: Tumors of the scaphoid are rare, and some can cause pathological fractures. No cases of pathological fractures of the scaphoid have been reported in children. The most common treatment for pathologic fractures of the scaphoid bone associated with a benign lesion in adults is surgical, with intralesional curettage associated with autologous bone grafting and internal fixation. Read More

Hand (N Y) 2019 Jan 5;14(1):73-79. Epub 2018 Sep 5.

1 Saint Louis University, MO, USA.

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. Read More

Am J Orthop (Belle Mead NJ) 2018 Aug;47(8)

Section of Orthopaedic Sports Medicine, Orthopaedic and Rehabilitation Centers, Chicago, IL.

Delayed unions and nonunions of the scaphoid are most often treated by open reduction and internal fixation with bone grafting. We sought to evaluate a large consecutive series of nondisplaced or minimally displaced scaphoid nonunions and delayed unions treated by a compression screw without bone grafting by 2 fellowship trained hand surgeons. A total of 23 patients (19 males, 4 females) were identified who had fractures located at the distal third (2), the waist (18), and the proximal third (3). Read More

J Wrist Surg 2018 Sep 8;7(4):319-323. Epub 2018 Jun 8.

Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York.

 Achieving adequate fixation and healing of small proximal pole acute scaphoid fractures can be surgically challenging due to both fragment size and tenuous vascularity.  The purpose of this study was to demonstrate that this injury can be managed successfully with osteosynthesis using a "micro" small diameter compression screw with distal radius bone graft with leading and trailing screw threads less than 2.8 mm. Read More

J Wrist Surg 2018 Sep 10;7(4):303-311. Epub 2018 Apr 10.

Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.

 Ipsilateral fractures of the distal radius and scaphoid are rare, with few reports describing mechanisms of injury, fracture patterns, and treatment approaches.  This article describes the clinical and radiographic features of ipsilateral distal radius and scaphoid fractures occurring simultaneously.  Electronic databases from 2007 to 2017 at a single Level 1 trauma center were reviewed for patients with concurrent fractures of the distal radius and scaphoid. Read More

J Wrist Surg 2018 Sep 24;7(4):298-302. Epub 2018 Apr 24.

Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York.

 Little is known about changes in scaphoid and lunate supination and pronation following scapholunate interosseous ligament (SLIL) injury. Information on these changes may help explain why some SLIL reconstructions have failed and help in the development of new techniques.  To determine if following simulated SLIL injury there was an increase in scaphoid pronation and lunate supination and to determine if concurrently there was an increase in the extensor carpi ulnaris (ECU) force. Read More

J Med Radiat Sci 2019 Mar 30;66(1):30-37. Epub 2018 Aug 30.

Sydney Medical School, University of Sydney, Sydney, Australia.

Introduction: Scaphoid fractures are the commonest carpal bone fracture. If untreated they pose significant risk to patients, thus if a scaphoid fracture is suspected, patients are managed with immobilisation. Although scaphoid fractures may be difficult to diagnose on plain radiography, sometimes for months after injury, ongoing radiographic surveillance is preferred due to its low upfront cost. Read More

BMC Musculoskelet Disord 2018 Aug 29;19(1):310. Epub 2018 Aug 29.

Buckinghamshire Hospitals NHS Trust, High Wycombe Hospital, High Wycombe, Amersham, HP11 2TT, UK.

Background: The aim of this study was to assess the inter observer and intra observer reliability of acute scaphoid fracture classification methods including a novel 'long axis' measurement, a simple method which we have developed with the aim of improving agreement when describing acute fractures.

Methods: We identified sixty patients with acute scaphoid fractures at two centres who had been investigated with both plain radiographs and a CT (Computed Tomography) scan within 4 weeks of injury. The fractures were assessed by three observers at each centre using three commonly used classification systems and the 'long axis' method. Read More

Hand (N Y) 2018 Aug 24:1558944718795266. Epub 2018 Aug 24.

1 University of Texas Southwestern Medical Center, Dallas, USA.

Background: Isolated scaphoid fractures (ISFs) are common, whereas transscaphoid fracture-dislocations (TSFDs) are not. Scaphoid fracture location and the extent of comminution are factors that affect treatment and outcome. The purpose of this study is to compare the radiographic characteristics of ISFs with TSFDs associated with greater arc injury. Read More

J Bone Joint Surg Am 2018 Aug;100(16):1379-1386

Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.

Background: Outcomes following revision surgery for scaphoid nonunions with osteonecrosis are guarded. We hypothesized that use of free vascularized medial femoral condyle (MFC) bone grafts can lead to healing of the nonunion, increase vascularity of the proximal pole, and restore scaphoid architecture, resulting in acceptable functional outcomes.

Methods: We performed a retrospective review of 49 patients who were treated with an MFC bone graft, between May 2005 and September 2016, after prior failure of operative treatment for scaphoid nonunion. Read More

J Hand Surg Am 2019 Apr 10;44(4):339.e1-339.e7. Epub 2018 Aug 10.

Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, AZ.

Purpose: Currently, there is no consensus on the optimal treatment for scaphoid nonunion with avascular necrosis (AVN). Various techniques, often involving vascularized corticocancellous bone grafting, have been proposed. The authors hypothesized that similar outcomes might be possible with volar plate fixation augmented with autogenous pure cancellous graft. Read More

Medicine (Baltimore) 2018 Aug;97(31):e11691

Department of Orthopedic Surgery, Louisiana State University Health Science Center, New Orleans.

Adult fracture nonunion risk is related to injury severity and surgical technique, yet nonunion is not fully explained by these risk factors alone; biological risk factors are also important. We test a hypothesis that risk factors associated with pediatric fracture nonunion are similar to adult nonunion risk factors.Inception cohort study in a large payer database of pediatric fracture patients (0-17 years) in the United States in calendar year 2011. Read More

J Hand Surg Eur Vol 2018 Jul 26:1753193418789329. Epub 2018 Jul 26.

Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA.

This study aimed to determine the outcome of free vascularized medial femoral condyle bone grafts in the primary treatment of scaphoid nonunions with scaphoid foreshortening or carpal collapse and intraoperatively documented avascular necrosis. Thirty-two patients (28 male, four female) met the inclusion criteria. Median time from injury to surgery was 70 weeks. Read More

J Belg Soc Radiol 2018 Jan 31;102(1). Epub 2018 Jan 31.

MSK Imaging Department, Clinique du Sport de Bordeaux-Mérignac, FR.

The keys to successful ultrasonography (US) of the wrist include knowledge of the relevant anatomy and understanding the biomechanical aspects. A wide spectrum of pathological findings including bone fractures (scaphoid, triquetrum) and ligament lesions (dorsal intercarpal and radiocarpal ligaments, scapholunate ligament) can be caused by an identical traumatic mechanism determined on the basis of the position of wrist at the time of injury. In the setting of wrist trauma, an early diagnosis can minimize the potential for inappropriate or delayed treatment. Read More

Hand (N Y) 2018 11 18;13(6):NP32-NP38. Epub 2018 Jul 18.

1 San Antonio Military Medical Center, TX, USA.

Background: "Floating forearm" injuries, perilunate injuries, with an elbow dislocation, are rare and challenging to treat.

Methods: We present the case of an unusual variant of a floating forearm injury, trans-scaphoid perilunate fracture dislocation and elbow dislocation, with a concomitant open both-bone forearm fracture after a fall from a ladder. Treatment involved irrigation and debridement of the forearm wound, open reduction and internal fixation of the forearm and perilunate injury, and closed reduction of the elbow. Read More

Case Rep Orthop 2018 11;2018:9591502. Epub 2018 Jun 11.

Department of Orthopaedic Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.

Isolated dislocations of the scaphoid are extremely uncommon injuries and are often associated with significant ligamentous failures. Since scaphoid dislocations typically present with associated carpal fractures, few cases of isolated dislocations of the scaphoid exist in the literature. The proposed treatment options in the literature range from closed reduction and casting to open reduction and internal fixation. Read More

Clin Imaging 2018 Sep - Oct;51:341-346. Epub 2018 Jun 30.

Akdeniz University, Medical Faculty, Department of Anatomy, Antalya, Turkey. Electronic address:

Aim: The purpose of this study was to investigate the role of anatomic variations in distal radius radiographic indices in patients with or without scaphoid fractures.

Materials And Methods: Radial inclination (RI), volar tilt (VT), radial height (RH) and ulnar variance (UV) were measured on wrist radiographs of 320 patients with (Group I, n = 167) or without (Group II, n = 153) scaphoid fracture, fall on outstretched hand (FOOSH). Receiver operating characteristics (ROC) curve analysis was used to assess the diagnostic performance for each variable. Read More

J Hand Surg Am 2019 Feb 28;44(2):160.e1-160.e7. Epub 2018 Jun 28.

Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, AZ.

Purpose: Treatment of scaphoid nonunion with a segmental defect presents a challenging clinical problem. Various techniques have been proposed, often involving structural grafting with vascularized and nonvascularized bone. The authors hypothesize that satisfactory clinical and radiographic outcomes are possible with a relatively simplified technique of volar plate fixation with autogenous, purely cancellous graft. Read More

Case Rep Orthop 2018 23;2018:8397638. Epub 2018 May 23.

Pan Am Clinic Foundation, 75 Poseidon Bay, Winnipeg, MB, Canada R3M 3E4.

Perilunate fracture dislocations are a rare but devastating injury, which is often missed on initial presentation leading to significant delays in treatment. With the delay in treatment and a high energy mechanism of injury, patients are at increased risk of developing complex regional pain syndrome following trauma. In this report, we review the case of a 57-year-old left-hand dominant female who presented to a clinic with a five-and-a-half-week-old transtriquetral, perilunate fracture dislocation with comminution of the scaphoid facet. Read More