Journal of Musculoskeletal Trauma

Treatment of Scaphoid Fractures and Nonunions: Wan-Sun Choi; J Korean Fract Soc 2022;35(4):182-189. Published online October 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.4.182

Abstract PDF: A scaphoid fracture is one of the most common types of wrist fractures, and if treatment is delayed, there is a high possibility of nonunion due to anatomical factors such as limited blood supply to the injured bone. Therefore, it is important to suspect a scaphoid fracture based on the mechanism of wrist injury and physical examination of the patient. A computed tomography scan or magnetic resonance imaging can also aid early diagnosis of the fracture. Stable acute fractures can be treated conservatively, but unstable fractures require surgical treatment, and percutaneous screw fixation is usually performed. Nonunions require bone grafts and are treated with non-vascularized bone grafts and screw fixation. However, if the nonunion is located at the proximal pole, a vascularized bone graft may be considered because there is a possibility of avascular necrosis. Pedicled vascularized and free vascularized medial femoral condyle bone grafts are mainly used in such cases. The treatment of a proximal pole nonunion with impaired blood flow remains controversial. There are conflicting opinions on whether a nonvascularized bone graft is sufficient or whether a vascularized bone graft is necessary.

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Pediatric Fractures around the Wrist: Gihun Kim, Kun-Bo Park; J Korean Fract Soc 2021;34(2):80-86. Published online April 30, 2021; DOI: https://doi.org/10.12671/jkfs.2021.34.2.80

Abstract PDF: Fractures around the wrist are the third most common fracture among all pediatric fractures. Furthermore, distal radius fractures, a type of wrist fracture, are the most common fractures in children. Understanding pediatric fractures around the wrist is very important considering their prevalence. There is a specific belief that pediatric fractures can heal easily because of remodeling, but not all fractures can heal without proper treatment. Complications such as growth problems, nonunion can occur if the fracture is not treated properly. This paper reviewed recent articles about distal radius fractures, Galeazzi-equivalent fractures, and carpal bone fractures, including scaphoid fractures in children and adolescents. Successful treatment can be achieved without complications when an accurate diagnosis and proper non-surgical or surgical treatment are performed based on this article.

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Scaphoid Fractures and Nonunion: Jin Rok Oh; J Korean Fract Soc 2016;29(1):79-92. Published online January 31, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.1.79

Abstract PDF: Fracture of scaphoid is relatively common, and accurate and prompt diagnosis leads to bony union with good clinical outcome. However, it can be easily missed due to vague symptomatic complaints by patients, which in turn leads to negligence of a doctor in making the diagnosis or anatomical shape of scaphoid that causes minute fracture to be ignored while viewing simple radiography. When missed, nonunion of scaphoid gradually progresses to arthritic change in the wrist. Thus when fracture of the scaphoid is suspected, further evaluation should be initiated with care, and if the diagnosis is confirmed, a proper treatment plan must be set with assessment of stability of the fracture fragment. Internal fixation is usually proposed since solid fixation of the fracture provides early return to daily activity. When nonunion of the scaphoid is present, most patients can achieve bony union with avascular bone graft and internal fixation. However, if there is sclerotic change, large bone cyst or avascular necrosis of the fracture fragment, internal fixation with bone graft that includes vascular supply should be introduced in order to achieve bony union.

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Transscaphoidal Dorsal Perilunar Dislocation Associated with Dislocation of Distal Radioulnar Joint: A Case Report: Chul Hyung Kang, Chul Hyun Cho, Dong Wan Kim; J Korean Fract Soc 2014;27(1):77-81. Published online January 31, 2014; DOI: https://doi.org/10.12671/jkfs.2014.27.1.77

Abstract PDF: Dorsal perilunar dislocations are rare traumatic entities. Associated fractures such as carpal bones and radial styloid processes can occur. However, the dorsal perilunar dislocation associated with dislocation of distal radioulnar joint is extremely rare. The authors herein report the case of a 34-year-old man who was presented with transscaphoidal perilunar dislocation which is associated with dislocation of distal radioulnar joint.

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Ipsilateral Distal Radius and Scaphoid Fractures Associated with Posteromedial Dislocation of the Elbow Joint: A Case Report: Jin Wan Kim, Young Chul Ko, Chul Young Jung, Il Soo Eun, Young Jun Kim, Chang Kyu Kim; J Korean Fract Soc 2012;25(2):150-154. Published online April 30, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.2.150

Abstract PDF: Arm injuries occurring from high energy injuries such as falls or traffic accidents can be accompanied by wrist and elbow injuries. Monteggia fracture, Galeazzi fracture, and Essex-Lopresti fracture-dislocation are known some examples of such injuries. However, there are no reports on the dislocation of the elbow occurring from a distal radius fracture accompanied by scaphoid fracture, and there is nothing published about its prognosis. The authors report on the treatment and outcomes of a case of a 42-year-old male who had a distal radius and scaphoid fracture associated with posteromedial dislocation of the elbow on the same side of his arm along with a literature review.

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Surgical Outcome of Stable Scaphoid Nonunion without Bone Graft: Eun Sun Moon, Myung Sun Kim, Il Kyu Kong, Min Sun Choi; J Korean Fract Soc 2010;23(1):69-75. Published online January 31, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.1.69

Abstract PDF: PURPOSE
To evaluate the results of Acutrak-screw fixation without bone-graft for the treatment of stable scaphoid nonunion and to assess its prognostic factors.
MATERIALS AND METHODS
Fifteen patients who underwent internal fixation using Acutrak-screw without bone graft for stable scaphoid nonunion were studied. Standard radiographs and CT were analyzed for degenerative changes (presence of cystic change and periscaphoid osteoarthritis), the nonunion site using fragment ratio and union. Clinically, patients age and the interval to surgery were evaluated.
RESULTS
Mean follow-up duration was 31 months and 11 of 15 (73.3 percentages) cases healed at mean time of 12.8 weeks. Fragment ratio of nonunion site was 37.2 percentages in nonunion group and 54.2 percentages in union group (p=0.016). Presence of cystic change and periscaphoid osteoarthritis showed no singnificant statistical difference in both groups. Younger age lower than 20 years was closely related with bone union (p=0.001). But there were little correlation between bone union and interval to surgery.
CONCLUSION
Internal fixation without bone graft showed 73.3 percentages of overall union rate in the treatment of stable scaphoid nonunion. And young patients who have distally located stable scaphoid nonunion can be successfully treated with internal fixation without bone graft.

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Volar Percutaneous Cannulated Screw Fixation for Subacute Scaphoid Wasit Fracture: Jae Kwang Kim, Jong Oh Kim, Seung Yup Lee, Nam Hoon Do; J Korean Fract Soc 2009;22(2):104-109. Published online April 30, 2009; DOI: https://doi.org/10.12671/jkfs.2009.22.2.104

Abstract PDF

PURPOSE
To report the surgical results of volar percutaneous cannulated compression screw fixation in subacute scaphoid fracture.
MATERIALS AND METHODS
Between January 2004 and January 2007, eight consecutive patients with subacute scaphoid waist fracture, who sought medical attention between 4 weeks to 6 months after injury, were included in this study. All patients were male of an average age 29.2 years (range, 19 to 44). Mean duration of injury was 10.3+/-4.1 weeks. An acutrak cannulated screw (Acumed, Hillsboro, OR) was introduced volarly under image intensifier guidance in all patients. We performed radiological evaluation preoperatively and postoperatively. And we performed 12 months postoperatively using grip strength, range of motion (ROM) of the wrist, Mayo Modified Wrist Score (MMWS) and Disabilities of the Arm, Shoulder and the Hand (DASH) score for functional evaluation.
RESULTS
Preoperative radiography showed minimal sclerosis line in three patients and a bone resorption around fracture sites in two patients. However, no patient had dorsal intercalated segment instability or more than 35 degrees of lateral intrascaphoid angle. Fractures united successfully at 11.6+/-2.1 weeks postoperatively without any requirement for a further procedure. At 12 months follow-up evaluations, ROM of the injured wrist was 93% of the uninjured wrist and grip strength of the injured wrist was 95% of the injured wrist. The mean MMWS was 93+/-6.6 and the mean DASH score was 4.8+/-1.2.
CONCLUSION
We believe that volar percutaneous cannulated screw fixation is a reliable method in case of subacute scaphoid waist fracture without scaphoid deformity or carpal instability.

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Surgical Outcome of Stable Scaphoid Nonunion without Bone Graft
Eun Sun Moon, Myung Sun Kim, Il Kyu Kong, Min Sun Choi
Journal of the Korean Fracture Society.2010; 23(1): 69. CrossRef

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Treatment of Scaphoid Nonunions with Autogenous Cancellous Bone Grafting Combined with Threaded K-wire Fixation: Yong Ho Kang, Hyung Gyu Kim, Seung Ju Jeon, Nam Heun Kim; J Korean Fract Soc 2005;18(3):317-324. Published online July 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.3.317

Abstract PDF: PURPOSE
To evaluate the results of surgical treatment of autogenous cancellous bone grafting combined with threaded K-wire fixation for scaphoid nonunions.
MATERIALS AND METHODS
We retrospectively reviewed the 13 patients with scaphoid nonunion, which was follow up at least 12 months from March 1999 to June 2003. According to the Mayo classification, two cases were type P (proximal third), eight cases were type W (waist) and three cases were type D (distal third). According to the Russe classification, eight cases showed horizontal oblique type, another two cases were transverse, and last three belonged to vertical oblique type. We assessed the radiologic bony union, correction of humpback deformity and lateral intrascaphoid angle and degenerative change of radioscaphoid joint, clinical results were evaluated using assessment of Maudsley.
RESULTS
Radiologic union was obtained in all cases, mean time of union was 15.4 weeks (13~17.4 weeks), and there was no radiological evidence of postoperative humpback deformity, intercarpal instability, proximal osteonecrosis and degenerative changes. According to assessment of Maudsley, there were 7 excellent cases, 4 good cases, 1 fair case and 1 poor case among these 13 cases. The final clinical results were 11 excellent cases, 2 good case in the aspect of wrist pain and tenderness. All range of motion was satisfactory to patients except 4 cases (3 fair, 1 poor) and every patients could return to work except 1 poor case.
CONCLUSION
The surgical treatment using a autogenous cancellous bone grafting combined with threaded K-wire fixation for scaphoid nonunion was a relatively straightforward technique, which provides simplicity, and high union rate.

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A Treatment of Carpal Scaphoid Fracture: Ki Do Hong, Sung Sik Ha, Sang Weon Park; J Korean Soc Fract 2000;13(4):1003-1010. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.1003

Abstract PDF: PURPOSE
To analyze the clinical result of treatment of scaphoid fractures MATERIALS AND METHODS: From January 1994 to December 1998, we reviewed 25 carpal scaphoid fractures. Conservative treatment was performed in non-displaced, acute fractures and operative treatment was performed in others.
RESULT
Bony union takes average 13.6weeks of all cases and no statistical difference was seen between conservative treatment group(average : 12.7weeks) and operative treatment group(average : 14.1weeks). The complications were seen in 6 cases(24%), which were non-union in one case among the conservative treatment group, and non-union in one case, osteoarthritis in 3 cases and reflex sympathetic dystrophy in one case among the operative treatment group. Satisfactory results were 17(68%) of 25 cases by Maudsley's method. No statistical difference was seen between conservative treatment group(satisfactory results:78%) and operative treatment group(satisfactory results:63%)(p>0.05), but statistical difference was seen between acute fracture group(satisfactory result:81%) and others(satisfactory results:44%)(p<0.05).
CONCLUSION
More satisfactory result was seen in acute fracture group than in subacute and old fracture group, therefore we think early diagnosis has important role in result of treatment of scaphoid fracture. Also we think conservative treatment is preferable to non-displaced, acute fracture and operative treatment is preferable to others.

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The Operative Treatment of Displaced Waist Fracture of Scaphoid: Kun Yung Lee, Young Kee Lee, Yong Man Cho, Heung Sik Kang, Cheon Dong Lee, Sang Su Oh; J Korean Soc Fract 1997;10(1):164-170. Published online January 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.1.164

Abstract PDF: The authors surveyed the clinical study of 17 cases of scaphoid fractures from March 1989 to September 1994 with minimal 1 year follow up at Department of Orthopedic Surgery, Lee-Rha general Hospital. The following conclusions were obtained through clinical survey. 1. Of all 17 cases, they were 13 males and 4 females; Among the 13 males, 10 cases were aged between 20 and 39 years, forming 58.8% of all. 2. All 17 cases were treated by open reduction. Unions were obtained at average 11.5 weeks in 7 cases treated with Herbert screw fixation and 12 weeks in 10 cases treated with K-wire fixation. 3. Two of ten K-wire treated cases resulted in delayed union, one of seven Herbert screw treated cases resulted in delayed union. 4. Unions were obtained at average 20 weeks in 3 cases of delayed union. We concluded that open reduction and K-wire fixation were recomanded for the compatible treatment method of displaced waist fracture of scaphoid.

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Treatment of Carpal Scaphoid Fracture: Byoung Ho Lee, Dong Min Shin, Sang Ho Ha; J Korean Soc Fract 1996;9(2):274-282. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.274

Abstract PDF: We reviewed 32 cases of scaphoid fracture, treated from June, 1989 to June, 1994. The average follow up period from operation was 13 months. We analyed clinical result according to fracture classification and method of treatment. Nonsurgical treatment of displaced fracture generall gave poor result. In scaphoid fracture associated with complex injury open anatomic reduction and ligament repair was significantly better than conservative treatment. In the treasradial-styloid scaphoid fracture, anatomic reuduction and fixation of radial stloid is neccessory. To protect the misplacenlent of hardware, procisional K-wirc fixation and radiological confirmation will be indispellsable.

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The Treatnent of Fracture and Nonunion of the Carpal Scaphoid: Sung Keun Sohn, Sung Soo Kim, Myung Soo Lee; J Korean Soc Fract 1996;9(2):264-273. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.264

Abstract PDF: The scaphoid fracture is the most common fracture in carpal bones and its incidence of nonunion, avascular necrosis and ostoarthritis is high because of its precarious blood supply and diffculties of diagnosis and treatment. Authors analyzed 14 cases of carpal scaphoid fractures that treated at the Department of Orthopaedic Surgery College of Medicine, Dong-A University from March 1991 to February 1994 The results were obtained as follows 1. The results of treatment were evaluated by Maudsley method. Excellent or good results were 7 of 8 cases in the Herbert screw fixation, 1 of 2 cases in the K-wire fixation and all cases in the conservative treatment and the bone graft. 2. The mean duration of immobilization was no significant difference regardless of the treatment method in fractures. But in nonunions,there was a decreased immbilization time with the Herbert screw fixation as comparing with the K-wire fixation. 3. In fractures, Herbert screw fixation showed early bone union comparing to other treatments. And there was no significant difference of bone union regardless of the treatment method in nonunion.

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Scaphoid nonunion Ireated by Bone Graft and Internal Fixation: Jae Sung Seo, Myun Whan Ahn, Woo Seok Jang; J Korean Soc Fract 1996;9(2):257-263. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.257

Abstract PDF: There is difficuity in the treatment of scaphoid nonunion, because of it is not easy to diagnosis scaphoid fracture after affecting the damage, and also of inadequate treatment. We have performed wedge bone Graft and internal fixation in treatment of 52scaphoid nonunions from April, 1986 to June, 1994. We got result as below by analysis of 27 cases which could follow up more than one year. 1. The most frequent age of fracture is the 3rd decade and the fracthre is more frequent in men (26 cases)than in woman (1 case). 2. The X-ray fingings of nonunion are bony sclerosis (13 cases), cystic change(3 cases), and absorption of fracture line (11 cases). 3. The mean period of bony union is 14.7 weeks. 4. In 8 cases there has been dorsal intercalated segmental instability(DISI) on preoperative X-ray finding and which is corrected after operation. 5. In evaluatory system by Herbert and Fischer about degree of patients satisfaction, the grade 0 is 15 cases, grade 1 is 11 cases and grade 2 is 1 case, in clinical results, grade 0 is 15 cases, grade lis 9 cases and grade 2 is 3 cases, in radiographic result, grade 0 is 22 cases, grade 1 is 4 cases, grado 2 is 1 case.

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Open Reduction & Internal Fixation for The Nonunion of Scaphoid Fracture: Eung Shick Kang, Ho Jeong Kang, Keun Soo Lee; J Korean Soc Fract 1996;9(1):8-14. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.8

Abstract PDF

Scaphoid fracture is the most common carpal bone fracture and at least 5% of acute fractures of the scaphoid fail to unite after conservative treatment. The failures have been attributed to delay in beginning treatment, inadequate immobilization, displacement of fragments, instability due to ligamentous injury, and inadequate blood supply of the proximal fragment. Previously, some authors reported several kinds of treatment mordality for nonunion of scaphoid. Of all the techniques that have been introduced, we have used open reduction and internal fixation (O/R & I/F) with autogenous iliac bone graft(AIBG). We reviewed the 10 cases of patients who underwent O/R & IT with K-wire or Herbert screw and A1BG from Jan 1985 to Aug 1994. The results were as follow 1.Among 10 cases, 9 cases were male and 1 case was female, and all cases were right hand, and most common age group was twenties (70%). 2.The most common cause of injury was falling with outstretched hand in 8 cases. 3.In the previous treatment, 8 cases had non-specific treatment and 2 cases had cast immobilization. 4.In the operation method, open reduction and internal fixation (O/R & IT) with K-wire combined with autogenous iliac bone graft (AIBG) for 8 cases, and O/R & I/F with Herbert screw combined with AIBG for I case and O/R & I/F with Herbert screw without bone graft for 1 case. 5-After operation, average duration of cast immobilization was 2.8 months (2.5months-3months). 6.All patients had a bony union with average duration 6.2 months (3months- 10months).

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Volar Percutaneous Cannulated Screw Fixation for Subacute Scaphoid Wasit Fracture
Jae Kwang Kim, Jong Oh Kim, Seung Yup Lee, Nam Hoon Do
Journal of the Korean Fracture Society.2009; 22(2): 104. CrossRef

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Lunate dislocation and perilunte dislocation with or without fracture: Won Jong Bahk, Jong Min Sohn, Nam Gee Lee, Seung Key Kim, Young Joo Park, Han Chang; J Korean Soc Fract 1996;9(1):42-49. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.42

Abstract PDF: The lnate dislocation and perilunte dislocation with or without fracture, occupying about 10% of carpal injury, might b classified as a same category of injury resulted from similar mechanim. Initial diagnosis was missed often. In case of failure of closed reduction, open reduction and internal fixation will be necessary. The authors analyzed retrospectively 15 patients with lunate dislocation and perilunate dislication without fracture(Group A)and perlunate dislication with scaphoid fracture(Group B) who were treated from 1989 to 1994 at our hespital. The follow-up periods were 7 months to 60 months with mean of 23.2 months. The results were as follows. 1.Group A were 2 cases of anterior dislication of lunate and 8 cases of perilunate dislocation Group B were 5 cases of transscaphoid perilunate fracture-dislocation. The direction of perilunar dislocation with or without scaphoid fracture was posterior in all cases. 2.The causes of injury were fall from height in 7 cases, slip in 3 cases, traffic accident in 3 cases and crushing injury in 2 cases. 3.The overall clinical results by modified Green and OBriens clinical score were excellent in 4 cases(26.7%), good in 4 cases (26.7%),fair in 4 cases(26.7)and poor in 3 cases(20%). 4.9 out of 10 cases (90%) in Group A and 3 out of 5 cases(60%) in Group B were superior to fair. Early treatment within 3 days injury was performed in 11 cases (7 in Group A,4 in Group B), The average point was 85 and 70, respectively and there was no statisticat significance between two groups(P>0.05). Treatment was delayed beyond two weeks after injury due to missed initial diagnosis and open wound in 4 cases(3 in Group A,1 in Grdup B). The final tesults were 1 case of good, 1 case of fair, 1 case of poor in Group a, and 1 case of poor in Group B. There was no statistical significance between the early treatment cases and delayed treatment cases(P>0.05). In conclusion, ounate and perilunate dislocation without scaphoid fracture can be treated by early operation to get and maintain the anatomical reduction. The authors thought that the presence of scaphoid fracture, nonanatomic reduction and delay in treatment are poor prognostic factors.

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The Result of Osteosynthesis of Scaphoid with Matti-Russe Technique and Herbert Screw: Duck Yun Cho, Young Gil Hahm, Myoung Hyoung Lee; J Korean Soc Fract 1996;9(1):24-32. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.24

Abstract PDF: Fracture of scaphoid are second most common fractures of wrist, and about 1/6 of these fractures proceed to nonunion. The most widely used surgical procedure of scaphoid nonunion has been Matti-Russe procedures,and Hebert screw is a recently introduced fixation device as a means of rigid internal fixation promoting union and decreasing immobilization time. Authors have managed 15 cases of scaphoid nonunion with Mtti-Russe bone grafting technique and herbert screw, and accomplished satisfactory results: The union rate Was 96.6%, the average time to union was 17.1 weeks, and according to Maudsleys assessment criteria, we obtained 7 cases of excellnt, 6 good, and 2 fair results. Despite of its technical demand and lack of the number and study material, Matti-Russe bone grafting technique with Herbert screw fixation seems efficient and reliable method of treatment.

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Surgical Treatment of Scaphoid Nonunion: Jae Ik Thim, Taek Sun Kim, Sung Jong Lee, Suk Ha Lee, Chang Moo Yoo, Kil Joo Han; J Korean Soc Fract 1996;9(1):15-23. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.15

Abstract PDF

The scaphoid fracture is the most common fracture of the carpal bone in young men and has high incidence of nonunion. Many methods of treatment for nonunion of the carpal scaphoid have been described; bone grafting, screw fixation, pulsed electromagnetic field and cast, percutaneous pinning and Herbert screw fixation. Two of the commonest methods of treatment are Matti-Russe procedure and Herbert screw fixation and this paper compares these two surgical treatments. At the Department of Orthopaedic Surgery, Korea Veterans Hospital, from October 1988 to October 1994, 11 cases of the scaphoid nonunion had been treated by Matti-Russe procedure only (4 cases), Matti-Russe procedure with K-wire (2 cases) and Bone graft with Herbert screw fixation (5 cases) and followed up more than 1 year. The results were as follows; 1. Among 11 cases, 10 cases were male and 1 case was female and the range of age was 19-46 years (Mean 26.2 years). 2. The sites of fracture were confined to the waist in 9 cases (82%) and prox 1/3 in 2 cases (18%). 3. The treatment methods were Matti-Russe only in 4 cases, Matti-Russe procedure with K-wire in 2 cases and Bone graft with Herbert screw fixation in 5 cases. 4. Postoperative cast immobilization was done for 16.5 weeks in the cases treated by Matti-Russe procedure and for 4 weeks in the cases treated by Bone graft with Herbert screw fixation. 5. The union rate was 91 % after postoperative 4 months (Mean 4.1 months). 6. The results of treatment were excellent in 7 cases (64%), good in 3 cases (27%) and fair in 1 case(9%). Therefore the Matti-Russe procedure and Bone graft with Herbert Screw fixation are good procedures in the treatment of scaphoid nonunion. But, Bone graft with Herbert screw fixation is more useful in young men because of short periods of immobilization and early returning to work.

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Citations to this article as recorded by

Volar Percutaneous Cannulated Screw Fixation for Subacute Scaphoid Wasit Fracture
Jae Kwang Kim, Jong Oh Kim, Seung Yup Lee, Nam Hoon Do
Journal of the Korean Fracture Society.2009; 22(2): 104. CrossRef

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Operative Treatment of Carpal Scaphoid Fractures with Herbert Screw: Sung Joon Kim, Kuhn Sung Whang, Jong Sun Leem; J Korean Soc Fract 1995;8(1):206-215. Published online January 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.1.206

Abstract PDF: Carpal scaphoid fracture is most common in carpal bone injury, but its not easy to diagnose this fracture after affecting the damage, and also is not rane induced avasular neeresis and/or non-union. 13 cases of carpal scaphoid fractures (5 displaced fresh fractures and 8 non-unions) were treated by open reduction and internal fixation with Herbert screw and also cancellous bone graft taking from distal radius were performed on the cases of non-union. The results and conclusions were follows 1. Bony union takes average 11.8 weeks in displaced fresh fractures and average 14.4 weeks in non-unions. 2. By final assessment, excellent result was taken in 10 and good in 3. 3. It might be effective procedure for which cancellous bone was harvested from distal radius of same operative site. 4. Herbert srrew would be one of the good and rigid internal fixation device for the treatment of scaphoid fracture.

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Surgical Treatment of Non-Union of the Carpal Scaphoid by Modified Matti-Russe Technique: Chearl Hyoung Kang, Chang Soo Kang, Young Sik Pyun, Kwang Soon Song, Byung Woo Min, Yo Han Choi; J Korean Soc Fract 1994;7(2):538-544. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.538

Abstract PDF: Although 90% of fresh carpal scaphoid fracture heals with adequate treatment, the rate of non-union is higher in untreated or misdiagnosed at the time of injury leading to carpal collapse and degenerative arthritis. We have treated these non-unions by modified Matti-Russe technique and all cases showed uneventful healing, but range of motion of the wrist joint decreased in some cases. We studied 18 patients of non-union of the carpal scaphoid treated modified Matti-Russe technique from November,1988 to December, 1992 and the results were as follows: 1. Among the 18 patients, the ratio of male and female was 16:2, and mean age was 23.0 years old. 2. Dominant hand was involved in 14 cases. 3. The fracture was most commonly situated at the waist of the scaphoid. 4. Bony union was obtained in all cases and the average time to radiological union was 18.0 weeks. 5. According to Maudsleys assessment, the results revealed as 7 cases of excellent, 9 cases of good and 2 cases of fair.

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A Diagnosis and Treatment of Carpal Scaphoid Fractures: Ig Gon Kim, Soo Gon Kim; J Korean Soc Fract 1994;7(2):371-378. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.371

Abstract PDF: The scaphoid fracture is the most common fracture in carpal bones. Its diagnosis is very difficult because of less symptoms and swelling. But unfortunately its complications such as nonunion, avascular necrosis, and osteoarthritis were severe. We reviewed 27 cases of the carpal scaphoid fractures treated from March 1989 to March 1993 in Hae-Dong hospital and obtained following results. 1. The highest peak was third and forth decades. 24 cases were male among 27 cases. The most common cause of fracture was outstretched hand injury. 2. The middle third was the most common location(60%) and transverse type fractures were 12 cases(75%) among these fractures. 3. We gained 75% bone union at average 15.4 weeks in proximal 1/3 carpal scaphoid fractures, 93% union at average 12.9 weeks in middle 1/3 fractures, and 100% union at average 11.2 weeks in distal 1/3 fractures. 4. The results of treatments were evaluated by Maudsley method. Excellent and good results were 10 of 11 cases in conservative treatment, 13 of 16 cases in operative treatment. According to fracture sites excellent, and good results were 1 of 4 cases in proximal fracture, 14 of 16 cases in middle fracture and all of 7 cases in distal. 5. The complications were 2 cases of nonunion,3 cases of avascular necrosis and 2 cases of osteoarthritis. 6. In case of delayed diagnosis, the longer duration of treatments were needed, We obtained better results in fresh, undisplaced fractures with thumb spica cast than old displaced fractures. We gained better results in displaced fractures with open reduction and bone graft than conservative methods.

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Clinical Study of the Trans-Scaphoid Perilunar Dislocation: Moon sang Chung, Choon Seong Lee, Se IL Suk; J Korean Soc Fract 1988;1(1):43-53. Published online November 30, 1988; DOI: https://doi.org/10.12671/jksf.1988.1.1.43

Abstract PDF

It is possible to diagnose trans-scaphoid perlunar dislocation(TSPD) with simple anteroposterior and lateral roetgenograms, But, there are many cases in which we make a wrong diagnosis as simple scaphoid fracture or perilunar dislocation. Most of the 7 cases among the 11 cases who visited Seoul Natioinal University Hospital from 1981 to 1987 were delayed 3 or more weeks because they were misdiagnosed as simple fracture, sprain or dislocation. It is important to identify the relationship of scaphoid with capitate or radius with simple lateral roetgerogran and we nust suspect accompanying perilunar dislocation if there is rotationary deformity in scaphoid fracture. We consider open reduction and internal fixation is better than closed reduction as treatment of TSPD because scaphoid fracture is easy to displace due to instability of fracture fragments in most cases. And we also suggest it is better to try open reductioin and internal fixation first than salvage operation as initral tratment of old fractures, if there is no osteoporosis and resorption of scaphoid fragment.

Citations

Citations to this article as recorded by

Treatment of Anchor Suture with Kirschner Wires Fixation for Chronic Perilunate Dislocation
Gab-Lae Kim, Yoon-Suk Hyun, Sung-Il Shin, Jung-Seob Park, Kyul Han, Sung-Yup Hong
Journal of the Korean Society for Surgery of the Hand.2014; 19(4): 200. CrossRef
Surgical Treatment of the Perilunate Dislocation and the Lunate Dislocation with Dorsal Approach
Soo-Hong Han, Jin-Myoung Dan, Dong-Hoon Lee, Young-Woong Kim
Journal of the Korean Fracture Society.2011; 24(4): 347. CrossRef

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