Aims. Occult (clinical) injuries represent 15% of all scaphoid fractures, posing significant challenges to the clinician. MRI has been suggested as the gold standard for diagnosis, but remains expensive, time-consuming, and is in high demand. Conventional management with immobilization and serial radiography typically results in multiple follow-up attendances to clinic, radiation exposure, and delays return to work. Suboptimal management can result in significant disability and, frequently, litigation. Methods. We present a service evaluation report following the introduction of a quality-improvement themed, streamlined, clinical
Objective. Delayed radiographs are routinely done to help in diagnosis of occult scaphoid fractures. Our aim was to determine the diagnostic value of these late x-rays. Methods. This is a radio-diagnostic study. We prospectively reviewed radiographs of 67 patients with injury to their wrists who presented with anatomical snuff box to the accident and emergency department.5 patients showed up a fracture of the
A prospective study was performed to develop
a clinical prediction rule that incorporated demographic and clinical factors
predictive of a fracture of the
This study describes the introduction of a virtual pathway for the management of suspected scaphoid fractures and reports patient-reported outcome measures (PROMs) and satisfaction following treatment with this service. All adult patients that presented with a clinically suspected scaphoid fracture that was not visible on presentation radiographs over a one-year period were eligible for inclusion in the pathway. Demographics, examination findings, clinical
Bone bruising of the
We randomly allocated 60 consecutive patients with fractures of the waist of the
We have investigated whether assessment of blood flow to the proximal
Fractures of the
Background. Fractures of the
Background. Controversy persists regarding preference between Herbert and Acutrak screw for internal fixation of
Introduction.
There is a lack of published evidence relating to the rate of nonunion seen in occult scaphoid fractures, diagnosed only after MRI. This study reports the rate of delayed union and nonunion in a cohort of patients with MRI-detected acute scaphoid fractures. This multicentre cohort study at eight centres in the UK included all patients with an acute scaphoid fracture diagnosed on MRI having presented acutely following wrist trauma with normal radiographs. Data were gathered retrospectively for a minimum of 12 months at each centre. The primary outcome measures were the rate of acute surgery, delayed union, and nonunion.Aims
Methods
We describe a semi-closed method of Herbert screw fixation for acute fractures of the
This is a retrospective study of six children with ununited scaphoid fractures treated conservatively. Their mean age was 12.8 years (9.7 to 16.3). Five had no early treatment. Radiological signs of nonunion were found at a mean of 4.6 months (3 to 7) after injury. Treatment consisted of cast immobilisation until clinical and radiological union. The mean clinical and radiological follow-up was for 67 months (17 to 90). We assessed the symptoms, the range of movement of the wrist and the grip strength to calculate the Modified Mayo Wrist score. The fracture united in all patients after a mean period of immobilisation of 5.3 months (3 to 7). Five patients were pain free; one had mild pain. All returned to regular activities, and had a range of movement and grip strength within 25% of normal, resulting in an excellent Modified Mayo Wrist score. Prolonged treatment with cast immobilisation resulted in union of the fracture and an excellent Modified Wrist Score in all patients.
Biomechanical studies have shown that a long, centrally placed screw is favourable in scaphoid fracture fixation. A volar percutaneous transtrapezial approach was developed to facilitate central screw placement. The purpose of this study was to evaluate radiographic changes at the ST-joint at long term follow up in patients where this approach was used. Results were graded with use of the visual analogue scale (VAS) and modified Mayo wrist score. Radiographs of both hands, comprising an anteroposterior, lateral and 45 degrees pronated oblique view were obtained. Degenerative changes at the ST-joint were staged according to the modified Eaton & Glickel classification.Introduction
Method
Aims. There has been an increasing use of early operative fixation for scaphoid fractures, despite uncertain evidence. We conducted a meta-analysis to evaluate up-to-date evidence from randomized controlled trials (RCTs), comparing the effectiveness of the operative and nonoperative treatment of undisplaced and minimally displaced (≤ 2 mm displacement) scaphoid fractures. Methods. A systematic review of seven databases was performed from the dates of their inception until the end of March 2021 to identify eligible RCTs. Reference lists of the included studies were screened. No language restrictions were applied. The primary outcome was the patient-reported outcome measure of wrist function at 12 months after injury. A meta-analysis was performed for function, pain, range of motion, grip strength, and union. Complications were reported narratively. Results. Seven RCTs were included. There was no significant difference in function between the groups at 12 months (Hedges’ g 0.15 (95% confidence interval -0.02 to 0.32); p = 0.082). The complication rate was higher in the operative group and involved more serious complications. Conclusion. We found no difference in functional outcome at 12 months for fractures of the waist of the
The use of pulsed electromagnetic fields (PEMF)
to stimulate bone growth has been recommended as an alternative to
the surgical treatment of ununited scaphoid fractures, but has never
been examined in acute fractures. We hypothesised that the use of
PEMF in acute scaphoid fractures would accelerate the time to union
by 30% in a randomised, double-blind, placebo-controlled, multicentre
trial. A total of 53 patients in three different medical centres
with a unilateral undisplaced acute scaphoid fracture were randomly
assigned to receive either treatment with PEMF (n = 24) or a placebo
(n = 29). The clinical and radiological outcomes were assessed at
four, six, nine, 12, 24 and 52 weeks. A log-rank analysis showed that neither time to clinical and
radiological union nor the functional outcome differed significantly
between the groups. The clinical assessment of union indicated that
at six weeks tenderness in the anatomic snuffbox (p = 0.03) as well
as tenderness on longitudinal compression of the
We studied 45 patients with 46 fractures of the
We treated 50 patients with fractures of the waist of the
INTRODUCTION. Scapholunate instability is a common form of carpal instability and Brunelli procedure has been advocated as a surgical intervention for this difficult problem. MATERIALS AND METHODS. Twenty five patients with clinical and radiological diagnosis of scapholunate dissociation were included in the study. Mean age of the patients was 37 years. All the patients were treated by modified Brunelli procedure, with the flexor carpi radialis tendon being passed through a drill hole in