摘要:

Ununited fractures of the scaphoid, with or without collapse and its associated dorsal-carpal instability, can be readily treated by open reduction, iliac crest bone graft, and Kirschner wire fixation. Internal fixation of the scaphoid after insertion of the bone graft is an integral part of the operation. When properly done, the operation can result in a 97% union of ununited fractures of the scaphoid.

ISSN:0885-9698    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The Herbert screw's unique double-threaded design allows for complete subchondral containment and offers the theoretical advantages of earlier return to function and elimination of the need for removal (in contrast to other internal fixation devices) for the management of scaphoid fractures and nonunions. Its use is technically demanding and associated with a significant learning curve. Indications and contraindications for use of the Herbert screw in scaphoid fractures and nonunions are discussed, as are the specific technical details to which the surgeon must adhere for successful application of the device. Common pitfalls associated with use of the Herbert screw and ways to avoid them are also described.

ISSN:0885-9698    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

300,000 scaphoid fractures occur in the United States each year. Cast immobilization requires 8 to 26 weeks to achieve union after accurate fracture reduction. Approximately 10% of these fractures progress to nonunion.To reduce the prolonged and costly period of cast immobilization, nondisplaced or minimally displaced acute scaphoid fractures can be fixed internally with a new cannulated titanium screw, using arthroscopic assistance. Postoperative immobilization ranges from only 1 to 4 weeks.This procedure can significantly reduce the required period of immobilization and the associated cost impact of this injury.

ISSN:0885-9698    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Direct scapholunate ligamentous repair, supported by a dorsal radioscaphoid capsulodesis, should be considered for the treatment of most scapholunate dissociations when there is no osteoarthritis, regardless of the time that has elapsed since injury. Thirty-one patients were treated with this technique between 1972 and 1989. The records of 27 were available for this study. Average time from injury to surgical treatment was 16 months. One patient had to change occupations because of wrist symptoms. One failure to preserve a satisfactory scapholunate reduction is awaiting a reoperation.

ISSN:0885-9698    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Triscaphe arthrodesis is the treatment of choice for chronic scapholunate dissociation in the absence of radioscaphoid degenerative disease. This surgical approach creates a strong, stable symptom-free wrist with excellent functional range of motion. Despite the resultant altered wrist kinematics, it has not been observed clinically, and no report to date has demonstrated, that this triscaphe arthrodesis leaks to further wrist degenerative disease.

ISSN:0885-9698    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Scapholunate dissociation is a common wrist problem that can result in a significant disability. The pathognomonic radiographic sign is widening of the space between the scaphoid and lunate due to rotatory subluxation of the scaphoid. Wrist radiographs in the anteroposterior (AP) rather than the posteroanterior (PA) projection facilitate visualizing the widened intercarpal space. Scapholunate dislocations can also be dynamic in nature and motion radiographic studies are necessary to make the diagnosis in these rare cases.Treatment for a scapholunate dissociation continues to pose a dilemma for the clinician. For chronic cases, reducing the scaphoid subluxation and arthrodesing it to the capitate is an effective procedure. Although the fusion, as with other intercarpal fusions involving the scaphoid alters wrist mechanics, it succeeds in restoring stability and reducing pain.

ISSN:0885-9698    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

This article describes a technique of treating acute and subacute scapholunate dissociations using arthroscopic techniques. The physical findings and radiographic abnormalities associated with scapholunate disruption, as well as the portal anatomy in wrist arthroscopy, are discussed. The technique of arthroscopic debridement of the torn ligament to create a suitable environment in a fibrous pseudoarthrosis is explored, as are the technique of arthroscopic-assisted visualization of the reduction from the radiocarpal and midcarpal joints and the use of the image intensifier in percutaneous pin fixation of that reduction. Finally, this article details the postoperative regimen used by the senior author (GGP). The authors believe that the technique of arthroscopic-assisted scapholunate ligament reconstruction provides a relatively noninvasive option with low morbidity for the management of a difficult problem. Further, it permits the diagnosis and possible treatment of associated ligamentous and cartilaginous injuries.

ISSN:0885-9698    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Performance of a precision oblique ulnar shortening osteotomy with the ROS SystemTMis an attractive alternative to the imprecise and technically demanding free-hand techniques that have been described. Exact osteotomy width and parallel bone surfaces are ensured. Compression of the osteotomy surfaces is simplified, and interfragmentary screw placement across the osteotomy is facilitated.

ISSN:0885-9698    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Mild ulnar impaction syndrome can be treated by resecting 2 to 4 mm of the head (pole) of the distal ulna. The styloid process of the ulna and the attachments of the triangular fibrocartilage complex (TFCC) into the fovea of the distal ulna are left intact. The majority of the articular cartilage of the distal radioulnar joint is preserved. The procedure decompresses the ulnocarpal junction, allows inspection and débridement of the TFCC, and avoids the potential complications of an osteotomy to shorten the ulna.

ISSN:0885-9698    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Arthroscopic removal of the distal ulna is a biomechanically sound treatment for the ulnar impaction syndrome. It is indicated for ulnar wrist pain unresponsive to conservative care for mild to moderate disease (palmar stage 2C). Success has been achieved in a series of 10 patients treated with arthroscopic distal ulna excision with gradual pain resolution over 3 months.

ISSN:0885-9698    

出版商:OVID    

年代:1992

数据来源: OVID