Background: There are many different methods for fixation of displaced scaphoid fractures or fractures that displaces after few weeks casting. Because of unique distal circulation of scaphoid, it seems that any method with less injury to its blood circulation would have better results. Based on this theory, we examined the feasibility of antegrade percutaneous fixation in a series of such fractures.Methods: This study was performed from April 2004-2006 at orthopedic department in Kashani hospital, affiliated to Isfahan University of Medical Sciences. Eleven patients with acute fracture or fibrous union were treated with rigid fixation by a bi-head titanium compression screw inserted via dorsal percutaneous technique.Findings: Physical examination, plain radiography and computed tomography confirmed the union in an average of ten weeks. According to the Mayo modified wrist score, there were eight excellent and three good results.Conclusion: The findings in this small series revealed that antegrade scaphoid fracture fixation provides rigid fixation to achieve healing. This finding should be confirmed by larger studies with longer follow-up periods.

Background and objective: Scaphoid Nonunion Advanced Collapse (SNAC) is a common pattern of degenerative wrist arthritis. Besides the conventional surgical method (4-corner fusion (4CF)), alternative methods have been described as capitolunate arthrodesis. The objective of this study was to investigate the surgical result of the capitolunate fusion and the results from the post-surgical one-year follow-up. Materials and methods: From March 2008 to March 2017, among 21 patients with SNAC wrist, stages 2 and 3, 14 were included. Following the scaphoid resection, by preserving capitate convexity and concavity of the lunate's distal face, the lunate was reduced on the capitate, and capitolunate fusion was done using Herbert screws, in the antegrade direction. All patients were followed for one year. Clinical examinations and wrist x-rays were investigated in each follow-up session. Visual analog score (VAS), Disability of the Arm, Shoulder, and Hand (DASH score) were compared before and after the surgery. Grip strength, flexion and extension were recorded one year after surgery, compared with intact nonoperated hand. Results and conclusion: Union occurred in all of the patients. VAS score and DASH score decreased (from 6. 5 to 3. 3 and from 46. 14 to 30. 43). The VAS score and DASH score decreased significantly after a one-year follow-up (P-value ≤ 0. 05). Operated hand flexion was 34. 30 (20-80), the extension was 32. 58 (20-60), and grip strength was 29. 69 Kg (22-40). Non-operated hand flexion was 56. 38(30-80), the extension was 61. 8 (38-80), and grip strength was 44. 54 Kg (28-76). These differences were statistically significant (P-value ≤ 0. 05). Based on our study results, scaphoid excision and capitolunate arthrodesis resulted in an acceptable functional wrist with minimal pain. This finding reflects that capitolunate arthrodesis is a time-saving and easy-to-learn procedure. Minimal morbidity of this method supports the idea that the capitolunate arthrodesis is an acceptable alternative to 4CF, the conventional surgical method.

Background: The carpal structure consists of eight individual bones aligned in officially two rows, in axial plains, proximal and distal. The proximal row is made of three main bones and one sesamoid bone and from radial to ulnar includes scaphoid, lunate, triquetrum, and finally pisiform, which could be barely considered as an individual bone. This is because it has no articular surface attachment to proximal or distal bony structures, and is engulfed by flexor carpi ulnaris tendon. The distal row from radial side to ulnar side includes trapezium, trapezoid, capitate, and hamate. . .

BACKGROUND: Negative ulnar variance can be a risk factor in Kienbock’s disease, wrist instability, and scaphoid bone fracture. This study focused on the ulnar variance in wrists with scaphoid bone nonunion.METHODS: We retrospectively reviewed posteroanterior wrist radiographs of 65 patients who were diagnosed as established scaphoid nonunion and underwent open reduction and bone grafting between 2005 and 2010. We used reference radiographs from contralateral wrists of 65 consecutive skeletally- mature patients with distal radius fracture as the control group and then measured ulnar variance and compared it in both groups.RESULTS: Ulnar variance was measured in standard posteroanterior wrist X-rays of 65 scaphoid nonunion and 65 normal controls. Twenty five patients (38.5%) in the scaphoid nonunion group had negative ulnar variance, and the mean value was -0.26 (± 1.24) mm (range: -3, +2). In the control group, 15 subjects (23.1 %) had an ulnar minus wrist, and the mean ulnar variance was +0.54 (±1.47) mm (range: -3, +4). The difference in ulnar variance was significant between the two groups (P-value=0.001).CONCLUSION: Ulnar variance may influence developing of nonunion process in scaphoid bone fracture.

Carpal fracture-dislocation is regarded as an unusual orthopedic injury and, thus, orthopedic surgeons are less experienced in dealing with and treating these fractures and dislocations. We report a 20-year-old worker man suffering from an unusual carpal fracture-dislocation. There was trans-scaphoid fracture and lunate dislocation with other carpal proximal bones toward volar of the wrist. Two volar and dorsal approaches were used to treat and stabilize the fracture. It was completely stabilized after open reduction and fixation using several pins. After two days, neural symptoms were completely recovered and the patient was discharged. Postoperative radiographies revealed complete restitution of lesser and greater arcs and normalization of Gilula’s line. Scapholunate and lunatocapitate angles reached to less than 60° and 10°, respectively. The combined approach had favorable results for treatment of this unusual type of carpus fracture dislocation. However longer follow up is need to evaluate the arthritis and degenerative changes in wrist.

No consensus regarding optimal treatment or etiology of Preiser disease exists. We described the epidemiology, classification and treatment characteristics of 18 patients with Preiser disease. Patients with changes related to previous trauma, and without radiographs were excluded. Based on the radiographs at diagnosis, we classified 13 scaphoids as Herbert Lanzetta stage II, four as stage III, and one as stage IV. In 12 patients nonspecific treatment was offered and only two patients received surgical treatment. We found that chosen treatment is not associated with the severity of Herbert Lanzetta stage and the outcome is not influenced by chosen treatment.