Objectives: Non-repairable scaphoid proximal pole nonunion remains a major challenge. Various reconstructive surgical approaches have been introduced, but each one has some limitations, including microvascular anastomosis, donor site morbidities, and the risk of compromising the scapholunate ligament. Methods: This prospective interventional case series was performed on five patients. The patients underwent reconstructive surgery using proximal hamate arthroplasty by a single surgeon and were followed up for at least 12 months. Results: All patients were male and the median age was 28, and the median follow-up time was 24 months. The median Mayo score was 70, and the DASH score was 0 (no disability) in 3 patients and 15 in two patients. The median of postoperative grip strength in the operated hands was 37. 3 kg (Range 36. 1–39) and in the opposite hands was 42. 5 kg (Range 40–45. 9). However, there were significant differences between grip strength between operated and opposite hands (P value= 0. 008). A reduction of 11. 1% and 15% was shown in postoperative flexion and extension compared with preoperative flexion and extension (P value = 0. 194, P value = 0. 102). Conclusion: Hamate arthroplasty for nonunion of the scaphoid proximal pole appears to be a viable surgical option with favorable outcomes in terms of union rates, functional recovery, and patient satisfaction. Level of evidence: IV

Background: Distal pole scaphoid resection (DPSR) is an effective way to manage chronic scaphoid non-union with limited degenerative arthritis. Studies have reported positive results in terms of pain relief, wrist range of motion and grip strength, and patient satisfaction. However, the biomechanical consequences of DPSR remain unclear. This study evaluates the effects of DPSR on carpal mechanics by assessing changes in radiographic parameters with varying quantities of scaphoid removal. Methods: Six fresh frozen cadaveric upper extremities were used. Resections of 25%, 50%, and 75% of the length of each scaphoid were performed under fluoroscopic image guidance. For the intact scaphoid and each resection level, the following radiographic parameters were assessed: radiolunate and capitolunate angles; carpal height and first metacarpal subsidence ratios, and ulnar carpal translation. Measurements were then repeated for grip and pinch as well as radial and ulnar wrist deviation positions. Radial styloid to trapezium distance in wrist radial deviation was also measured to assess for impingement. Results: There was a statistically significant increase in the mean radiolunate angle with increasing scaphoid resection quantities. No statistically significant correlations were found between radial styloid clearance and increasing scaphoid resection percentages. Changes in the remaining variables did not reach statistical significance. Conclusion: Increasing levels of scaphoid resection is associated with progressive signs of carpal malalignment best depicted by increasing radiolunate angles. Diminishing radial styloid clearance was clinically evident as more scaphoid was resected. For this, prophylactic radial styloidectomy may be considered to avoid bony impingement.

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. . .

Introduction: The scaphocapitate fracture syndrome is a rare injury and refers to concomitant fractures of the scaphoid and capitatecarpal bones. It is a special type of perilunate fracture dislocation, accompanied with rotation of 90 or 180 degrees of thefractured proximal pole of the capitate bone. Case Presentation: A right-handed 23-year-old man was presented due to left wrist pain after falling down from great height. Hiswrist was swollen with severe pain, tenderness, and remarkable restriction of the range of motion. Plain X rays and CT scan revealedscaphoid waist fracture accompanied with capitate fracture and rotation of its proximal pole indicating scaphocapitate fracturesyndrome. The scaphoid and head of the capitate were reduced and fixed with headless Herbert screws and the injured lunotriquetralligament was repaired followed by immobilization of the wrist for 6 weeks. After removing the cast, the patient was referred tophysical therapy and finally achieved a painless wrist with acceptable range of motion and grip strength. Conclusions: Careful clinical examination and appropriate imaging are essential for diagnosis of this rare injury. Open reductionthrough posterior approach as well as anatomic reduction and fixation with headless compression screws and repairing the ligamentousinjuries can result in acceptable clinical and radiological outcomes.

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.

Background and Objective: Treatment of scaphoid fractures is studied extensively due to the specific anatomic shape and position, blood flow and its performance. In recent years, several treatment methods have been devised which are associated with various findings. This study was done to evaluate the short-term results of limited dorsal approach in treatment of scaphoid fracture.Materials and Methods: In this descriptive study, 14 male patients with scaphoid fracture were gone under limited dorsal approach in treatment of scaphoid fracture in 5th Azar teaching hospital in Gorgan, Iran. Patients were followed up for 12 weeks and the onset of infection, screw breakage and joint degenerative changes were evaluated.Results: 64% of scaphoid fractures were in waist of the bone. The mean time to union was 10.5 weeks. 64% of patients returned to work after 12 weeks. In none of the patients, infection, wound breakdown and joint destruction were seen. There were two-delayed union (>12 weeks) and two screw head prominency in the scaphotrapezial joint but patients did not complain and their hand movements had no problem. During procedures, two guide pin failures occurred with no adverse effect in fixations. Complications were minor and wrist movements were nearly normal.Conclusion: Limited posterior approach in the treatment of scaphoid fractures is an easier, faster and better union rate. Despite the short duration of follow-up study, this method is recommended in the treatment of scaphoid fractures.

Background: Scaphoid fracture is the most common wrist injury with a high rate of misdiagnosis and subsequent complications. As the morphology of the distal radius affects the load transmission through the carpal bones, radiographic wrist indices may help prevent missing occult fractures. Objectives: The current retrospective case-control study compared the distal radius radiographic indices of patients with a scaphoid fracture with a control group. Methods: Wrist X-rays of 129 patients with scaphoid fractures (case group) and the contralateral uninjured side of 101 patients with distal radius fractures (control group) were assessed by two orthopedic surgeons. Anteroposterior and lateral radiographs were evaluated to measure the radial height (RH), radial inclination (RI), ulnar variance (UV), and volar tilt (VT). Results: The student t-test was used to compare the distal radius radiographic indices between the two groups. The average RI was 27. 14 in the scaphoid fracture group and 24. 35 in the control group (P<0. 05). Mean VT, RH, and UV of the case group were, 12. 32, 15. 01, and-0. 73, respectively,this is while in the control group, the above measures were 10. 76, 13. 52, and-0. 11, respectively (P<0. 05). Conclusion: High values of RH, RI, and VT, and negative amount of UV are significantly correlated with scaphoid fracture after a Fall Onto an Outstretched Hand (FOOSH) injury.

Suspected Scaphoid Fractures are common problems in medical practice, which account for countless work-hours losses each year. This was a prospective study that was performed on 51 patients with suspected scaphoid fracture in Doctor shariati and shahid Moaieri hospitals within eight months. The patients were treated with removable thumb splint and weekly physical examination. We found that 90% of immobilizations were unnecessary and removable brace and weekly examination and early rehabilitation can reduce the immobilization time in more than half of our patients.

Background: Scaphoid nonunion is not uncommon and may eventually lead to complications such as deformity, instability, and degenerative changes. Open reconstruction could jeopardize vascular supply and cause capsular contracture. Arthroscopic treatment of scaphoid nonunion is an effort to avoid such complications. Objectives: This study evaluated the mid-term results of arthroscopic assisted treatment of scaphoid nonunion. Methods: Fifteen patients who underwent arthroscopic assisted treatment of scaphoid nonunion were included in the study. Ten patients had scaphoid waist fractures, while in five patients, the fracture was in the proximal pole. The union was evaluated radiographically three months, six months, and one year after surgery. The range of active motion, grip strength, and standard disability questionnaires such as disabilities of the arm, shoulder, and hand (DASH), patient-related wrist evaluation (PRWE), and modified Mayo wrist scales were evaluated one year after surgery. Results: Based on radiographic findings, all patients’,fractures were satisfactorily united after three months. Functional scores, motion range, and grip strength improved to an acceptable level. There was no complication, including infection or nerve damage. Conclusions: Arthroscopic treatment of scaphoid nonunion seems to be an effective method with low complications and favorable results.