The management of pain, stiffness and weakness of the wrist following unsuccessful conservative treatment of fractures of the scaphoid or of Kienb#{246}ck’s disease is a difficult problem. The result of excision of the affected bone is unpredictable and arthrodesis is a major procedure which leaves a disability. To avoid these disadvantages Stamm (1944) suggested arthroplasty of the wrist by ex...

A vascularised bone-graft procedure from the base of the second metacarpal was performed in 14 patients with nonunion of the scaphoid. There were 11 men and three women with a mean age of 22 years. In eight patients, who had dorsiflexed intercalated segment instability (DISI), an open wedge was formed at the site of nonunion, and the vascular pedicle was grafted from the volar side. In the six ...

We report the use of a free vascularised iliac bone graft in the treatment of 21 patients (19 men and 2 women) with an avascular nonunion of the scaphoid in which conventional bone grafting had previously failed. The mean age of the patients was 32 years (23 to 46) and the dominant wrist was affected in 14. The mean interval from fracture to the vascularised bone grafting was 39 months (9 to 62...

Kienbock's disease, or osteonecrosis of the lunate, can lead to chronic, debilitating wrist pain. Etiologic factors include vascular and skeletal variations combined with trauma or repetitive loading. In stage I Kienbock's disease, plain radiographs appear normal, and bone scintigraphy or magnetic resonance imaging is required for diagnosis. Initial treatment is nonoperative. In stage II, scler...

PURPOSE To examine the effects of scaphoid retention, inclusion, and excision on wrist motion and radiolunate contact characteristics in a cadaveric model after simulated 4-corner fusion with rigid internal fixation. METHODS Seven fresh-frozen cadaveric upper extremities were examined. For all surgical manipulations the motion was measured and contact characteristics were assessed using ultra...

We reviewed 26 consecutive men of mean age 28 years who had wedge bone grafting and Herbert screw fixation for symptomatic established nonunion of the waist of the scaphoid. The period between injury and operation averaged 30 months (10 to 96), and 11 of the 26 patients had had previous operations, seven with bone grafts. At a mean follow-up of 14 months (6 to 42) 25 fractures (95%) had united ...

DISLOCATION of the scaphoid is a rare injury of which only a few reports of its occurrence appear in the literature. These include Higgs (1930), two cases; Buzby (1934); Kuth (1939); Wood-Walker (1943); Schlossbach (1954) and Connell & Dyson (1955), all reporting single cases. Russell (1949), in a review of intercarpal dislocations and fracture dislocations reported only one case of dislocation...

OBJECTIVE Ulnar variance may be a risk factor of developing scaphoid non-union. METHODS A review was made of the posteroanterior wrist radiographs of 95 patients who were diagnosed of scaphoid fracture. All fractures with displacement less than 1mm treated conservatively were included. The ulnar variance was measured in all patients. RESULTS Ulnar variance was measured in standard posteroan...

In an earlier study we have proposed a scaphoid decision-protocol in order to improve diagnostic accuracy in case of suspected scaphoid fractures. This pilot study evaluated this protocol. In this pilot study (n = 31) most cases with clinical suspicion of scaphoid fractures reached a positive test result on the combined 7 clinical tests (93.5%). Using this test combination, no scaphoid fracture...