scholarly journals Fractures of the scaphoid, diagnosis and managementa review

2013 ◽  
Vol 60 (2) ◽  
pp. 99-102 ◽  
Author(s):  
Sladjana Andjelkovic ◽  
Cedo Vuckovic ◽  
Aleksandar Lesic ◽  
Goran Tulic ◽  
Suzana Milutinovic ◽  
...  
Keyword(s):  
Scaphoid Fracture ◽  
Delayed Union ◽  
Adverse Outcomes ◽  
Scaphoid Bone ◽  
Wrist Injuries ◽  
Delay In Diagnosis ◽  
Scaphoid Fractures ◽  
Radiocarpal Joint ◽  
High Index Of Suspicion ◽  
Loss Of Motion

The scaphoid is vitally important for the proper mechanics of wrist function. Fracture of the scaphoid bone is the most common carpal fracture. Among all wrist injuries the incidence of scaphoid fracture is second only to fractures of the distal radius. Scaphoid fractures are significant because a delay in diagnosis can lead to a variety of adverse outcomes that include nonunion, delayed union, decreased grips strength, range of motion and osteoarthritis of the radiocarpal joint. To avoid missing this diagnosis, a high index of suspicion and a through history and physical examination are necessary, because initial radiographs are often negative. Regardless of the technique of bone grafting, there will almost always be some loss of motion even if the fracture unites.

scholarly journals Isolated Jejunal Perforation and Mesentery Injury following a Kick on the Abdomen of a College Student: A Case Report from a District Hospital in Northern Ghana

2020 ◽  
Vol 2020 ◽  
pp. 1-4 ◽  
Author(s):  
Engelbert A. Nonterah ◽  
Solomon Atindama ◽  
Emmanuel Achumbowina ◽  
Michael B. Kaburise ◽  
Edwin Saanwie ◽  
...  
Keyword(s):  
College Student ◽  
Bowel Perforation ◽  
Diagnostic Procedures ◽  
Adverse Outcomes ◽  
Northern Ghana ◽  
Diagnostic Challenge ◽  
Abdominal Ultrasonography ◽  
Delay In Diagnosis ◽  
High Index Of Suspicion ◽  
Physical Findings

Introduction. Isolated jejunal perforation from blunt abdominal trauma is an extremely rare intra-abdominal injury that poses a huge diagnostic challenge. Delay in diagnosis and initiation of treatment often leads to significant morbidity and mortality. Diagnosis particularly in resource-poor settings may be extremely challenging and often relies on a high index of suspicion. This is due to lack of adequate diagnostic facilities and human resource to deal with the condition with resulting high occurrence of adverse outcomes. Case Presentation. We report a case of isolated jejunal perforation with associated mesentery injury in a young college student who sustained a kick to his abdomen while playing soccer. This is an unusual presentation since most reported cases often resulted from motor vehicular accidents, bicycle handlebar, and fall from a height. We emphasized the role of critical level of suspicion with a good history and physical examination as the major source of diagnosis since diagnostic procedures, such as abdominal ultrasonography and computed tomography, are largely unavailable in most resource-constraint settings. Early surgical intervention following diagnosis leads to good recovery and reduced mortality. Conclusion. Sufficient vigilance and suspicions of small bowel perforation should always be considered after blunt trauma even when symptoms and physical findings are minimal and when diagnostic capacity is limited.

Association of Lunate Morphology With Progression to Scaphoid Fracture Nonunion

Hand ◽  
2020 ◽  
pp. 155894472093736
Author(s):  
Rachel E. Hein ◽  
Amanda N. Fletcher ◽  
Rose T. Tillis ◽  
Eric Q. Pang ◽  
David S. Ruch ◽  
...  
Keyword(s):  
Scaphoid Fracture ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Delayed Union ◽  
Type I ◽  
Type Ii ◽  
Fracture Location ◽  
Scaphoid Fractures ◽  
Fracture Nonunion ◽  
N 93

Background: The purpose of our study was to review a series of patients with scaphoid fractures to determine whether there was an association between lunate morphology and progression to delayed union or nonunion when treated operatively or nonoperatively. Secondary aims included evaluation of the relationship between lunate morphology and scaphoid fracture location. Methods: A retrospective review of all patients with a diagnosis of scaphoid fracture was performed at our institution between 2014 and 2017. Medical records and radiographs were evaluated to determine lunate morphology, scaphoid fracture location, treatment, and time to union. Differences between groups were determined using χ2 analysis with significance set at P <.05. Multiple logistic regression analyses were used to evaluate scaphoid union in the setting of lunate morphology when controlling for confounders. Results: A total of 169 patients were included; 45.0% (n = 76) of patients had type I lunate morphology, and 55.0% (n = 93) had type II. In all, 64.5% (n = 49) of patients with type I lunate and 68.8% (n = 64) with type II lunate had a fracture at the scaphoid waist. Among all patients with a scaphoid fracture, type II lunates were more likely than type I lunates to progress to nonunion when treated both operatively and nonoperatively (18.3% vs 4.0%, P = .0042). Lunate facet size was not shown to be a significant risk factor for nonunion among patients with a type II lunate ( P = .4221). Conclusions: Patients with a scaphoid fracture and type II lunate morphology were more likely to progress to nonunion than patients with a type I lunate.

Controversies and best practices for acute scaphoid fracture management

2017 ◽  
Vol 43 (1) ◽  
pp. 4-12 ◽  
Author(s):  
Nina Suh ◽  
Ruby Grewal
Keyword(s):  
Best Practices ◽  
Current Literature ◽  
Scaphoid Fracture ◽  
Evidence Based ◽  
Wrist Injuries ◽  
Treatment Practices ◽  
Scaphoid Fractures ◽  
Fracture Management ◽  
Management Algorithms

Acute scaphoid fractures are common wrist injuries that continue to elicit debate from surgeons regarding the most appropriate diagnostic and management algorithms. This review will examine the current literature and trends, in an attempt to provide the reader with an evidence-based discussion regarding current controversies of interest to clinicians. In addition, an attempt will be made to provide recommendations for the best treatment practices for acute scaphoid fractures.

Diagnostic Strategy for Suspected Scaphoid Fractures in the Presence of Other Fractures in the Carpal Region

2006 ◽  
Vol 31 (4) ◽  
pp. 416-418 ◽  
Author(s):  
F. J. P. BEERES ◽  
M. HOGERVORST ◽  
P. DEN HOLLANDER ◽  
S. J. RHEMREV
Keyword(s):  
Bone Scintigraphy ◽  
Bone Fractures ◽  
Scaphoid Fracture ◽  
Diagnostic Process ◽  
Scaphoid Bone ◽  
Diagnostic Strategy ◽  
X Rays ◽  
Scaphoid Fractures ◽  
Bone Injury ◽  
Suspected Scaphoid Fracture

Bone scintigraphy will identify up to 25% of occult scaphoid bone fractures after negative scaphoid X-rays. Consequently, it deserves a place in the diagnostic process of suspected scaphoid fractures. However, the role of bone scintigraphy is less clear if scaphoid X-rays show other fractures in the carpal region. We analysed 111 consecutive patients with a suspected scaphoid fracture on physical examination. Scaphoid X-rays revealed 61 fractures. Fifty-five patients had scaphoid fractures only and six patients had other fractures in the carpal region but no scaphoid fracture. In 50 cases, no bone injury was seen on these X-rays. In three out of the six patients with other fractures in the carpal region, bone scintigraphy revealed four occult concomitant fractures: one scaphoid, one scaphoid and trapezial and one capitate fracture. In conclusion, bone scintigraphy is required when scaphoid X-rays do not confirm a suspected scaphoid fracture, even in the presence of other fractures in the carpal region.

scholarly journals Suspected scaphoid injuries managed by MRI direct from the emergency department

2021 ◽  
Vol 2 (6) ◽  
pp. 447-453
Author(s):  
Benjamin J. F. Dean ◽  
Christopher Little ◽  
Nicholas D. Riley ◽  
Edward Sellon ◽  
Warren Sheehan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Scaphoid Fracture ◽  
Clinical Signs ◽  
Early Discharge ◽  
Median Number ◽  
Service Evaluation ◽  
Delayed Union ◽  
Cast Immobilization ◽  
Wrist Trauma ◽  
Scaphoid Fractures

Aims To determine the role of early MRI in the management of suspected scaphoid fractures. Methods A total of 337 consecutive patients presenting to an emergency department (ED) following wrist trauma over a 12-month period were prospectively included in this service evaluation project. MRI was not required in 62 patients with clear diagnoses, and 17 patients were not managed as per pathway, leaving a total of 258 patients with normal scaphoid series radiographs who were then referred directly from ED for an acute wrist MRI scan. Patient demographics, clinical details, outcomes, and complications were recorded at a minimum of a year following injury. Results The median time from injury to ED presentation was one day and the median number of positive clinical signs was two out of three (snuffbox tenderness, tubercle tenderness, pain on telescoping). Of 258 patients referred for acute MRI, 208 scans were performed as 50 patients either did not tolerate (five patients) or did not attend their scan (45 patients). MRI scans demonstrated scaphoid fracture (13%), fracture of another bone (22%), scaphoid contusion (6%), other contusion/ligamentous injury (20%), or solely degenerative pathology (10%). Only 29% of scans showed no abnormality. Almost 50% of those undergoing MRI (100 patients) were discharged by ED with advice, with only one re-presentation. Of the 27 undisplaced occult scaphoid fractures, despite prompt cast immobilization, two experienced delayed union which was successfully treated with surgery. Conclusion The use of MRI direct from ED enables prompt diagnosis and the early discharge of a large proportion of patients with normal radiographs following wrist trauma. Cite this article: Bone Jt Open 2021;2(6):447–453.

Operative Treatment of Acute Scaphoid Fractures

Hand Surgery ◽  
2015 ◽  
Vol 20 (02) ◽  
pp. 210-214 ◽  
Author(s):  
Lana Kang
Keyword(s):  
Operative Treatment ◽  
Scaphoid Fracture ◽  
Delayed Union ◽  
Carpal Bone ◽  
Non Union ◽  
Inherent Risk ◽  
Scaphoid Fractures ◽  
Appropriate Treatment ◽  
Missed Diagnosis ◽  
Challenging Situation

Optimal treatment of acute scaphoid fractures is a necessary goal for many reasons. One is that the scaphoid is the most commonly fractured carpal bone. Another is that a missed diagnosis of an acute scaphoid fracture leads to the more challenging situation of a delayed union, non-union and risk for premature radiocarpal arthrosis. Because the scaphoid has an inherent risk for nonunion due to its the tenuous blood supply, timely diagnosis and appropriate treatment are considered critical to achieving acceptable results and to avoiding the consequences of failed union.

VOLAR RADIOCARPAL DISLOCATION: CASE REPORT AND REVIEW OF LITERATURE

Hand Surgery ◽  
2011 ◽  
Vol 16 (02) ◽  
pp. 173-175 ◽  
Author(s):  
Kiran Singisetti ◽  
Michalopoulos Konstantinos ◽  
Alan Middleton
Keyword(s):  
Unusual Case ◽  
High Energy ◽  
Ligament Injury ◽  
Wrist Injuries ◽  
Review Of Literature ◽  
Complete Tear ◽  
Radiocarpal Joint ◽  
Bony Lesion ◽  
High Index Of Suspicion ◽  
Wrist Ligament

We describe here an unusual case of volar dislocation of the radiocarpal joint due to a complete tear of the dorsal radiocarpal ligament. Plain radiographs taken at initial presentation did not reveal any obvious abnormality. There was no associated bony lesion or intrinsic wrist ligament injury. Radiocarpal dislocations should be considered in the diagnosis of high-energy wrist injuries, even when initial radiographs look normal. The importance of a high index of suspicion in high velocity wrist injuries and need for further evaluation and imaging is highlighted.

scholarly journals Scaphoid fractures in children

2014 ◽  
Vol 142 (7-8) ◽  
pp. 444-449 ◽  
Author(s):  
Djordje Gajdobranski ◽  
Dragoljub Zivanovic ◽  
Aleksandra Mikov ◽  
Andjelka Slavkovic ◽  
Dusan Maric ◽  
...  
Keyword(s):  
Bone Growth ◽  
Scaphoid Fracture ◽  
Healing Process ◽  
Functional Results ◽  
Scaphoid Bone ◽  
Closed Fracture ◽  
Scaphoid Fractures ◽  
Mayo Wrist Score ◽  
Fractures In Children ◽  
Delayed Fracture Healing

Introduction. Scaphoid fractures are rare in childhood. Diagnosis is very difficult to establish because carpal bones are not fully ossified. In suspected cases comparative or delayed radiography is used, as well as computerized tomography, magnetic resonance imaging, ultrasound and bone scintigraphy. Majority of scaphoid fractures are treated conservatively with good results. In case of delayed fracture healing various types of treatment are available. Objective. To determine the mechanism of injury, clinical healing process, types and outcome of treatment of scaphoid fractures in children. Methods. We retrospectively analyzed patients with traumatic closed fracture of the scaphoid bone over a ten-year period (2002-2011). The outcome of the treatment of ?acute? scaphoid fracture was evaluated using the Mayo Wrist Score. Results. There were in total 34 patients, of mean age 13.8 years, with traumatic closed fracture of the scaphoid bone, whose bone growth was not finished yet. Most common injury mechanism was fall on outstretched arm - 76% of patients. During the examined period 31 children with ?acute? fracture underwent conservative treatment, with average immobilization period of 51 days. Six patients were lost to follow-up. In the remaining 25 patients, after completed rehabilitation, functional results determined by the Mayo Wrist Score were excellent. Conclusion. Conservative therapy of ?acute? scaphoid fractures is an acceptable treatment option for pediatric patients with excellent functional results.

scholarly journals Scaphoid Fracture Reconstruction with Rib Autograft: Case Report and Literature Review

2021 ◽  
Vol 20 (1) ◽  
pp. 32-40
Author(s):  
Mantas Fomkinas ◽  
Mantas Kievišas ◽  
Kęstutis Braziulis ◽  
Rytis Rimdeika
Keyword(s):  
Literature Review ◽  
Bone Fractures ◽  
Case Reports ◽  
Scaphoid Fracture ◽  
Adverse Outcomes ◽  
Scaphoid Bone ◽  
Proximal Pole ◽  
Function Score ◽  
Osteochondral Autograft ◽  
Wrist Function

Objective. To evaluate the results of scaphoid bone proximal pole reconstruction with rib osteochondral autograft due to comminuted scaphoid fracture. Material and methods. We present a clinical case of fragmented scaphoid bone proximal pole fracture reconstruction by rib osteochondral autograft. The modified wrist function score of Green and O’Brien and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome measuring scales were used for clinical evaluation before and 6 months after the reconstruction. Additio­nally, a literature review was conducted for case reports and previous literature reviews describing scaphoid bone proximal pole fracture surgical treatment. Medline (PubMed), ScienceDirect and UpToDate databases were used. Results. Conventional treatment methods for the treatment of comminuted proximal pole scaphoid bone fractures are often inappropriate due to technical issues or potential adverse outcomes. In these cases, reconstruction with rib autograft is possible. The study patient’s modified wrist function score of Green and O’Brien increased from 75 to 95 points out of 100 at 6 months postoperatively, and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score decreased from 13.64 to 4.55 points. The results of this technique have been investigated in several studies (Sandow, 1998, 2001; Veitch et al., 2007). All subjects (22, 47 and 14 patients, respectively), except one, experienced improvement of wrist function – enhanced wrist movement, grip strength, reduced pain and restored wrist function to the pre-injury performance level. Conclusions. Scaphoid bone proximal pole fragmented fracture reconstruction with osteochondrial rib autograft achieves favorable recovery of wrist function and avoids complications or unfavorable functional consequences of alternative surgical procedures.

scholarly journals The interplay of Clostridioides difficile infection and inflammatory bowel disease

2021 ◽  
Vol 14 ◽  
pp. 175628482110202
Author(s):  
Kanika Sehgal ◽  
Devvrat Yadav ◽  
Sahil Khanna
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Adverse Outcomes ◽  
Molecular Tests ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Clostridioides Difficile Infection ◽  
Pros And Cons ◽  
Inflammatory Bowel ◽  
High Index Of Suspicion

Inflammatory bowel disease (IBD) is a chronic disease of the intestinal tract that commonly presents with diarrhea. Clostridioides difficile infection (CDI) is one of the most common complications associated with IBD that lead to flare-ups of underlying IBD. The pathophysiology of CDI includes perturbations of the gut microbiota, which makes IBD a risk factor due to the gut microbial alterations that occur in IBD, predisposing patients CDI even in the absence of antibiotics. Superimposed CDI not only worsens IBD symptoms but also leads to adverse outcomes, including treatment failure and an increased risk of hospitalization, surgery, and mortality. Due to the overlapping symptoms and concerns with false-positive molecular tests for CDI, diagnosing CDI in patients with IBD remains a clinical challenge. It is crucial to have a high index of suspicion for CDI in patients who seem to be experiencing an exacerbation of IBD symptoms. Vancomycin and fidaxomicin are the first-line treatments for the management of CDI in IBD. Microbiota restoration therapies effectively prevent recurrent CDI in IBD patients. Immunosuppression for IBD in IBD patients with CDI should be managed individually, based on a thorough clinical assessment and after weighing the pros and cons of escalation of therapy. This review summarizes the epidemiology, pathophysiology, the diagnosis of CDI in IBD, and outlines the principles of management of both CDI and IBD in IBD patients with CDI.

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