Clinical application of nitinol memory alloy two foot fixator combined with Kirschner wire in treatment of trans-scaphoid perilunate dislocation / 中国修复重建外科杂志

Objective: To evaluate the effectiveness of nitinol memory alloy two foot fixator combined with Kirschner wire in the treatment of trans-scaphoid perilunate dislocation. Methods: Between September 2011 and October 2018, 17 patients with trans-scaphoid perilunate dislocation were treated with nitinol memory alloy two foot fixator and Kirschner wire. There were 12 males and 5 females, with an average age of 32.6 years (range, 23-52 years). The disease duration was 8 hours to 9 days, with an average of 6.5 days. The causes of injury included 6 cases of falling injury, 4 cases of traffic accident injury, 3 cases of stress injury of wrist caused by sports, 2 cases of violent injury of wrist caused by machine impact, 1 case of military training injury, and 1 case of other injury. One case was complicated with nerve injury. According to Herbert's classification, all the fractures were type B4. At 1 week before operation, 3 months, 6 months after operation and last follow-up, the wrist function was evaluated according to the Krimmer scale score. Results: All the 17 patients were followed up 10.5-48 months, with an average of 18.6 months. There was no loosening or infection of the internal fixator, no necrosis of the scaphoid and lunate. The periosteal dislocations of the patients were well reduced and the scaphoid fractures all healed. The healing time was 4-18 months, with an average of 11.3 months. The Krimmer wrist scores were 37.5±4.4, 61.3±7.2, 83.3±9.3, 87.3±8.2 at 1 week before operation, 3 months, 6 months after operation and last follow-up, respectively. The Krimmer wrist score at each time point after operation was significantly improved when compared with that before operation ( P0.05). At last follow-up, the Krimmer wrist function was excellent in 13 cases, good in 2 cases, fair in 1 case, poor in 1 case, and the excellent and good rate was 88.23%. Conclusion: Nitinol memory alloy two foot fixator combined with Kirschner wire in the treatment of trans-scaphoid periosteal dislocation has definite effectiveness, simple operation, and good recovery of wrist function after operation.

Multiple Flexor Tendon Ruptures with Compression Neuropathy at Neglected Volar Lunate Dislocation / 대한정형외과학회잡지

Perilunate dislocation represents approximately 3% of all carpal injuries and is diagnosed late in 25% of cases. Neglected perilunate dislocation accompanies many complications. Multiple flexor tendon rupture is a very rare complication of neglected perilunate dislocation. Three cases have been reported in the English literatures. No case has been reported in Korean literature. We report on a case of multiple flexor tendon ruptures with compressive neuropathy of median and ulnar nerve caused by neglected volar perilunate dislocation.

Headless Autocompression Screw Fixation of Scaphoid Fractures Using Open Dorsal Approach

PURPOSE: We present the clinical and radiological results of open reduction and internal fixation for scaphoid fracture with retrograde headless screw fixation via dorsal approach. METHODS: This study carried out a survey targeting 15 patients who have a retrograde headless screw fixation on nonunion of scaphoid fracture without previous operation, 2 patients who have a retrograde headless screw fixation on nonunion of scaphoid fracture with previous operation and 8 patients who have a trans-scaphoid perilunate dislocation. We figured out a mechanism of injury, and clinical symptom, radiologic findings. The surgery was done with open dorsal approach which is retrograde headless screw fixation internally, with or without bone graft. We analyzed the result by Maudsley method, in terms of bone union, duration for union, radiologic finding, clinical outcomes. RESULTS: After surgery, 22 of 25 patients had union result on fracture and other 3 patients had nonunion result. It took 12 weeks to achieve bone union on average. Based on radiograhs, we had one case of partial avascular necrosis of proximal fragment without clinical symptoms. We had one case of each scaphoid nonunion without previous operation, with operation and trans-scaphoid perilunate dislocation had arthritic change and non-symptomatic nonunion result. In terms of clinical outcome, 22 patients showed satisfactory results and 3 patients had slight limitation of range of motion. CONCLUSION: Retrograde headless screw fixation with or without bone graft for the treatment of scaphoid fracture is recommendable.

Trans-scaphoid Perilunate Fracture Dislocations: Screw Fixation of the Scaphoid and Lunotriquetral Ligament Repair Using a Dorsal Approach

PURPOSE: To evaluate clinical and radiological results after screw fixation of the scaphoid and lunotriquetral ligament repair using a dorsal approach in the treatement of trans-scaphoid perilunate fracture dislocations. MATERIALS AND METHODS: From May 2003 to August 2007, 11 patients who underwent operative management of a trans-scaphoid perilunate fracture dislocation were included in this study. Average follow up period was 58 months. In all patients, screw fixation of the scaphoid and lunotriquetral ligament repair with a suture anchor after open reduction was performed. Clinical evaluation was done by measuring range of motion and grip power and disabilities of arm, shoulder and hand (DASH) score evaluation for functional recovery at the last follow up. Union of scaphoid, change in lunotriquetral distance, and development of any instability and arthritis of wrist joint were radiographically assessed. RESULTS: In clinical outcomes, 89.3% recovery of grip power and 87.5% recovery of range of motion compared to healthy side were observed at the last follow-up. Average range of motions of extension, flexion, ulnar deviation, radial deviation, supination and pronation were 51.8degrees, 58.4degrees, 21.2degrees, 16.2degrees, 74.3degrees, 75.1degrees respectively. Average DASH score was 13.2. Bony union of scaphoid was achieved in all cases at the average of postoperative 19.3 weeks. Lunotriquetral distance after the operation and at the last follow up were 1.9 mm and 2.0 mm, respectively. There were no radiographic evidence of instability or arthritis. CONCLUSION: Dorsal approach allows reduction of carpal bone, scaphoid fixation and lunotriquetral ligament repair in the treatment of trans-scaphoid perilunate fracture dislocations, providing satisfactory clinical and radiological results.

Trans-Scaphoid Perilunate Dislocation with Fractured Carpal Bones in a Child: A Case Report / 대한정형외과학회잡지

Transcarpal fractures and dislocations in children are rarely reported in the orthopedics literature. This is a case report of a 10-year-old boy who sustained a trans-scaphoid perilunate dislocation with fractures across the carpal structure: these included injuries to the capitate and triquetrum bones. Treatment consists of a closed reduction for the dislocation and using the dorsal approach, an open reduction with internal fixation of the fractures. The injury healed well with a full return of good wrist function. This unusual pattern of injury is described so that it may be more readily appreciated in the future.

Perilunate Dislocations and Fracture-Dislocations / 대한정형외과학회잡지

We analysed the 16 cases of the perilunate dislocations (PLD) and fracture-dislocations (PLFD) to study the distribution of the different forms and provides additional information about the perilunate pattern of injury. The cases were followed at least 1 year and an average of 2 years and 3 months. The results were as follows: l. All of the cases, the direction of the dislocation was dorsal. The PLD was 4 cases (25%) and PLFD was 12 cases (75%). The transscapholid perilunate fracture-dislocation (TS-PLFD) was the most common type. 2. Scaphoid fracture was present in 9 cases (56%), It was transverse fracture in the middle 1/3. 3. Missed or delayed diagnoses were noted in 3 cases (18%). 4. Overall functional results were graded as exellent in 2 cases (13%), good in 9 cases (56%), fair in 3 cases (18%) and poor in 2 cases (13%).

A Clinical Study of Carpal Scaphoid Fracture and Perilunat Dislocation / 대한정형외과학회잡지

The wrist consists of a complex structure, including 8 tiny carpal bones and their adjoining soft tissue. Recently the number of injuries of carpal joint is on the increase by accident in leisure or by industrial accident. Carpal bone fracture or dislocation is often mistakably identified as a sprain, which is liable to lead its opportune time to care. So, we analyzed 39 cases to which long-term follow-up was available, among 44 cases which were treated at the department of orthopedic surgery, Yonsei University medical college. The results were as follows; l. Of all 44 cases, 42 were males, and males in 30, 40 decades numbered 32 cases, forming 73 % of all. 2. Of 29 scaphoid fractures, 22 cases were mid 1/3 fractures, and of 15 perilunate dislocation, 10 cases were dorsal transscaphoid perilunate dislocations. 3. Among 39 cases which long-term follow-up was available in the classification by Soto-Hall, 18 cases were acute, in 21 cases treatment was started beyond 2 weeks later after injury. 4. The more delayed diagnosis, the longer period needed bone union for scaphoid fracture. 5. All scaphoid fractures including transscaphoid perilunate dislocation, showed a union rate of 94.3%, and were complicated by 2 non-unions, 3 avascular necrosis, 1 osteoarthritis and one case accompanied an incomplete median nerve injury. So, initial careful evaluation is needed to good prognosis of scaphoid fracture.