A review of scaphoid fracture, treatment outcomes, and consequences.

PURPOSE: Scaphoid fractures are the most common carpal fracture and can lead to severe complications like carpal collapse and osteoarthritis. This study reviewed scaphoid fracture patterns, outcomes, and consequences in conservative and surgical management. METHODS: Sixty-four patients with scaphoid fracture who attended the hand clinic at King Hussein Medical City from January 2022 to December 2022 were included and reviewed regarding the anatomical fracture site, the associated injury, the treatment modality (conservative versus surgical), the healing time, and fracture sequelae such as nonunion and scaphoid nonunion advanced collapse. RESULTS: Most patients were males (62 patients, 96.9%), and most (47, 73.4%) fell within 25 to 40 years. Scaphoid waist fracture was the most common location (40, 52.5%). Most patients (47, 73.4%) received conservative treatment and 17 (26.6%) were fixed acutely. However, nonunion complicated 53 fractures (82.8%). Notably, there were no differences in the union rate or time between cases of scaphoid nonunion treated with vascularized or nonvascularized grafts. Furthermore, there were no variations in union rates among genders, extremities, age, fracture locations, or among smokers. However, a higher union rate was noted in office workers and those who received conservative treatment. CONCLUSION: Nonunions were higher in our study than in the literature, as our department is a referral center for established nonunion cases. For conservative treatment, we recommend aggressive management and follow-up with a clinical and CT scan at three months and early referral of non-united fractures to the hand clinic to avoid the advanced collapse of the scaphoid.

Outcome in TFCC repair using micro anchor and trans­osseous technique.

The triangular fibrocartilage complex (TFCC) is an intrinsic stabiliser of the distal radioulnar joint (DRUJ), which serves an important role in wrist movement, forearm rotation and grip strength. A stable DRUJ is a key requirement for pain-free movement of the wrist. TFCC tears are a common ulnar-sided wrist pain associated with decreased grip strength and impaired function. TFCC tears are classified according to the location and cause. The Palmer classification delineates tears into traumatic type 1 and degenerative type 2. The present study investigated the clinical outcomes of using micro suture anchors in open repair in comparison with trans-osseous TFCC repair. From July 2017 to July 2020, 51 patients underwent open repair of TFCC tear by hand and upper limb surgeons in Royal Rehabilitation Center at King Hussein Medical Center (Amman, Jordan). Stability of DRUJ and tenderness at the ulnar aspect of the wrist were evaluated by Disability of the Arm, Shoulder and Hand (DASH) and Modified Mayo Wrist Score (MMWS) pre- and post-operatively. A total of 38 patients (27 male and 11 females) underwent open repair using micro suture anchors and 13 (7 male and 6 female) by trans-osseous repair. A total of 51 patients in the follow-up 6-48 months had significant improvement in pain and range of motion. A total of 45 patients showed improved grip strength and were pain-free; six patients showed improvement of grip strength and decreased pain. For the patients who underwent TFCC repair by micro suture anchors, there was an improvement of MMWS from 70 to 90%, and for those who underwent TFCC repair by trans-osseous technique, MMWS improved from 65 to 85%. There was also significant improvement in DASH score post-operatively with both techniques, from 60 to 15% in the trans-osseous technique and from 70 to 15% in the suture anchors. Open repair of TFCC tears using either micro anchor or trans-osseous repair led to pain-free range of motion, improved grip strength, stable DRUJ and improvement in DASH and MMWS scores, with no significant differences in clinical outcome between techniques.

Pediatric Kienböck's Disease in an 11-Year-Old Boy: A Case Report.

Kienböck's disease is a rare condition in the pediatric age group, with little agreement on its natural history and the best treatment option. Typically, these patients present with vague wrist pain and a variable degree of joint motion restriction. Diagnosis is mainly based on clinical suspicion and MRI findings, as radiographs do not show significant changes in the early stages of the disease. Prognosis is better in children than in adults due to the good healing capacity in this age group. This study will report on an 11-year-old boy diagnosed with Kienböck's disease who underwent surgical treatment to temporarily offload the diseased lunate. Clinical and radiographic recovery was observed at the six-month follow-up.

Treatment of auricular keloids by triple combination therapy: Surgical excision, platelet-rich plasma, and cryosurgery.

BACKGROUND: Surgical excision alone for auricular keloids is frequently followed by recurrence making combining treatment options necessary. OBJECTIVE: We aimed to assess the long-term efficacy of combining surgical excision, cryosurgery, and platelet-rich plasma (PRP) in treatment of auricular keloids. METHODS: This interventional study was carried out on fifty auricular keloids in 50 patients. Patients were subjected to a combination therapy of surgical excision of the keloids, intraoperative cryosurgery, and PRP injections. The primary endpoint was defined as the number of patients who achieved major flattening of the keloid (reduction of more than 80% of the keloid) after a follow-up of 12 months. RESULTS: After follow-up of 12 months, 74% of the keloids achieved complete flattening in 10 cases and significant flattening in 14 cases. Thirty-four of the 50 keloids (68%) were treated with only excision, cryosurgery, and PRP and did not relapse. Three keloids (6%) had minor relapse after the first treatment but were considered persistent major flattening at the end of the study. Three other keloids (6%) needed intralesional triamcinolone to achieve major or complete flattening without further relapse. Treatment failure was observed in 30% who achieved <30% reduction in their surface. Treatment side effects were transient pain and focal hypoesthesia. CONCLUSIONS: This combination therapy was effective for treatment of auricular keloids, with a low recurrence rate and a favorable cosmetic outcome. Therapy was well tolerated and without significant side effects.