Comparison of the results and complications of palmar and dorsal miniinvasive approaches in the surgery of scaphoid fractures. A prospective randomized study.

AIMS: To compare the functional results and complications associated with palmar percutaneous and dorsal limited approaches in the surgical treatment of nondisplaced or minimally displaced scaphoid fractures type B2. METHODS: A total of 76 patients with acute nondisplaced or minimally displaced type B2 scaphoid fractures were included in a prospective randomised study. The assignment patients to groups according to type of operative approach was based on systematic sampling. Clinical follow-up, X-ray or CT imaging were performed at four, eight and twelve weeks and one year after the surgery. Patient satisfaction and the results of DASH form were evaluated as well. The differences were statistically tested. RESULTS: We found significantly better flexion and grip strength in the group of palmar percutaneous aprroach during the follow-up examination at eight weeks after the surgery. Significantly better flexion of the same group persisted at twelve-week follow-up examination. No differences in results or complications were statistically significant up to one year follow up. CONCLUSIONS: We found no advantage to the palmar percutaneous approach in the treatment of nondisplaced and minimally displaced scaphoid fractures type B2 compared to dorsal limited approach.

Is the dorsal percutaneous approach well-founded for osteosynthesis of scaphoid fractures?

AIMS: To compare complications associated with dorsal percutaneous and limited dorsal approaches in the surgical treatment of fractured scaphoid bone. METHODS: A total of 51 patients with acute type A2, B2 and B3 scaphoid fractures were treated by limited dorsal approach. During follow-up examinations we analysed the functional outcome and per- and post-operative complications, and we compared them with studies using the dorsal percutaneous approach. RESULTS: We found fewer complications using the limited dorsal approach. CONCLUSIONS: We found no advantages of the dorsal percutaneous approach. In addition to a favourable functional outcome, the limited dorsal approach permits visualization of the screw insertion point and of the fracture line course, and prevents insufficient screw sinking underneath the bone cartilage and malunion.

Spontaneous consolidation of scaphoid nonunion in a child.

BACKGROUND: Scaphoid nonunion is very rare in childhood. CASE REPORT: A 14 year old boy with scaphoid nonunion confirmed with CT did not past scheduled surgery. In spite of the short period of immobilisation union occurred and two years after the injury he was completely asymptomatic. CONCLUSIONS: We suspect that injury to the scaphoid, in this case may have accelerated the union shortly before the end of ossification.

Azygos vein injury in blunt chest trauma.

Injuries to the azygos vein in a blunt chest trauma are uncommon and have previously been described in only 21 cases. The diagnosis is crucially based on massive right haemothorax with signs of shock, hypotension and altered mental status. The severity of the trauma, speed of transport and surgical intervention are often decisive for the survival of the patient. This is confirmed by the three cases we report below.

Distal scaphoid resection arthroplasty for scaphoid nonunion with radioscaphoid arthritis.

The authors compare the functional outcome of 8 patients treated by distal scaphoid resection arthroplasty for scaphoid nonunion with symptomatic wrist arthritis before surgery and after a minimum follow-up of 6 months. There was a significantly better range of radial deviation and grip strength at the time of re-examination. Significantly fewer patients complained of resting pain. By contrast the change of radiolunate angle measured before the surgery and at the time of re-examination was statistically insignificant. Our preliminary results show that distal scaphoid resection arthroplasty seems to be a useful treatment method of scaphoid nonunion with symptomatic wrist arthritis.

Possible restorations of the upper extremity motion in tetraplegic patients - 5-year clinical experience.

AIM: The aim of the work is to objectify the functional effectiveness of these operations and their influence on the quality of life of handicapped patients. METHOD: The authors evaluate the results of reconstructive surgery restoring hand grip in a group of 15 tetraplegic patients (3 women and 12 men) with complete spinal cord lesion of C5-C7 segments. The average age of patients in the group is 33 (22-50) years old. The reconstructions were performed using tendon transfer and tenodesis in the forearm and hand area. The effectiveness of the transfer was assessed objectively with regard to muscle strength by measuring the restored "thumb-index finger" grip and "into fist" grip. The range of motion achieved was also evaluated. Transfer effectiveness was evaluated on the basis of subjective patients' evaluation. An ADL (activities of daily living) questionnaire by Mohammed's (1992) took into account the effect of the surgery in a whole range of common daily activities. RESULTS: An extended range of daily activities was evident mainly in the fields of: communication, eating and drinking and operations associated with increase in general selfcare of the patient. There was no deterioration of condition in any of the activities. CONCLUSIONS: Up to 80 % of tetraplegic patients are suitable candidates for transfers and, to a certain extent, it is possible to improve the upper limb function. In a partial function restoration of the upper limbs there is immense potential for improvement in the quality of life of these patients.

Percutaneous osteosynthesis versus cast immobilisation for the treatment of minimally and non-displaced scaphoid fractures. Functional outcomes after a follow-up of at least 12 month.

The authors compare the functional outcome of 26 patients successfully treated by percutaneous osteosynthesis and 24 patients successfully treated by a short-arm thumb cast for the acute scaphoid fracture after a follow-up of at least 12 months. The patients treated by percutaneous osteosynthesis showed a significantly better range of wrist motion at the time of re-examination. Differences in persistent complaints and in grip strength compared to the uninjured wrist between both groups were statistically insignificant yet slightly in favour of the surgically treated patients. The higher suitability of percutaneous osteosynthesis is further supported by the significantly lower failure rate compared to conservative treatment. Based on these results, percutaneous osteosynthesis seemed to be the more favourable method of treatment of minimally and non-displaced scaphoid fractures than conservative treatment.