Scaphoid fracture non-union: a systematic review of the arthroscopic management.

BACKGROUND AND AIM: There is no consensus regarding the most appropriate treatment of scaphoid nonunion. This systematic review aimed to investigate whether wrist arthroscopy exerts a positive influence on bone union and clinical outcomes. METHODS: We searched the literature on Medline (PubMed), Web of Science, Embase and Scopus databases using the combined keywords "scaphoid" AND "arthroscopy" AND "pseudoarthrosis" OR "nonunion". Eighteen studies were finally included in our review. The quality of the studies was assessed using the Coleman Methodological Score. RESULTS: Our systematic review has shown that arthroscopic management of scaphoid nonunion achieves a high rate of union and satisfactory clinical outcomes with minimal complications. CONCLUSIONS: There is need to perform randomized controlled trials reporting on the use of arthroscopy. In addition, the different pattern of pseudoarthrosis should be better classified to manage the patients who will benefit after the management.

Description and analysis of the dynamic and morphological flow pattern of the main arteries of the wrist and hand in a healthy spanish population. / Descripción y análisis del patrón de normalidad de flujo dinámico y morfológico de las arterias principales de la muñeca y mano en población sana española.

BACKGROUND AND AIM: The vascular anatomy of the hand has already been widely described macroscopically. However, there are very few papers that study the pattern of normality of in vivo vascularisation that describe and analyse the main arteries of the hand. The aim of this paper was to carry out a study to serve as a reference for the normal values of size and flow of the radial and ulnar artery at the level of the wrist, and the digital radial and ulnar arteries at the level of the fingers. MATERIAL AND METHOD: A descriptive observational cross-sectional study on 200 hands in 100 healthy volunteers aged between 20-30years. Doppler-colour ultrasound was performed on the ulnar and radial arteries in the wrist, as well as on the radial and ulnar digital arteries in each finger. Once the measurements had been taken, a general comparative analysis was performed also taking laterality, dominance and gender into account. RESULTS: It was observed that the radial artery is larger in size than the ulnar at wrist level, however, it was the ulnar artery that showed flow dominance at this level. At finger level, the arteries are greater in size and flow in the areas of the fingers more protected from injury (digital ulnar artery in the first three and radial artery in the fourth and fifth digits).

Arthroscopic Proximal Row Carpectomy Using the Volar Central Portal.

Proximal row carpectomy (PRC) is a well-accepted procedure for the treatment of degenerative lesions of the wrist and advance Kienböck disease. This procedure has been classically described as an open procedure but recently has been reported as an arthroscopic one. Arthroscopic PRC has several advantages such as minimal damage to the dorsal and volar ligaments as well as there being no need to detach the capsule, which can facilitate earlier mobilization and can decrease postoperative stiffness. In addition, there is a reduced risk of the interosseous posterior nerve being injured, and the proprioception system continues to function. This arthroscopically assisted technique uses the volar central portal as a third portal, which can be useful to remove the volar portions of the bones to view the dorsal areas of the bones and to allow the surgeon to work with 2 instruments at the same time. As a result, the time spent on the procedure can be reduced.