RESUMEN
BACKGROUND: Scaphoid nonunion advanced collapse (SNAC) injuries are frequently associated with irreversible degenerative wrist arthritic changes that necessitate surgical intervention. Midcarpal fusion remains the mainstay of the management of SNAC II and III injuries. A successful four-corner fusion (4CF) relies on a stable lunate-capitate fusion (LCF). There have been reports of management relying solely on LCF. The outcomes of LC- and 4 C-fusions in SNAC injuries were not widely documented. The objective of this research is to provide valuable insights into the effectiveness of both fusion procedures in the management of SNAC II and III wrist injuries, with a focus on reporting associated complications, functional and radiological outcomes. PATIENTS AND METHODS: This retrospective study encompassed 65 patients diagnosed with SNAC II and III wrist injuries who underwent limited wrist fusion procedures between 2015 and 2024, with a minimum of 2 years of postoperative follow-up. Exclusion criteria encompassed patients with carpal instability, prior wrist surgical interventions, and scapholunate advanced collapse. Following the fusion procedure performed, patients were stratified into two groups: the LCF group consisting of 31 patients, and the 4CF group comprising 34 patients. Preoperative and intraoperative data were retrieved from the patient's medical records. At their final follow-up appointments, patients underwent comprehensive radiographic and clinical evaluations. Clinical outcomes including hand grip strength, range of motion, the Disabilities of the Arm, Shoulder, and Hand Score, and the Mayo Modified Wrist Score, were compared between groups. Any associated complications were reported. RESULTS: The average healing time was 74.7 ± 15.6 and 72.2 ± 13.2 days for the LCF and 4CF groups, respectively. At the final visit, all patients showed functional improvement relative to their preoperative status, with comparable wrist range of motions observed in both groups. The functional wrist scores were slightly better in the LCF patients (P > 0.05). The average grip strength was significantly greater in the LCF group (P = 0.04), with mean strength values of 86.8% and 82.1% of the contralateral side, for the LCF and 4CF groups, respectively. CONCLUSION: The LCF is not less efficient than the 4CF in the treatment of SNAC II and III wrist injuries. Through a less time-consuming procedure, LCF can efficiently provide comparable results to 4CF. LEVEL OF EVIDENCE: level IV evidence.
Asunto(s)
Artrodesis , Hueso Grande del Carpo , Fracturas no Consolidadas , Hueso Semilunar , Hueso Escafoides , Humanos , Hueso Escafoides/cirugía , Hueso Escafoides/lesiones , Hueso Escafoides/diagnóstico por imagen , Masculino , Artrodesis/métodos , Femenino , Estudios Retrospectivos , Adulto , Persona de Mediana Edad , Hueso Semilunar/cirugía , Hueso Semilunar/lesiones , Hueso Semilunar/diagnóstico por imagen , Hueso Grande del Carpo/cirugía , Hueso Grande del Carpo/lesiones , Hueso Grande del Carpo/diagnóstico por imagen , Fracturas no Consolidadas/cirugía , Fracturas no Consolidadas/diagnóstico por imagen , Resultado del Tratamiento , Traumatismos de la Muñeca/cirugía , Traumatismos de la Muñeca/diagnóstico por imagen , Rango del Movimiento Articular , Articulación de la Muñeca/cirugía , Articulación de la Muñeca/diagnóstico por imagen , Articulación de la Muñeca/fisiopatología , Adulto Joven , Estudios de Seguimiento , Fuerza de la ManoRESUMEN
CASE: We present a case of an isolated palmar, open dislocation of the capitate that occurred after a crush injury from an all-terrain vehicle rollover accident. The capitate was completely dislocated, rotated 90 degrees in the coronal plane with only soft-tissue attachments palmarly, and associated with a 4 cm open wound. A successful outcome was achieved via surgical reduction with percutaneous fixation. A follow-up at 44 months demonstrated good range of motion and no pain. CONCLUSION: Capitate dislocations are extremely rare. Prompt identification and surgical reduction can lead to successful outcomes.
Asunto(s)
Hueso Grande del Carpo , Luxaciones Articulares , Hueso Grande del Carpo/diagnóstico por imagen , Hueso Grande del Carpo/lesiones , Hueso Grande del Carpo/cirugía , Humanos , Luxaciones Articulares/cirugía , Rango del Movimiento Articular , Extremidad SuperiorRESUMEN
Capitate and hamate fractures are infrequent injuries and are uncommon in isolation. A capitate fracture is usually associated with a scaphoid fracture. The primary mechanism of injury is a fall with the wrist in hyperextension. Other possible ways for capitate fractures are axial down trauma of the third metacarpal and direct trauma. Hamate fractures have a 2% incidence among carpal bone fractures, probably due to underreporting. They can occur on the hamate body or the hamulus or hook. Combined capitate and hamate fractures are uncommon and relevant studies, especially case reports, are scarce. We present a case report of a combined capitate and hamate fracture in a 44-year-old patient who suffered a direct trauma to the back of the hand during a fall. Following a clinical suspicion based on history and physical examination, radiographic and computed tomography (CT) studies were crucial for elucidating the case and proposed treatment, which involved ensuring absolute stability and performing an open reduction, using interfragmentary compression, with the Herbert bone screw implanted in each bone. After the surgical procedure, the patient wore a forearm plaster cast splint for four weeks. A satisfactory outcome was obtained in three months, with a complete range of motion and preserved force compared to the contralateral hand.
Asunto(s)
Tornillos Óseos , Hueso Grande del Carpo/lesiones , Hueso Grande del Carpo/cirugía , Moldes Quirúrgicos , Fijación Interna de Fracturas/métodos , Fracturas Óseas/cirugía , Hueso Ganchoso/lesiones , Hueso Ganchoso/cirugía , Adulto , Humanos , Masculino , Rango del Movimiento Articular , Resultado del TratamientoRESUMEN
The scapho-capitate or Fenton syndrome is characterized by an associate fracture of the scaphoid and capitate with rotation of 90° or 180° of the capitate's head. We report a case of this syndrome which occurred in a fifteen years old professional motorcyclist who came to our observation following a high-energy trauma that occurred during the track tests. Through a dorsal access the fractures of the capitate and scaphoid were reduced and stabilized with Kirschner wires. The patient was radiographically and clinically evaluated three years after surgery; complete healing of scaphoid fracture and reabsorption of the capitate's head as consequence of avascular necrosis with the onset of a midcarpal arthritis were observed. Despite this radiographic evolution, the patient achieved excellent clinical result featured by complete recovery of wrist motion and absence of pain thus allowing the return to motorcycling.
Asunto(s)
Traumatismos en Atletas/cirugía , Hueso Grande del Carpo/lesiones , Hueso Grande del Carpo/cirugía , Fijación Interna de Fracturas , Fracturas Óseas/cirugía , Traumatismo Múltiple/cirugía , Hueso Escafoides/lesiones , Hueso Escafoides/cirugía , Adolescente , Estudios de Seguimiento , Humanos , Masculino , Motocicletas , Síndrome , Factores de TiempoRESUMEN
CASE: A 14-year-old girl was diagnosed with nonunion of an isolated capitate fracture 5 months after she first presented to the emergency department. The fracture of the capitate was treated by cancellous proximal bone graft and screw fixation. This current case provides details of the surgical fixation method and long-term functional outcome after nonunion of an isolated capitate fracture after a follow-up of 18 months following fixation. CONCLUSIONS: Persisting localized tenderness over the capitate should be an indication to perform an additional computed tomography or magnetic resonance imaging scan. Nonunion of isolated capitate fractures can be treated by means of open reduction and internal fixation, with autologous bone grafting.
Asunto(s)
Hueso Grande del Carpo/lesiones , Fijación Interna de Fracturas/métodos , Fracturas no Consolidadas/cirugía , Adolescente , Trasplante Óseo , Hueso Grande del Carpo/diagnóstico por imagen , Diagnóstico Tardío , Femenino , Fijación Interna de Fracturas/instrumentación , Fracturas no Consolidadas/diagnóstico por imagen , Humanos , Tibia/trasplante , Tomografía Computarizada por Rayos XRESUMEN
Carpal bone fracture-dislocation is an uncommon wrist injury. Regarding limited prevalence of such injury, most of orthopedic surgeons have low experience in treatment and handling of these fractures and dislocations. A 25-year-old male worker with an uncommon carpal bone fracture-dislocation, namely bilateral scaphocapitate fracture syndrome, was described. Volar and dorsal approaches were used for reduction and fixation; complete stabilization was achieved after open reduction and fixation using Herbert screws into scaphoid and capitate. A 5-year follow-up showed satisfactory functional and radiographic results. In the case of scaphocapitate fracture syndrome open reduction and internal fixation by compression screws (rather than inserting multiple pins) leads to complete union in scaphoid and capitate. Restoration of normal anatomy in carpus bones can result in long-term satisfactory functional results while preventing possible complications.
Asunto(s)
Hueso Grande del Carpo/cirugía , Fractura-Luxación/cirugía , Hueso Escafoides/cirugía , Adulto , Tornillos Óseos , Hueso Grande del Carpo/diagnóstico por imagen , Hueso Grande del Carpo/lesiones , Estudios de Seguimiento , Fractura-Luxación/diagnóstico por imagen , Fijación Interna de Fracturas , Fuerza de la Mano , Humanos , Masculino , Reducción Abierta , Rango del Movimiento Articular , Hueso Escafoides/diagnóstico por imagen , Hueso Escafoides/lesionesRESUMEN
This is a case report of a seven-year-old boy with fractures of the capitate and triquetral bone. An X-ray revealed fractures of the capitate and triquetral bone, and a CT scan showed non-dislocated fractures suitable for conservative treatment. The patient was treated with a shin cast for four weeks and had full recovery. Fractures of both the capitate and triquetral bone in children under the age of ten have not previously been reported. Fractures of the carpal bones should be suspected and examined in children with relevant trauma and symptoms.
Asunto(s)
Hueso Grande del Carpo , Huesos del Carpo , Fracturas Óseas , Hueso Piramidal , Hueso Grande del Carpo/lesiones , Niño , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/terapia , Humanos , Masculino , Radiografía , Hueso Piramidal/lesionesRESUMEN
CASE: Comminuted fractures of the capitate, in the absence of associated carpal injuries, are exceedingly rare. Treatment of this complex injury is not well-documented in the literature. We describe the case of a comminuted capitate fracture that was successfully managed with Kirschner wire fixation. CONCLUSION: Based on this case and a review of the literature, management of a comminuted capitate fracture with Kirschner wire fixation can lead to successful treatment and positive patient outcomes.
Asunto(s)
Hueso Grande del Carpo , Fijación Interna de Fracturas , Fracturas Conminutas , Accidentes de Tránsito , Adulto , Hilos Ortopédicos , Hueso Grande del Carpo/diagnóstico por imagen , Hueso Grande del Carpo/lesiones , Hueso Grande del Carpo/cirugía , Femenino , Fijación Interna de Fracturas/instrumentación , Fijación Interna de Fracturas/métodos , Fracturas Conminutas/diagnóstico por imagen , Fracturas Conminutas/cirugía , Humanos , Adulto JovenRESUMEN
BACKGROUND: Scaphocapitate syndrome is a rare variety of perilunate instability, described as a trans-scaphoid, trans-capitate fracture, with rotation of the capitate head either 90° or 180°. METHODS: We present a unique case of scaphocapitate syndrome in which the rotated proximal capitate fragment expelled into the carpal canal. RESULTS: The capitate head was extricated from the carpal tunnel via the volar approach, and was anatomically aligned and fixed through the dorsal approach using two 2.0 mm headless compression screws. The scaphoid fracture was then also reduced through the dorsal approach and stabilized with a 2.5 mm headless compression screw. All intercarpal ligaments appeared intact. CONCLUSIONS: Volar dislocation of the proximal capitate into the carpal tunnel in scaphocapitate syndrome presents a unique challenge that can be addressed with a combined volar and dorsal approach.
Asunto(s)
Hueso Grande del Carpo/lesiones , Cuerpos Extraños/diagnóstico por imagen , Fracturas Óseas/etiología , Hueso Escafoides/lesiones , Articulación de la Muñeca/diagnóstico por imagen , Accidentes por Caídas , Adulto , Hueso Grande del Carpo/diagnóstico por imagen , Fracturas Óseas/diagnóstico por imagen , Humanos , Masculino , Hueso Escafoides/diagnóstico por imagen , Síndrome , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: Radiologic presentation of carpal instability at the radial side of the carpus, e.g. scapholunate diastasis following scapholunate interosseous ligament injury, has been studied extensively. By comparison, presentation at the ulnar-sided carpus has not. The purpose of this study was to assess the effects of lunate morphology, sex, and lunotriquetral interosseous ligament (LTIL) status on the radiologic measurement of the capitate-triquetrum joint (C-T distance). Further, we sought to evaluate the diagnostic accuracy of C-T distance for assessing LTIL injuries. MATERIALS AND METHODS: We retrospectively identified 223 wrists with wrist radiographs and MR arthrograms with contrast injection. Data collected included sex, lunate morphology and LTIL status from MR arthrography, and C-T distance from radiography. The effects of lunate morphology, sex, and LTIL injury status on C-T distance were evaluated using generalized linear models. Diagnostic performance of C-T distance was assessed by the area under receiver-operator characteristic curve (AUROC). RESULTS AND CONCLUSION: Lunate morphology, sex, and LTIL injury status all had significant effects on C-T distance; wrists with type II lunates, men, and wrists with LTIL injuries had greater C-T distances than wrists with type I lunates, women, and wrists without LTIL injuries, respectively (p < 0.01). The diagnostic value of the C-T distance for identifying patients with full-thickness LTIL tears was sufficient for women with type I (AUROC = 0.67) and type II lunates (0.60) and good for men with type I (0.72) and type II lunates (0.77). The demonstrated influence of LTIL status on C-T distance supports the use of C-T distance as a tool in assessing for full-thickness LTIL tears.
Asunto(s)
Hueso Grande del Carpo/diagnóstico por imagen , Hueso Grande del Carpo/lesiones , Ligamentos Articulares/diagnóstico por imagen , Ligamentos Articulares/lesiones , Hueso Semilunar/diagnóstico por imagen , Hueso Semilunar/lesiones , Imagen por Resonancia Magnética/métodos , Hueso Piramidal/diagnóstico por imagen , Hueso Piramidal/lesiones , Traumatismos de la Muñeca/diagnóstico por imagen , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores SexualesRESUMEN
Background: Perilunate fracture dislocations are often associated with fractures of the distal pole of the scaphoid or the proximal pole of the capitate. However, the combination of perilunate dislocation with multiple carpal fractures and associated scaphocapitate syndrome is very rare. Methods: We report a unique case of scaphocapitate fracture syndrome with perilunate dislocation and fracture of the hamate resulting from a high-energy injury to the wrist during a dirt-bike competition. Results: Open reduction and internal fixation of the scaphoid fracture with a 3.0-mm headless screw, the head of the capitate with a 1.5-mm lag screw, and the hamate fracture with a 1.3-mm lag screw was performed. The lunotriquetral dissociation was reduced, with the ligament repaired and the joint stabilized using a Kirschner wire. All screw heads are carefully buried under the articulate cartilage. Conclusions: Prompt anatomic reduction and stable osteosynthesis of all fractures in this patient resulted in successful healing and return to activity.
Asunto(s)
Hueso Grande del Carpo/lesiones , Fracturas Óseas/cirugía , Luxaciones Articulares/cirugía , Hueso Semilunar/lesiones , Hueso Escafoides/lesiones , Traumatismos de la Muñeca/cirugía , Hueso Grande del Carpo/diagnóstico por imagen , Fijación Interna de Fracturas/métodos , Fracturas Óseas/diagnóstico por imagen , Hueso Ganchoso/diagnóstico por imagen , Hueso Ganchoso/lesiones , Humanos , Luxaciones Articulares/diagnóstico por imagen , Hueso Semilunar/diagnóstico por imagen , Masculino , Traumatismo Múltiple/diagnóstico por imagen , Traumatismo Múltiple/cirugía , Hueso Escafoides/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Traumatismos de la Muñeca/diagnóstico por imagen , Adulto JovenRESUMEN
Capitate fractures are rare and dislocations are even more uncommon. To our knowledge, there has been no report of a Capitate fracture with complete dislocation in the literature. Here, we present the first case of a Capitate fracture-dislocation, sustained after a motorcycle accident.
Asunto(s)
Hueso Grande del Carpo/lesiones , Fracturas Óseas/complicaciones , Luxaciones Articulares/complicaciones , Accidentes de Tránsito , Adulto , Humanos , Masculino , MotocicletasRESUMEN
Rupture of the flexor digitorum profundus and superficialis tendons of the index finger secondary to non-union of the capitate has not yet been reported to our knowledge. We describe the case of a 48-year-old man with rupture of both flexor tendons of the index finger that occurred 15 years after a capitate fracture. The patient was completely asymptomatic before the rupture. Tendon reconstruction was performed using the palmaris longus. One year after surgery, the patient had acceptable range of motion and was pain-free.
Asunto(s)
Hueso Grande del Carpo/lesiones , Traumatismos de los Dedos/etiología , Fracturas no Consolidadas/complicaciones , Traumatismos de los Tendones/etiología , Hueso Grande del Carpo/diagnóstico por imagen , Traumatismos de los Dedos/diagnóstico por imagen , Traumatismos de los Dedos/cirugía , Fracturas no Consolidadas/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Rango del Movimiento Articular , Rotura Espontánea/diagnóstico por imagen , Rotura Espontánea/etiología , Traumatismos de los Tendones/diagnóstico por imagen , Traumatismos de los Tendones/cirugía , Factores de TiempoRESUMEN
PURPOSE: To describe the demographics, diagnosis, management, and outcomes of capitate fractures in the adult and pediatric population treated in our institution. METHODS: We performed a retrospective chart and radiographic review of 53 patients with capitate fractures treated in our institution between 2002 and 2015. Patients' demographic characteristics, mechanism of injury, management including surgery-related data, and outcomes, including complications, were recorded. A radiographic evaluation of the location and pattern of the fracture was performed. RESULTS: Capitate fractures were prevalent in young males and older females. Fracture location was variable with 9 different locations; in addition 80% of patients had an associated fracture in the wrist or hand. The most common fracture pattern was the transscaphoid, transcapitate perilunate dislocation. Most diagnoses were made with the aid of advanced imaging. Within this series, there was only 1 case (4%) of fracture nonunion and there were no cases of avascular necrosis of the proximal pole in limited follow-up. Isolated capitate fractures were significantly more common in children. In addition, children had better functional outcomes than adults. CONCLUSIONS: This series provides updated information on this rare injury. Nonunion of the capitate, which was previously described as the most common complication, was rare in this cohort. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
Asunto(s)
Hueso Grande del Carpo/lesiones , Fijación Interna de Fracturas/métodos , Fracturas Óseas/cirugía , Imagenología Tridimensional , Traumatismos de la Muñeca/cirugía , Adolescente , Adulto , Anciano , Hueso Grande del Carpo/cirugía , Estudios de Cohortes , Bases de Datos Factuales , Femenino , Fijación Interna de Fracturas/efectos adversos , Curación de Fractura/fisiología , Fracturas Óseas/diagnóstico por imagen , Fracturas no Consolidadas/diagnóstico por imagen , Fracturas no Consolidadas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Recuperación de la Función , Estudios Retrospectivos , Medición de Riesgo , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Traumatismos de la Muñeca/diagnóstico por imagen , Adulto JovenAsunto(s)
Hueso Grande del Carpo/diagnóstico por imagen , Hueso Grande del Carpo/lesiones , Fracturas Óseas/diagnóstico por imagen , Traumatismos de la Muñeca/diagnóstico por imagen , Accidentes por Caídas , Diagnóstico Diferencial , Humanos , Masculino , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
Carpal coronal fractures are rare. We report the case of a 15 year-old male who fell from a balcony and suffered a displaced coronal fracture of the capitate, hamate and triquetrum. The diagnosis, which was initially made based on the X-rays, was confirmed by CT scan. Open reduction and internal fixation using Herbert screws was performed. To the best of our knowledge, this is the first published case of a coronal fracture of these three bones. The patient returned to normal activities after six months.
Asunto(s)
Hueso Grande del Carpo/lesiones , Fracturas Óseas , Hueso Ganchoso/lesiones , Traumatismo Múltiple , Hueso Piramidal/lesiones , Adolescente , Hueso Grande del Carpo/diagnóstico por imagen , Hueso Grande del Carpo/cirugía , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/cirugía , Hueso Ganchoso/diagnóstico por imagen , Hueso Ganchoso/cirugía , Humanos , Masculino , Traumatismo Múltiple/diagnóstico por imagen , Traumatismo Múltiple/cirugía , Radiografía , Hueso Piramidal/diagnóstico por imagen , Hueso Piramidal/cirugíaRESUMEN
Midcarpal instability syndrome is often misdiagnosed, leading to delayed recognition, treatment and possibly poor clinical outcome. Four-dimensional computed tomography (4D CT) has previously proved useful in assessment of the acromioclavicular joint and wrist motion, allowing clinicians and radiologists to gain an understanding of abnormalities in function as well as morphology, which often contribute to patient symptoms. We present the case of a 25-year-old male with no history of trauma who presents with several months of a right wrist clunk on both passive and active (load bearing) motion. Plain film and 1.5 Tesla MRI with intra-articular contrast demonstrates a normal appearance, without joint space, tendon or ligament disturbance. We further investigated this condition using a wide volume detector CT scanning technique (4D CT). Data from the patient's asymptomatic wrist was utilized as a comparison for this study. Assessment of cine movie files from the symptomatic wrist revealed abnormal subluxation of the capitate from the lunate when compared with the normal wrist, in which the capitate did not deviate from the concavity of the lunate and did not cross the perpendicular line from the superior pole of the lunate in any phase of motion, which we defined as capitate subluxation. 4D CT allows for detection of capitate subluxation in an earlier stage of disease progression, constituting earlier recognition and providing the opportunity for earlier treatment of the disease, potentially mitigating significant patient morbidity. We have been able to confidently identify capitate subluxation both visually (assessment of the sagittal RLC axis) and objectively (documentation of percent subluxation of the capitate beyond the superior pole of the lunate). We propose that 4D CT investigation of all functional carpal instability syndromes may be beneficial as this technique has the potential to significantly increase our knowledge of dynamic carpal bone abnormalities.
Asunto(s)
Hueso Grande del Carpo/diagnóstico por imagen , Hueso Grande del Carpo/lesiones , Tomografía Computarizada Cuatridimensional/métodos , Luxaciones Articulares/diagnóstico por imagen , Hueso Semilunar/diagnóstico por imagen , Traumatismos de la Muñeca/diagnóstico por imagen , Adulto , Humanos , Imagenología Tridimensional/métodos , Masculino , Intensificación de Imagen Radiográfica/métodos , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
Almost all reported cases of longitudinal radioulnar dissociation have involved fracture of the radial head, rupture of the interosseous membrane, and disruption of the distal radioulnar joint, although unusual patterns of Essex-Lopresti injury have also been described. To our knowledge, this is the first report of a chronic Essex-Lopresti variant including fracture of the capitellum. A displaced capitellum fracture must alert to the possibility of longitudinal radioulnar dissociation, even without concomitant radial head fracture or symptoms at the forearm and ulnar wrist. Successful mid-term results can be achieved by treating malunion of humeral condyle and proximal migration of the radius with simultaneous Sauvé-Kapandji procedure at the wrist and reverse Sauvé-Kapandji at the elbow.