Scaphoid Healing Required for Unrestricted Activity: A Biomechanical Cadaver Model.

PURPOSE: To determine if scaphoid fractures with bridging bone of 50% of their width treated with a centrally placed screw will restore biomechanical integrity equivalent to that of the intact scaphoid. METHODS: Twenty-four fresh cadaver scaphoids were used. Six were left intact to serve as the control group. Six were osteotomized 50% of their width and made up the osteotomy without screw group. Six were included in the 50% osteotomy plus compression screw group. The remaining 6 were to be treated with an osteotomy of 25% or 75% with a screw, based upon the results of the 50% osteotomy with screw group. Biomechanical testing was performed using an Instron testing machine, with a load applied to the scaphoid's distal pole. Load to failure and stiffness were measured. RESULTS: Intact scaphoids had an average load to failure of 610.0 N. The average load to failure of the 50% osteotomy group without a screw was 272.0 N and with a screw was 666.3 N. There was no significant difference in load to failure between the 50% osteotomy plus screw and the intact scaphoid. The 75% osteotomy plus screw was found to have a load to failure of 174.0 N, significantly lower than the intact scaphoid. The 50% osteotomy plus screw had a significantly higher stiffness than the intact scaphoid control. CONCLUSIONS: A 50% intact scaphoid with a centrally placed screw showed similar load to failure and significantly higher stiffness than the intact scaphoid when tested in cantilever bending. CLINICAL RELEVANCE: This study demonstrates that patients with scaphoid waist fractures who undergo surgery with a compression screw may be able to return to unrestricted activity with 50% partial healing.

Anomalous muscles within the first dorsal extensor compartment of the wrist.

A 73-year-old woman presented with a 12-month history of a tender first dorsal extensor compartment of her right wrist along with swelling which extended proximally. Caring for her grandchildren exacerbated her pain, and rest relieved it. Over a 2-month period, two injections and splint immobilization failed to provide pain relief and swelling reduction. An ultrasound showed anomalous muscles within the first dorsal extensor compartment. Surgical release of the first compartment showed the abductor pollicis longus and extensor pollicis brevis tendons flanked by muscles within an inflamed sheath. Releasing the compartment resulted in complete pain relief. Anatomic variations within the first dorsal extensor compartment have been reported, but there has been no report on double anomalous muscles within the compartment. The details of the case, utility of ultrasound, and a brief review of the literature are described.