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Treatment options for distal radius fractures include nonoperative management, external fixation, and internal fixation. [ 4 ] [ 9 ] Indications for each depend on a variety of factors such as the patient's age, initial fracture displacement, and metaphyseal and articular alignment, with the ultimate goal to maximize strength and function in ...
Waist fractures in the middle third is the most frequent fracture site and has moderate risk of AVN. Fractures in the distal third are rarely complicated by AVN. Non union can also occur from undiagnosed or undertreated scaphoid fractures. Arterial flow to the scaphoid enters via the distal pole and travels to the proximal pole.
The scaphoid can be slow to heal because of the limited circulation to the bone. Fractures of the scaphoid must be recognized and treated quickly, as prompt treatment by immobilization or surgical fixation increases the likelihood of the bone healing in anatomic alignment, thus avoiding mal-union or non-union. [6] Delays may compromise healing.
Preiser disease, or avascular necrosis of the scaphoid, is a rare condition where ischemia and necrosis of the scaphoid bone occurs without previous fracture.It is thought to be caused by repetitive microtrauma or side effects of drugs (e.g., steroids or chemotherapy) in conjunction with existing defective vascular supply to the proximal pole of the scaphoid.
In this stage there are two surgical treatment options; total wrist arthroplasty and total wrist arthrodesis. Total wrist arthrodesis is the standard surgical treatment for patients with stage IV wrist osteoarthritis. During this procedure the carpal bones are all fused together and are then fastened to the distal radius. [14]
More advanced stages of SLAC wrist or SLAC wrist that is refractory to non-surgical management may be treated with surgical options including radial styloidectomy, proximal row carpectomy, scaphoid excision and four-corner fusion, wrist fusion, or wrist replacement (arthroplasty).
Four corner fusion, or partial wrist arthrodesis, is a procedure which involves resection/removal of the scaphoid bone and fixation of the remaining wrist bones with a plate or wires. [1] The procedure is usually performed due to wrist arthritis or due to scaphoid collapse.
Scaphoid pseudarthrosis, before and after treatment with Herbert screw. The Herbert screw (invented by Timothy Herbert) is a variable pitch cannulated screw typically made from titanium for its biocompatible properties as the screw is normally intended to remain in the patient indefinitely. It became generally available in 1978.