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Wrist osteoarthritis is gradual loss of articular cartilage and hypertrophic bone changes (osteophytes). While in many joints this is part of normal aging (senescence), in the wrist osteoarthritis usually occurs over years to decades after scapholunate interosseous ligament rupture or an unhealed fracture of the scaphoid.
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.
Another technique is used to reconstruct the volar beak ligament after trapeziectomy. The rationale is that ligament reconstruction(LR) helps maintain the gap between the metacarpal and the scaphoid, and that a larger gap is associated with greater comfort and capability. [32] Again these possibilities are not supported by experimental evidence.
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.
The Herbert classification is a system of categorizing scaphoid fractures. [1] Classification. Type Description A Acute/stable A1 Tubercle: A2 Nondisplaced waist ...
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.
At least 33% resolve without treatment within six years, and 50% within 10 years. [25] Surgical excision is the primary discretionary, elective treatment option for ganglion cysts. Alternatively, a hypodermic needle may be used to drain the fluid from the cyst (via aspiration). [26]
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.