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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.
Scapholunate advanced collapse is the most common form, followed by scaphoid non-union advanced collapse (SNAC). [3] Other post-traumatic causes such as intra-articular fractures of the distal radius or ulna can also lead to wrist osteoarthritis, but are less common.
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.
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.
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.
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.
Early detection, on the other hand, enables more effective treatment, a shorter hospitalization period if necessary, and decreased medical costs in the long run. It will also prevent inherent complications such as nonunion, malunion, premature osteoarthritis, and avascular osteonecrosis (as in scaphoid fracture). Of the three types of occult ...