Minimally invasive method to treat a rare wrist injury with simultaneous fractures of the scaphoid and hook of hamate: A case report and literature review

Concomitant fractures of the hook of hamate and scaphoid are rare injuries to the wrist. Whenever these fractures cannot be effectively managed, nonunion or osteonecrosis is encountered. Subsequent treatment is thus much more challenging for a hand surgeon or orthopedist. Minimally invasive percutaneous internal fixation is an optimal treatment with the potential to minimize injury and reduce fractures. However, the control of iatrogenic injuries, including possible damage to the adjacent vital tissue, is a challenge that needs to be addressed. Herein,we describe the case of a 26-year-old man who presented with fractures to the scaphoid and hook of hamate in his left wrist. Minimally invasive treatment-with closed reduction and percutaneous fixation of the scaphoid, wrist arthroscopy, and closed reduction and percutaneous fixation of the hook of hamate-was performed at our institution. The Mayo score of the wrist, visual analog scale(VAS) for pain, grip strength, pinch strength, and wrist motion in radial/ulnar and flexion/extension deviation were recorded. Primary healing was achieved in both fractures. At the final follow-up, the Mayo score of the wrist was 100(excellent), the VAS score was 0(no pain),and the grip and pinch strength of his injured hand were 90.9% and 83.3%, respectively, compared with the contralateral hand(grip strength: left, 50 kg;right, 55 kg. Pinch strength: left, 20 kg;right, 24 kg). The radialulnar, flexion-extension, and forearm pronation-supination directions were 30°, 140°, and 90°, respectively.Minimally invasive closed reduction with percutaneous internal fixation is an optimal technique with satisfactory outcomes for simultaneous fractures of the hook of hamate and scaphoid. Provided in this paper are details of the technique and technical suggestions for performing the procedure.

Experimental Study and Preliminary Clinical Application of Miniinvasive Percutaneous Internal Screw Fixation for Scaphoid Fracture under the Guidance of a 3D-printed Guide Plate

This study explored the feasibility of employing computer-aided design(CAD)and 3 dimensional(3D)-printed personalized guide plate for the mini-invasive percutaneous internal screw fixation of fractured scaphoid.The study consisted of two parts:(1)experimentation on upper limbs from corpses and(2)preliminary clinical application.Corpse experiments involved upper limbs of 6 adult corpses.The specimens of upper limbs were subjected to plain CT scan.Then the CT data were input into computer to conduct 3D reconstruction of wrist region.The direction and depth of the guide wire and screw were designed on the basis of the principle that screw should lie at the center of scaphoid and the long axis of the screw should be aligned with that of the scaphoid.The carpal bone model and the guide plate were designed and 3D-printed.By using the guide plates,the guide wire was placed and the cannulated compression screw was inserted.The wrist region was examined by X-ray and CT to observe the location of the screw in the scaphoid.The scaphoid was longitudinally excised to grossly observe the location and evaluate the result of screw insertion.For clinical application,the guide plate was employed in 4 patients with fresh scaphoid fracture using the aforementioned operative technique.Our results showed that,in the 6 corpse limbs,the guide plate well fitted the skin surface and the guide wire and screw were accurately put in place in one session.X-ray examination and gross observation confirmed that the screw was satisfactorily positioned and the result met the requirements of the preoperative design.For 4 patients,the guide wire and screw were all precisely inserted into place in one session.The operation time and X-ray exposure times were apparently reduced.The imaging examination exhibited satisfactory results and the hand functioned well.It was concluded that the operative guide plate used for the mini­invasive percutaneous internal screw fixation of fractured scaphoid not only can assist in accurate placement of screw but also shorten operation time and reduce insertion and X-ray exposure times,thereby reducing the radiation injury and damage to the substance and the blood circulation of carpal bone.Its use can also improve the learning curve of surgeons.

Radiographic evaluation of vascularity in scaphoid nonunions:A review

Scaphoid fractures,particularly those that occur more proximally,are unreliable in achieving union due to the retrograde blood supply of the scaphoid bone.Vascular compromise is associated with the development of nonunions and avascular necrosis of the proximal pole.Due to the tenuous blood supply of the scaphoid,it is imperative that the vascularity be assessed when creating diagnostic and treatment strategies.Early detection of vascular compromise via imaging may signal impending nonunion and allow clinicians to perform interventions that aid in restoring perfusion to the scaphoid.Vascular compromise in the scaphoid presents a diagnostic challenge,in part due to the non-specific findings on plain radiographs and computed tomography.Magnetic resonance imaging techniques have dramatically improved our ability to assess the blood supply to the scaphoid and improve time to intervention.This review aims to summarize these advances and highlights the importance of imaging in assessing vascular compromise in scaphoid nonunion and in reperfusion following surgical intervention.

Occult Fractures in the Carpal Region:Incidental Findings on Bone Scintigraphy

The aim of this study was to evaluate the number and distribution of fractures around the wrist found on bone scintigraphy in patients with a clinically suspected scaphoid fracture and negative initial radiographs. We retrospectively included 445 consecutive patients with a suspected scaphoid fracture who underwent routine bone scintigraphy. None of the radiographs showed evidence of a fracture. We analyzed the type and number of other fractures incidentally found on bone scintigraphy. On average, bone scintigraphy was done in 4 days (1 - 9). The outcome of bone scintigraphy: 80 (18.0%) a scaphoid fracture, 145 (32.6%) another fracture in the carpal region, 208 (46.7%) normal and the diagnosis of 12 (2.8%) was unclear. In the present study, we demonstrated that in patients with a clinically suspected scaphoid fracture and negative initial radiographs, bone scintigraphy detected in many cases (64.4%) other fractures in the carpal region. This suggests that radiographs not only miss scaphoid but also many other carpal and distal radius fractures. Solutions should be found to solve this problem and probably advanced imaging techniques like CT, MRI or bone scintigraphy should be used in the correct clinical scenario.

Advances in wrist arthroscopic surgery in Indonesia

Since the 1990s,new insights in wrist arthroscopy have led to the introduction of numerous treatment methods.Consequently,therapeutic procedures are no longer limited to resection as more specialized repair and functional reconstruc-tion methods,involving tissue replacement and essential structural augmentation,have been shown to be beneficial.This article discusses the most prevalent rea-sons and uses for wrist arthroscopy,with an emphasis on Indonesia’s most recent and major advances in reconstructive arthroscopic surgery.Joint debridement,synovectomy,ganglionectomy,capsular release,and osteotomies are frequent resection operations.Ligament repair and arthroscopy-aided reduction and fixation for fractures and nonunion are all examples of reconstructive surgery.