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Cievet M, Buffard M, Kumble A, Ramos-Pascual S, Locquet V, Burnier M. Outcomes of arthroscopic versus open reduction and internal fixation for the treatment of acute traumatic lunate fractures: a systematic review. HAND SURGERY & REHABILITATION 2023:S2468-1229(23)00114-7. [PMID: 37364729 DOI: 10.1016/j.hansur.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023]
Abstract
The purpose of the study was to compare outcomes of fully-arthroscopic reduction and internal fixation (ARIF) versus open reduction and internal fixation (ORIF) to treat acute traumatic lunate fractures. A literature search was conducted using Medline and Embase. Demographic data and outcomes were extracted for included studies. The search identified 2,146 references: 17 articles were included, reporting on 20 cases (4 ARIF and 16 ORIF). No differences between ARIF and ORIF were found in rate of union (100% vs 93%, P = 1.000), grip strength (mean difference, 8%; 95%CI, -16-31; P = 0.592), rate of return to work (100% vs 100%, P = 1.000), or range of motion (mean difference, 28°; 95%CI, -25-80; P = 0.426). Lunate fractures were not identified in 6 of the 19 radiographs, but were identified in all CT scans. There were no differences in outcome between ARIF and ORIF for the treatment of fresh lunate fracture. The authors recommend surgeons to perform CT scans when diagnosing high-energy wrist trauma so as not to overlook lunate fractures. LEVEL OF EVIDENCE: Level IV.
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Affiliation(s)
- Maxime Cievet
- Institut Chirurgical de la Main et du Membre Supérieur, 17 Avenue Condorcet, 69100, Villeurbanne, France; Clinique Trenel, 575 Rue du Dr Trenel, 69560, Sainte-Colombe, France.
| | - Marius Buffard
- Institut Chirurgical de la Main et du Membre Supérieur, 17 Avenue Condorcet, 69100, Villeurbanne, France; Hôpital Edouard Herriot, CHU Lyon, Service de Chirurgie Orthopédique Main et Membre Supérieur, 5 Place d'Arsonval, 69003, Lyon, France.
| | - Ankitha Kumble
- Hôpital Edouard Herriot, CHU Lyon, Service de Chirurgie Orthopédique Main et Membre Supérieur, 5 Place d'Arsonval, 69003, Lyon, France.
| | - Sonia Ramos-Pascual
- Hôpital Edouard Herriot, CHU Lyon, Service de Chirurgie Orthopédique Main et Membre Supérieur, 5 Place d'Arsonval, 69003, Lyon, France.
| | - Vincent Locquet
- Institut Chirurgical de la Main et du Membre Supérieur, 17 Avenue Condorcet, 69100, Villeurbanne, France.
| | - Marion Burnier
- Institut Chirurgical de la Main et du Membre Supérieur, 17 Avenue Condorcet, 69100, Villeurbanne, France.
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Kadar A, Iordache SD. Neglected Scaphocapitate Syndrome. J Wrist Surg 2023; 12:143-146. [PMID: 36923103 PMCID: PMC10010893 DOI: 10.1055/s-0041-1740402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 10/22/2021] [Indexed: 10/19/2022]
Abstract
Background Scaphocapitate syndrome is a rare injury where the proximal pole of the capitate rotates 90 to 180 degrees. The proximal pole of the capitate, thought to receive its vascular supply retrograde, is rendered avascular in such cases. However, recent evidence of low rates of avascular necrosis in displaced capitate fractures, and new vascular studies of the capitate, challenge this paradigm. Case Description We report a case of a missed and neglected scaphocapitate syndrome with more than 30 years follow-up. While the patient experienced midcarpal arthritis, the injury had not resulted in capitate proximal pole avascular necrosis as per T1 magnetic resonance imaging studies. Literature Review Missed and chronic cases of scaphocapitate syndrome were reported previously. Successful outcomes were achieved with anatomical reduction in cases without midcarpal arthritis. Salvage procedures or arthroplasty procedures are recommended with the presence of midcarpal arthritis. However, there are no reports of a neglected case with more than 30 years follow-up with preserved vascularity of the proximal pole of the capitate. Clinical Relevance This case illustrates that vascularity of the proximal pole of the capitate can be preserved even in longstanding displaced fractures.
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Affiliation(s)
- Assaf Kadar
- Department of Orthopedic Surgery, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sorin D. Iordache
- Department of Orthopedic Surgery, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Pedrazzini A, Daci L, Bertoni N, Pedrabissi B, Yewo Simo H, Medina V, Ceccarelli F, Pogliacomi F. The scapho-capitate syndrome: a case report with follow-up of three years. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:156-161. [PMID: 31821301 PMCID: PMC7233705 DOI: 10.23750/abm.v90i12-s.8881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 09/23/2019] [Indexed: 11/23/2022]
Abstract
The scapho-capitate or Fenton syndrome is characterized by an associate fracture of the scaphoid and capitate with rotation of 90° or 180° of the capitate's head. We report a case of this syndrome which occurred in a fifteen years old professional motorcyclist who came to our observation following a high-energy trauma that occurred during the track tests. Through a dorsal access the fractures of the capitate and scaphoid were reduced and stabilized with Kirschner wires. The patient was radiographically and clinically evaluated three years after surgery; complete healing of scaphoid fracture and reabsorption of the capitate's head as consequence of avascular necrosis with the onset of a midcarpal arthritis were observed. Despite this radiographic evolution, the patient achieved excellent clinical result featured by complete recovery of wrist motion and absence of pain thus allowing the return to motorcycling.
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Akinleye SD, Melamed E. A Unique Presentation of Scaphocapitate Syndrome With Extrusion Into the Carpal Tunnel: A Case Report. Hand (N Y) 2018; 13:NP39-NP45. [PMID: 30205706 PMCID: PMC6300171 DOI: 10.1177/1558944718799461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Scaphocapitate syndrome is a rare variety of perilunate instability, described as a trans-scaphoid, trans-capitate fracture, with rotation of the capitate head either 90° or 180°. METHODS We present a unique case of scaphocapitate syndrome in which the rotated proximal capitate fragment expelled into the carpal canal. RESULTS The capitate head was extricated from the carpal tunnel via the volar approach, and was anatomically aligned and fixed through the dorsal approach using two 2.0 mm headless compression screws. The scaphoid fracture was then also reduced through the dorsal approach and stabilized with a 2.5 mm headless compression screw. All intercarpal ligaments appeared intact. CONCLUSIONS Volar dislocation of the proximal capitate into the carpal tunnel in scaphocapitate syndrome presents a unique challenge that can be addressed with a combined volar and dorsal approach.
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Affiliation(s)
- Sheriff D. Akinleye
- Maimonides Medical Center, Brooklyn, NY, USA,Sheriff D. Akinleye, Maimonides Medical Center, Orthopaedic Surgery, 927 49th Street, Brooklyn, NY 11219, USA.
| | - Eitan Melamed
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York City, USA
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Shunmugam M, Phadnis J, Watts A, Bain GI. Lunate fractures and associated radiocarpal and midcarpal instabilities: a systematic review. J Hand Surg Eur Vol 2018; 43:84-92. [PMID: 29132239 DOI: 10.1177/1753193417740850] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to analyse lunate fractures and any associated osseo-ligamentous injuries. A systematic review identified 34 cases. We identified carpal instabilities at the radiocarpal and midcarpal joints in volar and dorsal directions. Radiocarpal instabilities (10/34) were usually dorsoradial (8/10), with a transverse lunate fracture, best seen on a coronal image. Midcarpal instabilities (24/34) were usually volar (14/18), with a volar lunate shear fracture, best seen on a sagittal image. Instabilities were sub-classified into non-displaced, subluxated and dislocated. Associated fractures of the scaphoid and the radial and ulnar styloid processes were common. Lunate fractures without subluxation or dislocation had good outcomes with cast immobilization or fixation of associated fractures. Lunate fracture-subluxations are unstable injuries that are best managed with fixation of the carpal fractures. Lunate fracture-dislocations are complex injuries, requiring stabilization of the lunate, associated fractures and ligament injuries; complications are common and acute or delayed salvage procedures may be required.
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Affiliation(s)
- Meenalochani Shunmugam
- 1 Flinders University, Adelaide, Australia.,2 Department of Orthopaedic Surgery and Trauma, Flinders Medical Centre, Adelaide, Australia
| | - Joideep Phadnis
- 1 Flinders University, Adelaide, Australia.,2 Department of Orthopaedic Surgery and Trauma, Flinders Medical Centre, Adelaide, Australia.,3 Department of Trauma and Orthopaedics, Brighton and Sussex University Hospitals, UK
| | - Amy Watts
- 1 Flinders University, Adelaide, Australia
| | - Gregory I Bain
- 1 Flinders University, Adelaide, Australia.,2 Department of Orthopaedic Surgery and Trauma, Flinders Medical Centre, Adelaide, Australia
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Nunez FA, Luo TD, Jupiter JB, Nunez FA. Scaphocapitate Syndrome With Associated Trans-Scaphoid, Trans-Hamate Perilunate Dislocation: A Case Report and Description of Surgical Fixation. Hand (N Y) 2017; 12:NP27-NP31. [PMID: 28344539 PMCID: PMC5349417 DOI: 10.1177/1558944716668837] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Perilunate fracture dislocations are often associated with fractures of the distal pole of the scaphoid or the proximal pole of the capitate. However, the combination of perilunate dislocation with multiple carpal fractures and associated scaphocapitate syndrome is very rare. Methods: We report a unique case of scaphocapitate fracture syndrome with perilunate dislocation and fracture of the hamate resulting from a high-energy injury to the wrist during a dirt-bike competition. Results: Open reduction and internal fixation of the scaphoid fracture with a 3.0-mm headless screw, the head of the capitate with a 1.5-mm lag screw, and the hamate fracture with a 1.3-mm lag screw was performed. The lunotriquetral dissociation was reduced, with the ligament repaired and the joint stabilized using a Kirschner wire. All screw heads are carefully buried under the articulate cartilage. Conclusions: Prompt anatomic reduction and stable osteosynthesis of all fractures in this patient resulted in successful healing and return to activity.
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Affiliation(s)
- Fiesky A. Nunez
- Wake Forest Baptist Medical Center, Winston-Salem, NC, USA,Fiesky A. Nunez Jr, Wake Forest Baptist Medical Center, Medical Center Blvd, Winston-Salem, NC 27157, USA.
| | - T. David Luo
- Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
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Abstract
This article reviews the most common complications associated with the management of carpal fractures. Discussion focuses on the recognition of commonly "missed" fractures and fracture patterns and the negative sequelae that can result from these delayed diagnoses. The pitfalls of conservative treatment of specific carpal fractures are reviewed, and the most common complications resulting from the operative management of carpal injuries are described.
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Affiliation(s)
- R Glenn Gaston
- OrthoCarolina, 1915 Randolph Road, Charlotte, NC 28207, USA.
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8
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The scaphocapitate fracture syndrome: a case report and literature analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 23 Suppl 2:S207-12. [DOI: 10.1007/s00590-013-1182-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 01/27/2013] [Indexed: 10/27/2022]
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Briseño MR, Yao J. Lunate fractures in the face of a perilunate injury: an uncommon and easily missed injury pattern. J Hand Surg Am 2012; 37:63-7. [PMID: 22051228 DOI: 10.1016/j.jhsa.2011.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 09/04/2011] [Accepted: 09/12/2011] [Indexed: 02/02/2023]
Abstract
Lunate fractures are rare and are usually associated with high-energy trauma. Typically, they are described in isolation or with associated carpal injuries such as scaphoid, capitate, or radial styloid fractures. We report a case of a complex lunate fracture in combination with a perilunate dissociation injury.
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Affiliation(s)
- Michael R Briseño
- Department of Orthopaedic Surgery, Stanford University Hospital and Clinics, Redwood City, CA 94063, USA.
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10
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Abstract
The scaphocapitate fracture syndrome is a rare entity of a perilunate fracture-dislocation. The diagnosis is frequently missed at initial presentation to a physician. Usually, a CT scan is required to reveal the extent of the lesion. Operative treatment consists of open reduction and internal fixation with screws (e.g. headless compression screw) or Kirschner wires. We report on a case of a 19-year-old man who presented to our hospital 2 months after he fell on his left wrist. He complained about persistent pain and a decreased range of motion after conservative treatment in a short arm cast. The diagnosis was finally made by a CT scan and the patient was treated operatively using headless compression screws in both the capitate and the scaphoid. After 12 weeks, fractures were completely healed radiographically and the patient returned to work. At follow-up 16 months after trauma, the patient had no further complaints. Range of motion increased and no avascular necrosis could be observed.
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Hamdi MF. The scaphocapitate fracture syndrome: report of a case and a review of the literature. Musculoskelet Surg 2011; 96:223-6. [PMID: 21373909 DOI: 10.1007/s12306-011-0108-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2010] [Accepted: 02/17/2011] [Indexed: 11/25/2022]
Abstract
The Fenton's syndrome or scaphocapitate fracture syndrome has been described since 1950. This severe and uncommon injury occurs after a high-energy trauma of the wrist. This syndrome associated the fractures of the scaphoid and capitate, with a rotation of 90° or 180° of the proximal fragment of the capitate. The diagnosis is determined by careful physical and radiological examinations, including conventional radiographs. Computed tomography can be helpful in detecting such lesions. We report one case of Fenton's syndrome that occurred after a high-energy trauma in a 22-year-old male. We discuss the mechanisms of the injury and the results of treatment.
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Affiliation(s)
- M F Hamdi
- Department of Trauma and Orthopaedic Surgery, F. Bourguiba University Hospital, 5000 Monastir, Tunisia.
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12
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Nagai T, Nagaoka M, Ryu J. Scaphocapitate fracture associated with median nerve palsy. J Orthop Sci 2009; 14:339-43. [PMID: 19499303 DOI: 10.1007/s00776-008-1328-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Accepted: 11/20/2008] [Indexed: 11/30/2022]
Affiliation(s)
- Takako Nagai
- Orthopaedic Department, Surugadai Nihon University Hospital, 1-8-13 Kanda Surugadai, Chiyoda-ku, Tokyo 101-8309, Japan
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13
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Abstract
Scaphoid fractures in children are uncommon. A high index of suspicion is required in children when clinical signs and symptoms indicate a scaphoid fracture in a child. Radiographic evaluation with multiple views should be performed to assess for fracture. If necessary, advanced imaging studies such as MRI should be performed. Most scaphoid fractures can be treated with cast immobilization, which results in healing in the vas majority of cases. Scaphoid nonunion is usually the result of delayed presentation or missed diagnosis. Fortunately union can be achieved reliably with cast immobilization or surgical fixation.
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Affiliation(s)
- Bassem T Elhassan
- Mayo Medical College, Department of Orthopaedic Surgery, Division of Hand Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
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14
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Abstract
Carpal injuries in children are relatively rare. Diagnosis is likely to be missed, or the severity of the injury might not fully be appreciated at the time of presentation. Fortunately, in the majority of cases the fracture heals uneventfully with a low incidence of complications. As in adults, the scaphoid is most susceptible to injury and the capitate, which often presents in association with other carpal bone injuries, the next most susceptible. Other carpal bone fractures are very unusual and the literature largely is confined to case reports or very small series. This review article lists the common carpal injuries in children and suggests a treatment plan in each case, emphasizing the importance of having a high index of suspicion when faced with a child with a wrist injury and seemingly normal radiographs.
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Abstract
Scaphocapitate syndrome is a rare injury and its incidence in immature skeleton is not well documented. We describe our experience of scaphocapitate syndrome in a 12-year-old boy and report the results after a 3-year follow-up period. Treatment involved open reduction internal fixation using K-wires. The 3-year follow-up evaluation revealed no evidence of avascular necrosis. The wrist was completely asymptomatic and the patient used it normally. The difficulty in examining an injured child and the presence of open physes on radiographs can make diagnosis difficult. Awareness among orthopedic surgeons about this injury in children is needed to avoid misdiagnosis and to initiate timely treatment.
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Affiliation(s)
- M Sawant
- Mayday University Hospital, Thornton Heath, Surrey, UK
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