We evaluated 100 consecutive patients with a suspected scaphoid fracture but without evidence of a fracture on plain radiographs using MRI within 24 hours of injury, and bone scintigraphy three to five days after injury. The reference standard for a true radiologically-occult scaphoid fracture was either a diagnosis of fracture on both MRI and bone scintigraphy, or, in the case of discrepancy, clinical and/or radiological evidence of a fracture. MRI revealed 16 scaphoid and 24 other fractures. Bone scintigraphy showed 28 scaphoid and 40 other fractures. According to the reference standard there were 20 scaphoid fractures. MRI was falsely negative for scaphoid fracture in four patients and bone scintigraphy falsely positive in eight. MRI had a sensitivity of 80% and a specificity of 100%. Bone scintigraphy had a sensitivity of 100% and a specificity of 90%. This study did not confirm that early, short-sequence MRI was superior to bone scintigraphy for the diagnosis of a suspected scaphoid fracture. Bone scintigraphy remains a highly sensitive and reasonably specific investigation for the diagnosis of an occult scaphoid fracture.

Aims The primary objective of this study was to compare migration of the cemented ATTUNE fixed bearing cruciate retaining tibial component with the cemented Press-Fit Condylar (PFC)-sigma fixed bearing cruciate retaining tibial component. The secondary objectives included comparing clinical and radiological outcomes and Patient Reported Outcome Measures (PROMs). Methods A single blinded randomized, non-inferiority study was conducted including 74 patients. Radiostereometry examinations were made after weight bearing, but before hospital discharge, and at three, six, 12, and 24 months postoperatively. PROMS were collected preoperatively and at three, six, 12, and 24 months postoperatively. Radiographs for measuring radiolucencies were collected at two weeks and two years postoperatively. Results The overall migration (mean maximum total point motion (MPTM)) at two years was comparable: mean 1.13 mm (95% confidence interval (CI), 0.97 to 1.30) for the ATTUNE and 1.16 mm (95% CI, 0.99 to 1.35) for the PFC-sigma. At two years, the mean backward tilting was -0.43° (95% CI, -0.65 to -0.21) for the ATTUNE and 0.08° (95% CI -0.16 to 0.31), for the PFC-sigma. Overall migration between the first and second postoperative year was negligible for both components. The clinical outcomes and PROMs improved compared with preoperative scores and were not different between groups. Radiolucencies at the implant-cement interface were mainly seen below the medial baseplate: 17% in the ATTUNE and 3% in the PFC-sigma at two weeks, and at two years 42% and 9% respectively (p = 0.001). Conclusion In the first two postoperative years the initial version of the ATTUNE tibial component was not inferior with respect to overall migration, although it showed relatively more backwards tilting and radiolucent lines at the implant-cement interface than the PFC-sigma. The version of the ATTUNE tibial component examined in this study has subsequently undergone modification by the manufacturer. Level of Evidence: 1 (randomized controlled clinical trial) Cite this article: Bone Joint J 2020;102-B(9):1158–1166.

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Bone scintigraphy will identify up to 25% of occult scaphoid bone fractures after negative scaphoid X-rays. Consequently, it deserves a place in the diagnostic process of suspected scaphoid fractures. However, the role of bone scintigraphy is less clear if scaphoid X-rays show other fractures in the carpal region. We analysed 111 consecutive patients with a suspected scaphoid fracture on physical examination. Scaphoid X-rays revealed 61 fractures. Fifty-five patients had scaphoid fractures only and six patients had other fractures in the carpal region but no scaphoid fracture. In 50 cases, no bone injury was seen on these X-rays. In three out of the six patients with other fractures in the carpal region, bone scintigraphy revealed four occult concomitant fractures: one scaphoid, one scaphoid and trapezial and one capitate fracture. In conclusion, bone scintigraphy is required when scaphoid X-rays do not confirm a suspected scaphoid fracture, even in the presence of other fractures in the carpal region.

Introduction: Scaphoid fracture nonunion presents a challenging problem. The best series in the literature report union rates of 85% following internal fixation with nonvascularised bone grafting. Despite bony union residual wrist stiffness often persists and some patients continue to complain of loss of function.Aims: We undertook prospective assessment of a consecutive series of 34 patients with scaphoid waist fracture nonunion treated at our hand unit, to determine union rate and functional outcomes following internal fixation with a cannulated compression screw (Twin fix-Stryker) and interpositional structural bone grafting.Materials and methods: The mean age was 29 years. The mean time from the original injury was 30 months (range 8 months-10 years) with an average post operative follow up of 20 months. All patients had upto date radiographs. Mayo wrist score and a subjective satisfactory scoring system (scale 1-5) were used to measure the functional outcomes. Grip strengths were recorded using a Jamar dynamometer.Results: The average time for union was 14 weeks with only 2 patients having persistent symptomatic nonunions. The average Mayo score was 86 (out of 100). The mean grip strength was 80% of the normal side with only modest improvement in the arc of wrist movements. The majority of them were very satisfied with the outcome and 85% of the patients returned to their pre injury activities including employment status.Conclusion: Our results of scaphoid fracture fixations with Twin fix screw show excellent union rates and good functional improvement, and we commend this procedure.

Abstracts 187 nificantly faster rate than the control groups with good skin appearance and minimal scar formation, while the control groups showed delayed wound healing and intensive wound contraction. Importantly, only in UCB-MSCs/MC group, most cells co-expressed with eGFP and human pan-cytokeratin in wound skin tissues. In addition, there was F VIII expression in the eGFP positive cells in UCB-MSCs/MC group.Conclusions: Human UCB-MSCs could differentiate into epithelial cells in wounded mouse skin tissues, and possess the potential to differentiate into vascular endothelial cells. These results imply that UCB-MSCs could contribute to skin tissue regeneration and play an important role in wound healing.

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