Ann R Coll Surg Engl 2008; 90: 488-491 488Carpal injuries are common presentations to emergency departments, general practitioners and orthopaedic clinics. The scaphoid bone is the most commonly injured of the carpal bones accounting for 50-80% of carpal injuries and predominantly occurs in young. healthy individuals.
1,2Scaphoid fractures are the most problematic to diagnose in a clinical setting because it can take up to 6 weeks for scaphoid fractures to become conclusive on plain X-ray films. It is estimated that up to 40% of scaphoid fractures are missed at first presentation. 3,4 A recent metaanalysis of scaphoid fractures calculated that the positive predictive value of clinical examination (those who proved to be 'clinical scaphoid' warranted X-rays of scaphoid views who subsequently had scaphoid fracture) is in the range 13-69% with an average of 21%.
5This means that four out of five patients without a fracture will be unnecessarily immobilised before radiological diagnosis is confirmed.
Patients and MethodsWe conducted a retrospective, chronological review of patients who attended an upper limb fracture clinic from January 2001 to October 2003 in a district general hospital. Patients with negative X-ray findings but positive clinical signs for scaphoid injury satisfied the criteria for CT. We defined clinical signs for a scaphoid injury as tenderness over the anatomical snuffbox, pain on axial loading of first metacarpal and tenderness over scaphoid tubercle in the presence of normal plain films and included patients whose plain X-rays proved inconclusive.Patients with clinical indications of scaphoid fracture but negative plain films had their wrists immobilised in a scaphoid cast in the accident unit while awaiting a hand clinic appointment.CT scans, where necessary, were carried out on the same day as review on the first presentation to the fracture
Background: The aim of this retrospective case series study was to assess the outcomes of patients with recurrent anterior shoulder instability with antero-inferior glenoid bone loss treated with a specific open stabilization technique using intra-substance coracoid bone-grafting and Bankart repair. Methods: Over a 4-year period, 34 shoulders in all male patients of mean age 21 years were stabilized with this technique. Pre-and postoperative function, motion and stability were assessed as part of Rowe stability scoring, and American Shoulder and Elbow Surgeons (ASES) and Oxford Instability were recorded, with at least 2 years of follow-up in all patients. Union of the graft was determined by post-operative computed tomography (CT) of the affected shoulder. Results: For all cases, two redislocations (5.9%) and two subluxations occurred when continuing high-risk sport after 2 years. Post-operative scores [median, mean (SD): Rowe 77.5, 77.2 (19.5); ASES 94.2, 92 (7.7); Oxford 43, 41.2 (6)]. CT scans on 28 shoulders at a mean of 4.5 months after surgery showed non-union in three cases (10%).Conclusions: These results demonstrate a high rate of success in cases of glenoid bone loss in the young contact athlete with recurrent instability treated with open stabilization and bone grafting.
BackgroundThe Congruent-Arc Latarjet is modification of the Latarjet open bony stabilisation for shoulder instability. It involves rotation of the coracoid so the curved under-surface lies congruent with the glenoid. The aim of this study was to define the relationship between the concave under surface of the coracoid and the glenoid.Methods An initial study of 210 cadaveric scapulae was performed followed by a study measuring the same curves using 3D CT reconstruction on 20 scapulae from living patients.
ResultsCadveric measurement revealed the glenoid's surface had a median radius of curvature of 30 mm and the coracoid had a median radius of curvature of 25 mm. The CT measurements revealed similar radii of curvature with the glenoid measuring 23.9 mm and the coracoid measuring 25.4 mm (p = 0.2488).
ConclusionThe curvature of the glenoid in the cadaveric specimens was slightly larger than the corresponding coracoid curvature. In life this difference may be minimised by articular cartilage, labrum and the attachment of capsule. The CT study revealed similar curves, although in contrast to the cadaveric specimens the coracoid curvature was slightly larger. Overall the curvature of the under surface of the coracoid is similar to the glenoid, which supports this modification of the Latarjet procedure.
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