Der Unfallchirurg
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Fractures of the scaphoid bone are common but can easily be overlooked in standard X‑rays. Inadequate diagnostics and therefore inappropriate treatment of scaphoid fractures often leads to problems in healing with formation of non-union and painful osteoarthritis of the wrist. ⋯ The main statements are that in cases of a clinically suspected scaphoid fracture, staged diagnostics including radiographs, computed tomography (CT) and when necessary magnetic resonance imaging (MRI) should be applied to confirm or exclude a fracture. Further treatment in the case of a fracture is planned according to a CT-based classification. There are fracture types that can be treated either conservatively or operatively and there are other fracture types that always require operative fixation. The operative technique depends on the exact fracture geometry. For osteosynthesis, cannulated headless compression screws are mostly used.
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Digitalization and standardization of documentation in medicine are increasingly progressing. In the decision of the Federal Joint Committee (G-BA) for a staged system of emergency structures in hospitals and in the report of the expert committee for development in the healthcare system on needs-oriented guidance of healthcare, the actuality of the topic is underlined with concrete naming of future tasks. ⋯ Digitalization makes the secondary use of primary clinical routine data possible. Digitalization decreases redundancies of data transmission by avoiding manual data input in, for example registers.
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The most important goals of scaphoid reconstruction in pseudarthrosis are correction of the humpback deformity, the realignment of the proximal carpal row and the bony union of the scaphoid. Therefore, in most cases bone grafting is required. To increase the healing rate and to improve vascularization, several kinds of vascularized bone grafts have been developed. ⋯ The use of vascularized grafts is still a matter of controversy, since their superiority is still unproven compared to nonvascularized grafts, which also achieved 100% fusion rates in several series. They are indicated in secondary procedures after failed reconstruction and nonunion with small avascular proximal pole fragments. Since no evidence-based guidelines exist, this article provides an experience-based treatment algorithm for scaphoid nonunion with special consideration to vascularized bone grafts.
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Nonunion of the scaphoid is a severe complication of often insufficiently treated scaphoid fractures or those which have been diagnosed too late. The treatment of scaphoid nonunion is challenging und should be performed by experienced hand surgeons. The anatomical shape, the retrograde blood supply and the biomechanics of the scaphoid complicate the healing process. ⋯ The available data do not enable the establishment of a superior treatment procedure. The most common surgical procedure used to treat scaphoid nonunion is autologous bone grafting combined with screw fixation. This article provides an up to date overview of the management and standard procedures for the primary treatment of scaphoid nonunion without a circulatory disorder.
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Among the carpal bones the scaphoid (Os scaphoideum) is the most important. The most frequent fracture of the carpus is a fracture of the scaphoid bone. The frequently occurring absence of healing of these fractures as well as unhealed ruptures of the ligament complex between the scaphoid and lunate, lead to the most severe biomechanical and thus the most severe clinical changes of the wrist. The detailed anatomy of the scaphoid, blood flow, ligament attachments, injury mechanisms and pathobiomechanics are described and illustrated.