Radioscapholunate ligament: A gross anatomic and histologic study of fetal and adult wrists
The radioscapholunate ligament was studied using fifty-four dissected adult cadaver wrists. Four of these wrists had arterial perfusions with colored latex and serial sections were made of twentyone wrists from fetuses ranging in size from 23 to 230 millimeters crown-rump length. The radioscapholunate ligament Mas consistently identified between the long and short radiolunate ligaments, emerging through the palmar capsule of the radiocarpal joint. It was found to be a neurovascular structure surrounded by synovial tissue with vascular origins from the anterior interosseous and radial arteries and a neural origin from the anterior interosseous nerve. On entering the radiocarpal joint it attaches proximally to the intcrfacct prominence on the articular surface of the radius and distally to form the proximal membrane of the scapholunate interosseous ligament system. We found no anatomic evidence that this structure should be considered a ligament in a traditional mechanical sense. However, this structure may be clinically important as the vascular supply of the scapholunate interosseous ligament, as well as a sensory pathway from the scapholunate articlation.
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Cited by (91)
Scaphoid Healing Required for Unrestricted Activity: A Biomechanical Cadaver Model
2018, Journal of Hand SurgeryTo determine if scaphoid fractures with bridging bone of 50% of their width treated with a centrally placed screw will restore biomechanical integrity equivalent to that of the intact scaphoid.
Twenty-four fresh cadaver scaphoids were used. Six were left intact to serve as the control group. Six were osteotomized 50% of their width and made up the osteotomy without screw group. Six were included in the 50% osteotomy plus compression screw group. The remaining 6 were to be treated with an osteotomy of 25% or 75% with a screw, based upon the results of the 50% osteotomy with screw group. Biomechanical testing was performed using an Instron testing machine, with a load applied to the scaphoid’s distal pole. Load to failure and stiffness were measured.
Intact scaphoids had an average load to failure of 610.0 N. The average load to failure of the 50% osteotomy group without a screw was 272.0 N and with a screw was 666.3 N. There was no significant difference in load to failure between the 50% osteotomy plus screw and the intact scaphoid. The 75% osteotomy plus screw was found to have a load to failure of 174.0 N, significantly lower than the intact scaphoid. The 50% osteotomy plus screw had a significantly higher stiffness than the intact scaphoid control.
A 50% intact scaphoid with a centrally placed screw showed similar load to failure and significantly higher stiffness than the intact scaphoid when tested in cantilever bending.
This study demonstrates that patients with scaphoid waist fractures who undergo surgery with a compression screw may be able to return to unrestricted activity with 50% partial healing.
Anatomy of the Scaphoid Bone and Ligaments
2018, Scaphoid Fractures: Evidence-Based ManagementThe scaphoid has characteristic anatomic features: it articulates with five adjacent bones through a largely cartilaginous surface and features a complex network of ligamentous attachments. A substantial variety in both osseous and ligamentous scaphoid anatomy has been described in literature. Variations in scaphoid anatomy are known to result in distinct kinematic patterns, thus playing a pivotal role in carpal (in)stability. A thorough understanding and clear description of scaphoid anatomy is therefore of crucial importance.
Classifying morphological scaphoid subtypes and their correlated kinematic patterns will allow these anatomic variations to be employed as a basis for the role of the scaphoid in carpal kinematics.
Validity of modified radiological views to detect screw protrusion at the distal radius. A comparative study with computerized tomography
2013, Revista Espanola de Cirugia Ortopedica y TraumatologiaEl tratamiento de las fracturas intraarticulares del radio distal mediante placas volares de ángulo fijo (PVAF) está ampliamente difundido en la actualidad. El uso de estas placas, debido a su peculiar configuración, conlleva un elevado riesgo de protrusión de los tornillos a nivel intraarticular y dorsal. El objetivo de nuestro trabajo es determinar la validez de las proyecciones radiológicas habituales, realizadas con la ayuda de soportes en forma de cuña, para detectar la protrusión de los tornillos a nivel intraarticular y dorsal, utilizando la tomografía axial computarizada (TAC) como prueba de referencia. En el estudio se presentan los resultados obtenidos en 26 pacientes tratados de una fractura articular de radio distal mediante una PVAF, modelo DVR®. Se ha observado una correlación satisfactoria entre los resultados de las radiografías con soportes cuando han sido comparadas con la TAC, con una sensibilidad del 100% para las protrusiones intraarticulares y del 66% para las protrusiones dorsales. Se recomienda la realización de estas proyecciones especiales de muñeca como una herramienta intraoperatoria útil para detectar la protrusión de los tornillos en las PVAF.
Volar fixed-angle plates (VFAP) are currently widely used for the treatment of extra-articular distal radius fractures. Using these plates has a high risk of articular and dorsal screw protrusion due to their special configuration. The aim of this study is to assess the validity of the standard X-rays, performed with the help of wedged supports, in order to detect articular and dorsal screw protrusion. A comparison with computed tomography (CT) scan imaging has been made. The outcome of 26 patients with distal radius articular fracture, treated with a VFAP, is reported. Good correlation between modified X-rays and CT scan was observed. A sensitivity of 100% for articular protrusion and 66% for dorsal have been obtained. When detecting screw protrusion at the distal radius, the use of wedged supports to perform special X-rays intraoperatively is an effective tool.
The carpal collapse
2012, Revue du Rhumatisme MonographiesLe collapsus carpien se définie comme une perte de hauteur du carpe. Il correspond a une désorganisation des pièces osseuses carpiennes entres elles, qui basculent les unes par rapport aux autres entraînant une dysfonction de la dynamique du carpe responsable d’une usure cartilagineuse progressive. Cette arthrose provoque des douleurs et un enraidissement du poignet qui prend un aspect « empâté ». On différencie deux grands groupes de collapsus carpiens : ceux qui résultent d’une anomalie de départ intracarpienne, qu’il s’agisse d’un cal vicieux, d’une pseudarthrose, d’une arthrose microcristalline ou d’une lésion ligamentaire et ceux qui résultent d’une désorientation radiocarpienne consécutive à un cal vicieux du radius que l’on appelle « collapsus carpien d’adaptation ». Ces derniers modifient l’orientation de la surface articulaire inférieure du radius auquel le carpe s’adapte en se réorientant avec une perte de hauteur. Une fois au stade de collapsus, il est important d’en connaître l’origine pour adapter au mieux la prise en charge thérapeutique et apprécier le pronostic. Cette démarche diagnostique rétrospective nécessite de connaître quelques caractéristiques anatomiques des structures ostéoligamentaires carpiennes ainsi que le mode d’analyse radiologique de l’orientation et de la hauteur du carpe. L’évolution des arthroses par collapsus carpien est alors prévisible et stéréotypé en fonction de leurs causes et différents traitements sont envisageables en fonction du stade évolutif. Le traitement initial de la lésion à l’origine du collapsus reste toutefois le plus à même d’éviter le recours à un traitement palliatif en général seul possible aux stades évolués.
The carpal collapse is defined as a loss of carpal height. It corresponds to a disorganization of carpal bone pieces that switch between them against each other resulting in dysfunction of the dynamics of carp responsible for progressive cartilage wear. Osteoarthritis causes pain and stiffness of the wrist with a “bloated” pattern. We distinguish two main groups of carpal collapse : those resulting from an anomaly starting intracarpal whether malunion, a nonunion, a microcrystalline arthritis or a ligament injury and those resulting from disorientation radiocarpal following a malunion of the radius is called “adaptive carpal collapse”. The latter changes the orientation of the articular surface of the radius at which the carp adapts by shifting with a loss of height. Once the stage of collapse is present, it is important to identify its cause to best adapt the therapeutic management and prognosis assessment. This retrospective diagnosis requires knowing some anatomical features of bone structure carpal ligaments and method of analysis of radiological guidance and carpal height. Outcome of osteoarthritis secondary to carpal collapse is so predictable and stereotyped according to their causes and different treatments are possible depending on staging. Initial treatment of the lesion causing collapse remains the most likely to avoid the use of palliative treatment usually only possible with advanced stages.
Osseous and ligamentous scaphoid anatomy: Part I. A systematic literature review highlighting controversies
2011, Journal of Hand SurgeryThe interpretation of scaphoid anatomy and kinematics is confusing and controversial. This results from a lack of consensus on the anatomy of the ligaments attaching to the scaphoid and an overwhelming variety of substantially different anatomic descriptions and classification systems of the wrist joint in the literature. The present study systemically reviews the consistencies or inconsistencies of the various scaphoid ligament descriptions and aims to clarify and unify different concepts and classification systems.
We performed a systematic search of the medical literature from 1950 to 2010. We included all descriptive reports of the anatomy or morphology of the scaphoid, ligaments, or both. With the aim to describe the best available evidence, we considered all anatomical descriptions but emphasized a selection of the most frequently cited articles.
The literature search resulted in 555 potentially eligible descriptive reports, 58 of which met the inclusion criteria and were included in the review. Variations in the anatomic descriptions appear to be mostly due to the difficulty of identifying individual interdigitating ligaments or bundles by macroscopic dissections, as well as the interindividual variability in ligament anatomy. The most important areas of controversy in the scaphoid ligament attachments include the radial collateral ligament, dorsal radiocarpal ligament, dorsal intercarpal ligament, volar scaphotriquetral ligament, and scaphotrapezium-trapezoid ligament.
None of the scaphoid ligaments other than the scaphocapitate ligament have been described consistently. Future research is required to verify the ligament attachments that currently have the most controversial descriptions, while addressing the interindividual variability of ligament insertions and morphology.
Thorough knowledge of the anatomy will enhance our understanding of the kinematics of the scaphoid.
Isolated scaphoid fracture with anterosuperior dislocation of the proximal fragment
2011, Chirurgie de la MainIsolated fracture of the scaphoid with an associated anterosuperior dislocation of the proximal fragment is an extremely rare injury. We present two cases where open reduction and internal fixation through a palmar and dorsal approach was performed. No instances of non-union, necrosis of the proximal fragment of the scaphoid or scapholunate dissociation were noted during a mean follow-up period of 18 months. Clinical results (active motion, power grip, DASH) following such injury and intervention are presented. The aetiology of this rare injury is discussed.
Une fracture isolée du scaphoïde associée à une luxation antérosupérieure du fragment proximal est une lésion très rare. Nous présentons deux cas pour lesquels une réduction à ciel ouvert avec fixation interne par abord palmaire et dorsal a été réalisée. Nous n’avons noté aucune pseudarthrose, nécrose du fragment proximal du scaphoïde ou dissociation scapholunaire sur une période de 18 mois. Les résultats cliniques (mobilité, force, DASH) sont présentés. Le mécanisme de cette lésion est discuté.