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A dorsal approach for the distal-to-proximal internal fixation of oblique scaphoid fractures

INTRODUCTION: Two methods using cannulated headless screws can be used for scaphoid fractures: Inserting the screw through the distal fragment and then into the proximal fragment through a palmar approach under direct vision or fluoroscopic guidance and inserting the screw in the proximal-to-distal...

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Autores principales: Tada, Takuya, Onuma, Kenji, Sukegawa, Koji, Otake, Yuya, Kenmoku, Tomonori, Takaso, Masashi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Indian Orthopaedic Research Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046440/
https://www.ncbi.nlm.nih.gov/pubmed/34169027
http://dx.doi.org/10.13107/jocr.2020.v10.i09.1920
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author Tada, Takuya
Onuma, Kenji
Sukegawa, Koji
Otake, Yuya
Kenmoku, Tomonori
Takaso, Masashi
author_facet Tada, Takuya
Onuma, Kenji
Sukegawa, Koji
Otake, Yuya
Kenmoku, Tomonori
Takaso, Masashi
author_sort Tada, Takuya
collection PubMed
description INTRODUCTION: Two methods using cannulated headless screws can be used for scaphoid fractures: Inserting the screw through the distal fragment and then into the proximal fragment through a palmar approach under direct vision or fluoroscopic guidance and inserting the screw in the proximal-to-distal direction through a dorsal approach with fluoroscopic guidance. These methods are sometimes difficult to use in oblique fractures when trying to achieve screw fixation perpendicular to the fracture plane. The most common mechanism of injury in the scaphoid fracture is forceful wrist hyperextension and punching something. Less commonly, a direct blow to the wrist also can cause a fracture. The mechanism of fracture by a direct blow to the wrist is not completely clear. CASE PRESENTATION: We experienced two rare cases of scaphoid fracture in goalkeepers sustained when they saved a goal by contacting the soccer ball with the palm of their hand. Both fractures were proximal oblique fractures. We performed through a dorsal approach to insert the screws in the distal-to-proximal direction under direct vision assisted with fluoroscopy. Bone union was noted after surgery in both cases. They returned to their occupations without wrist pain. We investigated the relationship between the fracture line and wrist position using a fresh cadaver. The experiment revealed that the fracture line of the scaphoid matched the dorsal edge of the articular surface of the radius with the wrist in 30° of dorsiflexion and 20° of ulnar deviation. CONCLUSION: In this report, we reported rare cases of scaphoid fracture due to contact with the soccer ball on the palm. We propose a surgical approach for an oblique fracture of the proximal scaphoid that used guide wires and screws, but was performed through a dorsal, and not palmar, approach to insert the screws in the distal-to-proximal direction. We presume that coronal shear stress to the scaphoid bone occurred when the palm contacted the ball with the wrist positioned at 30° dorsiflexion and 20° ulnar deviation.
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spelling pubmed-80464402021-06-23 A dorsal approach for the distal-to-proximal internal fixation of oblique scaphoid fractures Tada, Takuya Onuma, Kenji Sukegawa, Koji Otake, Yuya Kenmoku, Tomonori Takaso, Masashi J Orthop Case Rep Case Report INTRODUCTION: Two methods using cannulated headless screws can be used for scaphoid fractures: Inserting the screw through the distal fragment and then into the proximal fragment through a palmar approach under direct vision or fluoroscopic guidance and inserting the screw in the proximal-to-distal direction through a dorsal approach with fluoroscopic guidance. These methods are sometimes difficult to use in oblique fractures when trying to achieve screw fixation perpendicular to the fracture plane. The most common mechanism of injury in the scaphoid fracture is forceful wrist hyperextension and punching something. Less commonly, a direct blow to the wrist also can cause a fracture. The mechanism of fracture by a direct blow to the wrist is not completely clear. CASE PRESENTATION: We experienced two rare cases of scaphoid fracture in goalkeepers sustained when they saved a goal by contacting the soccer ball with the palm of their hand. Both fractures were proximal oblique fractures. We performed through a dorsal approach to insert the screws in the distal-to-proximal direction under direct vision assisted with fluoroscopy. Bone union was noted after surgery in both cases. They returned to their occupations without wrist pain. We investigated the relationship between the fracture line and wrist position using a fresh cadaver. The experiment revealed that the fracture line of the scaphoid matched the dorsal edge of the articular surface of the radius with the wrist in 30° of dorsiflexion and 20° of ulnar deviation. CONCLUSION: In this report, we reported rare cases of scaphoid fracture due to contact with the soccer ball on the palm. We propose a surgical approach for an oblique fracture of the proximal scaphoid that used guide wires and screws, but was performed through a dorsal, and not palmar, approach to insert the screws in the distal-to-proximal direction. We presume that coronal shear stress to the scaphoid bone occurred when the palm contacted the ball with the wrist positioned at 30° dorsiflexion and 20° ulnar deviation. Indian Orthopaedic Research Group 2020-12 /pmc/articles/PMC8046440/ /pubmed/34169027 http://dx.doi.org/10.13107/jocr.2020.v10.i09.1920 Text en Copyright: © Indian Orthopaedic Research Group https://creativecommons.org/licenses/by-nc-sa/3.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Tada, Takuya
Onuma, Kenji
Sukegawa, Koji
Otake, Yuya
Kenmoku, Tomonori
Takaso, Masashi
A dorsal approach for the distal-to-proximal internal fixation of oblique scaphoid fractures
title A dorsal approach for the distal-to-proximal internal fixation of oblique scaphoid fractures
title_full A dorsal approach for the distal-to-proximal internal fixation of oblique scaphoid fractures
title_fullStr A dorsal approach for the distal-to-proximal internal fixation of oblique scaphoid fractures
title_full_unstemmed A dorsal approach for the distal-to-proximal internal fixation of oblique scaphoid fractures
title_short A dorsal approach for the distal-to-proximal internal fixation of oblique scaphoid fractures
title_sort dorsal approach for the distal-to-proximal internal fixation of oblique scaphoid fractures
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046440/
https://www.ncbi.nlm.nih.gov/pubmed/34169027
http://dx.doi.org/10.13107/jocr.2020.v10.i09.1920
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