Abstract

Introduction: About 5–12 percent of scaphoid fractures are associated with other fractures, and approximately 1 percent of scaphoid fractures are bilateral.

Materials and Methods: Three hundred fifty patients sought treatment for established scaphoid non-union at the author’s department. All patients routinely underwent plain radiographs, taken with both hands in neutral position for preoperative measurement of scapholunate angle and scaphoid length. Unexpectedly however, radiological examination revealed a bilateral scaphoid Herbert type D2 pseudoarthrosis (24 waist) in 12 patients (5 females, 7 males with mean age 25 years, range 14 to 48). No patient was aware of the mechanism of controlateral injury or had previously complained of controlateral wrist pain. All patients received treatment for both sides. The scaphoid was exposed through a volar approach. The fracture was anatomically reduced and fixed with a Herbert screw. Iliac bone graft was used. Mean follow-up was 43 months (range, 25 to 68) using the modified Mayo wrist score.

Results: Fracture union was confirmed both clinically and radiographically and union rates were 96 percent. Mean union time was 7 months (range 4 to 12 months). Non-union occurred in 1 patient. According to the Mayo wrist score, excellent results were achieved in 17 cases, good in 6 and poor in 1.

Conclusion: Bilateral scaphoid pseudoarthrosis has a very rare incidence, and experience showed us that patients do not always complain of both sides. Routine pre-operative evaluation at our institution includes a set of comparative plain radiographs of the wrists and we strongly recommend this policy to avoid missing bilateral injuries.

Objective: The purpose of this communication was to evaluate the long-term outcome of patients with type II odontoid fractures treated with anterior screw fixation.

Material and Methods: In our prospective clinical study 34 patients, 21 males and 13 females (with mean age 35.4 + 0.8 years) with type II odontoid fractures of traumatic etiology, underwent anterior cannulated screw fixation, during a period of 36 months. All patients had radiologicaly confirmed intact transverse ligament and a reducible odontoid fracture. All patients were immobilized in a Miami J cervical collar for 4 weeks postoperatively. Radiological examination of the cervical spine with plain X rays and cervical spine CT was performed at 6 weeks and two, six and 12 and 24 months postoperatively. Follow-up time ranged between 36 and 80 months (mean follow-up 54.3+ months).

Results: 32 patients had an uneventful postoperative course, while one patient developed pulmonary atelectasis, which resolved without any significant sequelae and another one developed a superficial wound infection, which resolved without removing the implanted hardware. Radiographic evaluation showed satisfactory bony fusion and no evidence of abnormal movement at the fracture site in 31 patients (91.1%). In two patients (5.8%), the radiographic studies showed pseudo-arthrosis and instability while in one patient (2.9%) the implanted cannulated screw was broken but there was no instability shown.

Conclusions: In our series anterior odontoid screw fixation constituted a safe therapeutic modality with high stability and low mechanical failure rates in short and long term follow-up period.