Carpal Bones

Many orthodontic treatment modalities will yield a better result in less time if properly correlated with the unique facial growth patterns of the patients. The pubertal growth spurt depends on gender and varies in relationship to the chronologic age. General skeletal maturity usually is used as an indicator to predict timing of mandibular growth velocity peak. Hand-wrist radiographic evaluation is one of the diagnostic tools currently available to determine whether the pubertal growth has started, is occurring or has finished. The overview of topic related literature and skeletal maturity assessment (SMA) system developed by L. Fishman are presented. The SMA system is based on eleven discrete adolescence skeletal maturational indicators of hand-wrist bones, covering the entire period of adolescent development. Maturational stage and level demonstrated close correlation with maxillary and mandibular growth velocity, amount of incremental growth and timing. Clinical indications for t...

We report the long-term outcome of repeat Russe bone grafting after failure of a previous Russe graft for scaphoid non-union. 15 patients were followed for a mean of 71 months after their last surgical procedure. 11 patients had undergone a single previous Russe graft and four patients had two previous graft attempts. Internal fixation was used in only three patients. Eight out of 15 (53%) patients achieved union after a single repeat graft and one out of four united after a third attempt. When union was achieved, range of motion was unchanged, grip strength was increased 10% and pain was slight to none, allowing return to full employment in seven out of the nine patients. All patients who did not achieve union have either undergone a salvage procedure or are contemplating one. Based on the literature and our relatively low rate of union without internal fixation (53%), we recommmend supplementary internal fixation if repeat Russe bone grafting is undertaken. When union is achieved, satisfactory results can be expected.

The scaphoid bone is a very rare location for enchondroma. The literature reports eight cases; five of them presented with pathologic fracture, and the youngest patient was 13 years old. This is a report of an 11-year-old patient with scaphoid enchondroma who presented with only mild pain in the left wrist. Magnetic resonance imaging demonstrated the lesion clearly.

Hand bones from a single individual with a clear taxonomic affiliation are scarce in the hominin fossil record, which has hampered understanding the evolution of manipulative abilities in hominins. Here we describe and analyze a nearly complete wrist and hand of an adult female [Malapa Hominin 2 (MH2)] Australopithecus sediba from Malapa, South Africa (1.977 million years ago). The hand presents a suite of Australopithecus-like features, such as a strong flexor apparatus associated with arboreal locomotion, and Homo-like features, such as a long thumb and short fingers associated with precision gripping and possibly stone tool production. Comparisons to other fossil hominins suggest that there were at least two distinct hand morphotypes around the Plio-Pleistocene transition. The MH2 fossils suggest that Au. sediba may represent a basal condition associated with early stone tool use and production.

Radiocarpal fracture-dislocation is an uncommon but complex injury that is often the result of high energy trauma. The combination of ligamentous and osseous injuries demands meticulous attention to restoration of anatomy, especially of the radial styloid. Open reduction and internal fixation is often necessary to restore the relationship of the end of the radius to the carpus and distal ulna. We present a retrospective review of 12 patients treated over a 10-year period and review the literature.

Estimation of skeletal age using radiographic images is widely used for assessing biological growth in clinical and auxological studies. The most frequent areas used for age estimation in children and adolescents are tooth and wrist/hand, both giving good results with only a low level of radiation. In particular, ossification of the carpals shows good agreement with chronological age. This study of a sample of 150 Italian children and adolescents aged between 5 and 17 years focused on analyzing the possible applications of the proportion of carpal area (Ca) mineralization as a criterion of age estimation. The ratio between the total area of carpal bones and epiphyses of the ulna and radius (Bo) and Ca was calculated. This ratio (Bo/Ca) was used for linear regression analysis. The regression model, describing age as a linear function of the ratio Bo/Ca, yielded the following equation: Age=−3.253+0.719 g+20.610 Bo/Ca, and explained 83% of the total variance (R 2=0.83). The median of the absolute values of residuals (observed age minus predicted age) was 0.08 years, with a quartile deviation of 1.59 years, and a standard error of estimate of 1.19 years.

The os centrale carpi is one of the accessory ossicles that have been described in the carpus. We report on the imaging findings of a rare case of unilateral osteonecrosis in a patient with bilateral os centrale carpi. The differential diagnosis of this entity and the suggested etiology for the development of osteonecrosis are discussed

Limited wrist arthrodesis is a useful method for treating specific carpal disorders that maximizes residual wrist motion and strength while eliminating pain. Selective fusion of specific carpal units can be used in degenerative arthritis, rotary subluxation of the scaphoid, midcarpal instability, scaphoid nonunion, Kienböck’s disease, and congenital synchondrosis or partial fusion of specific carpal joints. This report presents our experience with more than 1000 limited wrist arthrodeses, and provides a review of the indications and technical considerations for specific intercarpal fusions, and subsequent results. To date this is the largest series of intercarpal arthrodeses and the study has demonstrated that these techniques are reliable and effective in dealing with a wide range of wrist disorders.

To determine the prevalence of carpal fracture in Singapore, to compare demographic differences between isolated scaphoid and other carpal fractures, and to identify parameters associated with multiple carpal fractures. A total of 149 patients with 162 carpal fractures seen at the National University Hospital in 2009 were enrolled into the study. We retrospectively reviewed their case records and radiographic studies. Pertinent demographic data including patient age, gender, occupation, injured wrist, dominant hand, mechanism of injury, and type of carpal fracture were then recorded and statistically analyzed. We also performed a separate analysis of isolated scaphoid versus other carpal fractures and single versus multiple carpal fractures. Patients with carpal fracture were predominantly male (132), below 40 years of age (116), and usually right hand dominant (136). The more common occupations were students (30), full-time military national servicemen (24), and construction workers (14). Most presented after a fall on an outstretched hand from standing height (81). The scaphoid was the most common single carpal fracture (99). This was followed by triquetrum (27), hamate (5), pisiform (4), lunate (2), capitate (1), and trapezium (1). No fracture of the trapezoid was encountered. Ten patients had multiple carpal fractures, of which 4 were perilunate fracture dislocations. The mean age and male/female ratio for isolated scaphoid and other carpal fractures was 26 years versus 41 years (p<.001) and 13:1 versus 4:1 (p=.036), respectively. A high-energy mechanism of injury was the only parameter associated with multiple carpal fractures (p=.009). The prevalence of carpal fracture in our population was consistent with studies performed in other countries. Military conscription was identified as an at-risk activity predisposing to carpal fracture. Isolated scaphoid and other carpal fractures exhibit different demographics in terms of age and gender, which may be related to differences in the mechanism of injury. A high-energy mechanism of injury was associated with multiple carpal fractures.

The purpose of the present study is to report on a cohort of patients with a volar shearing fracture of the distal end of the radius in whom the unique anatomy of the distal cortical rim of the radius led to failure of support of a volar ulnar lunate facet fracture fragment. Seven patients with a volar shearing fracture of the distal part of the radius who lost fixation of a volar lunate facet fragment with subsequent carpal displacement after open reduction and internal fixation were evaluated at an average of twenty-four months after surgery. One fracture was classified as B3.2 and six were classified as B3.3 according to the AO comprehensive classification system. All seven fractures initially were deemed to have an adequate reduction and internal fixation. Four patients required repeat open reduction and internal fixation, and one underwent a radiocarpal arthrodesis. At the time of the final follow-up, all patients were assessed with regard to their self-reported level of functi...