Fractura De Escafoide Jess. 1. FRACTURA DE ESCAFOIDE Jessica Cruz Muños ; 2. Generalidades Después de la fractura de Colles. A fratura do punho – rádio distal – é uma das mais frequentes do esqueleto. Não raro as fraturas acabam consolidando com deformidade. throsis. Cross-sectional studies. RESUMO. Objetivo: Verificar como os cirurgiões da mão conduzem o trat- amento da fratura de escafoide e suas complicações.
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ABSTRACTWe present a case report of an 18 year-old gymnast who was diagnosed with a scaphoid stress fracture associated with a distal radial epiphysiolysis, reporting the treatment of choice.
After a brief literature review about this rare association, the authors ask for attention concerning the importance of physical and image examination in making right diagnosis and finding associated injuries. Keywords – Epiphyses, slipped; Fractures, stress; Wrist. Frqtura conducted at the Instituto Vita. Stress fractures of the lower extremity are common and are often related to athletic activities. Meanwhile, those of the upper extremity are rare, with few cases reported in the literature 1.
Fratura do escafoide
Scaphoid fractures are diagnosed by a history of acute trauma to the wrist in dorsiflexion, pain in its radial aspect, on palpation of the scaphoid and in the anatomical snuffbox 2,3. Patients who have similar complaints without a history of acute injury, but perform activities involving repetitive stress should be examined carefully and the hypothesis of stress fracture of the scaphoid should be investigated 1,4.
It is important to pay attention to the fact that the implications of repetitive dorsiflexion and compression of the wrist are often related to the injuries of the growth plate of the radius, with radiographic evidence of openness and irregularity of the distal radial physis 5,6.
Although wrist pain in gymnasts is classified as “normal and direct consequences of the sport” 2complaints of pain in these young athletes should be carefully evaluated. Herein we report the case of a gymnast who had a stress fracture of the scaphoid associated with epiphysiolysis of the distal radius. His training routine was six hours a day, three days a week for the previous seven years.
Approximately three months before the visit to the doctor, he developed severe pain in the wrist, which worsened in extension, especially during the activities on the vault and the parallel bars. It was initially believed to be a muscle injury and treated conservatively, applying ice and reducing athletic activity, but with little improvement.
There was no history of pain or trauma to the affected wrist. Physical examination revealed the presence of skin calluses on the right distal radius and scaphoid. The patient reported pain in the anatomical snuffbox and distal radial epiphysis. Grip strength assessment of the right hand showed Pronation, supination, and digital mobility were within normal limits. A posteroanterior radiograph of the wrist showed a scaphoid waist fracture and an opening of the radial aspect of the distal radial epiphysis Figure 1.
Magnetic resonance imaging MRI was performed and revealed a complete scaphoid waist fracture and a representative sign of bone marrow edema in the proximal and distal poles. He also showed swelling in the radial portion of the physis, suggesting displacement Figures 2 and 3.
Fratura do escafoide – Wikipédia, a enciclopédia livre
We opted for surgical treatment with percutaneous fixation of the scaphoid and in situ fixation of the radial styloid process Figure 4. In the first week after surgery, we used a long orthesis, which immobilized the metacarpophalangeal joint of the thumb, and began rehabilitation in order to control swelling, treat scarring and fratuga movement.
Grip strength of right hand reached 66 kgf. In the twelfth week the patient was able to return to physical activities gradually; at 16 weeks, he returned to training on the equipment. At final evaluation, six months after surgery, the athlete was competing with no complaints. Figures 2 and 3 – Magnetic resonance image in T1 and T2. The coronal section shows a complete fracture of the scaphoid waist arrow and a representative sign of bone marrow edema in the proximal and distal poles.
Figure 4 – Posteroanterior radiograph showing percutaneous fixation and in situ fixation of the radial styloid process eight weeks after surgery. The scaphoid is the most commonly fractured carpal bone. Characteristically, it is difficult to diagnose due to its small size and irregular shape.
Another important feature is the risk of progression to nonunion or avascular necrosis, resulting from the proximal pole circulation’s dependence on the vessels that cross the waist of this bone.
Despite the high relative incidence of injury, stress fracture of the scaphoid is relatively rare, with only a few references in the literature 1, Rarer still are the fractures associated with traumatic epiphysiolysis.
Prior to the onset of symptoms, our athlete performed repetitive activities that reproduced the mechanism of acute fracture. These activities were performed with high intensity due to scheduled competitions that were approaching.
Fratura de Bennett – Wikipédia, a enciclopédia livre
Fratyra, there was no record of a fraturra intense trauma that had triggered the symptoms. The fact that the pain was insidious ruled out the possibility of an undiagnosed acute fracture. Another feature related to the stress fracture was the presence of edema around the scaphoid bone. The concomitant epiphyseal lesion observed on radiograph and MRI appeared as a complicating factor of the scaphoid fracture, requiring greater attention to the wrist.
Weiker 5 proposed that the wrists injuries of gymnasts are due to a weakness in the muscles of the wrist and fingers of the gymnasts. This weakness prevents adequate cushioning of the impact of dorsiflexion movements of the wrist.
Thus, there is impact on the distal radius and the carpal bones. The volar wrist ligaments protect the proximal pole of the scaphoid while its distal portion is exposed to impact.
The weakest point of the scaphoid is the waist, located immediately distal to the volar ligaments and is therefore the most likely site of injury. This principle holds true for stress fractures through repetitive forces applied in a lesser degree than those needed to trigger an acute fracture. The reasons for choosing surgical treatment of the scaphoid and distal radius were: Hand therapy sought to optimize rehabilitation as much as possible, to allow for an early return to sports activities in the shortest time possible.
Chronic pain in the wrist of a gymnast, even without a history of acute trauma, should raise the suspicion of a possible stress fracture of the scaphoid. The radiograph is the initial examination of choice, but is often not capable of revealing injury. In suspected cases, MRI is the examination of choice. Even bone scintigraphy may have negative results, as was shown in the series by Hanks et al.
For high-performance athletes, surgical treatment may represent a possibility of early return to sports. Curr Sports Med Rep. Manzione M, Pizzutillo PD. Stress fracture of the scaphoid waist: Am J Sports Med. Problems of the upper extremity in gymnasts. Hand and wrist problems in the gymnast. Stress fractures in the pediatric athlete. Matzkin E, Singer DI. Scaphoid stress fracture in a year-old gymnast: J Hand Surg Am. Inagaki H, Inoue G.
Stress fracture of the scaphoid combined with the distal radial epiphysiolysis. Br J Sports Med. Athletic injuries of the wrist. Clin Orthop Relat Res. Stress fractures of the carpal scaphoid: J Bone Joint Surg Am.