CASE CONFERENCE - November 20, 2007 -

1. CASE CONFERENCE- November 20, 2007 - 主講者：黃國欽 嘉義長庚紀念醫院骨科部 Chang Gung Memorial Hospital at Chiayi Chang Gung University College of Medicine

2. History & Physical exams Persistent painful disability & swelling of right hand dorsum for one more week A middle-aged healthy male patient Secondary to a motorbike vs. motor-vehicle accident Fall on right outstretched and dorsiflexed hand Hyperextension & radial deviation of the wrist joint Severe swelling of the hand & wrist Radial deviation deformity of the hand & wrist Diffuse tenderness at the mid-carpal joint Limited wrist & finger motion arc due to pain and swelling No definite evidence of neurovascular dysfunction

3. The normal wrist joint

4. Preoperative radiographs How do you describe the X-ray findings?

5. X-ray findings (PA)

6. X-ray findings (PA) Radial deviation force

7. X-ray findings (L)

8. X-ray findings (L) Hyperextension force

9. The diagnosis Essential components Scaphoid fracture Capitate fracture Scapho-capitate fracture (Fenton) syndrome

10. Fenton syndrome Scapho-capitate fracture is a rare lesion A severe injury of the carpus Firstly described in 1956 by Fenton Only 34 cases reported since 1937 A real challenge to every clinician Frequency of delayed diagnosis Hyperextension injury of the wrist Fractures of scaphoid waist and capitate neck Rotation of the proximal fragment of the capitate bone Potential complications Avascular necrosis Nonunion and pseudoarthrosis ~ J Coll Physicians Surg Pak 2007; 17(1): 55 ~ Chir Main 2003; 22(6): 318 ~ Handchir Mikrochir Plast Chir 2003; 35(5): 338 ~ Unfallchirurg 2003; 106(4):339 ~ Acta Orthop Belg 2001; 67(2): 185 ~ Ann Chir Main Memb Super 1996; 15(3): 181 ~ Acta Orthop Belg 1995; 61(1): 62 ~ Handchir Mikrochir Plast Chir 1994; 26(1): 12 ~ J Hand Surg Br 1993; 18(1): 53 ~ Handchir Mikrochir Plast Chir 1986; 18(2): 59 ~ Acta Orthop Scand 1985; 56(5): 509 ~ Z Orthop Ihre Grenzgeb 1985; 123(1): 60 ~ J Bone Joint Surg Br 1972; 54(1): 122

11. Trauma mechanism Scaphoid fracture Capitate fracture 180° rotation 90° rotation ~ J Bone Joint Surg Br 1972; 54(1): 122

12. Postoperative radiographs

13. The end Thanks for your attention. Kuo-Chin Huang, MD