The Journal of hand surgery
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A classification system for disruption patterns of the sigmoid notch of the radius associated with distal radius fractures has not been established. Using plain x-rays and corresponding computed tomography (CT) scans we characterized and quantified the types of sigmoid notch involvement in 20 consecutive distal radius fractures with radiocarpal joint extension. Plain radiographs revealed fracture extension into the sigmoid notch in only 7 cases (35%) and the CT scans demonstrated fracture extension into the sigmoid notch in 13 cases (65%). ⋯ Sigmoid notch articular step-off (n = 7) and gapping (n = 9) were detectable on the CT scans but not on the x-rays. Plain x-rays appear to underestimate sigmoid notch involvement following distal radius fractures. In addition, CT appears to be a superior diagnostic modality for quantifying sigmoid notch fracture step-off and articular gapping.
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Fourteen consecutive patients with acute displaced scaphoid waist fractures were treated with open reduction and internal fixation. The operative technique consisted of anatomic reduction of the displaced scaphoid waist fracture, correction of carpal instability, radial bone grafting for comminution, and internal fixation with K-wires or Herbert screw. The patients were evaluated an average of 26 months (range, 4-48 months) after surgery. ⋯ All patients regained functional wrist range of motion (wrist extension, 57 degrees; wrist flexion, 52 degrees ) and grip strength. Open reduction and internal fixation of acute displaced scaphoid waist fractures restores scaphoid alignment and leads to predictable union. Early operative intervention avoids malunion and carpal instability that often occurs with closed management of these complex fractures.