as he was being conveyed by trolley from Toondla, where the accident happened, to Agra, a distance of about 15 miles. On removing innumerable cloths soaked in blood, I found that the thumb with its metacarpal bone had entirely disappeared. Ttie metacarpal bone of the index finger was, as it were, dissected out from the palm of the hand, completely denuded of flesh, and separated from the carpal...

We report the use of a free vascularised iliac bone graft in the treatment of 21 patients (19 men and 2 women) with an avascular nonunion of the scaphoid in which conventional bone grafting had previously failed. The mean age of the patients was 32 years (23 to 46) and the dominant wrist was affected in 14. The mean interval from fracture to the vascularised bone grafting was 39 months (9 to 62...

Thirty-five of 44 nonunited scaphoid fractures that were at least 6 months old healed in a mean time of 4.3 months during pulsed electromagnetic field (PEMF) treatment using external coils and a thumb spica cast. The mean time from the onset of the fracture to treatment was 40 months. No concurrent operation was performed. Follow-up time averaged 8.4 months. Eight of nine fractures with avascul...

Kienbock's disease, or osteonecrosis of the lunate, can lead to chronic, debilitating wrist pain. Etiologic factors include vascular and skeletal variations combined with trauma or repetitive loading. In stage I Kienbock's disease, plain radiographs appear normal, and bone scintigraphy or magnetic resonance imaging is required for diagnosis. Initial treatment is nonoperative. In stage II, scler...

A 51-year-old female patient presented with a carpal giant cell tumor (GCT) of the right capitate bone. The lesion was initially misdiagnosed as having an osteomyelitis. First, the diagnosis of a benign GCT was confirmed by histological examination. Second, an intralesional curettage and packing of the cavity with cancellous iliac crest bone grafts combined with a fusion of the third carpometac...

Carpal injuries are uncommon and are mainly seen in the younger age group. The incidence is unclear as many of the cases go undiagnosed. A 22-year-old male patient coming to the hospital after road traffic accidentwith head, face and left wrist injury. After immediate primary management the patient was taken up for a definitive procedure 4 days after the injury. Scaphoid fracture was fixed with...

This article presents a brief description of the following modifications of the original Fisk procedure for navicular nonunions with carpal instability: (1) preoperative calculation of exact scaphoid length and form based on comparative roentgenograms of the opposite wrist, (2) the use of a palmar approach, (3) the insertion of a wedge-shaped corticocancellous graft from the iliac crest after r...

The medico legal expert can be confronted with persisting symptoms after a minor injury to the wrist. In this context, injuries to the scapholunate (SL) ligament should be considered. Its incidence is higher than expected and the impact is enormous if it remains undetected and untreated. Selective sectioning studies have established that the SL ligament is the primary stabilizer in the carpal r...

The scapholunate (SL) ligament (SLL) is the most commonly injured carpal ligament.1 The SLL is C-shaped and has three structurally distinct parts: volar; membranous; and dorsal (Fig. 1).2 The dorsal part of the SLL is the strongest and the primary stabiliser of the SL joint and can resist forces of up to 260 N.3 The avascular proximal membranous portion does not provide any significant laxity r...

Hand and wrist radiographic indexes such as radial inclination, ulnar variance, carpal height ratio, and radial tilt play an important role in the diagnosis and management of medical disorders, so they should be modified regarding the population and race difference. This study aims to compare the normal radiologic wrist indexes in Mashhad population with other existing databases and define some...