Background:Nondisplaced scaphoid fractures treated with prolonged cast immobilization may result in temporary joint stiffness and muscle weakness in addition to a delay in return to sports or work. Fixation of scaphoid fractures with a percutaneous cannulated screw has resulted in a shorter time to

Adult traumatic brachial plexus injuries are devastating, and they are occurring with increasing frequency. Patient evaluation consists of a focused assessment of upper extremity sensory and motor function, radiologic studies, and, most important, preoperative and intraoperative electrodiagn

Background: Surgically, it is difficult to achieve union of a scaphoid nonunion that is associated with osteonecrosis of the proximal pole, and those with carpal collapse are especially difficult to treat. A variety of vascularized bone grafts can be used. The purpose of this study was to compare the effectiveness of two types of vascularized bone graft—a distal radial pedicle graft and a free vascularized medial femoral condyle graft—in the treatment of scaphoid waist nonunions associated with proximal pole osteonecrosis and carpal collapse. Methods: A retrospective review was conducted at two institutions to identify all patients with a scaphoid waist nonunion associated with an avascular proximal pole and carpal collapse. Between January 1994 and June 2006, twenty-two such nonunions were identified in twenty-two patients. Ten were treated with a distal radial pedicle vascularized graft and twelve, with a free vascularized medial femoral condyle graft. Patient demographics were similar between the groups, and the duration of follow-up averaged twelve months. Union was determined with use of plain radiographs and computed tomography or trispiral tomograms. In addition, carpal angles, time to union, union rates, and complications were recorded. Results: Four of the ten nonunions treated with the distal radial pedicle graft healed, at a median of nineteen weeks, and all twelve nonunions treated with the free medial femoral condyle graft healed, at a median of thirteen weeks. The rate of union was significantly higher (p = 0.005) and the median time to healing was significantly shorter (p < 0.001) for the nonunions treated with the medial femoral condyle graft. Conclusions: A vascularized interposition graft from the medial femoral condyle is the recommended vascularized bone graft for the surgical treatment of scaphoid waist nonunion with avascularity of the proximal pole and carpal collapse. Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

The accuracy of magnetic resonance imaging of the hip was prospectively evaluated in 19 military subjects engaged in endurance training. These patients had hip pain, negative radiographs, and radionuclide bone scans consistent with femoral neck stress fracture. Twenty-two hips were identified as positive for femoral neck stress fracture by bone scan. Each patient under went magnetic resonance imaging and 6-week fol low-up plain radiographs of the hips. Magnetic reso nance imaging studies differentiated femoral neck stress fractures from a synovial pit, iliopsoas muscle tear, iliopsoas tendinitis, obturator externus tendinitis, avascular necrosis of the femoral head, and a unicam eral bone cyst. The follow-up radiographs were used to verify the diagnosis of stress fracture. The radiographs showed healing callus in patients with stress fractures. Patients with diagnoses other than stress fractures had no changes on follow-up radiographs. Magnetic reso nance imaging studies were as sensitive and much more specific than bone scan in determining the cause of hip pain. Radionuclide bone scan had an accuracy of 68% for femoral neck stress fractures with 32% false-positive results; MRI was 100% accurate. Mag netic resonance imaging proved to be superior to ra dionuclide bone scanning in providing an early and accurate diagnostic tool that aided in the differential diagnosis of hip pain in the young endurance athlete.