PMC9197156_01
Pre-operative image and physical examinations. (A) Anteroposterior X-ray, (B) Lateral X-ray showing severe deterioration of the scaphoid. (C) & (D) MRI showing the soft tissue involvement as well. (E)-(H) Reduction in range of motion of the right wrist.
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F1
X-ray examination confirmed bone resorption of the scaphoid (Figure 1A, B). Magnetic resonance imaging (MRI) examination showed hyperplasia of the surrounding tissue, but no damage to the articular surface of the radiolunate joint (Figure 1C, D).
(A) Hyperplasia of the synovium. (B) No damage to the surface of the radiolunate joint. (C) Destruction of the radialis carpal articular surface of the radius. (D) The outcome of FCA. The stars denoting the surfaces.
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F2
Arthrodesis and Synoviectomy to alleviate the damage of the joint and preserve motor function. At the time of surgery under general anesthesia, we observed synovial hyperplasia (Figure 2A), the collapse of the proximal half of the scaphoid, an intact radiolunate joint surface (Figure 2B), wear of the radialis carpal articular surface of radius (Figure 2C), and a deformity of dorsal intercalary segment instability (DISI). Following a limited intercarpal arthrodesis, the intraoperative radiograph showed improvement (Figure 2D).
(A) (B) X-ray showing the results of the surgery. (C) (D) Follow-up 1 month after surgery. (E) 2 months after surgery, the swollen wrist and destruction of carpal bone. (F) (G) Follow-up after 103 days, with the right wrist spontaneously and completely fused. (H) -(K) 1 year after the surgery, no wrist pain but with limitation in range of motion.
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F3
Imaging indicated increased carpal bone damage (Figure 3C-E). After 2 months of conservative treatment, the right wrist spontaneously and completely fused and the pain disappeared (Figure 3F, G). During the 1-year follow-up, there was no acute change in the condition (Figure 3H-K).
(A) (B) MRI of Chiari II syringomyelia, with stars denoting the syrinx. (C) Timeline and key changes of disease progression.
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F4
Because of the hypalgesia before surgery, a cervical MRI was conducted for further antidiastole, which revealed Chiari II syringomyelia (Figure 4A, B).