Objective To discuss the etiology, cl inical manifestation, imaging, staging, and treatment of bone necrosis of the second metatarsal head, the navicular bone, and the talus so as to provide more information for cl inical appl ication. Methods The related home and abroad l iterature concerning bone necrosis of the second metatarsal head, the navicular bone, and the talus in recent years was reviewed extensively. And the cl inical manifestation, imaging, staging, and treatment were summarized and analyzed. Results Bone necrosis of the second metatarsal head, the navicular bone, and thetalus were more closely related to the particular anatomy; the environmental and genetic factors also lead to such diseases. The cl inical presentation was typically local pain and swell ing around the joint, frequently with restricted joint motion in severe cases. Both radiographs and MRI were used to be the main criteria for diagnosis and staging of these diseases. According to different phases, conservative therapy was effective in treating osteonecrosis at early stage. While surgical treatments such as osteotomy, fixation, and arthrodesis were used in late-stage bone necrosis. Conclusion The current methods of treatment have achieved good effect, but long-term cl inical follow-up is needed and the new surgery should be further studied.
Objective To report the clinical outcome of the transposition of the radial styloid bone flap pedicled on the recurrent branch of the radial artery in the treatment of scaphoid nonunion. Methods From March 2000 to June 2005,the procedure was done in 18 patients with scaphoid nonunion, a small bone flap(1.5 cm×3.5 cm×0.5 cm) pedicled on the recurrent branch of radial artery to the styloid process was raised from the radial styloid process and grafted into the corresponding slot chiseled along the vertical axis of scaphoid crossing the fracture line. Of 18 patients, 15 were males and 3 were females, aging 18-39 years. The locations were lumbar scaphoid in 11 patients and proximal scaphoid in 7 patients,among whom 5 had presented avascular necrosis in the proximal fragments of the scaphoid. Pain occurred in the act of wrist motion, and became obvious in the case of dorsiextension and radial deviation. Compression pain was observed in the stuff nest. The wrist joint activity is subjected to limit. The X-ray showed hardening and cystic degereration at fracture end and obviously widening fracture line. Results The scaphoid fracture healed in all 18 cases, the 5 proximal scaphoid fracture fragments which had previously been necrosed survived, a mean healing time of scaphoid was4 months. A follow-up of 1 to 5 years revealed normal wrist motion without pain in all cases. The life and job was good every day. Conclusion Transposition of the bone flap pedicled on the recurrent branch of the radial artery to the scaphoid is relatively simple and can effectively treat scaphoid nonunion and avascular necrosis with a great value in clinical application.