Original Article
Fenton syndrome
Síndrome de Fenton
L. Natera Cisneros
, C. Lamas Gómez, I. Proubasta Renart, E. Moya Gómez
Corresponding author
Servicio de Cirugía Ortopédica y Traumatología, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
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A) Posición de la muñeca en hiperextensión en el momento del impacto. Obsérvese que el hueso grande se sitúa a 90° con respecto al radio. B) El margen posterior del radio fractura el hueso grande. C) Fractura del escafoides y rotación del polo proximal del hueso grande a 90°. D) A medida que la muñeca vuelve a la posición neutra, el polo proximal del hueso grande continúa rotando hasta llegar a los 180°.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Natera Cisneros, C. Lamas Gómez, I. Proubasta Renart, E. Moya Gómez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Natera Cisneros" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Lamas Gómez" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Proubasta Renart" ] 3 => array:2 [ "nombre" => "E." 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Natera Cisneros, C. Lamas Gómez, I. Proubasta Renart, E. Moya Gómez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Natera Cisneros" "email" => array:1 [ 0 => "lnatera@santpau.cat" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Lamas Gómez" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Proubasta Renart" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Moya Gómez" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Cirugía Ortopédica y Traumatología, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome de Fenton" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 955 "Ancho" => 951 "Tamanyo" => 236397 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">CT study of the wrist of the same patient as in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. Note the rotation of the head of the capitate bone.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Trans-scaphocapitate fracture-dislocation, scaphocapitate or Fenton syndrome, is a special form of trans-scaphoid–perilunate carpal fracture in which there is a combined fracture of the scaphoid and capitate bones and in which the proximal fragment of the latter is rotated over 90°, generally 180°.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> Very few cases of this syndrome have been published and most of them are unique.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–15</span></a> The problem is that this lesion, mainly the capitate bone fracture, is often overlooked in the initial radiographic examination, thus leading to functional sequelae with difficult solution.</p><p id="par0010" class="elsevierStylePara elsevierViewall">This work is based on 3 new cases and also conducts an extensive review of the literature on this particular lesion, commenting on its aetiology, diagnosis and treatment.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Material and method</span><p id="par0015" class="elsevierStylePara elsevierViewall">Between 2007 and 2010 we treated 3 patients (2 males and 1 female) for Fenton syndrome at our centre. Their mean age was 26 years (19, 21 and 32 years) and the affected wrist was the right wrist in all cases. Two of the 3 patients reported suffering the lesion due to a motorcycle accident and the third had an accidental fall. All cases reported significant pain and swelling of the dorsum of the wrist. The radiographic study by anteroposterior, lateral and oblique projections showed an association of both fractures, as well as a rotation over 90° of the head of the capitate bone with respect to the rest of the bone (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">In addition, computed tomography (CT) studies revealed a rotation of the proximal fragment of the capitate bone (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The treatment established for all 3 patients (which was not delayed more than 3 days) consisted of open reduction of both fractures and internal fixation, using Acutrak<span class="elsevierStyleSup">®</span> miniscrews (Acumed, USA) in 2 cases and Herbert-Whipple<span class="elsevierStyleSup">®</span> miniscrews (Zimmer, USA) in the remaining case (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Moreover, we also temporarily stabilised the 2 carpal rows using Kirschner wires. Following surgery, the wrist was immobilised for 6 weeks, after which the cast and Kirschner wires were withdrawn and rehabilitation with the assistance of a physiotherapist was started.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The mean follow-up period was 16 months, with a minimum of 12 and a maximum of 24 months. At the end of this period we assessed the presence of pain, balance of the wrist joint, fracture consolidation and the presence of osteoarthritis and/or necrosis of the head of the capitate and/or scaphoid bones.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">None of the patients reported pain at the end of the follow-up period, although 1 of the 3 patients reported mild discomfort after strenuous activity. The mean wrist joint balance was 55° extension, 50° flexion, 22° ulnar tilt and 8° radial tilt. The consolidation of both fractures was achieved at 8 weeks in all 3 cases. The postoperative CT scan performed at 6 months enabled us to rule out the development of degenerative changes and avascular necrosis of the proximal pole of the capitate and scaphoid bones.</p><p id="par0045" class="elsevierStylePara elsevierViewall">All patients were satisfied with the outcome.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">According to Adler and Shaftan,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> capitate bone fractures are classified into 3 types: (1) isolated fractures, both transverse at the neck level or oblique affecting the distal dorsal cortex; (2) scaphocapitate or Fenton syndrome; and (3) capitate bone fractures associated with other fractures of the carpal bones.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Fenton syndrome is a special form of trans-scaphoid–perilunate fracture-dislocation.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This severe carpal injury is extremely rare, which is why there are very few publications on the topic and most of them deal with a single case.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–15</span></a> In fact, the most extensive series consists of 5 cases.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> The injury mechanism involved is controversial, although most authors agree that it would consist of a hand trauma with forced hyperextension associated with axial compression. According to Stein and Siegel,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> the lesion would go through 3 stages during the sequence of trauma: in the first stage, the neck of the capitate bone would break on impact with the dorsal edge of the radius; in the second stage, the force would continue and would fracture the scaphoid, while the proximal fragment of the capitate bone would rotate 90°; and in the third stage, the hand would return to its initial position, thus rotating the proximal fragment of the capitate bone to 180° (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Fenton syndrome may be associated with other complex fractures-dislocations of the carpus<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> or of the distal end of the ulna and radius,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> may also occur in children<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> and may even be bilateral.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> In any case, the diagnosis of Fenton syndrome is difficult, mainly due to the extreme rotation undergone by the proximal fragment of the capitate bone. For this reason, it is important to pay very close attention when assessing radiographs. This assessment involves identifying the 3 carpal arcs of Gilula.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Arc I is formed by the margins of the proximal surfaces of the scaphoid, lunate and triquetrum bones, arc II is formed by the edges of the distal surfaces of these same bones, and arc III is formed by the edges of the proximal surfaces of the capitate and hamate bones. In Fenton syndrome, arc III becomes completely altered, indicating the presence of a lesion in the midcarpal joint (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>).</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">However, we believe that obtaining a complementary CT scan is almost essential, not only to confirm both fractures, but also to assess the degree of rotation of the capitate head. Moreover, it enables planning of the most appropriate surgical technique. In this sense, although some studies report satisfactory results without reduction of the capitate bone fracture, we believe the only way to prevent possible complications, including capitate head necrosis,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> is to carry out open reduction of both fractures and to stabilise them with internal fixation. In this regard, the synthesis of fractures can be performed with Kirschner wires and/or either Herbert<span class="elsevierStyleSup">®</span>, Herbert-Wipple<span class="elsevierStyleSup">®</span> and/or Acutrak<span class="elsevierStyleSup">®</span> miniscrews, as in our cases. As for the approach route, this may be volar, dorsal or combined. In our 3 patients, we performed surgery via a dorsal approach to initially synthesise the scaphoid fracture. This procedure is done in any trans-scaphoid-perilunate fracture-dislocation, as the scaphoid bone integrates the 2 carpal rows, so its stabilisation facilitates reduction of the capitate bone. Next, we reduced the dislocation of the proximal fragment of the capitate bone and also synthesised it with a screw. Since the lesion was accompanied by severe involvement of the intercarpal ligament, we supplemented the stabilisation with temporary fixation of both carpal rows using Kirschner wires, although some authors do not consider this step necessary. The immobilisation period varies from 6 to 9 weeks and assisted rehabilitation is required since there is significant postoperative stiffness, as was the case in our patients. With regard to prognosis, it will depend on whether the reduction obtained in both fractures is optimal and stable, or else has a deficit in reduction and/or poor stabilisation. However, given the severity of the lesion, sequelae are common regardless of whether a perfect reduction has been achieved. These sequelae include necrosis of the capitate head fragment and/or radiocarpal and midcarpal osteoarthritis. Patients should be informed of these events.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Level of evidence</span><p id="par0070" class="elsevierStylePara elsevierViewall">Level of evidence IV.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical responsibilities</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Protection of people and animals</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that this investigation did not require experiments on humans or animals.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Confidentiality of data</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declare that this work does not reflect any patient data.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Right to privacy and informed consent</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors declare that this work does not reflect any patient data.</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interests</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:2 [ "identificador" => "xres116671" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec103956" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres116672" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec103957" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and method" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Level of evidence" ] 9 => array:3 [ "identificador" => "sec0030" "titulo" => "Ethical responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Right to privacy and informed consent" ] ] ] 10 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflict of interests" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-04-23" "fechaAceptado" => "2012-06-11" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec103956" "palabras" => array:5 [ 0 => "Wrist" 1 => "Carpus" 2 => "Fracture" 3 => "Dislocation" 4 => "Capitate bone" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec103957" "palabras" => array:5 [ 0 => "Muñeca" 1 => "Carpo" 2 => "Fractura" 3 => "Luxación" 4 => "Hueso grande" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Scaphocapitate, or Fenton syndrome, is a rare injury. This article presents three new cases that were treated by open reduction and internal fixation with miniscrews, obtaining good results at 16 months follow-up.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El síndrome de la fractura-luxación transescafo-hueso grande o síndrome de Fenton, constituye una lesión muy poco frecuente. En este artículo se presentan 3 casos que fueron tratados mediante reducción abierta y fijación interna con minitornillos, obteniendo buenos resultados a los 16 meses del seguimiento medio.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Natera Cisneros L, et al. Síndrome de Fenton. Rev Esp Cir Ortop Traumatol. 2012;56:369–73.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1087 "Ancho" => 1301 "Tamanyo" => 135458 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Radiographic study of a patient with Fenton syndrome. (A) Anteroposterior projection. (B) Oblique projection. Note the association of a scaphoid fracture with another, located in the neck of the capitate, with the proximal fragment rotated 180°.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 955 "Ancho" => 951 "Tamanyo" => 236397 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">CT study of the wrist of the same patient as in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. Note the rotation of the head of the capitate bone.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1334 "Ancho" => 951 "Tamanyo" => 88354 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Radiographic study at 3 months after surgery. (A) Anteroposterior projection. (B) Lateral projection.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 862 "Ancho" => 1488 "Tamanyo" => 139911 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Mechanism of injury in Fenton syndrome (extract from an article by Stein and Siegel,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> with permission from the publisher, JBJS). (A) Position of the wrist in hyperextension at the time of impact. Note that the capitate bone is situated at 90° with respect to the radius. (B) The posterior edge of the radius fractures the capitate bone. (C) Fracture of the scaphoid and rotation of the proximal pole of the capitate to 90°. (D) As the wrist returns to the neutral position, the proximal pole of the capitate continues to rotate up to 180°.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1938 "Ancho" => 951 "Tamanyo" => 621435 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Disruption of arc III of Gilula<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> in the anteroposterior projection in a patient with Fenton syndrome.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Un caso de fractura del escafoidio carpiano y del hueso grande" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.P. 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| 2024 November | 7 | 0 | 7 |
| 2024 October | 48 | 8 | 56 |
| 2024 September | 44 | 4 | 48 |
| 2024 August | 67 | 3 | 70 |
| 2024 July | 41 | 2 | 43 |
| 2024 June | 29 | 6 | 35 |
| 2024 May | 46 | 1 | 47 |
| 2024 April | 40 | 4 | 44 |
| 2024 March | 49 | 5 | 54 |
| 2024 February | 62 | 12 | 74 |
| 2024 January | 54 | 10 | 64 |
| 2023 December | 68 | 7 | 75 |
| 2023 November | 56 | 5 | 61 |
| 2023 October | 83 | 16 | 99 |
| 2023 September | 47 | 5 | 52 |
| 2023 August | 56 | 3 | 59 |
| 2023 July | 93 | 7 | 100 |
| 2023 June | 81 | 6 | 87 |
| 2023 May | 132 | 4 | 136 |
| 2023 April | 63 | 2 | 65 |
| 2023 March | 57 | 4 | 61 |
| 2023 February | 42 | 5 | 47 |
| 2023 January | 51 | 7 | 58 |
| 2022 December | 40 | 18 | 58 |
| 2022 November | 60 | 23 | 83 |
| 2022 October | 48 | 10 | 58 |
| 2022 September | 39 | 9 | 48 |
| 2022 August | 36 | 10 | 46 |
| 2022 July | 38 | 8 | 46 |
| 2022 June | 41 | 14 | 55 |
| 2022 May | 48 | 13 | 61 |
| 2022 April | 53 | 8 | 61 |
| 2022 March | 65 | 14 | 79 |
| 2022 February | 60 | 6 | 66 |
| 2022 January | 105 | 14 | 119 |
| 2021 December | 56 | 14 | 70 |
| 2021 November | 49 | 11 | 60 |
| 2021 October | 50 | 17 | 67 |
| 2021 September | 28 | 11 | 39 |
| 2021 August | 36 | 6 | 42 |
| 2021 July | 28 | 14 | 42 |
| 2021 June | 35 | 8 | 43 |
| 2021 May | 29 | 15 | 44 |
| 2021 April | 61 | 14 | 75 |
| 2021 March | 50 | 13 | 63 |
| 2021 February | 17 | 11 | 28 |
| 2021 January | 8 | 4 | 12 |
| 2020 December | 4 | 1 | 5 |
| 2019 May | 1 | 2 | 3 |
| 2018 April | 1 | 0 | 1 |
| 2018 February | 12 | 1 | 13 |
| 2018 January | 18 | 0 | 18 |
| 2017 December | 16 | 0 | 16 |
| 2017 November | 16 | 4 | 20 |
| 2017 October | 29 | 1 | 30 |
| 2017 September | 17 | 9 | 26 |
| 2017 August | 21 | 6 | 27 |
| 2017 July | 30 | 3 | 33 |
| 2017 June | 33 | 7 | 40 |
| 2017 May | 53 | 6 | 59 |
| 2017 April | 35 | 16 | 51 |
| 2017 March | 25 | 24 | 49 |
| 2017 February | 76 | 3 | 79 |
| 2017 January | 24 | 1 | 25 |
| 2016 December | 30 | 5 | 35 |
| 2016 November | 33 | 4 | 37 |
| 2016 October | 44 | 8 | 52 |
| 2016 September | 90 | 1 | 91 |
| 2016 August | 23 | 0 | 23 |
| 2016 July | 19 | 1 | 20 |
| 2016 June | 29 | 11 | 40 |
| 2016 May | 40 | 9 | 49 |
| 2016 April | 27 | 23 | 50 |
| 2016 March | 22 | 11 | 33 |
| 2016 February | 28 | 13 | 41 |
| 2016 January | 20 | 13 | 33 |
| 2015 December | 21 | 6 | 27 |
| 2015 November | 23 | 9 | 32 |
| 2015 October | 21 | 15 | 36 |
| 2015 September | 19 | 11 | 30 |
| 2015 August | 62 | 5 | 67 |
| 2015 July | 63 | 9 | 72 |
| 2015 June | 27 | 2 | 29 |
| 2015 May | 49 | 2 | 51 |
| 2015 April | 57 | 8 | 65 |
| 2015 March | 26 | 6 | 32 |
| 2015 February | 13 | 0 | 13 |
| 2015 January | 22 | 5 | 27 |
| 2014 December | 32 | 10 | 42 |
| 2014 November | 16 | 3 | 19 |
| 2014 October | 20 | 6 | 26 |
| 2014 September | 16 | 6 | 22 |
| 2014 August | 1 | 0 | 1 |
| 2014 June | 1 | 0 | 1 |
| 2014 May | 2 | 0 | 2 |
| 2013 May | 2 | 0 | 2 |
Show all
