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Busse F, Felderhoff J, Krimmer H, Lanz U. [Scapholunate dissociation: treatment by dorsal capsulodesis]. HANDCHIR MIKROCHIR P 2002; 34:173-81. [PMID: 12203151 DOI: 10.1055/s-2002-33690] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Between December 1994 and December 1996, 26 patients with a scapholunate ligament injury (three with SLD 1. degrees, 16 with SLD 2. degrees and 7 with SLD 3. degrees ) underwent an operation for dorsal capsulodesis in the Klinik für Handchirurgie, Bad Neustadt/Saale. Mean follow-up was 24 months (16 to 37 months). Follow-up criteria were range of motion, grip strength, pain relief, and X-ray findings. Clinical outcome was evaluated using a personal questionnaire, the DASH- and a modified Cooney-Score. Although significant reduction of joint mobility compared to the opposite site was found in all cases (E/F 32 %, U/R 19 %), the reduction of pain was 30 %. Grip-strength was not altered. Thus, 86 % of the patients were satisfied with the result obtained. On X-ray, the scapholunate angle was raised in the SLD 3. degrees -group by 12 degrees postoperatively; in the group with dynamic instability, X-ray findings were normal. Overall, 19 % (5/26) needed further operations due to persistent pain.
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127
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Schädel-Höpfner M. [Therapy of acute triquetrum fractures and LT ligament injuries]. KONGRESSBAND. DEUTSCHE GESELLSCHAFT FUR CHIRURGIE. KONGRESS 2002; 118:395-8. [PMID: 11824283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Fractures of the triquetrum: Triquetrum fractures consist of two types: chip fractures of the dorsum and fractures of the body of the bone. Dorsal cortical fractures respond well to a short time splint or cast support. Non-displaced fractures of the body can be treated by immobilization for four to six weeks. Displacement of body fractures is very rare and often the result of perilunate instability. This condition usually requires open reduction, internal fixation and ligament repair. Lunotriquetral ligament injury: Partial lunotriquetral ligament disruption and dynamic instability should be treated by immobilization alone. Acute complete ligament disruption with static instability results from perilunate instability and requires operative treatment with ligament reconstruction and joint stabilization with K-wires followed by longer immobilization.
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128
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Towfigh H. [Acute perilunar dislocations: algorithm for treatment]. KONGRESSBAND. DEUTSCHE GESELLSCHAFT FUR CHIRURGIE. KONGRESS 2002; 118:405-10. [PMID: 11824286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
In most cases, perilunar dislocations of the wrist are caused by high speed accidents. Usually these injuries occur by a fall on the dorsiflexed superextension of the hand. The instability caused by injuries of various erticular structures (ligament, bone) show various developmental stages. Clinical symptoms are reduced and painful movement, instability of the carpus, snapping and swelling. The diagnosis is established by X-ray, cinematography, arthrography MRT or CT. Perilunar instability with or without associated fractures and particularly de Quervain must be reduced and treated operatively including suture of the ligament and stabilization of the fracture.
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Abstract
A rare case of bilateral bipartite lunate is reported. Radiographs showed that the lunate was divided into palmar and dorsal parts. Computed tomography and magnetic resonance imaging were used to differentiate this variant from lunate fracture.
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130
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Ebinger T, Hintringer W, Wachter K, Merk S, Mentzel M. [Dorsal V-ligament reconstruction in scapholunate instability]. HANDCHIR MIKROCHIR P 2001; 33:401-7. [PMID: 11917678 DOI: 10.1055/s-2001-19450] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
In dynamic and static scapholunate instability after trauma, the repair of the scapholunate ligament is important to avoid scapholunate advanced collapse of the wrist. Direct suture even of fresh-torn ligaments can be technically demanding and occasionally unreliable, thus reconstruction may require additional tissue beside the ligament. Eighteen patients suffering from dynamic (n = 10) and static (n = 8) scapholunate instability were treated by a dorsal ligament reconstruction six months after trauma. A clinical wrist score according to Cooney showed an average of 86 points (maximum 100) within a follow-up of nineteen months after surgery. X-ray films documented no significant loss of scapholunate reduction. Using local tissue only, this method is always possible, very reliable and easy to perform.
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131
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Tünnerhoff HG, Das Gupta K, Haussmann P. [Functional results of medio-carpal partial arthrodesis with excision of the scaphoid]. HANDCHIR MIKROCHIR P 2001; 33:408-17. [PMID: 11917679 DOI: 10.1055/s-2001-19451] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Midcarpal arthrodesis with excision of the scaphoid for the treatment of painful carpal collapse has been performed in our hospital since 1993. A clinical study was carried out to evaluate the results and determine special factors, which might influence the results. 26 out of 29 patients operated until 1999 were reexamined after an average follow-up of 27 months. The results were evaluated according to the Mayo-modified wrist score. The DASH score and the pain-disability index (PDI) were calculated postoperatively. Standard X-rays of the wrist were analyzed for alteration of the radio-lunate joint space, the position of the lunate with respect to the radius and the correction of the carpal height as calculated by the Youm index. Carpal collapse was due to scapholunate pathology (SLAC) in 12 cases, long-standing scaphoid nonunion (SNAC) in ten cases, perilunate dislocation, which was only simply reduced, in three cases, and calcium pyrophosphate deposition disease in two cases. The Mayo-modified wrist score improved significantly from an average of 46 points before to 76 points after surgery. The DASH score postoperatively was 22, the PDI 13. All patients reported improvement of their situation after the operation, eight were completely free of pain. The average range of motion from extension to flexion was 64 degrees, which was almost identical to the average preoperative value. The average grip strength before surgery was 24 kg, after surgery 34 kg. There was a correlation between the position of the lunate to the radius in the lateral X-ray and the range of extension. If the lunate was positioned correctly, wrist extension was significantly better. The radiolunate joint space was maintained during the period of observation with only two exceptions. Apparent subchondral sclerosis was seen in most of the cases. It was not possible to restore carpal height completely. Some results after perilunate luxations and one case of calcium pyrophosphate deposition disease were unsatisfactory. Midcarpal arthrodesis with scaphoid excision is a reliable method for treating radioscaphoid arthrosis caused by carpal collapse. Correction of the hyperextended position of the lunate is important to obtain optimum results. In our hospital, a wrist arthrodesis is only rarely performed nowadays, except in the rheumatoid patient.
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132
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Sauerbier M, Bishop AT. [Possible applications of pedicled vascularized bone transplants of the distal radius]. HANDCHIR MIKROCHIR P 2001; 33:387-400. [PMID: 11917677 DOI: 10.1055/s-2001-19455] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
Reverse-flow pedicle vascularized bone grafts (VBGs) from the distal radius may be used for the surgical treatment of carpal fracture nonunions and avascular necrosis. Such grafts remain viable with quantifiable blood flow as demonstrated in a recent canine experiment. In this paper, the vascular anatomy of the distal radius is demonstrated and the surgical technique of VBG harvest is described. Our indications and results for treatment of scaphoid nonunion and Kienböck's disease are discussed and compared with the current literature. Fifteen patients with scaphoid nonunion and nine patients with Kienböck's disease stage IIIa were treated by reverse-flow pedicled VBG. Range of motion and grip strength were measured postoperatively and compared to the contralateral hand in all patients. An outcome questionnaire was used to measure patient's satisfaction and ADL's in the patients with Kienböck's disease. The radiologic diagnostic was performed with conventional X-rays, trispiral tomograms and MRI. In the scaphoid nonunion group, all patients were male, with an average age of 27.6 years. Five patients had prior attempts of autogenous bone grafting which failed. Six patients had a radiographic suggestion of proximal fragment avascular necrosis. All scaphoids healed. Time to union was 11.1 weeks on average. Average follow-up was 36.2 months. Pain relief, range of motion and grip strength were very promising. The treatment of Kienböck's disease was also promising in nine patients. Mean patient age was 31 years, and follow-up averaged 32 months. Six patients had complete pain relief, and three had occasional pain. Grip strength reached 86% of the contralateral side (a 25% improvement from preoperative values). Postoperative MRI demonstrated progressive revascularization with time. The results of treating scaphoid nonunions are promising. The use of vascularized bone graft facilitates rapid, reliable union of established scaphoid nonunion, even with proximal location and/or avascular changes. Clinical results in Kienböck's disease have been gratifying as well, with MRI evidence of gradual revascularization on follow-up studies.
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133
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Schellhammer F, Isenberg J, Brochhagen HG. [Traumatic dislocation of the lunate bone and the scaphoid bone]. ROFO-FORTSCHR RONTG 2001; 173:1053-5. [PMID: 11704917 DOI: 10.1055/s-2001-18304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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134
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Masmejean E, Cognet JM. [Bipolar dislocation of the forearm: elbow and perilunate dislocation]. REVUE DE CHIRURGIE ORTHOPEDIQUE ET REPARATRICE DE L'APPAREIL MOTEUR 2001; 87:499-502. [PMID: 11547237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
We report a case of bifocal dislocation of the forearm due to posterior dislocation of the elbow and transcaphocapital retrolunate dislocation of the carpus, Fenton's syndrome, associated with fracture of both bones of the forearm. The emergency procedure achieved reduction of the elbow, plate fixation of the radius and ulna, used a posterior and an anterior access to achieve reduction and osteosynthesis of the radial styloid, the scaphoid, and the capitatum and temporary schapholunate, triquetrolunate, scaphocapitate, and radiolunate pinning. At ten months, the patient only complained of moderate pain for exceptional efforts. Complete amplitude elbow motion was restored. Wrist flexion and extension were 50 degrees and 30 degrees respectively. X-rays demonstrated union of the scaphoid and the capitatum. There was no scapholunate diastasis and the scapholunate angle was normal.
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135
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Schädel-Höpfner M, Iwinska-Zelder J, Böhringer G, Braus T, Klose KJ, Gotzen L. [MRI or arthroscopy in the diagnosis of scapholunate ligament tears in fractures of the distal radius?]. HANDCHIR MIKROCHIR P 2001; 33:234-8. [PMID: 11518983 DOI: 10.1055/s-2001-16588] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
In a prospective study, 45 patients with fractures of the distal radius and radiologically suspected tears of the scapholunate interosseous ligament were examined. Magnetic resonance imaging was performed prior to wrist arthroscopy. The latter examination gave the definite diagnosis. MRI was performed in conventional technique (without contrast medium) in 25 cases and after additional intravenous injection of contrast medium in the remaining 20 patients. The images were obtained with a 1.0-T clinical imager using a T(2)-weighted turbo spin echo sequence (slice 3 mm, transversal) and a FLASH 2D sequence (slice 2 mm, oblique/coronal). Three independent observers assessed the MRI scans before arthroscopy was performed. The correct diagnosis was made by MRI in 76 %. Overall sensitivity and specificity came to 71 % and 86 %, respectively. The use of intravenously applied contrast medium did not improve MRI accuracy. In conclusion, MRI is not recommended for the diagnosis of scapholunate ligament tears. Presumably, the results of MRI could be improved by a more sophisticated technique.
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136
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Schädel-Höpfner M, Böhringer G, Junge A, Celik I, Gotzen L. [Arthroscopic diagnosis of concomitant scapholunate ligament injuries in fractures of the distal radius]. HANDCHIR MIKROCHIR P 2001; 33:229-33. [PMID: 11518982 DOI: 10.1055/s-2001-16590] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
To investigate the occurrence of carpal ligamentous injuries in patients with fractures of the distal radius, the results of 122 wrist arthroscopies were analysed within a retrospective study. Indications for arthroscopy included suspected carpal instability according to radiographic findings and/or the necessity for internal fixation of the radius fracture. Arthroscopy revealed acute scapholunate ligament tears in 84 patients. Scapholunate separation was found to be of prognostic value for ligament tears. There was no association between ligamentous lesions and carpal angles or fracture dislocation. Scapholunate ligament tears were most frequent in sagittal articular fractures. In these cases, wrist arthroscopy should be performed during operative treatment of the radius fracture to allow direct visualization and subsequent repair of ligamentous tears.
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137
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van Schoonhoven J, Prommersberger KJ, Schmitt R. Traumatic disruption of a fibrocartilage lunate-triquetral coalition--a case report and review of the literature. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2001; 6:103-8. [PMID: 11677672 DOI: 10.1142/s0218810401000497] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2000] [Accepted: 08/21/2000] [Indexed: 11/18/2022]
Abstract
Whilst osseous coalitions of the lunate and the triquetrum are known to be asymptomatic, fibrocartilage lunate-triquetral coalitions can present an uncommon cause for ulnar-sided wrist pain. To diagnose this condition a high degree of suspicion is needed. We present a case with painful post-traumatic disruption of a fibrocartilage lunate-triquetral coalition that was primary misdiagnosed to be a disruption of the interosseous lunotriquetral ligament and was initially treated arthroscopically. Persistent symptoms lead to X-ray examination of the opposite wrist, revealing a complete osseous lunate-triquetral coalition. CT and MRI investigations demonstrated the fibrocartilage coalition of the affected wrist. Subsequently, lunotriquetral fusion using a cannulated Herbert screw was performed and settled the symptoms completely.
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138
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Abstract
We present a case of lunate dislocation with total disruption of all ligaments and, consequently, nutrient vessels. The injury was handled by fusion of the lunate with the scaphoid, capitate and triquetrum. This 'anchor fusion' has led to a very good long-term result.
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139
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Abstract
A case of a volar periscapholunate dislocation is reported. Treatment by closed reduction and Kirschner wire fixation gave a good clinical result.
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140
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Abstract
The authors report a rare case of palmar lunate transscaphoid fracture-dislocation resulting from a palmar flexion injury. After performing an open reduction of the lunate, they used a dorsal approach to fix the fractured scaphoid with a Herbert screw. A Kirschner wire fixation was also performed to stabilize the lunotriquetral joint.
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141
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Perron AD, Brady WJ, Keats TE, Hersh RE. Orthopedic pitfalls in the ED: lunate and perilunate injuries. Am J Emerg Med 2001; 19:157-62. [PMID: 11239263 DOI: 10.1053/ajem.2001.21306] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Occult dislocations at and around the lunate can accompany wrist trauma. When left unrecognized and untreated, these injuries lead to a high incidence of long-term functional disability and chronic pain. Emergency medicine practitioners need to be vigilant for both lunate and perilunate dislocations. This review article examines the clinical presentation, diagnostic techniques, and management options applicable to the emergency practitioner.
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142
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Schädel-Höpfner M, Iwinska-Zelder J, Braus T, Böhringer G, Klose KJ, Gotzen L. MRI versus arthroscopy in the diagnosis of scapholunate ligament injury. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 2001; 26:17-21. [PMID: 11162008 DOI: 10.1054/jhsb.2000.0450] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In a prospective study 103 patients with clinically or radiologically suspected tears of the scapholunate interosseous ligament were investigated with magnetic resonance imaging (MRI) and wrist arthroscopy. MRI was performed with the conventional technique in 72 cases and after intravenous injection of contrast medium in the remaining 31 patients. The correct diagnosis was made by MRI in 75% of cases and its overall sensitivity and specificity were 63% and 86% respectively. There was no statistical difference in the accuracy of MRI for acute or chronic tears and the use of intravenous contrast medium did not improve its accuracy. In conclusion, MRI is not recommended for the diagnosis of scapholunate ligament injury.
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143
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Wilhelm K, Kettler M, Strassmair M. [Scapho-lunate ligament reconstruction with Mitek suture anchors. Initial clinical results]. Unfallchirurg 2001; 104:127-30. [PMID: 11471405 DOI: 10.1007/s001130050702] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The scapholunate dissociation is an often misjudged lesion of carpal ligaments as clinical and radiological signs often don't allow a clear interpretation. Apart from chronical courses with increasing arthrosis the consequences are limited and more difficult operations. The application of Mitek suture anchors is a new and simple supplement to large-scale operative reconstructions of ligaments or partial arthrodesis. Of nine reconstructions of the scapholunate interosseous ligament using this anchor method so far only one relaps occurred.
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144
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Kaneko K, Miyazaki H, Yamaguchi T, Yanagihara Y, Kurosawa H. Bilateral transcapholunate dislocation. CHIRURGIE DE LA MAIN 2000; 19:263-8. [PMID: 11147199 DOI: 10.1016/s1297-3203(00)73489-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
An uncommon case has been reported of bilateral transscaphoid-perilunate dislocation fracture following trauma. A 35-year-old male with bilateral transscapholunate dislocation was treated by closed reduction and internal fixation. The case was examined in detail, and compared to the findings in the literature; observations regarding fracture prognosis were also made. Two years post-surgery, the patient remained asymptomatic.
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145
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Hildebrand KA, Ross DC, Patterson SD, Roth JH, MacDermid JC, King GJ. Dorsal perilunate dislocations and fracture-dislocations: questionnaire, clinical, and radiographic evaluation. J Hand Surg Am 2000; 25:1069-79. [PMID: 11119665 DOI: 10.1053/jhsu.2000.17868] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Twenty-two consecutive patients (23 wrists) underwent open reduction internal fixation of dorsal perilunate dislocations and fracture-dislocations through combined dorsal and volar approaches. One of 5 experienced wrist surgeons performed these procedures within an average of 3 days of injury (range, 0-26 days) and intercarpal fixation was kept within the proximal carpal row. Motion was instituted an average of 10 weeks (range, 5-16 weeks) after injury. All patients were males. The average age at the time of injury was 32 years (range, 16-60 years). The average follow-up period was 37 months (range, 13-65 months). Average flexion-extension motion arc and grip strength in the injured wrist were 57% and 73%, respectively, compared with the contralateral wrist. The scapholunate angle increased and the revised carpal height ratio decreased over time, which was statistically significant for both measurements. Three patients (3 wrists) required wrist arthrodesis and a fourth patient had an immediate scaphoid excision and 4-corner arthrodesis secondary to an irreparable scaphoid fracture. One patient required a proximal row carpectomy to treat septic arthritis. Nine of the remaining 18 wrists had radiographic evidence of arthritis, most often at the capitolunate or scaphocapitate articulations. Short form-36 mental summary scores were significantly greater than age- and gender-matched US population values; physical summary scores were significantly less. The disabilities of arm, shoulder, and hand evaluation, Mayo wrist score, and patient-rated wrist evaluation all reflected loss of function. Seventy-three percent of all patients had returned to full duties in their usual occupations and a total of 82% were employed.
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146
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Schädel-Höpfner M, Böhringer G, Gotzen L. [Results after minimally invasive therapy of acute scapholunate dissociation]. HANDCHIR MIKROCHIR P 2000; 32:333-8. [PMID: 11103691 DOI: 10.1055/s-2000-10941] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
In 27 cases with acute scapholunate ligament injury, minimal invasive treatment was performed. After closed reduction scapholunate transfixation was achieved by Kirschner wires. Postoperatively, a short-arm cast was applied for six weeks. All patients have been reexamined on average 26 months after operation. Follow-up results have been good concerning clinical examination and patients' satisfaction. Radiological examination has shown recurrence of scapholunate instability in 15 cases. In fact, 11% of the patients had dynamic and 44% static instability at follow-up. Recurrence has been most frequent in cases involving primary static instability. Consequently, these cases should be treated by open reduction. Minimal invasive treatment of acute scapholunate dissociation is not recommended. The therapeutic procedure must be adapted to the different stages of scapholunate ligament injury.
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147
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Ouarab M, Fnini S, Harfaoui A, Trafeh M. [Antelunar dislocation of the wrist. Apropos of 3 cases]. CHIRURGIE DE LA MAIN 2000; 19:235-42. [PMID: 11079181 DOI: 10.1016/s1297-3203(00)73486-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Volar perilunar dislocation of the carpus is rare. We report three cases here. The patients were 18, 23 and 31 years of age. The etiology was a traffic accident in all cases and palmar hyperflexion of the wrist was noted in all three. Palmar dislocation was associated with a scaphoid fracture in two cases. In the third case, there was an associated fracture of the radial styloid and capitate. The patients were operated on after a delay of 48 h in two cases and four weeks in one. The dorsal approach was used in two cases and the palmar approach in the other. Reduction, fracture osteosynthesis and intracarpal temporary arthrodesis were the main lines of treatment. The functional result evaluated after a minimum of eight months' follow-up was good in two cases, and acceptable in one (Green and O'Brien score). Volar perilunar dislocation is often associated with fracture of a carpal bone, mainly the scaphoid. It occurs in young men, after a violent injury. Polytrauma is often associated. Closed reduction is attempted first but open reduction is often needed because of instability of the lesion. The functional result is good if the treatment restores carpal bone congruence.
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148
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Teklote JR, Fritz T, Meeder PJ. [Trans-scaphoid perilunar dislocation of the wrist (de Quervain) as a rare complication of electric injury]. Chirurg 2000; 71:1172-4. [PMID: 11043139 DOI: 10.1007/s001040051197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We describe the case of a 67-year-old man with an electricity inflicted injury in the left hand and a transscaphoidal perilunear dislocation of the opposite right hand. On admission, the injury was missed on the standard ap-radiogram of the right hand, so the operative reconstruction was delayed. Later on, the lunate showed aseptic necrosis and wrist collapse as consequence.
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149
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Linkous MD, Pierce SD, Gilula LA. Scapholunate ligamentous communicating defects in symptomatic and asymptomatic wrists: characteristics. Radiology 2000; 216:846-50. [PMID: 10966721 DOI: 10.1148/radiology.216.3.r00se15846] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine whether the sizes and locations of scapholunate ligamentous communicating defects are different in symptomatic and asymptomatic cases. MATERIALS AND METHODS Bilateral wrist arthrograms were reviewed for 30 consecutive patients with a history of wrist trauma and unilateral wrist pain who had at least one scapholunate ligamentous communicating defect and unremarkable conventional radiographs. The location and size of each ligamentous defect was recorded. Differences between symptomatic and asymptomatic wrists were analyzed with the chi(2) or Fisher exact test. RESULTS Most communicating defects in both groups were incomplete and ranged from pinhole size to large. There was a higher frequency of complete disruption in the symptomatic wrists (nine [32%] of 28 wrists) than in the asymptomatic wrists (two [10%] of 20 wrists; P: =.092). Communicating defects involved the dorsal portion in 18 (64%) of the 28 symptomatic cases and in five (25%) of the 20 asymptomatic cases (P: =.007). CONCLUSION The data suggest that the demonstration of a complete ligamentous disruption or involvement of the dorsal portion of the ligament may indicate a traumatic cause rather than a degenerative change.
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150
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Calandruccio JH, Gelberman RH, Duncan SF, Goldfarb CA, Pae R, Gramig W. Capitolunate arthrodesis with scaphoid and triquetrum excision. J Hand Surg Am 2000; 25:824-32. [PMID: 11040297 DOI: 10.1053/jhsu.2000.16364] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A retrospective two-center outcome study was designed to evaluate the results of capitolunate arthrodesis with scaphoid and triquetrum excision mainly for scapholunate advanced collapse patterns of arthritis. Fourteen wrists in 14 patients were evaluated objectively by standard parameters and subjectively by the Short Musculoskeletal Functional Assessment at an average of 28 months after surgery (range, 14-51 months). All patients were men between the ages of 20 and 70 years (average, 49 years). Two patients had a painful nonunion and one had persistent pain despite conversion to a solid wrist arthrodesis. One patient had x-ray evidence of progressive radiolunate narrowing, but only occasional pain. Postoperative wrist flexion-extension arc was 53 degrees and radioulnar deviation arc was 18 degrees. Grip and pinch strengths were 71% and 75%, respectively, of the normal contralateral wrist. The results of our study indicate that capitolunate arthrodesis with scaphoid and triquetrum excision is comparable to other motion-preserving operative procedures for scapholunate advance collapse.
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