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Trentadue TP, Thoreson A, Lopez C, Breighner RE, Leng S, Holmes DR, Kakar S, Rizzo M, Zhao KD. Morphology of the scaphotrapeziotrapezoid joint: A multi-domain statistical shape modeling approach. J Orthop Res 2024. [PMID: 38956833 DOI: 10.1002/jor.25918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 07/04/2024]
Abstract
The scaphotrapeziotrapezoid (STT) joint is involved in load transmission between the wrist and thumb. A quantitative description of baseline STT joint morphometrics is needed to capture the variation of normal anatomy as well as to guide staging of osteoarthritis. Statistical shape modeling (SSM) techniques quantify variations in three-dimensional shapes and relative positions. The objectives of this study are to describe the morphology of the STT joint using a multi-domain SSM. We asked: (1) What are the dominant modes of variation that impact bone and articulation morphology at the STT joint, and (2) what are the morphometrics of SSM-generated STT joints? Thirty adult participants were recruited to a computed tomography study of normal wrist imaging and biomechanics. Segmentations of the carpus were converted to three-dimensional triangular surface meshes. A multi-domain, particle-based entropy system SSM was used to quantify variation in carpal bone shape and position as well as articulation morphology. Articular surface areas and interosseous proximity distributions were calculated between mesh vertex pairs on adjacent bones within distance (2.0 mm) and surface-normal angular (35°) thresholds. In the SSM, the first five modes of variation captured 76.2% of shape variation and contributed to factors such as bone scale, articular geometries, and carpal tilt. Median interosseous proximities-a proxy for joint space-were 1.39 mm (scaphotrapezium), 1.42 mm (scaphotrapezoid), and 0.61 mm (trapeziotrapezoid). This study quantifies morphological and articular variations at the STT joint, presenting a range of normative anatomy. The range of estimated interosseous proximities may guide interpretation of imaging-derived STT joint space.
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Affiliation(s)
- Taylor P Trentadue
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic Medical Scientist Training Program, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic Graduate Program in Biomedical Engineering and Physiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew Thoreson
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Cesar Lopez
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan E Breighner
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, New York, USA
| | - Shuai Leng
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Radiology, Mayo Clinic Computed Tomography Clinical Innovation Center, Mayo Clinic, Rochester, Minnesota, USA
| | - David R Holmes
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Biomedical Imaging Resource Core Facility, Mayo Clinic, Rochester, Minnesota, USA
| | - Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Marco Rizzo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kristin D Zhao
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic Graduate Program in Biomedical Engineering and Physiology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
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Myllykoski J, Räisänen MP, Kotkansalo T, Juntunen M, Pääkkönen M. Arthroscopic Scaphotrapeziotrapezoid Joint Fusion for Osteoarthritis. J Hand Surg Asian Pac Vol 2023; 28:580-586. [PMID: 37905364 DOI: 10.1142/s2424835523500613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Background: Arthroscopic scaphotrapeziotrapezoid (STT) fusion (ASTTF) has emerged in the recent decade as an option for traditional open surgery. This retrospective study describes our technique and results of ASTTF. Methods: Medical records and radiological data of patient who had undergone ASTTF between 2014 and 2022 in two tertiary hospitals were reviewed. Results: Five ASTTF in four patients were identified. The mean age of the patients were 52.4 years. Fusion was achieved in four out of five wrists (80%). The mean postoperative radio-scaphoid angle was 48°, grip 32 kg (70% compared to contralateral hand), extension 54° (86%) and flexion 46° (93%). The mean follow-up time was 18 months (range 5 months to 4 years). One wrist (20%) developed STT non-union requiring a reoperation 2 years after index surgery. Conclusions: ASTTF is a technically challenging procedure with a long learning curve and surgery time. However, ASTTF is less invasive compared to the open procedure and our results were like the open procedures described in literature. Further studies are needed to compare the benefits and results of open and ASTTF in a prospective and randomised setup. Level of Evidence: Level IV (Therapeutic).
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Affiliation(s)
- Jan Myllykoski
- Department of Hand Surgery, Division of Diseases of the Musculoskeletal System, Turku University Hospital, and CoE TYKS ORTO, Turku, Finland
| | - Mikko P Räisänen
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | | | - Matti Juntunen
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Markus Pääkkönen
- Department of Hand Surgery, Division of Diseases of the Musculoskeletal System, Turku University Hospital, and CoE TYKS ORTO, Turku, Finland
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Alder KD, Feroe AG, Karim KE. Management of Scaphotrapeziotrapezoid Osteoarthritis: A Critical Analysis Review. JBJS Rev 2023; 11:01874474-202310000-00007. [PMID: 38096476 DOI: 10.2106/jbjs.rvw.23.00093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
» The scaphotrapeziotrapezoid (STT) joint is a common location of degenerative osteoarthritis (OA) in the wrist.» STT OA may occur in isolation or with concomitant thumb carpometacarpal joint (CMCJ) OA or scapholunate advanced collapse (SLAC) and other wrist OA patterns.» Nonoperative management strategies include activity modification, bracing, anti-inflammatory medications, occupational therapy, and injections.» Surgical treatment may be determined by whether the STT OA occurs in isolation or with concomitant thumb CMCJ or SLAC OA and includes STT arthrodesis, distal scaphoid excision with or without interposition or implant arthroplasty, trapeziectomy with proximal trapezoid excision, four-corner fusion in combination with scaphoid/radial column excision, and proximal row carpectomy.
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Affiliation(s)
- Kareme D Alder
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Atiyya AN, Eldiasty A, Koriem I, Nabil A. Modified Graner's Technique with\without Vascularized Capitate Lengthening for Kienböck Disease Stage IIIb-A Pilot Study. J Wrist Surg 2023; 12:67-72. [PMID: 36644725 PMCID: PMC9836775 DOI: 10.1055/s-0041-1731328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/21/2021] [Indexed: 01/18/2023]
Abstract
Background Intercarpal fusions are used to treat stage IIIb Kienböck disease. They increase force transfer across the radioscaphoid articulation with predisposition to arthritis. Description of Technique This technique is excision of lunate followed by proximal transfer of capitate, with scaphocapitate and triquetrocapitate fusion to increase area of load transfer mimicking wrist hemiarthroplasty. Our purpose is to evaluate mid-term results of this technique. Patients and Methods A prospective case series study was conducted on 11 patients with stage IIIb and IIIc. In seven cases, transfer of the capitate was performed by osteotomizing the capitate just distal to its waist, proximal migration to replace the excised lunate then bone grafting. In four cases, proximal transfer of vascularized pedicled capitate was done. Clinical outcome measures included pain (visual analog scale), grip strength, range of motion, and functional evaluation by modified Mayo wrist score and scoring system of Evans. Radiological outcome measures included healing of fusion mass, progression of the disease, and occurrence of avascular necrosis to the capitate. Results Follow-up period averaged 54 months. Scaphocapitate fusion healing averaged 11 weeks. Union of the lengthened capitate occurred in 10 patients only. There was postoperative improvement in pain scores, grip, Evans, and modified Mayo wrist score. There was postoperative decrease in wrist flexion and extension. One patient showed resorption of the capitate head with progressive radioscaphoid arthritis-necessitated wrist fusion. Conclusion The mid-term results of this technique may be satisfactory due to low incidence of degenerative arthritis in the radioscaphoid joint. However, longer follow-up with recruiting larger number of patients is needed.
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Affiliation(s)
| | | | - Islam Koriem
- Department of Orthopaedics, Ain Shams University Hospital, Cairo, Egypt
| | - Amr Nabil
- Department of Orthopaedics, Hand Surgery Unit, Ain Shams University, Cairo, Egypt
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Rogers MJ, Lu CC, Stephens AR, Garcia BN, Chen W, Sauer BC, Tyser A. Scaphotrapeziotrapezoid Arthrodesis: A 10-Year Follow-up Study of Complications in 58 Wrists. Hand (N Y) 2022; 17:919-925. [PMID: 33106027 PMCID: PMC9465779 DOI: 10.1177/1558944720964972] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Scaphotrapeziotrapezoid (STT) arthrodesis is a procedure used for specific degenerative arthritis and instability patterns of the wrist. This study evaluates nonunion rate and risk factors for reoperation after STT arthrodesis in the Veterans Affairs Department patient population. The purpose of our study was to assess the long-term nonunion rate following STT arthrodesis and to identify factors associated with reoperation. METHODS The national Veterans Health Administration Corporate Data Warehouse and Current Procedural Terminology codes identified STT arthrodesis procedures from 1995 to 2016. Frequencies of total wrist arthrodesis (TWA) and secondary operations were determined. Univariate analyses provided odds ratios for risk factors associated with complications. RESULTS Fifty-eight STT arthrodeses were performed in 54 patients with a mean follow-up of 120 months. Kirschner wires (K-wires) were the most common fixation method (69%). Six wrists (10%) required secondary procedures: 5 TWAs and 1 revision STT arthrodesis. Four patients underwent additional procedures for nonunion (7%). Twenty-four patients required K-wire removal, 8 (14%) of these in the operating room, which were not included in regression analysis. Every increase in 1 year of age resulted in a 15% decrease in likelihood of reoperation (95% confidence interval: 0.77-0.93; P < .0001). Opioid use within 90 days before surgery (P = 1.00), positive smoking history (P = 1.00), race (P = .30), comorbidity count (P = .25), and body mass index (P = .19) were not associated with increased risk of reoperation. CONCLUSIONS At a mean follow-up of 10 years, patients undergoing STT arthrodesis have a 10% risk of reoperation, and this risk decreases with older patient age. There was a symptomatic nonunion rate of 7%, similar to prior published rates. Patient demographics, comorbidity, smoking history, and opioid use did not appear to increase risk of reoperation.
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Affiliation(s)
| | - Chao-Chin Lu
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
- University of Utah, Salt Lake City, USA
| | | | | | - Wei Chen
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
- University of Utah, Salt Lake City, USA
| | - Brian C. Sauer
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
- University of Utah, Salt Lake City, USA
| | - Andrew Tyser
- University of Utah Orthopaedic Center, Salt Lake City, USA
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Cholley-Roulleau M, Bouju Y, Lecoq FA, Fournier A, Bellemère P. Pyrocardan Scaphotrapeziotrapezoid Joint Arthroplasty for Isolated Osteoarthritis: Results after a Mean Follow-Up of 5 Years. J Wrist Surg 2022; 11:262-268. [PMID: 35837588 PMCID: PMC9276069 DOI: 10.1055/s-0041-1733877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
Background Isolated scaphotrapeziotrapezoid (STT) osteoarthritis (OA) mainly develops in women over 50 years of age in a bilateral manner. Many surgical treatments are available, including distal scaphoid resection with or without interposition, trapeziectomy, and STT arthrodesis. However, there is a controversy about which procedure is the most effective. Purposes The purpose of this study was to report the outcomes of the Pyrocardan implant for treating STT isolated OA at a mean follow-up of 5 years. Patients and Methods Consecutive patients who underwent STT arthroplasty using the Pyrocardan were reviewed retrospectively by an independent examiner who performed a clinical and radiological evaluation. Results The mean follow-up time was 5 years (range 3-8 years). Thirteen patients (76%) were followed for more than 5 years. Between the preoperative assessment and the last follow-up, pain levels decreased significantly. There was no significant difference in the mean Kapandji opposition score. Grip and pinch strengths were 88 and 91% of the contralateral side. The active range of motion in flexion-extension and radioulnar deviation was not significantly different to the contralateral side (119° vs. 121° and 58° vs. 52°, p > 0.1). Functional scores were improved significantly. No identifiable differences were found in the radioscaphoid, capitolunate, and scapholunate angles before and after surgery. In three cases, the preoperative dorsal intercalated scapholunate instability (DISI) failed to be corrected. In one case, DISI appeared after the procedure. There was one asymptomatic dislocation of the implant. Calcification around the trapezium and/or distal scaphoid was found in four cases. The survival rate of the implant without reoperation was 95%. Conclusions In the medium term, Pyrocardan implant is an effective treatment for STT OA as it reduces pain, increases grip strength, and maintains wrist mobility. This is consistent with the results of other published case series using pyrocarbon implants. It provides a high rate of patient satisfaction. Nevertheless, the surgical procedure must be done carefully to avoid STT ligament damage, periarticular calcifications, or dislocation.
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Affiliation(s)
- Martin Cholley-Roulleau
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Émile Gallé, CHU Nancy, Nancy, France
| | - Yves Bouju
- Department of Hand Surgery, Institut de la main Nantes-Atlantique, Santé Atlantique, Saint-Herblain, France
| | - Flore-Anne Lecoq
- Department of Hand Surgery, Institut de la main Nantes-Atlantique, Santé Atlantique, Saint-Herblain, France
| | - Alexandre Fournier
- Department of Hand Surgery, Institut de la main Nantes-Atlantique, Santé Atlantique, Saint-Herblain, France
| | - Philippe Bellemère
- Department of Hand Surgery, Institut de la main Nantes-Atlantique, Santé Atlantique, Saint-Herblain, France
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Stephens AR, Garcia BN, Rogers MJ, Zhang C, Himbert C, McFarland MM, Presson AP, Kazmers NH, Tyser AR. Scaphotrapeziotrapezoid Arthrodesis: Systematic Review. J Hand Surg Am 2022; 47:218-227.e2. [PMID: 35033404 DOI: 10.1016/j.jhsa.2021.09.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 05/10/2021] [Accepted: 09/21/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Scaphotrapeziotrapezoid (STT) arthrodesis surgery is used for various types of wrist pathologies. The objective of our study was to perform a systematic review of complications and outcomes after STT arthrodesis. METHODS Several major databases were used to perform a systematic literature review in order to obtain articles reporting complications and outcomes following STT arthrodesis. The primary purpose was to identify rates of nonunion and conversion to total wrist arthrodesis. Secondary outcomes included wrist range of motion, grip strength, and Disabilities of the Arm Shoulder and Hand scores. A multivariable analysis was performed to evaluate factors associated with the primary and secondary outcomes of interest. RESULTS Out of the 854 records identified in the primary literature search, 30 studies were included in the analysis. A total of 1,429 procedures were performed for 1,404 patients. The pooled nonunion rate was 6.3% (95% CI, 3.5-9.9) and the rate of conversion to total wrist arthrodesis following the index STT was 4.2% (95% CI, 2.2-6.7). The mean pooled wrist flexion was 40.7° (95% CI, 30.8-50.5) and extension was 49.7° (95% CI, 43.5-55.8). At final follow-up, the mean pooled grip strength was 75.9% (95% CI, 69.3-82.5) of the nonsurgical contralateral hand. Compared with all other known indications, Kienbock disease had a statistically significant lower nonunion rate (14.1% vs 3.3%, respectively). Mixed-effects linear regression using patient-level data revealed that increasing age was significantly associated with complications, independent of occupation and diagnosis. CONCLUSIONS Our study demonstrated a low failure rate and conversion to total wrist arthrodesis after STT arthrodesis and acceptable postoperative wrist range of motion and strength when compared to the contralateral hand. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
| | | | - Miranda J Rogers
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
| | - Chong Zhang
- Division of Public Health, University of Utah, Salt Lake City, UT
| | | | - Mary M McFarland
- Eccles Health Sciences Library, University of Utah, Salt Lake City, UT
| | | | | | - Andrew R Tyser
- Department of Orthopaedics, University of Utah, Salt Lake City, UT.
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Eeckhoudt A, Hollevoet N. Results of treatment of osteoarthritis of the scaphotrapeziotrapezoidal joint with tendon allograft interposition. Acta Orthop Belg 2021. [DOI: 10.52628/87.3.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of the study was to determine if the use of tendon allografts in combination with distal scaphoid resection for the treatment of isolated STT arthrosis is a save procedure. We reviewed the postoperative complications, re-operations, clinical and radiological results of this treatment modality. A retrospective cohort study was conducted. Investigated parameters include wrist mobility (wrist extension and -flexion), strength (grip- and pinch strength), patient-reported outcome scores : Visual Analogue Scale (VAS), Quick Disabilities of the Arm, Shoulder and Hand score (Q-DASH) and Patient Rated Wrist/Hand Evaluation score (PRWHE) and radiographic measurements : scapholunate (SL) angle, radiolunate (RL) angle and capitolunate (CL) angle. Ten wrists were included in nine patients. No revision surgery was performed. Two patients had transient neuropraxia of the radial nerve. Postoperative flexion-extension arc was 112°. Grip-strength was significantly increased after surgery (20 to 28kg). The average VAS score the past week was 1.75 (range 0-6.7), the average maximum VAS score was 3.0 (range 0-10). The mean PRWHE score was 16.6 (range 0- 69). The mean Q-DASH score was 17.95 (range 0-51). The current study indicates that distal scaphoid resection for isolated STT arthritis is a save procedure with minimal complications. It significantly improves grip strength. Mobility of the wrist was similar to contralateral wrist after surgery. Pain postoperatively was very limited (low VAS scores) and good functional scores (Q-DASH and PRWHE) were noted. Our findings support the prior findings that excisional arthroplasty might worsen carpal instability.
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Cholley-Roulleau M, Dap F, Dautel G, Athlani L. Scaphotrapeziotrapezoid arthrodesis for isolated osteoarthritis: results at a mean 8 years' follow-up. HAND SURGERY & REHABILITATION 2021; 40:602-608. [PMID: 33992817 DOI: 10.1016/j.hansur.2021.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/01/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
The aim of this retrospective study was to report medium- to long-term outcome of scaphotrapeziotrapezoid (STT) arthrodesis with staple fixation to treat painful isolated osteoarthritis (OA). Twenty-one consecutive patients (22 wrists) who had undergone STT arthrodesis were retrospectively reviewed by an independent examiner. Clinical and radiological evaluation was performed. At a mean follow-up of 8 years (range 2-20 years), pain levels were significantly decreased, and functional scores were significantly improved. Grip and pinch strength were 86% and 82% of those of the contralateral side. Wrist range of motion in flexion-extension and radial-ulnar deviation was significantly less than on the contralateral side at last follow-up (104° vs. 131° and 38° vs. 55°, respectively). Non-union was found on X-ray in 4 wrists (18%), but in 2 cases showed as partial non-union on CT, with complete scaphotrapezial consolidation; 1 of the 4 wrists required surgical revision. Another patient was re-operated on for symptomatic external staple displacement without non-union. There were 8 cases (36%) of radiographic narrowing of the styloscaphoid joint space; contact between the staple and styloid was found in all 8 cases. Four patients (18%) had narrowing of the scaphocapital joint space; protrusion of the proximal part of the staple into the joint space was noted in all 4 wrists. No differences were found for the radioscaphoid, capitolunate and scapholunate angles before and after surgery. STT arthrodesis with staple fixation to treat isolated STT OA led to a significant reduction in pain, with improved strength and functional scores. To avoid styloid impingement, we recommend systematic styloidectomy. Complete non-union seems to be overestimated on radiographs. Partial non-union with scaphotrapezial union should not be considered as a complication. LEVEL OF EVIDENCE: IV.
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Affiliation(s)
- M Cholley-Roulleau
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU Nancy, 49 rue Hermite, 54000 Nancy, France.
| | - F Dap
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU Nancy, 49 rue Hermite, 54000 Nancy, France.
| | - G Dautel
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU Nancy, 49 rue Hermite, 54000 Nancy, France.
| | - L Athlani
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU Nancy, 49 rue Hermite, 54000 Nancy, France.
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Li X, Lu L, Gong X, Jiang Z. Vascularized Capitate Transposition for the Treatment of Stage IIIB Kienböck Disease. J Hand Surg Am 2020; 45:1085.e1-1085.e11. [PMID: 32829960 DOI: 10.1016/j.jhsa.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 03/27/2020] [Accepted: 05/01/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The treatment of Kienböck disease (KD) continues to be controversial. In this study, we report the long-term follow-up outcomes of patients who were diagnosed with stage IIIB KD treated with vascularized capitate transposition. METHODS A total of 16 patients were retrospectively reviewed. Baseline clinical information was extracted from medical records, and wrist function was clinically evaluated, including x-ray images. RESULTS At the final follow-up, wrist pain was severe in 0 patients, moderate in 2 patients, mild in 5 patients, and absent in 9 patients. The mean postoperative active flexion and extension of the affected wrist was significantly improved after surgery compared with before surgery. The postoperative and preoperative mean grip strength was 35 kg and 27 kg, respectively. The Disabilities of the Arm, Shoulder, and Hand score was significantly improved after surgery compared with before surgery. CONCLUSIONS Vascularized capitate transposition for the treatment of Lichtman stage IIIB KD is feasible and associated with improvements in wrist function and pain. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Xiucun Li
- Department of Hand and Foot Surgery, The Second Hospital, Cheelo College of Medicine, Shandong University, Jinan, Shandong Province, China
| | - Laijin Lu
- Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Xu Gong
- Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Zhenmin Jiang
- Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, China.
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Goyal N, Singh V, Barik S, Behera S. Limited Carpal Fusion in Kienböck's Disease: Early Results following Scaphocapitate Arthrodesis. J Wrist Surg 2020; 9:404-410. [PMID: 33042643 PMCID: PMC7540655 DOI: 10.1055/s-0040-1712517] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
Background Kienböck's disease leading to progressive carpal collapse alters the wrist biomechanics leading to early arthritis and degenerative changes. Out of multiple surgical procedures present, no gold standard has been described. Scaphocapitate arthrodesis (SCA) is limited carpal fusion which shifts the loading axis toward radioscaphoid joint. This study presents the midterm clinical and radiological results of SCA in Kienböck's disease. Materials and Methods The data were reviewed from January 2016 to December 2017. Lichtman's classification used to stage the disease. Clinical variables were noted for wrist range of motion, grip strength, visual analog scale (VAS) score, quick disabilities of the arm, shoulder, and hand (quickDASH), and patient-rated wrist evaluation (PRWE) scores. Radiographs were evaluated for union, ulnar variance, carpal height ratio, radioscaphoid angle, and scapholunate angle. Results A total of 11 patients of Stage IIIA and IIIB Kienböck's disease with mean age of 24 years were included in the study with a minimum of 18 months of clinical follow-up. The procedure resulted in decreased ranges of motion but improved grip strength (26.09 ± 4.76 from 19.54 ± 4.63 kgf) and reduced pain with VAS score decreased from 7.36 ± 0.8 to 2 ± 1. Radiographic analysis showed union in all patients, reduced carpal height with a corrected radioscaphoid angle (from 62.12 to 48.3 degrees), and scapholunate angle (from 34 to 26.27 degrees). Discussion SCA has advantage of technical ease of orientation of the scaphoid and osteosynthesis of only one intercarpal joint with a large contact surface. Coupling the distal and proximal carpal rows results in significant loss of mean wrist range of motion but with improved grip strength, shifting the load away from the radiolunate joint. However, long-term studies are needed for clinical benefits and radiographic signs of radioscaphoid arthritis for the treatment of advanced-stage Kienböck's disease. Level of Evidence This is a Level IV, retrospective observational study.
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Affiliation(s)
- Nikhil Goyal
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Vivek Singh
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sitanshu Barik
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Santosh Behera
- Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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12
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Elajnaf M, Rust PA, Wallace R. The effect of surgery for basal osteoarthritis of the thumb on dart thrower's motion. J Hand Surg Eur Vol 2020; 45:495-500. [PMID: 32000569 DOI: 10.1177/1753193419900854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study aimed to identify the effects of basal thumb surgery on the range of dart thrower's motion. Thirteen fresh-frozen cadaveric specimens were placed in a customized jig. Simulated scaphotrapeziotrapezoid joint fusion was carried out on all specimens. Half the specimens then underwent trapeziectomy and the rest had excision of the distal pole of the scaphoid. Simulated scaphotrapeziotrapezoid fusion reduced the range of dart thrower's motion to 89% of the range in the intact wrists, from a mean of 117° to 104°. Although this reduction is not large, it was statistically significant. Simulated trapeziectomy caused a very small increase in dart thrower's motion range compared with the range in the intact wrists. Simulated distal pole of scaphoid excision did not change the range of dart thrower's motion. These results may inform preoperative decisions for surgical management of basal osteoarthritis of the thumb.
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Affiliation(s)
- Mohamed Elajnaf
- Anatomy, Edinburgh Medical School: Biomedical Sciences, University of Edinburgh, Edinburgh, UK
| | - Philippa A Rust
- Anatomy, Edinburgh Medical School: Biomedical Sciences, University of Edinburgh, Edinburgh, UK.,Hooper Hand Unit, St John's Hospital, Livingston, UK
| | - Robert Wallace
- Department of Biomechanical Engineering, University of Edinburgh, Edinburgh, UK
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Functional outcomes after surgical treatment of isolated scaphotrapeziotrapezoid osteoarthritis: Retrospective single-center 24-case series. HAND SURGERY & REHABILITATION 2020; 39:107-112. [DOI: 10.1016/j.hansur.2019.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/22/2019] [Accepted: 11/04/2019] [Indexed: 11/19/2022]
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Lans J, Chen SH, Jupiter JB, Scheker LR. Distal Radioulnar Joint Replacement in the Scarred Wrist. J Wrist Surg 2019; 8:55-60. [PMID: 30723603 PMCID: PMC6358447 DOI: 10.1055/s-0038-1670681] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 08/09/2018] [Indexed: 10/28/2022]
Abstract
Background Radiocarpal or midcarpal arthritis can occur simultaneously with arthritis of the distal radioulnar joint (DRUJ), leading to functional impairment of the wrist. Treatment often involves wrist arthroplasty or arthrodesis, either with simultaneous or secondary procedures, addressing the DRUJ. Successful treatment of solitary DRUJ arthritis with DRUJ replacement has been reported. However, outcomes in patients with multiple prior wrist surgeries are lacking. Surgery in these wrists is challenging because surgical scarring and advanced bone deformities make implant positioning more difficult. Therefore, the aim of this study was to evaluate the outcomes in patients that underwent total wrist arthrodesis and DRUJ replacement after multiple prior wrist surgeries. Methods We prospectively enrolled patients that underwent total wrist arthrodesis and replacement of the DRUJ, either simultaneously or during separate procedures from 1999 to 2012. We included 14 patients with a median age of 43 years (interquartile range [IQR]: 35-47). As objective outcomes range of motion, weight-bearing ability, grip strength, was measured. For the subjective outcomes, we used an analogue pain score and the disabilities of the arm shoulder and hand (DASH) scores. Results At a median follow-up of 5.6 years (IQR: 3.2-7.1). The average DRUJ range of motion and weight lifting ability significantly improved. As for the subjective evaluations, postoperative pain scores improved significantly, as did the DASH scores. Four of the patients had a postoperative complication, including infection and heterotopic ossification, of which two required reoperations. Additionally, 5 patients developed pisotriquetral arthritis requiring, pisiform excision, triquetrum excision, or the combination of both. Conclusion Distal radioulnar joint replacement with a semiconstrained prosthesis was an effective method to restore the function of the wrist and forearm. As the surgical anatomy and soft tissue envelope were compromised in these patients, additional surgical exposure is necessary, adding to the complexity in these patients. No radiographic loosening Level of Evidence This is a therapeutic level IV study.
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Affiliation(s)
- Jonathan Lans
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Boston, Massachusetts
| | - Shih-Heng Chen
- Christine M. Kleinert Institute for Hand and Microsurgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Jesse B. Jupiter
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Boston, Massachusetts
| | - Luis R. Scheker
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Boston, Massachusetts
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Strobel K, van der Bruggen W, Hug U, Gnanasegaran G, Kampen WU, Kuwert T, Paycha F, van den Wyngaert T. SPECT/CT in Postoperative Hand and Wrist Pain. Semin Nucl Med 2018; 48:396-409. [DOI: 10.1053/j.semnuclmed.2018.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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16
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Unglaub F, Langer MF, Unglaub JM, Sauerbier M, Müller LP, Krimmer H, Hahn P, Spies CK. (Teil‑)Arthrodesen am Handgelenk. Unfallchirurg 2017; 120:513-526. [DOI: 10.1007/s00113-017-0356-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Gauthier E, Truffandier MV, Gaisne E, Bellemère P. Treatment of scaphotrapeziotrapezoid osteoarthritis with the Pyrocardan ® implant: Results with a minimum follow-up of 2 years. HAND SURGERY & REHABILITATION 2017; 36:113-121. [DOI: 10.1016/j.hansur.2017.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 09/19/2016] [Accepted: 01/21/2017] [Indexed: 01/01/2023]
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Deans VM, Naqui Z, Muir LTSW. Scaphotrapeziotrapezoidal Joint Osteoarthritis: A Systematic Review of Surgical Treatment. J Hand Surg Asian Pac Vol 2017; 22:1-9. [PMID: 28205478 DOI: 10.1142/s0218810417300017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The management of scaphotrapeziotrapezoidal (STT) joint osteoarthritis (OA) remains controversial. This systematic review aims to review the evidence for surgical interventions specific to STT OA. METHODS Medline and Embase libraries were searched using a pre-defined search strategy in October 2014. All study designs and languages were included and evaluated by two reviewers (VMD and LM) against the inclusion/exclusion criteria. The study eligibility criteria included papers discussing surgical treatment of STT OA, and the review was conducted using the PRISMA guidelines. RESULTS 295 unique results were identified from the search strategy after duplicates were filtered. 21 articles met the eligibility criteria. CONCLUSIONS Trapezial excision and partial trapezoidal excision is an effective treatment with low morbidity and complications, although can lead to weakness of the thumb. Distal scaphoid excision remains an effective pain relief treatment with improved grip and pinch strengths post-operatively. The procedure is technically less demanding than arthrodesis, does not carry the risks of non-union and complication rate of STT joint arthrodesis, and has a shorter immobilisation requirement. It produces reliable results, but is contraindicated if there is either scapholunocapitate pathology or midcarpal instability. STT joint fusion has a place, typically producing 75% range of movement of the non-operated wrist. However it has a higher associated complication rate, and simultaneous radial styloidectomy is recommended to reduce ongoing pain from impingement. Implant arthroplasty using a graphite-coated pyrocarbon implant has been used more recently. The patients gained significant pain relief, although there have been reports of implant dislocation secondary to surgical errors. A reduction in post-operative wrist extension and radial deviation has been noted. From this systematic review, we have composed a treatment algorithm for the surgical management of STT joint OA.
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Affiliation(s)
- Victoria M Deans
- 1 Department of Hand Surgery, Salford Royal NHS Foundation Trust, Stott Lane, Salford, UK
| | - Zafar Naqui
- 1 Department of Hand Surgery, Salford Royal NHS Foundation Trust, Stott Lane, Salford, UK
| | - Lindsay T S W Muir
- 1 Department of Hand Surgery, Salford Royal NHS Foundation Trust, Stott Lane, Salford, UK
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Kienböck's disease. ACTA ACUST UNITED AC 2015; 34:4-17. [DOI: 10.1016/j.main.2014.10.149] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 10/14/2014] [Accepted: 10/26/2014] [Indexed: 02/06/2023]
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Abstract
BACKGROUND The precise etiology of Kienböck's disease is unclear. Controversy exists regarding the appropriate treatment modality. The present study sought to investigate and compare surgical and nonsurgical treatment outcomes of patients suffering from Kienböck's disease in the province of Newfoundland and Labrador (NL), Canada. METHODS The present study was a retrospective analysis of 66 patients. The primary outcome was the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Student's t test was used to assess differences in outcomes between treatment groups. One-way ANOVA was used to assess differences in primary outcome in time since first assessed in an effort to examine progression over time. Pearson correlation was used to assess for correlation between primary outcome and age at diagnosis. RESULTS The average age was 38.6 ± 11.4 (18-70) years; Four patients were excluded due to inaccessible imaging. Of the remaining patients, 44 were treated conservatively, while 18 were treated surgically. The DASH scores for the surgical group were 23.7 ± 24.5 (0.9-82.8) and nonsurgical group were 20.0 ± 20.1 (1.7-81). As expected, the surgical group was mainly comprised of late-stage Kienböck's. When both groups were compared, there was no significant difference in the DASH scores. There were no difference in DASH scores within groups according to time since first diagnosed (<5 years; between 5 and 10 years; and >10 years). A positive correlation was found between age at diagnosis and DASH score (r = 0.42, p = 0.007), despite treatment modality. This finding remained significant after accounting for confounding factors (p = 0.029). CONCLUSION The DASH score for the surgical group was 23.7 ± 24.5 (0.9-82.8) and nonsurgical group was 20.0 ± 20.1 (1.7-81). No significant difference in DASH scores was found between surgically and nonsurgically treated patients. A positive association was found between the age at diagnosis of Kienböck's and DASH score, which suggests that patients diagnosed and treated later in life tend not to do as well.
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Lee JS, Park MJ, Kang HJ. Scaphotrapeziotrapezoid arthrodesis and lunate excision for advanced Kienböck disease. J Hand Surg Am 2012; 37:2226-32. [PMID: 23101517 DOI: 10.1016/j.jhsa.2012.08.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 08/21/2012] [Accepted: 08/21/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze the outcomes of lunate excision combined with scaphotrapeziotrapezoid arthrodesis for the treatment of advanced Kienböck disease. METHODS Sixteen patients with Lichtman stage IIIB Kienböck disease were treated with scaphotrapeziotrapezoid arthrodesis and lunate excision and were followed for a mean of 67 months (range, 49 to 108 mo). The indications for lunate excision included pain and limited motion associated with a collapsed lunate. Clinical evaluation included range of motion, grip strength, and modified Mayo wrist score. Based on plain radiographs, the carpal height ratio, ulnar carpal distance ratio, scaphoid translation ratio, and radioscaphoid angle were measured and any presence of degenerative changes was assessed. To investigate the effects of lunate excision on the radiologic results, we compared 12 patients with stage IIIB Kienböck disease who had only scaphotrapeziotrapezoid arthrodesis as the control group. RESULTS Range of motion tended to be preserved, with a trend toward an increase in extension after surgery. Grip strength and modified Mayo score improved significantly. Fourteen patients with lunate excision demonstrated radiographic ulnar translation of the scaphoid beyond the scapholunate ridge, and radioscaphoid arthritis was observed in 4 patients. Compared to initial postoperative radiographs, the scaphoid translation ratio was significantly decreased, but neither ulnar carpal distance ratio nor radioscaphoid angle showed significant differences. In the control group, neither ulnar translation of the scaphoid nor significant changes of radiologic parameters was found between initial postoperative and final radiographs. CONCLUSIONS Scaphotrapeziotrapezoid arthrodesis with lunate excision for advanced Kienböck disease provided favorable clinical results in terms of pain relief and functional improvement. With the absence of the lunate, however, the scaphoid had a tendency to shift toward the lunate fossa. This study suggests the risk of early development of radioscaphoid arthritis as a negative effect of lunate excision.
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Affiliation(s)
- Jae Sung Lee
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
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22
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Zimmermann MS, Weiss APC. Scaphotrapezium-trapezoid arthrosis. J Hand Surg Am 2012; 37:2139-41; quiz 2141. [PMID: 22763064 DOI: 10.1016/j.jhsa.2012.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 04/09/2012] [Indexed: 02/02/2023]
Affiliation(s)
- Matthew S Zimmermann
- Department of Orthopaedics, Brown University/Rhode Island Hospital, Providence, RI, USA.
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Wolf JM, Delaronde S. Current trends in nonoperative and operative treatment of trapeziometacarpal osteoarthritis: a survey of US hand surgeons. J Hand Surg Am 2012; 37:77-82. [PMID: 22119601 DOI: 10.1016/j.jhsa.2011.10.010] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 10/11/2011] [Accepted: 10/11/2011] [Indexed: 02/06/2023]
Abstract
PURPOSE Multiple procedures have been described for trapeziometacarpal (TM) osteoarthritis with varying levels of evidence support. The purpose of this study was to evaluate current trends in the treatment of TM arthritis by surveying active members of the American Society for Surgery of the Hand. METHODS We sent an online questionnaire to the e-mail addresses of 2,326 active members of the American Society for Surgery of the Hand, consisting of 5 treatment and 2 demographic questions. Surgeons were contacted twice by e-mail and provided with a link to a de-identified online survey. We performed statistical analysis of correlations between demographics and treatment preferences using chi-square testing. RESULTS We received responses from 1,156 out of 2,326 hand surgeons, a response rate of 50%. The vast majority of surgeons use corticosteroid injections for TM arthritis, and 719 out of 1,156 perform trapeziectomy with ligament reconstruction and tendon interposition (LRTI) for common Eaton stage III arthritis. For scaphotrapeziotrapezoid (STT) arthritis, approximately half of respondents also perform trapeziectomy/LRTI, followed by STT fusion. For a younger woman with minimal radiographic change and pain, 535 out of 1,142 surgeon respondents would advocate continued conservative treatment, whereas the remainder chose Eaton ligament reconstruction, arthroscopy, and metacarpal osteotomy. CONCLUSIONS This survey study presents the current opinions of a group of hand surgeons who responded to an online questionnaire regarding treatment of TM arthritis. The results show that trapeziectomy/LRTI is the treatment of choice by most respondents. The use of trapeziectomy/LRTI in the treatment of STT arthritis has not been studied in depth, but this procedure was chosen by half the respondents. The process of choosing treatment strategies is a question for future study. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Jennifer Moriatis Wolf
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT 06030-4037, USA.
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Low AK, Edmunds IA. ISOLATED SCAPHOTRAPEZIOTRAPEZOID OSTEOARTHRITIS: PRELIMINARY RESULTS OF TREATMENT USING A PYROCARBON IMPLANT. ACTA ACUST UNITED AC 2011; 12:73-7. [DOI: 10.1142/s0218810407003523] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Accepted: 09/25/2007] [Indexed: 11/18/2022]
Abstract
The scaphotrapeziotrapezoid (STT) joint is the second most common site in the wrist affected by degenerative arthritis. STT fusion has been the traditional treatment for patients with isolated STT arthritis but there are concerns about the complication rate and loss of wrist movement post-surgery. The current study presents the results of an interposition arthroplasty using a scaphoid trapezium pyrocarbon implant (STPI, BIOProfile). Ten STPI's were implanted in nine patients (mean age 66, 58–76 years) with isolated STT arthritis. The mean follow-up was 16.4 (3–35) months. Following surgery, VAS pain scores improved significantly and most patients had minimal restrictions in function, with a mean DASH score of 21. The mean wrist flexion-extension arc was 126° and radioulnar deviation was 43°. Mean grip strength was 82% and pinch strength 85% compared to the non-operated side. Patients were highly satisfied with the results of their surgery (mean VAS score 9.1). No surgical complications were encountered and no significant changes in carpal alignment were noted on radiographs. The results of this study suggest that STPI interposition arthroplasty may be a good alternative to STT fusion for isolated STT arthritis.
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Affiliation(s)
- A. K. Low
- Hornsby Hand Centre, 2/49 Palmerston Road, Hornsby, NSW 2077, Australia
| | - I. A. Edmunds
- Hornsby Hand Centre, 2/49 Palmerston Road, Hornsby, NSW 2077, Australia
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Westhuizen JVD, Mennen U. A WORKING CLASSIFICATION FOR THE MANAGEMENT OF SCAPHO-TRAPEZIUM-TRAPEZOIDOSTEO-ARTHRITIS. ACTA ACUST UNITED AC 2011; 15:203-10. [DOI: 10.1142/s0218810410004849] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 06/22/2010] [Accepted: 08/03/2010] [Indexed: 11/18/2022]
Abstract
Osteo-arthritis (OA) of the scapho-trapezium-trapezoid joint (STT) is the second most common involved joint after trapezium-metacarpal I OA in the wrist. The possible aetiology causing or contributing to the development of STT OA is shortly discussed. A working classification is then proposed, which assists in the management of STT OA.
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Affiliation(s)
| | - Ulrich Mennen
- Suite 7/8 Jacaranda Hospital, Muckleneuk, Pretoria, South Africa
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Abstract
Partial and total wrist arthrodeses have become common procedures for treating degenerative diseases arising from numerous conditions, including posttraumatic arthrosis, intercalated segment instability, inflammatory arthropathy, and carpal osteonecrosis. The goals of these two procedures are to provide pain relief and improved function by fusing arthritic or unstable joints. A thorough understanding of the complications and the best practices to avoid them is critical for the surgeon in the preoperative, intraoperative, and postoperative management of candidates for total or limited wrist arthrodesis.
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Abstract
Conventional bone grafts have some osteogenic potential, whereas vascularized bone grafts retain live, functional osteocytes and osteoblasts. High rates of scaphoid union have been achieved with conventional bone grafting in the absence of osteonecrosis or prior surgery. Vascularized bone grafting is valuable in the management of wrist disorders with compromised bone vascularity (eg, scaphoid nonunion with proximal pole necrosis, Preiser disease, Kienböck disease) or when previous grafting has failed. Improved understanding of the vascular anatomy of the wrist has allowed the use of an array of vascularized bone grafts that do not require microsurgical anastomosis. Successful outcome depends on careful patient selection and appropriate surgical technique.
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Abstract
The wide intraarticular exposure of the wrist joint under arthroscopic view provides an excellent ground for various forms of partial wrist fusion. Combining with percutaneous fixation technique, arthroscopic partial wrist fusion can potentially generate the best possible functional outcome by preserving the maximal motion pertained with each type of partial wrist fusion because the effect of extraarticular adhesion associated with open surgery can be minimized. From November 1997 to May 2008, the author had performed 12 cases of arthroscopic partial wrist fusion, including scaphotrapeziotrapezoid fusion in 3, scaphoidectomy and 4-corner fusion in 4, radioscapholunate fusion in 3, radiolunate fusion in 1, and lunotriquetral fusion in 1 case. Through the radiocarpal or midcarpal joint, the corresponding articular surfaces were denuded of cartilage using arthroscopic burr and curette. Carpal bones involved in the fusion process were then transfixed with K wires percutaneously after alignment corrected and confirmed under fluoroscopic control. Autogenous cancellous bone graft or bone substitute were inserted and impacted to the fusion site through cannula under direct arthroscopic view. Final fixation could be by multiple K wires or cannulated screw system. Early mobilization was encouraged. Surgical complications were minor, including pin tract infection, skin burn, and delay union in 1 case. Uneventful radiologic union was obtained in 9 cases, stable fibrous union in 2, and nonunion in 1. The average follow-up period was 70 months. Symptom was resolved or improved, and functional motion was gained in all cases. All surgical scars were almost invisible, and aesthetic outcome was excellent.
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Affiliation(s)
- Pak-Cheong Ho
- Department of Orthopaedics & Traumatology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR.
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Croog AS, Stern PJ. Proximal row carpectomy for advanced Kienböck's disease: average 10-year follow-up. J Hand Surg Am 2008; 33:1122-30. [PMID: 18762108 DOI: 10.1016/j.jhsa.2008.02.031] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Revised: 02/24/2008] [Accepted: 02/26/2008] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the clinical and radiographic results after a proximal row carpectomy for Lichtman stage III and IV Kienböck's disease at an average 10-year follow-up. METHODS Twenty-one patients with either Lichtman stage IIIA, IIIB, or IV Kienböck's disease were treated surgically at an average age of 38 years. At follow-up evaluation, each patient was evaluated subjectively with the Quick Disabilities of the Arm, Shoulder, and Hand and the Patient-Related Wrist Evaluation questionnaires (both are validated, patient-reported questionnaires assessing pain and function) and objectively with an assessment of range of motion and grip strength. Radiographs were obtained to assess the radiocapitate articulation. RESULTS Three patients had persistent pain after a proximal row carpectomy requiring a radiocapitate arthrodesis at a mean of 23 months (range, 5-53 months). Two of these 3 patients had preoperative stage IV disease. The remaining 18 patients were evaluated at an average follow-up of 10 years (range, 4-17 years). The average wrist flexion-extension arc was 105 degrees, which averaged 78% of that of the contralateral wrist. Average maximal grip strength was 35 kg, which averaged 87% of that of the contralateral wrist. Average Quick Disabilities of the Arm, Shoulder, and Hand score was 12 points and average Patient-Related Wrist Evaluation score was 17 points, each representing minimal functional limitation. Radiographic analysis at final follow-up demonstrated degeneration of the radiocapitate articulation in 16 patients. Narrowing of the joint space was rated as none in 2 wrists, partial in 10 wrists, and complete in 4 wrists. There was no significant association between the radiographic findings and the subjective and objective outcome. CONCLUSIONS At an average follow-up of 10 years, proximal row carpectomy is a reliable and durable procedure for patients with Lichtman stage IIIA or IIIB Kienböck's disease. Caution should be exercised in performing the procedure in patients with stage IV disease because of risk of early symptomatic radiocapitate degeneration. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Alexander S Croog
- Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Watanabe T, Takahara M, Tsuchida H, Yamahara S, Kikuchi N, Ogino T. Long-term follow-up of radial shortening osteotomy for Kienbock disease. J Bone Joint Surg Am 2008; 90:1705-11. [PMID: 18676901 DOI: 10.2106/jbjs.g.00421] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Three previous studies have investigated the long-term outcome of radial osteotomy in the treatment of Kienböck disease. However, none used patient-based assessment. The purpose of this study was to investigate the long-term clinical and radiographic outcomes of this osteotomy, including the subjective evaluation of the patient with use of the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire. METHODS A DASH questionnaire was sent to nineteen patients with Kienböck disease who had undergone a radial shortening osteotomy, and thirteen replied. The mean age at the time of surgery was thirty-nine years. On the basis of the Lichtman classification, six patients had stage-II, four had stage-IIIA, and three had stage-IIIB disease. Prior to surgery, ulnar variance was positive in six patients, neutral in four, and negative in three. The mean duration of follow-up was twenty-one years. Clinical evaluation, including calculation of the modified Mayo wrist score, and radiographic evaluation were also performed on twelve of the thirteen patients. RESULTS The mean DASH score was 8 points (range, 0 to 23 points), and patient satisfaction was high. Compared with the findings in the contralateral wrist, the mean range of motion was 81% in flexion and 82% in extension and mean grip strength was 88%. The mean modified Mayo wrist score was 83 points, and the clinical results were excellent in six patients, good in five, and moderate in one. The DASH scores tended to be worse in patients with Lichtman stage-IIIB disease. Follow-up radiographs revealed that the Lichtman stage had progressed in six of the twelve patients. CONCLUSIONS Although most patients had mild wrist pain, patient satisfaction and the clinical results were satisfactory following a radial shortening osteotomy. This procedure is a reliable long-term treatment for Lichtman stage-II and IIIA disease and may be a reasonable option for patients with stage-IIIB disease.
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Affiliation(s)
- Tadayoshi Watanabe
- Department of Orthopaedic Surgery, Yamagata University School of Medicine, Iida-Nishi 2-2-2, Yamagata 990-9585, Japan
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Abstract
Arthritis of the scaphotrapeziotrapezoid (STT) joint presents with deep thenar eminence and thumb basilar pain and is often coexistent with carpometacarpal arthritis of the thumb. Conservative treatment includes splinting and corticosteroid injections. Operative treatment consists primarily of fusion of the STT joint, although alternatives include trapeziectomy, fibrous arthroplasty, and prosthetic replacements. When STT arthritis is coexistent with carpometacarpal arthritis, excision of the trapezium and proximal 2 mm of trapezoid has been recommended. Complications of surgery include pericarpal arthrosis, superficial radial nerve injury, and nonunion.
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Abstract
Since its description in 1910, Kienböck's disease has continued to be a difficult problem for clinicians as well as patients. An incomplete understanding of the etiology as well as the natural history of the disease has led to an assortment of surgical treatment options. The authors present a review of Kienböck's disease and the theories behind different surgical interventions, as well as their current approach to treatment of patients with Kienböck's disease.
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Affiliation(s)
- Jeffrey Luo
- Division of Hand, Upper Extremity, and Microvascular Surgery, Department of Orthopaedic Surgery, University of California San Francisco, MU-320W, San Francisco, CA 94143, USA
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Daecke W, Lorenz S, Wieloch P, Jung M, Martini AK. Vascularized os pisiform for reinforcement of the lunate in Kienböck's Disease: an average of 12 years of follow-up study. J Hand Surg Am 2005; 30:915-22. [PMID: 16182045 DOI: 10.1016/j.jhsa.2005.03.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2004] [Revised: 03/23/2005] [Accepted: 03/23/2005] [Indexed: 02/02/2023]
Abstract
PURPOSE Little is known about the long-term results of vascularized bone transplantation for Kienböck's disease. This retrospective study investigated the long-term results of vascularized pisiform transfer. METHODS We reviewed 23 patients to analyze results after vascularized pisiform transposition to a cored-out lunate for Lichtman stages II and III. Patients with ulnar-minus variance received additional radial shortening. RESULTS Pain improved in 20 of 23 patients. Range of motion increased significantly relative to preoperative values but was only 80% that of opposite side. Grip power was 84% of the contralateral hand. At follow-up evaluation the mean Disabilities of the Arm, Shoulder, and Hand questionnaire score was 15.3 +/- 17.9 and the mean Cooney score was 82.4 +/- 10.0. Radiologically, out of 20 patients with preoperative x-rays Lichtman stage was unchanged in 11, improved in 3, and progressed in 6 patients. No patient showed radiologic signs of arthritis before surgery. At follow-up evaluation osteoarthritis was found in 7 of 22 patients. The majority of degenerative changes were of low grade and were seen at the radiocarpal joint. CONCLUSIONS The results show high patient satisfaction and good function after vascularized bone transplantation for Kienböck's disease. In the long term vascularized pisiform transfer prevented lunate collapse in 16 of 22 patients.
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Affiliation(s)
- Wolfgang Daecke
- Department of Orthopaedic Surgery, University of Heidelberg, Heidelberg, Germany.
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Daecke W, Lorenz S, Wieloch P, Jung M, Martini AK. Lunate resection and vascularized Os pisiform transfer in Kienböck's Disease: an average of 10 years of follow-up study after Saffar's procedure. J Hand Surg Am 2005; 30:677-84. [PMID: 16039357 DOI: 10.1016/j.jhsa.2005.02.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2004] [Revised: 02/21/2005] [Accepted: 02/21/2005] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the long-term results of lunate replacement by vascularized bone transfer in advanced Kienböck's disease. METHODS Twenty-one patients were reviewed (mean follow-up period +/- SD, 9.9 +/- 3.5 y) to analyze results after lunate replacement by vascularized pisiform transposition (Saffar's procedure) for Lichtman stages III and IV. RESULTS Pain was improved in 16 of 21 patients but range of motion did not improve after surgery. Range of motion was reduced to 68% and grip power to 80% of that of the opposite hand. At follow-up evaluation the mean score on the Disabilities of the Arm, Shoulder, and Hand Questionnaire was 22.3 +/- 17.9 and the mean Cooney score was 75.4 +/- 13.2. Radiologically, Lichtman stage persisted in 8, improved in 1, progressed in 8, and could not be evaluated in 3 patients. Two patients had radiologic signs of arthritis before surgery. At follow-up examination osteoarthritis was found in 50% of patients. The majority of degenerative changes were associated with carpal collapse. CONCLUSIONS The replacement of the lunate by vascularized pisiform transposition maintained preoperative ranges of motion. At follow-up examination both patient satisfaction and wrist function were high. In the long term, however, Saffar's procedure can restore alignment of the carpus only partly and also results in osteoarthritis in half of all patients.
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Affiliation(s)
- Wolfgang Daecke
- Department of Orthopaedic Surgery, University of Heidelberg, Heidelberg, Germany.
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Budoff JE, Gable G. Ulnar translation of scaphocapitate arthrodeses in Kienböck's disease--two case reports. J Hand Surg Am 2005; 30:65-8. [PMID: 15680557 DOI: 10.1016/j.jhsa.2004.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2004] [Accepted: 08/18/2004] [Indexed: 02/02/2023]
Abstract
The treatment of Kienböck's disease can be problematic. We report 2 cases of ulnar translation of the wrist after scaphocapitate arthrodesis with lunate excision for the treatment of advanced Kienbock's disease. The radioscaphocapitate ligament was intact in both cases.
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Affiliation(s)
- Jeffrey E Budoff
- Department of Orthopaedic Surgery, Baylor College of Medicine, 1 Baylor Plaza, 6550 Fannin, #2500, Houston, TX 77030, USA
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Hogan CJ, McKay PL, Degnan GG. Changes in radiocarpal loading characteristics after proximal row carpectomy. J Hand Surg Am 2004; 29:1109-13. [PMID: 15576224 DOI: 10.1016/j.jhsa.2004.07.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2004] [Accepted: 07/12/2004] [Indexed: 02/02/2023]
Abstract
PURPOSE To document the changes in wrist loading that occur after proximal row carpectomy in a cadaver model. METHODS The normal radioulnar carpal pressure distributions of 7 cadaver wrists were measured using super-low-pressure-sensitive film. Proximal row carpectomies were performed and the loading characteristics re-evaluated. RESULTS In the lunate fossa the contact area increased 37%, the average contact pressure increased 57%, and the location of the contact moved radially 5.5 mm. With wrist motion between 40 degrees of extension and 20 degrees of flexion the volar/dorsal excursion of the lunate fossa contact point increased by 108%. CONCLUSIONS Significant changes in radiocarpal loading occur after proximal row carpectomy. The increased radiocarpal excursion with wrist motion may explain the low incidence of radiocapitate arthritis in patients who have had proximal row carpectomy.
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Affiliation(s)
- Christopher J Hogan
- Department of Orthopedic Surgery, Naval Medical Center Portsmouth, Portsmouth, VA 23708, USA
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