1
|
Pappa E, Argyrou C, Tetsios G, Ampadiotaki MM, Syngouna S, Kanellos P, Fandridis E. Surgical management and functional outcomes of perilunate dislocations and fracture dislocations through the dorsal approach. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-03999-3. [PMID: 38761199 DOI: 10.1007/s00590-024-03999-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/09/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Perilunate dislocations and perilunate fracture dislocations (PLD/PLFDs) are rare injuries of the wrist, with surgical management leading to acceptable functional results. PURPOSE The purpose of this study was to assess the functional outcomes of the patients of our department who were treated with surgical management of PLDs/PLFDs through dorsal approach, as well as to report any complications on their follow-up. PATIENTS AND METHODS In this retrospective study, 52 patients with PLD/PLFD, fulfilling the inclusion and exclusion criteria of the study, underwent surgical management of their injury. All patients were followed up at 6 weeks, 12 weeks, 6 months, 1 year postoperatively with radiographic imaging as well as functional scores measured with the modified mayo wrist score and the QuickDASH questionnaire. RESULTS The mean postoperative modified Mayo score was 76.8 ± 8.8 and the mean QuickDASH score was 1.52 ± 2.18. Of the 52 cases, 20% had excellent results, 42% had good results, 29% had fair results and 9% had poor results as per the modified Mayo wrist score. No patient signed any symptoms of median nerve neuropathy. CONCLUSION In conclusion, open reduction and internal fixation through dorsal approach is a reliable technique to manage perilunate injuries in spite of radiological evidence of wrist arthritis, as it also provides consistently good results in terms of functional outcomes. LEVEL OF EVIDENCE IV Retrospective case series study.
Collapse
Affiliation(s)
- Eleni Pappa
- Department of Upper Limb and Microsurgery, KAT General Hospital, Athens, Greece.
| | - Chrysoula Argyrou
- Department of Upper Limb and Microsurgery, KAT General Hospital, Athens, Greece
| | - George Tetsios
- Department of Upper Limb and Microsurgery, KAT General Hospital, Athens, Greece
| | | | - Sophia Syngouna
- Department of Upper Limb and Microsurgery, KAT General Hospital, Athens, Greece
| | - Panagiotis Kanellos
- Department of Upper Limb and Microsurgery, KAT General Hospital, Athens, Greece
| | - Emmanouil Fandridis
- Department of Upper Limb and Microsurgery, KAT General Hospital, Athens, Greece
| |
Collapse
|
2
|
Akhoondinasab MR, Saraee A, Akbari H, Forghani SF, Naderi B. Aesthetic and Functional Outcomes of Open Carpal Tunnel Release and Thread Carpal Tunnel Release: A Randomized Clinical Trial. Indian J Plast Surg 2024; 57:129-135. [PMID: 38774727 PMCID: PMC11105821 DOI: 10.1055/s-0043-1778645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024] Open
Abstract
Background and Objectives Surgical techniques for carpal tunnel release (CTR) have gradually become less invasive. No substantial evidence supports replacing the open carpal tunnel release (OCTR) with novel minimally invasive approaches. Thread carpal tunnel release (TCTR) is a new minimally invasive CTR method associated with promising results. This study aimed to compare the aesthetic and functional outcomes of OCTR with TCTR. Materials and Methods This study was a randomized clinical trial conducted in a hospital in Tehran, Iran, in 2022. Patients were randomized to OCTR and TCTR groups through simple randomization. Data such as demographics, nerve conduction study, electromyography, pain, and sensory evaluation by monofilament test were recorded in patients at baseline and after 3 months. Aesthetic evaluation was conducted by assessing the scar length and patients' satisfaction 3 months after the surgery. Results Twenty patients (10 in each group) entered the final analysis. Nerve conduction study, electromyography, and sensory evaluation were similar between groups 3 months after the operation. The TCTR group had lower postsurgical pain ( p < 0.001) and lower scar length ( p < 0.001) compared to the OCTR group. Overall satisfaction was not statistically different between TCTR and OCTR. Conclusion The TCTR method is safe in patients with CTS, and its efficacy is similar to OCTR. It can be a good alternative for OCTR, with a better aesthetic outcome.
Collapse
Affiliation(s)
- Mohammad-Reza Akhoondinasab
- Department of Plastic and Reconstructive Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Saraee
- Department of Plastic and Reconstructive Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Akbari
- Department of Plastic and Reconstructive Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Siamak-Farokh Forghani
- Department of Plastic and Reconstructive Surgery, Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Babak Naderi
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
3
|
Liechti R, Merky DN, Grobbelaar AO, van de Wall BJM, Vögelin E, Hirsiger S. Outcomes of acute perilunate injuries-a systematic review. Eur J Trauma Emerg Surg 2023; 49:2071-2084. [PMID: 36750472 DOI: 10.1007/s00068-023-02222-y] [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] [Received: 09/27/2022] [Accepted: 01/07/2023] [Indexed: 02/09/2023]
Abstract
PURPOSE The objective of this systematic review was to perform epidemiological as well as clinical, radiological and patient-reported outcome analysis of surgically treated perilunate dislocations and fracture dislocations (PLDs and PLFDs) based on the so far largest pooled patient population to date. MATERIAL AND METHODS This systematic review was written according to the updated guideline for reporting systematic reviews by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. A comprehensive literature search of Pubmed, Embase, CENTRAL, and CINAHL databases was performed. All studies reporting on complications, radiological, functional and/or patient-reported outcomes of surgically treated acute PLDs and PLFDs with a minimum follow-up of 12 months were included. RESULTS Twenty-six studies encompassing 550 patients with 553 operatively treated acute perilunate injuries (106 PLDs and 447 PLFDs) were included. The overall postoperative complication rate was 15.0% with secondary reduction loss representing the main contributing factor (10.1%). The overall reoperation rate was 10.4% and the incidence of salvage procedures was 2.8%. The risk for secondary reduction loss was higher for PLD than for PLFD injuries (24.2% vs. 7.0%, relative risk [RR] 3.5, 95% confidence interval [CI] 1.6-7.5). There was a higher overall complication rate for the combined dorsopalmar approach when compared to the isolated dorsal approach (17.4% vs. 8.4%, RR 0.5, 95% CI 0.2-1.0, number needed to treat [NNT] 11.2) and for open surgery versus arthroscopic surgery (17.4% vs. 4.8%, RR 0.3, 95% CI 0.1-0.9, NNT 8.0). A significant correlation was found between radiological osteoarthritis (rOA) and follow-up duration of the individual studies, while functional and patient-rated outcomes were comparable. CONCLUSIONS Regardless of surgical technique, PLFDs appear to be less susceptible to secondary reduction loss than PLDs. Whenever possible, less invasive (e.g. arthroscopic) surgery should be performed to minimize postoperative complications. The rate of rOA is high and increases significantly with follow-up duration. Interestingly, rOA does not seem to correlate with reduced wrist function nor patient dissatisfaction and the need for salvage surgery is surprisingly rare. LEVEL OF EVIDENCE Systematic review of level IV studies.
Collapse
Affiliation(s)
- Rémy Liechti
- Department of Plastic and Hand Surgery, Inselspital, University Hospital of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland.
| | - Dominique Nellie Merky
- Department of Plastic and Hand Surgery, Inselspital, University Hospital of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Adriaan Ockert Grobbelaar
- Department of Plastic and Hand Surgery, Inselspital, University Hospital of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Bryan J M van de Wall
- Department of Orthopedic and Trauma Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Esther Vögelin
- Department of Plastic and Hand Surgery, Inselspital, University Hospital of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| | - Stefanie Hirsiger
- Department of Plastic and Hand Surgery, Inselspital, University Hospital of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland
| |
Collapse
|
4
|
Cievet M, Buffard M, Kumble A, Ramos-Pascual S, Locquet V, Burnier M. Outcomes of arthroscopic versus open reduction and internal fixation for the treatment of acute traumatic lunate fractures: a systematic review. HAND SURGERY & REHABILITATION 2023:S2468-1229(23)00114-7. [PMID: 37364729 DOI: 10.1016/j.hansur.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023]
Abstract
The purpose of the study was to compare outcomes of fully-arthroscopic reduction and internal fixation (ARIF) versus open reduction and internal fixation (ORIF) to treat acute traumatic lunate fractures. A literature search was conducted using Medline and Embase. Demographic data and outcomes were extracted for included studies. The search identified 2,146 references: 17 articles were included, reporting on 20 cases (4 ARIF and 16 ORIF). No differences between ARIF and ORIF were found in rate of union (100% vs 93%, P = 1.000), grip strength (mean difference, 8%; 95%CI, -16-31; P = 0.592), rate of return to work (100% vs 100%, P = 1.000), or range of motion (mean difference, 28°; 95%CI, -25-80; P = 0.426). Lunate fractures were not identified in 6 of the 19 radiographs, but were identified in all CT scans. There were no differences in outcome between ARIF and ORIF for the treatment of fresh lunate fracture. The authors recommend surgeons to perform CT scans when diagnosing high-energy wrist trauma so as not to overlook lunate fractures. LEVEL OF EVIDENCE: Level IV.
Collapse
Affiliation(s)
- Maxime Cievet
- Institut Chirurgical de la Main et du Membre Supérieur, 17 Avenue Condorcet, 69100, Villeurbanne, France; Clinique Trenel, 575 Rue du Dr Trenel, 69560, Sainte-Colombe, France.
| | - Marius Buffard
- Institut Chirurgical de la Main et du Membre Supérieur, 17 Avenue Condorcet, 69100, Villeurbanne, France; Hôpital Edouard Herriot, CHU Lyon, Service de Chirurgie Orthopédique Main et Membre Supérieur, 5 Place d'Arsonval, 69003, Lyon, France.
| | - Ankitha Kumble
- Hôpital Edouard Herriot, CHU Lyon, Service de Chirurgie Orthopédique Main et Membre Supérieur, 5 Place d'Arsonval, 69003, Lyon, France.
| | - Sonia Ramos-Pascual
- Hôpital Edouard Herriot, CHU Lyon, Service de Chirurgie Orthopédique Main et Membre Supérieur, 5 Place d'Arsonval, 69003, Lyon, France.
| | - Vincent Locquet
- Institut Chirurgical de la Main et du Membre Supérieur, 17 Avenue Condorcet, 69100, Villeurbanne, France.
| | - Marion Burnier
- Institut Chirurgical de la Main et du Membre Supérieur, 17 Avenue Condorcet, 69100, Villeurbanne, France.
| |
Collapse
|
5
|
Lee CH, Lee BG, Kim JH, Yoon HS, Han KJ, Choi WS. Complications and outcomes of operative treatment for acute perilunate injuries: a systematic review. J Hand Surg Eur Vol 2023:17531934221150331. [PMID: 36708152 DOI: 10.1177/17531934221150331] [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: 01/29/2023]
Abstract
We systematically reviewed the incidence of complications and outcomes of different surgical methods for acute perilunate injury in the MEDLINE, Scopus, Embase and Cochrane Library databases. Forty-three articles with 880 patients were included. The most common complications were arthritis (30%), carpal instability (15%), avascular necrosis of the lunate (12%), complex regional pain syndrome (11%), and nonunion or avascular necrosis of the scaphoid (9%). In the meta-analysis, the mean scapholunate gap was 1.7 mm in the closed surgery group and 2.3 mm in the open surgery group, which was a statistically significant difference. The mean flexion-extension arc of the wrist and modified Mayo wrist score were better in the closed surgery group than in the open surgery group. However, these findings may relate to different cohorts in terms of injury severity. Therefore, the causal relationship between closed surgery and better outcomes may be uncertain as less severe subluxations are more likely to be treated closed.
Collapse
Affiliation(s)
- Chang-Hun Lee
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seongdon, Seoul, Republic of Korea
| | - Bong Gun Lee
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seongdon, Seoul, Republic of Korea
| | - Joo-Hak Kim
- Department of Orthopaedic Surgery, Myoungji Hospital, Deogyang-gu, Goyang-si, Republic of Korea
| | - Ha Seung Yoon
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Yeongtong-gu, Suwon-si, Republic of Korea
| | - Kyeong-Jin Han
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Yeongtong-gu, Suwon-si, Republic of Korea
| | - Wan-Sun Choi
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Yeongtong-gu, Suwon-si, Republic of Korea
| |
Collapse
|