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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; 34:2751-2756. [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] [MESH Headings] [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.
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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
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Pridgen B, von Rabenau L, Luan A, Gu AJ, Wang DS, Langlotz C, Chang J, Do B. Automatic Detection of Perilunate and Lunate Dislocations on Wrist Radiographs Using Deep Learning. Plast Reconstr Surg 2024; 153:1138e-1141e. [PMID: 37467052 DOI: 10.1097/prs.0000000000010928] [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: 07/21/2023]
Abstract
SUMMARY Delayed or missed diagnosis of perilunate or lunate dislocations can lead to significant morbidity. Advances in computer vision provide an opportunity to improve diagnostic performance. In this study, a deep learning algorithm was used for detection of perilunate and lunate dislocations on lateral wrist radiographs. A total of 435 lateral wrist radiographs were labeled as normal or pathologic (perilunate or lunate dislocation). The lunate in each radiograph was segmented with a rectangular bounding box. Images were partitioned into training and test sets. Two neural networks, consisting of an object detector followed by an image classifier, were applied in series. First, the object detection module was used to localize the lunate. Next, the image classifier performed a binary classification for normal or pathologic. The accuracy, sensitivity, and specificity of the overall system were evaluated. A receiver operating characteristic curve and the associated area under the curve were used to demonstrate the overall performance of the computer vision algorithm. The lunate object detector was 97.0% accurate at identifying the lunate. Accuracy was 98.7% among the subgroup of normal wrist radiographs and 91.3% among the subgroup of wrist radiographs with perilunate/lunate dislocations. The perilunate/lunate dislocation classifier had a sensitivity (recall) of 93.8%, a specificity of 93.3%, and an accuracy of 93.4%. The area under the curve was 0.986. The authors have developed a proof-of-concept computer vision system for diagnosis of perilunate/lunate dislocations on lateral wrist radiographs. This novel deep learning algorithm has potential to improve clinical sensitivity to ultimately prevent delayed or missed diagnosis of these injuries.
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Affiliation(s)
- Brian Pridgen
- From the Division of Plastic Surgery, Department of Surgery
- The Buncke Clinic
| | | | - Anna Luan
- From the Division of Plastic Surgery, Department of Surgery
| | | | - David S Wang
- Department of Radiology, Stanford University School of Medicine
| | - Curtis Langlotz
- Department of Radiology, Stanford University School of Medicine
| | - James Chang
- From the Division of Plastic Surgery, Department of Surgery
| | - Bao Do
- Department of Radiology, Stanford University School of Medicine
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Zhang X, Yang Y, Shen YW, Zhang KR, Jiang ZK, Ma LT, Ding C, Wang BY, Meng Y, Liu H. Diagnostic accuracy and potential covariates of artificial intelligence for diagnosing orthopedic fractures: a systematic literature review and meta-analysis. Eur Radiol 2022; 32:7196-7216. [PMID: 35754091 DOI: 10.1007/s00330-022-08956-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/07/2022] [Accepted: 06/08/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To systematically quantify the diagnostic accuracy and identify potential covariates affecting the performance of artificial intelligence (AI) in diagnosing orthopedic fractures. METHODS PubMed, Embase, Web of Science, and Cochrane Library were systematically searched for studies on AI applications in diagnosing orthopedic fractures from inception to September 29, 2021. Pooled sensitivity and specificity and the area under the receiver operating characteristic curves (AUC) were obtained. This study was registered in the PROSPERO database prior to initiation (CRD 42021254618). RESULTS Thirty-nine were eligible for quantitative analysis. The overall pooled AUC, sensitivity, and specificity were 0.96 (95% CI 0.94-0.98), 90% (95% CI 87-92%), and 92% (95% CI 90-94%), respectively. In subgroup analyses, multicenter designed studies yielded higher sensitivity (92% vs. 88%) and specificity (94% vs. 91%) than single-center studies. AI demonstrated higher sensitivity with transfer learning (with vs. without: 92% vs. 87%) or data augmentation (with vs. without: 92% vs. 87%), compared to those without. Utilizing plain X-rays as input images for AI achieved results comparable to CT (AUC 0.96 vs. 0.96). Moreover, AI achieved comparable results to humans (AUC 0.97 vs. 0.97) and better results than non-expert human readers (AUC 0.98 vs. 0.96; sensitivity 95% vs. 88%). CONCLUSIONS AI demonstrated high accuracy in diagnosing orthopedic fractures from medical images. Larger-scale studies with higher design quality are needed to validate our findings. KEY POINTS • Multicenter study design, application of transfer learning, and data augmentation are closely related to improving the performance of artificial intelligence models in diagnosing orthopedic fractures. • Utilizing plain X-rays as input images for AI to diagnose fractures achieved results comparable to CT (AUC 0.96 vs. 0.96). • AI achieved comparable results to humans (AUC 0.97 vs. 0.97) but was superior to non-expert human readers (AUC 0.98 vs. 0.96, sensitivity 95% vs. 88%) in diagnosing fractures.
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Affiliation(s)
- Xiang Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, China
| | - Yi Yang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, China
| | - Yi-Wei Shen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, China
| | - Ke-Rui Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, China
| | - Ze-Kun Jiang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, 610000, China
| | - Li-Tai Ma
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, China
| | - Chen Ding
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, China
| | - Bei-Yu Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, China
| | - Yang Meng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, China
| | - Hao Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, China.
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Pinto FNZ, Fernandes CH, Dos Santos JBG. The Radiolunate Index: a retrospective radiographic analysis of a new diagnostic measurement for perilunate injuries. J Hand Surg Eur Vol 2022; 47:660-661. [PMID: 35128989 DOI: 10.1177/17531934221078149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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van der Oest MJ, Duraku LS, Artan M, Hundepool CA, Power DM, Rajaratnam V, Zuidam JM. Perilunate Injury Timing and Treatment Options: A Systematic Review. J Wrist Surg 2022; 11:164-176. [PMID: 35478950 PMCID: PMC9038303 DOI: 10.1055/s-0041-1735841] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
Introduction Perilunate injuries are uncommon yet challenging and often missed injuries, representing 7% of all carpal traumas. Two types of injuries can be identified as follows: perilunate dislocations (PLD) and perilunate fracture-dislocations (PLFD). The purpose of this study was to conduct a systematic review and meta-analysis to establish which surgical treatment is superior for patients with perilunate injuries and the significance of delayed treatment. Methods A total of 2056 articles were screened, and 16 articles were included. Risk of bias for case-control series and case series were assessed through the National Institute of Health study quality assessment tool. Qualitative outcomes of clinical scores for hand function were compared between different time points (acute, < 7 days; delayed 7-45 days; chronic > 45 days), open and closed reduction, and PLD and PLFD. Results Overall, the clinical outcome scores of patients treated within 7 days are good. The results suggest that closed reduction and internal fixation (CRIF) offers slightly better outcomes than open reduction and internal fixation (ORIF) for PLFD. Patients treated 6 weeks or more after the initial injury seem to have the worst overall outcomes than patients in the acute or delayed setting. The results suggest that patients with chronic PLD have even worse outcomes than patients with chronic PLFD. Conclusions Timing of surgery is essential for an optimal outcome. When there is a delay of treatment, the outcomes are inferior to those treated acutely. Early referral to centralized treatment units for perilunate injuries would allow for targeted treatment and facilitate research on this difficult wrist injury.
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Affiliation(s)
- Mark J.W. van der Oest
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Liron S. Duraku
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Madina Artan
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Caroline A. Hundepool
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Dominic M. Power
- Department of Birmingham Hand Centre, Queen Elisabeth Hospital, University of Birmingham, Birmingham, United Kingdom
| | | | - J. Michiel Zuidam
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Garner M, Rudran B, Khan A, Tang Q, Mathew P. Lunate dislocations: anatomy, diagnosis and management. Br J Hosp Med (Lond) 2021; 82:1-10. [PMID: 34338022 DOI: 10.12968/hmed.2021.0025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Lunate dislocation is an uncommon but serious wrist injury, often resulting from a high energy mechanism of trauma. Advanced trauma life support protocols should be followed to diagnose and treat concomitant life-threatening pathology. Thorough neurovascular and soft tissue examination is required to identify open wounds and median nerve dysfunction, including acute onset carpal tunnel syndrome. Imaging is undertaken to appreciate injury severity, which is graded by the Mayfield classification. Closed reduction in the emergency department is the initial management, which alleviates pressure on neurovascular structures. Definitive management is surgical, most commonly via open reduction and direct ligamentous stabilisation. The aims of surgery are to restore anatomical carpal alignment and maintain stability, allowing repair and healing of the important wrist ligaments. Medium-to long-term functional outcomes are adequate, with most patients returning to work within 6 months. However, progressive radiographic midcarpal arthrosis is common, as well as permanent loss of grip strength, range of motion and chronic pain. This article considers the anatomy, diagnosis and management of acute lunate and perilunate dislocations.
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Affiliation(s)
- Madeleine Garner
- Department of Trauma and Orthopaedics, Chelsea & Westminster Hospital, London, UK
| | - Branavan Rudran
- Department of Trauma and Orthopaedics, Royal National Orthopaedic Hospital, London, UK
| | - Amir Khan
- Department of Trauma and Orthopaedics, Royal National Orthopaedic Hospital, London, UK
| | - Quen Tang
- Department of Trauma and Orthopaedics, Chelsea & Westminster Hospital, London, UK
| | - Philip Mathew
- Department of Trauma and Orthopaedics, Chelsea & Westminster Hospital, London, UK
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Tanure AA, de Andrade FR, Rezende LGRA, Cagnolati AF, Mandarano-Filho LG, Mazzer N. Diagnostic Failure Rate in Detecting Perilunate Carpal Fractures and Dislocations Using Plain Wrist X-Rays. Rev Bras Ortop 2021; 56:340-345. [PMID: 34239199 PMCID: PMC8249065 DOI: 10.1055/s-0040-1714227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 05/05/2020] [Indexed: 11/22/2022] Open
Abstract
Objectives
The present study aimed to evaluate the diagnostic failure rate in detecting perilunate fractures and dislocations using plain wrist radiographs by orthopedists and orthopedic residents. A secondary objective was to identify possible groups with a greater or lesser chance of establishing a correct diagnosis.
Methods
An online questionnaire was sent to several orthopedists through e-mail, social networks, and smartphone-based communication applications to assess the rate of diagnostic failure in detecting perilunate fractures and dislocations using plain radiographs.
Results
A total of 511 responses was obtained, with a diagnostic error rate of 8.81% for simple dislocations and 1.76% for trans-scaphoid perilunate fractures. Group stratification showed that residents presented the highest error rates in simple perilunate dislocations (23.91%), whereas hand surgeons presented the lowest error rates (1.74%).
Conclusion
Compared with the literature, the failure rates found were lower, suggesting that plain radiography is effective and that the error rate may not be as high as reported.
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Affiliation(s)
- Aleixo Abreu Tanure
- Programa de Cirurgia da Mão, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (HC-FMRP-USP), Ribeirão Preto, SP, Brasil
| | - Fernanda Ruiz de Andrade
- Programa de Cirurgia da Mão, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (HC-FMRP-USP), Ribeirão Preto, SP, Brasil
| | - Luis Guilherme Rosifini Alves Rezende
- Programa de Cirurgia da Mão, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (HC-FMRP-USP), Ribeirão Preto, SP, Brasil
| | - Amanda Favaro Cagnolati
- Programa de Cirurgia da Mão, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (HC-FMRP-USP), Ribeirão Preto, SP, Brasil
| | - Luiz Garcia Mandarano-Filho
- Programa de Cirurgia da Mão, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (HC-FMRP-USP), Ribeirão Preto, SP, Brasil
| | - Nilton Mazzer
- Divisão de Cirurgia da Mão, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (HC-FMRP-USP), Ribeirão Preto, SP, Brasil
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Wong CR, Sacevich N, McRae MC, Heywood J, Upadhye S. Sensory neuropraxia of the median nerve in a perilunate injury: a review of a near miss. CAN J EMERG MED 2021; 23:709-711. [PMID: 33993454 DOI: 10.1007/s43678-021-00144-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/05/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Chloe R Wong
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
| | - Nathan Sacevich
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Matthew C McRae
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - James Heywood
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Suneel Upadhye
- McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
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Franssen NT, Carpenter RJ, Stuart SM. Wrist Injury in Deployed U.S. Marine-How to Maintain the Mission. Mil Med 2021; 185:e1290-e1293. [PMID: 31665415 DOI: 10.1093/milmed/usz365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Wrist pain commonly affects military members and while most instances are benign, some require urgent orthopedic attention to prevent permanent loss of function. A 27-year-old male Marine while deployed presented with wrist pain after a seemingly benign fall during recreation. Radiographs were initially read as unremarkable and treated as a sprain. Though when reviewed by the Shock Trauma Platoon physicians, a perilunate dislocation was noted. After unsuccessful closed attempts to reduce injury, the Marine was sent to orthopedic surgery and underwent open reduction internal fixation and required a subsequent closed reduction and percutaneous pinning. Perilunate dislocations are uncommon but are among the most severe types of wrist injuries. This case is a reminder that proper evaluation of all injuries is critical. Proper evaluation of wrist injuries includes an attentive physical exam and careful examination of the radiographs; paying close attention to Gilula arcs and collinearity of the radius, lunate, and capitate. Prompt recognition and referral to specialty care for definitive treatment are important to maximize functional outcomes.
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Affiliation(s)
- Nathan T Franssen
- VMFA 211 Flight Surgeon, Marine Center Medical Home, Marine Corps Air Station, Yuma, AZ 85639-9180
| | | | - Sean M Stuart
- Surgeon-13th Marine Expeditionary Unit, Combat Trauma Research Group, Oceanside, CA 92058
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Çolak İ, Bulut G, Bekler Hİ, Çeçen GS, Gülabi D. Mid-term clinical and radiographic outcomes of perilunate injuries treated with open reduction and internal fixation. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2021; 55:57-61. [PMID: 33650513 DOI: 10.5152/j.aott.2021.19246] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to present the mid-term clinical and radiographic outcomes of patients with perilunate injuries treated with open reduction and internal fixation (ORIF). METHODS Patients who underwent ORIF due to perilunate injuries from 2004 to 2015 were retrospectively reviewed. Surgery was mostly performed using a standard dorsal approach. Each injury was graded as per Mayfield staging. At the final follow-up, pain intensity was evaluated using a 10-cm visual analog scale (VAS). Wrist and elbow range of motion, handgrip and pinch strength, Modified Mayo Wrist Scores, and the disabilities of the arm, shoulder, and hand (DASH) scores were measured. On plain radiographic examination, the scapholunate (SL) angle, SL interval, carpal height, and continuity of Gilula arcs were evaluated. The presence of arthritis was also assessed using the Herzberg classification. RESULTS In total, 26 male patients (27 wrists) who met the inclusion criteria were included in the study. The mean age was 40 years (range: 20-58); the mean follow-up was 45 months (range: 16-96). Most of the injuries were fracture-dislocations (n=20; 71.4%). According to Mayfield staging, 7 wrists were grade 3, and 20 wrists were grade 4. According to Herzberg staging, 11 (40.7%) patients were stage 2a. The mean VAS was 2.3 (range: 0-5) at rest and 3.3 (range: 0-7) during activity. The mean wrist flexion and extension were 50° (range: 21-80°; 73.5% of the unaffected side) and 45.1° (range: 20-74°; 70.9% of the unaffected side), respectively. The mean radial and ulnar deviation were 14.6° (range: 6-25°; 63.6% of the unaffected side) and 22.3° (range: 5-40°; 64.7% of the unaffected side), respectively. Grip and pinch strength were 57.6 kg (range: 15-106; 65.5% of the unaffected side) and 18.6 kg (range: 8-28; 78.2% of the unaffected side), respectively. The mean Mayo score was 63.3 (range: 20-90), and the DASH score was 24.1±25.2. The mean SL angle was 61.6° (range: 40-83). There was 1 wrist with a pathological SL interval, 11 wrists with dorsal intercalated segmental instability, and 3 wrists with fractures of the Gilula arcs. The mean carpal height was within the normal range. CONCLUSION In the treatment of perilunate injuries, satisfactory clinical and radiographic outcomes can be expected from ORIF at mid-term follow-up. LEVEL OF EVIDENCE Level IV, Therapeutic Study.
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Affiliation(s)
- İlker Çolak
- Department of Orthopaedics and Traumatology, Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Güven Bulut
- Department of Orthopaedics and Traumatology, Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Halil İbrahim Bekler
- Clinic of Orthopaedics and Traumatology, VM Medical Park Pendik Hospital, İstanbul, Turkey
| | - Gültekin Sıtkı Çeçen
- Department of Orthopaedics and Traumatology, Bahcesehir University, School of Medicine, İstanbul, Turkey
| | - Deniz Gülabi
- Clinic of Orthopaedics and Traumatology, VM Medical Park Pendik Hospital, İstanbul, Turkey
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Bianchi S, Hoffman DF, Tamborrini G, Poletti PA. Ultrasound Findings in Less Frequent Causes of Carpal Tunnel Syndrome. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:2469-2482. [PMID: 32459879 DOI: 10.1002/jum.15349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/03/2020] [Accepted: 05/06/2020] [Indexed: 06/11/2023]
Abstract
The most common etiology of carpal tunnel syndrome (CTS) is idiopathic. However, secondary causes of CTS should be considered when symptoms are unilateral, or electrodiagnostic studies are discrepant with the clinical presentation. Imaging of the carpal tunnel should be performed when secondary causes of CTS are suspected. An ultrasound evaluation of the carpal tunnel can assess for pathologic changes of the median nerve, detect secondary causes of CTS, and aid in surgical planning.
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Affiliation(s)
- Stefano Bianchi
- Cabinet d'Imagerie Médicale SA, Geneva, Switzerland
- Division of Radiology, Hopitaux Universitaires de Genève, Geneva, Switzerland
| | - Douglas F Hoffman
- Departments of Orthopedics and Radiology, Essentia Health, Duluth, Minnesota, USA
| | - Giorgio Tamborrini
- Ultraschall Zentrum Rheumatologie Aeschenvorstadt, Basel, Switzerland
- Rheumatology University Hospital Basel, Basel, Switzerland
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Diagnostic accuracy of deep learning in orthopaedic fractures: a systematic review and meta-analysis. Clin Radiol 2020; 75:713.e17-713.e28. [DOI: 10.1016/j.crad.2020.05.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/20/2020] [Indexed: 02/07/2023]
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13
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Xu Y, Xu Y, He X, Li C, Yang X, Zhang X, Zhao W. [Clinical application of nitinol memory alloy two foot fixator combined with Kirschner wire in treatment of trans-scaphoid perilunate dislocation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:671-675. [PMID: 32538554 DOI: 10.7507/1002-1892.201911013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To evaluate the effectiveness of nitinol memory alloy two foot fixator combined with Kirschner wire in the treatment of trans-scaphoid perilunate dislocation. Methods Between September 2011 and October 2018, 17 patients with trans-scaphoid perilunate dislocation were treated with nitinol memory alloy two foot fixator and Kirschner wire. There were 12 males and 5 females, with an average age of 32.6 years (range, 23-52 years). The disease duration was 8 hours to 9 days, with an average of 6.5 days. The causes of injury included 6 cases of falling injury, 4 cases of traffic accident injury, 3 cases of stress injury of wrist caused by sports, 2 cases of violent injury of wrist caused by machine impact, 1 case of military training injury, and 1 case of other injury. One case was complicated with nerve injury. According to Herbert's classification, all the fractures were type B4. At 1 week before operation, 3 months, 6 months after operation and last follow-up, the wrist function was evaluated according to the Krimmer scale score. Results All the 17 patients were followed up 10.5-48 months, with an average of 18.6 months. There was no loosening or infection of the internal fixator, no necrosis of the scaphoid and lunate. The periosteal dislocations of the patients were well reduced and the scaphoid fractures all healed. The healing time was 4-18 months, with an average of 11.3 months. The Krimmer wrist scores were 37.5±4.4, 61.3±7.2, 83.3±9.3, 87.3±8.2 at 1 week before operation, 3 months, 6 months after operation and last follow-up, respectively. The Krimmer wrist score at each time point after operation was significantly improved when compared with that before operation ( P<0.05), and at 6 months after operation and last follow-up than at 3 months after operation ( P<0.05). There was no significant difference between at 6 months and last follow-up ( P>0.05). At last follow-up, the Krimmer wrist function was excellent in 13 cases, good in 2 cases, fair in 1 case, poor in 1 case, and the excellent and good rate was 88.23%. Conclusion Nitinol memory alloy two foot fixator combined with Kirschner wire in the treatment of trans-scaphoid periosteal dislocation has definite effectiveness, simple operation, and good recovery of wrist function after operation.
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Affiliation(s)
- Yujian Xu
- The Graduate School, Army Military Medical University, Chongqing, 400000, P.R.China
| | - Yongqing Xu
- Department of Orthopaedics, the 920th Hospital of Joint Logistics Support Force of Chinese PLA, Kunming Yunnan, 650032, P.R.China
| | - Xiaoqing He
- Department of Orthopaedics, the 920th Hospital of Joint Logistics Support Force of Chinese PLA, Kunming Yunnan, 650032, P.R.China
| | - Chuan Li
- Department of Orthopaedics, the 920th Hospital of Joint Logistics Support Force of Chinese PLA, Kunming Yunnan, 650032, P.R.China
| | - Xi Yang
- Department of Orthopaedics, the 920th Hospital of Joint Logistics Support Force of Chinese PLA, Kunming Yunnan, 650032, P.R.China
| | - Xulin Zhang
- Department of Orthopaedics, the 920th Hospital of Joint Logistics Support Force of Chinese PLA, Kunming Yunnan, 650032, P.R.China
| | - Wanqiu Zhao
- Department of Orthopaedics, the 920th Hospital of Joint Logistics Support Force of Chinese PLA, Kunming Yunnan, 650032, P.R.China
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Huang C, You D, Guo W, Qu W, Hu Y, Li R, Zhu Z. First-stage scapholunate fusion for the treatment of a chronic lunate dislocation: A case report. Medicine (Baltimore) 2019; 98:e16453. [PMID: 31305477 PMCID: PMC6641798 DOI: 10.1097/md.0000000000016453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Lunate dislocation is a rare injury to the wrist caused by high-energy trauma, and poor prognosis is often associated with missed initial diagnosis. To date, there is no consensus regarding an effective treatment plan for such cases. PATIENT CONCERNS Here, we describe the case of a 36-year-old man who presented with lunate dislocation following a delay in diagnosis of over 7 weeks, and further illuminate its diagnosis and treatment. DIAGNOSIS The diagnosis of chronic lunate dislocation was rendered. INTERVENTIONS The patient was treated using reduction via the dorsal approach brachial plexus anesthesia. After the reduction, a headless compression screw fixation was performed for first-stage scapholunate fusion, and Kirschner wire fixation of the lunate-triquetrum-hamate was used to stabilize the distal and proximal carpal rows. OUTCOMES The patient was followed up for 1 year and showed wrist function recovered well; radiographic examination showed no lunate dislocation and successful scapholunate bony fusion. A satisfactory outcome was achieved. LESSONS The case study presented here provide evidence that performing an effective first-stage scapholunate fusion is recommended to achieve better therapeutic outcomes for a chronic lunate dislocation. Furthermore, this approach led to a good long-term clinical outcome in our case.
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Affiliation(s)
- Chao Huang
- Hand and Foot Surgery, The Second Hospital of Jilin University
| | - Di You
- Department of Anesthesiology, The Sino-Japanese Friendship Hospital of Jilin University, Nanguan District, Changchun City, Jilin, P. R. China
| | - Wenlai Guo
- Hand and Foot Surgery, The Second Hospital of Jilin University
| | - Wenrui Qu
- Hand and Foot Surgery, The Second Hospital of Jilin University
| | - Yuchen Hu
- Hand and Foot Surgery, The Second Hospital of Jilin University
| | - Rui Li
- Hand and Foot Surgery, The Second Hospital of Jilin University
| | - Zhe Zhu
- Hand and Foot Surgery, The Second Hospital of Jilin University
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