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Deglmann CJ. [Osteoarthritis of the wrist]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:463-476. [PMID: 38789591 PMCID: PMC11143053 DOI: 10.1007/s00132-024-04502-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/05/2024] [Indexed: 05/26/2024]
Abstract
The term osteoarthritis (OA) of the wrist can be used as an umbrella term for various, often independent areas of OA, as the wrist is made up of several joints. Radiocarpal OA often occurs after untreated ligament injuries, incorrectly healed bone fractures in the carpus or after radius fractures involving the joint. A typical sequence of propagation is known for radiocarpal OA following scapholunate (SL) insufficiency or scaphoid pseudarthrosis. Other causes include inflammation, crystal deposits or bone necrosis. Ulnocarpal arthrosis occurs posttraumatically or primarily when there are differences in levels between the ulna and radius. When treating wrist arthrosis, after conservative measures have been exhausted a surgical procedure should be chosen that enables the best possible load-bearing and residual mobility, considering the surgical risks and individual requirements. During salvage operations, the defective cartilage areas are either fused directly or eliminated using appropriate diverting partial fusions and resection arthroplasty. An accurate analysis of the affected zones is crucial for selecting an appropriate intervention.
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Affiliation(s)
- C J Deglmann
- MünchenHand - Privatpraxis für Hand- und Handgelenkchirurgie, Marienplatz 21, 80333, München, Deutschland.
- Deutsches Zentrum für Obere Extremität, Effnerstr. 38, 81925, München, Deutschland.
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2
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Trentadue TP, Thoreson AR, Lopez C, Breighner RE, An KN, Holmes DR, Moran SL, Kakar S, Murthy NS, Leng S, Zhao KD. Detection of scapholunate interosseous ligament injury using dynamic computed tomography-derived arthrokinematics: A prospective clinical trial. Med Eng Phys 2024; 128:104172. [PMID: 38789217 PMCID: PMC11342909 DOI: 10.1016/j.medengphy.2024.104172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/22/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024]
Abstract
Scapholunate interosseous ligament injuries are a major cause of wrist instability and can be difficult to diagnose radiographically. To improve early diagnosis of scapholunate ligament injuries, we compared injury detection between bilateral routine clinical radiographs, static CT, and dynamic four-dimensional CT (4DCT) during wrist flexion-extension and radioulnar deviation. Participants with unilateral scapholunate ligament injuries were recruited to a prospective clinical trial investigating the diagnostic utility of 4DCT imaging for ligamentous wrist injury. Twenty-one participants underwent arthroscopic surgery to confirm scapholunate ligament injury. Arthrokinematics, defined as distributions of interosseous proximities across radioscaphoid and scapholunate articular surfaces at different positions within the motion cycle, were used as CT-derived biomarkers. Preoperative radiographs, static CT, and extrema of 4DCT were compared between uninjured and injured wrists using Wilcoxon signed rank or Kolmogorov-Smirnov tests. Median interosseous proximities at the scapholunate interval were significantly greater in the injured versus the uninjured wrists at static-neutral and maximum flexion, extension, radial deviation, and ulnar deviation. Mean cumulative distribution functions at the radioscaphoid joint were not significantly different between wrists but were significantly shifted at the scapholunate interval towards increased interosseous proximities in injured versus uninjured wrists in all positions. Median and cumulative distribution scapholunate proximities from static-neutral and 4DCT-derived extrema reflect injury status.
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Affiliation(s)
- Taylor P Trentadue
- Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Medical Scientist Training Program, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Graduate Program in Biomedical Engineering and Physiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew R Thoreson
- Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Cesar Lopez
- Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan E Breighner
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Kai-Nan An
- Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - David R Holmes
- Biomedical Imaging Resource Core Facility, Mayo Clinic, Rochester, Minnesota, USA
| | - Steven L Moran
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Naveen S Murthy
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Shuai Leng
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA; Computed Tomography Clinical Innovation Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Kristin D Zhao
- Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA.
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Hendrix N, Hendrix W, Maresch B, van Amersfoort J, Oosterveld-Bonsma T, Kolderman S, Vestering M, Zielinski S, Rutten K, Dammeier J, Ong LLS, van Ginneken B, Rutten M. Artificial intelligence for automated detection and measurements of carpal instability signs on conventional radiographs. Eur Radiol 2024:10.1007/s00330-024-10744-1. [PMID: 38634877 DOI: 10.1007/s00330-024-10744-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/26/2024] [Accepted: 03/21/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES To develop and validate an artificial intelligence (AI) system for measuring and detecting signs of carpal instability on conventional radiographs. MATERIALS AND METHODS Two case-control datasets of hand and wrist radiographs were retrospectively acquired at three hospitals (hospitals A, B, and C). Dataset 1 (2178 radiographs from 1993 patients, hospitals A and B, 2018-2019) was used for developing an AI system for measuring scapholunate (SL) joint distances, SL and capitolunate (CL) angles, and carpal arc interruptions. Dataset 2 (481 radiographs from 217 patients, hospital C, 2017-2021) was used for testing, and with a subsample (174 radiographs from 87 patients), an observer study was conducted to compare its performance to five clinicians. Evaluation metrics included mean absolute error (MAE), sensitivity, and specificity. RESULTS Dataset 2 included 258 SL distances, 189 SL angles, 191 CL angles, and 217 carpal arc labels obtained from 217 patients (mean age, 51 years ± 23 [standard deviation]; 133 women). The MAE in measuring SL distances, SL angles, and CL angles was respectively 0.65 mm (95%CI: 0.59, 0.72), 7.9 degrees (95%CI: 7.0, 8.9), and 5.9 degrees (95%CI: 5.2, 6.6). The sensitivity and specificity for detecting arc interruptions were 83% (95%CI: 74, 91) and 64% (95%CI: 56, 71). The measurements were largely comparable to those of the clinicians, while arc interruption detections were more accurate than those of most clinicians. CONCLUSION This study demonstrates that a newly developed automated AI system accurately measures and detects signs of carpal instability on conventional radiographs. CLINICAL RELEVANCE STATEMENT This system has the potential to improve detections of carpal arc interruptions and could be a promising tool for supporting clinicians in detecting carpal instability.
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Affiliation(s)
- Nils Hendrix
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
- Jheronimus Academy of Data Science, Sint Janssingel 92, 5211 DA, 's-Hertogenbosch, The Netherlands.
| | - Ward Hendrix
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Department of Radiology, Jeroen Bosch Ziekenhuis, Henri Dunantstraat 1, 5223 GZ, 's-Hertogenbosch, The Netherlands
| | - Bas Maresch
- Department of Radiology, Ziekenhuis Gelderse Vallei, Willy Brandtlaan 10, 6717 RP, Ede, The Netherlands
| | - Job van Amersfoort
- Department of Surgery, Ziekenhuis Gelderse Vallei, Willy Brandtlaan 10, 6717 RP, Ede, The Netherlands
| | - Tineke Oosterveld-Bonsma
- Department of Radiology, Ziekenhuis Gelderse Vallei, Willy Brandtlaan 10, 6717 RP, Ede, The Netherlands
| | - Stephanie Kolderman
- Department of Radiology, Ziekenhuis Gelderse Vallei, Willy Brandtlaan 10, 6717 RP, Ede, The Netherlands
| | - Myrthe Vestering
- Department of Radiology, Ziekenhuis Gelderse Vallei, Willy Brandtlaan 10, 6717 RP, Ede, The Netherlands
| | - Stephanie Zielinski
- Department of Surgery, Ziekenhuis Gelderse Vallei, Willy Brandtlaan 10, 6717 RP, Ede, The Netherlands
| | - Karlijn Rutten
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Jan Dammeier
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Lee-Ling Sharon Ong
- Jheronimus Academy of Data Science, Sint Janssingel 92, 5211 DA, 's-Hertogenbosch, The Netherlands
- Cognitive Science and Artificial Intelligence Department, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands
| | - Bram van Ginneken
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Matthieu Rutten
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Department of Radiology, Jeroen Bosch Ziekenhuis, Henri Dunantstraat 1, 5223 GZ, 's-Hertogenbosch, The Netherlands
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Krishna SV, Fernandez DL. Radially Displaced Perilunate Injuries: A Report of Two Cases. J Wrist Surg 2024; 13:49-53. [PMID: 38264132 PMCID: PMC10803142 DOI: 10.1055/s-0043-1770952] [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: 08/09/2022] [Accepted: 06/02/2023] [Indexed: 01/25/2024]
Abstract
We present two unusual cases of radially displaced perilunate dislocations, one of which involved acute ulnar nerve compression requiring Guyon's canal release. The first case underwent closed reduction and cast immobilization but developed scapholunate instability, necessitating secondary ligament reconstruction. The second case, treated with open reduction and fixation, resulted in persistent volar intercalated segment instability of the proximal row and ulnar nerve paresthesia 1 year after surgery.
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Affiliation(s)
- Sathya Vamsi Krishna
- Department of Hand Surgery, Sanjay Gandhi Institute of Orthopaedics and Trauma, Bangalore, Karnataka, India
| | - Diego L. Fernandez
- Department of Orthopaedic Surgery, University of Bern, Bern, Switzerland
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5
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Tijare C. The Medium-Term Outcomes of Patients With Suspected Scaphoid Fractures: A Single-Centre Retrospective Cohort Study. Cureus 2024; 16:e53361. [PMID: 38435207 PMCID: PMC10907903 DOI: 10.7759/cureus.53361] [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] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Background The medium-term outcomes of patients (six to 14 months post-injury) with non-specific wrist injuries managed as suspected scaphoid fractures are not clear from the current literature. These patients' wrists are immobilized in casts or splints, and some receive physiotherapy. They receive serial imaging and follow-up appointments as needed. Aims This study aims to describe the medium-term outcomes of patients with non-specific wrist injuries managed as suspected scaphoid fractures. Methods This is a single-centre retrospective cohort study. Patients with suspected scaphoid fractures were identified from a consecutive database and were included. Patients diagnosed with a definitive scaphoid fracture at any point in time were excluded. Patients with any pre-existing wrist pathology were also excluded. In total 113 patients were posted the Patient-Rated-Wrist-Evaluation (PRWE) questionnaire at six to 14 months post-injury with a self-addressed return envelope. Demographic and PRWE data were collated and described. Results Twenty-two patients (19% of total patients) returned a completed questionnaire. The median PRWE score was 32 out of 100 indicating mild pain and disability. 45.5% of patients were in this category. A minority of patients (9%) continued to suffer severe or very severe pain and disability. Patients with PRWE scores <40, representing pain and disability that is mild or less, reported very low difficulty completing work and recreational activities. Patients tended not to have pain at rest and experienced the most difficulty lifting heavy objects. Conclusion Most patients with non-specific wrist injuries managed as suspected scaphoid fractures experience some pain and disability in the medium term. For most this is minimal or mild, however some patients experience significant pain and disability. This study adds to existing evidence that this is the case. The reasons why these patients suffer are unclear. This study highlights the need to refine clinical practice to improve the outcomes of these patients.
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Wessel LE, Wolfe SW. Scapholunate Instability: Diagnosis and Management - Anatomy, Kinematics, and Clinical Assessment - Part I. J Hand Surg Am 2023; 48:1139-1149. [PMID: 37452815 DOI: 10.1016/j.jhsa.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/19/2023] [Accepted: 05/19/2023] [Indexed: 07/18/2023]
Abstract
Injuries to the scapholunate joint are the most frequent cause of carpal instability. The sequelae of these injuries account for considerable morbidity, and if left untreated, may lead to scapholunate advanced collapse and progressive deterioration of the carpus. Rupture of the scapholunate interosseous ligament and its critical stabilizers causes dyssynchronous motion between the scaphoid and lunate. Additional ligament injury or attenuation leads to rotary subluxation of the scaphoid and increased scapholunate gap. Intervention for scapholunate instability is aimed at halting the degenerative process by restoring ligament integrity and normalizing carpal kinematics. In the first section of this review, we discuss the anatomy, kinematics, and biomechanical properties of the scapholunate ligament as well as its critical ligament stabilizers. We provide a foundation for understanding the spectrum of scapholunate ligament instability and incorporate meaningful new anatomical insights that influence treatment considerations. The purpose is to provide an update regarding the anatomy of the scapholunate ligament complex, importance of the critical ligament stabilizers of the proximal carpal row, introduction of safe technique to surgically expose the scaphoid and lunate, as well as pathoanatomy as it pertains to the treatment of scapholunate dissociation. In the second section of this review, we propose a novel ligament-based treatment algorithm based on the stage of injury, degree and nature of ligament damage, and presence of arthritic changes.
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Affiliation(s)
- Lauren E Wessel
- Department of Orthopaedic Surgery, University of California Los Angeles, Santa Monica, CA.
| | - Scott W Wolfe
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
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Bulstra AEJ, Vidovic AJ, Doornberg JN, Jaarsma RL, Buijze GA. Scaphoid Length Loss Following Nonunion Is Associated with Dorsal Intercalated Segment Instability. J Wrist Surg 2023; 12:407-412. [PMID: 37841362 PMCID: PMC10569863 DOI: 10.1055/s-0043-1760753] [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: 05/07/2022] [Accepted: 12/19/2022] [Indexed: 10/17/2023]
Abstract
Background Dorsal intercalated segment instability (DISI) in scaphoid nonunions is frequently attributed to fracture location relative to ligamentous attachments onto the scaphoid apex. We hypothesize scaphoid length loss to have a stronger correlation with DISI deformity than fracture location in patients with scaphoid nonunion. Questions/Purposes To investigate the correlation between (1) scaphoid length loss, (2) fracture location relative to the scaphoid apex, and (3) type of nonunion (Herbert classification) and DISI deformity in skeletally mature patients with scaphoid nonunion. Patients and Methods Twenty-seven cases of computed tomography (CT)-confirmed scaphoid nonunion (>6 months) were retrospectively included. Our primary outcome was the degree of DISI as measured by the radiolunate (RL) angle on CT. Scaphoid length loss was expressed as height-to-length (H/L) ratio. Fracture location was classified as proximal or distal to the scaphoid apex. Nonunions were classified as fibrous unions (type D1) or pseudoarthrosis (type D2). The correlation between RL angle, H/L ratio, fracture location, and nonunion type was evaluated. Results H/L ratio was the only factor associated with the degree of DISI as measured by RL angle. As scaphoid length loss increased (increasing H/L ratio), the RL angle increased. There was no significant difference in RL angle between fractures located proximal (30 degrees) or distal (28 degrees) to the scaphoid apex, or type D1 (31 degrees) versus type D2 (28 degrees) nonunions. There was no correlation between patient age, sex, or wrist side affected and RL angle. Conclusions Scaphoid length loss, rather than fracture location, is correlated to the degree of DISI deformity in patients with scaphoid nonunion. This highlights the importance of restoring scaphoid height when planning scaphoid nonunion reconstruction. Level of Evidence Level III, diagnostic study.
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Affiliation(s)
- Anne Eva J. Bulstra
- Department of Orthopaedic and Trauma Surgery, Flinders Medical Centre, Flinders University, Bedford Park, South Australia
- Department of Orthopaedic Surgery, Amsterdam UMC, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Alex Jug Vidovic
- Department of Orthopaedic and Trauma Surgery, Flinders Medical Centre, Flinders University, Bedford Park, South Australia
| | - Job N. Doornberg
- Department of Orthopaedic and Trauma Surgery, Flinders Medical Centre, Flinders University, Bedford Park, South Australia
- Department of Orthopaedic Surgery, Amsterdam UMC, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Ruurd L. Jaarsma
- Department of Orthopaedic and Trauma Surgery, Flinders Medical Centre, Flinders University, Bedford Park, South Australia
| | - Geert Alexander Buijze
- Department of Orthopaedic Surgery, Amsterdam UMC, Location Academic Medical Center, Amsterdam, The Netherlands
- Department of Hand and Upper Limb Surgery, Clinique Générale d'Annecy, Annecy, France
- Department of Orthopedic Surgery, Montpellier University Medical Center, Lapeyronie Hospital, Montpellier, France
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Zhang X, Tham S, Ek ET, McCombe D, Ackland DC. Scaphoid, lunate and capitate kinematics in the normal and ligament deficient wrist: A bi-plane X-ray fluoroscopy study. J Biomech 2023; 158:111685. [PMID: 37573806 DOI: 10.1016/j.jbiomech.2023.111685] [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: 12/13/2022] [Revised: 05/26/2023] [Accepted: 06/07/2023] [Indexed: 08/15/2023]
Abstract
The ligamentous structures of the wrist stabilise and constrain the interactions of the carpal bones during active wrist motion; however, the three-dimensional translations and rotations of the scaphoid, lunate and capitate in the normal and ligament deficient wrist during planar and oblique wrist motions remain poorly understood. This study employed a computer-controlled simulator to replicate physiological wrist motion by dynamic muscle force application, while carpal kinematics were simultaneously measured using bi-plane x-ray fluoroscopy. The aim was to quantify carpal kinematics in the native wrist and after sequential sectioning of the scapholunate interosseous ligament (SLIL) and secondary scapholunate ligament structures. Seven fresh-frozen cadaveric wrist specimens were harvested, and cycles of flexion-extension, radial-ulnar deviation and dart-thrower's motion were simulated. The results showed significant rotational and translational changes to these carpal bones in all stages of disruptions to the supporting ligaments (p < 0.05). Specifically, following the disruption of the dorsal SLIL (Stage II), the scaphoid became significantly more flexed, ulnarly deviated, and pronated relative to the radius, whereas the lunate became more extended, supinated and volarly translated (p < 0.05). Sectioning of the dorsal intercarpal (DIC), dorsal radiocarpal (DRC), and scaphotrapeziotrapezoid (STT) ligaments (Stage IV) caused the scaphoid to collapse further into flexion, ulnar deviation, and pronation. These findings highlight the importance of all the ligamentous attachments that relate to the stability of the scapholunate joint, but more importantly, the dorsal SLIL in maintaining scapholunate stability, and the preservation of the attachments of the DIC and DRC ligaments during dorsal surgical approaches. The findings will be useful in diagnosing wrist pathology and in surgical planning.
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Affiliation(s)
- X Zhang
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - S Tham
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia; Department of Plastic and Hand Surgery, St. Vincent's Hospital, Fitzroy, Victoria, Australia; Division of Hand Surgery, Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Dandenong, Australia; Hand and Wrist Biomechanics Laboratory, O'Brien Institute, Fitzroy, Victoria, Australia
| | - E T Ek
- Division of Hand Surgery, Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Dandenong, Australia; Hand and Wrist Biomechanics Laboratory, O'Brien Institute, Fitzroy, Victoria, Australia
| | - D McCombe
- Department of Plastic and Hand Surgery, St. Vincent's Hospital, Fitzroy, Victoria, Australia; Division of Hand Surgery, Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Dandenong, Australia; Hand and Wrist Biomechanics Laboratory, O'Brien Institute, Fitzroy, Victoria, Australia
| | - D C Ackland
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia.
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Trentadue TP, Lopez C, Breighner RE, Akbari-Shandiz M, An KN, Leng S, Holmes DR, Moran SL, Kakar S, Smith J, Thoreson A, Zhao KD. Assessing carpal kinematics following scapholunate interosseous ligament injury ex vivo using four-dimensional dynamic computed tomography. Clin Biomech (Bristol, Avon) 2023; 107:106007. [PMID: 37295340 PMCID: PMC10619963 DOI: 10.1016/j.clinbiomech.2023.106007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/28/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Scapholunate interosseous ligament injuries are prevalent and often challenging to diagnose radiographically. Four-dimensional CT allows visualization of carpal bones during motion. We present a cadaveric model of sequential ligamentous sectionings ("injuries") to quantify their effects on interosseous proximities at the radioscaphoid joint and scapholunate interval. We hypothesized that injury, wrist position, and their interaction affect carpal arthrokinematics. METHODS Eight cadaveric wrists were moved through flexion-extension and radioulnar deviation after injuries. Dynamic CT images of each motion were acquired in each injury condition using a second-generation dual-source CT scanner. Carpal osteokinematics were used to calculate arthrokinematic interosseous proximity distributions during motion. Median interosseous proximities were normalized and categorized by wrist position. Linear mixed-effects models and marginal means tests were used to compare distributions of median interosseous proximities. FINDINGS The effect of wrist position was significant for both flexion-extension and radioulnar deviation at the radioscaphoid joint; the effect of injury was significant for flexion-extension at the scapholunate interval; and the effect of their interaction was significant for radioulnar deviation at the scapholunate interval. Across wrist positions, radioscaphoid median interosseous proximities were less able to distinguish injury conditions versus scapholunate proximities. Median interosseous proximities at the scapholunate interval are majoritively able to detect differences between less (Geissler I-III) versus more (Geissler IV) severe injuries when the wrist is flexed, extended, and ulnarly-deviated. INTERPRETATION Dynamic CT enhances our understanding of carpal arthrokinematics in a cadaveric model of SLIL injury. Scapholunate median interosseous proximities in flexion, extension, and ulnar deviation best demonstrate ligamentous integrity.
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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, MN, United States of America; Mayo Clinic Medical Scientist Training Program, Mayo Clinic, Rochester, MN, United States of America; Biomedical Engineering and Physiology Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, United States of America.
| | - Cesar Lopez
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States of America.
| | - Ryan E Breighner
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, United States of America.
| | - Mohsen Akbari-Shandiz
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States of America
| | - Kai-Nan An
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States of America.
| | - Shuai Leng
- Department of Radiology, Mayo Clinic, Rochester, MN, United States of America; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States of America.
| | - David R Holmes
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States of America; Biomedical Imaging Resource, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, United States of America.
| | - Steven L Moran
- Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN, United States of America.
| | - Sanjeev Kakar
- Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN, United States of America; Department of Clinical Anatomy, Mayo Clinic, Rochester, MN, United States of America.
| | - Jay Smith
- Department of Radiology, Mayo Clinic, Rochester, MN, United States of America; Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States of America.
| | - Andrew Thoreson
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States of America.
| | - Kristin D Zhao
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States of America; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States of America; Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States of America.
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10
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Trentadue TP, Lopez C, Breighner RE, Fautsch K, Leng S, Holmes III DR, Moran SL, Thoreson AR, Kakar S, Zhao KD. Evaluation of Scapholunate Injury and Repair with Dynamic (4D) CT: A Preliminary Report of Two Cases. J Wrist Surg 2023; 12:248-260. [PMID: 37223378 PMCID: PMC10202581 DOI: 10.1055/s-0042-1758159] [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: 11/30/2021] [Accepted: 09/15/2022] [Indexed: 02/11/2023]
Abstract
Background In predynamic or dynamic scapholunate (SL) instability, standard diagnostic imaging may not identify SL interosseous ligament (SLIL) injury, leading to delayed detection and intervention. This study describes the use of four-dimensional computed tomography (4DCT) in identifying early SLIL injury and following injured wrists to 1-year postoperatively. Description of Technique 4DCT acquires a series of three-dimensional volume data with high temporal resolution (66 ms). 4DCT-derived arthrokinematic data can be used as biomarkers of ligament integrity. Patients and Methods This study presents the use of 4DCT in a two-participant case series to assess changes in arthrokinematics following unilateral SLIL injury preoperatively and 1-year postoperatively. Patients were treated with volar ligament repair with volar capsulodesis and arthroscopic dorsal capsulodesis. Arthrokinematics were compared between uninjured, preoperative injured, and postoperative injured (repaired) wrists. Results 4DCT detected changes in interosseous distances during flexion-extension and radioulnar deviation. Generally, radioscaphoid joint distances were greatest in the uninjured wrist during flexion-extension and radioulnar deviation, and SL interval distances were smallest in the uninjured wrist during flexion-extension and radioulnar deviation. Conclusion 4DCT provides insight into carpal arthrokinematics during motion. Distances between the radioscaphoid joint and SL interval can be displayed as proximity maps or as simplified descriptive statistics to facilitate comparisons between wrists and time points. These data offer insight into areas of concern for decreased interosseous distance and increased intercarpal diastasis. This method may allow surgeons to assess whether (1) injury can be visualized during motion, (2) surgery repaired the injury, and (3) surgery restored normal carpal motion. Level of Evidence Level IV, Case series.
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Affiliation(s)
- Taylor P. Trentadue
- Mayo Clinic Medical Scientist Training Program and Mayo Clinic Graduate Program in Biomedical Engineering and Physiology, Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Cesar Lopez
- Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Ryan E. Breighner
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Kalli Fautsch
- Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Shuai Leng
- Computed Tomography Clinical Innovation Center, Mayo Clinic, Rochester, Minnesota
| | - David R. Holmes III
- Biomedical Imaging Resource Division, Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Steven L. Moran
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Andrew R. Thoreson
- Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kristin D. Zhao
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
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11
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Mack ZE, Kamal RN, Best GM, Wolfe SW, Pichora DR, Rainbow MJ. The Intercalated Segment: Does the Triquetrum Move in Synchrony With the Lunate? J Hand Surg Am 2022; 47:762-771. [PMID: 34627631 DOI: 10.1016/j.jhsa.2021.08.014] [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: 06/29/2020] [Revised: 06/20/2021] [Accepted: 08/20/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To quantify the relative motion between the lunate and triquetrum during functional wrist movements and to examine the impact of wrist laxity on triquetral motion. METHODS A digital database of wrist bone anatomy and carpal kinematics for 10 healthy volunteers in 10 different positions was used to study triquetral kinematics. The orientation of radiotriquetral (RT) and radiolunate rotation axes was compared during a variety of functional wrist movements, including radioulnar deviation (RUD) and flexion-extension (FE), and during a hammering task. The motion of the triquetrum relative to the radius during wrist RUD was compared with passive FE range of motion measurements (used as a surrogate measure for wrist laxity). RESULTS The difference in the orientation of the radiolunate and RT rotation axes was less than 20° during most of the motions studied, except for radial deviation and for the first stage of the hammering task. During wrist RUD, the orientation of the RT rotation axis varied as a function of passive FE wrist range of motion. CONCLUSIONS The suggestion that the lunate and triquetrum move together as an intercalated segment may be an oversimplification. We observed synchronous movement during some motions, but as the wrist entered RUD, the lunate and triquetrum no longer moved synchronously. These findings challenge the assumptions behind models describing the mechanical function of the carpals. CLINICAL RELEVANCE Individual-specific differences in the amount of relative motion between the triquetrum and lunate may contribute to the variability in outcomes following lunotriquetral arthrodesis. Variation in triquetral motion patterns may also have an impact on the ability of the triquetrum to extend the lunate, affecting the development of carpal instability.
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Affiliation(s)
- Zoe E Mack
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON, Canada
| | - Robin N Kamal
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Gordon M Best
- Department of General Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Scott W Wolfe
- Department of Orthopaedic Surgery, Hospital for Special Surgery and Weill Cornell Medical Centre, New York, NY
| | - David R Pichora
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON, Canada; Division of Orthopaedic Surgery, Queen's University, Kingston, ON, Canada
| | - Michael J Rainbow
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON, Canada.
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12
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Ikumi A, Ichimura H, Asanuma S, Nagashima K, Takeuchi Y, Tatsumura M, Mammoto T, Ogawa T, Yoshii Y, Hirano A, Yamazaki M. Flexor Pollicis Longus Tendon Rupture and Carpal Tunnel Syndrome due to Scaphoid Nonunion Advanced Collapse: A Case Report. JBJS Case Connect 2022; 12:01709767-202209000-00050. [PMID: 36137070 DOI: 10.2106/jbjs.cc.22.00380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 07/27/2022] [Indexed: 06/16/2023]
Abstract
CASE We report a case of flexor pollicis longus (FPL) tendon rupture and carpal tunnel syndrome due to scaphoid nonunion advanced collapse deformity. Intraoperative findings showed disruption of the palmar joint capsule and a sharp proximal bone fragment protruding into the carpal tunnel. Removal of this proximal fragment and tendon grafting were performed. At the postoperative 2-year follow-up, the patient had no wrist pain, finger numbness, or restriction of thumb motion. CONCLUSION Our results suggest that minimally invasive surgical procedures, such as proximal pole or osteophyte resection, might be optimal choices for early rehabilitation after tendon repair in cases of FPL tendon rupture due to asymptomatic scaphoid nonunion.
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Affiliation(s)
- Akira Ikumi
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba City, Ibaraki, Japan
- Department of Orthopedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito City, Ibaraki, Japan
| | - Harumitsu Ichimura
- Department of Orthopedic Surgery, Ibaraki Seinan Medical Center Hospital, Sashimagun Sakaimachi, Ibaraki, Japan
| | - Sho Asanuma
- Department of Orthopedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito City, Ibaraki, Japan
| | - Katsuya Nagashima
- Department of Orthopedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito City, Ibaraki, Japan
| | - Yousuke Takeuchi
- Department of Orthopedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito City, Ibaraki, Japan
| | - Masaki Tatsumura
- Department of Orthopedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito City, Ibaraki, Japan
| | - Takeo Mammoto
- Department of Orthopedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito City, Ibaraki, Japan
| | - Takeshi Ogawa
- Department of Orthopedic Surgery, National Hospital Organization, Mito Medical Center, Higashiibarakigun Ibarakimachi, Ibaraki, Japan
| | - Yuichi Yoshii
- Department of Orthopedic Surgery, Tokyo Medical University Ibaraki Medical Center, Inashikigun Amimachi, Ibaraki, Japan
| | - Atsushi Hirano
- Department of Orthopedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito City, Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba City, Ibaraki, Japan
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13
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Eladawi S, Balamoody S, Amerasekera S, Choudhary S. 3T MRI of wrist ligaments and TFCC using true plane oblique 3D T2 Dual Echo Steady State (DESS) - a study of diagnostic accuracy. Br J Radiol 2022; 95:20210019. [PMID: 34797695 PMCID: PMC8722236 DOI: 10.1259/bjr.20210019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE This study was designed to assess the accuracy of unenhanced 3T MRI supplemented with dedicated true plane reformats of 3D T2 Dual Echo Steady State (DESS), in assessing tears of scapholunate, lunotriquetral ligaments and triangular fibrocartilage complex, using arthroscopy as gold-standard. METHODS In a retrospective cohort review, patients who underwent wrist arthroscopy and MRI over 2 years (n=46) were identified. Dedicated axial and coronal reformats were obtained from 3D T2 DESS sequence for assessing intrinsic ligaments and triangular fibrocartilage (TFCC). At arthroscopy, tears were classified using Geissler's classification and compared to MRI findings. RESULTS The sensitivity of unenhanced 3T MRI in detecting scapholunate ligament tears was 87%, specificity was 90% and negative predictive value of 93%. The lunate triquetral ligament was assessed with a high specificity (97%) and negative predictive value (93%), sensitivity was 63%. TFCC tears were assessed with a sensitivity of 100%. The overall diagnostic accuracy of unenhanced 3T MRI of wrist in detecting ligament tears was 91%. CONCLUSION 3T wrist MRI with dedicated reformats from 3D T2 DESS has a high diagnostic accuracy in assessing acute intrinsic ligament and TFCC injuries. High strength 3T MRI with good technical quality isotropic 3D T2 DESS is critical for accurate wrist ligament assessment. Negative predictive values of 3T MRI of 95% can lead to reduced need for diagnostic arthroscopy of the wrist. ADVANCES IN KNOWLEDGE This study assesses the diagnostic performance of unenhanced 3T MRI with 3D T2 DESS in assessing traumatic wrist ligament tears. The accuracy of T2 DESS in wrist imaging has not been previously reported.
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Affiliation(s)
- Sondos Eladawi
- Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sharon Balamoody
- Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Steve Amerasekera
- Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Surabhi Choudhary
- Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
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14
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Urbanschitz L, Pastor T, Fritz B, Schweizer A, Reissner L. Posttraumatic Carpal Instability Nondissociative. J Wrist Surg 2021; 10:290-295. [PMID: 34381631 PMCID: PMC8328563 DOI: 10.1055/s-0041-1723794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
Background Posttraumatic midcarpal instability nondissociative (CIND) is an exceptional rare condition, therefore the outcome after different treatment options remains unknown. Questions The purpose of this study was to investigate the different treatment options for posttraumatic CIND. We also describe the different radiological and magnetic resonance imaging (MRI) findings in this patient cohort. Patients and Methods We present outcomes of 10 patients who developed CIND following acute wrist trauma between 2007 and 2018, 3 with dorsal intercalated segment instability pattern (CIND-DISI) and 7 with volar intercalated segment instability (CIND-VISI) radiographically. Results Three patients with CIND-VISI had satisfactory outcomes with conservative treatment. Two patients with irreducible CIND-DISI and one with CIND-VISI underwent proximal row carpectomy (PRC), two with reducible CIND-VISI had radiolunate fusion, and two with secondary osteoarthritis had total wrist fusion. All patients with CIND-DISI needed surgery, whereas only four of the seven patients with CIND-VISI needed surgery. On MRI, all three patients with CIND-DISI had rupture of the radiolunate ligament. Conclusions The data collected in this study may provide the first step toward better understanding of the pathology for this exceptionally rare finding. In CIND-VISI, we have not seen any ligament injury in four patients. Therefore, conservative therapy is more likely to be the first step. In CIND-DISI, we recommend an operative procedure: if detected early, with ligament suture, otherwise by radiolunate fusion, PRC, or total wrist fusion. Level of Evidence This is a Level IV study.
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Affiliation(s)
- Lukas Urbanschitz
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Tatjana Pastor
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Benjamin Fritz
- Department of Radiology, Balgrist University Hospital, Zurich, Switzerland
| | - Andreas Schweizer
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Lisa Reissner
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
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15
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Affiliation(s)
- Natalie S Braun
- Hand and Upper Extremity, Center, Department of Orthopedic Surgery Hospital for Special Surgery, New York, NY, USA
| | - Richard A Berger
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Scott W Wolfe
- Hand and Upper Extremity, Center, Department of Orthopedic Surgery Hospital for Special Surgery, New York, NY, USA
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16
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Margulies IG, Xu H, Gopman JM, Freeman MD, Dayan E, Taub PJ, Melamed E. Narrative Review of Ligamentous Wrist Injuries. J Hand Microsurg 2021; 13:55-64. [PMID: 33867762 PMCID: PMC8041499 DOI: 10.1055/s-0041-1724224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Ligamentous wrist injuries are common occurrences that require complex anatomical mastery and extensive understanding of diagnostic and treatment modalities. The purpose of this educational review article is to delve into the most clinically relevant wrist ligaments in an organized manner to provide the reader with an overview of relevant anatomy, function, clinical examination findings, imaging modalities, and options for management. Emphasis is placed on elucidating reported diagnostic accuracies and treatment outcomes to encourage evidence-based practice.
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Affiliation(s)
- Ilana G. Margulies
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, United States
| | - Hope Xu
- Section of Plastic Surgery, University of Chicago, Chicago, Illinois, United States
| | - Jared M. Gopman
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Matthew D. Freeman
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Etan Dayan
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Peter J. Taub
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Eitan Melamed
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
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17
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Ranota P, Zhang Y, Lalone EA, Suh N. Four-Dimensional Computed Tomography to measure distal radial-ulnar and radio-carpal joint congruency following distal radius fractures. J Orthop 2021; 25:31-39. [PMID: 33867752 DOI: 10.1016/j.jor.2021.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/21/2021] [Indexed: 10/21/2022] Open
Abstract
Four-dimensional computed tomography (4DCT) allows for the assessment of the wrist contact mechanics and kinematics during motion. The purpose of this study was to employ 4DCT to measure the differences in joint surface area (JSA) (3D joint space) at the radioscaphoid, radiolunate, and distal radioulnar joints between a cohort of participants with a distal radius fracture (DRF) and an age-matched cohort of healthy participants. Our results indicated that following a DRF, there was a 20% decrease in JSA at the DRUJ when compared to the healthy (control) cohort. This study demonstrated the use of a non-invasive tool to examine wrist contact mechanics.
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Affiliation(s)
- Puneet Ranota
- School of Biomedical Engineering, Faculty of Engineering, The University of Western Ontario, London, Canada
| | - Yiyang Zhang
- Department of Surgery, The University of Western Ontario, London, Canada.,Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada
| | - Emily A Lalone
- School of Biomedical Engineering, Faculty of Engineering, The University of Western Ontario, London, Canada.,Department of Surgery, The University of Western Ontario, London, Canada.,Department of Mechanical and Materials Engineering, The University of Western Ontario, London, Canada.,Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada
| | - Nina Suh
- Department of Surgery, The University of Western Ontario, London, Canada.,Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada
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18
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Imaging evaluation of traumatic carpal instability. Emerg Radiol 2020; 28:349-359. [PMID: 32808235 DOI: 10.1007/s10140-020-01839-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To review the epidemiology, pertinent wrist anatomy, classification system, and emergent imaging evaluation of carpal instability with a focus on radiographic assessment of instability. METHODS A review of current literature on carpal instability was performed with summary presentation of carpal instability epidemiology, carpal anatomy, imaging evaluation, and classification with imaging evaluation focused on diagnosis in the emergency setting. RESULTS Carpal instability is a common pathology in falls on outstretched hand and is likely underdiagnosed due to instability being occult or demonstrating subtle malalignment on static imaging of the wrist. While there is a complex network of intrinsic and extrinsic ligaments contributing to carpal instability, a detailed knowledge of these ligaments is not necessary for radiologists to make an accurate diagnosis in the emergency setting, as identification and classification of carpal instability is based on identification of carpal malalignment patterns on radiography as opposed to identification of specific ligament injuries on advanced imaging. The Mayo classification is the most widely used classification system, which divides carpal instability into four categories: dissociative, non-dissociative, complex, and adaptive. Understanding this classification system allows radiologists to successfully classify almost all carpal instability injuries they will encounter, even in the setting of unusual or rare instability patterns. CONCLUSION In working with the treating clinician, it is essential that the emergency radiologist is comfortable with identifying and classifying carpal instability. This will ensure prompt treatment of seemingly benign injuries and those that require intervention, surgical or otherwise, improving the likelihood of a good outcome.
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Oka K, Moritomo H. Current Management of Scaphoid Nonunion Based on the Biomechanical Study. J Wrist Surg 2018; 7:94-100. [PMID: 29576913 PMCID: PMC5864502 DOI: 10.1055/s-0038-1637739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 02/08/2018] [Indexed: 10/17/2022]
Abstract
Scaphoid nonunion causes abnormal wrist kinematics and typically leads to carpal collapse and subsequent degenerative arthritis of the wrist. However, the natural history, including carpal collapse and degenerative arthritis of scaphoid nonunion, may vary at different fracture locations. This article reviews recent biomechanical studies related to the natural history of scaphoid nonunion. In the distal-type fractures (type B2 in Herbert classification), where the fracture located distal to the scaphoid apex, the proximal scaphoid fragment and lunate, which are connected through the dorsal scapholunate interosseous ligament (DSLIL) and dorsal intercarpal ligament (DIC), extend together, and the distal fragment of the scaphoid flexes individually. Therefore, untreated type B2 fractures normally show the humpback deformity, resulting in dorsal intercalated segment instability deformity relatively earlier after the injury. In the proximal-type fractures (type B1), where the fracture is located proximal to the scaphoid apex, the connection between the distal fragment and lunate is preserved through the DSLIL and DIC so that the scaphoid-lunate complex remains stable and the carpal collapse is less severe than that in distal-type fractures. The fracture location relative to the apex of the dorsal scaphoid ridge is a reliable landmark in the determination of the natural history of scaphoid nonunion.
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Affiliation(s)
- Kunihiro Oka
- Health and Counseling Center, Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hisao Moritomo
- Department of Physical Therapy, Osaka Yukioka College of Health Science, Osaka, Japan
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Feehan L, Fraser T. Early controlled mobilization using dart-throwing motion with a twist for the conservative management of an intra-articular distal radius fracture and scapholunate ligament injury: A case report. J Hand Ther 2017; 29:191-8. [PMID: 27264904 DOI: 10.1016/j.jht.2016.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 02/22/2016] [Accepted: 02/25/2016] [Indexed: 02/03/2023]
Abstract
UNLABELLED This case describes an early controlled mobilization (ECM) approach that uses dart-throwing motion (DTM) with a twist orthoses as an alternative to immobilization for conservative management of a minimally displaced and intra-articular distal radius styloid fracture with an associated scapholunate ligament injury in a 47-year-old female health care administrator (JP). Pain-free active DTM began at day 10 (5 times/d) with a dynamic DTM with a twist orthosis worn during the day from weeks 3 to 6. At 6 weeks, JP had pain-free functional mobility and strength with minimal limitation in household and occupational activities, returning to her normal sporting activities by 3 months. ECM led to rapid return of normal functioning in the short term with no apparent impact on intermediate outcomes at 8 months. This case allows hand therapists to consider a similar ECM approach for the management of similar injuries in their patients. LEVEL OF EVIDENCE Level 5 and case report.
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Affiliation(s)
- Lynne Feehan
- Clinical Research, Rehabilitation Program, Fraser Health Authority, Surrey, British Columbia, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Trevor Fraser
- HealthOne Physiotherapy & Hand Clinic, Surrey, British Columbia, Canada
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Coulet B, Gauci MO, Lazerges C, Chammas M. Désaxations carpiennes adaptatives après fractures de l’extrémité distale du radius. HAND SURGERY & REHABILITATION 2016; 35S:S115-S119. [DOI: 10.1016/j.hansur.2016.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 03/20/2016] [Accepted: 04/02/2016] [Indexed: 11/30/2022]
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Browne KL, Merrill E. Musculoskeletal Management Matters: Principles of Assessment and Triage for the Nurse Practitioner. J Nurse Pract 2015. [DOI: 10.1016/j.nurpra.2015.08.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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