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Mugnai R, Pantaleoni F, Montanari M, Petrella G, Roberto A. Modified volar approach for proximal row carpectomy. J Hand Microsurg 2024; 16:100129. [PMID: 39234371 PMCID: PMC11369711 DOI: 10.1016/j.jham.2024.100129] [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: 06/05/2024] [Revised: 07/09/2024] [Accepted: 07/13/2024] [Indexed: 09/06/2024] Open
Abstract
Objectives Proximal row carpectomy is a well-accepted surgical procedure for the management of traumatic and degenerative wrist pathologies. It is routinely performed through a dorsal approach; a volar surgical access was presented in order to enable concomitant carpal tunnel release and avoid flexion limitation or disabilities caused by adhesions of the dorsal capsule and extensor tendons. We propose a modification to the volar approach, with detailed description of skin incision (reproducing the standard palmar access to the scaphoid), capsular section (beginning with a longitudinal cut radial to flexor carpi radialis tendon and prolonged transversally along the radio-lunate joint) and sequence of carpal bone removal (starting with the scaphoid rather than the lunate). Materials and methods The patients who underwent surgical treatment with modified volar proximal row carpectomy between 1992 and 2015 were enrolled in a retrospective analysis. Results We report postoperative improvement in both the Mayo Wrist score and total active range of motion in 38 patients, in line with the outcomes of dorsal proximal row carpectomy. Conclusions The modified volar approach is highly recommended when better visualization and access to proximal carpal bones are needed (particularly useful for inveterate perilunate dislocations), moreover if concomitant carpal tunnel syndrome or extensor tendon pathologies are present.
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Affiliation(s)
- Raffaele Mugnai
- Department of Orthopaedic Surgery, University of Modena and Reggio Emilia, Policlinico di Modena, Largo del Pozzo 71, Modena, 41125, Italy
| | - Filippo Pantaleoni
- Department of Hand Surgery and Microsurgery, University of Modena and Reggio Emilia, Policlinico di Modena, Largo del Pozzo 71, Modena, 41125, Italy
| | - Marta Montanari
- Department of Hand Surgery and Microsurgery, University of Modena and Reggio Emilia, Policlinico di Modena, Largo del Pozzo 71, Modena, 41125, Italy
| | - Giovanna Petrella
- Department of Hand Surgery and Microsurgery, University of Modena and Reggio Emilia, Policlinico di Modena, Largo del Pozzo 71, Modena, 41125, Italy
| | - Adani Roberto
- Department of Hand Surgery and Microsurgery, University of Modena and Reggio Emilia, Policlinico di Modena, Largo del Pozzo 71, Modena, 41125, Italy
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Witters M, Delgove A, Camuzard O, Bougie E, De Villeneuve Bargemon JB, Abellan Lopez M, Casanova D, Legré R, Casoli V, Jaloux C. Vascularized hemi-hamate graft: Anatomic description of a novel pedicled osteo-chondro-ligamentous flap for proximal scaphoid reconstruction. J Plast Reconstr Aesthet Surg 2024; 98:64-72. [PMID: 39241678 DOI: 10.1016/j.bjps.2024.08.050] [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: 10/31/2023] [Revised: 06/28/2024] [Accepted: 08/09/2024] [Indexed: 09/09/2024]
Abstract
Scaphoid proximal pole destruction remains a surgical challenge owing to its high propensity for nonunion and osteonecrosis. The hemi-hamate graft has shown promising results in addressing this issue. However, long-term results of non-vascularized composite grafts remain uncertain. The purpose of this study was to investigate the feasibility of a vascularized hemi-hamate osteo-chondro-ligamentous pedicled flap for the reconstruction of the proximal pole of the scaphoid. Thirty fresh cadaveric wrists were used to harvest the hamate proximal pole on the dorsal intercarpal arch. A loss of substance of the scaphoid proximal pole was simulated and the hamate flap was transferred. In 15 wrists, a canulated screw osteosynthesis was performed to assess donor site morbidity and carpus stability on post-osteosynthesis dynamic radiographs. This study suggests that the proximal hamate can be harvested pedicled on the dorsal intercarpal arch. The pedicle (average pedicle diameter 0.9 mm, mean length 31.5 mm) allowed tension-free graft placement in all dissections, except for one. The morphology of the graft was very similar to that of the scaphoid proximal pole and the palmar capito-hamate ligament allowed scapholunate ligament reconstruction in all dissections. This is the first study that describes the use of a pedicled flap to fully reconstruct the complex osteo-chondro-ligamentous anatomy of the scaphoid proximal pole. This vascularized hemi-hamate flap could facilitate better long-term preservation of cartilage biomechanical properties compared to non-vascularized grafts. Donor site morbidity requires further investigation before recommending clinical use.
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Affiliation(s)
- Marie Witters
- Faculty of Medical Science, Aix-Marseille University, 27 Boulevard Jean-Moulin, 13005 Marseille, France; Department of Hand Surgery and Limb Reconstruction, Timone University Hospital, 278 Rue St-Pierre, 13005 Marseille, France.
| | - Anaïs Delgove
- Plastic Surgery, Hand Surgery, and Burns Unit, FX Michelet Center, University Hospital of Bordeaux, Place Amélie Raba Léon, 33076 Bordeaux, France; Surgery School, Human Anatomy Laboratory, University of Bordeaux, 146 Rue Léo Saignat, Bordeaux, France
| | - Olivier Camuzard
- Pasteur University Hospital, Plastic Surgery Department and Hand Reconstruction, 30 voie Romaine, 06001 Nice, France; Human Anatomy Laboratory, Faculty of Medicine of Nice, Avenue de Valombrose, Nice, France
| | - Emilie Bougie
- Division of Plastic and Reconstructive Surgery, Sainte-Justine Mother and Child University Hospital Center, 3175 Chemin de la Côte Sainte-Catherine, Montreal, QC, Canada
| | - Jean-Baptiste De Villeneuve Bargemon
- Faculty of Medical Science, Aix-Marseille University, 27 Boulevard Jean-Moulin, 13005 Marseille, France; Department of Hand Surgery and Limb Reconstruction, Timone University Hospital, 278 Rue St-Pierre, 13005 Marseille, France
| | - Maxime Abellan Lopez
- Faculty of Medical Science, Aix-Marseille University, 27 Boulevard Jean-Moulin, 13005 Marseille, France; Department of Plastic and Reconstructive Surgery, Conception University Hospital, 147 Boulevard Baille, 13005 Marseille, France
| | - Dominique Casanova
- Faculty of Medical Science, Aix-Marseille University, 27 Boulevard Jean-Moulin, 13005 Marseille, France; Department of Plastic and Reconstructive Surgery, Conception University Hospital, 147 Boulevard Baille, 13005 Marseille, France
| | - Régis Legré
- Faculty of Medical Science, Aix-Marseille University, 27 Boulevard Jean-Moulin, 13005 Marseille, France; Department of Hand Surgery and Limb Reconstruction, Timone University Hospital, 278 Rue St-Pierre, 13005 Marseille, France
| | - Vincent Casoli
- Plastic Surgery, Hand Surgery, and Burns Unit, FX Michelet Center, University Hospital of Bordeaux, Place Amélie Raba Léon, 33076 Bordeaux, France; Surgery School, Human Anatomy Laboratory, University of Bordeaux, 146 Rue Léo Saignat, Bordeaux, France
| | - Charlotte Jaloux
- Faculty of Medical Science, Aix-Marseille University, 27 Boulevard Jean-Moulin, 13005 Marseille, France; Department of Hand Surgery and Limb Reconstruction, Timone University Hospital, 278 Rue St-Pierre, 13005 Marseille, France
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Teunissen JS, Duraku LS, Feitz R, Zuidam JM, Selles RW, Wouters RM. Routinely-Collected Outcomes of Proximal Row Carpectomy. J Hand Surg Am 2024; 49:795.e1-795.e9. [PMID: 36372595 DOI: 10.1016/j.jhsa.2022.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 08/11/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE To describe patient-reported pain and function 12 months after proximal row carpectomy (PRC). Secondary outcomes included return to work, grip strength, range of wrist motion, satisfaction with treatment results, and complications. METHODS This cohort study was part of the British Society for Surgery of the Hand Studyathon 2021, using ongoing routinely-collected data of 304 eligible patients who underwent PRC (73% scapholunate advanced collapse, 11% scaphoid nonunion advanced collapse wrist; 11% Kienböck, 5% other indications) from Xpert Clinics, the Netherlands between 2012-2020. The primary outcome was the Patient Rated Wrist/Hand Evaluation total score (range, 0-100, lower scores indicate better performance). RESULTS Of the 304 patients, the primary outcome was available in 217 patients. The total Patient Rated Wrist/Hand Evaluation score improved from 60 (95% confidence interval [CI], 57-63) to 38 (95% CI, 35-41) at 3 months, and 26 (95% CI, 23-29) at 12 months. The pain and function subscales improved by 18 (95% CI, 17-20) and 16 (95% CI, 14-18) points, respectively. At 12 months, 82% had returned to work at a median time of 12 (95% CI, 9-14) weeks following PRC. Grip strength did not improve. Wrist flexion and extension demonstrated a clinically irrelevant decrease. Satisfaction with treatment result was excellent in 27% of patients, good in 42%, fair in 20%, moderate in 6%, and poor in 5%. Complications occurred in 11% of patients, and conversion to wrist arthroplasty occurred in 2 patients. CONCLUSION A clinically relevant improvement in patient-reported pain and function was observed at 3 months after PRC, with continued improvement to 12 months. These data can be used for shared-decision making and expectation management. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Joris S Teunissen
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands; Hand and Wrist Center, Xpert Clinics, Amsterdam, The Netherlands.
| | - Liron S Duraku
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Reinier Feitz
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands; Hand and Wrist Center, Xpert Clinics, Amsterdam, The Netherlands
| | - J Michiel Zuidam
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robbert M Wouters
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Wang L, Huang Z, Xie W, Luo D, Liu H, Lian K, Lin D. Comparative Analysis of Radial Corrective Osteotomy and Sauvé-Kapandji Procedure for Malunited Distal Radius Fractures in Older Adults. J Hand Surg Am 2024:S0363-5023(24)00300-9. [PMID: 39066761 DOI: 10.1016/j.jhsa.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 05/16/2024] [Accepted: 06/05/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE Malunited distal radius fractures frequently occur in the older population, posing a dilemma in selecting ideal management for symptomatic patients. Radial corrective osteotomy (RCO) and the Sauvé-Kapandji procedure (SK) have been used to treat this challenging condition. However, it remains unknown which approach is better for the older population. The objective of this study was to compare the outcomes of RCO with those of SK for the treatment of symptomatic distal radius malunion in older adults. METHODS Thirty-three patients aged ≥60 years, with malunited distal radius fractures, were randomized to be treated with either RCO or SK and followed for a minimum of 2 years. The primary evaluation parameter was grip strength, and secondary outcome parameters were surgical time, range of motion of the wrist, exercise-related wrist pain assessment using visual analog scale scores, radiographic results, patient-reported outcomes evaluated using the Disability of the Arm, Shoulder, and Hand (DASH), and Patient-Related Wrist Evaluation (PRWE) scores. RESULTS The average follow-up duration was 36.7 ± 10.2 months. The grip strength was significantly higher in the RCO group. The surgical time was shorter in the SK group than in the RCO group. The postoperative wrist range of motion and visual analog scale scores for exercise-related pain alleviation were similar in both groups. The ulnar variance decreased in both groups and was similar when compared with the postoperative images. The DASH and PRWE scores were similar between the RCO and SK groups. CONCLUSIONS Radial corrective osteotomy and SK surgeries have similar clinical and functional outcomes in patients aged ≥60 years. Grip strength is higher in the RCO group than in the SK group. However, the operating time to accomplish SK is shorter than RCO. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
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Affiliation(s)
- Lei Wang
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China; Institute of Orthopedics, Xijing Hospital, The Air Force Medical University, Xi'an, China
| | - Ziyang Huang
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Wei Xie
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Deqing Luo
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Hui Liu
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Kejian Lian
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Dasheng Lin
- Department of Orthopedic Surgery, The Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China; Department of Orthopedic Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
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Reiser D, Sagerfors M, Wretenberg P, Pettersson K, Fischer P. Clinical, Radiographic, and Patient-Perceived Outcome After Radial Hemi-Wrist Arthroplasty With a New Implant: 20 Cases With 5-Year Follow-up. Hand (N Y) 2024; 19:742-750. [PMID: 36752076 PMCID: PMC11284997 DOI: 10.1177/15589447231151427] [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] [Indexed: 02/09/2023]
Abstract
BACKGROUND Distal component loosening is a common mode of failure in total wrist arthroplasty (TWA). A radial hemi-wrist arthroplasty (RHWA) has the potential to avoid problems related to the distal component in TWA. The aim of this study is to investigate clinical outcomes following surgical treatment with a new RHWA design. METHODS In this pilot study of 20 consecutive RHWAs, patients were assessed preoperatively and postoperatively for range of motion, grip strength, Visual Analog Scale (VAS) pain scores, and functional scoring using Patient-Rated Wrist Evaluation (PRWE), Disabilities of the Arm, Shoulder, and Hand (DASH), and Canadian Occupational Performance Measure. Radiographs were analyzed at 12 months and 5 years (mean, 5.1 years) postoperatively. RESULTS A total of 46 secondary surgeries were undertaken in 16 wrists, including 7 revisions. Another 6 patients are waiting for revision to radiocarpal arthrodesis. In non-revised patients, the DASH and PRWE scores improved, and wrist range of motion remained largely unchanged except for wrist flexion, which decreased. The VAS pain score during activity was reduced, and hand grip strength remained largely unchanged. CONCLUSIONS The new implant resulted in improved functional scoring and improved VAS pain scores in non-revised patients, but many cases needed secondary surgery due to persistent pain. The high revision rate is a major concern, and further use of the implant in its current form cannot be recommended.
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Affiliation(s)
- Daniel Reiser
- Department of Orthopaedic and Hand Surgery, Faculty of Medicine and Health, Örebro University, Sweden
| | - Marcus Sagerfors
- Department of Orthopaedic and Hand Surgery, Faculty of Medicine and Health, Örebro University, Sweden
| | - Per Wretenberg
- Department of Orthopaedic and Hand Surgery, Faculty of Medicine and Health, Örebro University, Sweden
| | - Kurt Pettersson
- Department of Orthopaedic and Hand Surgery, Faculty of Medicine and Health, Örebro University, Sweden
| | - Per Fischer
- Department of Orthopaedic and Hand Surgery, Faculty of Medicine and Health, Örebro University, Sweden
- Karlskoga Hospital, Sweden
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Gruisen JAE, Schormans PMJ, Punt IM, Roth AK, van Kuijk SMJ, Poeze M, Hannemann PFW. Patient reported and functional outcome measures after surgical salvage procedures for posttraumatic radiocarpal osteoarthritis - a systematic review. BMC Musculoskelet Disord 2024; 25:453. [PMID: 38849773 PMCID: PMC11157883 DOI: 10.1186/s12891-024-07527-6] [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: 01/15/2024] [Accepted: 05/15/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Posttraumatic wrist osteoarthritis is an irreversible and often progressive condition. Many surgical treatments, used in (daily) practice, aim to relieve symptoms like pain and restore function. The aim of this systematic review is to assess the patient reported and functional outcomes of the most common surgical interventions in patients with posttraumatic wrist osteoarthritis. This overview can help clinicians select the best treatment and manage patient's expectations. METHODS A literature search was performed in Pubmed, Embase and Cochrane for articles published between 1990 and November 2022 according to the PRISMA guidelines. The study protocol has been registered in the PROSPERO database (CRD42017080427). Studies that describe patient reported outcomes (pain and Disability of Arm, Shoulder and Hand (DASH) -score) and functional outcomes (range of motion (ROM) and grip strength) after surgical intervention with a minimal follow-up of 1 year were included. The identified surgical procedures included denervation, proximal row carpectomy, interpositional- and total arthroplasty, and midcarpal-, radiocarpal- and total arthrodesis. The pre-and postoperative outcomes were pooled and presented per salvage procedure. RESULTS Data from 50 studies was included. Pain score improved after all surgeries except denervation. Flexion/extension decreased after radiocarpal arthrodesis, did not show significant changes after proximal row carpectomy, and improved for all other surgeries. DASH score improved after arthroplasty, proximal row carpectomy and midcarpal arthrodesis. Grip strength improved after interposition arthroplasty and partial arthrodesis. CONCLUSION Evidence from this review did not support the indication for denervation in this particular patient population. In patients with SLAC/SNAC II, proximal row carpectomy might be favourable to a midcarpal arthrodesis solely based on better FE ROM of the radiocarpal joint after proximal row carpectomy. In terms of radiocarpal mobility, total wrist arthroplasty might be preferred to radiocarpal arthrodesis in patients with osteoarthritis after a distal radius fracture. More uniform measurements of outcomes would improve the understanding of the effect of surgical treatments of the posttraumatic osteoarthritic wrist.
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Affiliation(s)
- Jane A E Gruisen
- Department of Trauma and Orthopedic Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Philip M J Schormans
- Department of Surgery, Amphia Hospital Breda, Molengracht 21, 4818 CK Breda, The Netherlands.
| | - Ilona M Punt
- Department of Trauma and Orthopedic Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Alex K Roth
- Department of Trauma and Orthopedic Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Sander M J van Kuijk
- Department of Klinische Epidemiologie en Medical Technology Assessment, Maastricht University, P.Debyelaan 25, Maastricht, 6229 HX, The Netherlands
| | - Martijn Poeze
- Department of Trauma and Orthopedic Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Pascal F W Hannemann
- Department of Trauma and Orthopedic Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
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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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Zoccolan A, Ferrari E, Vitali F, Ursino C, Zotta I, Rivellino MC, Greco D, Formica M. Lunate Shift Index (LSI): A New Parameter for the Evaluation of Residual Ulnar Side Wrist Pain in Patients with Wrist Osteoarthritis Undergoing Three-Corners Arthrodesis vs. Four-Corners Arthrodesis-A Retrospective Comparative Study with Minimum 2 Years of Follow-up. Indian J Orthop 2024; 58:794-801. [PMID: 38812875 PMCID: PMC11130084 DOI: 10.1007/s43465-024-01127-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 02/25/2024] [Indexed: 05/31/2024]
Abstract
Purpose Both scaphoid non-union advanced collapse wrist (SNAC) and scapho-lunate advanced collapse wrist (SLAC) at stage II-III are common indications for limited wrist fusions including four-corners fusion (4CF) and three-corners fusion (3CF). The aim of this study was to assess the clinical and radiological outcomes in patients undergoing 3CF vs. 4CF. A new radiological index called Lunate Shift Index (LSI) was devised to evaluate the importance of the lunate displacement relative to the radiolunate joint. Materials and Methods Twenty-eight patients undergoing 3CF and 40 patients undergoing 4CF were clinically evaluated. The radiolunate angle, the carpal height, and the LSI were recorded radiographically. The LSI corresponds to the ratio between the distance from the lunate centre to the middle of the intermediate column and the length of the intermediate column of the distal radius. Results A statistically significant correlation was observed between LSI and clinical outcomes. The lunate displacement was associated with an increased incidence of wrist ulnar pain. No statistically significant differences were observed between 3 and 4CF in all parameters compared. Conclusions The osteoarthritis of piso-triquetral joint has been identified as the cause of wrist ulnar pain in patients undergoing 4CF. The lunate correct positioning allows to maintain the carpal height and to increase the contact area at the level of the radiolunate joint. A good reduction of the lunate could be obtained with the 3CF compared to 4CF. This study showed how proper realignment of the lunate following midcarpal arthrodesis correlates with a better clinical outcome. Level of Evidence Level III, Retrospective comparative study.
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Affiliation(s)
- Andrea Zoccolan
- Hand Surgery Department, Ospedale San Paolo, Via Genova 30, 17100 Savona, Italy
| | - Emilio Ferrari
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), Ospedale Policlinico San Martino, University of Genoa, Largo Rosanna Benzi 10, 16132 Genoa, Italy
| | - Federico Vitali
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), Ospedale Policlinico San Martino, University of Genoa, Largo Rosanna Benzi 10, 16132 Genoa, Italy
| | - Chiara Ursino
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), Ospedale Policlinico San Martino, University of Genoa, Largo Rosanna Benzi 10, 16132 Genoa, Italy
| | - Irene Zotta
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), Ospedale Policlinico San Martino, University of Genoa, Largo Rosanna Benzi 10, 16132 Genoa, Italy
- APSS Santa Chiara, Largo Medaglie d’oro, 9, 38122 Trento, Italy
| | | | - Davide Greco
- Hand Surgery Department, Ospedale San Paolo, Via Genova 30, 17100 Savona, Italy
| | - Matteo Formica
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), Ospedale Policlinico San Martino, University of Genoa, Largo Rosanna Benzi 10, 16132 Genoa, Italy
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Zhou JY, Jodah R, Joseph LP, Yao J. Scapholunate Ligament Injuries. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:245-267. [PMID: 38817761 PMCID: PMC11133945 DOI: 10.1016/j.jhsg.2024.01.015] [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: 01/09/2024] [Accepted: 01/13/2024] [Indexed: 06/01/2024] Open
Abstract
Injuries to the scapholunate interosseous ligament (SLIL) complex can result in a predictable cascade of incongruous motion in the carpus that leads to radiocarpal degeneration. Both acute traumatic impact and repetitive motion can render the SLIL insufficient. A thorough understanding of SLIL anatomy is required for appropriate diagnosis and treatment. Here, we review scapholunate ligament anatomy, prevention strategies, methods of diagnosis, nonoperative and operative treatments, and outcomes. A myriad of treatment options exist for each stage of the SLIL injury, and management should be an open discussion between the patient and physician.
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Affiliation(s)
- Joanne Y. Zhou
- Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA
| | | | - Lauren P. Joseph
- Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA
| | - Jeffrey Yao
- Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA
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Smees CJ, van Es EM, Tuijthof GJM, Colaris JW, de Graaff F, Vochteloo AJH. A comparison of 3-D CT and 2-D plain radiograph measurements of the wrist in extra-articular malunited fractures of the distal radius. J Hand Surg Eur Vol 2024; 49:546-553. [PMID: 37987680 PMCID: PMC11044515 DOI: 10.1177/17531934231213790] [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: 02/01/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023]
Abstract
Two-dimensional (2-D) plain radiographs may be insufficient for the evaluation of distal radial malunion, as it is a three-dimensional (3-D) deformity. This study introduced a 3-D measuring method that outputs radial inclination, ulnar variance, palmar tilt and axial rotation. To this end, a standardized and clearly defined coordinate system was constructed that allowed 3-D measurements closely resembling the conventional 2-D method in 35 patients. Mean differences between 3-D and 2-D measurements in affected wrists were 1.8° for radial inclination, 0.8 mm for ulnar variance and 3.7° for palmar tilt. In addition, inter- and intra-observer reproducibility of all 3-D and 2-D measurements were good or excellent (intraclass correlation coefficient >0.75), with 3-D reproducibility always better than 2-D. Axial rotation was present in all patients with a mean of 7.9° (SD 6.9). Although the differences between 2-D and 3-D measurements were small, 3-D evaluation enables the assessment of axial rotation and brings us closer to a routine 3-D evaluation of malunion.Level of evidence: III.
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Affiliation(s)
- Camiel J. Smees
- Centre for Orthopaedic Surgery and Sports Medicine, OCON, Hengelo, The Netherlands
- Biomedical Device Design and Production Technology, University of Twente, Enschede, The Netherlands
| | - Eline M. van Es
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Gabriëlle J. M. Tuijthof
- Biomedical Device Design and Production Technology, University of Twente, Enschede, The Netherlands
| | - Joost W. Colaris
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Feike de Graaff
- Centre for Orthopaedic Surgery and Sports Medicine, OCON, Hengelo, The Netherlands
| | - Anne J. H. Vochteloo
- Centre for Orthopaedic Surgery and Sports Medicine, OCON, Hengelo, The Netherlands
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11
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Rieussec C, Caillard G, Helfter L, Girard P, Forli A, Corcella D. Comparison of proximal row carpectomy with RCPI® versus proximal row carpectomy with Eaton's capsular interposition in the management of advanced wrist osteoarthritis. Orthop Traumatol Surg Res 2024; 110:103783. [PMID: 38048904 DOI: 10.1016/j.otsr.2023.103783] [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: 03/20/2023] [Revised: 11/15/2023] [Accepted: 11/29/2023] [Indexed: 12/06/2023]
Abstract
INTRODUCTION Proximal row carpectomy (PRC) is one of the recommended techniques for managing wrist osteoarthritis, it implies the integrity of the lunate fossa of the radius and the proximal pole of the capitate. If PRC is not possible, it is suggested to consider combining it with a capsule interposition (such as Eaton's flap) or opting for intra- or radiocarpal arthrodesis. Another alternative is to combine capitate resurfacing with a pyrocarbon implant (RCPi®). The aims of this study was to assessed the results between proximal PRC+Eaton and those associated PRC+RCPi® for advanced wrist osteoarthritis. HYPOTHESIS We hypothesized that there would be no differences in clinical or functional outcome between proximal row carpectomy associated with RCPI® and those associated with Eaton capsular flap. MATERIAL AND METHODS It is a monocentric, retrospective, multi-operator study involving 83 wrists with osteoarthritis, included between January 2000 and December 2020 with a minimum follow-up period of 12 months. Thirty-nine patients underwent PRC+Eaton and 44 patients underwent RCPI® resurfacing. Data such as pain, flexion, extension and strength as well as functional scores (PRWE, Mayo and quick DASH) were collected from the patient files at the last check-up. RESULTS Results were comparable between the two groups in terms pain (VAS), mobility (flexion and extension), strength (GRASP) and functional scores (PRWE, Mayo and quick DASH). Carpal height was better preserved in the PRC+RCPI® group, with a Youm and McMurtry index evaluated at 0.3 in the PRC+Eaton group compared to 0.4 in the PRC+RCPI® group (p-value<0.001). Radiocarpal arthrodesis was required in 16% of the PRC+Eaton group and 6.8% of the PRC+RCPI® group, with a statistically significant difference (p-value=0.023). DISCUSSION This study reports clinical and functional results that suggest RCPI® is an interesting alternative and can be associated with proximal row carpectomy in advanced wrist osteoarthritis. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Clémentine Rieussec
- Service de chirurgie de la main, hôpital Nord de la Tronche, CHU de Grenoble-Alpes, Grenoble, France.
| | - Gauthier Caillard
- Service de chirurgie de la main, hôpital Nord de la Tronche, CHU de Grenoble-Alpes, Grenoble, France
| | - Laura Helfter
- Service de chirurgie de la main, hôpital Nord de la Tronche, CHU de Grenoble-Alpes, Grenoble, France
| | - Pierre Girard
- Service de chirurgie de la main, hôpital Nord de la Tronche, CHU de Grenoble-Alpes, Grenoble, France
| | - Alexandra Forli
- Service de chirurgie de la main, hôpital Nord de la Tronche, CHU de Grenoble-Alpes, Grenoble, France
| | - Denis Corcella
- Service de chirurgie de la main, hôpital Nord de la Tronche, CHU de Grenoble-Alpes, Grenoble, France
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12
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Maris S, Apergis E, Apostolopoulos A, Melissaridou D, Koulouvaris P, Papagelopoulos PJ, Savvidou O. Scapholunate Advanced Collapse (SLAC) and Scaphoid Nonunion Advanced Collapse (SNAC): A Review of Treatment Options for Stage II. Cureus 2024; 16:e59014. [PMID: 38800268 PMCID: PMC11127752 DOI: 10.7759/cureus.59014] [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: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) represent clinical entities identified by a pattern of predictable degenerative changes. They are the most common causes of wrist arthritis. Both entities can remain asymptomatic for many years and may go undiagnosed. Diagnosis is usually confirmed through clinical examination, which reveals progressive wrist pain and instability. Radiographically, degenerative changes in the radiocarpal and midcarpal joints are present, as well as nonunion of the scaphoid fracture in SNAC. The management differs according to the stage. Particularly in this review article, we reviewed the treatment options for stage II SLAC and SNAC wrist. In addition to the well-described surgical techniques such as proximal row carpectomy and four-corner fusion, alternatives such as capitolunate arthrodesis, three-corner fusion, and soft tissue procedures like capsulodesis and tenodesis are available. Proximal row carpectomy and partial arthrodeses yield comparable results. Soft tissue procedures are viable alternatives and are preferred in younger patients to avoid early salvage operations.
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Affiliation(s)
- Spyridon Maris
- Department of Orthopaedics and Traumatology, General Hospital Hellenic Red Cross Korgialenio Benakio, Athens, GRC
| | - Emmanouil Apergis
- Department of Orthopaedics, General Hospital Hellenic Red Cross Korgialenio Benakio, Athens, GRC
| | - Alexandros Apostolopoulos
- Department of Orthopaedics, East Surrey Hospital, Surrey and Sussex Healthcare NHS Trust, Redhill, GBR
| | - Dimitra Melissaridou
- First Department of Orthopaedic Surgery, Attikon University General Hospital, Athens, GRC
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Panagiotis Koulouvaris
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Panayiotis J Papagelopoulos
- First Department of Orthopaedic Surgery, Attikon University General Hospital, Athens, GRC
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Olga Savvidou
- First Department of Orthopaedic Surgery, Attikon University General Hospital, Athens, GRC
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
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13
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Cobb T, Chase C, Cobb J. Arthroscopic Resection Arthroplasty for Scapholunate Advanced Collapse Wrist. J Wrist Surg 2023; 12:528-533. [PMID: 38213559 PMCID: PMC10781571 DOI: 10.1055/s-0043-1768927] [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: 08/27/2022] [Accepted: 04/03/2023] [Indexed: 01/13/2024]
Abstract
Purpose Scapholunate advanced collapse (SLAC) wrist results from an untreated scapholunate dissociation and is the most common type of degenerative arthritis of the wrist. The most common surgical treatments for SLAC wrist are proximal row carpectomy and four-corner fusion with scaphoid excision. Arthroscopic surgical treatment for SLAC wrist has been reported; however, only limited data on functional outcomes are available. The purpose of this study is to report our 5-year follow-up clinical outcomes for arthroscopic treatment for SLAC wrist. Methods Thirty-one consecutive cases of arthroscopic resection arthroplasty for SLAC wrist were reviewed. Preoperative and postoperative Disabilities of the Arm, Shoulder, and Hand (DASH) scores, range of motion, grip strength, and pain (on 0-10 scale) as well as postoperative satisfaction (0 = not satisfied, 5 = completely satisfied) were recorded. Grip and range of motion were measured by an occupational therapist. Results The preoperative pain score was 7 and 0.18 postoperatively. The mean satisfaction at final follow-up was 4.8. Preoperative and final follow-up scores of the mean DASH was 48 and 3, respectively. The total arc of motion was 114 degrees preoperatively and 126.5 degrees postoperatively. Mean grip strength before surgery was 41 and 49 kg at final follow-up. Conclusion Arthroscopic resection arthroplasty for SLAC wrist results in significant improvement in patient function as measured by DASH and pain scores. Type of Study/Level of Evidence Therapeutic IV.
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Affiliation(s)
- Tyson Cobb
- Shoulder, Elbow, Wrist, and Hand Center of Excellence, Davenport, Iowa
| | - Collin Chase
- Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Jessica Cobb
- Morsani College of Medicine, University of South Florida, Tampa, Florida
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14
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Larsson SL, Ekstrand E, Dahlin LB, Björkman A, Brogren E. A self-managed exercise therapy program for wrist osteoarthritis: study protocol for a randomized controlled trial. Trials 2023; 24:628. [PMID: 37784197 PMCID: PMC10546651 DOI: 10.1186/s13063-023-07668-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/22/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Post-traumatic wrist osteoarthritis (OA) can eventually lead to pain, muscular weakness, and stiffness of the wrist, which can affect the function of the entire upper limb and reduce the quality of life. Although there is strong evidence that all patients with OA should be offered adequate education and exercises as a first-line treatment, an effective self-management program, including structured education and therapeutic exercises, has not yet been introduced for individuals with wrist OA. This trial aims to evaluate the effectiveness of an exercise therapy program with joint protective strategies to improve neuromuscular control (intervention group) compared to a training program with range of motion exercises (control group). METHODS This is a single-blinded randomized controlled trial (RCT) with two treatment arms in patients with symptomatic and radiographically confirmed wrist OA. The trial will be conducted at a hand surgery department. The participants will be randomly assigned either to a neuromuscular exercise therapy program or to a training program with range of motion exercises only. Participants in both groups will receive a wrist orthosis and structured education on wrist anatomy, pathophysiology, and joint protective self-management strategies. The programs consist of home exercises that will be performed twice a day for 12 weeks. The Patient-Rated Wrist Evaluation (PRWE) is the primary outcome measure of pain and function. Wrist range of motion (ROM), grip strength, the Numeric Pain Rating scale (NPRS), Disabilities of the Arm, Shoulder, and Hand (DASH), the General Self-Efficacy Scale (GSES), Global Rating of Change (GROC), and conversion to surgery are the secondary measures of outcome. Assessments will be performed at baseline and at 3, 6, and 12 months after baseline by a blinded assessor. DISCUSSION The upcoming results from this trial may add new knowledge about the effectiveness of a self-managed exercise therapy program on pain and function for individuals with wrist OA. If the present self-management program proves to be effective, it can redefine current treatment strategies and may be implemented in wrist OA treatment protocols. TRIAL REGISTRATION ClinicalTrials.gov, NCT05367817. Retrospectively registered on 27 April 2022. https://clinicaltrials.gov .
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Affiliation(s)
- Sara L Larsson
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden.
- Department of Translational Medicine - Hand Surgery, Lund University, Jan Waldenströms Gata 5, 205 03, Malmö, Sweden.
| | - Elisabeth Ekstrand
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Lars B Dahlin
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Translational Medicine - Hand Surgery, Lund University, Jan Waldenströms Gata 5, 205 03, Malmö, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Anders Björkman
- Department of Hand Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Elisabeth Brogren
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Translational Medicine - Hand Surgery, Lund University, Jan Waldenströms Gata 5, 205 03, Malmö, Sweden
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15
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Alanen M, Stjernberg-Salmela S, Waris E, Karjalainen T, Miettunen J, Ryhänen J, Aspinen S. Proximal ROw carpectOmy versus four-corner Fusion (PROOF-trial) for osteoarthritis of the wrist: study protocol for multi-institutional double-blinded randomized controlled trial. Trials 2023; 24:499. [PMID: 37550711 PMCID: PMC10405450 DOI: 10.1186/s13063-023-07544-1] [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: 11/14/2022] [Accepted: 07/25/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Scapholunate advanced collapse (SLAC) and scaphoid non-union advanced collapse (SNAC) are common types of wrist osteoarthritis (OA). Non-operative treatment consists of pain medication, splinting, and avoiding activities that induce pain. However, in case a course of conservative treatment is unsuccessful, operative treatment is needed. The two most conventional operative approaches for SLAC/SNAC OA are four-corner arthrodesis (FCA) and proximal row carpectomy (PRC). Although FCA is the gold-standard operative technique and may lead to superior grip strength, the evident benefit of PRC is that it obviates any need for hardware removal and controlling for bony union. To date, no high-quality randomized controlled trial comparing FCA and PRC exists. As clinical outcomes seem comparable, a trial that assesses patient-reported outcomes, adverse events, and secondary operations may guide clinical decision making between these two procedures. Thus, the aim of this multi-institutional double-blind randomized controlled trial is to study whether PRC is non-inferior to FCA in treating SLAC/SNAC OA. We hypothesize that PRC is non-inferior to FCA with lower economic expanses. METHODS The trial is designed as a randomized, controlled, patient- and outcome-assessor blinded multicenter, two-armed 1:1 non-inferiority trial. Patients with SLAC/SNAC-induced wrist pain meeting trial inclusion criteria will undergo wrist arthroscopy to further assess eligibility. Each patient eligible for the trial will be randomly assigned to undergo either FCA or PRC. The primary endpoint of this study is the Patient Rated Wrist Evaluation (PRWE) at 1-year after FCA versus PRC. Secondary outcomes include Quick-Disabilities of the Arm, Shoulder and Hand, EQ-5D-5L, pain, grip strength, wrist active range of motion, radiographic evaluation, and adverse events. Trial design, methods, and statistical analysis plan will be presented here. DISCUSSION We present an RCT design comparing FCA vs PRC for SLAC/SNAC-induced OA. The results of this trial will assist in decision making when planning surgery for SLAC/SNAC. TRIAL REGISTRATION ClinicalTrials.gov NCT04260165 . Registered February 7, 2020.
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Affiliation(s)
- Mikko Alanen
- Department of Hand Surgery, Helsinki University Hospital, Helsinki, Finland.
| | | | - Eero Waris
- Department of Hand Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Teemu Karjalainen
- Department of Hand Surgery, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Jouko Miettunen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Jorma Ryhänen
- Department of Hand Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Samuli Aspinen
- Department of Hand Surgery, Helsinki University Hospital, Helsinki, Finland
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16
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LoGiudice A, Awan H. Wrist Arthritis and Arthrodesis: Preserving Function, Minimizing Problems. Hand Clin 2023; 39:353-365. [PMID: 37453763 DOI: 10.1016/j.hcl.2023.04.001] [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] [Indexed: 07/18/2023]
Abstract
Wrist arthritis is a common condition with numerous causes and presentations. Several management options exist, and treatment should be individualized based on patient age, comorbidities, occupation, duration of symptoms, and failed treatment modalities. Arthroscopy and denervation are appealing because of shorter recovery time and preservation of motion, but duration of effectiveness varies between patients. Patients who fail these smaller procedures or those with pancarpal arthrosis are treated effectively with total wrist arthrodesis or total wrist arthroplasty in lower-demand patients. This article reviews causes and patterns of wrist arthritis and discusses treatment strategies aimed at preserving function and minimizing complications.
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Affiliation(s)
- Anthony LoGiudice
- Department of Orthopaedic Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Hisham Awan
- Ohio State University Hand and Upper Extremity Center, 915 Olentangy River Road, Suite 3200, Columbus, OH 43212, USA.
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17
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Kale NN, Foote J, Medvedev G. Use of Wrist Denervation in the Treatment of SLAC and SNAC Wrist by ASSH Members. J Wrist Surg 2023; 12:280-286. [PMID: 37223381 PMCID: PMC10202580 DOI: 10.1055/s-0042-1756498] [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: 10/11/2021] [Accepted: 06/30/2022] [Indexed: 10/10/2022]
Abstract
Background Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) are common patterns of wrist arthritis, and surgical treatment options include partial and total wrist arthrodesis and wrist denervation, which maintains the current anatomy while relieving pain. Introduction The purpose of this study is to elucidate current practices within the hand surgery community with respect to the use of anterior interosseous nerve/posterior interosseous nerve (AIN/PIN) denervation in the treatment of SLAC and SNAC wrists. Methods An anonymous survey was distributed to 3,915 orthopaedic surgeons via the American Society for Surgery of the Hand (ASSH) listserv. The survey collected information on conservative and operative management, indications, complications, diagnostic block, and coding of wrist denervation. Results In total, 298 answered the survey. 46.3% ( N = 138) of the respondents used denervation of AIN/PIN for every SNAC stage, and 47.7% ( N = 142) of the respondents used denervation of AIN/PIN for every SLAC wrist stage. AIN and PIN combined denervation was the most common standalone procedure ( N = 185, 62.1%). Surgeons were more likely to offer the procedure ( N = 133, 55.4%) if motion preservation had to be maximized ( N = 154, 64.4%). The majority of surgeons did not consider loss of proprioception ( N = 224, 84.2%) or diminished protective reflex ( N = 246, 92.1%) to be significant complications. 33.5%, 90 respondents reported never performing a diagnostic block prior to denervation. Conclusion Both SLAC and SNAC patterns of wrist arthritis can result in debilitating wrist pain. There is a wide range of treatment for different stages of disease. Further investigation is required to identify ideal candidates and evaluate long-term outcomes.
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Affiliation(s)
- Nisha N. Kale
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Jake Foote
- Department of Orthopaedics, MSUCHM Ascension Providence Hospital, Southfield, Michigan
| | - Gleb Medvedev
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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18
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Fitzgerald K, Bindra R, Canning S, Tansley G, Lloyd DG, Zheng M, Quinn A, Maharaj J, Perevoshchikova N, Saxby DJ. A human-centred design approach to hybrid manufacturing of a scapholunate interosseous ligament medical practice rig. ANNALS OF 3D PRINTED MEDICINE 2022. [DOI: 10.1016/j.stlm.2022.100084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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19
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Mayoly A, Witters M, Jouve E, Bec C, Iniesta A, Kachouh N, Veran J, Grimaud F, Zavarro AC, Fernandez R, Bendahan D, Giraudo L, Dumoulin C, Chagnaud C, Casanova D, Sabatier F, Legré R, Jaloux C, Magalon J. Intra Articular Injection of Autologous Microfat and Platelets-Rich Plasma in the Treatment of Wrist Osteoarthritis: A Pilot Study. J Clin Med 2022; 11:5786. [PMID: 36233654 PMCID: PMC9572253 DOI: 10.3390/jcm11195786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
No injection treatment has been proven to be effective in wrist osteoarthritis. When conservative measures fail, its management involves invasive surgery. Emergence of biotherapies based on adipose derived stem cells (ADSC) offers promising treatments for chondral degenerative diseases. Microfat (MF) and platelets-rich plasma (PRP) mixture, rich in growth factors and ADSC could be a minimally invasive injectable option in the treatment of wrist osteoarthritis. The aim of this uncontrolled prospective study was to evaluate the safety of a 4 mL autologous MF-PRP intra-articular injection, performed under local anesthesia. The secondary purpose was to describe the clinical and MRI results at 12 months of follow-up. Patients' data collected were: occurrence of adverse effects, Visual analog scale (VAS), Disabilities of the Arm, Shoulder and Hand score (DASH) and Patient-Rated Wrist Evaluation (PRWE) scores, wrist strength, wrist range of motion and 5-level satisfaction scale. No serious adverse event was recorded. A statistically significant decrease in pain, DASH, PRWE and force was observed at each follow-up. Our preliminary results suggest that intra-articular autologous MF and PRP injection may be a new therapeutic strategy for wrist osteoarthritis resistant to medical symptomatic treatment prior to surgical interventions.
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Affiliation(s)
- Alice Mayoly
- Department of Hand and Limb Reconstructive Surgery, Hôpital de la Timone, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Marie Witters
- Department of Hand and Limb Reconstructive Surgery, Hôpital de la Timone, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Elisabeth Jouve
- Pharmacometry, Clinical Investigation Center—Center for Clinical Pharmacology and Therapeutic Evaluations (CIC-CPCET), Clinical Pharmacology and Pharmacovigilance Department, Hôpital de la Timone, AP-HM, 13005 Marseille, France
| | - Cécilia Bec
- Therapy Cell Laboratory, Hôpital de la Conception, AP-HM, INSERM CIC BT 1409, 13005 Marseille, France
| | - Aurélie Iniesta
- Department of Hand and Limb Reconstructive Surgery, Hôpital de la Timone, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Najib Kachouh
- Department of Hand and Limb Reconstructive Surgery, Hôpital de la Timone, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Julie Veran
- Therapy Cell Laboratory, Hôpital de la Conception, AP-HM, INSERM CIC BT 1409, 13005 Marseille, France
| | - Fanny Grimaud
- Therapy Cell Laboratory, Hôpital de la Conception, AP-HM, INSERM CIC BT 1409, 13005 Marseille, France
| | - Anouck Coulange Zavarro
- Therapy Cell Laboratory, Hôpital de la Conception, AP-HM, INSERM CIC BT 1409, 13005 Marseille, France
| | - Rémi Fernandez
- Radiology Department, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
- Biological and Medical Magnetic Resonance Center, 13005 Marseille, France
| | - David Bendahan
- Biological and Medical Magnetic Resonance Center, 13005 Marseille, France
| | - Laurent Giraudo
- Therapy Cell Laboratory, Hôpital de la Conception, AP-HM, INSERM CIC BT 1409, 13005 Marseille, France
| | - Chloé Dumoulin
- Therapy Cell Laboratory, Hôpital de la Conception, AP-HM, INSERM CIC BT 1409, 13005 Marseille, France
| | - Christophe Chagnaud
- Radiology Department, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Dominique Casanova
- Department of Plastic and Reconstructive Surgery, Hôpital de la Conception, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Florence Sabatier
- Therapy Cell Laboratory, Hôpital de la Conception, AP-HM, INSERM CIC BT 1409, 13005 Marseille, France
- C2VN, INSERM 1263, INRA 1260, Aix-Marseille University, 13005 Marseille, France
| | - Régis Legré
- Department of Hand and Limb Reconstructive Surgery, Hôpital de la Timone, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Charlotte Jaloux
- Department of Hand and Limb Reconstructive Surgery, Hôpital de la Timone, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Jérémy Magalon
- Therapy Cell Laboratory, Hôpital de la Conception, AP-HM, INSERM CIC BT 1409, 13005 Marseille, France
- C2VN, INSERM 1263, INRA 1260, Aix-Marseille University, 13005 Marseille, France
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20
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Total Wrist Arthroplasty for Posttraumatic Wrist Osteoarthritis: A Cohort Study Comparing Three Indications. Life (Basel) 2022; 12:life12050617. [PMID: 35629285 PMCID: PMC9145948 DOI: 10.3390/life12050617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 11/17/2022] Open
Abstract
Scapholunate ligament ruptures and scaphoid nonunion with consecutive advanced collapse (SLAC and SNAC wrists) as well as intra-articular distal radius fractures (DRF) are prone to cause posttraumatic wrist osteoarthritis. The aim of this study was to compare the outcomes of these indications for total wrist arthroplasty. We included 13, 11, and 8 patients with an overall mean age of 60 ± 9 years in the SLAC, SNAC, and DRF cohort, respectively. After an average follow-up period of 6 ± 3 years, we found no difference between our groups regarding pain levels and functional scores, although these parameters significantly improved compared to preoperative parameters. Complication and revision rates revealed no significant difference. However, significantly higher extension, arc of range of motion values in the flexion-extension, as well as in radial-ulnar deviation plain were detected in the SLAC compared to the DRF group. Finally, TWA proved to show a beneficial performance in all three investigated indications.
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21
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Azócar C, Lecaros JJ, Bernal N, Sanhueza M, Liendo R, Cifras JL. Four-Corner Arthrodesis: Comparative Analysis of Open Technique Versus Percutaneous Technique with Arthroscopic Assistance. J Wrist Surg 2022; 11:127-133. [PMID: 35478943 PMCID: PMC9038305 DOI: 10.1055/s-0041-1735838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
Introduction Four-corner arthrodesis is a salvage technique for patients with carpal advanced osteoarthritis. Nowadays, percutaneous techniques with arthroscopic assistance have been described, achieving favorable results with minimally invasive techniques advantages over open surgery. Objective To compare functional and radiological results in patients with SLAC or SNAC wrists operated with open surgical technique versus percutaneous surgery with arthroscopic assistance. Materials and Methods Retrospective case-control study of clinical records and radiological images of patients with carpal advanced osteoarthritis operated with both surgical techniques. We studied demographic variables, pain with visual analog scale (VAS) score, function in ranges of mobility, time of consolidation, and correction of DISI deformity. Results A total of 22 male patients with an average age of 32.5 years were studied. Thirteen patients in the case group (percutaneous technique with arthroscopic assistance) and nine patients in the control group (open surgery). Pain score in VAS at discharge was 3 for cases and 5 in controls ( p = 0.008), and at 30 days postoperatively, it was 0 and 3 respectively ( p = 0.00). The extension and flexion ranges were 52.6°and 38.7° in the cases and 35.7° and 32.4° in the control group ( p = 0.119 and 0.0016, respectively). The capitolunate angle was 10°in the controls and 5°in the cases ( p = 0.0008). The time of consolidation was 8.8 weeks in cases and 12.5 weeks in controls ( p = 0.039). Conclusions The percutaneous technique with arthroscopic assistance for the 4-courner arthrodesis is a reproducible technique and is effective in achieving consolidation, pain reduction and preservation of wrist motion. In the present study, we demonstrate superiority of this technique over the open surgery. Level of Evidence This is a Level III, therapeutic study.
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Affiliation(s)
- Camila Azócar
- Department of Hand Surgery, Hospital Mutual de Seguridad, Santiago, Chile
- Department of Hand Surgery, Clínica Indisa, Santiago, Chile
- Department of Orthopaedics and Trauma, Universidad de Chile, Santiago, Chile
| | - Juan J. Lecaros
- Resident of Orthopaedics and Trauma, Universidad de Chile, Santiago, Chile
| | - Nazira Bernal
- Department of Orthopaedics and Trauma, Clinica Alemana – Universidad del Desarrollo, Santiago, Chile
| | - Miguel Sanhueza
- Department of Hand Surgery, Hospital Mutual de Seguridad, Santiago, Chile
- Department of Hand Surgery, Clínica Santa María, Santiago, Chile
| | - Rodrigo Liendo
- Department of Orthopaedics and Trauma, UC-Christus, Santiago, Chile
| | - José L. Cifras
- Department of Hand Surgery, Hospital Mutual de Seguridad, Santiago, Chile
- Department of Hand Surgery, Hospital Regional de Talca, Talca, Chile
- Departamento of Orthopaedics and Trauma, Clínica Dávila, Santiago, Chile
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Coskun T, Arik HO. Mid-term radiological results of intra-articular penetration of the screw used in scaphoid surgery. Niger J Clin Pract 2022; 25:1158-1162. [DOI: 10.4103/njcp.njcp_1833_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
OBJECTIVE Focal cartilage injuries, and posttraumatic osteoarthritis (OA) in the wrist are likely common and a cause of wrist pain. To estimate the incidence of cartilage lesions and to understand the pathomechanisms leading to wrist cartilage injuries and OA, a literature review on the subject was performed combined with a presentation of one of the authors' own experience. DESIGN This study includes a literature review of the topic. As a comparison to the review findings, the observations of one of the authors' consecutive 48 wrist arthroscopies, were assessed. PubMed, Scholar, and Cochrane databases were searched using the keywords "cartilage injury AND wrist AND treatment" and "wrist AND cartilage AND chondral AND osteochondral AND degenerative OA." :RESULT A total of 11 articles, including 9 concerning chondral and osteochondral repair and treatment and 2 regarding posttraumatic OA, were retrieved. The cartilage repair treatments used in these articles were drilling, osteochondral autograft, juvenile articular cartilage allograft, and chondrocyte implantation. One article displayed concomitant cartilage injuries in displaced distal radius fractures in 32% of the patients. The review of our findings from a 1-year cohort of wrist arthroscopies showed 17% cartilage injuries. CONCLUSION There is a lack of knowledge in current literature on cartilage injuries and treatment, as well as posttraumatic OA in the wrist. Cartilage injuries appear to be common, being found in 17% to 32% of all wrist arthroscopies after trauma, but no guidelines regarding conservative or surgical treatment can be recommended at the moment. Larger prospective comparative studies are needed.
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Affiliation(s)
- Jonny K. Andersson
- Department of Surgery, Aspetar
Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Department of Orthopaedics, Institute
of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg,
Sweden
| | - Elisabet Hagert
- Arcademy, H.M. Queen Sophia Hospital,
Stockholm, Sweden
- Department of Clinical Science and
Education, Karolinska Institutet, Stockholm, Sweden
- Department of Health Promotion Science,
Musculoskeletal and Sports Injury Epidemiology Center, Sophiahemmet University,
Stockholm, Sweden
| | - Mats Brittberg
- Cartilage Research Unit, Region Halland
Orthopaedics, Kungsbacka Hospital, University of Gothenburg, Kungsbacka,
Sweden
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Vande Voorde K, Caekebeke P, Duerinckx J. Scaphoidectomy and 4-corner arthrodesis with headless compression screws: results, complications and their treatment. Acta Orthop Belg 2021; 87:771-777. [PMID: 35172447 DOI: 10.52628/87.4.25] [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: 11/20/2022]
Abstract
Scaphoidectomy and 4-corner arthrodesis is a common salvage surgery for degenerative wrist pathology. The purpose of this study was to evaluate the results of this procedure performed with headless compression screws, with a special focus on postoperative complications and their treatment. We assessed 36 wrists in 31 patients that were treated between 2009 and 2017. Mean follow-up was 5.2 years (range 2.9- 9.4). Pain was expressed on a Visual Analog Scale. The Quick Disabilities of the Arm, Shoulder and hand (qDASH) questionnaire and Michigan Hand Outcome Questionnaire (MHOQ) were used to assess patient functionality and satisfaction. Range of motion and grip strength of both wrists were measured. Radiographs of the operated wrist were evaluated. Mean pain score was 1.5 ± 2.3 with 19% of patients being completely free of pain also during activity. Mean qDASH was 44 ± 20 and mean MHOQ was 10 ± 5. Mean flexion-extension arc of the operated wrist was 69° and 61% of the contralateral wrist. Mean grip strength was 35kg and 89% of the opposite wrist. Non-union was observed in two patients. Two patients required hardware removal and in three patients a pisiformectomy was performed. Conversion to total wrist arthrodesis was needed in one patient. We observed postoperative complications in 28% of our patients. Most complications can successfully be treated with additional surgery. The presence of pisotriquetral arthritis should be assessed before surgery and treated with pisiform excision.
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25
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Cohen A, Hoogendam L, Reijman M, Selles RW, Hovius SER, Colaris JW. Patient-reported physical functioning and pain improve after scaphoid nonunion surgery: A Cohort Study. Injury 2021; 52:2952-2958. [PMID: 34253353 DOI: 10.1016/j.injury.2021.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Since all patients with a scaphoid nonunion are generally treated surgically to prevent progressive osteoarthritis, it is important to set postoperative expectations regarding physical functioning and pain. Previous study mainly focus on postoperative scaphoid union and physician-based outcomes. Therefore we aim to report the change from preoperative to postoperative patient-reported outcomes to inform patients with a scaphoid nonunion about their postoperative expectations. MATERIAL AND METHODS Data were prospectively collected as part of usual care at the Xpert Clinic in the Netherlands. Adult patients who underwent scaphoid nonunion surgery minimally 3 months after a scaphoid fracture, were eligible for inclusion. Only patients with complete preoperative and postoperative questionnaires regarding our primary outcome (Patient Rated Hand/Wrist Evaluation (PRWHE) were included. As secondary outcomes, we assessed the Visual Analog Scale (VAS) pain and hand function, range of motion of the injured wrist measured by a hand therapist, and patient satisfaction with questionnaires. RESULTS We included 118 patients with complete preoperative and postoperative (11 - 92 months) PRWHE questionnaires. The median PRWHE score improved significantly from 47 [IQR 27 - 62]) preoperative to 11 [IQR 5 - 23] postoperative (p<0.001). Postoperative improvement in pain and physical functioning was also observed in the PWRHE subdomains pain and disability separately (p<0.001), VAS pain, and VAS function (p<0.001). There was no difference between preoperative and postoperative range of motion of the injured wrist. Satisfaction with the hand improved significantly from preoperative to postoperative (p<0.001). Good or excellent satisfaction with the treatment result was reported by 69% of the patients and 86% would undergo the treatment again. CONCLUSIONS Patients can expect an improvement in physical functioning and pain after scaphoid nonunion surgery. Most patients are satisfied with the treatment result.
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Affiliation(s)
- Abigael Cohen
- Department of Orthopedic Surgery, Erasmus MC University Medical Center Rotterdam, PO Box 2040, 3000CA Rotterdam, the Netherlands.
| | - Lisa Hoogendam
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000CA Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, PO Box 2040, 3000CA Rotterdam, the Netherlands.
| | - Max Reijman
- Department of Orthopedic Surgery, Erasmus MC University Medical Center Rotterdam, PO Box 2040, 3000CA Rotterdam, the Netherlands.
| | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000CA Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, PO Box 2040, 3000CA Rotterdam, the Netherlands.
| | - Steven E R Hovius
- Hand and Wrist Center, Xpert Clinic, 1213 RH Hilversum, the Netherlands
| | - Joost W Colaris
- Department of Orthopedic Surgery, Erasmus MC University Medical Center Rotterdam, PO Box 2040, 3000CA Rotterdam, the Netherlands.
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Terzis A, Klinger A, Seegmüller J, Sauerbier M. Inter-Rater Reliability of Magnetic Resonance Imaging in Comparison to Computed Tomography and Wrist Arthroscopy in SLAC and SNAC Wrist. J Clin Med 2021; 10:3592. [PMID: 34441890 PMCID: PMC8397217 DOI: 10.3390/jcm10163592] [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: 05/28/2021] [Revised: 08/03/2021] [Accepted: 08/12/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of the study was to assess the inter-rater reliability of magnetic resonance imaging (MRI) in comparison to computed tomography (CT) and wrist arthroscopy in patients with scapholunate (SLAC) or scaphoid non-union advanced collapse (SNAC) as well as to evaluate a grading score of cartilage lesions. A total of 42 patients (36 male, 6 female) at a mean age of 45 years (range: 19-65 years) with a SLAC or SNAC wrist who had a preoperative MRI and CT scan as well as underwent arthroscopy of the wrist between 2013 and 2018 were included in this study. Cartilage lesions, as assessed by MRI, CT and wrist arthroscopy, were classified by two hand surgeons in three stages. Inter-rater reliability was evaluated using the Kendall Tau-b test as well as the chi-square test to analyze for trend. The correlation between cartilage lesions, classified by arthroscopy and MRI, was low. A moderate correlation between CT and arthroscopy staging was shown. The highest inter-rater correlation was found between MRI and CT staging. An additionally performed logistic regression showed that progression of cartilage lesions as shown in MRI scans correlates with a restriction of range of motion (ROM). The level of cartilage lesion may be more severely classified in an MRI than during arthroscopy. Arthroscopy remains the gold standard in detecting cartilage lesions and thus in the decision-making process of the definitive treatment in carpal collapse.
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Affiliation(s)
- Athanasios Terzis
- Department of Plastic, Hand and Reconstructive Surgery, BG Trauma Center Frankfurt am Main, Friedberger Landstrasse 430, 60389 Frankfurt am Main, Germany; (A.K.); (J.S.)
| | - Arlena Klinger
- Department of Plastic, Hand and Reconstructive Surgery, BG Trauma Center Frankfurt am Main, Friedberger Landstrasse 430, 60389 Frankfurt am Main, Germany; (A.K.); (J.S.)
| | - Jessica Seegmüller
- Department of Plastic, Hand and Reconstructive Surgery, BG Trauma Center Frankfurt am Main, Friedberger Landstrasse 430, 60389 Frankfurt am Main, Germany; (A.K.); (J.S.)
| | - Michael Sauerbier
- Private Practice for Hand and Plastic Surgery, 61348 Bad Homburg v. d. Höhe, Germany;
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Grunz JP, Gietzen CH, Christopoulos G, van Schoonhoven J, Goehtz F, Schmitt R, Hesse N. Osteoarthritis of the Wrist: Pathology, Radiology, and Treatment. Semin Musculoskelet Radiol 2021; 25:294-303. [PMID: 34374064 DOI: 10.1055/s-0041-1730948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Osteoarthritis (OA) is a degenerative disease that can manifest in any synovial joint under certain conditions. It leads to destruction of articular cartilage and adjacent bone, as well as formation of osteophytes at the edges of afflicted joint surfaces. Regarding the wrist, typical degenerative arthritis affects particular joints at a specific patient age, due to asymmetric load distribution and repetitive microtrauma. However, in the presence of instability or systemic diseases, early-onset degeneration can also impair the range of motion and grip strength in younger patients. Although advanced stages of OA display characteristic signs in radiography, the detection of early manifestations frequently requires computed tomography or magnetic resonance imaging (in some cases with additional arthrography). If a wrist becomes unstable, timely diagnosis and precise treatment are essential to prevent rapid disease progression. Therefore, close collaboration between radiologists and hand surgeons is obligatory to preserve the carpal function of patients.
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Affiliation(s)
- Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Carsten Herbert Gietzen
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Georgios Christopoulos
- Department of Diagnostic and Interventional Radiology, Rhön-Klinikum Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | - Jörg van Schoonhoven
- Clinic for Hand Surgery, Rhön-Klinikum Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | - Florian Goehtz
- Clinic for Hand Surgery, Rhön-Klinikum Campus Bad Neustadt, Bad Neustadt an der Saale, Germany
| | - Rainer Schmitt
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany.,Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Nina Hesse
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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28
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Peymani A, de Roo MGA, Dobbe JGG, Streekstra GJ, McCarroll HR, Strackee SD. Carpal Kinematics in Madelung Deformity. J Hand Surg Am 2021; 46:622.e1-622.e12. [PMID: 33849749 DOI: 10.1016/j.jhsa.2020.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 10/03/2020] [Accepted: 11/20/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Various skeletal and soft tissue abnormalities have been identified in Madelung deformity and have been hypothesized to play a causal role in its progressive symptomatology; however, our pathological understanding of these changes remains limited. In this study, we biomechanically assessed the Madelung deformity wrist, using 4-dimensional computed tomography imaging. METHODS Nine Madelung deformity wrists (5 patients; age, 24 ± 5 y) and 18 healthy wrists (9 volunteers; age, 28 ± 3 y) underwent 4-dimensional imaging during flexion-extension motion and radioulnar deviation. Carpal kinematics and radiocarpal joint parameters were quantified and compared. RESULTS In Madelung deformity wrists, significantly decreased rotation was seen in the lunate (-4.6°) and the triquetrum (-4.8°) during flexion-extension motion. During radioulnar deviation, significant decreases were visible in lunate bone translation (-0.7 mm), triquetrum bone translation (-0.6 mm), and triquetrum bone rotation (-1.9°). Patients had significantly decreased articulating surface areas of the scaphoid (1.4 ± 0.2 cm2 versus 1.6 ± 0.2 cm2) and lunate (1.2 ± 0.4 cm2 versus 1.5 ± 0.3 cm2) fossa, and significantly increased radioscaphoid (1.3 ± 0.1 mm versus 1.2 ± 0.1 mm) and radiolunate (1.6 ± 0.2 mm versus 1.3 ± 0.3 mm) joint space thicknesses. CONCLUSIONS There is a decreased mobility of the lunate and triquetrum bones in Madelung deformity. CLINICAL RELEVANCE Four-dimensional imaging could be used in future studies that investigate the effect of surgical ligament release on carpal kinematics and subsequent wrist mobility.
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Affiliation(s)
- Abbas Peymani
- Department of Plastic, Reconstructive and Hand Surgery; Department of Biomedical Engineering and Physics.
| | - Marieke G A de Roo
- Department of Plastic, Reconstructive and Hand Surgery; Department of Biomedical Engineering and Physics
| | | | - Geert J Streekstra
- Department of Biomedical Engineering and Physics; Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Henry R McCarroll
- Department of Orthopaedic Surgery, California Pacific Medical Center, San Francisco, CA
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Lestienne V, Chaves C, Tanwin Y, Loubersac T, Gaisne E, Kerjean Y, Bellemère P. Results of interposition arthroplasty with the Amandys® pyrocarbon implant in rheumatoid wrist at a mean 5 years' follow-up. HAND SURGERY & REHABILITATION 2021; 40:579-587. [PMID: 34033930 DOI: 10.1016/j.hansur.2021.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/27/2021] [Accepted: 05/15/2021] [Indexed: 12/21/2022]
Abstract
Management of severe joint involvement in rheumatoid wrist is controversial. The gold-standard is total wrist fusion, but total wrist replacement offers a motion-conserving alternative. The purpose of this study was to present the results of interposition arthroplasty with the Amandys® pyrocarbon implant in rheumatoid wrist. We performed a retrospective review of 28 arthroplasties for rheumatoid wrist arthritis. Eighteen females and 5 males were included, with a mean age of 55.7 years. Mean follow-up was 64 months. We measured range of motion, grip strength, and pain (on VAS). Function was evaluated preoperatively and at last follow-up with the DASH and PRWE scores. Mean range of motion in flexion-extension was maintained while mean inclination and rotational range of motion showed significant improvement. Mean grip strength increased from 10 kg to 17 kg. Mean pain score decreased from 6/10 to 2/10. Mean PRWE and QuickDASH scores decreased from 62/100 to 25/100 and from 62/100 to 36/100, respectively. Three patients underwent early reoperation to reposition a dislocated implant. No implants had to be removed. Amandys® pyrocarbon arthroplasty is a reliable alternative to total fusion or total replacement in rheumatoid wrist. Indications must be limited to well-aligned wrists with competent capsule-ligament structures.
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Affiliation(s)
- V Lestienne
- Institut de la Main Nantes-Atlantique, Santé Atlantique, Avenue Claude Bernard, 44800 Saint Herblain, France
| | - C Chaves
- Institut de la Main Nantes-Atlantique, Santé Atlantique, Avenue Claude Bernard, 44800 Saint Herblain, France
| | - Y Tanwin
- Service de chirurgie orthopédique et traumatologique, CHU d'Amiens, 1 rue du Professeur Christian Cabrol, 80054 Amiens, France
| | - T Loubersac
- Institut de la Main Nantes-Atlantique, Santé Atlantique, Avenue Claude Bernard, 44800 Saint Herblain, France
| | - E Gaisne
- Institut de la Main Nantes-Atlantique, Santé Atlantique, Avenue Claude Bernard, 44800 Saint Herblain, France
| | - Y Kerjean
- Institut de la Main Nantes-Atlantique, Santé Atlantique, Avenue Claude Bernard, 44800 Saint Herblain, France
| | - P Bellemère
- Institut de la Main Nantes-Atlantique, Santé Atlantique, Avenue Claude Bernard, 44800 Saint Herblain, France.
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Campbell CC, Neustein TM, Daly CA, Wagner ER. Surgical Treatment of Wrist Arthritis in Young Patients. JBJS Rev 2021; 8:e0078. [PMID: 32149931 DOI: 10.2106/jbjs.rvw.19.00078] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Surgical treatment of wrist arthritis in the younger patient population remains a challenging issue, and various surgical options need to be carefully considered for each patient. Proximal row carpectomy and 4-corner arthrodesis have proven to be reliable options for reducing pain and restoring adequate function in most young high-demand patients if the lunate facet is spared. Selective neurectomy has proven to be a promising stand-alone or complementary procedure for the treatment of pain that is associated with wrist arthritis in patients of all ages, with spared motion and the opportunity to perform additional procedures if pain continues. Alternative procedures, including capitolunate arthrodesis, total wrist arthrodesis, radial styloidectomy, total wrist arthroplasty, and wrist hemiarthroplasty, have considerable strengths and weaknesses and need to be studied further in younger patients.
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31
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Osseous Pathology on Wrist Magnetic Resonance Imaging. Top Magn Reson Imaging 2021; 29:245-261. [PMID: 33021576 DOI: 10.1097/rmr.0000000000000257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Advanced imaging of the osseous structures of the wrist by magnetic resonance imaging (MRI) yields powerful information regarding marrow composition and overall bone structure. Various forms of pathology, both benign and malignant, have unique marrow signal abnormalities that can be easily detected by MRI given its high sensitivity to radiographically occult processes. In particular, osseous pathology can be seen in the setting of traumatic, degenerative, congenital, infectious, and neoplastic conditions. The acuity or chronicity of these conditions can often be determined by imaging to aid in appropriate therapy. A thorough understanding of the breadth of pathology and corresponding MRI appearances can allow the interpreting radiologist to formulate a concise and accurate assessment of an examination.
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Mechanical performance comparison of two surgical constructs for wrist four-corner arthrodesis via dorsal and radial approaches. Clin Biomech (Bristol, Avon) 2021; 82:105274. [PMID: 33508561 DOI: 10.1016/j.clinbiomech.2021.105274] [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: 10/21/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Four-corner arthrodesis, which involves fusing four carpal bones while removing the scaphoid bone, is a standard surgery for the treatment of advanced stages of wrist arthritis. Nowadays, it can be performed using a dorsal approach by fixing a plate to the bones and a new radial approach is in development. To date, there is no consensus on the biomechanically optimal and most reliable surgical construct for four-corner arthrodesis. METHODS To evaluate them biomechanically and thus assist the surgeon in choosing the best implant orientation, radial or dorsal, the two different four-corner arthrodesis surgical constructs were virtually simulated on a 3D finite element model representing all major structures of the wrist. Two different realistic load sets were applied to the model, representing common tasks for the elderly. FINDINGS Results consistency was assessed by comparing with the literature the force magnitude computed on the carpal bones. The Von Mises stress distribution in the radial and dorsal plates were calculated. Stress concentration was located at the plate-screw interface for both surgical constructs, with a maximum stress value of 413 MPa for the dorsal plate compared to 326 MPa for the radial plate, meaning that the stress levels are more unfavourable in the dorsal approach. INTERPRETATION Although some bending stress was found in one load case, the radial plate was mechanically more robust in the other load case. Despite some limitations, this study provides, for the first time, quantified evidence that the newly developed radial surgical construct is mechanically as efficient as the dorsal surgical construct.
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Approaching "Elective" Surgery in the Era of COVID-19. J Hand Surg Am 2021; 46:60-64. [PMID: 33223343 PMCID: PMC7522705 DOI: 10.1016/j.jhsa.2020.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/14/2020] [Accepted: 09/16/2020] [Indexed: 02/02/2023]
Abstract
The coronavirus disease 2019 pandemic created unprecedented challenges for the health care system. To meet capacity demands, hospitals around the world suspended surgeries deemed to be elective. In hand surgery, numerous pathologies are treated on an elective basis, but a delay or absence of care may result in poorer outcomes. Here, we present an ethical framework for prioritizing elective surgery during a period of resource scarcity. Instead of using the term "elective," we define procedures that can be safely delayed on the basis of 3 considerations. First, a safe delay is possible only if deferral will not result in permanent injury. Second, a delay in care will come with tolerable costs and impositions that can be appropriately managed in the future. Third, a safe delay will preserve the bioethical principle of patient autonomy. In considering these criteria, 3 case examples are discussed considering individual patient characteristics and the pathophysiology of the condition. This framework design is applicable to ambulatory surgery in any period of crisis that may strain resources, but further considerations may be important if an operation requires hospital admission.
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Thompson RG, Dustin JA, Roper DK, Kane SM, Lourie GM. Suture Tape Augmentation for Scapholunate Ligament Repair: A Biomechanical Study. J Hand Surg Am 2021; 46:36-42. [PMID: 32811693 DOI: 10.1016/j.jhsa.2020.06.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 05/10/2020] [Accepted: 06/30/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Scapholunate (SL) ligament tears in the acute setting can be treated by primary repair through various techniques. The purpose of this study was to compare repair of the SL ligament with suture anchors alone versus repair of the SL ligament augmented with suture tape. METHODS Twelve fresh-frozen cadavers (6 matched pairs) underwent a dorsal approach to the wrist and the SL ligament was sharply dissected off of its scaphoid attachment. Six cadavers underwent direct repair of the SL ligament using 2 suture anchors. The other 6 underwent repair of the SL ligament, which was then augmented with suture tape. All specimens then underwent load to failure testing using tensile distraction forces applied by a universal testing system. Maximum load to failure and mode of failure were recorded. RESULTS Maximum load to failure (135 N; SD, 44.94 N) for specimens that were repaired and augmented with the internal brace was higher than that for specimens in the repair-only group (68 N; SD, 14.69 N). CONCLUSIONS Biomechanical testing demonstrated a higher maximum load to failure in SL ligament repairs augmented with suture tape compared with a repair-only technique in this cadaveric model. CLINICAL RELEVANCE Acute SL ligament injuries may benefit from suture tape augmentation by increasing the stability of the primary repair. This may prove to be beneficial in higher-demand patients.
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Affiliation(s)
- R Gil Thompson
- Department of Orthopedic Surgery, Wellstar Atlanta Medical Center, Atlanta, GA.
| | - Joel A Dustin
- Department of Biological Engineering, Utah State University, Logan, UT
| | - D Keith Roper
- Department of Biological Engineering, Utah State University, Logan, UT
| | - Steven M Kane
- Department of Orthopedic Surgery, Wellstar Atlanta Medical Center, Atlanta, GA
| | - Gary M Lourie
- Department of Orthopedic Surgery, Wellstar Atlanta Medical Center, Atlanta, GA; The Hand and Upper Extremity Center of Georgia, Atlanta, GA
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Oliveira RKD, Aita M, Brunelli J, Carratalá V, Delgado PJ. Introducing the “SOAC Wrist”: Scaphotrapeziotrapezoid Osteoarthritis Advanced Collapse. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2020. [DOI: 10.1055/s-0040-1721045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
AbstractDespite being the second most common osteoarthritis of the wrist, little is known about scaphotrapeziotrapezoid osteoarthritis. Not all patients with this type of osteoarthritis have symptoms, and, even in those symptomatic patients, the intensity of the complaint is not proportional to the severity of the degeneration. In symptomatic patients, when the conservative treatment fails, grading classifications to help define the surgical treatment are solely based on the joint characteristics, and fail to assess the rest of the carpus.In general, most carpal degenerative processes show the same evolution pattern, which varies according to the initial injury, along with the type of deformity and the inherent instabilities. Thus, we hypothesize that the degenerative evolution due to primary osteoarthritis of the scaphotrapeziotrapezoid joint also follows a logical evolutionary sequence, similar to the one that occurs in cases of scapholunate advanced collapse (SLAC), scaphoid nonunion advanced collapse (SNAC), scaphoid malunion advanced collapse (SMAC), and scaphoid chondrocalcinosis advanced collapse (SCAC), thus resulting in scaphotrapeziotrapezoid osteoarthritis advanced collapse (SOAC). We have divided the SOAC into three groups, and considered that their treatment shall be guided by the evolutionary stage of the disease, and not by the surgeon's preferred technique.
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Affiliation(s)
| | - Márcio Aita
- Universidade Federal do ABC, Santo André, SP, Brazil
| | - João Brunelli
- Department of Orthopedics and Traumatology, Cirurgia de Mão e Microcirurgia, Santa Casa de Misericórdia, São Paulo, SP, Brazil
| | - Vicente Carratalá
- Traumatology Service, Hospital Quirónsalud Valencia, Valencia, Spain
| | - Pedro J Delgado
- Hospital Universitário HM Montepríncipe, Universidad CEU San Pablo, Boadilla del Monte, Madrid, Spain
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Kromka JJ, Maher P, Fowler JR. Volar Carpus Dislocation Following Proximal Row Carpectomy for Scapholunate Advanced Collapse: A Rare Complication. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2020; 2:260-265. [PMID: 35415498 PMCID: PMC8991635 DOI: 10.1016/j.jhsg.2020.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 04/16/2020] [Indexed: 10/26/2022] Open
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Abstract
To elucidate whether nonsurgical treatment for Preiser disease is effective.Eight patients with Preiser disease (median age 59 [47-69] years) underwent nonsurgical treatment (median symptom-onset-to-treatment interval 8 [9-180] months). At presentation, 7 patients complained of constant pain and 1 of motion-related pain. Pain restricted wrist range of motion (median modified Mayo wrist score [MMWS] 17.5 [range 10-30]). Radiography revealed stages 1 to 3 disease (Herbert-Lanzetta classification). Median scapholunate angle was 62° (54°-75°), with 3 wrists suffering dorsal intercalated segment instability (DISI). Magnetic resonance imaging showed (Kalainov criteria) 4 stage 1 wrists (complete necrosis) and 4 stage 2 (incomplete necrosis). Two had concomitant Kienböck disease. All patients underwent nonsurgical treatment (ie, oral pain killer, immobilization, rest) and were monitored via radiographic and clinical evaluations. Scapholunate angles and the scaphoid area reduction ratio were calculated using radiography. Response criteria were the patients' subjective and objective status. Endpoint was the time from start of non-surgical to surgical treatment.Immobilization lasting 0 to 24 months (median 1.8 months) did not relieve their symptoms. Follow-up radiography showed that the disease stage had progressed in 5 of 8 wrists, with 5 wrists having DISI. The median area reduction ratio of the scaphoid was 11% (4%-52%) on anteroposterior views and 4% (-23% to 17%) on lateral views. Compared with the contralateral wrist, the median wrist flexion-extension arc was 61% (50%-79%) and the median grip strength 39%. Median MMWS score was 17.5 (10-25) - poor in 6 of 8 patients. Surgery was thus necessary in all patients.Nonsurgical treatment for Preiser disease did not improve subjective or objective outcomes and did not prevent deterioration of radiographic findings.Type of study/level of evidence: Therapeutic, Level V.
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Abstract
Background: Scapholunate advanced collapse (SLAC) is the most common pattern of wrist arthritis. Sparse data exist regarding the SLAC wrist pattern of arthritis. This study aimed to document the epidemiology of advanced SLAC in terms of patients' sociodemographics and possible association with trauma. Methods: Sixty-one patients with severe SLAC wrist were included. Baseline sociodemographic characteristics were reviewed. To evaluate the relationship to injury, this group of cases was compared with a control group of 61 patients with first carpometacarpal osteoarthritis (CMC OA). The following data were collected for both groups: age, gender, history of traumatic injury, history of manual labor, duration of symptoms, and dominant hand involvement. Pearson chi-square tests for categorical variables and independent samples t test for continuous variables were performed to determine differences between groups. Results: Patients with SLAC wrist were more likely to be male (80.3% vs 31.1%; p<0.001), have a history of a traumatic injury (69.5% vs 25.9%, P < .001), have longer symptom duration (10.3 ± 13.3 vs 3.5 ± 2.5 years, P = .001), be involved in a manual labor job (49.0% vs 20.0%, P = .002), and be younger (53.1 ± 10.4 vs 58.3 ± 9.8; P = .006) compared with patients with CMC OA. There was no difference in dominant hand involvement (49.2% vs 53.3%; P = .571) between the groups. Conclusions: This study identified the characteristics of patients with advanced SLAC wrist. Compared with a control cohort of CMC OA, patients with SLAC wrist were more likely to be male, have a history of a traumatic injury, and be younger.
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Affiliation(s)
| | | | | | | | - Steven J. McCabe
- University of Toronto, Ontario,
Canada,Steven J. McCabe, Division of Plastic and
Reconstructive Surgery, Toronto Western Hospital, 399 Bathurst Street, 2 East
Wing, Toronto, ON M5T 2S8, Canada.
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Tomori Y, Sawaizumi T, Nanno M, Takai S. Closing Radial Wedge Osteotomy for Preiser Disease: Clinical Outcomes. J Hand Surg Am 2019; 44:896.e1-896.e10. [PMID: 30685137 DOI: 10.1016/j.jhsa.2018.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 09/25/2018] [Accepted: 11/18/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine clinical outcomes of Preiser disease treated with closing radial wedge osteotomy (CRWO). METHODS Seven patients with Preiser disease underwent CRWO. Two wrists had stage 2 disease, 3 had stage 3, 2 had stage 4 (Herbert-Lanzetta classification). Magnetic resonance imaging (MRI) showed that 4 wrists had stage 1 and 3 had stage 2 indicating complete and incomplete necrosis, respectively (Kalainov criteria), before surgery. Two wrists had concomitant Kienböck disease. The range of motion (ROM) of the wrists was restricted owing to pain, and median Modified Mayo Wrist Score (MMWS) was 15 points. Patients were followed after surgery with radiography, MRI, and clinical evaluation (ROM, grip strength, MMWS). Radiolunate and scapholunate angles were calculated on lateral radiographs. RESULTS Although there were no usual postoperative complications (eg, infection, neuropathy, distal radius nonunion), 1 patient had an extensor pollicis longus tendon rupture, and another experienced osteoarthritis with deterioration of the distal radioulnar joint. Final follow-up radiography showed that 2 wrists were stage 3, 5 were stage 5 (Herbert-Lanzetta classification). At 1 year after surgery, T1-weighted MRI showed that 2 of 6 wrists had improved from stage 1 to stage 2 (Kalainov criteria). At the final evaluation, 5 wrists had no pain, and 2 had only mild pain. Compared with the contralateral wrist, the median ROM was 80% in extension, 73% in flexion. Median grip strength was 71%, median MMWS was 75 points, and clinical results were good in 1 patient, fair in 5, and poor in 1. CONCLUSIONS Although follow-up radiography showed that the disease stage had progressed in 4 of 7 patients, wrist pain alleviation, retention of ROM, and improvement of grip strength were obtained. The CRWO may be an option for reducing wrist pain and retaining ROM of the wrist owing to Preiser disease. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Affiliation(s)
- Yuji Tomori
- Department of Orthopaedic Surgery, Nippon Medical School, Tokyo, Japan.
| | - Takuya Sawaizumi
- Department of Orthopaedic Surgery, Nippon Medical School, Tokyo, Japan
| | - Mitsuhiko Nanno
- Department of Orthopaedic Surgery, Nippon Medical School, Tokyo, Japan
| | - Shinro Takai
- Department of Orthopaedic Surgery, Nippon Medical School, Tokyo, Japan
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Montiel V, Payo-Ollero J, Amillo S. Proximal row carpectomy in patients older than 50 years: 3 to 16 years of follow-up. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019. [DOI: 10.1016/j.recote.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Kim SR. Successful treatment of scapholunate advanced collapse: A case report. Clin Case Rep 2019; 7:1230-1232. [PMID: 31183100 PMCID: PMC6552941 DOI: 10.1002/ccr3.2201] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/03/2019] [Accepted: 04/26/2019] [Indexed: 12/20/2022] Open
Abstract
This case illustrates the successful treatment by injection of amniotic membrane and umbilical cord particulate for scapholunate advanced collapse unresponsive to traditional nonsurgical treatment.
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Affiliation(s)
- Sunny R. Kim
- Progressive Rehabilitation Medicine, PCCedar RapidsIowa
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Montiel V, Payo-Ollero J, Amillo S. Proximal row carpectomy in patients older than 50 years: 3 to 16 years of follow-up. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 63:295-299. [PMID: 30926416 DOI: 10.1016/j.recot.2019.02.001] [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: 10/22/2018] [Revised: 01/22/2019] [Accepted: 02/01/2019] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To analyze the long-term results and the prognosis of patients who have undergone proximal row carpectomy (PRC) in our hospital. MATERIAL AND METHOD This is a retrospective study of 14 patients undergoing PRC with a follow-up of 3 to 16 years. The ability to perform daily activities, mobility and functional capacity after the surgery were assessed using the Patient-Rated Wrist Evaluation questionnaire (PRWE). RESULTS The range of movement was satisfactory. The mean score on the PRWE scale was 20.9±17.2 for the pain subscale and 39±35.5 for the functional capacity subscale. None of the patients required revision surgery or developed complications. Eighty percent of the patients were satisfied or very satisfied. Ninety percent of the patients would undergo surgery again. DISCUSSION The wrist's range of movement achieved with this technique is similar to that obtained with other mobility preservation techniques. Secondary arthritic changes in the radio-capitate joint do not necessarily produce pain. Some authors have described that the degree of satisfaction after PRC is equivalent to that of other procedures such as arthrodesis in 4 corners with circular plate arthrodesis or middle-carpal arthrodesis. CONCLUSION PRC achieved high satisfaction rates among the patients providing pain relief, good mobility and post-operative functionality of the wrist. In addition, it presented few complications.
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Affiliation(s)
- V Montiel
- Departamento Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, Navarra, España.
| | - J Payo-Ollero
- Departamento Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - S Amillo
- Departamento Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, Navarra, España
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Development of Autologous Platelet-Rich Plasma Mixed-Microfat as an Advanced Therapy Medicinal Product for Intra-Articular Injection of Radio-Carpal Osteoarthritis: From Validation Data to Preliminary Clinical Results. Int J Mol Sci 2019; 20:ijms20051111. [PMID: 30841510 PMCID: PMC6429478 DOI: 10.3390/ijms20051111] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 02/25/2019] [Accepted: 02/28/2019] [Indexed: 12/11/2022] Open
Abstract
Wrist osteoarthritis (OA) is one of the most common conditions encountered by hand surgeons with limited efficacy of non-surgical treatments. The purpose of this study is to describe the Platelet-Rich Plasma (PRP) mixed-microfat biological characteristics of an experimental Advanced Therapy Medicinal Product (ATMP) needed for clinical trial authorization and describe the clinical results obtained from our first three patients 12 months after treatment (NCT03164122). Biological characterization of microfat, PRP and mixture were analysed in vitro according to validated methods. Patients with stage four OA according to the Kellgren Lawrence classification, with failure to conservative treatment and a persistent daily painful condition >40 mm according to the visual analog scale (VAS) were treated. Microfat-PRP ATMP is a product with high platelet purity, conserved viability of stromal vascular fraction cells, chondrogenic differentiation capacity in vitro and high secretion of IL-1Ra anti-inflammatory cytokine. For patients, the only side effect was pain at the adipose tissue harvesting sites. Potential efficacy was observed with a pain decrease of over 50% (per VAS score) and the achievement of minimal clinically important differences for DASH and PRWE functional scores at one year in all three patients. Microfat-PRP ATMP presented a good safety profile after an injection in wrist OA. Efficacy trials are necessary to assess whether this innovative strategy could delay the necessity to perform non-conservative surgery.
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Classifications in Brief: Watson and Ballet Classification of Scapholunate Advanced Collapse Wrist Arthritis. Clin Orthop Relat Res 2019; 477:663-666. [PMID: 30179931 PMCID: PMC6382201 DOI: 10.1097/corr.0000000000000451] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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MR angiogram confirms sustained blood flow in 1,2 ICSR artery of vascularized bone grafting in scaphoid nonunion treatment. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:343-348. [DOI: 10.1007/s00590-018-2339-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 11/03/2018] [Indexed: 12/21/2022]
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Dean B, Henari S, Thurley N, Little C, McNab I, Riley N. Therapeutic interventions for osteoarthritis of the wrist: a systematic review and meta-analysis. F1000Res 2018; 7:1484. [PMID: 30631440 PMCID: PMC6281017 DOI: 10.12688/f1000research.16218.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2018] [Indexed: 12/21/2022] Open
Abstract
Background: In order to evaluate the effectiveness of interventions for osteoarthritis of the wrist in adults we performed a systematic review and meta-analysis. Methods: The MEDLINE and EMBASE via OVID, CINAHL and SPORTDiscus via EBSCO databases were searched from inception to 25 th April 2018.All randomised controlled clinical trials (RCTs) and any prospective studies of adults with wrist osteoarthritis investigating any intervention with a comparator were included. Data were extracted and checked for accuracy and completeness by pairs of reviewers. Primary outcomes were pain and function. Comparative treatment effects were analysed by random effects at all time points. Results: Three RCTs were identified for inclusion after screening and all had a high risk of bias. Two compared proximal row carpectomy (PRC) with four corner fusion (4CF) for post-traumatic osteoarthritis, while the other compared leather with commercial wrist splints in patients with chronic wrist pain, of which a small group had wrist osteoarthritis. Conclusion: There is no prospective study comparing operative to non-operative treatment for wrist osteoarthritis, while there is a paucity of prospective studies assessing the effectiveness of both non-operative and operative interventions. Further research is necessary in order to better define which patients benefit from which specific interventions. Registration: The review protocol was registered with PROSPERO under the registration number CRD42018094799.
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Affiliation(s)
- Benjamin Dean
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, Oxon, OX3 7LD, UK
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, Oxon, OX3 7LD, UK
| | - Shwan Henari
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, Oxon, OX3 7LD, UK
| | - Neal Thurley
- Bodleian Health Care Libraries, University of Oxford, Oxford, Oxon, OX3 9DU, UK
| | - Chris Little
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, Oxon, OX3 7LD, UK
| | - Ian McNab
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, Oxon, OX3 7LD, UK
| | - Nicholas Riley
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, Oxon, OX3 7LD, UK
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Dean B, Henari S, Thurley N, Little C, McNab I, Riley N. Therapeutic interventions for osteoarthritis of the wrist: a systematic review and meta-analysis. F1000Res 2018; 7:1484. [PMID: 30631440 PMCID: PMC6281017 DOI: 10.12688/f1000research.16218.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2018] [Indexed: 10/05/2023] Open
Abstract
Background: In order to evaluate the effectiveness of interventions for osteoarthritis of the wrist in adults we performed a systematic review and meta-analysis. Methods: The MEDLINE and EMBASE via OVID, CINAHL and SPORTDiscus via EBSCO databases were searched from inception to 25 th April 2018.All randomised controlled clinical trials (RCTs) and any prospective studies of adults with wrist osteoarthritis investigating any intervention with a comparator were included. Data were extracted and checked for accuracy and completeness by pairs of reviewers. Primary outcomes were pain and function. Comparative treatment effects were analysed by random effects at all time points. Results: Three RCTs were identified for inclusion after screening and all had a high risk of bias. Two compared proximal row carpectomy (PRC) with four corner fusion (4CF) for post-traumatic osteoarthritis, while the other compared leather with commercial wrist splints in patients with chronic wrist pain, of which a small group had wrist osteoarthritis. Conclusion: There is no prospective study comparing operative to non-operative treatment for wrist osteoarthritis, while there is a paucity of prospective studies assessing the effectiveness of both non-operative and operative interventions. Further research is necessary in order to better define which patients benefit from which specific interventions. Registration: The review protocol was registered with PROSPERO under the registration number CRD42018094799.
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Affiliation(s)
- Benjamin Dean
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, Oxon, OX3 7LD, UK
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, Oxon, OX3 7LD, UK
| | - Shwan Henari
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, Oxon, OX3 7LD, UK
| | - Neal Thurley
- Bodleian Health Care Libraries, University of Oxford, Oxford, Oxon, OX3 9DU, UK
| | - Chris Little
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, Oxon, OX3 7LD, UK
| | - Ian McNab
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, Oxon, OX3 7LD, UK
| | - Nicholas Riley
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, Oxon, OX3 7LD, UK
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48
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Health Effects of Wrist-Loading Sports During Youth: A Systematic Literature Review. J Phys Act Health 2018; 15:708-720. [PMID: 29741447 DOI: 10.1123/jpah.2017-0328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The benefits and risks of performing popular wrist-loading sports at a young age have not been investigated systematically. We aimed to evaluate positive and negative long-term wrist-related health effects of sports performance requiring repetitive wrist loading during youth. METHODS Six databases were searched for cohort and cross-sectional studies. Three investigators selected studies evaluating quantitatively measured health effects of upper extremities in athletes practicing wrist-loading sports (gymnastics, tennis, volleyball, field hockey, rowing, and judo) for minimally 4 months before the age of 18. RESULTS A total of 23 studies with 5 outcome measures, nearly all of moderate to good quality, were eligible for inclusion. Bone mineral density and bone mineral content were higher in athletes compared with controls and in tennis players' dominant arm. Mixed results were found for ulnar variance in gymnasts. Handgrip strength was greater in tennis players' dominant arm and in experienced gymnasts. CONCLUSIONS Wrist-loading sports performance during youth can promote bone strength in wrists and dominant handgrip strength, but evidence on the lasting of these effects and on prevalence of wrist joint degeneration in former young athletes is limited. For better counseling of young athletes and their parents, future studies with increased comparability are essential, for which recommendations are provided.
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Abstract
Scapholunate ligament (SLL) injuries are a common cause of wrist pain and instability. Treatment of SLL injuries requires intricate understanding of wrist anatomy and biomechanics. Mindful physical exam and appropriate diagnostic studies can orient the surgeon to the defined stage of injury. Review of the literature on each treatment by stage can prepare the upper extremity surgeon to provide the best evidence-based care. The optimal management of SLL injuries should result in a stable, painless wrist.
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Affiliation(s)
- Geoffrey Konopka
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA,
| | - Harvey Chim
- Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine, Gainesville, FL, USA,
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50
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Buijze GA, Leong NL, Stockmans F, Axelsson P, Moreno R, Ibsen Sörensen A, Jupiter JB. Three-Dimensional Compared with Two-Dimensional Preoperative Planning of Corrective Osteotomy for Extra-Articular Distal Radial Malunion: A Multicenter Randomized Controlled Trial. J Bone Joint Surg Am 2018; 100:1191-1202. [PMID: 30020124 DOI: 10.2106/jbjs.17.00544] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Malunion is the most frequent complication seen after a fracture of the distal end of the radius. The primary aim of this study was to compare patient-reported outcome measures (PROMs) after corrective osteotomy for malunited distal radial fractures with and without 3-dimensional (3D) planning and use of patient-specific surgical guides. METHODS From September 2010 to May 2015, 40 adult patients with a symptomatic extra-articular malunited distal radial fracture were randomized to 3D computer-assisted planning or conventional 2-dimensional (2D) planning for corrective osteotomy. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) score. Secondary outcomes included the Patient-Rated Wrist Evaluation (PRWE) score, pain and satisfaction scores, grip strength, and radiographic measurements at 3, 6, and 12 months postoperatively. RESULTS From baseline to 12 months of follow-up, the reduction in the mean DASH score was -30.7 ± 18.7 points for the 3D planning group compared with -20.1 ± 17.8 points for 2D planning (p = 0.103). Secondary functional outcome by means of the PRWE resulted in a similar reduction of -34.4 ± 22.9 points for the 3D planning group compared with -26.6 ± 18.3 points for the 2D planning group (p = 0.226). There were no significant differences in pain, satisfaction, range of motion, and grip strength. Radiographic analysis showed significant differences in the mean residual volar angulation (by 3.3°; p = 0.04) and radial inclination (by 2.7°; p = 0.028) compared with the templated side, in favor of 3D planning and guidance. The duration of preoperative planning and surgery as well as complication rates were comparable. CONCLUSIONS Although there was a trend toward a minimal clinically important difference in PROMs in favor of 3D computer-assisted guidance for corrective osteotomy of extra-articular distal radial malunion, it did not attain significance because of (post hoc) insufficient power. Despite the challenge of feasibility, a trial of large magnitude is warranted to draw definitive conclusions regarding clinical advantages of this advanced, more expensive technology. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Geert A Buijze
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, the Netherlands.,Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Natalie L Leong
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Filip Stockmans
- Handgroep Groeninge, AZ Groeninge, Kortrijk, Belgium.,KU Leuven Campus Kortrijk, Kortrijk, Belgium
| | - Peter Axelsson
- Department of Hand Surgery, Institute of Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rodrigo Moreno
- Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, Kentucky
| | - Allan Ibsen Sörensen
- Department of Hand Surgery, Institute of Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jesse B Jupiter
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
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