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Paeffgen L, Riederer J, Adler T, Voegelin E, Haug LCP. Carpal instability after partial trapeziectomy, total trapeziectomy and the resection of the distal scaphoid pole: a cadaveric study. Arch Orthop Trauma Surg 2024; 144:1443-1451. [PMID: 38123865 DOI: 10.1007/s00402-023-05134-z] [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: 07/19/2023] [Accepted: 11/08/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Non-dissociative carpal instability (CIND) may lead to severe functional impairment. Destabilisation of the scapho-trapezial-trapezoidal (STT) ligament complex seems to result in a CIND. MATERIALS AND METHODS In one group with eight cadaver arms, distal scaphoid pole was resected with the adjacent ligaments. In the other eight cadavers, hemitrapeziectomy was performed followed by total trapeziectomy. CT scans were performed in different wrist positions, and the changed positions of the scaphoid, lunate and capitate were measured in comparison to non-operated wrists. RESULTS Mainly in clenched fist position, dissociation between proximal and distal row can be determined after total trapeziectomy and resection of distal scaphoid pole. Capitate rotates dorsally up to 24°, the scaphoid up to 17° and the lunate up to 7° compared to the non-operated wrists. Resection of the distal scaphoid pole results in dorsal rotation of capitate and scaphoid of about 14° and the lunate 8°. Relative scapholunate and capitolunate angle increased significantly after total trapeziectomy, especially in clenched fist position. After scaphoid pole resection, significant SL and CL angles changes could be seen in almost every wrist position. CONCLUSION Destabilisation of the STT ligament complex by total trapeziectomy or distal scaphoid pole resection results in dissociation of the proximal and distal carpal row without instability within the proximal or distal row, corresponding to a CIND. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Leo Paeffgen
- Hand Surgery and Surgery of Peripheral Nerves, University Hospital of Bern, CH-3010, Bern, Switzerland
| | - Janina Riederer
- Hand Surgery and Surgery of Peripheral Nerves, University Hospital of Bern, CH-3010, Bern, Switzerland
| | - Tom Adler
- Orthoklinik Dornach AG, CH-4143, Dornach, Switzerland
| | - Esther Voegelin
- Hand Surgery and Surgery of Peripheral Nerves, University Hospital of Bern, CH-3010, Bern, Switzerland
| | - Luzian C P Haug
- Hand Surgery and Surgery of Peripheral Nerves, University Hospital of Bern, CH-3010, Bern, Switzerland.
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2
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Bae JY, Choi SW, Lee W, Song MG, Song JS, Kim JK. Cancellous bone graft from the distal radius and headless screw fixation for unstable scaphoid waist nonunion. INTERNATIONAL ORTHOPAEDICS 2024; 48:487-493. [PMID: 37796332 DOI: 10.1007/s00264-023-05998-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/27/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE Cancellous bone harvested from the distal radius has been used in various hand surgeries, but studies on its use in scaphoid waist nonunions are insufficient. We investigated the usefulness of cancellous bone graft from the distal radius and headless screw fixation in unstable scaphoid waist nonunion. METHODS Thirty-one patients who underwent cancellous bone graft from the distal radius and headless screw fixation for unstable scaphoid waist nonunion with follow-up for at least 1 year were included. Bone union time, the number of patients with bone union at six and 12 weeks, total number of patients with bone union at last follow-up, and bone union on the computed tomography (CT) image at postoperative six weeks were evaluated. Further, pre- and postoperative radiological measurements, such as scaphoid length and height, lateral intra-scaphoid angle, and height-to-length ratio, and functional outcomes were compared. Additionally, inter-observer reliability of radiologic parameters was checked. RESULTS Bone union was achieved in 29 patients. There were two nonunions (6.5%). Bone union time was 10.7 (range, 6-26) weeks. Eighteen (58%) and 25 patients (80.6%) were diagnosed with bone union on the plain radiographs at six and 12 weeks, respectively. Twenty-two patients (71%) were diagnosed with bone union on CT performed at six weeks. Radiological measurements and functional outcomes improved postoperatively. The scaphoid length showed good inter-observer agreement. CONCLUSIONS In treating unstable scaphoid waist nonunion, cancellous bone graft from the distal radius and headless screw fixation achieved 93.5% union and improved radiological measurements as well as functional outcomes.
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Affiliation(s)
- Joo-Yul Bae
- Department of Orthopedic Surgery, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, Korea
| | - Shin Woo Choi
- Department of Orthopedic Surgery, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, Korea
| | - Wonsun Lee
- Department of Orthopedic Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Myeong Geun Song
- Department of Orthopedic Surgery, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, Korea
| | - Jae-Seok Song
- Department of Preventive Medicine & Public Health, Catholic Kwandong University College of Medicine, Gangneung, Korea
| | - Jae Kwang Kim
- Department of Orthopedic Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
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Gvozdenovic R, Presman B, Larsen MB, Radev DI, Joerring S, Jensen CH. Can CT-Scan Measurements of Humpback Deformity, Dislocation, and the Size of Bony Cysts Predict Union after Surgery for Scaphoid Nonunion? J Wrist Surg 2021; 10:418-429. [PMID: 34631295 PMCID: PMC8490000 DOI: 10.1055/s-0041-1730342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/13/2021] [Indexed: 10/21/2022]
Abstract
Objective Scaphoid fractures are associated with high rates of late- or nonunion after conservative treatment. Nonunion is reported to occur in approximately 10% of all scaphoid fractures. It is known that the union of scaphoid fractures is affected by factors such as location at proximal pole, tobacco smoking, and the time from injury to treatment. Same factors seem to affect the healing after surgery for scaphoid nonunion. While the impact of preoperative humpback deformity on the functional outcome after surgery has been previously reported, the impact of humpback deformity, displacement, and the presence of bony cysts on union rate and time to healing after surgery has not been studied. Purpose The primary purpose of this study is to assess the association of humpback deformity, fragment displacement, and the size of cysts along the fracture line with the union rate and union time, following surgery of scaphoid nonunion. The second purpose of the study is to investigate the interobserver reliability in the evaluation of computed tomography (CT) scans of scaphoid nonunion. Patients and Methods From January 2008 to December 2018, 178 patients were surgically treated in our institution. After exclusion criteria were met, 63 patients with scaphoid delayed- or established nonunion, and preoperative CT scans of high quality (<2mm./ slice), were retrospectively analyzed. There was 58 men and 5 women with a mean age of 30 years (range: 16-72 years). Four orthopaedic surgeons and one radiologist independently analyzed the CT scans. The dorsal cortical angle (DCA), lateral intrascaphoid angle (LISA), the height-to-length ratio, the size of the cysts, and displacement of the fragments were measured. Healing was defined by CT scan, or by conventional X-ray, and status of no pain at clinical examination. Thirty-two of the patients had developed nonunion (>6 months postinjury), while 31 were in a stage of delayed union (3-6 months postinjury). Results Open surgery with cancellous or structural bone graft was the treatment of choice in 49 patients, 8 patients were treated with arthroscopic bone grafting, and 6 patients with delayed union were operated with percutaneous screw fixation, without bone graft. Overall union rate was 86% (54/63) and was achieved after 84 days (12 weeks) (mean). The failure rate and time to healing were not associated with the degree of the humpback deformity, size of the cysts, or displacement of the nonunion in general. However, greater dislocation, and the localization of the nonunion at the scaphoid waist, showed significant influence on the union rate. Dislocation at nonunion site, in the group of the patients who united after surgery, was 2.7 mm (95% confidence interval [CI]: 1.5-3.7), and in the group who did not unite was 4.2 mm (95% CI: 2.9-5.7); p = 0.048). Time from injury to surgery was significantly correlated with time to union ( p < 0.05), but not associated with the union rate ( p < 0.4). Patients treated arthroscopically achieved faster healing (42 days), (standard deviation [SD]: 22.27) as compared with patients treated by open techniques (92 days; SD: 70.86). Agreement among five observers calculated as intraclass correlation coefficient was for LISA: 0.92; for height-to-length ratio: 0.73; for DCA: 0.65; for size of cysts: 0.61; and for displacement in millimeters: 0.24, respectively. Conclusions The degree of humpback deformity and the size of cysts along the fracture line of scaphoid nonunion have no predictive value for the result, neither for the union rate nor the union time after surgery for the scaphoid nonunion. However, larger dislocation of the fragments measured at the scaphoid waist showed lower union rate. Time to healing following surgery is mainly influenced by the time from injury to the surgical treatment and may be influenced by the choice of the surgical technique. Interrater reliability calculation was best with LISA measurements, and worse with the measurements of the dislocation. Level of Evidence This is a Level III, observational, case-control study.
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Affiliation(s)
- Robert Gvozdenovic
- Department of Orthopedics, Hand Surgery Unit, Herlev/Gentofte Copenhagen University Hospital, Hellerup, Denmark
| | - Benjamin Presman
- Department of Orthopedics, Hvidovre Copenhagen University Hospital, Hvidovre, Denmark
| | - Morten Bo Larsen
- Department of Orthopedics, Hand Surgery Unit, Herlev/Gentofte Copenhagen University Hospital, Hellerup, Denmark
| | - Dimitar Ivanov Radev
- Department of Radiology, Bispebjerg/Frederiksberg Copenhagen University Hospital, Copenhagen NV, Denmark
| | - Stig Joerring
- Department of Orthopedics, Hand Surgery Unit, Herlev/Gentofte Copenhagen University Hospital, Hellerup, Denmark
| | - Claus Hjorth Jensen
- Department of Orthopedics, Hand Surgery Unit, Herlev/Gentofte Copenhagen University Hospital, Hellerup, Denmark
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4
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Guldbrandsen CW, Radev DI, Gvozdenovic R. Normal ranges for measurements of the scaphoid bone from sagittal computed tomography images. J Hand Surg Eur Vol 2021; 46:594-599. [PMID: 33459143 PMCID: PMC8226418 DOI: 10.1177/1753193420987522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study aimed to determine normal values of three parameters commonly used to determine malunion by investigating intact scaphoids on sagittal computed tomography images from healthy individuals. We analysed 62 normal scaphoids and found the mean height-length ratio, lateral intrascaphoid angle and dorsal cortical angle to be 0.58, 27° and 128°, respectively. These measurements had good-to-excellent, poor-to-moderate and moderate-to-good inter- and intra-rater reliabilities, respectively. This study provides information on normal parameters of the scaphoid that may inform clinical decision making when assessing malunion. We suggest that the lateral intrascaphoid angle should be used with great caution as a measure of deformity.Level of evidence: III.
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Affiliation(s)
- Cæcilie W. Guldbrandsen
- Department of Hand Surgery, Herlev/Gentofte
University Hospital of Copenhagen, Hellerup, Denmark,Cæcilie W. Guldbrandsen, Department of Orthopedic
Surgery, Hand Surgery Unit, Herlev/Gentofte University Hospital, Gentofte Hospitalsvej 17,
st., 2900 Hellerup, Denmark.
| | - Dimitar I. Radev
- Department of Radiology, Bispebjerg and
Frederiksberg Hospital, Copenhagen, Denmark
| | - Robert Gvozdenovic
- Department of Hand Surgery, Herlev/Gentofte
University Hospital of Copenhagen, Hellerup, Denmark
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5
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Peeters W, Verstreken F, Vanhees M. Correction of scaphoid nonunion humpback deformity using three-dimensional printing technology. J Hand Surg Eur Vol 2021; 46:430-432. [PMID: 33121299 DOI: 10.1177/1753193420967295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Wouter Peeters
- Department of Orthopedic Surgery, Monica Hospital, Antwerp, Belgium
| | - Frederik Verstreken
- Department of Orthopedic Surgery, Monica Hospital, Antwerp, Belgium.,Department of Orthopedic Surgery, Antwerp University Hospital, Antwerp, Belgium.,Monica Orthopedic Research (MoRe) Institute, Antwerp, Belgium
| | - Matthias Vanhees
- Department of Orthopedic Surgery, Monica Hospital, Antwerp, Belgium.,Department of Orthopedic Surgery, Antwerp University Hospital, Antwerp, Belgium.,Monica Orthopedic Research (MoRe) Institute, Antwerp, Belgium
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Schmidle G, Kastenberger TJ, Kaiser P, Stock K, Benedikt S, Arora R. [3D Imaging for the analysis of scaphoid fractures and non-unions]. HANDCHIR MIKROCHIR P 2020; 52:392-398. [PMID: 32992396 DOI: 10.1055/a-1250-7913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
The aim of the present study is to give an overview over the possibilities of 3D imaging in the analysis of scaphoid fractures and non-unions and to discuss them on the base of case studies and literature.
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Affiliation(s)
- Gernot Schmidle
- Medical University Innsbruck, University Hospital for Trauma Surgery
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7
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Nagy L. [3D analysis and computer assisted reconstruction for scaphoid non-union]. HANDCHIR MIKROCHIR P 2020; 52:435-440. [PMID: 32992399 DOI: 10.1055/a-1238-2688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The odd shape of the scaphoid is a challenge to our spatial sense. Computer assistance is of an unmatched value when reconstructing a non-united scaphoid: From CT data a true 3-D-model can be generated, fully interactive; thus it can be moved, manipulated and of course also printed for hands-on experience. Comparing the virtual 3-D-models of the nonunion with the healthy contralateral scaphoid, the exact amount of the deformity is calculated which allows for the planning of an anatomically precise reconstruction of the scaphoid shape. Finally, computer generated patient specific instruments will facilitate the implementation of this planning intraoperatively. This proceeding enables us to reconstruct the non-united scaphoid markedly more accurately and with this reliably normalize wrist kinematics. Meanwhile we have applied this technique successfully in more than 50 cases of scaphoid-nonunions presenting with significant deformity.
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8
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Luria S. Understanding the Patterns of Deformity of Wrist Fractures Using Computer Analysis. Curr Rheumatol Rev 2020; 16:194-200. [PMID: 32967607 DOI: 10.2174/1573397115666190429144944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 11/14/2018] [Accepted: 04/11/2019] [Indexed: 11/22/2022]
Abstract
Computer modeling of the wrist has followed other fields in the search for descriptive methods to understand the biomechanics of injury. Using patient-specific 3D computer models, we may better understand the biomechanics of wrist fractures in order to plan better care. We may better estimate fracture morphology and stability and evaluate surgical indications, design more adequate or effective surgical approaches and develop novel methods of therapy. The purpose of this review is to question the actual advances made in the understanding of wrist fractures using computer models.
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Affiliation(s)
- Shai Luria
- Department of Orthopaedic Surgery, Hadassah Hebrew-University Medical Center, Kiryat Hadassah, POB 12000, Jerusalem 91120, Israel
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9
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Singh S, Andronic O, Kaiser P, Jud L, Nagy L, Schweizer A. Recent advances in the surgical treatment of malunions in hand and forearm using three-dimensional planning and patient-specific instruments. HAND SURGERY & REHABILITATION 2020; 39:352-362. [PMID: 32544631 DOI: 10.1016/j.hansur.2020.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/06/2020] [Accepted: 04/09/2020] [Indexed: 01/10/2023]
Abstract
Malunions of the forearm and hand cause significant disability. Moreover, intraarticular deformities may contribute to early onset osteoarthritis. Such conditions require precise surgical correction in order to improve functional outcomes and prevent early or late complications. The purpose of this study was to describe the technical advantages of accurate anatomical reconstruction using 3D guided osteotomies and patient specific instruments (PSI) in multiple joints of the hand and forearm. Acquisition of three-dimensional (3D) datasets and surgical implementation of PSI was performed in a series of patients between December 2014 and July 2017. Patients had intra- or extra-articular malunions of the forearm, radiocarpal joint, trapeziometacarpal joint, or proximal interphalangeal joint. A previously described 3D surface model that incorporates CT data was used for segmentation (Mimics®, Materialise™, Belgium). For all the cases, CT scans of both forearms were acquired to use the contralateral uninjured side as the anatomic reconstruction template. Computer-assisted assessment of the deformity, the preoperative plan, and the design of PSI are described. Outcomes were determined by evaluating step-off correction, fusion, changes in range of motion (ROM) and grip strength. Six patients were included in the study; all achieved fusion. Improved clinical outcomes including pain reduction, better ROM and grip strength were obtained. Complete correction of intraarticular step-off was achieved in all cases with intraarticular malunions. 3D guided osteotomies are an established surgical treatment option for malunions of the hand and forearm. 3D analysis is a helpful diagnostic tool that provides detailed information about the underlying deformity. PSI can be developed and used for surgical correction with maximal accuracy for both intraarticular step-off and angular deformity.
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Affiliation(s)
- S Singh
- Department of orthopedics, Balgrist university hospital, university of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland.
| | - O Andronic
- Department of orthopedics, Balgrist university hospital, university of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - P Kaiser
- Department of orthopedics, Balgrist university hospital, university of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - L Jud
- Department of orthopedics, Balgrist university hospital, university of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - L Nagy
- Department of orthopedics, Balgrist university hospital, university of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - A Schweizer
- Department of orthopedics, Balgrist university hospital, university of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland
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10
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Abstract
This article presents historical aspects, rationale, indications, planning, and execution of anterior interpositional bone grafting technique for unstable scaphoid nonunions. The author's original technique considers four points: (1) preoperative planning based on comparative anteroposterior radiographs in maximal ulnar deviation was used to calculate resection zone, size of the graft, and scaphoid length; (2) a volar approach was used; (3) an iliac crest wedge-shaped corticocancellous graft was interposed; and (4) Kirschner wires were inserted for fixation. Contemporary refinements of the technique including a modification to treat nonunions with failed previous screw fixation with tricks and hints and results are shown.
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11
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Abstract
Successful bone union is only a portion of scaphoid fracture management. Malunion is possible and can alter wrist kinematics, potentially causing wrist pain and accelerated degeneration. Evaluation of scaphoid malunion begins with adequate imaging and understanding of deformity. Treatment includes nonoperative management, reconstruction, or salvage options. Correction of malunion can be obtained with an osteotomy and the use of structural graft to recreate anatomy and restore normal carpal motion. Clinical improvement of symptomatic scaphoid malunion can be reliably obtained with reconstruction, although the natural history and role for intervention in asymptomatic malunions remains unclear.
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12
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Elatta MA, Elglaind SM, Talat E, Alqaseer AM, Basheer HM. Scapho-Capitate Ratio for Estimation of Scaphoid Length. J Hand Surg Asian Pac Vol 2019; 24:202-207. [PMID: 31035873 DOI: 10.1142/s2424835519500279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: The failure of scaphoid reconstruction by restoring both length and shape may lead to carpal mal-alignment and progressive degenerative arthritis. The aim of our study is to find a reliable method to find out the scaphoid length without measuring the contralateral scaphoid. Methods: Three X-ray wrist views were collected for 51 patients without any signs suggesting any hand and wrist fractures. The scaphoid, capitate and 3rd metacarpal bone axes lengths and carpal height were measured by 4 hand surgeons separately. Results: The scapho-capitate ratio was 1.1 ± 0.084, 1.01 ± 0.084 and 0.92 ± 0.109 for lateral, postero-anterior with ulnar deviation and postero-anterior view respectively. The ulnar deviation view had the highest reliability. Conclusions: Scapho-capitate ratio estimation is an easy and accurate measure of normal scaphoid length in situations when the scaphoid is short. It is helpful for the estimation of the size of the bone graft that need for reconstruction of the scaphoid.
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Roner S, Bersier P, Fürnstahl P, Vlachopoulos L, Schweizer A, Wieser K. 3D planning and surgical navigation of clavicle osteosynthesis using adaptable patient-specific instruments. J Orthop Surg Res 2019; 14:115. [PMID: 31036029 PMCID: PMC6489333 DOI: 10.1186/s13018-019-1151-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 04/11/2019] [Indexed: 12/01/2022] Open
Abstract
Background Preoperative three-dimensional planning and intraoperative navigation by patient-specific instruments is a promising method for the exact correction of bone deformities. Nevertheless, disadvantages of current concepts are the missing options of adapting the surgical plan intraoperatively. By providing the surgeons with a controlled length adjustment through the patient-specific instruments, the application area can usefully be expanded in the treatment of clavicle osteosyntheses. Methods In three cases, preoperative three-dimensional surgical planning with the intraoperative use of patient-specific instruments was applied. The computer-assisted assessments of clavicle deformities, the preoperative plan, and the design of patient-specific instruments were created on the basis of computed tomography data. Reduction guides for restoring length and rotation according to the mirrored healthy contralateral side were enhanced with adaptable length adjustment functions. The screw thread of the reduction guides enabled temporary distraction of the clavicle fracture fragments and a controlled compression of the optionally used interposed bone block between clavicle fragments. Results Navigated clavicle osteosyntheses by enhanced patient-specific instruments was executed uneventful in all three cases. The surgeon was able to adapt clavicle length in a planned axis intraoperatively as clinically desired. Conclusion Computer-assisted planning of clavicle osteosynthesis and surgical navigation with additional adaptable patient-specific instruments can usefully expand the previous application areas. By using guided length adjustments, the fragments and optionally the graft can be compressed along a planned axis as desired to ensure optimal bone healing. Level of evidence Basic science study, Surgical technique Electronic supplementary material The online version of this article (10.1186/s13018-019-1151-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Roner
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Forchtrasse, 340 8008, Zurich, Switzerland.
| | - P Bersier
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Forchtrasse, 340 8008, Zurich, Switzerland
| | - P Fürnstahl
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Forchtrasse, 340 8008, Zurich, Switzerland
| | - L Vlachopoulos
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - A Schweizer
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - K Wieser
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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14
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Schenk P, Vlachopoulos L, Hingsammer A, Fucentese SF, Fürnstahl P. Is the contralateral tibia a reliable template for reconstruction: a three-dimensional anatomy cadaveric study. Knee Surg Sports Traumatol Arthrosc 2018; 26:2324-2331. [PMID: 27872989 DOI: 10.1007/s00167-016-4378-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 11/07/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE The contralateral anatomy is regularly used as a reconstruction template for corrective osteotomies of several deformities and pathological conditions. However, there is lack of evidence that the intra-individual differences between both tibiae are sufficiently small to use the contralateral tibia as a 3D reconstruction template for complex osteotomies. The aim of this study was to evaluate the intra-individual side differences of the tibia in length, torsion, angulation, and translation using 3D measurement techniques. METHODS 3D surface models of both tibiae were created from computed tomography data of 51 cadavers. The (mirrored) models of the right tibiae were divided into two halves at the centre of the shaft. Thereafter, the proximal and distal segments were aligned to the left (contralateral) tibia in an automated fashion. The relative 3D transformation between both aligned segments was measured to quantify the side difference in 6° of freedom (3D translation vector, 3 angles of rotation). RESULTS The mean side difference in tibia length was 2.1 mm (SD 1.3 mm; range 0.2-5.9 mm). The mean side difference in torsion was 4.9° (SD 4.1°; range 0.2°-17.6°). The mean side difference in the coronal and sagittal planes was 1.1° (SD 0.9°; range 0.0°-4.6°) and 1.0° (SD 0.8°; range 0.1°-2.9°), respectively. CONCLUSION The present study confirms small side differences in torsion between the left and right tibia, while the side differences in the coronal and sagittal plane are probably negligible. The contralateral tibia seems to be a reliable reconstruction template for the 3D preoperative planning of complex corrective osteotomies of the tibia. However, torsional differences should be interpreted with caution, as a single cut-off value of a clinically relevant torsional side difference cannot be defined. The presented results are relevant to surgeons considering the contralateral tibia as a 3D reconstruction template for corrective osteotomies of the tibia. LEVEL OF EVIDENCE Basic science.
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Affiliation(s)
- Pascal Schenk
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Lazaros Vlachopoulos
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.,Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Andreas Hingsammer
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Philipp Fürnstahl
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Oka K, Moritomo H. Current Management of Scaphoid Nonunion Based on the Biomechanical Study. J Wrist Surg 2018; 7:94-100. [PMID: 29576913 PMCID: PMC5864502 DOI: 10.1055/s-0038-1637739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 02/08/2018] [Indexed: 10/17/2022]
Abstract
Scaphoid nonunion causes abnormal wrist kinematics and typically leads to carpal collapse and subsequent degenerative arthritis of the wrist. However, the natural history, including carpal collapse and degenerative arthritis of scaphoid nonunion, may vary at different fracture locations. This article reviews recent biomechanical studies related to the natural history of scaphoid nonunion. In the distal-type fractures (type B2 in Herbert classification), where the fracture located distal to the scaphoid apex, the proximal scaphoid fragment and lunate, which are connected through the dorsal scapholunate interosseous ligament (DSLIL) and dorsal intercarpal ligament (DIC), extend together, and the distal fragment of the scaphoid flexes individually. Therefore, untreated type B2 fractures normally show the humpback deformity, resulting in dorsal intercalated segment instability deformity relatively earlier after the injury. In the proximal-type fractures (type B1), where the fracture is located proximal to the scaphoid apex, the connection between the distal fragment and lunate is preserved through the DSLIL and DIC so that the scaphoid-lunate complex remains stable and the carpal collapse is less severe than that in distal-type fractures. The fracture location relative to the apex of the dorsal scaphoid ridge is a reliable landmark in the determination of the natural history of scaphoid nonunion.
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Affiliation(s)
- Kunihiro Oka
- Health and Counseling Center, Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hisao Moritomo
- Department of Physical Therapy, Osaka Yukioka College of Health Science, Osaka, Japan
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Schwarcz Y, Schwarcz Y, Peleg E, Joskowicz L, Wollstein R, Luria S. Three-Dimensional Analysis of Acute Scaphoid Fracture Displacement: Proximal Extension Deformity of the Scaphoid. J Bone Joint Surg Am 2017; 99:141-149. [PMID: 28099304 DOI: 10.2106/jbjs.16.00021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Our goal was to analyze the movement of acute scaphoid waist fracture fragments and adjacent bones in a common coordinate system. Our hypothesis was that the distal scaphoid fragment flexes and pronates and the proximal fragment extends. METHODS Computed tomography (CT) scans of patients diagnosed with an acute scaphoid waist fracture were evaluated using a 3-dimensional (3D) model. The scans of 57 nondisplaced and 23 displaced fractures were compared with a control group of 27 scans showing no pathological involvement of the wrist. Three anatomical landmarks were labeled on the distal and proximal fragments of the scaphoid, the lunate, and the trapezium. Each set of labels formed a triangle representing the bone or fragment. Four landmarks were labeled on the distal radial articular surface and used to create a common coordinate system. The position of each bone or fragment was calculated in reference to these coordinates. RESULTS The displaced fracture group showed significant extension, supination, and volar translation of the proximal scaphoid fragment when compared with the other groups. The lunate tended toward a supinated position, which was not statistically significant. The distal scaphoid fragment and the trapezium showed no movement. CONCLUSIONS In acute displaced scaphoid fractures, it is the proximal fragment that displaces and should be reduced. CLINICAL RELEVANCE The typical "humpback" deformity is actually a "proximal extension" deformity, the consequence of displacement of the proximal fragment of the scaphoid (with the lunate). Manipulating only the proximal fragment (with the lunate) may be technically easier and more effective than manipulating both fragments.
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Affiliation(s)
- Yonatan Schwarcz
- 1Department of Orthopaedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel 2School of Engineering and Computer Science, the Hebrew University, Jerusalem, Israel 3University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Oura K, Moritomo H, Kataoka T, Oka K, Murase T, Sugamoto K, Yoshikawa H. Three-dimensional analysis of osteophyte formation on distal radius following scaphoid nonunion. J Orthop Sci 2017; 22:50-55. [PMID: 27589915 DOI: 10.1016/j.jos.2016.06.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 04/28/2016] [Accepted: 08/10/2016] [Indexed: 02/09/2023]
Abstract
BACKGROUND The purposes of this study were to quantitatively analyze osteophyte formation of the distal radius following scaphoid nonunion and to investigate how fracture locations relate to osteophyte formation patterns. METHODS Three-dimensional surface models of the scaphoid and distal radius were constructed from computed tomographic images of both the wrists of 17 patients' with scaphoid nonunion. The scaphoid nonunions were classified into 3 types according to the location of the fracture line: distal extra-articular (n = 6); distal intra-articular (n = 5); and proximal (n = 6). The osteophyte models of the radius were created by subtracting the mirror image of the contralateral radius model from the affected radius model using a Boolean operation. The osteophyte locations on the radius were divided into 5 areas: styloid process, dorsal scaphoid fossa, volar scaphoid fossa, dorsal lunate fossa, and volar lunate fossa. Osteophyte volumes were compared among the areas and types of nonunion. The presence or absence of dorsal intercalated segment instability (DISI) deformity was also determined. RESULTS The distal intra-articular type exhibited significantly larger osteophytes in the styloid process than the distal extra-articular type. Furthermore, the proximal type exhibited significantly larger osteophytes in the dorsal scaphoid fossa than the distal extra-articular type. Finally, the distal intra- and extra-articular types were more associated with DISI deformity and tended to have larger osteophytes in the lunate fossa than the proximal type. CONCLUSION The pattern of osteophyte formation in the distal radius determined using three-dimensional computed tomography imaging varied among the different types of scaphoid nonunion (distal extra-articular, distal intra-articular, and proximal). The results of this study are clinically useful in determining whether additional resection of osteophytes or radial styloid is necessary or not during the treatment of the scaphoid nonunion.
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Affiliation(s)
- Keiichiro Oura
- Department of Orthopaedic Surgery, Japan Community Health Care Organization Osaka Hospital, 4-2-78 Fukushima, Fukushima-ku, Osaka 553-0003, Japan
| | - Hisao Moritomo
- Department of Physical Therapy, Osaka Yukioka College of Health Science, 1-1-41 Sojiji, Ibaraki-shi, Osaka 567-0801, Japan.
| | - Toshiyuki Kataoka
- Department of Orthopaedic Surgery, Japan Community Health Care Organization Hoshigaoka Medical Center, 4-8-1 Hoshiga-oka, Hirakata, Osaka 573-8511, Japan
| | - Kunihiro Oka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Tsuyoshi Murase
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Kazuomi Sugamoto
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
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Ten Berg PWL, Dobbe JGG, Horbach SER, Gerards RM, Strackee SD, Streekstra GJ. Analysis of deformity in scaphoid non-unions using two- and three-dimensional imaging. J Hand Surg Eur Vol 2016; 41:719-26. [PMID: 26553886 DOI: 10.1177/1753193415614430] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 09/30/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED Pre-operative assessment of the deformity in scaphoid non-unions influences surgical decision-making. To characterize deformity, we used three-dimensional computed tomographic modelling in 28 scaphoid non-unions, and quantified bone loss, dorsal osteophyte volume and flexion deformity. We further related these three-dimensional parameters to the intrascaphoid and capitate-lunate angles, and stage of scaphoid non-union advanced collapse assessed on conventional two-dimensional images and to the chosen surgical procedure. Three-dimensional flexion deformity (mean 26°) did not correlate with intrascaphoid and capitate-lunate angles. Osteophyte volume was positively correlated with bone loss and stage of scaphoid non-union advanced collapse. Osteophyte volume and bone loss increased over time. Three-dimensional modelling enables the quantification of bone loss and osteophyte volume, which may be valuable parameters in the characterization of deformity and subsequent decision-making about treatment, when taken in addition to the clinical aspects and level of osteoarthritis. TYPE OF STUDY/LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- P W L Ten Berg
- Department of Plastic, Reconstructive, and Hand Surgery, University of Amsterdam, Amsterdam, The Netherlands
| | - J G G Dobbe
- Department of Biomedical Engineering and Physics, University of Amsterdam, Amsterdam, The Netherlands
| | - S E R Horbach
- Department of Plastic, Reconstructive, and Hand Surgery, University of Amsterdam, Amsterdam, The Netherlands
| | - R M Gerards
- Department of Orthopaedic Surgery, University of Amsterdam, Amsterdam, The Netherlands
| | - S D Strackee
- Department of Plastic, Reconstructive, and Hand Surgery, University of Amsterdam, Amsterdam, The Netherlands
| | - G J Streekstra
- Department of Biomedical Engineering and Physics, University of Amsterdam, Amsterdam, The Netherlands Department of Radiology, University of Amsterdam, Amsterdam, The Netherlands
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Schweizer A, Mauler F, Vlachopoulos L, Nagy L, Fürnstahl P. Computer-Assisted 3-Dimensional Reconstructions of Scaphoid Fractures and Nonunions With and Without the Use of Patient-Specific Guides: Early Clinical Outcomes and Postoperative Assessments of Reconstruction Accuracy. J Hand Surg Am 2016; 41:59-69. [PMID: 26710736 DOI: 10.1016/j.jhsa.2015.10.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 10/03/2015] [Accepted: 10/04/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To present results regarding the accuracy of the reduction of surgically reconstructed scaphoid nonunions or fractures using 3-dimensional computer-based planning with and without patient-specific guides. METHODS Computer-based surgical planning was performed with computed tomography (CT) data on 22 patients comparing models of the pathological and the opposite uninjured scaphoid in 3 dimensions. For group 1 (9 patients), patient-specific guides were designed and manufactured using additive manufacturing technology. During surgery, the guides were used to define the orientation of the reduced fragments. The scaphoids in group 2 (13 patients) were reduced with the conventional freehand technique. All scaphoids in both groups were fixed with a headless compression screw or K-wires, and all bone defects (except one) were filled with autologous bone grafts or vascularized grafts. Postoperative CT scans were acquired 2 or more months after the operations to monitor consolidation and compare the final result with the preoperative plan. The clinical results and accuracy of the reconstructions were compared. RESULTS In group 1, 8 of 9 scaphoids healed after 2 to 6 months, and partial nonunion after 9 months was observed in one patient. In group 2, 11 of 13 scaphoids healed between 2 and 34 months whereas 2 scaphoids did not consolidate. Comparison of the preoperative and postoperative 3-dimensional data revealed an average residual displacement of 7° (4° in flexion-extension, 4° in ulnar-radial deviation, and 3° in pronation-supination) in group 1. In group 2, residual displacement after surgery was 26° (22° in flexion-extension, 12° in ulnar-radial deviation, and 7° in pronation-supination). The difference in the accuracy of reconstruction was significant. CONCLUSIONS Although the scaphoid is small, patient-specific guides can be used to perform scaphoid reconstructions. When the guides were used, the reconstructions were significantly more anatomic compared with those resulting from the freehand technique. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
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Affiliation(s)
- Andreas Schweizer
- Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Flavien Mauler
- Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lazaros Vlachopoulos
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Ladislav Nagy
- Orthopedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Philipp Fürnstahl
- Computer Assisted Research and Development Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
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21
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Three-Dimensional Assessment of Bilateral Symmetry of the Scaphoid: An Anatomic Study. BIOMED RESEARCH INTERNATIONAL 2015; 2015:547250. [PMID: 26413532 PMCID: PMC4564638 DOI: 10.1155/2015/547250] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 03/20/2015] [Accepted: 03/20/2015] [Indexed: 11/20/2022]
Abstract
Preoperative 3D CT imaging techniques provide displacement analysis of the distal scaphoid fragment in 3D space, using the matched opposite scaphoid as reference. Its accuracy depends on the presence of anatomical bilateral symmetry, which has not been investigated yet using similar techniques. Our purpose was to investigate symmetry by comparing the relative positions of distal and proximal poles between sides. We used bilateral CT scans of 19 adult healthy volunteers to obtain 3D scaphoid models. Left proximal and distal poles were matched to corresponding mirrored right sides. The left-to-right positional differences between poles were quantified in terms of three translational and three rotational parameters. The mean (SD) of ulnar, dorsal, and distal translational differences of distal poles relative to proximal poles was 0.1 (0.6); 0.4 (1.2); 0.2 (0.6) mm and that of palmar rotation, ulnar deviation, and pronation differences was −1.1 (4.9); −1.5 (3.3); 1.0 (3.7)°, respectively. These differences did not significantly differ from zero and thus were not biased to left or right side. We proved that, on average, the articular surfaces of scaphoid poles were symmetrically aligned in 3D space. This suggests that the contralateral scaphoid can serve as reference in corrective surgery. No level of evidence is available.
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22
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Hingsammer AM, Vlachopoulos L, Meyer DC, Fürnstahl P. Three-dimensional corrective osteotomies of mal-united clavicles-is the contralateral anatomy a reliable template for reconstruction? Clin Anat 2015; 28:865-71. [DOI: 10.1002/ca.22572] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 04/22/2015] [Accepted: 05/14/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Andreas M. Hingsammer
- Orthopaedic Department; Balgrist University Hospital, University of Zurich; Forchstrasse 340 Zurich 8008 Switzerland
| | - Lazaros Vlachopoulos
- Computer Assisted Research and Development Group; University Hospital Balgrist, University of Zurich; Forchstrasse 340 Zurich 8008 Switzerland
| | - Dominik C. Meyer
- Orthopaedic Department; Balgrist University Hospital, University of Zurich; Forchstrasse 340 Zurich 8008 Switzerland
| | - Philipp Fürnstahl
- Computer Assisted Research and Development Group; University Hospital Balgrist, University of Zurich; Forchstrasse 340 Zurich 8008 Switzerland
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Complex Osteotomies of Tibial Plateau Malunions Using Computer-Assisted Planning and Patient-Specific Surgical Guides. J Orthop Trauma 2015; 29:e270-6. [PMID: 25932528 DOI: 10.1097/bot.0000000000000301] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The accurate reduction of tibial plateau malunions can be challenging without guidance. In this work, we report on a novel technique that combines 3-dimensional computer-assisted planning with patient-specific surgical guides for improving reliability and accuracy of complex intraarticular corrective osteotomies. Preoperative planning based on 3-dimensional bone models was performed to simulate fragment mobilization and reduction in 3 cases. Surgical implementation of the preoperative plan using patient-specific cutting and reduction guides was evaluated; benefits and limitations of the approach were identified and discussed. The preliminary results are encouraging and show that complex, intraarticular corrective osteotomies can be accurately performed with this technique. For selective patients with complex malunions around the tibia plateau, this method might be an attractive option, with the potential to facilitate achieving the most accurate correction possible.
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Haefeli M, Schaefer DJ, Schumacher R, Müller-Gerbl M, Honigmann P. Titanium template for scaphoid reconstruction. J Hand Surg Eur Vol 2015; 40:526-33. [PMID: 25167978 DOI: 10.1177/1753193414549008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 07/15/2014] [Indexed: 02/03/2023]
Abstract
Reconstruction of a non-united scaphoid with a humpback deformity involves resection of the non-union followed by bone grafting and fixation of the fragments. Intraoperative control of the reconstruction is difficult owing to the complex three-dimensional shape of the scaphoid and the other carpal bones overlying the scaphoid on lateral radiographs. We developed a titanium template that fits exactly to the surfaces of the proximal and distal scaphoid poles to define their position relative to each other after resection of the non-union. The templates were designed on three-dimensional computed tomography reconstructions and manufactured using selective laser melting technology. Ten conserved human wrists were used to simulate the reconstruction. The achieved precision measured as the deviation of the surface of the reconstructed scaphoid from its virtual counterpart was good in five cases (maximal difference 1.5 mm), moderate in one case (maximal difference 3 mm) and inadequate in four cases (difference more than 3 mm). The main problems were attributed to the template design and can be avoided by improved pre-operative planning, as shown in a clinical case.
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Affiliation(s)
- M Haefeli
- Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland Hand Surgery, Kantonsspital Baden, Baden, Switzerland
| | - D J Schaefer
- Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - R Schumacher
- University of Applied Sciences of Northwestern, Switzerland
| | - M Müller-Gerbl
- Institute of Anatomy, University Basel, Basel, Switzerland
| | - P Honigmann
- Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
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ten Berg PWL, Dobbe JGG, Strackee SD, Streekstra GJ. Quantifying scaphoid malalignment based upon height-to-length ratios obtained by 3-dimensional computed tomography. J Hand Surg Am 2015; 40:67-73. [PMID: 25534836 DOI: 10.1016/j.jhsa.2014.10.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 10/14/2014] [Accepted: 10/14/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine if 3-dimensional height-to-length (H/L) measurements including coronal plane assessment will improve malalignment detection of scaphoid fractures and to determine if more waist than proximal pole nonunions are malaligned. METHODS Computed tomography scans of uninjured wrists (n = 74) were used to obtain 3-dimensional models of healthy scaphoids. These models were used to determine 95% normal ranges of the H/L ratio in standard sagittal and coronal planes in an automated fashion. Subsequently, the H/L ratios of fibrous nonunions (n = 26) were compared with these normal ranges and were classified as either aligned or malaligned. RESULTS The mean normal H/L ratio in the sagittal plane was 0.61 (range, 0.54-0.69) and in the coronal plane 0.42 (range, 0.36-0.48). The mean H/L ratios of the nonunions differed from those of the healthy scaphoids in these planes: 0.65 and 0.48, respectively. Based on sagittal plane evaluation of all nonunions, 46% exceeded the normal H/L range versus 54% based on combining sagittal and coronal plane measurements. More waist nonunions (71%) than proximal pole nonunions (22%) exceed the normal H/L range. CONCLUSIONS Evaluation of the H/L ratio in the coronal plane provided valuable additional information for the detection of scaphoid deformities. More malaligned cases were found for waist nonunions than for proximal pole nonunions. CLINICAL RELEVANCE This method may be a helpful diagnostic tool to detect malalignment and to choose between in situ fixation or reconstruction.
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Affiliation(s)
- Paul W L ten Berg
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Johannes G G Dobbe
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Simon D Strackee
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Geert J Streekstra
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Reliability and validity of carpal alignment measurements in evaluating deformities of scaphoid fractures. Arch Orthop Trauma Surg 2014; 134:887-93. [PMID: 24756533 DOI: 10.1007/s00402-014-1998-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Indexed: 02/09/2023]
Abstract
PURPOSE Several radiographic carpal alignment indices are used to evaluate the deformities of scaphoid fractures. The purpose of this study was to determine the reliabilities and validities of radiographic carpal alignment indices commonly used to evaluate deformities of scaphoid fractures. METHODS Thirty-six patients with a scaphoid fracture were evaluated. Five carpal alignment indices were assessed on lateral plain radiographs, namely, scapholunate angle, radioscaphoid angle, radiolunate angle, radiocapitate angle, and capitolunate angle. Three examiners measured these radiographic indices at two sessions, and intraobserver and interobserver reliabilities were determined and expressed as intraclass correlation coefficients. Discriminant validities of radiographic carpal alignment indicies between injured and uninjured wrists were evaluated. For convergent validity testing, the correlation between the radiographic carpal alignment indices and intrascaphoid angles (ISAs) or height-to-length (HL) ratios on CT longitudinal scans was assessed. Further, carpal alignment indices after surgical reconstruction were compared to the Mayo wrist score. RESULTS Scapholunate and radiolunate angles had the highest reliabilities, and radiocapitate angle had the lowest. Radiolunate angle had the highest discriminant validity followed by scapholunate, and capitolunate angles. In convergent validity testing, scapholunate angles and radiolunate angles correlated with ISA angles, and radiolunate and capitolunate angles correlated with HL ratios. Only the radiolunate angles correlated with the Mayo wrist scores. CONCLUSIONS Among radiographic carpal alignment measures, radiolunate angle is the most reliable and valid carpal alignment index for evaluating deformities of scaphoid fractures. Scapholunate and capitolunate angles could be used as an alternative, but have less validity.
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Intraosseous rotation of the scaphoid: assessment by using a 3D CT model—an anatomic study. Eur Radiol 2014; 24:1357-65. [DOI: 10.1007/s00330-014-3116-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 01/27/2014] [Accepted: 02/05/2014] [Indexed: 10/25/2022]
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Quantification of contralateral differences of the scaphoid: a comparison of bone geometry in three dimensions. ANATOMY RESEARCH INTERNATIONAL 2014; 2014:904275. [PMID: 24715983 PMCID: PMC3942206 DOI: 10.1155/2014/904275] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 12/19/2013] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to accurately quantify contralateral differences of the scaphoid in three-dimensional space to evaluate the feasibility of using the healthy contralateral bone as a reconstruction template in the preoperative planning of complex mal- or nonunions. Three-dimensional surface models of the left and right scaphoids were reconstructed from computed tomography images and compared in 26 individuals. Left-right differences were quantified with respect to volume, surface area, length, and surface-to-surface deviation. The average left-right differences in volume, surface area, and length were 95.4 mm(3) (SD 66.2 mm(3)), 32.7 mm(2) (SD 22.9 mm(32)), and 0.28 mm (SD 0.4 mm), respectively. The average surface-to-surface deviation between the sides was 0.26 mm (SD 0.2 mm). High statistical correlation (Pearson) between the left and the right side was found in all evaluated measures.
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