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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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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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Delamarre M, Chantelot C, Saab M. Three-corner arthrodesis for scapholunate and scaphoid nonunion advanced collapsed wrists: outcomes at long term follow-ups. Injury 2024; 55 Suppl 1:111350. [PMID: 39069341 DOI: 10.1016/j.injury.2024.111350] [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: 11/19/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVES This study aimed to assess clinical, functional and radiological outcomes after three-corner arthrodesis in patients suffering from symptomatic scapholunate or scaphoid non-union advanced collapsed wrists. We hypothesised that three-corner arthrodesis provided satisfactory clinical and radiological results in the long term. MATERIAL AND METHODS This was a retrospective study of 13 patients (14 wrists) who underwent a three-corner arthrodesis between March 2004 and January 2019 with a mean follow-up of 6,7 years. Clinical assessment consisted of wrist motion, grip strength, pain and functional scores (Quick-DASH, PRWE, MWS). All complications and surgical revisions were investigated. Radiographic assessment searched for union, evaluated carpal height and ulnar translation, lunate tilt and occurrence of radio-lunate arthritis. RESULTS At the last follow-up Quick-DASH and PRWE scores were 24,87(± 17.2) and 47.4 (± 26.9) respectively and were significantly improved. Wrist motion was 35°, 32°, 10° et 24° of flexion, extension, radial and ulnar deviation respectively. Union was obtained for 13 (92,9%) wrists. The mean radiolunate angle was 11° (-17°-34°). Three patients needed reintervention, which 2 consisted of total wrist arthrodesis due to persisting pain. Mild signs of radio-lunate arthritis were found in three patients. CONCLUSION Three-corner arthrodesis seemed to provide satisfactory long-term functional outcomes. The union rate was high and even patients with signs of radio-lunate arthritis still had improved outcomes at the last follow-up. It could be a part of surgical options in wrists with radio- and midcarpal arthritis, among other procedures.
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Affiliation(s)
- Morgane Delamarre
- Service d'Orthopédie 1 et Traumatologie, Hôpital Roger Salengro, F-59000, Lille, France
| | - Christophe Chantelot
- Service d'Orthopédie 1 et Traumatologie, Hôpital Roger Salengro, F-59000, Lille, France
| | - Marc Saab
- Service d'Orthopédie 1 et Traumatologie, Hôpital Roger Salengro, F-59000, Lille, France.
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Solgård L, Gvozdenovic R. Single- and Bicolumn Limited Intercarpal Fusion: A Solution for the SLAC or SNAC Wrist. J Wrist Surg 2024; 13:16-23. [PMID: 38264130 PMCID: PMC10803153 DOI: 10.1055/s-0043-1762932] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/16/2023] [Indexed: 01/25/2024]
Abstract
Background Single- or bicolumn limited intercarpal fusion, also called one- or two-column fusion, has been introduced as an alternative to four-corner fusion. The rationale behind this is obtaining less need for bone grafting and consequently improving the chances of the union. Method From August 2014 to October 2020, 45 consecutive patients (15 women), with a mean age of 58.4 years (range: 35-79), have been treated for scapholunate advanced collapse or scaphoid nonunion advanced collapse wrist. In 33 cases, the surgery was performed as two-column fusion, and in 12 cases as one-column fusion. The union was determined by a computed tomography (CT) scan or X-ray follow-up studies. The pain assessments (visual analog score: 0-100), range of motion (ROM), grip strength, and Quick Disabilities of the Arm, Shoulder, and Hand score were prospectively included. Results Of 45 patients, 43 were available for the follow-up, at a mean of 35 months (range: 12-68). All patients but two achieved union at a mean of 9.5 weeks (range: 5-25 weeks). Pain diminished from 60.3 (mean) preoperatively to 16.7 (mean) postoperatively ( p = 0.0001). Grip strength slightly increased from 28.2 KgF (mean) to 29 KgF (mean) (not significantly, p = 0.86). Quick Disability of the Arm, Shoulder, and Hand score improved from 39.5 (median) before the surgery to 11 (median) after the surgery ( p = 0.0004). The postoperative ROM of 62/37 degrees (mean) were recorded for total dorsovolar/radioulnar flexions, respectively. Three patients were converted to total wrist fusion and one to total wrist arthroplasty. One had a rearthrodesis to two-column fusion, which united. Conclusion One- and two-column fusion showed significant improvement in pain and function, with minimal impairment of the grip strength on the short- to mid-term follow-up. A union rate of 95% and an acceptable complication rate were achieved, without fusing all carpals. Level of Evidence Prospective, cohort study, level III.
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Affiliation(s)
- Lars Solgård
- Department of Hand Surgery, Herlev/Gentofte University Hospital of Copenhagen, Hellerup, Denmark
| | - Robert Gvozdenovic
- Department of Hand Surgery, Herlev/Gentofte University Hospital of Copenhagen, Hellerup, Denmark
- Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
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Gvozdenovic R, Schioedt MA, Solgaard L, Vadstrup LS, Soee NH. Limited intercarpal fusion versus proximal row carpectomy in the treatment of SLAC or SNAC wrist, results after 3.5 years. J Orthop Surg Res 2023; 18:681. [PMID: 37705034 PMCID: PMC10498579 DOI: 10.1186/s13018-023-04177-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/09/2023] [Indexed: 09/15/2023] Open
Abstract
The present study compares the postoperative clinical, radiological, and patient-reported functional results between the surgical procedures Proximal Row Carpectomy and Limited Carpal Fusion, in the treatment of SLAC and SNAC conditions of the wrist. 15 Proximal Row Carpectomy patients and 45 Limited Carpal Fusion patients were included in the study. Postoperative outcomes were assessed and compared for pain at load, range of motion, grip strength, Quick-DASH, and satisfaction. A radiological assessment was performed at the follow-up. The Proximal Row Carpectomy patients had a mean age of 60 years (range 31-77) and a mean follow-up of 42 months. The Limited Carpal Fusion patients had a mean age of 58 years (range 35-76) and a mean follow-up of 41 months. The patients treated with Limited Carpal Fusion performed significantly better regarding pain, radial-ulnar motion, and the Quick-DASH (p = 0.002, p = 0.003, and p = 0.002), respectively. The grip strength difference between the treatment groups was stratified for gender and was found significantly better for men in the LCF-treated patients, but not different for women (p = 0.03, p = 0.26), respectively. Differences in flexion-extension between the groups were insignificant (p = 0.525). A higher conversion rate to total wrist fusion was observed in the patients treated with the Proximal Row Carpectomy. All the Proximal Row Carpectomy patients had osteoarthritis at follow-up, whereas it was seen in 19% of the Limited Carpal Fusion patients. The patient-reported satisfaction was substantially better for the Limited Carpal Fusion patients. In conclusion, among patients treated for SNAC and SLAC wrist conditions, besides the findings of flexion-extension, and grip strength which were found without difference for women the findings are in favour of Limited Carpal Fusion compared to Proximal Row Carpectomy. Further, preferably prospective studies are needed to confirm or reject our findings.Level of evidence: Retrospective, comparative cohort study, level III.
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Affiliation(s)
- Robert Gvozdenovic
- Department of Hand Surgery, Herlev/Gentofte University Hospital of Copenhagen, Hospitalsvej 1, 2900, Hellerup, Denmark.
- Faculty of Health and Medical Sciences, Institute of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.
| | - Martina Agerskov Schioedt
- Department of Hand Surgery, Herlev/Gentofte University Hospital of Copenhagen, Hospitalsvej 1, 2900, Hellerup, Denmark
| | - Lars Solgaard
- Department of Hand Surgery, Herlev/Gentofte University Hospital of Copenhagen, Hospitalsvej 1, 2900, Hellerup, Denmark
| | - Lars Soelberg Vadstrup
- Department of Hand Surgery, Herlev/Gentofte University Hospital of Copenhagen, Hospitalsvej 1, 2900, Hellerup, Denmark
| | - Niels Henrik Soee
- Department of Hand Surgery, Herlev/Gentofte University Hospital of Copenhagen, Hospitalsvej 1, 2900, Hellerup, Denmark
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Politikou O, Reissner L, Besmens IS, Calcagni M. Arthroscopic three-corner or lunocapitate arthrodesis: technical tips and early outcomes. J Plast Surg Hand Surg 2021; 56:138-144. [PMID: 34313544 DOI: 10.1080/2000656x.2021.1951744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The purpose of the study is to present a technical approach for arthroscopic three-corner or lunocapitate arthrodesis with mini-open scaphoid excision and to report about the early clinical and functional results. The median surgery time was 112 min with shorter times achieved once mastering the technique. Radiological and clinical union was observed in 11 out of 12 patients in a median time of five months. For final assessments nine patients were included with a median follow-up of 15 months. Wrist extension and flexion after surgery decreased to 58 and 62% of preoperative measurements and represented 37 and 42% of the unaffected side. Grip strength also decreased to 80% of the preoperative value and 57% of the unaffected side. All patients reported significant pain relief and functional improvement. Arthroscopic three-corner or lunocapitate arthrodesis was a safe, reliable and minimally invasive technique for treating wrist osteoarthritis, while it was technically demanding and time-consuming during learning curve.
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Affiliation(s)
- Olga Politikou
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Austria
| | - Lisa Reissner
- Orthopaedics Department, University Hospital Balgrist, Zurich, Switzerland
| | - Inga S Besmens
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Switzerland
| | - Maurizio Calcagni
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Switzerland
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Zhang Y, Gillis JA, Moran SL. Management of scapholunate advanced collapse and scaphoid nonunion advanced collapse without proximal row carpectomy or four corner fusion. J Hand Surg Eur Vol 2021; 46:50-57. [PMID: 33202162 DOI: 10.1177/1753193420973322] [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] [Indexed: 02/03/2023]
Abstract
Four corner arthrodesis and proximal row carpectomy are the most common techniques for the management of advanced radiocarpal arthritis due to longstanding scapholunate instability and scaphoid nonunion. The advantages and short comings of each technique have been well defined in the literature. Advancements in joint replacement and arthroscopic surgery have resulted in new operations to manage radiocarpal and midcarpal arthritis. Most of these new procedures are modifications of the two classical operations, but some use modern implants and newer materials. New individualized options, like osteochondral grafting in combination with proximal row carpectomy or (arthroscopic) distal resection of the scaphoid, allowed us to improve our treatment and offer patients less invasive but equally effective procedures. We consider that four corner arthrodesis and proximal row carpectomy should not always be standard management for advanced radiocarpal arthritis.
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Affiliation(s)
- Yiyang Zhang
- Division of Orthopedic Surgery, Roth
- McFarlane Hand and Upper Limb Centre, London, ON, Canada
| | - Joshua A Gillis
- Division of Plastic and Reconstructive Surgery, Roth
- McFarlane Hand and Upper Limb Centre, London, ON, Canada
| | - Steven L Moran
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA
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Gauci MO, Waitzenegger T, Chammas PE, Coulet B, Lazerges C, Chammas M. Comparison of clinical outcomes of three-corner arthrodesis and bicolumnar arthrodesis for advanced wrist osteoarthritis. J Hand Surg Eur Vol 2020; 45:679-686. [PMID: 32106758 DOI: 10.1177/1753193420905484] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We retrospectively compared results of 27 wrists with bicolumnar arthrodesis with mean follow-up of 67 months to 28 wrists with three-corner arthrodesis adding triquetral excision with mean follow-up of 74 months in 54 patients (55 wrists). Minimal follow-up was 2 years for all patients. Capitolunate nonunion occurred in three wrists with bicolumnar arthrodesis and six wrists with three-corner arthrodesis, and radiolunate arthritis developed in four wrists with three-corner arthrodesis. Among patients with bicolumnar arthrodesis, hamatolunate arthritis occurred in seven wrists, all with a Viegas type II lunate; and pisotriquetral arthritis occurred in three wrists. At mean 5 years after surgery, 45 wrists had not needed revision surgery, and both groups had similar revision rates. The wrists with three-corner arthrodesis and bicolumnar arthrodesis had similar functional outcomes, and range of wrist motion was not significantly different between the two groups. We concluded that bicolumnar arthrodesis results in greater longevity than three-corner arthrodesis for a type I lunate. We do not recommend bicolumnar arthrodesis for type II lunate. We also concluded that three-corner arthrodesis has a greater incidence of radiolunate arthritis and capitolunate nonunion.Level of evidence: III.
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Affiliation(s)
- Marc Olivier Gauci
- Institut Universitaire Locomoteur et du Sport (iULS), CHU de Nice, Université Côte d'Azur, UR2CA, France
| | - Thomas Waitzenegger
- Division of Hand and Upper Extremity Surgery, Lapeyronie University Hospital, Montpellier, France
| | - Pierre-Emmanuel Chammas
- Division of Hand and Upper Extremity Surgery, Lapeyronie University Hospital, Montpellier, France
| | - Bertrand Coulet
- Division of Hand and Upper Extremity Surgery, Lapeyronie University Hospital, Montpellier, France
| | - Cyril Lazerges
- Division of Hand and Upper Extremity Surgery, Lapeyronie University Hospital, Montpellier, France
| | - Michel Chammas
- Division of Hand and Upper Extremity Surgery, Lapeyronie University Hospital, Montpellier, France
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Ledgard JP, Siddiqui J, Pelletier MH, Walsh WR, Scougall PJ. Midcarpal Arthrodesis Biomechanics: Memory Staples versus Cannulated Screws. J Hand Surg Asian Pac Vol 2018; 23:474-478. [PMID: 30428793 DOI: 10.1142/s2424835518500455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Midcarpal arthrodesis is a treatment of choice in patients with midcarpal arthritis. Traditionally a four corner fusion has been favoured, however recent research has shown improved results when the triquetrum and scaphoid are excised. There is no clear evidence as to which remaining bones should be fused or which implants should be used. The purpose of this study is to compare the biomechanics of midcarpal arthrodesis after scaphoid and triquetrum excision, using memory staples or cannulated screws, in recognised construct patterns. METHODS 36 identical sets of carpal bones were 3D printed from acetyl butyl styrene. Midcarpal arthrodeses were performed in three configurations with shape memory alloy staples or headless compression screws. This gave 6 treatment groups; lunocapitate single staple or screw, lunocapitate with 2 staples or screws, three corner fusion with 2 staples or screws. Peak torque to distraction was measured and analysed. RESULTS The peak torque to distraction was significantly greater in almost all constructs utilizing screws compared to staples, with two lunocapitate screws having the highest peak torque at both 1 and 3 mm distraction with 244 Nmm and 749 Nmm respectively (p < 0.05). CONCLUSIONS Constructs utilizing screws have a peak torque to distraction significantly higher when compared to staples. Our recommendation when performing a midcarpal arthrodesis after scaphoid and trapezium excision is to fuse the midcarpal joint with 2 headless compression screws.
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Affiliation(s)
- James P Ledgard
- * The Sydney Hospital Hand Unit, Sydney Hospital, Sydney, Australia
| | | | - Matthew H Pelletier
- † Surgical & Orthopaedic Research Laboratories, Prince of Wales Clinical School, Sydney, Australia
| | - William R Walsh
- † Surgical & Orthopaedic Research Laboratories, Prince of Wales Clinical School, Sydney, Australia
| | - Peter J Scougall
- * The Sydney Hospital Hand Unit, Sydney Hospital, Sydney, Australia
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Abstract
Partial wrist arthrodesis (PWA) is a well-known procedure for treating degenerative or posttraumatic wrist conditions. Four-corner fusion (4CF) is mostly used for scapholunate advanced collapse and scaphoid nonunion advanced collapse. The author performed 39 procedures, including 4CFs, 2-corner fusions, 3-corner fusions, scaphoid-capitate/scaphoid-capitate-lunate fusions, scaphoid-trapezium-trapezoid arthrodeses, and radioscapholunate arthroscopic PWAs (A-PWAs). There were 8 revision cases including 4 partial nonunions. All A-PWAs healed satisfactorily after revision surgery. This article discusses the surgical techniques and tips to avoid mistakes. The pros and cons for open versus arthroscopic techniques and for screws versus Kirschner wires are also discussed.
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Affiliation(s)
- Eva-Maria Baur
- Practice for Plastic and Hand Surgery, James-Loeb-Str. 13, Murnau D-82418, Germany.
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11
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Kakar S. What's New in Hand Surgery. J Bone Joint Surg Am 2016; 98:511-6. [PMID: 26984920 DOI: 10.2106/jbjs.15.01214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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