1
|
Marcuzzi A, Pederiva D, Pilla F, Canovi A, Corradini A, Adani R, Ruffilli A, Faldini C, Vita F. The use of resurfacing capitate pyrocarbon implants (RCPI) in chronic diseases of the wrist: outcomes of more than 100 cases. Musculoskelet Surg 2024; 108:367-371. [PMID: 38038900 DOI: 10.1007/s12306-023-00803-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/07/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION In advanced chronic post-traumatic wrist pathology, the goal of surgery has always been to reduce pain while trying to preserve the function of the wrist itself as much as possible; numerous interventions have been developed to achieve these goals (partial arthrodesis, 4-angle arthrodesis, the use of prosthetic implants…). PURPOSES The purpose of the study is to evaluate outcomes and complications rate of proximal row carpectomy associated with the resurfacing capitate pyrocarbon implant (RCPI) for chronic diseases of the wrist. MATERIALS AND METHODS A retrospective analysis of the patients operated on between June 2004 and March 2021 was performed. Pain, wrist range of motion in flexion, extension, radial and ulnar deviation and grip strength were compared preoperatively and at 1, 6, 12 and 24 months. Complications and additional procedures were recorded. RESULTS A total of 112 patients underwent surgery for proximal row carpectomy and placement of RCPI with a mean follow-up of 6.6 years. Between the preoperative and the 2-year follow-up, a reduction in pain (VAS from 7.3 to 0.5), an increase in grip strength (from 8 to 17 kg) and an increase in ROM in all planes (flexion from 19° to 44°, extension from 20° to 46°, radial deviation from 7° to 14° and ulnar deviation from 13° to 28°) were recorded. Ten (8.9%) patients required additional surgery, with only 2 (1.8%) patients requiring revision of the implant. CONCLUSIONS Proximal row carpectomy associated with RCPI is an excellent surgical strategy to relieve pain and to improve wrist range of motion and grip strength in patients with chronic diseases of the wrist.
Collapse
Affiliation(s)
- A Marcuzzi
- Hand and Microvascular Unit, Azienda Ospedaliera Policlinico di Modena, Modena, Italy
| | - D Pederiva
- Research Hospital Rizzoli Orthopedic Institute IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
| | - F Pilla
- Research Hospital Rizzoli Orthopedic Institute IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - A Canovi
- Orthopedics and Traumatology, Magati Hospital Scandiano, Scandiano, Italy
| | - A Corradini
- Orthopedics and Traumatology, Santa Maria Bianca Hospital, Mirandola, Italy
| | - R Adani
- Hand and Microvascular Unit, Azienda Ospedaliera Policlinico di Modena, Modena, Italy
| | - A Ruffilli
- Research Hospital Rizzoli Orthopedic Institute IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - C Faldini
- Research Hospital Rizzoli Orthopedic Institute IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - F Vita
- Research Hospital Rizzoli Orthopedic Institute IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Mitchell AR, Kerkhof FD, Wadhwa H, Ladd AL. The Role of the Flexor Carpi Radialis Groove in Trapeziometacarpal Osteoarthritis. Hand (N Y) 2024; 19:90-95. [PMID: 36050929 PMCID: PMC10786103 DOI: 10.1177/15589447221120844] [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: 11/16/2022]
Abstract
BACKGROUND Thumb carpometacarpal (CMC) osteoarthritis (OA) is a common condition. The contribution of surrounding ligaments and tendons to the stability of the CMC joint is likely altered in OA. The flexor carpi radialis (FCR) tendon runs in the trapezial FCR groove and is often noted to be frayed during CMC arthroplasty. We hypothesized that decreased integrity of the FCR tendon is related to FCR groove morphology and is associated with increased severity of CMC OA. METHODS We examined 3-dimensional surface models based on computed tomography (CT) scans of explanted trapezia from patients who underwent thumb CMC arthroplasty. Fraying of the FCR tendon was rated intraoperatively. Measurements were taken of the FCR groove to evaluate its morphology. Preoperative thumb CMC radiographs for each patient were scored using the modified Eaton classification system and the Thumb Osteoarthritis Index. Differences in the tendon groups were examined, and multivariable linear regression models were used to test the association between tendon group and FCR groove measurement. RESULTS There were 136 patients who were categorized into 4 tendon groups: intact, minor fraying, fraying, and ruptured. There were no differences between the tendon groups on any measures. CONCLUSIONS Our findings do not demonstrate a significant influence of FCR groove morphology on FCR tendon fraying in CMC arthroplasty patients. We also did not find a significant association between the FCR tendon state and degree of radiographic CMC OA. Further studies should investigate the in vivo FCR tendon to evaluate its tearing and inflammation in relation to basilar thumb pain.
Collapse
|
5
|
Reyniers P, van Beek N, De Schrijver F, Goeminne S, Reyniers P. Proximal row carpectomy versus four-corner arthrodesis in the treatment of SLAC and SNAC wrist: meta-analysis and literature review. HAND SURGERY & REHABILITATION 2023; 42:194-202. [PMID: 37031919 DOI: 10.1016/j.hansur.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 04/11/2023]
Abstract
A systematic literature review was performed on 84 articles from 2000 to 2020 on proximal row carpectomy (PRC) or four-corner arthrodesis (FCA) in patients with posttraumatic wrist osteoarthritis. Qualitative assessment was conducted on 14 articles. Pain, range of motion (ROM), grip strength and complications were analyzed using weighted average means. Meta-analysis with a random effects model was performed for the flexion-extension arc and grip strength. A total of 1,066 PRCs and 2,771 FCAs were analyzed, with a mean follow-up of 9 and 7 years respectively. Mean flexion after PRC and FCA respectively was 36.2 ° and 31.1 °, mean extension 41.4 ° and 32.4 °, and mean grip strength 26.4 kg and 27.5 kg. PRC had a larger flexion-extension arc than FCA, with a standard mean difference (SMD) of 0.41 (range, 0.02-0.81). No significant difference was found for grip strength. Osteoarthritis occurred in 42.2% of PRC cases, independently of capitate shape. Conversion to wrist arthrodesis was performed in 10.1% of failed PRCs. Revision was chosen in 4.7% of FCAs and conversion to wrist arthrodesis in 4.6%. We conclude that the functional results of both techniques are similar, but prefer PRC to FCA because of the lower complications rate.
Collapse
Affiliation(s)
- P Reyniers
- AZ Herentals, Nederrij 133, 2200 Herentals, Netherlands
| | - N van Beek
- AZ Herentals, Nederrij 133, 2200 Herentals, Netherlands
| | | | - S Goeminne
- AZ Herentals, Nederrij 133, 2200 Herentals, Netherlands
| | | |
Collapse
|
6
|
Cholley-Roulleau M, Bouju Y, Lecoq FA, Fournier A, Bellemère P. Pyrocardan Scaphotrapeziotrapezoid Joint Arthroplasty for Isolated Osteoarthritis: Results after a Mean Follow-Up of 5 Years. J Wrist Surg 2022; 11:262-268. [PMID: 35837588 PMCID: PMC9276069 DOI: 10.1055/s-0041-1733877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
Background Isolated scaphotrapeziotrapezoid (STT) osteoarthritis (OA) mainly develops in women over 50 years of age in a bilateral manner. Many surgical treatments are available, including distal scaphoid resection with or without interposition, trapeziectomy, and STT arthrodesis. However, there is a controversy about which procedure is the most effective. Purposes The purpose of this study was to report the outcomes of the Pyrocardan implant for treating STT isolated OA at a mean follow-up of 5 years. Patients and Methods Consecutive patients who underwent STT arthroplasty using the Pyrocardan were reviewed retrospectively by an independent examiner who performed a clinical and radiological evaluation. Results The mean follow-up time was 5 years (range 3-8 years). Thirteen patients (76%) were followed for more than 5 years. Between the preoperative assessment and the last follow-up, pain levels decreased significantly. There was no significant difference in the mean Kapandji opposition score. Grip and pinch strengths were 88 and 91% of the contralateral side. The active range of motion in flexion-extension and radioulnar deviation was not significantly different to the contralateral side (119° vs. 121° and 58° vs. 52°, p > 0.1). Functional scores were improved significantly. No identifiable differences were found in the radioscaphoid, capitolunate, and scapholunate angles before and after surgery. In three cases, the preoperative dorsal intercalated scapholunate instability (DISI) failed to be corrected. In one case, DISI appeared after the procedure. There was one asymptomatic dislocation of the implant. Calcification around the trapezium and/or distal scaphoid was found in four cases. The survival rate of the implant without reoperation was 95%. Conclusions In the medium term, Pyrocardan implant is an effective treatment for STT OA as it reduces pain, increases grip strength, and maintains wrist mobility. This is consistent with the results of other published case series using pyrocarbon implants. It provides a high rate of patient satisfaction. Nevertheless, the surgical procedure must be done carefully to avoid STT ligament damage, periarticular calcifications, or dislocation.
Collapse
Affiliation(s)
- Martin Cholley-Roulleau
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Émile Gallé, CHU Nancy, Nancy, France
| | - Yves Bouju
- Department of Hand Surgery, Institut de la main Nantes-Atlantique, Santé Atlantique, Saint-Herblain, France
| | - Flore-Anne Lecoq
- Department of Hand Surgery, Institut de la main Nantes-Atlantique, Santé Atlantique, Saint-Herblain, France
| | - Alexandre Fournier
- Department of Hand Surgery, Institut de la main Nantes-Atlantique, Santé Atlantique, Saint-Herblain, France
| | - Philippe Bellemère
- Department of Hand Surgery, Institut de la main Nantes-Atlantique, Santé Atlantique, Saint-Herblain, France
| |
Collapse
|
7
|
The role of Interleukin-1 receptor antagonist as a treatment option in calcium pyrophosphate crystal deposition disease. Mol Biol Rep 2021; 48:4789-4796. [PMID: 34075537 PMCID: PMC8260411 DOI: 10.1007/s11033-021-06457-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/27/2021] [Indexed: 12/30/2022]
Abstract
Calcium Pyrophosphate Crystal Deposition (CPPD) disease is characterized by the deposition of calcium pyrophosphate crystals in the cartilage. In most cases, it can manifest as a subclinical condition named chondrocalcinosis, often revealed by joint x-ray examination. In other cases, deposition can cause flares of arthritis, known as acute CPP crystal arthritis. In the last few years, many pathogenic pathways have been discovered. Interleukin-1 (IL-1) plays a key role in the pathogenesis of CPPD disease, both as a mediator of inflammatory response to crystals and as a promoter of damage to articular cartilage. In this review, we investigated the role of IL-1R inhibitor, such as Anakinra, as an alternative to the various therapeutic strategies for CPPD disease, especially among patients resistant to traditional treatment with NSAIDs, corticosteroids and colchicine.
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Functional outcomes after surgical treatment of isolated scaphotrapeziotrapezoid osteoarthritis: Retrospective single-center 24-case series. HAND SURGERY & REHABILITATION 2020; 39:107-112. [DOI: 10.1016/j.hansur.2019.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/22/2019] [Accepted: 11/04/2019] [Indexed: 11/19/2022]
|
11
|
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.
Collapse
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.
| |
Collapse
|
12
|
El Abiad R, Rizkallah M, Issa El Khoury F, El Rayes J, Maalouf P. Lunate Excision with Partial Bicolumnar Wrist Fusion: A New Alternative for Isolated Radiolunate Arthritis?: A Report of 2 Cases. JBJS Case Connect 2019; 9:e0465. [PMID: 31821199 DOI: 10.2106/jbjs.cc.18.00465] [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: 06/10/2023]
Abstract
CASE We report the case of 2 patients presenting with advanced isolated radiolunate arthritis with limited wrist strength and range of motion (ROM). After failure of conservative therapy, both patients underwent lunate excision and scaphocapitate and triquetrohamate joints fusion using compression headless screws. Improved functional outcomes are reported at 4 years of follow-up with painless wrists and increased grip strength and ROM. CONCLUSIONS Lunate excision and partial bicolumnar wrist fusion lead to increased grip strength and wrist ROM. This is a unique alternative for people suffering isolated radiolunate osteoarthritis, for which no standard surgical care exists.
Collapse
Affiliation(s)
- Rami El Abiad
- Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Maroun Rizkallah
- Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | | | - Johnny El Rayes
- Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Peter Maalouf
- Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| |
Collapse
|
13
|
Wu JC, Calandruccio JH. Evaluation and Management of Scaphoid-Trapezium-Trapezoid Joint Arthritis. Orthop Clin North Am 2019; 50:497-508. [PMID: 31466665 DOI: 10.1016/j.ocl.2019.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Degenerative arthritis at the articulation of the scaphoid, trapezium, and trapezoid (STT or triscaphe joint) is a common degenerative disease of the wrist. Pain and weakness with grip strength reduction and functional limitations when performing routine daily tasks are common complaints of patients with STT arthritis. Initial conservative treatments for STT arthritis include splinting, bracing, activity modification, anti-inflammatory medication, and steroid injections for pain relief. Failure of conservative treatment is the main indication for surgery, which may include distal scaphoid excision, with or without filling of the void after excision, trapeziectomy, STT arthrodesis, or STT implant arthroplasty.
Collapse
Affiliation(s)
- John C Wu
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA.
| | - James H Calandruccio
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA
| |
Collapse
|
14
|
Abstract
The thumb basal joint is the second most common site of osteoarthritis in the hand, and osteoarthritis of this joint can contribute to painful movement and debilitating function. To achieve a high degree of prehensile and manipulative function, this highly mobile joint is constrained by both the saddle morphology of the trapezium and a stout complement of ligamentous constraints. The disease proceeds progressively with several wear patterns. Substantial new biomechanical and longitudinal clinical studies have changed some of the prevailing opinions on the process of serial degenerative changes. Diagnosis is made with a thorough clinical examination and radiographic staging, as described by Eaton and Littler. Thumb basal joint arthritis can be initially managed with medications, orthoses, and steroid injections; however, it frequently progresses despite these interventions. Surgical management commonly consists of trapeziectomy with or without interposition or suspension, arthroplasty with implant, volar ligament reconstruction, osteotomy, or arthrodesis; none of these techniques has been proved to be superior to the others.
Collapse
|
15
|
Abstract
Partial wrist fusion is a useful technique for the treatment of such specific carpal disorders as arthritis, Kienböck's disease, midcarpal instability, scaphoid nonunion, etc.Many techniques have been described by removing arthritic joint surfaces and transfering load, using, for bone fixation, K-wires, screws, staples, and more recently dedicated plates.The goal of this procedure is to maximise wrist motion and strength while minimizing or eliminating pain.The purpose of this article is to discuss the most commonly used combination of intercarpal arthrodeses, to clarify the indications for each fusion, to describe the appropriate surgical technique for each fusion, and to provide an overview of results and current concepts. Cite this article: Houvet, P. Intercarpal fusions: indications, treatment options and techniques. EFORT Open Rev 2016;1:45-51. DOI: 10.1302/2058-5241.1.000019.
Collapse
Affiliation(s)
- Patrick Houvet
- Institut Français de Chirurgie de la Main, Paris, France
| |
Collapse
|
16
|
Gauthier E, Truffandier MV, Gaisne E, Bellemère P. Treatment of scaphotrapeziotrapezoid osteoarthritis with the Pyrocardan ® implant: Results with a minimum follow-up of 2 years. HAND SURGERY & REHABILITATION 2017; 36:113-121. [DOI: 10.1016/j.hansur.2017.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 09/19/2016] [Accepted: 01/21/2017] [Indexed: 01/01/2023]
|
17
|
Delattre O, Goulon G, Vogels J, Wavreille G, Lasnier A. Three-Corner Arthrodesis With Scaphoid and Triquetrum Excision for Wrist Arthritis. J Hand Surg Am 2015; 40:2176-82. [PMID: 26409577 DOI: 10.1016/j.jhsa.2015.07.032] [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: 01/13/2015] [Revised: 07/30/2015] [Accepted: 07/30/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To report the clinical and radiographic results of a consecutive series of patients who underwent the 3-corner arthrodesis (3CA) (arthrodesis of capitate, hamate, and lunate with scaphoid and triquetrum excision) procedure for wrist arthritis. METHODS This was a retrospective study of 30 consecutive patients who underwent a 3CA between 1994 and 2008. The indications were painful wrist osteoarthritis due to stage 2 or 3 scapholunate advanced collapse, scaphoid nonunion advanced collapse, or scaphoid chondrocalcinosis advanced collapse wrists. The clinical assessment consisted of range of motion, grip strength, and the Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation scores. The radiographic assessment parameters consisted of bone fusion, carpal height and translation, lunate tilt, and appearance of the radiolunate joint space. RESULTS The average follow-up was 6 years (± 4 years). The arthrodesis was performed with staples, 2 screws, or a plate and screws. Grip strength was 72% of the contralateral side. The mean range of motion in flexion-extension arc and ulnar-radial deviation arc was 70° and 36°, respectively. The mean Disabilities of the Arm, Shoulder, and Hand and the Patient-Rated Wrist Evaluation scores were 17 (± 11) and 22 (± 24), respectively. The fusion incidence was 90% (27 of 30). The mean difference of radiolunate angle on preoperative and postoperative radiographs was 8° (16°-8° in dorsal direction). The radiolunate joint space had narrowed in 1 patient. Six surgical revisions (20%) were necessary owing to dorsal pain in patients operated using plates, staples, or excessively long screws. CONCLUSIONS Three-corner arthrodesis results are comparable with 4-corner arthrodesis and proximal row carpectomy. We feel that it is simpler technically than 4-corner arthrodesis. Although 3CA is more complex than proximal row carpectomy, it preserves the native radiolunate joint. Complications that can be attributed to the dorsal fixation hardware (particularly staples and plates) were noteworthy. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Olivier Delattre
- Service de Chirurgie Orthopédique et Traumatologique du membre supérieur, Centre Hospitalier Universitaire Pierre Zobda Quitman, Fort-de-France, Martinique, France
| | - Gilles Goulon
- Service de Chirurgie Orthopédique et Traumatologique du membre supérieur, Centre Hospitalier Universitaire Pierre Zobda Quitman, Fort-de-France, Martinique, France
| | - Jérôme Vogels
- Service de Chirurgie Orthopédique et Traumatologique du membre supérieur, Centre Hospitalier Universitaire Pierre Zobda Quitman, Fort-de-France, Martinique, France
| | | | - Arthur Lasnier
- Service de Chirurgie Orthopédique et Traumatologique du membre supérieur, Centre Hospitalier Universitaire Pierre Zobda Quitman, Fort-de-France, Martinique, France.
| |
Collapse
|
18
|
Scapholunate Advanced Collapse: Nomenclature and Differential Diagnosis. J Hand Surg Am 2015; 40:2085-9. [PMID: 26243321 DOI: 10.1016/j.jhsa.2015.06.110] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 06/10/2015] [Accepted: 06/15/2015] [Indexed: 02/02/2023]
|
19
|
Laulan J, Marteau E, Bacle G. Wrist osteoarthritis. Orthop Traumatol Surg Res 2015; 101:S1-9. [PMID: 25596986 DOI: 10.1016/j.otsr.2014.06.025] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 05/24/2014] [Accepted: 06/20/2014] [Indexed: 02/02/2023]
Abstract
Painful wrist osteoarthritis can result in major functional impairment. Most cases are related to posttraumatic sequel, metabolic arthropathies, or inflammatory joint disease, although wrist osteoarthritis occurs as an idiopathic condition in a small minority of cases. Surgery is indicated only when conservative treatment fails. The main objective is to ensure pain relief while restoring strength. Motion-preserving procedures are usually preferred, although residual wrist mobility is not crucial to good function. The vast array of available surgical techniques includes excisional arthroplasty, limited and total fusion, total wrist denervation, partial and total arthroplasty, and rib-cartilage graft implantation. Surgical decisions rest on the cause and extent of the degenerative wrist lesions, degree of residual mobility, and patient's wishes and functional demand. Proximal row carpectomy and four-corner fusion with scaphoid bone excision are the most widely used surgical procedures for stage II wrist osteoarthritis secondary to scapho-lunate advanced collapse (SLAC) or scaphoid non-union advanced collapse (SNAC) wrist. Proximal row carpectomy is not indicated in patients with stage III disease. Total wrist denervation is a satisfactory treatment option in patients of any age who have good range of motion and low functional demands; furthermore, the low morbidity associated with this procedure makes it a good option for elderly patients regardless of their range of motion. Total wrist fusion can be used not only as a revision procedure, but also as the primary surgical treatment in heavy manual labourers with wrist stiffness or generalised wrist-joint involvement. The role for pyrocarbon implants, rib-cartilage graft implantation, and total wrist arthroplasty remains to be determined, given the short follow-ups in available studies.
Collapse
Affiliation(s)
- J Laulan
- Département de chirurgie orthopédique, CHRU de Tours, route de Loches, 37044 Tours cedex, France.
| | - E Marteau
- Département de chirurgie orthopédique, CHRU de Tours, route de Loches, 37044 Tours cedex, France
| | - G Bacle
- Département de chirurgie orthopédique, CHRU de Tours, route de Loches, 37044 Tours cedex, France
| |
Collapse
|
20
|
Kahloune M, Libouton X, Omoumi P, Larbi A. Osteoarthritis and scapholunate instability in chondrocalcinosis. Diagn Interv Imaging 2015; 96:115-9. [PMID: 25577977 DOI: 10.1016/j.diii.2013.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- M Kahloune
- Radiology Department, Saint-Luc University Hospitals, av. Hippocrate 10, 1200 Brussels, Belgium.
| | - X Libouton
- Orthopedic and Trauma Surgery Department, Saint Luc University Hospitals, av. Hippocrate 10, 1200 Brussels, Belgium
| | - P Omoumi
- Radiology Department, Saint-Luc University Hospitals, av. Hippocrate 10, 1200 Brussels, Belgium
| | - A Larbi
- Radiology Department, Saint-Luc University Hospitals, av. Hippocrate 10, 1200 Brussels, Belgium
| |
Collapse
|
21
|
Scordino LE, Bernstein J, Nakashian M, McIntosh M, Cote MP, Rodner CM, Wolf JM. Radiographic prevalence of scaphotrapeziotrapezoid osteoarthrosis. J Hand Surg Am 2014; 39:1677-82. [PMID: 25037508 DOI: 10.1016/j.jhsa.2014.05.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 05/20/2014] [Accepted: 05/22/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To define the radiographic prevalence of scaphotrapeziotrapezoid (STT) osteoarthrosis (OA) in a cohort of patients presenting to a hand surgeon for any complaint. The secondary purpose was to evaluate coexisting thumb carpometacarpal (CMC) joint OA. METHODS Seven hundred radiographs were evaluated for presence and degree of STT and thumb CMC arthritic changes in consecutive patients presenting to a hand clinic for any chief complaint over the study period. RESULTS OA was noted at the STT joint in 111 of the 700 (16%) radiographs reviewed. Increased age, female sex, presence of a scapholunate (SL) ligament gap greater than 3 mm, and presence of radiographic thumb CMC joint OA were all significantly correlated with presence of STT joint OA. However, logistical regression analysis demonstrated that only increasing age, presence of an SL ligament gap greater than 3 mm, and presence of thumb CMC joint OA were strong predictors of STT joint OA. CONCLUSIONS STT joint OA is a common finding on hand radiographs of patients presenting to a hand clinic. Its prevalence increases with age, the presence of an SL ligament gap greater than 3 mm, and with the presence of CMC joint OA. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic III.
Collapse
Affiliation(s)
- Laura E Scordino
- New England Musculoskeletal Institute, University of Connecticut Health Center, Farmington, CT.
| | - Jenna Bernstein
- New England Musculoskeletal Institute, University of Connecticut Health Center, Farmington, CT
| | - Michael Nakashian
- New England Musculoskeletal Institute, University of Connecticut Health Center, Farmington, CT
| | - Masai McIntosh
- New England Musculoskeletal Institute, University of Connecticut Health Center, Farmington, CT
| | - Mark P Cote
- New England Musculoskeletal Institute, University of Connecticut Health Center, Farmington, CT
| | - Craig M Rodner
- New England Musculoskeletal Institute, University of Connecticut Health Center, Farmington, CT
| | - Jennifer Moriatis Wolf
- New England Musculoskeletal Institute, University of Connecticut Health Center, Farmington, CT
| |
Collapse
|
22
|
The role of imaging in diagnosing diseases of the distal radioulnar joint, triangular fibrocartilage complex, and distal ulna. AJR Am J Roentgenol 2014; 203:146-53. [PMID: 24951208 DOI: 10.2214/ajr.13.11573] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to review the anatomy, biomechanics, and multimodality imaging findings of common and uncommon distal radioulnar joint (DRUJ), triangular fibrocartilage complex, and distal ulna abnormalities. CONCLUSION The DRUJ is a common site for acute and chronic injuries and is frequently imaged to evaluate chronic wrist pain, forearm dysfunction, and traumatic forearm injury. Given the complex anatomy of the wrist, the radiologist plays a vital role in the diagnosis of wrist pain and dysfunction.
Collapse
|
23
|
Marcuzzi A, Ozben H, Russomando A. The use of a pyrocarbon capitate resurfacing implant in chronic wrist disorders. J Hand Surg Eur Vol 2014; 39:611-8. [PMID: 23962871 DOI: 10.1177/1753193413501730] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The present study describes the technique and results of proximal row carpectomy with resection of the head of the capitate and replacement with a pyrocarbon capitate resurfacing implant. The major indication for surgical treatment was arthritic changes on the head of the capitate. Patients were assessed by range of motion, grip strength, pain and functional scoring, and radiographic studies. In most patients, wrist function was improved and pain relief was obtained. This surgical procedure may represent a good alternative to total and partial wrist arthrodesis.
Collapse
Affiliation(s)
- A Marcuzzi
- Modena University Hospital, Department of Hand Surgery, Modena, Italy
| | - H Ozben
- Modena University Hospital, Department of Hand Surgery, Modena, Italy
| | - A Russomando
- Modena University Hospital, Department of Hand Surgery, Modena, Italy
| |
Collapse
|
24
|
Bear DM, Moloney G, Goitz RJ, Balk ML, Imbriglia JE. Joint space height correlates with arthroscopic grading of wrist arthritis. Hand (N Y) 2013; 8:296-301. [PMID: 24426937 PMCID: PMC3745247 DOI: 10.1007/s11552-013-9522-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Osteoarthritis of the radiocarpal joints is commonly encountered by hand surgeons. To date, there is no well-defined method of radiographically grading osteoarthritis of the wrist. METHODS Preoperative radiographs of 48 patients undergoing wrist arthroscopy were evaluated retrospectively. Images were graded subjectively by five surgeons based on overall severity of arthritis, osteophytes, subchondral cysts, and subchondral sclerosis. The joint space height (JSH) ratio was calculated by measuring the space of the mid-radioscaphoid and mid-radiolunate joints and dividing each by the height of the capitate. Arthroscopic grading of arthritis was obtained from operative records and compared to subjective and objective grades. ANOVA testing evaluated for statistical significance with p < 0.05. Inter-rater and intra-rater reliability was determined using Pearson's correlation analysis and Cohen's kappa coefficient. RESULTS Objective measurement using the JSH ratio demonstrated a significant decrease as arthroscopic arthritis grade increased for both radioscaphoid and radiolunate joints. Subjective grading of radioscaphoid and radiolunate joints was able to detect moderate/severe, but not mild arthritis. Subjective grading underestimated the degree of arthritis, particularly in the radiolunate joint. Inter-rater reliability was better for objective compared to subjective grading. CONCLUSIONS Subjective grading of wrist arthritis can detect moderate/severe radiocarpal arthritis but poorly evaluates early arthritis and underestimates severity. Objective grading using the JSH ratio accurately grades radioscaphoid arthritis and detects early radiolunate arthritis. The JSH ratio more accurately assesses radiocarpal arthritis compared with subjective grading. As there currently is no accepted method to radiographically grade wrist arthritis, the JSH ratio represents a promising option.
Collapse
Affiliation(s)
- David M. Bear
- />Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261 USA
| | - Gele Moloney
- />Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261 USA
| | - Robert J. Goitz
- />Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261 USA
| | - Marshall L. Balk
- />Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261 USA
| | - Joseph E. Imbriglia
- />Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261 USA , />Hand and Upper Extremity Center, 6001 Stonewood Dr, Wexford, PA 15090 USA
| |
Collapse
|
25
|
Shah CM, Stern PJ. Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrist arthritis. Curr Rev Musculoskelet Med 2013; 6:9-17. [PMID: 23325545 PMCID: PMC3702758 DOI: 10.1007/s12178-012-9149-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) are the two most common patterns of posttraumatic wrist arthritis. This review discusses the etiology and clinical evaluation, as well as up-to-date treatment options, for both of these conditions. Classic as well as newer innovative techniques are discussed with clinical outcomes in order to provide an evidence-based review of the world's literature on SLAC/SNAC wrist.
Collapse
Affiliation(s)
- Chirag M. Shah
- Hand Surgery Specialists, Inc., 538 Oak Street, Suite 200, Cincinnati, OH 45219 USA
| | - Peter J. Stern
- Hand Surgery Specialists, Inc., 538 Oak Street, Suite 200, Cincinnati, OH 45219 USA
| |
Collapse
|
26
|
Abstract
Resection arthroplasty is an old, and yet reliable, solution for the isolated osteoarthritis (OA) of some joints of the hand. With complication low rates, this technically undemanding option is ideal for scapho-trapezial-trapezoidal joint OA, as well as for the OA of the carpometacarpal joints of the fingers. This paper reviews its indications, surgical technique, and results.
Collapse
Affiliation(s)
- Alberto L Lluch
- Institut Kaplan for surgery of the Hand and Upper Extremity, Paseo Bonanova, 9, Barcelona 08022, Spain.
| | | | | |
Collapse
|
27
|
Luegmair M, Houvet P. Effectiveness of four-corner arthrodesis with use of a locked dorsal circular plate. Clin Orthop Relat Res 2012; 470:2764-70. [PMID: 22430314 PMCID: PMC3441990 DOI: 10.1007/s11999-012-2312-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Accepted: 02/27/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Compared with traditional methods of fixation in four-corner arthrodesis, reviews of results using a dorsal circular plate (DCP) have identified higher complication rates. As the use of circular plate fixation for limited wrist arthrodesis was found to be a valuable concept per se and continued innovation and technical advancement are crucial to improve future treatment, changes in plate design were encouraged. QUESTIONS/PURPOSES To further evaluate the use of DCP fixation in four-corner arthrodesis, we report the first results using a radiolucent, nonmetallic (polyetheretherketone), locked DCP for four-corner arthrodesis. METHODS We retrospectively analyzed the clinical and radiographic results of 24 patients who underwent four-corner arthrodesis with a locked DCP at a minimum followup of 63 months (mean, 76 months; range, 63-91 months). There were nine women and 15 men, with a mean age of 53 years (range, 37-78 years) at the time of surgery. We evaluated ROM with a goniometer and grip strength with a dynamometer. Function was assessed using QuickDASH. Radiographs were evaluated for union, carpal alignment, and hardware problems. RESULTS At latest followup, ROM averaged 66% and 77% of the uninjured side in flexion-extension and radioulnar deviation, respectively. Grip strength averaged 70% of the uninjured side. The average postoperative QuickDASH score was 19.11. Union was achieved by 22 of the 24 patients. CONCLUSIONS Our data show four-corner arthrodesis with a radiolucent, nonmetallic, locked DCP is an effective procedure that allows stable primary fixation as a basis for good functional outcome, provided surgical technique and quality of bone graft are adequate. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Matthias Luegmair
- Department of Orthopaedic Surgery, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Patrick Houvet
- Institut Français de Chirurgie de la Main, Paris, France
| |
Collapse
|
28
|
Suresh SS, Raniga S, Shanmugam V, George M, Zaki H. Carpal tunnel syndrome due to hydroxyapatite crystal deposition disease. J Hand Microsurg 2012; 5:96-9. [PMID: 24426687 DOI: 10.1007/s12593-012-0076-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 08/31/2012] [Indexed: 11/28/2022] Open
Affiliation(s)
- S S Suresh
- Department of Orthopaedics, Ibri Regional Referral Hospital, PO Box 46, Ibri, 516 Sultanate of Oman ; PO Box 396, Ibri, 516 Sultanate of Oman
| | - Sameer Raniga
- Department of Radiology, Khoula Hospital, PB 90, Muscat, 116 Sultanate of Oman
| | - Vijay Shanmugam
- Department of Orthopaedics, Ibri Regional Referral Hospital, PO Box 46, Ibri, 516 Sultanate of Oman
| | - Mina George
- Department of Pathology, Khoula Hospital, PO 90, Muscat, 116 Sultanate of Oman
| | - Hosam Zaki
- Department of Orthopaedics, Ibri Regional Referral Hospital, PO Box 46, Ibri, 516 Sultanate of Oman
| |
Collapse
|
29
|
Westhuizen JVD, Mennen U. A WORKING CLASSIFICATION FOR THE MANAGEMENT OF SCAPHO-TRAPEZIUM-TRAPEZOIDOSTEO-ARTHRITIS. ACTA ACUST UNITED AC 2011; 15:203-10. [DOI: 10.1142/s0218810410004849] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 06/22/2010] [Accepted: 08/03/2010] [Indexed: 11/18/2022]
Abstract
Osteo-arthritis (OA) of the scapho-trapezium-trapezoid joint (STT) is the second most common involved joint after trapezium-metacarpal I OA in the wrist. The possible aetiology causing or contributing to the development of STT OA is shortly discussed. A working classification is then proposed, which assists in the management of STT OA.
Collapse
Affiliation(s)
| | - Ulrich Mennen
- Suite 7/8 Jacaranda Hospital, Muckleneuk, Pretoria, South Africa
| |
Collapse
|
30
|
Holveck A, Wolfram-Gabel R, Dosch JC, Sanda R, Antunes ABF, Decock S, Zorn P, Foessel L, Bierry G, Clavert P, Dietemann JL, Kahn JL. Scaphotrapezial ligament: normal arthro-CT and arthro-MRI appearance with anatomical and clinical correlation. Surg Radiol Anat 2011; 33:473-80. [DOI: 10.1007/s00276-010-0742-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 10/21/2010] [Indexed: 11/30/2022]
|
31
|
Scapholunate advanced collapse and scaphoid nonunion advanced collapse arthritis--update on evaluation and treatment. J Hand Surg Am 2011; 36:729-35. [PMID: 21463735 DOI: 10.1016/j.jhsa.2011.01.018] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 01/17/2011] [Indexed: 02/02/2023]
Abstract
Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse are common patterns of wrist arthritis. Scaphoid nonunion advanced collapse is caused by trauma, whereas SLAC wrist may also result from chronic pseudogout and can appear bilaterally without a clear history of injury. Surgical treatment for SLAC wrist includes 4-corner arthrodesis, capitolunate arthrodesis, complete wrist arthrodesis, proximal row carpectomy (PRC), denervation, and radial styloidectomy. Scaphoid nonunion advanced collapse wrist has the additional surgical option of excision of the distal ununited scaphoid fragment. Controversy persists over the relative merits of PRC versus 4-corner arthrodesis and whether PRC may be performed in the setting of capitate arthritis.
Collapse
|
32
|
White L, Clavijo J, Gilula LA, Wollstein R. Classification system for isolated arthritis of the scaphotrapeziotrapezoidal joint. J Plast Surg Hand Surg 2010; 44:112-7. [DOI: 10.3109/02844311003675388] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
33
|
Crystal Deposition Disease Masquerading as Proliferative Tenosynovitis and Its Associated Sequelae. Ann Plast Surg 2009; 62:128-33. [DOI: 10.1097/sap.0b013e3181788e98] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
34
|
Abstract
Osteoarthritis of the wrist is one of the commonest conditions encountered in clinical orthopaedic practice. This article looks at our approach to this problem including clinical assessment, radiographic analysis and the management of wrist osteoarthritis.
Collapse
Affiliation(s)
- S. C. Talwalkar
- Centre for Hand and Upper Limb Surgery, Wrightington Hospital for Joint Disease, Wigan, Lancashire, U.K
| | - M. J. Hayton
- Centre for Hand and Upper Limb Surgery, Wrightington Hospital for Joint Disease, Wigan, Lancashire, U.K
| | - J. K. Stanley
- Centre for Hand and Upper Limb Surgery, Wrightington Hospital for Joint Disease, Wigan, Lancashire, U.K
| |
Collapse
|
35
|
Yamazaki H, Uchiyama S, Kato H. Median nerve and ulnar nerve palsy caused by calcium pyrophosphate dihydrate crystal deposition disease: case report. J Hand Surg Am 2008; 33:1325-8. [PMID: 18929195 DOI: 10.1016/j.jhsa.2008.04.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Revised: 04/26/2008] [Accepted: 04/29/2008] [Indexed: 02/02/2023]
Abstract
Calcium pyrophosphate dihydrate crystal deposition disease can cause extra-articular pathology including nerve compression syndrome. We report a rare case of this complication in a 79-year-old woman.
Collapse
Affiliation(s)
- Hiroshi Yamazaki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
| | | | | |
Collapse
|
36
|
Yamazaki H, Uchiyama S, Hata Y, Murakami N, Kato H. Extensor tendon rupture associated with osteoarthritis of the distal radioulnar joint. J Hand Surg Eur Vol 2008; 33:469-74. [PMID: 18687835 DOI: 10.1177/1753193408090098] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Non-rheumatoid osteoarthritis of the distal radioulnar joint can cause extensor tendon rupture. We analysed the radiographic morphology of the distal radioulnar joint to identify the risk factors for this complication. Forty-one wrist X-rays of 37 patients with extensor tendon rupture caused by distal radioulnar joint osteoarthritis were evaluated retrospectively for the severity of osteoarthritis by the Kellgren/Lawrence scoring system. Measurements were obtained from posteroanterior views. All but one wrist had severe osteoarthritic changes exceeding grade 3. The radiographic features that were different from those of the contralateral wrists included deepening and widening of the sigmoid notch, radial shift of the ulnar head and dorsal inclination of the sigmoid notch. There was no significant association between tendon rupture and the morphology of the ulnar head or ulnar variance. The scallop sign, dorsal inclination of the sigmoid notch and radial shift of the ulnar head are radiological risk factors for extensor tendon ruptures.
Collapse
Affiliation(s)
- H Yamazaki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
| | | | | | | | | |
Collapse
|
37
|
Gajendran VK, Peterson B, Slater RR, Szabo RM. Long-term outcomes of dorsal intercarpal ligament capsulodesis for chronic scapholunate dissociation. J Hand Surg Am 2007; 32:1323-33. [PMID: 17996765 DOI: 10.1016/j.jhsa.2007.07.016] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2007] [Revised: 07/21/2007] [Accepted: 07/24/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE Chronic scapholunate dissociation is the most common cause of symptomatic wrist instability. In an attempt to restore normal carpal mechanics and prevent wrist arthrosis, we developed and tested biomechanically the dorsal intercarpal ligament capsulodesis (DILC). Previously, we reported good early clinical results for this procedure at an average follow-up period of 25 months. Here, we report on the functional and radiographic outcomes at a longer follow-up period of a minimum of 5 years. METHODS Records of patients undergoing the DILC for chronic (greater than 6 weeks), flexible, static scapholunate dissociation were reviewed. Only patients with follow-up evaluation of greater than 60 months were included. Physical examination, radiographs, and validated outcome instruments were used to evaluate the patients. RESULTS Twenty-one patients (22 wrists) met the inclusion criteria. Fifteen of 21 patients (16 wrists) were available for follow-up evaluation. Average follow-up period was 86 months. Physical examination revealed average wrist flexion and extension of 50 degrees and 55 degrees , respectively, radial and ulnar deviation of 17 degrees and 36 degrees , respectively, and grip strength of 43 kgf. Disabilities of the Arm, Shoulder and Hand, Short Form-12, and Mayo wrist scores averaged 19, 78, and 78, respectively. Radiographs revealed an average scapholunate angle and gap of 62 degrees and 3.5 mm, respectively. Eight of the 16 wrists in our study demonstrated arthritic changes on radiographs. CONCLUSIONS The DILC does not consistently prevent radiographic deterioration and the development of arthrosis in the long-term; however, the level of functionality and patient satisfaction remained relatively high in 58% of our patients, suggesting a lack of correlation between the radiographic findings and development of arthrosis and the functional outcomes and patient satisfaction. We believe that the DILC is still a reasonable option for treating flexible static scapholunate dissociation in patients without radiographic signs of arthritis presenting with wrist pain despite conservative treatment. Prevention of radiographic deterioration and arthrosis remains an unsolved problem.
Collapse
Affiliation(s)
- Varun K Gajendran
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA 95817, USA
| | | | | | | |
Collapse
|
38
|
Goubier JN, Bauer B, Alnot JY, Teboul F. Traitement de l'arthrose scaphotrapézotrapézoidienne isolée par arthrodèse scaphotrapézotrapézoidienne: une série de 13 cas. ACTA ACUST UNITED AC 2006; 25:179-84. [PMID: 17195598 DOI: 10.1016/j.main.2006.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Scapho-trapezio-trapezoid arthrodesis was originally performed for the treatment of scapho-lunate instability. However, only a few publications have described this technique for treatment of osteoarthritis of the scapho-trapezio-trapezoid (STT) joint. The purpose of this paper is to analyze the results of triscaphoid arthrodesis for STT osteoarthritis with a long-term follow-up. Thirteen cases of osteoarthritis of the STT joint in twelve patients, all treated by STT arthrodesis, were reviewed with an average follow-up of 60 months. Pain was classified according to Alnot's classification: eight patients were classified as grade III, two as grade IV and two as grade II. The average preoperative range of motion of the wrist was 51 degrees for flexion, 39 degrees for extension, 9 degrees for radial deviation and 28 degrees for ulnar deviation. Grip strength was compared to the contralateral side. Radiographic changes were classified according to Crosby's classification, including sublevels for carpal instability. Four wrists were classified 2a and nine wrists were classified 2b. The average radio-lunate and scapho-lunate angles were 14 and 45 degrees respectively. Pain was improved in all patients (P = 0.05) all of whom were subjectively satisfied. Strength and range-of-motion did not statistically decrease after STT arthrodesis except for wrist extension (P = 0.03). Radio-lunate and scapho-lunate angles were unchanged in five patients and improved in five patients. There were four non-unions of whom two patients without pain were not re-operated. The other two were re-operated with the same technique leading to fusion. Scapho-trapezio-trapezoid arthrodesis is an efficient procedure for STT osteoarthritis with regard to pain reduction. Strength and global range-of-motion are not modified by this procedure. Moreover, as it limits carpal instability, this procedure is preferable in active patients.
Collapse
Affiliation(s)
- J N Goubier
- Centre international de chirurgie de la main (CICM), clinique du pare Monceau, 21, rue de Chazelles, 75017, Paris, France.
| | | | | | | |
Collapse
|
39
|
Atzeni F, Sarzi-Puttini P, Bevilacqua M. Calcium Deposition and Associated Chronic Diseases (Atherosclerosis, Diffuse Idiopathic Skeletal Hyperostosis, and Others). Rheum Dis Clin North Am 2006; 32:413-26, viii. [PMID: 16716887 DOI: 10.1016/j.rdc.2006.02.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Extracellular matrix mineralization or calcification occurs in many pathologic conditions, including atherosclerosis, medial wall calcification, diffuse idiopathic skeletal hyperostosis, and chondrocalcinosis. Vascular wall calcification is the most common and involves two mechanisms: passive calcification resulting from breakdown of the protection system and active calcification resulting from transdifferentiation of mesenchymal cells in the vascular wall to bone. Although reports are conflicting, several matrix proteins are identified as protective factors against dystrophic calcification in nonosseous tissues. Serum matrix Gla protein may be a marker of osteometabolic syndromes that cause hyperostosis and plays a role in Milwaukee shoulder syndrome.
Collapse
Affiliation(s)
- Fabiola Atzeni
- Rheumatology Unit, L Sacco University Hospital, Milan, Italy
| | | | | |
Collapse
|
40
|
Abstract
PURPOSE OF REVIEW This review is an attempt to keep current in the sparse literature addressing the still underutilized area of crystal identification. RECENT FINDINGS The emphasis has been on the subtleties of the microscopic identification of common crystals and other less common potentially confusing crystals. Imaging is noted to provide increasing help, but microscopic crystal identification remains the gold standard. SUMMARY Quality control is still a concern as is the infrequency of attempted arthrocentesis for crystal identification.
Collapse
Affiliation(s)
- Lan X Chen
- VA Medical Center, Rheumatology Research 151K, Philadelphia, Pennsylvania 19104, USA
| | | |
Collapse
|
41
|
Hollevoet N, Verdonk R, Van Maele G. The influence of articular morphology on non-traumatic degenerative changes of the distal radioulnar joint. A radiographic study. ACTA ACUST UNITED AC 2005; 31:221-5. [PMID: 16337322 DOI: 10.1016/j.jhsb.2005.10.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2005] [Revised: 10/15/2005] [Accepted: 10/20/2005] [Indexed: 11/23/2022]
Abstract
We examined 248 wrist X-rays of patients over 50 years of age to find out if ulnar variance, orientation of the sigmoid notch and ulnar head inclination play a role in the development of non-traumatic osteoarthritis of the distal radioulnar joint. Minor degenerative changes, viz. focal joint space narrowing and/or lipping, or small osteophytes at the inferior edge of the ulnar head, were present in 13% of the X-rays of these wrists. They were significantly more frequent in wrists with a more inclined ulnar head and significantly less present in wrists with an oblique, distally orientated sigmoid notch. There was no significant association with ulnar variance or age. This study suggests that articular morphology may play a role in the development of degenerative changes of the distal radioulnar joint.
Collapse
Affiliation(s)
- N Hollevoet
- Department of Orthopaedic Surgery, Ghent University Hospital, Belgium.
| | | | | |
Collapse
|