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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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Zhang C, Chen H, Fan H, Xiong R, He R, Huang C, Peng Y, Yang P, Chen G, Wang F, Yang L. Carpal bone replacement using personalized 3D printed tantalum prosthesis. Front Bioeng Biotechnol 2023; 11:1234052. [PMID: 37965053 PMCID: PMC10642728 DOI: 10.3389/fbioe.2023.1234052] [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] [Received: 06/03/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
Objective: Scaphoid and lunate fractures have a relatively high incidence rate. Traditional carpectomy and carpal arthrodesis in the treatment of carpal osteonecrosis will lead to many complications. Three-dimensional (3D) printed tantalum has good biocompatibility and can be designed to match the patient's personalized anatomical carpal structure. This study aims to investigate carpal function and prosthesis-related conditions after carpal bone replacement using 3D printed tantalum prostheses. Methods: From July 2020 to January 2022 at our center, seven patients with osteonecrosis of the carpus received carpal bone replacement using 3D printed tantalum prosthesis. The Disability of the Arm, Shoulder and Hand (DASH) score and patient satisfaction, as well as the Mayo Wrist Scores (Cooney method, modified Green, and O'Brien wrist score), were used to evaluate the preoperative and postoperative wrist function of patients. The Visual Analog Scale (VAS) pain scores were also recorded before and after surgery. The angles of flexion, dorsiflexion, ulnar deviation, and radial deviation were measured using an arthrometer. The grip strength and pinch strength of the operated hand after carpal bone replacement and the contralateral healthy carpus were measured using a dynamometer. Radiographs were taken to confirm the condition and complications of the tantalum prosthesis. Results: All seven patients were followed for 19.6 ± 2.7 months. At the last follow-up, the grip strength of the operated wrist joint after carpal bone replacement was 33.4 ± 2.3 kg, the pinch strength was 8.9 ± 0.7 kg, the flexion was 54.6° ± 0.8°, the dorsiflexion was 54.7° ± 1.7°, the ulnar deviation was 34.6° ± 1.9°, and the radial deviation was 25.9° ± 0.8°, all of which showed no statistically significant difference with the contralateral healthy carpus (p > 0.05). There were significant differences in the VAS, DASH, and MAYO scores between the preoperative and the last follow-up (p < 0.01). Patients had reduced postoperative pain and improved wrist function and range of motion (ROM), and the tantalum prostheses were stable. Conclusion: The 3D printed tantalum brings us new hope, not only for hip or knee replacement, but also for joint replacement of other complex anatomical structures, and patients with other irregular bone defects such as bone tumors and deformity, which could realize personalized treatment and precise medicine.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Guangxing Chen
- Center for Joint Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Fuyou Wang
- Center for Joint Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, Army Medical University, Chongqing, China
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Debril H, Saab M, Demondion X, Muys P, Cotten A, Jacques T. Anatomical study of the dorsal capsulo-scapholunate septum using high frequency ultrasonography. Orthop Traumatol Surg Res 2022; 109:103483. [PMID: 36435373 DOI: 10.1016/j.otsr.2022.103483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 03/11/2022] [Accepted: 03/22/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The dorsal capsulo-scapholunate septum (DCSS) is a recently described capsuloligamentous structure between the dorsal bundle of the scapholunate ligament (SLL) and the joint capsule of the wrist. It acts a secondary stabilizer of the scapholunate joint. The aim of this study was to evaluate the visibility and normal appearance of DCSS on high frequency ultrasound. HYPOTHESIS The DCSS can be analyzed using high frequency ultrasound. MATERIALS AND METHODS Three cadaveric wrists were dissected in order to study the DCSS; one without labeling and the other two after labeling under ultrasound guidance. On two other wrists, a correlation between the structure considered to be the DCSS on ultrasound and the corresponding CT arthrography and anatomical sections was carried out. Finally, sagittal ultrasound sections of the DCSS region on 42 healthy wrists were analyzed retrospectively. RESULTS During dissection, the DCSS corresponded to a fibrous structure extending to the dorsal surface of the scaphoid and lunate, with certain fibers converging towards the SLL. On high-frequency ultrasound, a hyperechoic fibrillar structure was visualized at the theoretical position of the DCSS. The dissections performed after ultrasound-guided transfixion showed that its limits corresponded to the limits of the DCSS. The anatomical, CT arthrography and ultrasound sections in the DCSS region were concordant. The DCSS was retrospectively visible on at least one reference ultrasound slice in 90.5% of healthy wrists, and was always hyperechoic. Its average thickness was 1.38±0.24mm. DISCUSSION Our study describes the normal sonographic characteristics of the DCSS, visible in a majority of healthy patients on high-frequency ultrasound. The analysis of the sonographic characteristics of the DCSS in the context of acute wrist trauma should be evaluated, and a diagnostic decision tree has been proposed. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Héloïse Debril
- Service de radiologie et d'imagerie musculo-squelettique, centre de consultation et d'imagerie de l'appareil locomoteur, CHU de Lille, avenue du Professeur Emile-Laine, 59000 Lille, France; Faculté de médecine, université de Lille, Lille, France
| | - Marc Saab
- Service d'orthopédie 1, CHU de Lille, hôpital Roger-Salengro, avenue du Professeur Emile-Laine, 59000 Lille, France; Faculté de médecine, université de Lille, Lille, France
| | - Xavier Demondion
- Service de radiologie et d'imagerie musculo-squelettique, centre de consultation et d'imagerie de l'appareil locomoteur, CHU de Lille, avenue du Professeur Emile-Laine, 59000 Lille, France; Laboratoire d'anatomie, faculté de médecine de Lille, Lille, France; Faculté de médecine, université de Lille, Lille, France; Unité de taphonomie médico-légale & d'anatomie, ULR 7367, UTML&A, CHU de Lille, University Lille, 59000 Lille, France
| | - Paul Muys
- Laboratoire d'anatomie, faculté de médecine de Lille, Lille, France; Faculté de médecine, université de Lille, Lille, France
| | - Anne Cotten
- Service de radiologie et d'imagerie musculo-squelettique, centre de consultation et d'imagerie de l'appareil locomoteur, CHU de Lille, avenue du Professeur Emile-Laine, 59000 Lille, France; Faculté de médecine, université de Lille, Lille, France; MABLab-Marrow Adiposity and Bone Lab ULR4490, université de Lille, université du Littoral Côte d'Opale, Lille, France.
| | - Thibaut Jacques
- Service de radiologie et d'imagerie musculo-squelettique, centre de consultation et d'imagerie de l'appareil locomoteur, CHU de Lille, avenue du Professeur Emile-Laine, 59000 Lille, France; Faculté de médecine, université de Lille, Lille, France
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