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Ly L, Bentejac A, Corcella D, Forli A. Clinical and functional outcomes of surgical treatment of grade III ulnar collateral ligament injuries of thumb metacarpophalangeal joint. HAND SURGERY & REHABILITATION 2023; 42:127-133. [PMID: 36764359 DOI: 10.1016/j.hansur.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVES The aim of this study was to compare the clinical and functional outcomes of three surgical techniques (subperiosteal suture, bone anchor and direct repair) for the management of severe acute ulnar collateral ligament injuries of the thumb metacarpophalangeal joint with a minimum of 1 year follow-up. MATERIAL AND METHODS Between 2015 and 2020, 230 collateral ligament injuries required surgical treatment in our department. After the inclusion and exclusion criteria were applied, 100 were included in the study. The Glickel score and functional scores such as QuickDASH and PRWE were assessed. Time to return to work and to sport was quantified. RESULTS Ulnar collateral ligament injuries affected men who were statistically younger than women (41.8 years old vs 48.3). Subperiosteal suture was the preferred technique (81%), then bone anchor reattachment (12%) and direct repair (7%). All three techniques produced excellent stability (91-100%). Better range of motion was reported in the subperiosteal group, but better strength was found in the bone anchor group. Subperiosteal suture had 89% excellent and good results, while there was 83% in the bone anchor group and 71% in the direct repair group. Mean time to return to work was 2 months in the bone anchor group versus 3 months in the subperiosteal group. Mean QuickDASH was 8.7/100 and mean PRWE was 7.1/100. CONCLUSION This is the biggest case series to date on surgical treatment of severe ulnar collateral ligament injuries of the thumb metacarpophalangeal joint. The subperiosteal technique is simpler and less expensive. While the results are not often described in the literature, it produces comparable clinical and functional outcomes to bone anchor reattachment with a minimum follow-up of 1 year.
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Affiliation(s)
- L Ly
- Department of Plastic and Reconstructive Surgery of Limbs and Hand Surgery, Grenoble Alpes University Hospital, 38043 Grenoble Cedex 09, France
| | - A Bentejac
- Department of Plastic and Reconstructive Surgery of Limbs and Hand Surgery, Grenoble Alpes University Hospital, 38043 Grenoble Cedex 09, France
| | - D Corcella
- Department of Plastic and Reconstructive Surgery of Limbs and Hand Surgery, Grenoble Alpes University Hospital, 38043 Grenoble Cedex 09, France
| | - A Forli
- Department of Plastic and Reconstructive Surgery of Limbs and Hand Surgery, Grenoble Alpes University Hospital, 38043 Grenoble Cedex 09, France.
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Chen PH, Chen CY. Rupture of finger distal interphalangeal collateral ligament treated with a mini soft anchor. Injury 2023:S0020-1383(23)00250-4. [PMID: 36977618 DOI: 10.1016/j.injury.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Ruptured finger distal interphalangeal (DIP) collateral ligament is a rare injury, with controversial treatment until the present. Our case series aimed to demonstrate feasible surgical intervention using a mini anchor. METHODS The present study includes four patients with ruptured finger DIP collateral ligaments who received primary repair in a single institute. They have suffered from joint instability due to ligament loss caused by infection, motorcycle accidents, and work-related accidents. All patients were operated on similarly using a 1.0 mm mini anchor for ligament reattachment. RESULTS The finger DIP joint range of motion (ROM) was documented in all patients during follow-up. Joint ROM recovered to almost normal degrees, and the pinch strength recovered to > 90% compared to the contralateral side in all patients. Additionally, collateral ligament re-rupture, DIP joint subluxation or re-dislocation, and infection were not noted during follow-up. CONCLUSIONS Ruptured finger DIP joint ligament requiring surgery is usually based on a combination with other soft tissue injuries and defects. However, repair with a 1.0 mm mini anchor is a feasible surgical intervention to reattach the ligament with minimal complication.
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Affiliation(s)
- Po-Hsiang Chen
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Extn: 3051, Kaohsiung city, Taiwan, ROC; Department of Medical education and research, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung city, Taiwan, ROC
| | - Chun-Yu Chen
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Extn: 3051, Kaohsiung city, Taiwan, ROC; Department of Occupational Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung city, Taiwan, ROC; Department of Biomedical Engineering, I-Shou University, Kaohsiung city, Taiwan, ROC.
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Oliver WM, Place ZJ, Bell KR, Molyneux SG, Duckworth AD. Outcome Following Acute Suture Anchor Repair of the Ulnar Collateral Ligament of the Thumb. J Hand Surg Asian Pac Vol 2022; 27:982-990. [PMID: 36476090 DOI: 10.1142/s2424835522500874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: The aim of this study was to evaluate the outcomes following acute repair of the ulnar collateral ligament of the thumb metacarpophalangeal joint (thumb UCL) using a suture anchor technique. Methods: From 2011 to 2019, we retrospectively identified 40 adult patients from a single centre who had undergone an acute thumb UCL repair (≤6 weeks post-injury). The mean age of the study cohort was 37 years (range 16-70) and 68% (n = 27/40) were male. The short-term outcomes included postoperative complications and failure of repair. The long-term outcomes were QuickDASH, the EuroQol 5-Dimension (EQ-5D), Visual Analogue Scale (EQ-VAS), return to sport and work and satisfaction with outcome. Results: The outcomes survey was completed at a mean of 4.3 years (range 1.0-9.2) for 33 patients (83%). Postoperative complications included self-limiting sensory disturbance (7.5%, n = 3/40), superficial infection (requiring oral antibiotics; 5%, n = 2/40) and wound dehiscence (requiring surgical debridement and re-closure; 2.5%, n = 1/40). No failures of repair were reported. The mean QuickDASH was 3.7 (range 0-27.3), EQ-5D 0.821 (range -0.041 to 1) and EQ-VAS 84 (range 60-100). Of the 32 employed patients, all returned to work at a median of 0.5 weeks (range 0-416) and the mean QuickDASH Work Module was 4.1 (range 0-50). Of the 24 patients playing sport prior to injury, 96% (n = 23/24) returned at a median of 16 weeks (range 5-52) and the mean QuickDASH Sport Module was 4.6 (range 0-25). All the patients were satisfied with their outcome (mean satisfaction score 9.8/10 [8-10O]). Conclusions: Thumb UCL repair using a suture anchor technique is safe and effective up to 6 weeks post injury. Pain and stiffness may persist in the longer term, but most patients report excellent upper limb function and health-related quality of life. The majority return to work and sport and are highly satisfied with their outcome. Level of Evidence: Level IV (Therapeutic).
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Affiliation(s)
- William M Oliver
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Zach J Place
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Katrina R Bell
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Andrew D Duckworth
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
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Sahin MS. Midterm clinical outcomes of collateral ligament repair of the thumb and lesser digits: a retrospective analysis of 35 cases. BMC Musculoskelet Disord 2022; 23:697. [PMID: 35869452 PMCID: PMC9306151 DOI: 10.1186/s12891-022-05605-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/28/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Finger collateral ligament injuries are common, and conservative treatment usually works well. However, complete ruptures that lead to instability could cause painful disability. This study presents our clinical experience and a qualitative functional evaluation following the surgical repair of the thumb and proximal interphalangeal (PIP) joint collateral ligament ruptures.
Methods
Thirty-five patients (22 men and 13 women), diagnosed via a physical examination and magnetic resonance imaging (MRI) with a total collateral ligament rupture in the metacarpophalangeal thumb (16) and PIP joints of the lesser digits (19) and treated surgically, were evaluated retrospectively. The limited range of motion; functional score by Saetta; disabilities of the arm, shoulder, and hand (DASH) score; pre- and post-operative pain, deformity level; and post-operative ability to grip keys, buttons, and jars were measured. The significance of the change between the pre and post-operative visual analog scale for pain (VAS) scores were evaluated using the Wilcoxon signed-rank test. The difference between the lesser digits and thumb groups by patient age was evaluated using the Mann–Whitney-U test. All data, such as the mean, range, and standard deviation, were calculated using SPSS.
Results
The mean pre- and post-operative VAS scores were 4.8 (from 3 to 7) and 0.91 (0 to 4), respectively. The mean post-operative limitation in the range of motion was 9.78° (s = 14.47) for lesser digits and 6.87° (s = 12.29) for the thumb. According to Seatta et al., the final functional score was 62.5% excellent, 25% good, and 12.5% moderate for the thumb and 84.2% excellent, 10.5% good, and 5.3% poor for the lesser digits. The mean post-operative DASH score was 13.55 (SD: 8.77) for lesser digits and 14.22 (SD: 8.9) for the thumb. The mean contralateral (healthy) hand DASH score was 0.75 (SD: 1.05) for lesser digits and 0.75 (SD: 1.05) for the thumb. For the thumb and lesser digits, the z-scores were − 3.55 and − 3.787, respectively, and the progress of the VAS score was significant (p < 0.05).
Conclusion
After a 40-month follow-up for 35 acute, subacute, and chronic cases, the results suggest that direct and suture-anchor repairs are feasible, painless treatments associated with good finger function.
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Kastenberger T, Kaiser P, Schmidle G, Stock K, Benedikt S, Arora R. Clinical results of the BoneWelding®Fiji® anchor for the treatment of Stener lesions of the thumb. Arch Orthop Trauma Surg 2021; 141:1499-1507. [PMID: 33040206 PMCID: PMC8354924 DOI: 10.1007/s00402-020-03625-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/30/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION A new technology (Sportwelding®) was recently presented, which uses ultrasonic energy to meld a resorbable suture anchor at the interface with the host bone. A standardized clinical use was not investigated yet. This study prospectively evaluated the surgical and clinical outcomes of the Fiji Anchor® (Sportwelding®, Schlieren, Switzerland) in the repair of an ulnar collateral ligament lesion of the metacarpophalangeal joint of the thumb. MATERIAL AND METHODS The range of motion, grip and pinch strength, disability of arm, shoulder and the hand (DASH) and patient rated evaluation (PRWE) score, pain, satisfaction, complications and adverse events were assessed in 24 patients after surgical treatment for an acute displaced rupture or avulsion of the ulnar collateral metacarpophalangeal ligament of the thumb using the Fiji Anchor® after 6, 12 and 52 weeks. RESULTS At final follow up, the range of motion of the metacarpophalangeal joint reached almost the contralateral side (49.3° SD 11.7°). Thumb opposition showed a Kapandji score of 9.7 (SD 0.5; range 9-10). Grip strength, the lateral, tip and the three jaw pinch showed nearly similar values compared to the contralateral side (83-101%). Pain was low (0.2 SD 0.7 at rest and 0.6 SD 1.0 during load). The DASH score was 5.0 (SD 7.3) and the PRWE score was 4.1 (SD 9.0). 81% of patients were very satisfied at final follow-up. Two patients were rated unstable during the follow-up period due to a second traumatic event. Three cases experienced difficulties during anchor insertion, whereby incorrect anchor insertion resulted in damage to the suture material; however, this was resolved after additional training. CONCLUSION One advantage of this anchor appears to be its stable fixation in cancellous bone. The surgical treatment of an ulnar collateral ligament lesion of the thumb using the Fiji Anchor® can lead to an excellent clinical outcome with a minor complication rate; however, long-term dangers and the cost effectiveness of the procedure are not known yet.
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Affiliation(s)
- Tobias Kastenberger
- Department of Orthopaedics and Trauma Surgery, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Peter Kaiser
- Department of Orthopaedics and Trauma Surgery, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Gernot Schmidle
- Department of Orthopaedics and Trauma Surgery, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Kerstin Stock
- Department of Orthopaedics and Trauma Surgery, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Stefan Benedikt
- Department of Orthopaedics and Trauma Surgery, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Rohit Arora
- Department of Orthopaedics and Trauma Surgery, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
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Miller EA, Friedrich JB. Management of Finger Joint Dislocation and Fracture-Dislocations in Athletes. Clin Sports Med 2020; 39:423-442. [PMID: 32115092 DOI: 10.1016/j.csm.2019.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Although finger joint dislocations are generally thought of as benign by many athletes and assumed to be a sprain, these injuries represent a spectrum that includes disabling fracture-dislocations. Failure to recognize certain dislocations or fracture-dislocations may result in permanent deformity and loss of motion. Simple dislocations are frequently amenable to early return to play with protection; however, more complex injuries may require specialized splinting or surgery. Delay in diagnosis of unstable proximal interphalangeal fracture-dislocations may require reconstruction or fusion. Early diagnosis and appropriate treatment are essential to ensure optimal functional results.
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Affiliation(s)
- Erin A Miller
- Division of Plastic Surgery, Department of Surgery, University of Washington, Harborview Medical Center, 325 9th Avenue, Box 359796, Seattle, WA 98104, USA
| | - Jeffrey B Friedrich
- Division of Plastic Surgery, Department of Surgery, University of Washington, Harborview Medical Center, 325 9th Avenue, Box 359796, Seattle, WA 98104, USA.
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Abstract
Proximal interphalangeal joint (PIPJ) injuries are common and challenging to treat, involving a spectrum of conditions ranging from isolated ligamentous injuries to severe fracture dislocations. The main goal of treatment is to achieve a congruent, stable joint, which is key to achieving early range of motion and a favorable outcome. Injuries that do not compromise the stability of the joint may be treated nonsurgically, whereas those that render the joint unstable may be managed with one of many surgical strategies available. This article focuses on the current practices of treatment of injuries around the PIPJ.
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Affiliation(s)
- Ruth En Si Tan
- Department of Hand and Reconstructive Microsurgery, National University Health System, Level 11, Tower Block, 1E Kent Ridge Road, 119228, Singapore
| | - Andre Eu Jin Cheah
- Department of Hand and Reconstructive Microsurgery, National University Health System, Level 11, Tower Block, 1E Kent Ridge Road, 119228, Singapore.
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Branco PM, Baptista C, Dias CM. Mid- to long-term outcomes of collateral ligament repairs of 18 metacarpophalangeal joints with bone suture anchors. J Hand Surg Eur Vol 2018; 43:563-564. [PMID: 29320905 DOI: 10.1177/1753193417751802] [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: 02/03/2023]
Affiliation(s)
- Pedro M Branco
- Department of Orthopedic Surgery, CUF Santarém Hospital, Santarém, Portugal
| | - Carolina Baptista
- Department of Orthopedic Surgery, CUF Santarém Hospital, Santarém, Portugal
| | - Carlos M Dias
- Department of Orthopedic Surgery, CUF Santarém Hospital, Santarém, Portugal
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Abstract
Proximal interphalangeal (PIP) joint dislocation a common injury. Usually, concentric stable reduction can be achieved with closed reduction. Occasionally, PIP joint dislocations are irreducible and open reduction is necessary. Complications include prolonged splinting and delay in presentation with subluxation or persistent dislocation. Surgery is often recommended for contracture or joint reduction. Surgical techniques focus on contracture release, joint reduction, and range of motion. Techniques have evolved from primary repair to tenodesis and suture anchor reconstruction. Most studies on PIP joint dislocations are retrospective case reports with good outcomes but chronic mild contracture and deformity are consistent in the literature.
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10
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Abstract
Football and rugby athletes are at increased risk of finger injuries given the full-contact nature of these sports. Some players may return to play early with protective taping, splinting, and casting. Others require a longer rehabilitation period and prolonged time away from the field. The treating hand surgeon must weigh the benefits of early return to play for the current season and future playing career against the risks of reinjury and long-term morbidity, including post-traumatic arthritis and decreased range of motion and strength. Each player must be comprehensively assessed and managed with an individualized treatment plan.
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Affiliation(s)
- Kate E. Elzinga
- Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Kevin C. Chung
- Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan, USA
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Abstract
PURPOSE OF REVIEW The purpose of this review is to identify current principles in the diagnosis and treatment of collateral ligament injuries of the thumb in the athlete. RECENT FINDINGS Cadaver studies have clearly identified the ulnar and radial collateral ligaments origin and insertion footprints for repair or reconstruction. Ulnar and radial collateral ligament injuries are common in athletics. History and physical examination are paramount in determining partial versus complete tear. When surgical treatment is indicated, placing the repair/reconstruction in the anatomic footprint restores stability while maintaining motion. The senior author's preferred techniques are reported.
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Affiliation(s)
- Daniel M Avery
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, 523 East 72nd Street, 4th Floor, New York, NY, 10021, USA
| | - Elizabeth R Inkellis
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, 523 East 72nd Street, 4th Floor, New York, NY, 10021, USA
| | - Michelle G Carlson
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, 523 East 72nd Street, 4th Floor, New York, NY, 10021, USA.
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Khandwala AR, Khan IU, Elliot D. The use of Acufex Wedge Tag Tissue Anchors in Hand Surgery. ACTA ACUST UNITED AC 2017; 29:22-5. [PMID: 14734064 DOI: 10.1016/j.jhsb.2003.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Over a period of 4 years, in various circumstances commonly seen in hand surgery, 100 patients underwent 127 soft tissue attachments to bone using the Acufex wedge tag system (Acufex Microsurgical, Inc, Mansfield, MA), a non-metallic bone anchor. No failures to maintain the attachment of the desired soft tissue to bone were identified. While less robust than the Mitek anchor, the other commonly available system of bone anchoring, and therefore possibly inappropriate for general orthopaedics, the Acufex wedge tag proved adequate for the smaller forces of hand surgery.
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Affiliation(s)
- A R Khandwala
- Hand Surgery Department, St.Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, Essex, CM1 7ET, England, UK
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13
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Lee SJ, Lee JH, Hwang IC, Kim JK, Lee JI. Clinical outcomes of operative repair of complete rupture of the proximal interphalangeal joint collateral ligament: Comparison with non-operative treatment. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:44-48. [PMID: 28003115 PMCID: PMC6197416 DOI: 10.1016/j.aott.2016.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/10/2016] [Accepted: 04/30/2016] [Indexed: 12/02/2022]
Abstract
Objectives The purpose of this study was to compare the outcomes of non-operative treatment and operative repair of grade III injuries with complete rupture of the collateral ligament of the proximal interphalangeal (PIP) joint. Patients and methods Seventeen patients with grade III injuries with at least 6 months of follow-up were included. Seven patients underwent non-operative treatment and 10 patients underwent operative treatment. We evaluated the following clinical outcomes after treatment: 1) range of motion of the PIP and distal interphalangeal (DIP) joints, 2) joint stability, 3) pain score, and 4) amount of fusiform deformity of the PIP joint. Results There was no instability in the lateral stress test in either group. The ranges of motion of the PIP and DIP joints were not statistically different between the two groups at final follow-up. However, the ranges of motion recovered more quickly in the operative group than the non-operative group within the first 3 months after treatment. Patients in the operative group had less pain and better cosmetic appearance of the PIP joint. Conclusion Our results suggest that operative repair of the PIP collateral ligament can provide good joint stability, rapid functional recovery, and minimize fusiform deformity of the PIP joint. Level of evidence Level III, Therapeutic study.
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Affiliation(s)
- Seoung Joon Lee
- Department of Orthopedic Surgery, School of Medicine, Konkuk University Medical Center, Seoul, South Korea
| | - Jun Hee Lee
- Department of Orthopedic Surgery, School of Medicine, Konkuk University Medical Center, Seoul, South Korea
| | - In Cheul Hwang
- Department of Orthopedic Surgery, School of Medicine, Konkuk University Medical Center, Seoul, South Korea
| | - Joon Kuk Kim
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, South Korea
| | - Jung Il Lee
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, South Korea.
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Picard F, Khalifa H, Dubert T. Duration of sick leave after surgical repair of the ulnar collateral ligament of the thumb metacarpophalangeal joint with K-wire immobilization: Prospective case series of 21 patients. HAND SURGERY & REHABILITATION 2016; 35:122-6. [DOI: 10.1016/j.hansur.2015.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 12/13/2015] [Accepted: 12/18/2015] [Indexed: 10/22/2022]
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Carlo J, Dell PC, Matthias R, Wright TW. Collateral Ligament Reconstruction of the Proximal Interphalangeal Joint. J Hand Surg Am 2016; 41:129-32. [PMID: 26614593 DOI: 10.1016/j.jhsa.2015.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 05/31/2015] [Accepted: 10/15/2015] [Indexed: 02/02/2023]
Abstract
Proximal interphalangeal joint collateral ligament injuries are common; however, chronic instability of this joint is rare. In such cases, however, there is no consensus on optimal management. Various repairs and reconstructions have been devised, although the literature on outcomes remains scant. We present a method of reconstruction of the proximal interphalangeal joint collateral ligament using a distally based slip of the flexor digitorum superficialis tendon.
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Affiliation(s)
- Julian Carlo
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL
| | - Paul C Dell
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL
| | - Rob Matthias
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL
| | - Thomas W Wright
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL.
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Comparison of in vitro motion and stability between techniques for index metacarpophalangeal joint radial collateral ligament reconstruction. J Hand Surg Am 2013; 38:1324-30. [PMID: 23747165 PMCID: PMC3755456 DOI: 10.1016/j.jhsa.2013.03.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 03/25/2013] [Accepted: 03/25/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate a technique using interference screws to secure a tendon graft for reconstruction of the radial collateral ligament (RCL) of the index finger metacarpophalangeal (MCP) joint. We hypothesized that this technique would provide equivalent stability and flexion as a 4-tunnel reconstruction. METHODS We isolated the RCL in 17 cadaveric index fingers. A cyclic load was applied to the intact RCL across the MCP joint to assess flexion, ulnar deviation at neutral (UD 0), and ulnar deviation at 90° of MCP joint flexion (UD 90). The RCL was excised from its bony origin and insertion. We performed each reconstruction (4-tunnel and interference screw) sequentially on each specimen in a randomized order using a palmaris longus tendon graft. We repeated testing after each reconstruction and compared differences from the intact state between techniques using paired t-tests for all joint positions (flexion/UD 0/UD 90). RESULTS There was no statistically significant difference in UD 0 or UD 90 between the intact state and after interference screw reconstruction. Compared with the intact state, there was significantly less UD 0 and significantly more UD 90 after 4-tunnel reconstruction. There was no statistically significant difference between techniques when we compared changes in -UD 0 or UD 90. Change in flexion was statistically significantly different, which indicates that the interference screw technique better replicated intact MCP joint flexion compared with the 4-tunnel technique. CONCLUSIONS Interference screw reconstruction of the index RCL provides stability comparable to 4-tunnel reconstruction and is less technically challenging. These results substantiate our clinical experience that the interference screw technique provides an optimal combination of stability and flexion at the index MCP joint. CLINICAL RELEVANCE Using an interference screw to reconstruct the index RCL is less challenging than 4-tunnel reconstruction and provides stability and range of motion that closely resemble the native MCP joint.
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Abstract
OBJECTIVES Rupture of the ulnar collateral ligament (UCL) is a frequent injury of the hand. When untreated, this injury may lead to decreased pinch strength, pain, instability, and osteoarthritis. There is currently no consensus on treatment of acute or chronic UCL injuries. Our primary purpose was to compare nonoperative treatment with surgical repair and surgical reconstruction of thumb UCL injuries. A secondary purpose was to compare graft choice and surgical technique for reconstruction. DATA SOURCES A systematic review of multiple medical databases was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines with specific inclusion and exclusion criteria. Clinical outcome studies after nonoperative or operative treatment of thumb UCL injuries, with a minimum of 2 years mean follow-up, were included. Pain, range of motion, key-pinch strength, and stability testing were used as outcome measures. MAIN RESULTS Fourteen articles were included and analyzed (293 thumbs). All but 2 were level IV evidence. Mean Quality Appraisal Tool score was 13.1 (55% overall rating study methodological quality). Thirty-two thumbs were treated nonoperatively and 261 operatively. Mean subject age was 33.9 years. There were 200 acute injuries and 93 chronic injuries. Mean study follow-up was 42.8 months. Nonoperative treatment often failed, necessitating surgery. Acute UCL repair and autograft UCL reconstruction for chronic injury led to excellent clinical outcomes, without a significant difference between the 2 groups. After significant delay to treatment or even failed nonoperative treatment, excellent clinical outcomes can be achieved, without a difference between initially treating the injury surgically. Complications after surgery were rare. CONCLUSIONS This review has demonstrated excellent clinical outcomes after surgical treatment of both acute and chronic UCL injury, without any significant difference between repair and reconstruction for acute and chronic injury, respectively.
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Lee JI, Jeon WJ, Suh DH, Park JH, Lee JM, Park JW. Anatomical collateral ligament reconstruction in the hand using intraosseous suture anchors and a free tendon graft. J Hand Surg Eur Vol 2012; 37:832-8. [PMID: 22311916 DOI: 10.1177/1753193412436947] [Citation(s) in RCA: 9] [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
We describe anatomical collateral ligament reconstruction using a free tendon graft and intraosseous suture anchors in the digits. Eleven patients who underwent collateral ligament reconstruction at the proximal interphalangeal or metacarpophalangeal joints were enrolled in this study. Proper and accessory collateral ligaments were reconstructed using a free tendon graft in an anatomical configuration and the grafted tendons were fixed with suture anchors. The mean time from surgery to last follow-up was 9.2 months. All anchors used for fixation of grafted tendons remained securely at their original positions at the last follow-up visits. No significant complications were associated with the use of anchors. Clinical results were excellent in 10 patients and good in one. Anatomical reconstruction of collateral ligaments using suture anchors is simpler, faster, and safer than the conventional bone tunnel technique and it does not have the risks of breakage of bone bridges, skin irritation, or graft loosening.
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Affiliation(s)
- J I Lee
- Department of Orthopedic Surgery, College of Medicine, Korea University, Seoul, Korea
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Abstract
Suture anchors are an important tool in the orthopedist's armamentarium. Their use is prevalent in surgery of the entire upper limb. Suture anchors have mostly obviated the need for multiple drill holes when striving for secure fixation of soft tissue to bone. As with most other orthopedic products, the designs of these anchors and the materials used to fabricate them have evolved as their use increased and their applications became more widespread. It is ultimately the surgeon's responsibility to be familiar with these rapidly evolving technologies and to use the most appropriate anchor for any given surgery.
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Affiliation(s)
- Min Jung Park
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, 2501 Christian Street 103, Philadelphia, PA 19146, USA
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Abstract
The thumb collateral ligaments at the metacarpophalangeal joint are important to the elite athlete for precision grip and pinch. Injuries to these ligaments can result in pain and instability and are seen at a higher frequency at the elite level. Whereas the collateral ligament tears used to be associated primarily with recreational skier's injury, these injuries have been reported with increasing frequency in major professional sports. The ulnar collateral and radial collateral ligament injuries of the thumb occur through different mechanisms and are described in separate sections given the differences in their anatomy.
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Affiliation(s)
- Arthur T Lee
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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Adler T, Eisenbarth I, Hirschmann MT, Müller-Gerbl M, Fricker R. Can clinical examination cause a Stener lesion in patients with skier's thumb?: a cadaveric study. Clin Anat 2011; 25:762-6. [PMID: 22109689 DOI: 10.1002/ca.22005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Revised: 10/25/2011] [Accepted: 10/26/2011] [Indexed: 11/09/2022]
Abstract
Approximately one-third of all injuries of the upper limb and 7% of all injuries in skiing affect the ulnar collateral ligaments of the thumb metacarpophalangeal joint (skier's thumb). In some patients the collateral ligaments are displaced proximally over the adductor aponeurosis, resulting in a so-called Stener lesion. In these cases surgical treatment is indicated. We hypothesized that a Stener lesion could be provoked by clinical stability testing in patients with a skiers thumb and performed a cadaveric study on 10 Thiel fixated cadaver hands. For clinical stability testing, the thumb was manually deviated in radial direction in both 30° flexion and extension of the MP-joint. It was performed with maximum strength by two hand surgeons after sequential detachment of the ulnar collateral ligaments. After every sequence, it was assessed if the clinical stability testing had caused a Stener lesion. All of the 10 cadavers showed identical results while testing the clinical stability. A decreased stability was only found after cutting both parts of the ulnar collateral ligaments. A Stener lesion could not be provoked in any of the cadavers at any time by clinical stability testing. Summarizing our findings we conclude that a proper performed clinical stability testing of the thumb MP joint is a safe maneuver, which does not lead to a Stener lesion in patients with skier's thumb.
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Affiliation(s)
- Tom Adler
- Hand Surgery Unit, Department of Orthopaedic Surgery and Traumatology, Kantonsspital Bruderholz, Bruderholz, Switzerland.
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Chan JCY, Purcell EM, Kelly JL. SURGICAL REPAIR OF CENTRAL SLIP AVULSION INJURIES WITH MITEK BONE ANCHOR — RETROSPECTIVE ANALYSIS OF A CASE SERIES. ACTA ACUST UNITED AC 2011; 12:29-34. [PMID: 17613181 DOI: 10.1142/s0218810407003377] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Accepted: 05/08/2007] [Indexed: 11/18/2022]
Abstract
The purpose of this study is to describe our technique of central slip repair using the Mitek bone anchor and to evaluate the treatment outcome. Eight digits in eight patients were reconstructed using the bone anchor: three little fingers, two middle fingers, two index fingers and one ring finger. There were two immediate and six delayed repairs (range from one day to eight months). Four patients had pre-operative intensive splinting and physiotherapy to restore passive extension of the proximal interphalangeal joint prior to central slip reconstruction. All patients have made good progress since surgery. No patient requires a second procedure and none of the bone anchors have dislodged or loosened. We conclude that the Mitek bone anchor is a reliable technique to achieve soft tissue to bone fixation in central slip avulsion injuries. We recommend that this technique be considered as a treatment option for patients requiring surgical repair.
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Affiliation(s)
- Jeffrey C Y Chan
- Department of Plastic, Reconstructive and Hand Surgery, University College Hospital Galway, Newcastle Road, Galway, Republic of Ireland.
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Mirza A, Reinhart MK, Bove JJ. Index radial collateral ligament repair with titanium mini-suture anchor: osteolysis complication of an underreported injury. Hand (N Y) 2010; 5:294-8. [PMID: 19826880 PMCID: PMC2920380 DOI: 10.1007/s11552-009-9230-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Accepted: 09/23/2009] [Indexed: 12/15/2022]
Abstract
We are reporting on a case of an index radial collateral ligament tear repaired with a titanium Mitek bone suture anchor. The development of cystic radiographic changes and increased pain and weakness led to suture anchor removal at 10 months post-repair. Periprosthetic osteolysis due to titanium-induced osteoclastogenesis and micromotion was suspected to be the cause. This case report provides a dual focus by stressing the importance of the diagnosis and treatment of this underreported ligament tear and highlighting our osteolysis complication via the mechanism of titanium-induced osteoclastogenesis for future therapeutic preventive measures.
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Affiliation(s)
- Ather Mirza
- Hand and Microsurgery, St. Catherine of Siena Medical Center, Smithtown, NY USA ,North Shore Surgi-Center, Smithtown, NY USA ,Stony Brook University, Stony Brook, NY USA ,290 East Main Street, Suite 200, Smithtown, NY 11787 USA
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Mehdi SY, Masood Q, Lawlor D, Eadie PA. Repair of the central slip of extensor tendon and the open mallet using Mitek mini bone anchors. EUROPEAN JOURNAL OF PLASTIC SURGERY 2010. [DOI: 10.1007/s00238-010-0440-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Delayed Anatomical Repair of Ruptured Ulnar Collateral Ligament Injuries of the Thumb Using a Dissolvable Polylactic Acid Bone Anchor. ACTA ACUST UNITED AC 2008; 65:1502-6. [DOI: 10.1097/ta.0b013e31818c12c3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dennison DG. A complete radial collateral ligament avulsion of the small finger metacarpophalangeal joint with displacement through the radial sagittal band. Hand (N Y) 2008; 3:220-3. [PMID: 18780099 PMCID: PMC2525884 DOI: 10.1007/s11552-008-9087-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Accepted: 02/08/2008] [Indexed: 11/30/2022]
Abstract
A displaced complete radial collateral ligament avulsion with associated injury to the sagittal band of the metacarpophalangeal joint of the small finger, if left untreated, may result in chronic pain, instability, weakness, and deformity. A case of a displaced radial collateral ligament that ruptured through the radial sagittal band of the small finger, with resultant injury to the extensor mechanism, is described and discussed with a review of the literature. Proper identification of this injury by physical exam and imaging studies along with surgical repair is associated with good outcome.
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Affiliation(s)
- David G. Dennison
- Department Of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, 200 1st Street SW, Gonda 14th Flr, Rochester, MN 55905 USA
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Onishi Y, Fujioka H, Doita M. Treatment of chronic post-traumatic hyperextension deformity of proximal interphalangeal joint using the suture anchor: a case report. ACTA ACUST UNITED AC 2007; 12:47-9. [PMID: 17613184 DOI: 10.1142/s0218810407003390] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2006] [Accepted: 04/05/2007] [Indexed: 11/18/2022]
Abstract
We present a case of chronic post-traumatic hyperextension of the PIP joint of the little finger. The volar plate was reattached at the original attachment site of the proximal phalanx using two suture anchors and tenodesis of the radial half slip of the FDS tendon was added. An acceptable result was obtained.
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Affiliation(s)
- Yasuo Onishi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, 650-0017, Japan
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Kang L, Rosen A, Potter HG, Weiland AJ. Rupture of the radial collateral ligament of the index metacarpophalangeal joint: diagnosis and surgical treatment. J Hand Surg Am 2007; 32:789-94. [PMID: 17606055 DOI: 10.1016/j.jhsa.2007.04.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Accepted: 12/13/2006] [Indexed: 02/02/2023]
Abstract
PURPOSE To report the diagnosis and results of 12 surgically treated cases of isolated radial collateral ligament (RCL) tears of the index finger (IF) metacarpophalangeal (MCP) joint. METHODS Between 1996 and 2002, there were 12 patients who were diagnosed with a tear of the index RCL based on clinical evaluation, had surgical treatment, and were followed up for a minimum of 23 months. All 12 patients sustained complete, full-thickness tears. Three patients chose immediate surgical treatment, and 9 patients failed an initial trial of conservative treatment. Surgical repair was performed because of pain, swelling, tenderness, and instability, and a suture anchor was used in all repairs. Intraoperative findings correlated with preoperative magnetic resonance imaging regarding to the site of the tear and the presence of associated injuries. Range of motion, grip strength, and lateral pinch strength were recorded. Patients were questioned regarding satisfaction with their treatment and with their ability to return to work and/or sporting activities. RESULTS The RCL was avulsed more commonly from the metacarpal (7 patients) than from the proximal phalanx (5 patients). There were no midsubstance tears. All patients reported resolution of pain, ability to return to activities of daily living or sporting activities, and satisfaction with treatment. The mean IF MCP joint arc of motion was 80 degrees , with a mean extension and flexion of 0 degrees and 80 degrees , respectively. There was no extensor lag and no laxity to stress in any of the repaired ligaments. The mean grip strength expressed as a percentage of the injured/noninjured side was 111%. The mean lateral pinch expressed as a percentage of the injured/noninjured side was 112%. CONCLUSIONS On the basis of this study, IF RCL ruptures can be treated successfully with surgical repair.
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Affiliation(s)
- Lana Kang
- Hospital for Special Surgery, Division of Hand & Upper Extremity Surgery, New York, NY, USA.
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Spranklin D, Elder S, Boyle C, McLaughlin R. Comparison of a suture anchor and a toggle rod for use in toggle pin fixation of coxofemoral luxations. J Am Anim Hosp Assoc 2006; 42:121-6. [PMID: 16527912 DOI: 10.5326/0420121] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The mechanical characteristics of toggle rods and Bone Biter anchors inserted through the medial acetabular wall for toggle pin repair of coxofemoral luxations were compared in 16 canine cadaver pelves. No differences were detected in maximum load to failure, displacement at failure, or energy to failure between the two constructs. Toggle rod constructs failed primarily by breakage of the suture at the rod eyelet. All of the Bone Biter anchor constructs failed when the anchors pulled through the medial acetabular wall.
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Affiliation(s)
- David Spranklin
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi 39762, USA
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Ulkür E, Açikel C, Ergun O, Celiköz B. Repair of Chronic Mallet Finger Deformity Using Mitek Micro Arc Bone Anchor. Ann Plast Surg 2005; 54:393-6. [PMID: 15785280 DOI: 10.1097/01.sap.0000151464.03967.a2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Surgical correction of chronic mallet finger caused by terminal tendon disruption was carried out in 22 patients. The distal stump of the tendon was fixed to the base of the distal phalanx with a Mitek micro arc bone anchor. In all patients the mallet finger deformity was corrected. There were 15 patients with excellent results, 5 with good results, and 2 with fair results. None of the patients had a poor result. No further treatment was needed. The Mitek micro arc bone anchor system is a reliable alternative for the treatment of chronic mallet finger deformity without proximal interphalangeal hyperextension.
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Affiliation(s)
- Ersin Ulkür
- Gülhane Military Medical Academy and Medical Faculty, Haydarpaşa Training Hospital, Department of Plastic and Reconstructive Surgery and Burn Unit, Istanbul, Turkey.
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Yasuda M, Masada K, Takeuchi E. Isolated rupture of radial collateral ligament of the small finger dip joint repaired with a bone suture anchor: a case report. ACTA ACUST UNITED AC 2004; 9:121-4. [PMID: 15368640 DOI: 10.1142/s021881040400208x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2003] [Accepted: 03/12/2004] [Indexed: 11/18/2022]
Abstract
Isolated rupture of radial collateral ligament of the small finger DIP joint is a rare injury. We treated this lesion using a bone suture anchor with excellent results.
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Affiliation(s)
- Masataka Yasuda
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan.
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Balara JM, McCarthy RJ, Boudrieau RJ, Kraus KH. Mechanical Performance of a Screw-Type Veterinary Suture Anchor Subjected to Single Load to Failure and Cyclic Loads. Vet Surg 2004; 33:615-9. [PMID: 15659017 DOI: 10.1111/j.1532-950x.2004.04084.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To characterize the mechanical performance of a veterinary bone anchor under static and cyclic loads. STUDY DESIGN Mechanical testing study. ANIMALS Cadaveric canine humeri. METHODS Humeri (6 pairs) were collected from skeletally mature dogs (mean [+/-SD] age, 17.2+/-2.1 months; weight, 20.8+/-1.5 kg). Bone anchors were inserted in the proximal metaphysis using nylon, and were longitudinally extracted. For the opposite humerus, anchors were subjected to longitudinal cyclic load (50% of the load at failure of their pair) for 1200 cycles then longitudinally loaded to failure. Anchors were then installed in a similar and adjacent area of these 2(nd) humeri with nylon and cyclically tested perpendicular to the axis of anchor insertion (100% of the longitudinal holding power of their pair) for 1200 cycles, then perpendicularly loaded to failure. Paired t-tests were used to compare holding power before and after longitudinal cyclic testing. RESULTS Longitudinal holding power of the screw-type anchor in the proximal humerus was 385+/-30 N. Anchor pullout was the only mode of failure. Anchors in the paired humeri did not fail after 1200 cycles of 50% longitudinal loading, and post-cycle holding strength was not different (335+/-87 N; P=.32). Perpendicularly loaded anchors did not fail after 1200 cycles of 100% of opposite longitudinal holding strength, and had post-cycle perpendicular holding strengths of 514+/-72 N. Suture breakage was the mode of failure. CLINICAL RELEVANCE Bone anchor holding strength is dependent on orientation of suture load. Screw-type bone anchor holding strength was not affected by longitudinal cyclic loading, and holding strengths of approximately 385 N can be expected in metaphyseal bone of large-breed mature dogs. Perpendicularly loaded anchors have higher failure loads, and holding strength of approximately 514 N can be expected in metaphyseal bone of the proximal humerus.
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Affiliation(s)
- Jason M Balara
- Department of Clinical Sciences, Tufts University School of Veterinary Medicine, 200 Westboro Road, N. Grafton, MA 01536, USA
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Abstract
Early repair of complete collateral ligament tears restores joint alignment, stability, and full passive range of motion.
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Affiliation(s)
- Alan E Freeland
- Department of Orthopedic Surgery and Rehabilitation, University of Mississippi Medical Center, Jackson, Miss, USA
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Minami A, Kato H, Iwasaki N. Treatment of scapholunate dissociation: ligamentous repair associated with modified dorsal capsulodesis. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2003; 8:1-6. [PMID: 12923927 DOI: 10.1142/s0218810403001443] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2001] [Accepted: 03/08/2002] [Indexed: 11/18/2022]
Abstract
We previously reported that our repair and/or reconstruction of the scapholunate interosseous ligament reduced the scapholunate dissociation and improved the clinical results. Re-evaluation of these patients after three years revealed that malrotation of the scaphoid advanced significantly although the clinical results declined only slightly. To prevent progression of scaphoid malrotation, a modified dorsal capsulodesis was subsequently added to the ligamentous repair of scapholunate dissociation. The records of 17 patients were available for this study. The time lapse from injury to surgical treatment ranged from four days to one year and six months. All but three patients were operated less than two months after the injury. All patients were followed for more than one year, with an average of 49 months. Clinical results were expressed by a modification of the point score method of Green and O'Brien. Scapholunate angles were measured on lateral X-ray films with the wrist in neutral position. Overall clinical results averaged 83 points (range: 25-100). The scapholunate angles averaged 49 degrees (range: 45-60). In the three patients, in whom the operation was performed more than 11 months after the injury, the clinical results averaged 38 points and scapholunate angles averaged 54 degrees, respectively. These clinical and X-ray results suggest that early repair of the scapholunate interosseous ligament along with a modified dorsal capsulodesis is a useful procedure in the treatment of scapholunate dissociation.
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Affiliation(s)
- Akio Minami
- Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Sapporo, Japan.
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Abstract
In a porcine tibia model, we subjected widely used anchor-suture combinations to a fatigue-testing protocol. The Ethibond No. 2 suture was the weakest part of the anchor-suture combinations when they were loaded to failure by a single pull. Under cyclic-loading conditions, fixation strength was decreased compared with single-pull tests. The suture/anchor interface was identified as the weakest link in the Mitek GII/No. 2 combination and in the Zimmer Statak 3.5/No. 2 combination. In most cases the suture was worn through at the eyelet. Threading the GII anchor with a No. 5 suture and use of larger anchors in combination with No. 2 sutures increased the fatigue strength. Suture breakage at the knot was the predominant failure mode for biodegradable anchors inserted into cortical bone. The highest fatigue strength was seen for the Super Anchor/No. 5 combination when the anchor was inserted in cortical bone. Fatigue testing is crucial for evaluation of suture anchors and should be performed along with single-pull testing. The mechanical performance of a suture anchor threaded with a defined suture depends on several key factors: the pullout strength of the anchor, the tensile strength of the suture, and the interaction of anchor and suture at the eyelet (suture/anchor interface).
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Affiliation(s)
- Stefan Rupp
- Department of Orthopaedic Surgery, University of Saarland, Homburg/Saar, Germany
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Nishizawa S, Yokota N, Yokoyama T, Mukodaka H, Watanabe T, Hoshino T, Ueda Y. Prevention of postoperative complications in skull base surgery for nasal or paranasal sinus carcinoma invading the skull base. J Clin Neurosci 2001; 8 Suppl 1:67-70. [PMID: 11386830 DOI: 10.1054/jocn.2001.0881] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
With recent technical advances in skull base surgery, radical resection of a nasal or paranasal sinus carcinoma invading the skull base can now be achieved. To assure a satisfactory surgical result, it is essential to prevent postoperative infection. In our series of 14 cases, serious postoperative infections occurred in the earliest 10 cases, and only 2 of these patients are still alive. The vascularised abdominal muscle flap for skull base reconstruction was fixed with fibrin glue, but was not adequate to fill the dead space, resulting in cerebrospinal fluid leakage and subsequent meningitis. Once the infection occurred, a free bone flap became the focus of infection. Based on these earlier experiences, we used a ROC fastener system to completely fill the dead space with an abdominal muscle flap, and bone flap was primarily craniectomised in the four most recent cases. With this technique, there were no postoperative infections.
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Affiliation(s)
- S Nishizawa
- Department of Neurosurgery, Hamamatsu University School of Medicine, Shizuoka, Japan
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