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Carlson C, Nezha A, Mathison G, Ablove R. The Effect of Proximal Row Carpectomy and Trapeziectomy on First Ray Stability: A Cadaveric Study. J Hand Surg Am 2024; 49:752-756. [PMID: 37542496 DOI: 10.1016/j.jhsa.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/29/2023] [Accepted: 06/21/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE Wrist and thumb pathology can coexist leading to potential indications for proximal row carpectomy (PRC) and trapeziectomy. In this setting, the axial stability of the first ray is not known. We sought to evaluate axial subsidence of the first metacarpal in cadavers following trapeziectomy and trapeziectomy with PRC to determine the mechanical effects of the procedures performed concurrently. METHODS Eleven fresh-frozen cadaveric distal forearm specimens were used in this study. The specimens were fixed in cement and mounted to a material test system frame. A predetermined force (20 N) was applied to the thumb metacarpal to simulate forces observed with lateral pinch. Axial displacement of the thumb metacarpal was measured. The application of force was repeated following trapeziectomy on each hand and then again following PRC. Analysis was performed to compare thumb metacarpal subsidence of the 3 groups: native, trapeziectomy, and trapeziectomy with PRC. RESULTS Before trapeziectomy, native cadaver specimens had an average of 5.1 ± 1.9 mm of thumb metacarpal subsidence under the material test system load (20 N), compared to 16.2 ± 3.4 mm following trapeziectomy, and 25.0 ± 5.5 mm for trapeziectomy with PRC. CONCLUSION We observed a significant increase in thumb metacarpal subsidence following concurrent trapeziectomy with PRC when compared to trapeziectomy alone. Our results suggest that performing both operations together would lead to a substantial risk of first ray subsidence. CLINICAL RELEVANCE When treating concurrent basilar thumb and wrist arthritis, it may be more effective to stage the procedures or use a form of thumb metacarpal suspension or arthrodesis.
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Affiliation(s)
- Charles Carlson
- Department of Orthopaedics and Sports Medicine, University at Buffalo, Buffalo NY; SUNY Upstate Medical University Norton College of Medicine, Syracuse NY.
| | - Anxhela Nezha
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
| | - Grant Mathison
- Department of Orthopaedics and Sports Medicine, University at Buffalo, Buffalo NY
| | - Robert Ablove
- Department of Orthopaedics and Sports Medicine, University at Buffalo, Buffalo NY
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2
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Chowdhary S, Kale A. A Rare Case of Chronic Lunate Dislocation Along With Avascular Necrosis of the Lunate With Median Nerve Compression Treated With Lunate Excision With Carpal Tunnel Release. Cureus 2023; 15:e45957. [PMID: 37900399 PMCID: PMC10600644 DOI: 10.7759/cureus.45957] [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: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
A young 22-year-old male presented with complaints of pain, tingling, and numbness over his right wrist for 1 year and had a history of falls on his outstretched hand. Radiological evaluations such as X-rays were done, which showed a break in the proximal carpal arc. An MRI of the affected wrist was done. MRI findings are suggestive of avascular necrosis of the lunate along with lunate dislocation with marrow edema/contusion in the lunate. Complete disruption of the scapholunate, lunotriquetral, and radioscaphocapitate ligaments was noted. The patient was operated with lunate excision with carpal tunnel release and given strict pillow cover elevation in a volar slab.
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Affiliation(s)
- Sahil Chowdhary
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Amit Kale
- Orthopaedics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
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3
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Perry AC, Wilkes C, Curran MWT, Ball BJ, Morhart MJ. Proximal Row Carpectomy Modifications for Capitate Arthritis: A Systematic Review. J Wrist Surg 2023; 12:86-94. [PMID: 36644731 PMCID: PMC9836777 DOI: 10.1055/s-0042-1751013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 05/12/2022] [Indexed: 01/18/2023]
Abstract
Introduction Proximal row carpectomy (PRC) is a motion-sparing procedure for radiocarpal arthritis with reliable results. Traditionally, proximal capitate arthritis is a contraindication to PRC; however, PRC with modifications are proposed to circumvent this contraindication. PRC modifications can be broadly grouped into capitate resurfacing (CR) and capsular interposition (CI) procedures which could expand PRC indications. Our primary question was to characterize the outcomes achievable with various PRC modifications. Our secondary question was to determine which PRC modification was the optimal procedure when capitate arthritis was present. Methods A systematic review was conducted to examine the outcomes of modified PRC procedures. Independent reviewers appraised multiple databases for PRC studies with modifications for capitate arthritis in adult patients (age >18 years) with a minimum of three cases and extractable outcomes. Modified PRC procedures included capsular/allograft interposition, resurfacing capitate pyrocarbon implants, and osteochondral grafting. Pertinent outcomes included patient demographics, range-of-motion, grip strength, patient-reported outcomes, and complications, including salvage rates. Results Overall, 18 studies met the inclusion criteria-10 studies ( n = 147) on CI and 8 studies on CR ( n = 136). PRC with CI had the greatest flexion-extension arc and grip strength. Complications were marginally higher in the CR group (4%), while the CI group had a higher conversion to total wrist arthrodesis (10%). Conclusion Techniques to address capitate arthritis center around resurfacing or soft tissue interposition. PRC modifications with CI produces better range-of-motion and grip strength but higher conversion to total wrist arthrodesis. Higher conversion rates may be attributable to longer follow-up periods in studies examining CI compared with CR. Level of Evidence This is a Level III study.
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Affiliation(s)
- Alexander C. Perry
- Division of Plastic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Courtney Wilkes
- Division of Plastic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew W. T. Curran
- Division of Plastic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Brandon J. Ball
- Division of Plastic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Michael J. Morhart
- Division of Plastic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
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Fisher ND, Bi AS, De Tolla JE. Perilunate Dislocations: Current Treatment Options. JBJS Rev 2022; 10:01874474-202209000-00003. [PMID: 36413343 DOI: 10.2106/jbjs.rvw.22.00106] [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: 11/24/2022]
Abstract
➢ Approximately 25% of all patients who sustain perilunate dislocations present in a delayed fashion. ➢ While management of acute injuries is relatively well-described, treatment of chronic injuries can be complex and there is a paucity of scientific evidence to guide management. ➢ Treatment options include open reduction internal fixation, proximal row carpectomy, scaphoid or lunate excision with or without arthrodesis, and total wrist arthrodesis, although indications vary based on chronicity of injury and patient factors. ➢ The purpose of this article was to determine the quality of evidence supporting surgical options for the treatment of these injuries.
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Wagner ER, Spencer CC, Dawes AM, Gottschalk MB, Daly CA. Management of Proximal Pole Scaphoid Nonunions: A Critical Analysis Review. JBJS Rev 2021; 9:01874474-202104000-00001. [PMID: 33819205 DOI: 10.2106/jbjs.rvw.19.00181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Optimal management of nonunions of the proximal pole of the scaphoid is controversial and dependent on many patient and pathophysiologic considerations. » If the proximal pole subchondral bone support is sufficient, options include open reduction and internal fixation, either alone or in combination with autologous nonvascularized or vascularized bone graft. » If the proximal pole is not salvageable, replacement with osteochondral autografts or osteochondral flaps is the only option for reconstruction of the native anatomy.
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Affiliation(s)
- Eric R Wagner
- Emory University School of Medicine, Atlanta, Georgia
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6
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Garg B, Batra S. Chronic trans-scaphoid perilunate dislocation: Current management protocol. J Clin Orthop Trauma 2020; 11:523-528. [PMID: 32684688 PMCID: PMC7355076 DOI: 10.1016/j.jcot.2020.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/01/2020] [Accepted: 05/05/2020] [Indexed: 11/16/2022] Open
Abstract
Trans-scaphoid perilunate dislocations are complex injuries; usually occur as a result of high-energy trauma and are frequently missed. Chronic trans-scaphoid perilunate dislocation is often difficult to manage and delayed presentation leads to poor functional outcomes. Various treatment modalities have been described which range from open reduction and internal fixation, staged reduction, proximal row carpectomy and wrist arthrodesis.
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Affiliation(s)
- Bhavuk Garg
- All India Institute of Medical Sciences, New Delhi, India,Corresponding author.
| | - Sahil Batra
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
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7
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Meier R. [Treatment options for scaphoid nonunion advanced collapse]. Unfallchirurg 2019; 122:211-218. [PMID: 30887083 DOI: 10.1007/s00113-019-0631-y] [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: 10/27/2022]
Abstract
Untreated scaphoid nonunion as a rule results in subsequent scaphoid nonunion advanced collapse (SNAC) wrist. While reconstructive treatment of the scaphoid in association with resection of the styloid process of the radius is still promising in stage I SNAC wrist, salvage procedures are available for higher degrees of SNAC wrist to reduce pain and to preserve the function of the wrist. Denervation, proximal row carpectomy and partial wrist fusion maintain wrist mobility. Total wrist arthrodesis and total wrist arthroplasty are salvage procedures in cases of panarthritis or failed motion-preserving procedures.
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Affiliation(s)
- R Meier
- Unfall‑, Hand und Wiederherstellungschirurgie, Helios Klinikum Meiningen, Akademisches Lehrkrankenhaus des Universitätsklinikums Jena, Bergstr. 3, 98617, Meiningen, Deutschland.
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Goodman AD, Harris AP, Gil JA, Park J, Raducha J, Got CJ. Evaluation, Management, and Outcomes of Lunate and Perilunate Dislocations. Orthopedics 2019; 42:e1-e6. [PMID: 30403823 DOI: 10.3928/01477447-20181102-05] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 03/07/2018] [Indexed: 02/03/2023]
Abstract
Lunate and perilunate dislocations are potentially devastating injuries that are often unrecognized at initial evaluation. Prompt recognition and treatment is necessary to prevent adverse sequelae, including median nerve dysfunction, carpal instability, posttraumatic arthritis, reduced functionality, and avascular necrosis. In patients who are surgical candidates, operative intervention is warranted to restore carpal kinematics and provide optimal outcomes. [Orthopedics. 2019; 42(1):e1-e6.].
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Ault DL, Mann DJ, Troutner AM, Kettner NW. Post-traumatic Scapholunate Advanced Collapse of the Wrist: A Case Report. J Chiropr Med 2018; 17:128-134. [PMID: 30166970 DOI: 10.1016/j.jcm.2018.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 01/10/2018] [Accepted: 02/28/2018] [Indexed: 10/14/2022] Open
Abstract
Objective The purpose of this report is to describe a patient with scapholunate advanced collapse (SLAC) of the wrist. Clinical Features A 38-year-old man presented to a chiropractic teaching clinic with right wrist pain after falling off of the tailgate of a truck 7 years prior. The mechanism of injury was a fall on an outstretched hand. Ultrasonography and radiography were performed, which demonstrated abnormal lunate kinematics and scapholunate interval diastasis associated with a clenched-fist maneuver. These findings were consistent with SLAC. Intervention and Outcome Following the diagnosis of SLAC, the wrist was splinted. Conservative care consisting of physical therapy included paraffin dips, therapeutic ultrasound, and stretching. The patient received only minimal alleviation of pain, and a surgical consultation was obtained. The patient elected surgical intervention, utilizing the proximal row carpectomy procedure. Conclusion This case demonstrates a patient with chronic wrist pain, with progression to carpal instability, which ultimately manifested as SLAC. We demonstrate, utilizing multiple imaging modalities, both preoperative and postoperative findings. To our knowledge, this is the first case to describe the use of diagnostic ultrasonography in the evaluation of the proximal row carpectomy procedure.
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Affiliation(s)
- Daniel L Ault
- Department of Radiology, Logan University, Chesterfield, Missouri
| | - David J Mann
- Chiropractic Health Centers, Logan University, Chesterfield, Missouri
| | - Alyssa M Troutner
- Chiropractic Health Centers, Logan University, Chesterfield, Missouri
| | - Norman W Kettner
- Department of Radiology, Logan University, Chesterfield, Missouri
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Williams JB, Weiner H, Tyser AR. Long-Term Outcome and Secondary Operations after Proximal Row Carpectomy or Four-Corner Arthrodesis. J Wrist Surg 2018; 7:51-56. [PMID: 29383276 PMCID: PMC5788763 DOI: 10.1055/s-0037-1604395] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 06/26/2017] [Indexed: 02/07/2023]
Abstract
Background Proximal row carpectomy (PRC) and four-corner arthrodesis (FCA) are common surgical procedures used to treat degenerative wrist conditions; however, complications and failures can occur. Purpose This study aimed to investigate and compare the long-term rate of secondary surgeries including conversion to total wrist arthrodesis in patients who underwent PRC or FCA. Materials and Methods A retrospective chart review of all patients who underwent PRC or FCA in the past 20 years at a tertiary referral institution and associated Veterans Affairs (VA) hospital was performed. Patient demographics, comorbidities, surgical indications, and associated complications were tabulated. Patients were contacted via phone to obtain additional follow-up information regarding any additional surgeries, 10-point visual analog scale (VAS) for pain, quick Disabilities of the Arm, Shoulder, and Hand (quickDASH) scores, hand dominance, and occupational data. Results A total of 123 wrists made up the final dataset. Sixty-two wrists treated with PRC and 61 wrists treated with FCA were reviewed at a mean follow-up of 8.2 years. We did not find a significant difference in the rate of conversion to total wrist arthrodesis between the PRC (14.5%) and FCA (19.5%, p = 0.51) cohorts. Secondary operations were significantly greater in the FCA group (34.4%) compared with the PRC group (16.1%, p = 0.02). Females were 2.6 times more likely than males to undergo secondary operations when controlling for surgical procedure and smoking status ( p = 0.04). We did not detect a significant difference in VAS pain or in quickDASH scores between the two groups ( p = 0.35, 0.48, respectively). Conclusion PRC and FCA have comparable patient reported outcomes and wrist arthrodesis conversion rates at a mean follow-up of 8.2 years. In contrast, the FCA patient group had a significantly higher rate of secondary operations, including those for nonunion, symptomatic hardware, and other implant-related issues, when combined with wrist arthrodesis conversion. Level of Evidence Level IV, therapeutic study.
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Affiliation(s)
| | - Hadley Weiner
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Andrew R. Tyser
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
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11
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Muller T, Hidalgo Diaz JJ, Pire E, Prunières G, Facca S, Liverneaux P. Treatment of acute perilunate dislocations: ORIF versus proximal row carpectomy. Orthop Traumatol Surg Res 2017; 103:95-99. [PMID: 27923762 DOI: 10.1016/j.otsr.2016.10.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 10/09/2016] [Accepted: 10/24/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE Some authors have proposed performing proximal row carpectomy (PRC) as the initial treatment for perilunate dislocations. HYPOTHESIS The goal of this retrospective study was to compare the results of a cohort of perilunate dislocation cases that were operated by open reduction and internal fixation (ORIF) or by PRC between 2006 and 2011. METHODS The cohort consisted of 21 men with a mean age of 33years, who either had an isolated perilunate dislocation (7 cases) or a fracture-dislocation (14 cases). All dislocations were dorsal, with 10 stage I and 12 stage II. Thirteen patients had been treated by ORIF (group 1) a mean of 1.2days after the injury. Eight patients had been treated by PRC (group 2) a mean of 18.7days after the injury. Immobilization time was 6-12weeks in group 1 and 2weeks in group 2. RESULTS The mean operative time was 95minutes in group 1 and 65minutes in group 2. After a mean follow-up of 35months, the following outcomes were found for groups 1 and 2, respectively: pain 3/10 and 1/10, strength 77% and 73%, strength in supination 79% and 93%, strength in pronation 67% and 95%, QuickDASH 27/100 and 16/100, PRWE 43/150 and 15.5/150, flexion 69% and 57%, extension 84% and 58%, pronation 97% and 103%, supination 98% and 97%. There were four cases of osteoarthritis in both groups. CONCLUSION Treatment of acute perilunate dislocations by PRC leads to medium-term results that are at least as good as those with ORIF treatment. The surgery duration is shorter with PRC, as is the immobilization period. TYPE OF STUDY Retrospective comparative. LEVEL OF EVIDENCE III.
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Affiliation(s)
- T Muller
- Hand Surgery Department, SOS Main, CCOM, University Hospital of Strasbourg, Translational Medicine Federation Strasbourg (FMTS), University of Strasbourg, CNRS Icube 7357-10, 10, Baumann Avenue, 67403 Illkirch Cedex, France
| | - J J Hidalgo Diaz
- Hand Surgery Department, SOS Main, CCOM, University Hospital of Strasbourg, Translational Medicine Federation Strasbourg (FMTS), University of Strasbourg, CNRS Icube 7357-10, 10, Baumann Avenue, 67403 Illkirch Cedex, France
| | - E Pire
- Hand Surgery Department, SOS Main, CCOM, University Hospital of Strasbourg, Translational Medicine Federation Strasbourg (FMTS), University of Strasbourg, CNRS Icube 7357-10, 10, Baumann Avenue, 67403 Illkirch Cedex, France
| | - G Prunières
- Hand Surgery Department, SOS Main, CCOM, University Hospital of Strasbourg, Translational Medicine Federation Strasbourg (FMTS), University of Strasbourg, CNRS Icube 7357-10, 10, Baumann Avenue, 67403 Illkirch Cedex, France
| | - S Facca
- Hand Surgery Department, SOS Main, CCOM, University Hospital of Strasbourg, Translational Medicine Federation Strasbourg (FMTS), University of Strasbourg, CNRS Icube 7357-10, 10, Baumann Avenue, 67403 Illkirch Cedex, France
| | - P Liverneaux
- Hand Surgery Department, SOS Main, CCOM, University Hospital of Strasbourg, Translational Medicine Federation Strasbourg (FMTS), University of Strasbourg, CNRS Icube 7357-10, 10, Baumann Avenue, 67403 Illkirch Cedex, France.
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Delclaux S, Israel D, Aprédoaei C, Rongières M, Mansat P. Proximal row carpectomy on manual workers: 17 patients followed for an average of 6 years. HAND SURGERY & REHABILITATION 2016; 35:401-406. [PMID: 27890248 DOI: 10.1016/j.hansur.2016.09.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 09/18/2016] [Accepted: 09/26/2016] [Indexed: 12/21/2022]
Abstract
Proximal row carpectomy (PRC) is indicated for the treatment of SNAC or SLAC wrist with preservation of the midcarpal joint. Our hypothesis was that PRC is not appropriate for treating advanced wrist osteoarthritis in patients who carry out heavy manual work. Twenty-three PRCs were performed on 21 patients, 5 women and 16 men with an average age of 54 years (33-77). All patients performed manual work; 11 of them performed heavy manual work. Etiologies were: SLAC wrist in 14 cases (2 stage III, 11 stage II, and 1 stage I) and SNAC wrist in 9 cases (6 stage IIIB and 3 stage IIB). At an average 75 months' follow-up (24-153), five patients were lost to follow-up. Radiocarpal arthrodesis was performed in one patient 10 years after the PRC. In the 17 remaining patients (18 wrists), pain (VAS) averaged 2.2, with residual pain of 5. Flexion-extension range was similar to preoperative levels (67% of contralateral wrist). Wrist strength was decreased by 34% compared to preoperative. The QuickDASH score averaged 26 points and the PRWE 20 points. Radiocapitate distance decreased by 0.3mm on average with joint line narrowing in 6 patients. The carpal translation index was 0.33mm, which was unchanged relative to preoperative values. Three patients had work-related limitations that required retraining and one patient had to be reassigned. PRC preserved the preoperative range of motion and reduced pain levels. However, significant loss of strength was observed, resulting in 23% of manual workers needing retraining or reassignment. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- S Delclaux
- Département d'orthopédie et traumatologie, urgences mains, hôpital Pierre-Paul-Riquet, hôpital universitaire de Toulouse, place du Dr-Baylac, 31059 Toulouse cedex, France.
| | - D Israel
- Département d'orthopédie et traumatologie, urgences mains, hôpital Pierre-Paul-Riquet, hôpital universitaire de Toulouse, place du Dr-Baylac, 31059 Toulouse cedex, France.
| | - C Aprédoaei
- Département d'orthopédie et traumatologie, urgences mains, hôpital Pierre-Paul-Riquet, hôpital universitaire de Toulouse, place du Dr-Baylac, 31059 Toulouse cedex, France.
| | - M Rongières
- Département d'orthopédie et traumatologie, urgences mains, hôpital Pierre-Paul-Riquet, hôpital universitaire de Toulouse, place du Dr-Baylac, 31059 Toulouse cedex, France.
| | - P Mansat
- Département d'orthopédie et traumatologie, urgences mains, hôpital Pierre-Paul-Riquet, hôpital universitaire de Toulouse, place du Dr-Baylac, 31059 Toulouse cedex, France.
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Wagner ER, Bravo D, Elhassan B, Moran SL. Factors associated with improved outcomes following proximal row carpectomy: a long-term outcome study of 144 patients. J Hand Surg Eur Vol 2016; 41:484-91. [PMID: 26228698 DOI: 10.1177/1753193415597096] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 06/09/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED We conducted a review of 144 consecutive patients who underwent proximal row carpectomy from 1967 to 2010 for the diagnosis of wrist arthritis. At a mean follow-up of 13.4 years, patients experienced good pain relief with preservation (but not improvement) of wrist motion. A total of 17 patients (12%) required revision surgery at an average of 44.6 months. Improved pain, function, and survival outcomes were seen in those who underwent proximal row carpectomy after the age of 40, had a preoperative diagnosis of Kienbock's disease, who underwent a concomitant neurectomy procedure, patients who were non-labourers, and patients who underwent surgery after 1990. Although 45% of patients developed moderate to severe radiocapitate arthrosis postoperatively, these findings did not correlate with clinical outcomes or risk of revision surgery. Patients with type II lunate and type II and III capitate shapes had higher rates of postoperative radiocapitate arthrosis. LEVEL OF EVIDENCE III, Prognostic.
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Affiliation(s)
- E R Wagner
- Mayo Clinic, Department of Orthopedic Surgery, Rochester, MN, USA
| | - D Bravo
- Mayo Clinic, Department of Orthopedic Surgery, Rochester, MN, USA
| | - B Elhassan
- Mayo Clinic, Department of Orthopedic Surgery, Rochester, MN, USA
| | - S L Moran
- Mayo Clinic, Department of Orthopedic Surgery, Rochester, MN, USA Mayo Clinic, Division of Plastic and Reconstructive Surgery, Rochester, MN, USA
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14
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Bhatia DN. Arthroscopic Reduction and Stabilization of Chronic Perilunate Wrist Dislocations. Arthrosc Tech 2016; 5:e281-90. [PMID: 27354948 PMCID: PMC4912605 DOI: 10.1016/j.eats.2015.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 12/28/2015] [Indexed: 02/03/2023] Open
Abstract
An acute perilunate wrist injury that is unreduced for more than 6 weeks results in severe disability, and even open reduction with stabilization through wide dorsal and volar approaches is technically challenging. This report describes an arthroscopic technique for reduction and percutaneous wire stabilization of a chronic perilunate wrist dislocations. The technique involves initial radiocarpal and midcarpal access through the 6R and 3-4 portals, and these portals are used for synovectomy and debridement of capsular flap tears. The midcarpal joint is accessed initially through the radiocarpal joint, and additional midcarpal portals are used for sequential perilunate adhesiolysis before carpal mobilization and reduction. A percutaneous wire drilled into the lunate is used as a joystick to manipulate the lunate into its anatomic alignment along the carpal bones, and percutaneous transcarpal wire fixation is performed to stabilize the carpus. Arthroscopic and fluoroscopic guidance is used to optimize anatomic reduction and to confirm stability. The wrist is immobilized for 6 weeks; the percutaneous wires are removed thereafter, and the wrist is mobilized. Overall, the arthroscopic technique provides a safe and reproducible method for treatment of this complex chronic injury.
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Affiliation(s)
- Deepak N. Bhatia
- Address correspondence to Deepak N. Bhatia, M.S.(Orth), D.N.B.(Orth), Department of Orthopaedic Surgery, Seth GS Medical College, and King Edward VII Memorial Hospital, Parel, Mumbai 400012, India.Department of Orthopaedic SurgerySeth GS Medical College, and King Edward VII Memorial HospitalParelMumbai400012India
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Griffin M, Roushdi I, Osagie L, Cerovac S, Umarji S. Patient-Reported Outcomes Following Surgically Managed Perilunate Dislocation: Outcomes After Perilunate Dislocation. Hand (N Y) 2016; 11:22-8. [PMID: 27418885 PMCID: PMC4920520 DOI: 10.1177/1558944715617222] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Perilunate dislocations (PLDs) are uncommon high-energy injuries that may result in significant morbidity if inadequately treated. We report the midterm outcomes following surgical intervention and the validity of the Patient-Rated Wrist Evaluation (PRWE) score as an assessment tool post injury. METHODS We prospectively present outcomes in 16 patients with perilunate injuries. Definitive surgical management comprised fixation of all fractures and anatomical reconstruction of ruptured ligaments where possible. All patients completed the Disabilities of the Arm, Shoulder and Hand (DASH), 12-Item Short-Form Health Survey, and PRWE, for which internal consistency and construct validity were assessed. RESULTS At 24 months, the mean grip strength was 59% of the uninjured side (range 33%-85%) and the mean range of flexion was 71% and extension was 58%. Eighty-eight percent of patients returned to work within 6 months and 63% to sport within 1 year. The PRWE score was 36.2 (range 14.5-77.3) and DASH 25.2 (range 7.5-91.7). The mean visual analog scale (VAS) satisfaction score was 7.9 (range 0-10), VAS pain at rest 1.9 (range 0-6) and on activity 3.3 (range 1-6). DASH and PRWE demonstrated similar internal consistencies with Cronbach alphas of .98 and .91, respectively, and a strongly positive correlation coefficient of r = +.7 (P < .05). CONCLUSIONS Surgical treatment of PLDs can provide good clinical outcomes allowing patients to return to normal activities in a reasonable timescale when delays to surgery are kept to a minimum. The PRWE demonstrated high internal consistency and was found to be a valid questionnaire with advantages over the DASH for use following severe carpal injures.
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Affiliation(s)
| | | | | | | | - Shamim Umarji
- St Georges Healthcare, London, UK,Shamim Umarji, Department of Orthopaedic Surgery, St Georges Healthcare Trust, Tooting London, 0208 6721255, UK.
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Başar H, Başar B, Erol B, Tetik C. Isolated volar surgical approach for the treatment of perilunate and lunate dislocations. Indian J Orthop 2014; 48:301-5. [PMID: 24932038 PMCID: PMC4052031 DOI: 10.4103/0019-5413.132523] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Volar and/or dorsal surgical approaches are used for surgical treatment of perilunate and lunate dislocations. There are no accepted approaches for treatment in the literature. We evaluated the functional results of isolated volar surgical approach for the treatment of perilunate and lunate dislocation injuries. MATERIALS AND METHODS 9 patients (6 male and 3 female patients average age 34.5 ± 3.6 years) diagnosed with perilunate or lunate dislocations between January 2000 and January 2009 were involved in the study. The reduction was performed through isolated volar surgical approach and K-wire fixation, fracture stabilization with volar ligament repair was performed. Range of wrist joint motion, fracture healing, carpal stability, grip strength, return to work were evaluated and also direct radiographs were taken routinely at each control. The scapholunate interval and the scapholunate angle were evaluated radiographically. Evaluations of the clinical results were done using the DASH, VAS and Modified Mayo Wrist Scores. RESULTS The physical rehabilitation was started at 6(th) week, after the K-wires were removed. The average followup was 18.2 months (range 12-28 months). At the final followup, the average flexion extension arc was 105.0 ± 9.6° (74.6% of the other side), the average rotation arc was 138.8 ± 7.8° (81.5% of the other side) and the average radioulnar arc was 56.1 ± 9.9° (86.4% of the other side). The grip strength was 0.55 bar; 83.2% that the uninjured arm. According to the Mayo Modified Wrist score, the functional result was excellent in five patients and good in four and the average DASH score was 22.8. The scapholunate interval was 2.1 mm and scapholunate angle was 51°. CONCLUSION The clinical and radiological results of the isolated volar surgical approach were satisfactory. The dorsal approach was not needed for reduction of dislocations during operations. Our results showed that an isolated volar approach was adequate.
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Affiliation(s)
- Hakan Başar
- Department of Orthopedics and Traumatology, Sakarya Training and Research Hospital, Sakarya, Turkey,Address for correspondence: Dr. Hakan Başar, Eski Kazımpaşa cad. yolu Arabacı alanı mah. Akkent villaları NO: 156/25 Serdivan/Sakarya, Turkey. E-mail:
| | - Betül Başar
- Department of Physical Medicine and Rehabilitation, Akyazı State Hospital, Sakarya, Turkey
| | - Bülent Erol
- Department of Orthopaedic Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Cihangir Tetik
- Department of Orthopaedics and Traumatology, Acibadem Maslak Hospital, Istanbul, Turkey
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Marzouki A, Almoubaker S, Hamdi O, Laharch K, Boutayeb F. Fracture-luxation trans-scapho-rétrolunaire du carpe avec énucléation antérieure du lunatum et du fragment proximal du scaphoïde. À propos d’un cas. ACTA ACUST UNITED AC 2013; 32:96-9. [DOI: 10.1016/j.main.2013.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 11/26/2012] [Accepted: 02/12/2013] [Indexed: 12/01/2022]
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Acute proximal row carpectomy to treat a transscaphoid, transtriquetral perilunate fracture dislocation: case report and review of the literature. Hand (N Y) 2013; 8:105-9. [PMID: 24426904 PMCID: PMC3574483 DOI: 10.1007/s11552-012-9462-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Proximal row carpectomy (PRC) is a motion-preserving treatment for the degenerated wrist. PRC provides painless wrist range of motion with few complications. PRC treats specifically scapholunate advanced collapse, scaphoid non-union advanced collapse, chronic perilunate dislocations, and Kienbock's disease. The best candidates are older than 35 with an intact capitate head and lunate facet of the distal radius. Proximal row carpectomy provides satisfactory postoperative wrist range of motion and grip strength with few complications, especially when there is no capitolunate arthrosis. Postoperative progressive changes at the radiocapitate articulation have been documented, yet these changes tend to remain asymptomatic.
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Affiliation(s)
- Lindley B Wall
- Washington University Orthopedics, St Louis, MO 63110, USA
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20
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Abstract
Proximal row carpectomy (PRC) combined with distal radius hemiarthroplasty is a relatively novel procedure that rivals total wrist arthrodesis and offers a new surgical treatment option for select patients with painful, end-stage wrist disease. We present our early experience with this procedure. A retrospective chart review was conducted for nonrheumatoid patients diagnosed with wrist arthritis and subsequently treated with wrist hemiarthroplasty combined with PRC. The minimum follow-up duration was 12 months. Preoperative and postoperative flexion, extension, and grip strength were recorded. Postoperative radiographic findings were assessed. The Patient-Rated Wrist Evaluation (PRWE) questionnaire was administered to gauge postoperative pain and function. The records of 10 patients were reviewed. The mean age was 64 years and the mean postoperative follow-up duration was 19 months. Postoperative flexion, extension, and grip strength were all found to be less than the preoperative levels. The mean postoperative PRWE score for pain and function were 26 and 23, respectively. The complications were diverse and occurred at a relatively high rate. PRC combined with distal radius hemiarthroplasty is a novel procedure that offers a potential surgical option for the treatment of wrist arthritis in select patients. Our early experience has lead us to modify our technique with regard to the implant material, and at this stage, the surgical technique and the most appropriate implant may require further optimization. The level of evidence for this study is IV (therapeutic).
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Affiliation(s)
- Randall W. Culp
- Division of Hand Surgery, Department of Orthopaedic Surgery, The Philadelphia Hand Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Abdo Bachoura
- Division of Hand Surgery, Department of Orthopaedic Surgery, The Philadelphia Hand Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Scott E. Gelman
- Division of Hand Surgery, Department of Orthopaedic Surgery, The Philadelphia Hand Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Sidney M. Jacoby
- Division of Hand Surgery, Department of Orthopaedic Surgery, The Philadelphia Hand Center, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Garg B, Goyal T, Kotwal PP. Staged reduction of neglected transscaphoid perilunate fracture dislocation: a report of 16 cases. J Orthop Surg Res 2012; 7:19. [PMID: 22607705 PMCID: PMC3489547 DOI: 10.1186/1749-799x-7-19] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Accepted: 05/02/2012] [Indexed: 12/02/2022] Open
Abstract
Background Transscaphoid perilunate fracture dislocation is a rare injury and can be easily missed at the initial treatment. Once ignored, late reduction is not possible and needs extensive dissection. An alternative treatment such as proximal row carpectomy may be required for neglected injuries, but surgical outcome is not as good as that of an early reduction. We aim to present an alternative technique of staged reduction and fixation in patients of neglected transscaphoid perilunate dislocations and study its outcome. Material & Methods 16 cases (14 males & 2 females) with neglected transscaphoid perilunate fracture dislocation (> 3 month old) were treated with staged reduction. Mean duration between injury and surgery was 4.5 months. In first stage an external fixator was applied across the wrist and distraction was done at 1 mm/day. Second surgery was done through dorsal approach and we were able to reduce all the fractures & dislocations. Herbert screws and K wires were used for fixation. Results The mean duration between two surgeries was 2.4 weeks (range 2–4 weeks). 9 cases had excellent results, 5 had good result. Two patients developed reflex sympathetic dystrophy and had fair results. Conclusion Staged reduction should be considered for neglected transscaphoid perilunate dislocations. If properly executed, a good functional pain free range of motion is the usual outcome.
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Affiliation(s)
- Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, 110029, New Delhi, India
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Siwicka K, Horii E. LATE REDUCTION FOR A CHRONIC TRANS-SCAPHOID PERILUNATE DISLOCATION IN A SKELETALLY IMMATURE 15-YEAR-OLD BOY: A CASE REPORT. ACTA ACUST UNITED AC 2011; 12:177-81. [DOI: 10.1142/s0218810407003699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Accepted: 12/25/2007] [Indexed: 11/18/2022]
Abstract
Fracture dislocation of the wrist is a rare injury in adolescents, and therefore it is easily ignored at the initial treatment. Once ignored, an alternative treatment such as proximal row carpectomy is indicated, but surgical outcome is not as good as that of an early reduction. We have experienced a chronic case of fracture dislocation in a 15-year-old, skeletally immature boy and treated it by scaphoid osteotomy, associated with bone grafting, screw fixation and ligament repair. The patient had no difficulties in daily activities nine years post-operatively, however the X-ray showed slight deformity of the scaphoid. Even for a chronic case, late reduction with ligamentous repair should be considered in adolescents.
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Affiliation(s)
- Karolina Siwicka
- Department of Hand Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Emiko Horii
- Hand Department, Nagoya First Red Cross Hospital, Nagoya, Japan
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Abstract
Thirty-one patients underwent proximal row carpectomy for static scapholunate dissociation without degenerative arthritis. We report the radiographic and clinical results including wrist range of motion, grip strength, use of pain medication, pain severity and patient satisfaction. Mean postoperative flexion/extension was 74° (range 5°-150°) compared with 137° (range 70°-175°) for the uninvolved side. Mean grip strength was 22 kg for the involved side and 39 kg for uninvolved side. Fifteen of 31 patients reported moderate or severe pain after proximal row carpectomy, requiring wrist arthrodesis in four patients. Nearly half of patients involved in manual labour did not return to their pre-injury work status. Our findings suggest that proximal row carpectomy, when performed for static scapholunate dissociation, results in a stiffened, weakened wrist. When compared to historic series involving other treatments for scapholunate dissociation, patients are less likely to return to pre-injury occupation and have subjective and objective parameters that are below normally expected values after proximal row carpectomy performed for other conditions.
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Affiliation(s)
- J C Elfar
- University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA.
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Dhillon MS, Prabhakar S, Bali K, Chouhan D, Kumar V. Functional outcome of neglected perilunate dislocations treated with open reduction and internal fixation. Indian J Orthop 2011; 45:427-31. [PMID: 21886924 PMCID: PMC3162679 DOI: 10.4103/0019-5413.83138] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Management of neglected perilunate dislocations is controversial. The various procedures such as open reduction and internal fixation (ORIF), proximal row carpectomy, lunate excision, and wrist arthrodesis have been advocated. The aim of our study was to evaluate the functional outcome of neglected perilunate dislocations managed by ORIF. MATERIALS AND METHODS Over a period of 10 years (1996 to 2006), 14 patients with neglected perilunate dislocations (undiagnosed or untreated for 6 weeks or more) were managed by ORIF. Six patients had dorsal trans-scaphoid perilunate dislocation, 6 patients had volar lunate dislocation while the remaining two had a dorsal perilunate dislocation The results were evaluated by clinical scoring system of Cooney et al. RESULTS The average followup was 4.1 years (range 2-12 years). All except one of the patients operated earlier than 5 months had good results. Of the four patients operated after 5 months, two had a fair result while two had a poor outcome. Chondral damage to the capitate was noted intraoperatively in both the cases with poor outcomes. The two patients were found to have avascular necrosis (AVN) of the lunate; however, functional outcome was fair in both, and both were able to return to their profession. CONCLUSION We observed favorable functional results of ORIF in neglected perilunate dislocations up to 5 months after injury. The development of AVN or midcarpal arthritis was not a major disabling factor as long as stability of wrist has been restored. Beyond 5 months, an alternative surgical procedure such as proximal row carpectomy should be contemplated as results of ORIF have not been good uniformly.
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Affiliation(s)
| | | | - Kamal Bali
- Department of Orthopedics, PGIMER, Chandigarh, India,Address for correspondence: Dr. Kamal Bali, Department of Orthopedic Surgery, PGIMER, Chandigarh - 160 012, India. E-mail:
| | | | - Vishal Kumar
- Department of Orthopedics, PGIMER, Chandigarh, India
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Risk management and avoiding legal pitfalls in the emergency treatment of high-risk orthopedic injuries. Emerg Med Clin North Am 2010; 28:969-96. [PMID: 20971400 DOI: 10.1016/j.emc.2010.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Avoiding legal pitfalls of orthopedic injuries in the emergency department (ED) requires an understanding of certain high-risk injuries, their presentation, evaluation, and disposition. Various pitfalls pertaining to both upper and lower extremity injuries are discussed in detail, with recommendations regarding the history, physical examination, and radiographic techniques that minimize the risk inherent in these injuries. When approaching these injuries in the ED, a high level of suspicion coupled with appropriate evaluation and management will allow the practitioner to avoid mismanagement of these potential pitfall cases.
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Edouard P, Vernay D, Martin S, Hirsch P, Bardoux S, Grange C, Claus D, Claise JM. Proximal row carpectomy: Is early postoperative mobilisation the right rehabilitation protocol? Orthop Traumatol Surg Res 2010; 96:513-20. [PMID: 20538538 DOI: 10.1016/j.otsr.2010.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 12/08/2009] [Accepted: 02/18/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE OF THE STUDY To determine the feasibility and interest of an early rehabilitation protocol with no initial immobilisation after proximal row carpectomy. MATERIAL AND METHODS Thirteen patients were included in this retrospective study. Range of motion (ROM) and wrist strength (grip strength and grasp strength) were evaluated 3 and 6 weeks after surgery on the both wrists (operated and non-operated). Postoperatively, patients had no immobilisation of the wrist, and began a rehabilitation program immediately after surgery in the department of Physical Therapy and Rehabilitation under multidisciplinary team supervision. The same surgical technique was used for all patients by the same surgeon. RESULTS Six weeks after PRC, there was a 25-51% deficit in passive ROM and 54-64% deficit in active ROM compared to the corresponding non-operated wrist. Six weeks after PRC, mean overall grip strength was nearly 55% and Jamar dynamometer grip strength was 51% of the contralateral side. DISCUSSION This study shows that immediate immobilisation following PRC is unnecessary, and that early rehabilitation is of the essence. Early rehabilitation could reduce the delay necessary to recover range of motion and strength, and probably the time to return to work. LEVEL OF EVIDENCE Level 4, prospective cohort study.
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Affiliation(s)
- P Edouard
- Department of Physical Medicine and Rehabilitation, LPE EA 4338, Bellevue Hospital, University Hospital of Saint-Etienne, 42055 Saint-Etienne cedex 2, France.
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Abstract
Perilunate injuries are complex injuries of the bony and ligamentous structures of the wrist. They require operative management with careful restoration of carpal alignment and open reduction and internal fixation of associated fractures. Even with optimal treatment, mild to moderate dysfunction affects most patients.
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Affiliation(s)
- David J Sauder
- Hand and Upper Limb Centre, St Joseph's Health Care, University of Western Ontario, London, ON, N6A 4L6, Canada
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Zhu YL, Xu YQ, Ding J, Li J, Chen B, Ouyang YF. Biomechanics of the wrist after proximal row carpectomy in cadavers. J Hand Surg Eur Vol 2010; 35:43-5. [PMID: 19786401 DOI: 10.1177/1753193409344527] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We investigated the biomechanics of the radiocapitate joint after a proximal row carpectomy in six fresh-frozen cadaver wrists using super-low-pressure-sensitive film on a material testing system. The average pressure within the lunate fossa increased significantly from 23.2 to 136.4 N/cm(2) with a sharp decrease in the contact area from 2.08 to 0.30 cm(2) after a proximal row carpectomy. The cartilage of the proximal capitate had four sub-facets and therefore was not as smooth as the normal proximal lunate. We found that the wrist was overloaded after a proximal row carpectomy and the main cause was the anatomical mismatch of the radiocapitate articulation.
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Affiliation(s)
- Y-L Zhu
- Orthopaedic Department, Kunming General Hospital, Third Military Medical University, China.
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Kwon BC, Choi SJ, Shin J, Baek GH. Proximal row carpectomy with capsular interposition arthroplasty for advanced arthritis of the wrist. ACTA ACUST UNITED AC 2009; 91:1601-6. [DOI: 10.1302/0301-620x.91b12.22335] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Advanced osteoarthritis of the wrist or the distal articulation of the lunate with the capitate has traditionally been treated surgically by arthrodesis. In order to maintain movement, we performed proximal row carpectomy with capsular interposition arthroplasty as an alternative to arthrodesis in eight patients with advanced arthritis and retrospectively reviewed their clinical and radiographic outcomes after a mean follow-up of 41 months (13 to 53). The visual analogue scale (VAS) for pain at its worst and at rest, and the patient-rated wrist evaluation score improved significantly after surgery, whereas ranges of movement and grip strength were maintained at the pre-operative levels. Progression of arthritis in the radiocapitate joint was observed in three patients, but their outcomes were not significantly different from those without progression of arthritis. Proximal row carpectomy with capsular interposition arthroplasty is a reasonable option for the treatment of patients with advanced arthritis of the wrist.
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Affiliation(s)
- B. C. Kwon
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Pyeongchon-dong Dongan-gu, Anyang-si Gyeonggi-do, 431-070, Republic of Korea
| | - S.-J. Choi
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Pyeongchon-dong Dongan-gu, Anyang-si Gyeonggi-do, 431-070, Republic of Korea
| | - J. Shin
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Pyeongchon-dong Dongan-gu, Anyang-si Gyeonggi-do, 431-070, Republic of Korea
| | - G. H. Baek
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, 28 Yeongeon-dong Jongno-gu, Seoul 110-744, Republic of Korea
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Abstract
Fifty-one patients who had had proximal row carpectomy between 1992 and 2002 with a minimum follow-up of one year were followed up clinically and radiologically retrospectively. Their diagnoses included Kienböck disease (n=21), avascular necrosis of the scaphoid (n=4), nonunion of the scaphoid with osteoarthritis (n=9), and scapholunate advanced collapse (n=17). The mean follow-up was 5 years, 8 months. The mean "disabilities of the arm, shoulder and hand" (DASH) score was 18. The mean patient-rated wrist evaluation (PRWE) score list was 25% of maximum disability for the function and pain score. Thirty-four patients (87%) were able to return to work a mean of six months after operation (range 3 weeks - 35 months). Nine patients (11%) required arthrodesis of the wrist and are considered as failures. Mean flexion of the wrist was 66%, extension 73%, radial deviation 74%, ulnar deviation 76%, and grip force 70% of the opposite side. Excision of the proximal row provided predictable and durable pain relief, restored functional movement and grip strength, and allowed returned to gainful employment in most of the patients.
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Affiliation(s)
- Luc De Smet
- Department of Orthopaedic Surgery, U.Z. Pellenberg, Lubbeek, Pellenberg, Belgium.
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Jacobs R, Degreef I, De Smet L. Proximal row carpectomy with or without postoperative immobilisation. J Hand Surg Eur Vol 2008; 33:768-70. [PMID: 18936119 DOI: 10.1177/1753193408092490] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Previously published reports have shown good results after proximal row carpectomy in all cases that had a postoperative immobilisation period from 1 to 4 weeks. Immobilisation is thought to be necessary because of the risk of postoperative subluxation of the carpus and for pain relief. There is, however, no evidence of its value. The results in 13 patients who underwent proximal row carpectomy without postoperative immobilisation were compared with those in 25 patients who underwent proximal row carpectomy with postoperative immobilisation for 4 weeks. After a mean follow-up period of 27 months, no significant differences were found for pain, range of motion or return to work between the two groups. We conclude that postoperative immobilisation is not necessary after proximal row carpectomy.
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Affiliation(s)
- R Jacobs
- University Hospital Leuven, Pellenberg, Belgium
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Abstract
OBJECTIVES Transscaphoid perilunate fracture-dislocations are complex injuries. The aim of this study is to discuss and compare open reduction and internal fixation for acute and delayed transscaphoid perilunate fracture-dislocations and review the literature. DESIGN The design of this study is retrospective and randomized. SETTINGS Gülhane Military Medical Academy, Department of Orthopedics and Traumatology. PATIENTS/PARTICIPANTS Twelve cases (6 acute and 6 delayed) of dorsal stage 2 fracture-dislocations were involved in the study. INTERVENTION Scaphoid fractures were treated with reduction and internal fixation by using either a cannulated screw or a Herbert screw. Temporary triquetrocapitate and lunotriquetral fixation were performed in all cases using two 1.8-mm Kirschner wires after reduction of the dislocations. MAIN OUTCOME MEASUREMENT Range of motion (flexion and extension), grip strength evaluation with Jamar dynamometer, comparison of preoperative and early postoperative average of scapholunate (SL) and radiolunate angle (RL), and revised carpal height ratio were used for outcomes assessment. Clinical evaluation was performed according to the clinical scoring system modified from Green and O'Brien. Revised carpal height ratio, SL angle, RL angle, and appearance of midcarpal arthritis were used for radiologic analysis. RESULTS Average follow-up period was 45 months (23-70). Mean clinical score of early treated group and delayed treated group was 89.2 (good) and 72.5 (fair), respectively, according to clinical scoring system of Green and O'Brien. The overall clinical score of all cases was 80.8 (good). Two of the 6 cases in the delayed group developed posttraumatic midcarpal arthritis. Mean range of motion (flexion and extension) was 129.5 +/- 20.42 degrees in the early treated group and 95.5 +/- 18.08 degrees in the delayed group. Four of the 6 patients treated in the acute group gained normal grip strength, but 2 patients had more than 50% loss in grip strength compared with the contralateral wrist. Two of the 6 patients in the delayed group had normal grip strength, and 4 patients had more than 50% loss in grip strength compared with the contralateral wrist. The mean grip strength of the normal hands of all patients was 43.75 +/- 7.71 kg. The mean grip strength of the early treated group was 34.00 +/- 12.83 kg, whereas the mean grip strength of the delayed treated group was 26.33 +/- 13.48 kg. Average SL and RL angle in the early postoperative period were 47.5 and -9.40 degrees, respectively. At the last follow-up, average SL and RL angle were 55.5 and 5.43 degrees, respectively. The revised carpal height ratio was 1.51 in the early postoperative period and decreased to 1.45 at the last follow-up. CONCLUSIONS We recommend open reduction and internal fixation for early and delayed transscaphoid perilunate fracture-dislocations.
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Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Understand the anatomy and the biomechanical properties of the wrist. 2. Understand the standard examination process for wrist injuries. 3. Accurately diagnose common wrist conditions. 4. Establish a management plan for wrist problems. BACKGROUND Although common, wrist injuries and conditions are difficult to treat if the physician is unfamiliar with their management. METHODS Wrist anatomy and kinematics are discussed. Physical and radiographic examinations that are mandatory for diagnosing wrist conditions are presented. Common wrist injuries are reviewed. RESULTS Understanding the anatomy and kinematics of the wrist is important in diagnosing and treating wrist conditions and in predicting outcomes after treatment. Physical examination of the wrist requires an understanding of the surface anatomy and a number of specific maneuvers. Physicians should also be familiar with other diagnostic tests, which include radiography, arthrography, computed tomography, magnetic resonance imaging, and arthroscopy. CONCLUSIONS Physicians who treat wrist injuries should be able to establish an adequate management plan for common wrist injuries and conditions and be able to predict outcomes based on these treatment plans.
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Affiliation(s)
- Kenji Kawamura
- Ann Arbor, Mich. From the Section of Plastic Surgery, Department of Surgery, University of Michigan Health System
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Lecomte F, Wavreille G, Limousin M, Strouk G, Fontaine C, Chantelot C. Résection de la rangée proximale des os du carpe. ACTA ACUST UNITED AC 2007; 93:444-54. [PMID: 17878835 DOI: 10.1016/s0035-1040(07)90326-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE OF THE STUDY Resection of the proximal row of the carpus which simplifies the radiocarpal joint is mainly performed for advanced collapse. With the development of several therapeutic alternatives, further study of outcome is warranted to better identify indications. MATERIAL AND METHODS Twenty-five patients who underwent proximal row carpectomy between January 1999 and February 2004 were reviewed clinically and radiologically at 30 months mean follow-up. Three main etiologies were noted: scaphoid fracture (n=9), scapholunate dissociation (n=9), Kienböck disease (n=6). A posterior approach was used for all patients. Outcome was assessed clinically (pain, force, mobility), radiologically (carpal height, radiocapital space), and subjectively by the patient. Resumption of occupational activity was noted as were the Cooney and Culp scores. RESULTS Average flexion-extension was 60 degrees . Average wrist force was 65% of the healthy side. Pain improved in 88% of wrists and the mean subjective score was 15.2. The mean Cooney and Culp scores were 58 and 67.8 respectively. A reduction in the height of the new articular space was not correlated with less favorable clinical outcome. Outcome in patients with Kienböck disease were less favorable than in trauma patients but the difference did not reach significance. DISCUSSION First row carpectomy is a paliative procedure which should only be performed when conservative treatment is no longer a valid option. Indications should be limited to Watson grade II, before cartilaginous damage affects the head of the capitatum. New techniques such as fusion-shortening, theoretically similar to resection, can now be used for advances collapse. We prefer resection over four-bone arthrodesis because of the lower risk of complications. In Kienböck disease, first row carpectomy should only be used for selected patients (Lichtmann III) due to the risk of early degeneration of the capitatum and radius heads.
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Affiliation(s)
- F Lecomte
- Service d'Orthopédie B, Chirurgie de la main et du membre supérieur, hôpital Roger-Salengro, CHRU de Lille, 59000 Lille.
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Abstract
Perilunate injuries are complex injuries of the bony and ligamentous structures of the wrist. They require operative management with careful restoration of carpal alignment and open reduction and internal fixation of associated fractures. Even with optimal treatment, mild to moderate dysfunction affects most patients.
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Affiliation(s)
- David J Sauder
- Hand and Upper Limb Centre, St. Joseph's Health Care, University of Western Ontario, 268 Grosvenor Street, London, ON, N6A 4L6, Canada
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Daecke W, Wieloch PT, Martini AK, Jung M. Proximale Karpektomie versus mediokarpale Teilarthrodese. ACTA ACUST UNITED AC 2006. [DOI: 10.1007/s11678-006-0006-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Streich NA, Martini AK, Daecke W. Proximal row carpectomy: an adequate procedure in carpal collapse. INTERNATIONAL ORTHOPAEDICS 2006; 32:85-9. [PMID: 17089124 PMCID: PMC2219951 DOI: 10.1007/s00264-006-0281-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Revised: 07/04/2006] [Accepted: 09/17/2006] [Indexed: 12/14/2022]
Abstract
Proximal row carpectomy (PRC) is an established procedure in the treatment of advanced radiocarpal arthritis. The aim of this study was to evaluate the individual, functional and radiological results in relation to the initial diagnosis. Seventeen patients (15 men, two women), who had undergone PRC, were evaluated. Their average age at the time of the operation was 48 years (range 21-70 years). The most frequent diagnosis leading to PRC was scaphoid non-union advanced collapse (SNAC), which was observed in nine patients, while in three cases each the condition treated had been scapholunate advanced collapse (SLAC) and perilunate dislocation, and in two cases, Kienboeck's disease. At the time of the follow-up examination (median 65.41 months), a significant improvement in the range of movement was seen. While only four (36%) of the patients with SNAC had radiological signs of arthrosis of the radiocapitate joint, visible radiological involvement was noted in all patients who underwent PRC due to scapholunate dissociation and perilunate dislocation. The results of this study show that PRC is a good way of achieving long-term improvement of the degree of subjective freedom from symptoms and of the functional range of movement. Interruption of ligamentous structures, as in scapholunate dissociation and perilunate dislocation, seems to influence the radiological outcome.
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Affiliation(s)
- Nikolaus A Streich
- Department of Orthopaedic Surgery, Universitätsklinik Heidelberg, Heidelberg, Germany.
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Chung KC, Watt AJ, Kotsis SV. A Prospective Outcomes Study of Four-Corner Wrist Arthrodesis Using a Circular Limited Wrist Fusion Plate for Stage II Scapholunate Advanced Collapse Wrist Deformity. Plast Reconstr Surg 2006; 118:433-42. [PMID: 16874215 DOI: 10.1097/01.prs.0000227737.90007.5d] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Scapholunate advanced collapse wrist deformity is a common pattern of degenerative arthrosis of the wrist. This study prospectively evaluated a series of patients who underwent four-corner fusion using a circular plate internal fixation technique. METHODS Patients with symptomatic stage II scapholunate advanced collapse wrist deformity were treated with scaphoid excision and four-corner fusion using the Spider Limited Wrist Fusion Plate (KMI, San Diego, Calif.). Patients were prospectively evaluated at 6 months and 1 year using a standard study protocol with radiographs, functional tests, and an outcomes questionnaire. Outcomes were compared with those of historical series from the literature. RESULTS Eleven patients were enrolled and 10 patients completed their 1-year follow-up. Grip strength, lateral pinch strength, and Jebsen-Taylor test scores at 1 year were not significantly different from preoperative values. Mean active range of motion was 87 degrees preoperatively and 74 degrees at 1-year follow-up (p = 0.19). The Michigan Hand Outcomes Questionnaire showed no significant improvement in function, activities of daily living, work, pain, or patient satisfaction. The mean pain scores decreased from 54 preoperatively to 42 1-year postoperatively (p = 0.30), indicating persistent wrist discomfort. Three patients had broken screws: one was asymptomatic, one required 3 months of strict wrist immobilization, and one was reoperated for symptomatic nonunion. CONCLUSIONS Four-corner fusion using the first-generation Spider plate technique has the advantage of earlier mobility and more patient comfort from absence of protruding Kirschner wires; however, patients continued to have disabling pain, functional limitations, work impairment, and low satisfaction scores postoperatively. Although limited by a small patient sample, this series presents outcomes data that may be useful in counseling patients who are contemplating four-corner fusion using this internal fixation device. Further investigation is necessary to evaluate the biomechanical properties of the Spider plate. The data suggest that better implants should be designed to avoid implant failure, which occurred in three of the 11 patients in this series.
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Affiliation(s)
- Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, and University of Michigan School of Medicine, Ann. Arbor, Mich. 48109-0340, USA.
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Givissis P, Christodoulou A, Chalidis B, Pournaras J. Neglected trans-scaphoid trans-styloid volar dislocation of the lunate. ACTA ACUST UNITED AC 2006; 88:676-80. [PMID: 16645120 DOI: 10.1302/0301-620x.88b5.16884] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A rare case of radiocarpal dislocation is presented. The lunate and proximal pole of the scaphoid were displaced in a volar and proximal direction. The injury was missed initially and the patient was subsequently operated on six weeks later. Open reduction and internal fixation of the scaphoid was performed and this was followed by an uneventful postoperative period, with a satisfactory functional outcome at the eight-year follow-up, despite carpal instability non-dissociative-dorsal intercalated segmental instability configuration of the carpus. We believe that although open reduction in neglected cases carries the potential risks of avascular necrosis and nonunion of the affected carpal bones, an attempt should be made to restore the anatomy of the carpus.
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Affiliation(s)
- P Givissis
- 11st Orthopaedic Department, Aristotle University of Thessaloniki George Papanikolaou Hospital, Exochi, Thessaloniki 570101, Greece.
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Abstract
Proximal row carpectomy is extremely useful as a wrist reconstructive technique for cases of degenerative joint arthritis of the radiocarpal joint cause by scapholunate advanced collapse, scapholunate advanced collapse, schaphoid nonunion advanced collapse, trans-scaphoid perilunate fracture dislocations, lunate dislocations, and Kienböck disease. It should be selected with caution for patients younger than 35 years old. The procedure can be performed with or without temporary internal fixation with with Kirschner wires, and adjunctive techniques of dorsal capsule interposition, proximal capitate excision, and radial styloidectomy can be used. The longevity of the operation is good, but the patient should be informed preoperatively that secondary procedures may be required. Based on historical series, these procedures have included addition have included of radial styloidectomy when this has not been performed at the index procedure, revision of the surgery with capitate debridement or conversion to total wrist arthodesis. Conversion of proximal row carpectomy to total wrist arthoplasty with implants can be contemplated in selected patient particularly as newer implants are designed. The technique the senior author has used on occasion has been to perform revision surgery on those patients who have chronic pain who might need further debridement of the radius in the radial styloid, the proximal capitate, or evaluation of the integrity of the interposition.
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Affiliation(s)
- Edward Diao
- Department of Orthopaedic Surgery, University of California San Francisco, 500 Parnassus Avenue, MU320W, San Francisco, CA 94143-0728, USA.
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Abstract
Orthopedic injuries are frequently seen in the ED. Whereas the diagnosis and management of most of these injuries is straightforward, there are distinct pitfalls to avoid. The common theme among the high-risk "pitfall" injuries discussed in this article, besides a thorough patient history and careful physical examination with appropriate radiographs, is a high suspicion for the presence of these injuries. When the EP is knowledgeable about these orthopedic pitfalls, these injuries are much less likely to slip by in clinical practice.
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Affiliation(s)
- Andrew D Perron
- Department of Emergency Medicine, University of Virginia Health System, Box 800699, Charlottesville, VA 22908, USA.
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Perron AD, Brady WJ, Keats TE, Hersh RE. Orthopedic pitfalls in the ED: lunate and perilunate injuries. Am J Emerg Med 2001; 19:157-62. [PMID: 11239263 DOI: 10.1053/ajem.2001.21306] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Occult dislocations at and around the lunate can accompany wrist trauma. When left unrecognized and untreated, these injuries lead to a high incidence of long-term functional disability and chronic pain. Emergency medicine practitioners need to be vigilant for both lunate and perilunate dislocations. This review article examines the clinical presentation, diagnostic techniques, and management options applicable to the emergency practitioner.
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Affiliation(s)
- A D Perron
- Department of Emergency Medicine, University of Virginia Health System, Charlottesville, VA, USA
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