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Marcuzzi A, Pederiva D, Pilla F, Canovi A, Corradini A, Adani R, Ruffilli A, Faldini C, Vita F. The use of resurfacing capitate pyrocarbon implants (RCPI) in chronic diseases of the wrist: outcomes of more than 100 cases. Musculoskelet Surg 2024; 108:367-371. [PMID: 38038900 DOI: 10.1007/s12306-023-00803-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/07/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION In advanced chronic post-traumatic wrist pathology, the goal of surgery has always been to reduce pain while trying to preserve the function of the wrist itself as much as possible; numerous interventions have been developed to achieve these goals (partial arthrodesis, 4-angle arthrodesis, the use of prosthetic implants…). PURPOSES The purpose of the study is to evaluate outcomes and complications rate of proximal row carpectomy associated with the resurfacing capitate pyrocarbon implant (RCPI) for chronic diseases of the wrist. MATERIALS AND METHODS A retrospective analysis of the patients operated on between June 2004 and March 2021 was performed. Pain, wrist range of motion in flexion, extension, radial and ulnar deviation and grip strength were compared preoperatively and at 1, 6, 12 and 24 months. Complications and additional procedures were recorded. RESULTS A total of 112 patients underwent surgery for proximal row carpectomy and placement of RCPI with a mean follow-up of 6.6 years. Between the preoperative and the 2-year follow-up, a reduction in pain (VAS from 7.3 to 0.5), an increase in grip strength (from 8 to 17 kg) and an increase in ROM in all planes (flexion from 19° to 44°, extension from 20° to 46°, radial deviation from 7° to 14° and ulnar deviation from 13° to 28°) were recorded. Ten (8.9%) patients required additional surgery, with only 2 (1.8%) patients requiring revision of the implant. CONCLUSIONS Proximal row carpectomy associated with RCPI is an excellent surgical strategy to relieve pain and to improve wrist range of motion and grip strength in patients with chronic diseases of the wrist.
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Affiliation(s)
- A Marcuzzi
- Hand and Microvascular Unit, Azienda Ospedaliera Policlinico di Modena, Modena, Italy
| | - D Pederiva
- Research Hospital Rizzoli Orthopedic Institute IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
| | - F Pilla
- Research Hospital Rizzoli Orthopedic Institute IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - A Canovi
- Orthopedics and Traumatology, Magati Hospital Scandiano, Scandiano, Italy
| | - A Corradini
- Orthopedics and Traumatology, Santa Maria Bianca Hospital, Mirandola, Italy
| | - R Adani
- Hand and Microvascular Unit, Azienda Ospedaliera Policlinico di Modena, Modena, Italy
| | - A Ruffilli
- Research Hospital Rizzoli Orthopedic Institute IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - C Faldini
- Research Hospital Rizzoli Orthopedic Institute IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - F Vita
- Research Hospital Rizzoli Orthopedic Institute IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
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Lin JS, Moran SL. Proximal row carpectomy or scaphoid excision and four-corner arthrodesis for treatment of scapholunate advanced collapse arthritis. J Hand Surg Eur Vol 2024:17531934241265838. [PMID: 39169776 DOI: 10.1177/17531934241265838] [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] [Indexed: 08/23/2024]
Abstract
Degenerative wrist conditions, such as scapholunate advanced collapse and scaphoid nonunion advanced collapse, often require salvage procedures to reduce pain and improve function. For early stages of disease, both proximal row carpectomy and scaphoid excision four-corner arthrodesis are viable motion-preserving options. There remains controversy on which technique is superior. Selection is a nuanced decision that requires consideration of patient characteristics and stage of disease. The traditional notion that proximal row carpectomy should be reserved for older individuals with low demands has been challenged; long-term studies in younger populations demonstrate similar patient-reported outcomes, pain relief and survivorship without conversion to total wrist arthrodesis between proximal row carpectomy and four-corner arthrodesis. The existing evidence suggests proximal row carpectomy has advantages of greater range of motion, fewer complications and lower costs. Advancements such as arthroscopic techniques for both procedures show potential, although mastery involves a steep learning curve.
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Affiliation(s)
- James S Lin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Steven L Moran
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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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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Gruisen JAE, Schormans PMJ, Punt IM, Roth AK, van Kuijk SMJ, Poeze M, Hannemann PFW. Patient reported and functional outcome measures after surgical salvage procedures for posttraumatic radiocarpal osteoarthritis - a systematic review. BMC Musculoskelet Disord 2024; 25:453. [PMID: 38849773 PMCID: PMC11157883 DOI: 10.1186/s12891-024-07527-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/15/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Posttraumatic wrist osteoarthritis is an irreversible and often progressive condition. Many surgical treatments, used in (daily) practice, aim to relieve symptoms like pain and restore function. The aim of this systematic review is to assess the patient reported and functional outcomes of the most common surgical interventions in patients with posttraumatic wrist osteoarthritis. This overview can help clinicians select the best treatment and manage patient's expectations. METHODS A literature search was performed in Pubmed, Embase and Cochrane for articles published between 1990 and November 2022 according to the PRISMA guidelines. The study protocol has been registered in the PROSPERO database (CRD42017080427). Studies that describe patient reported outcomes (pain and Disability of Arm, Shoulder and Hand (DASH) -score) and functional outcomes (range of motion (ROM) and grip strength) after surgical intervention with a minimal follow-up of 1 year were included. The identified surgical procedures included denervation, proximal row carpectomy, interpositional- and total arthroplasty, and midcarpal-, radiocarpal- and total arthrodesis. The pre-and postoperative outcomes were pooled and presented per salvage procedure. RESULTS Data from 50 studies was included. Pain score improved after all surgeries except denervation. Flexion/extension decreased after radiocarpal arthrodesis, did not show significant changes after proximal row carpectomy, and improved for all other surgeries. DASH score improved after arthroplasty, proximal row carpectomy and midcarpal arthrodesis. Grip strength improved after interposition arthroplasty and partial arthrodesis. CONCLUSION Evidence from this review did not support the indication for denervation in this particular patient population. In patients with SLAC/SNAC II, proximal row carpectomy might be favourable to a midcarpal arthrodesis solely based on better FE ROM of the radiocarpal joint after proximal row carpectomy. In terms of radiocarpal mobility, total wrist arthroplasty might be preferred to radiocarpal arthrodesis in patients with osteoarthritis after a distal radius fracture. More uniform measurements of outcomes would improve the understanding of the effect of surgical treatments of the posttraumatic osteoarthritic wrist.
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Affiliation(s)
- Jane A E Gruisen
- Department of Trauma and Orthopedic Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Philip M J Schormans
- Department of Surgery, Amphia Hospital Breda, Molengracht 21, 4818 CK Breda, The Netherlands.
| | - Ilona M Punt
- Department of Trauma and Orthopedic Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Alex K Roth
- Department of Trauma and Orthopedic Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Sander M J van Kuijk
- Department of Klinische Epidemiologie en Medical Technology Assessment, Maastricht University, P.Debyelaan 25, Maastricht, 6229 HX, The Netherlands
| | - Martijn Poeze
- Department of Trauma and Orthopedic Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Pascal F W Hannemann
- Department of Trauma and Orthopedic Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
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Almigdad A, Al-Zoubi A, Mustafa A, Al-Qasaimeh M, Azzam E, Mestarihi S, Khair Y, Almanasier G. A review of scaphoid fracture, treatment outcomes, and consequences. INTERNATIONAL ORTHOPAEDICS 2024; 48:529-536. [PMID: 37880341 DOI: 10.1007/s00264-023-06014-2] [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: 08/24/2023] [Accepted: 10/15/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE Scaphoid fractures are the most common carpal fracture and can lead to severe complications like carpal collapse and osteoarthritis. This study reviewed scaphoid fracture patterns, outcomes, and consequences in conservative and surgical management. METHODS Sixty-four patients with scaphoid fracture who attended the hand clinic at King Hussein Medical City from January 2022 to December 2022 were included and reviewed regarding the anatomical fracture site, the associated injury, the treatment modality (conservative versus surgical), the healing time, and fracture sequelae such as nonunion and scaphoid nonunion advanced collapse. RESULTS Most patients were males (62 patients, 96.9%), and most (47, 73.4%) fell within 25 to 40 years. Scaphoid waist fracture was the most common location (40, 52.5%). Most patients (47, 73.4%) received conservative treatment and 17 (26.6%) were fixed acutely. However, nonunion complicated 53 fractures (82.8%). Notably, there were no differences in the union rate or time between cases of scaphoid nonunion treated with vascularized or nonvascularized grafts. Furthermore, there were no variations in union rates among genders, extremities, age, fracture locations, or among smokers. However, a higher union rate was noted in office workers and those who received conservative treatment. CONCLUSION Nonunions were higher in our study than in the literature, as our department is a referral center for established nonunion cases. For conservative treatment, we recommend aggressive management and follow-up with a clinical and CT scan at three months and early referral of non-united fractures to the hand clinic to avoid the advanced collapse of the scaphoid.
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Affiliation(s)
- Ahmad Almigdad
- Department of Hand and Upper Limb Surgery, Department of Orthopedic, King Hussein Medical City, King Abdullah II St, Amman, 230, Jordan.
| | - Ahmad Al-Zoubi
- Department of Hand and Upper Limb Surgery, Department of Orthopedic, King Hussein Medical City, King Abdullah II St, Amman, 230, Jordan
| | - Ayman Mustafa
- Department of Hand and Upper Limb Surgery, Department of Orthopedic, King Hussein Medical City, King Abdullah II St, Amman, 230, Jordan
| | - Motaz Al-Qasaimeh
- Department of Hand and Upper Limb Surgery, Department of Orthopedic, King Hussein Medical City, King Abdullah II St, Amman, 230, Jordan
| | - Ehab Azzam
- Department of Hand and Upper Limb Surgery, Department of Orthopedic, King Hussein Medical City, King Abdullah II St, Amman, 230, Jordan
| | - Saab Mestarihi
- Department of Hand and Upper Limb Surgery, Department of Orthopedic, King Hussein Medical City, King Abdullah II St, Amman, 230, Jordan
| | - Yousef Khair
- Department of Hand and Upper Limb Surgery, Department of Orthopedic, King Hussein Medical City, King Abdullah II St, Amman, 230, Jordan
| | - Ghandi Almanasier
- Department of Hand and Upper Limb Surgery, Department of Orthopedic, King Hussein Medical City, King Abdullah II St, Amman, 230, Jordan
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Kopriva JM, Karzon AL, Cooke HL, Suh N, Gottschalk MB, Wagner ER. A Changing Landscape in the Surgical Management of Wrist Arthritis: An Analysis of National Trends From 2009 to 2019. J Hand Surg Am 2024; 49:83-90. [PMID: 38085190 DOI: 10.1016/j.jhsa.2023.11.009] [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: 05/09/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE The purpose of this study was to analyze the trends in the annual volume and incidence of proximal row carpectomy (PRC), four-corner fusion (4CF), total wrist arthrodesis (TWF), and total wrist arthroplasty (TWA) from 2009 to 2019 in the United States. METHODS The IBM Watson Health MarketScan databases were queried to identify annual case volumes for PRC, 4CF, TWF, and TWA from 2009 to 2019. The annual incidence of these procedures was then calculated based on the population estimates from the US Census Bureau. Trends in annual volume and incidence over the study period were evaluated using regression line analysis. Further subgroup analysis was conducted based on age and region. RESULTS From 2009 to 2019, the total case volumes for the four procedures increased by 3.4%, but the incidence decreased by 2.8%. However, PRC case volume and incidence trends significantly increased (38.2% and 29.7%, respectively), whereas 4CF remained constant. Conversely, the case volume and incidence of TWA significantly decreased (-52.2% and -54.5%, respectively), whereas TWF remained constant. When stratified by age, all four procedures decreased in the <45-year-old cohort (combined -35.1%) significantly for 4CF, TWF, and TWA. TWA decreased significantly in the <45-year-old and 45- to 65-year-old cohorts (53.6% and 63.2%, respectively). For age >65 years, the total case incidence increased by 98.9%, including a significant positive trend in TWF (175%). CONCLUSIONS Surgical management of wrist arthritis remains a controversial issue. However, PRC has gained recent support in the literature, and our results reflect this shift, even for the <45-year-old cohort. Furthermore, TWA declined, despite reports of positive early outcomes for fourth-generation implants. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
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Affiliation(s)
- John M Kopriva
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA
| | - Anthony L Karzon
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA
| | - Hayden L Cooke
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA
| | - Nina Suh
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA
| | | | - Eric R Wagner
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA.
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Cobb T, Chase C, Cobb J. Arthroscopic Resection Arthroplasty for Scapholunate Advanced Collapse Wrist. J Wrist Surg 2023; 12:528-533. [PMID: 38213559 PMCID: PMC10781571 DOI: 10.1055/s-0043-1768927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 04/03/2023] [Indexed: 01/13/2024]
Abstract
Purpose Scapholunate advanced collapse (SLAC) wrist results from an untreated scapholunate dissociation and is the most common type of degenerative arthritis of the wrist. The most common surgical treatments for SLAC wrist are proximal row carpectomy and four-corner fusion with scaphoid excision. Arthroscopic surgical treatment for SLAC wrist has been reported; however, only limited data on functional outcomes are available. The purpose of this study is to report our 5-year follow-up clinical outcomes for arthroscopic treatment for SLAC wrist. Methods Thirty-one consecutive cases of arthroscopic resection arthroplasty for SLAC wrist were reviewed. Preoperative and postoperative Disabilities of the Arm, Shoulder, and Hand (DASH) scores, range of motion, grip strength, and pain (on 0-10 scale) as well as postoperative satisfaction (0 = not satisfied, 5 = completely satisfied) were recorded. Grip and range of motion were measured by an occupational therapist. Results The preoperative pain score was 7 and 0.18 postoperatively. The mean satisfaction at final follow-up was 4.8. Preoperative and final follow-up scores of the mean DASH was 48 and 3, respectively. The total arc of motion was 114 degrees preoperatively and 126.5 degrees postoperatively. Mean grip strength before surgery was 41 and 49 kg at final follow-up. Conclusion Arthroscopic resection arthroplasty for SLAC wrist results in significant improvement in patient function as measured by DASH and pain scores. Type of Study/Level of Evidence Therapeutic IV.
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Affiliation(s)
- Tyson Cobb
- Shoulder, Elbow, Wrist, and Hand Center of Excellence, Davenport, Iowa
| | - Collin Chase
- Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Jessica Cobb
- Morsani College of Medicine, University of South Florida, Tampa, Florida
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Laudermilch D, Morales-Restrepo A, Bhogal S, Kaufmann RA. Parallel K-Wire Placement Leads to Fusion and Midcarpal Settling in Scaphoid Excision Four-Corner Fusion. Hand (N Y) 2023; 18:589-597. [PMID: 34933586 PMCID: PMC10233651 DOI: 10.1177/15589447211057302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Scaphoid excision 4-corner fusion is a motion-sparing procedure in patients with advanced radioscaphoid arthritis. This study introduces an alternate technique for scaphoid excision 4-corner fusion using a parallel Kirschner wire (K-wire) construct across the midcarpal joints that leads to reliable fusion rates, and good patient outcomes. METHODS This is a single-surgeon, retrospective study of patients who underwent scaphoid excision 4-corner fusion, using a parallel K-wire construct across the midcarpal joints. Once fusion was achieved, K-wires were removed. Radiographic union rate, time to union, capitolunate angle, capitolunate coverage, and amount of midcarpal settling are measured. Patient-reported outcome measures and descriptive statistics are presented. RESULTS Sixty-five wrists were included in this study with a mean age of 50.1 years. One patient was lost to follow-up. All 64 wrists (100%) fused at an average of 2.6 months. The mean capitolunate angle was 7°, and capitolunate coverage was 99.2%. Fifty-two patients (81%) had adequate radiographs for measurement. Average midcarpal settling was 1.1 mm. Thirty-two patients (51%) were available for long-term follow-up at an average of 5.3 years (0.7-10.2 years), and participated in patient reported outcomes (PRO) surveys. The mean Quick Disabilities of the Arm, Shoulder, and Hand score was 16.6, and numeric pain rating scale score was 1.8. CONCLUSIONS Parallel K-wire placement across the midcarpal joints with scaphoid leads to a high rate of fusion with good patient outcomes long term. Midcarpal settling that occurs through dynamic compression around the K-wires may have contributed to bony fusion. This technique may provide an alternative approach to achieving reliable fusion across the midcarpal joints.
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Mirza A, Mirza JB, Zappia LC, Thomas TL, Corabi J, Dusckas Z, Lubahn JD. Clinical Outcomes of Lunocapitate Arthrodesis: A Retrograde Single-Screw Approach. Hand (N Y) 2023:15589447231174041. [PMID: 37243476 DOI: 10.1177/15589447231174041] [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] [Indexed: 05/28/2023]
Abstract
BACKGROUND A single-site retrospective study was designed to evaluate the clinical outcomes of single-screw lunocapitate arthrodesis (LCA) using a retrograde approach for the treatment of scapholunate advanced collapse (SLAC) wrist. METHODS We retrospectively identified 31 patients (33 cases) between September 2010 and December 2019 with SLAC wrist changes who were treated with single-screw LCA. Objective outcomes included time to fusion, union rate, range of motion, and grip and pinch strength recovery. Subjective outcomes included Disabilities of the Arm, Shoulder, and Hand (DASH) scores. RESULTS We report on 33 cases (7 female), mean age 58.4 years (range: 41-85), with SLAC wrist who underwent LCA. Our cohort reported a 94% union rate and a 90-day mean time to fusion. Final active wrist range of motion was 38° dorsiflexion, 35° volarflexion, 17° radial deviation, 17° ulnar deviation, 82° pronation, and 83° supination (mean: 450.8 days). Final grip and pinch strengths recovered was 75% gross grip, 84% lateral pinch, and 75% precision pinch (mean: 379.0 days) compared with the contralateral side. The mean postoperative DASH score was 27 (mean: 1203.9 days). Two nonunions were observed. Two hardware complications occurred: one symptomatic screw and one screw fatigue fracture. CONCLUSIONS We found retrograde single-screw LCA to be an effective salvage procedure for SLAC wrist. LCA is a less-taxing procedure, requires shorter operating time, and produces range of motion and grip and pinch strength recovery comparable to those of 4-corner arthrodesis. Furthermore, the viability of single-screw fixation may reduce hardware-related operative costs without compromising union rates.
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Affiliation(s)
- Ather Mirza
- North Shore Surgi-Center, Smithtown, NY, USA
- Mirza Orthopedics, Smithtown, NY, USA
| | - Justin B Mirza
- North Shore Surgi-Center, Smithtown, NY, USA
- Mirza Orthopedics, Smithtown, NY, USA
| | - Luke C Zappia
- Mirza Orthopedics, Smithtown, NY, USA
- New York Institute of Technology, Old Westbury, USA
| | | | | | - Zachary Dusckas
- University of Pittsburgh Medical Center Hamot, Erie, PA, USA
| | - John D Lubahn
- University of Pittsburgh Medical Center Hamot, Erie, PA, USA
- Hand, Microsurgery & Reconstructive Orthopaedics, LLP, Erie, PA, USA
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Reyniers P, van Beek N, De Schrijver F, Goeminne S, Reyniers P. Proximal row carpectomy versus four-corner arthrodesis in the treatment of SLAC and SNAC wrist: meta-analysis and literature review. HAND SURGERY & REHABILITATION 2023; 42:194-202. [PMID: 37031919 DOI: 10.1016/j.hansur.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 04/11/2023]
Abstract
A systematic literature review was performed on 84 articles from 2000 to 2020 on proximal row carpectomy (PRC) or four-corner arthrodesis (FCA) in patients with posttraumatic wrist osteoarthritis. Qualitative assessment was conducted on 14 articles. Pain, range of motion (ROM), grip strength and complications were analyzed using weighted average means. Meta-analysis with a random effects model was performed for the flexion-extension arc and grip strength. A total of 1,066 PRCs and 2,771 FCAs were analyzed, with a mean follow-up of 9 and 7 years respectively. Mean flexion after PRC and FCA respectively was 36.2 ° and 31.1 °, mean extension 41.4 ° and 32.4 °, and mean grip strength 26.4 kg and 27.5 kg. PRC had a larger flexion-extension arc than FCA, with a standard mean difference (SMD) of 0.41 (range, 0.02-0.81). No significant difference was found for grip strength. Osteoarthritis occurred in 42.2% of PRC cases, independently of capitate shape. Conversion to wrist arthrodesis was performed in 10.1% of failed PRCs. Revision was chosen in 4.7% of FCAs and conversion to wrist arthrodesis in 4.6%. We conclude that the functional results of both techniques are similar, but prefer PRC to FCA because of the lower complications rate.
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Affiliation(s)
- P Reyniers
- AZ Herentals, Nederrij 133, 2200 Herentals, Netherlands
| | - N van Beek
- AZ Herentals, Nederrij 133, 2200 Herentals, Netherlands
| | | | - S Goeminne
- AZ Herentals, Nederrij 133, 2200 Herentals, Netherlands
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Risk of Total Wrist Arthrodesis Following Proximal Row Carpectomy: An Analysis of 1,070 Patients. J Hand Surg Am 2023; 48:195.e1-195.e10. [PMID: 34857405 DOI: 10.1016/j.jhsa.2021.09.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 07/23/2021] [Accepted: 09/22/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Proximal row carpectomy (PRC) is a motion-sparing procedure with good patient-reported and clinical outcomes. Although some studies have investigated the risk of conversion to total wrist arthrodesis (TWA) after PRC, additional larger studies evaluating the specific risk factors that lead to failure are required. This study aimed to investigate the patient and procedure factors that are associated with increased risk for conversion to TWA in a large cohort of patients who underwent PRC. METHODS The current procedural technology codes identified patients in a National Veteran's Health database undergoing a PRC over a 26-year period. Risk factors of interest comprised age, posterior interosseous nerve neurectomy, wrist arthritis pattern, bilateral surgery, smoking, comorbidities, and preoperative opioid use. The primary outcome was the rate of conversion to TWA. Cox proportional hazard regression was used to create hazard ratios of selected factors for reoperation. RESULTS There were 1,070 PRCs performed, with a mean follow-up of 79.8 ± 59.6 months. A total of 5.3% (57/1,070) wrists underwent conversion to TWA. Younger age at the time of PRC (<50 years) significantly increased the risk of TWA (hazard ratio, 3.8; 95% confidence interval, 2.2-6.6). With every 1-year increase in age, there was a reduction of 4% (hazard ratio, 0.96; 95% confidence interval: 0.94-0.98) in the hazard of conversion to TWA. No other factors, including concomitant posterior interosseous nerve neurectomy or bilateral PRC, increased the risk of conversion to TWA. CONCLUSIONS Proximal row carpectomy is a motion-preserving salvage procedure with a low rate of conversion to wrist arthrodesis. Younger patient age increases the risk of conversion to arthrodesis, whereas posterior interosseous nerve neurectomy, bilateral PRCs, and comorbidity status do not appear to have an impact on the risk of arthrodesis. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Athlani L, Cholley-Roulleau M, Blum A, Teixeira PAG, Dap F. Intercarpal arthrodesis: A systematic review. HAND SURGERY & REHABILITATION 2023; 42:93-102. [PMID: 36642245 DOI: 10.1016/j.hansur.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/24/2022] [Accepted: 12/18/2022] [Indexed: 01/15/2023]
Abstract
Intercarpal arthrodesis is a well-established option to treat various disorders of the carpus, such as localized osteoarthritis, carpal instability, and Kienböck's disease. This is a non-conservative procedure aimed at obtaining a stable and congruent interface between the radius and the proximal carpal row, which restores wrist function by minimizing pain and restoring grip strength. These procedures generally yield good predictable results that are maintained over time. However, all intracarpal arthrodesis procedures cause a loss of wrist range of motion. To optimize outcomes and minimize complications, especially nonunion, this surgery may require a learning curve. A precise surgical technique for preparing the bone surfaces, bringing enough bone graft, and using reliable fixation is essential. Since the late 1960s, several intracarpal arthrodesis procedures have been described. Commonly used fusions target the scaphotrapeziotrapezoid, scaphocapitate, four corners, capitolunate or capitohamatolunate regions. Lesser used fusions focus on specific lesions such as the scapholunate, scapholunocapitate, lunotriquetral and triquetrohamate. Here, we propose a systematic review of the various types of intercarpal arthrodesis procedures described in the literature. After having described each arthrodesis, we specify their indications, the variations of the surgical techniques, and then present an overview of the results and complications. Finally, we discuss how these surgeries affect wrist biomechanics. LEVEL OF EVIDENCE: III.
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Affiliation(s)
- Lionel Athlani
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, Nancy University Hospital, 49 rue Hermite, 54000 Nancy, France; Université de Lorraine, IADI Laboratory, INSERM, CIC-IT Nancy, Nancy, France.
| | - M Cholley-Roulleau
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, Nancy University Hospital, 49 rue Hermite, 54000 Nancy, France.
| | - A Blum
- Guilloz Imaging Department, Central Hospital, Nancy University Hospital, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France.
| | - P A Gondim Teixeira
- Guilloz Imaging Department, Central Hospital, Nancy University Hospital, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France; Université de Lorraine, IADI Laboratory, INSERM, CIC-IT Nancy, Nancy, France.
| | - F Dap
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, Nancy University Hospital, 49 rue Hermite, 54000 Nancy, France.
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Total arthrodesis for non-rheumatoid wrists: Outcomes at 5 and 20years of follow-up. Orthop Traumatol Surg Res 2022; 109:103522. [PMID: 36539032 DOI: 10.1016/j.otsr.2022.103522] [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: 01/07/2022] [Revised: 05/16/2022] [Accepted: 07/18/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Total wrist arthrodesis (TWA) aims to obtain a painless wrist with a strong grip. Its main disadvantage is compromised mobility and for many authors it remains a rescue intervention. However, after one or more palliative interventions, TWA confers poorer results. The objective of our study was to evaluate the medium-term results of TWA, and their long-term stability. HYPOTHESIS Our hypothesis was that the results are reliable and persistent for pain and strength, without repercussions to other joints. MATERIAL AND METHODS This was a single-center consecutive series of TWA performed with a dedicated plate, excluding rheumatoid wrists, evaluated at 5.4 and 21.1years of follow-up. RESULTS Thirty wrists were assessed at the first review and 17 reassessed at the last follow-up. At the mean follow-up of 5.4years, 93% of patients considered themselves "very satisfied" or "satisfied" with the TWA surgery. No infectious complications occurred. At the mean follow-up of 21.1years, all were "very satisfied" or "satisfied" and 88% of them considered their result stable or improved compared to the first revision. The average VAS had gone from 8.4/10 preoperatively to 1.8/10 at the first evaluation and to 0.3/10 at the last follow-up. Except for a patient with both wrists operated on for whom comparison was not possible, the strength of the operated side was on average 89.7% of that of the contralateral side (from 45% to 150%). The mean Quick DASH score was 30.3 (4.5 to 61.4) and the mean PRWE score was 32.5 (1 to 77). DISCUSSION TWA using a plate provides excellent results for both pain control and strength restoration. The clinical results remain stable over time, and arthrodesis at more than 20years of follow-up does not seem to have any impact on the other joints of the upper limb. After wrist surgery, the main complaint of patients is the limited range of motion, but the main cause of dissatisfaction is persistent pain. Arthrodesis can be performed first-line in case of questionable indication of partial arthrodesis on a stiff wrist because the results of TWA are better in the absence of a surgical history. LEVEL OF EVIDENCE IV; retrospective study.
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Chammas PE, Hadouiri N, Chammas M, Ramos-Pascual S, Stirling P, Nover L, Klouche S. Proximal row carpectomy generates better mid- to long-term outcomes than four-corner arthrodesis for post-traumatic wrist arthritis: A meta-analysis. Orthop Traumatol Surg Res 2022; 108:103373. [PMID: 35940440 DOI: 10.1016/j.otsr.2022.103373] [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: 01/09/2022] [Revised: 04/04/2022] [Accepted: 04/25/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION In posttraumatic wrist arthritis of intermediate severity, two main palliative procedures are used to preserve some mobility in the wrist: proximal row carpectomy (PRC) and scaphoid excision followed by four corner arthrodesis (4CA). Despite satisfactory overall results, the debate continues about which one provides the best results and long-term outcomes, particularly prevention of arthritis progression. Recent comparative studies now provide us with information about mid- and long-term results. The aim of this study was to compare the clinical results, complications, conversion rate to total wrist arthrodesis and progression to osteoarthritis of PRC versus 4CA in the medium and long term. HYPOTHESIS The null hypothesis was that there is no significant difference between PRC and 4CA in the clinical results, complications, conversion to total wrist arthrodesis and arthritis progression. MATERIALS AND METHODS A systematic literature review was carried out by following the PRISMA guidelines. Included were studies comparing 4CA and PRC for the treatment of post-traumatic wrist arthritis secondary to scapholunate dissociation (SLAC) and scaphoid nonunion (SNAC) with a mean follow-up of 5 years. A search was performed of the MEDLINE, EMBASE and Cochrane databases that identified 831 articles. After removing 230 duplicates and excluding 595 articles based on their title and/or abstract, and then adding 1 article manually, 7 articles were included in our analysis. Parameters analyzed were range of motion (ROM), pain, grip strength, functional scores, complications, conversion to total wrist arthrodesis, and arthritis progression. RESULTS In the 7 articles, 1059 wrists - 582 PRC and 477 4CA - were analyzed with follow-up ranging from 5.2 to 18 years. PRC produced significantly better ROM in flexion (weighted mean difference [WMD]=10.0°; p<0.01) and in ulnar deviation (WMD=8.7°; p<0.01) along with significantly lower complication rates (OR=0.3; p<0.01) and reoperation rates (OR=0.1; p<0.01). There was no significant difference in the conversion rate, grip strength, extension, radial deviation, pain, DASH and PRWE scores. The progression of osteoarthritis could not be analyzed due to lack of data. DISCUSSION This meta-analysis was the first to include recently published mid- and long-term studies comparing PRC and 4CA. The main finding is that PRC is superior overall with better ROM and a lower complication rate. Another important finding was the absence of differences in grip strength and the conversion rate to total wrist arthrodesis. Unfortunately, the lack of systematic studies on arthritis progression leaves this question unanswered. Our findings must be interpreted cautiously because it was impossible to stratify the cases by etiology and osteoarthritis stage. LEVEL OF EVIDENCE III; systematic review and meta-analysis.
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Affiliation(s)
- Pierre-Emmanuel Chammas
- Hand and Upper Extremity Surgery Unit, Lapeyronie Hospital, Montpellier University Medical Center, Av. du Doyen Gaston Giraud 371, 34295 Montpellier, France; Collège des Jeunes Orthopédistes, Rue Boissonade 56, 75014 Paris, France.
| | - Nawale Hadouiri
- Department of Physical Medicine and Rehabilitation, Dijon-Bourgogne University Hospital, Boulevard du Maréchal de Lattre de Tassigny 2, 21000 Dijon, France; InterSyndicale Nationale des Internes, Rue du Fer À Moulin 17, 75005 Paris, France
| | - Michel Chammas
- Hand and Upper Extremity Surgery Unit, Lapeyronie Hospital, Montpellier University Medical Center, Av. du Doyen Gaston Giraud 371, 34295 Montpellier, France
| | | | | | - Luca Nover
- ReSurg SA, Rue Saint Jean 22, 1260 Nyon, Switzerland
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Ahmad F, Ayala S, Smith S, Fernandez JJ, Cohen MS, Simcock XC, Wysocki RW. Relationship Between Preoperative and Postoperative Motion After Four-Corner Wrist Fusion for Osteoarthritis: Clustering and Regression Analyses. J Hand Surg Am 2022; 47:874-880. [PMID: 36058565 DOI: 10.1016/j.jhsa.2022.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 04/26/2022] [Accepted: 06/13/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Four-corner fusion (4CF) is a surgical option for refractory scapholunate advanced collapse and scaphoid nonunion advanced collapse wrist arthritis. Preoperative range of motion (ROM) predicts outcomes in many orthopedic procedures. This study investigates ROM in a cohort of 4CF patients to examine the relationship between preoperative and postoperative motion and identifies different clinical patterns. METHODS We performed a retrospective review of 4CF patients. Patients with a history of inflammatory arthritis and radiographic characteristics of inflammation were excluded. Demographics, prior wrist surgery history, and ROM data were collected at preoperative and postoperative intervals after cast removal at 8 weeks, 3 months, and 8 months. Regression analysis compared the motion before and after 4CF. Subsequent cluster analysis to reduce confounding compared postoperative motion differences in the top 20% to the bottom 20% of patients by preoperative motion. RESULTS We included 148 patients; 27 had prior surgery on the ipsilateral wrist. Preoperative arc averaged 86° ± 28° (flexion 46° ± 17°, extension 40° ± 15°); 8-week arc 43° ± 19° (flexion 19° ± 12°, extension 24° ± 12°); 3-month arc 62° ± 17° (flexion 30° ± 12°, extension 32° ± 11°); and 8-month arc 74° ± 17° (flexion 36° ± 11°, extension 37° ± 12°). Preoperative and final arcs were (r = 0.39). Clustering by the preoperative arc, the top 20% (mean 124° ± 15°) achieved a mean final arc of 81° ± 16°, while the bottom 20% (mean 47° ± 16°) achieved a mean final arc of 65° ± 19°. Intercluster differences were statistically significant. The bottom 20% gained motion postoperatively. Most patients in the middle 60% did not differ significantly in postoperative motion. CONCLUSIONS Although wrist motion following 4CF correlates positively with preoperative motion, most patients do not differ significantly in postoperative motion. Patients with substantial preoperative motion deficits gain motion after 4CF. This information is important when counseling patients, determining the timing of surgical intervention, and managing expectations related to motion outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Abstract
To report the clinical and radiological outcomes of arthroscopic bone grafting and percutaneous K-wire fixation without radial styloidectomy in patients with scaphoid nonunion advanced collapse (SNAC). We retrospectively analyzed the records of 15 patients with SNAC who were treated with arthroscopic bone grafting and percutaneous K-wire fixation and subsequently followed up for a minimum of 1 year between November 2009 and March 2018. The clinical outcomes were evaluated by comparing the range of motion (ROM), grip strength, the modified Mayo Wrist Score, and visual analog scale (VAS) scores for pain, all of which were measured preoperatively and at the last follow-up. The radiologic outcomes were evaluated by comparing the scapholunate (SL) and radiolunate (RL) angles preoperatively and at the last follow-up. All 15 cases of nonunion were resolved. The average radiologic union time was 9.7 ± 1.2 weeks. The average VAS score increased from 5.7 ± 2.3 (range, 2 - 10) preoperatively to 1.3 ± 1.3 (range, 0 - 3) at the last follow-up (P < .05). The average modified Mayo wrist score increased from 58.3 ± 14.0 preoperatively to 80.0 ± 9.2 at the last follow-up (P < .05). The mean ROM of the wrist improved, but there was no statistical significance. At the last follow-up, the mean flexion and radial deviation on the affected side were significantly decreased, and the mean extension on the affected side was significantly improved compared to the normal side (P < .05). The mean preoperative SL and RL angles were 66 ± 11.9° and 7.2 ± 6.8°, respectively, and were decreased to 50.4 ± 7.5° and 6.4 ± 5.2°, respectively, at the last follow-up. The mean SL angle was significantly corrected (P = .01). Arthroscopic bone grafting and percutaneous Kerschner (K)-wire fixation without radial styloidectomy are considered to be very effective methods for correcting scaphoid deformities to treat SNAC stage I. However, caution may be needed during the surgery to prevent reductions in flexion and the radial deviation of the wrist.
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Affiliation(s)
- Young-Keun Lee
- Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Jeonbuk, Republic of Korea
- *Correspondence: Young Keun Lee MD, PhD, Department of Orthopedic Surgery, Jeonbuk National University Medical School, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeollabuk-do 54896, Republic of Korea (e-mail: )
| | - Young-Ran Jung
- Department of Orthopedic Surgery, Soo Sarang General Hospital, Iksan, Jeonbuk
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Dittman LE, Kakar S. CMC Mimickers: Differential Diagnosis and Work-Up for Radial-Sided Wrist Pain. Hand Clin 2022; 38:149-160. [PMID: 35465933 DOI: 10.1016/j.hcl.2022.01.001] [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] [Indexed: 02/02/2023]
Abstract
In patients with radial-sided wrist pain, a myriad of possible etiologies exists and as such, a detailed history, examination, and, where indicated, imaging is obtained to try and aid with its diagnosis. The purpose of this article is to provide an overview of radial-sided wrist pain, diagnostic modalities and discuss current treatment options. More detailed information is out-of-scope for this article and if needed, we would guide the reader to seek out other selected texts, as indicated.
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Affiliation(s)
| | - Sanjeev Kakar
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Saltzman EB, Wahl EP, Fletcher AN, Said N, Mithani SK, Klifto CS. A Reliability Study of Multiplanar Radiographs for the Evaluation of SNAC Wrist Arthritis. Hand (N Y) 2022; 17:465-470. [PMID: 32674623 PMCID: PMC9112731 DOI: 10.1177/1558944720937359] [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] [Indexed: 11/16/2022]
Abstract
Background: Scaphoid nonunion advanced collapse (SNAC) is a common form of wrist arthritis, the treatment of which depends on the arthritic stage. The Vender classification serves to describe SNAC arthritis based on a single posteroanterior (PA) radiograph. The purpose of this study was to evaluate the intraobserver and interobserver agreement of the Vender classification, comparing multi versus single radiographic views. Methods: A retrospective review of patients with SNAC arthritis who underwent a proximal row carpectomy or a 4-corner fusion was performed. The included patients had 3 radiographic views of the pathologic wrist. Fifteen patients were analyzed by 5 blinded reviewers. Wrists were graded using the Vender classification first on the PA view and then using multiview radiographs. The intraobserver and interobserver agreement was determined using weighted kappa analysis. χ2 tests were calculated comparing the evaluation between single- versus multiview radiographs and determining a higher Vender stage. Results: Multiview radiographs demonstrated a higher intraobserver κw compared with single-view radiographs (0.72 vs 0.66), both representing substantial agreement. The average interobserver agreement was moderate (κw of 0.48) for single view and slight (κw of 0.30) for multiview evaluation. Evaluating multiview radiographs was 6.37 times more likely to demonstrate Vender stage 3 arthritis compared with single view (odds ratio = 6.37 [confidence interval, 3.81-10.64], P < .0001). Conclusion: Reviewing multiview radiographs more commonly yielded Vender stage 3 osteoarthritis classification. The decreased interrater reliability in the multiview analysis is likely related to the increased number of articular surfaces evaluated. Using a single PA view may underestimate the severity of arthritis present.
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Affiliation(s)
- Eliana B. Saltzman
- Duke University Medical Center, Durham, NC, USA,Eliana B. Saltzman, Department of Orthopaedic Surgery, Duke University Medical Center, Box 3000, Durham, NC 27710, USA.
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Li NY, Kuczmarski AS, Hresko AM, Goodman AD, Gil JA, Daniels AH. Four-Corner Arthrodesis versus Proximal Row Carpectomy: Risk Factors and Complications Associated with Prolonged Postoperative Opioid Use. J Hand Microsurg 2022; 14:163-169. [PMID: 35983285 PMCID: PMC9381174 DOI: 10.1055/s-0040-1715426] [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: 10/23/2022] Open
Abstract
Introduction This article compares opioid use patterns following four-corner arthrodesis (FCA) and proximal row carpectomy (PRC) and identifies risk factors and complications associated with prolonged opioid consumption. Materials and Methods The PearlDiver Research Program was used to identify patients undergoing primary FCA (Current Procedural Terminology [CPT] codes 25820, 25825) or PRC (CPT 25215) from 2007 to 2017. Patient demographics, comorbidities, perioperative opioid use, and postoperative complications were assessed. Opioids were identified through generic drug codes while complications were defined by International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification codes. Multivariable logistic regressions were performed with p < 0.05 considered statistically significant. Results A total of 888 patients underwent FCA and 835 underwent PRC. Three months postoperatively, more FCA patients (18.0%) continued to use opioids than PRC patients (14.7%) ( p = 0.033). Preoperative opioid use was the strongest risk factor for prolonged opioid use for both FCA (odds ratio [OR]: 4.91; p < 0.001) and PRC (OR: 6.33; p < 0.001). Prolonged opioid use was associated with an increased risk of implant complications (OR: 4.96; p < 0.001) and conversion to total wrist arthrodesis (OR: 3.55; p < 0.001) following FCA. Conclusion Prolonged postoperative opioid use is more frequent in patients undergoing FCA than PRC. Understanding the prevalence, risk factors, and complications associated with prolonged postoperative opioid use after these procedures may help physicians counsel patients and implement opioid minimization strategies preoperatively.
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Affiliation(s)
- Neill Y. Li
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Alexander S. Kuczmarski
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Andrew M. Hresko
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Avi D. Goodman
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Joseph A. Gil
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Alan H. Daniels
- Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, Rhode Island, United States
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Mevel G, De Geyer A, Kim W, Ebalard M, Ropars M, Dreano T. Four-corner arthrodesis using the 4Fusion® quadripodal shape memory staple: a long-term review. J Hand Surg Eur Vol 2022; 47:387-392. [PMID: 34851782 DOI: 10.1177/17531934211063614] [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] [Indexed: 02/03/2023]
Abstract
We investigated the reliability of the 4Fusion® quadripodal memory staple in a consecutive series of 59 four-corner arthrodeses in a single centre. Forty-one patients (46 wrists) had a radiological and clinical assessment at a mean follow-up of 7.4 years. Thirteen patients (13 wrists) were lost to follow-up. Bone union was achieved in all but one patient. Seven patients were reoperated, six for device removal and one for nonunion. Most patients were satisfied, had a functional range of wrist mobility, good strength and were free of pain, comparable with the best previously reported series.Level of evidence: IV.
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Affiliation(s)
- Gwenaël Mevel
- Service de chirurgie orthopédique et traumatologie, CHU Pontchaillou, Rennes, France
- Université de Rennes-1 UFR Médecine, Rennes, France
| | - Aymeric De Geyer
- Service de chirurgie orthopédique et traumatologie, CHU Pontchaillou, Rennes, France
- Université de Rennes-1 UFR Médecine, Rennes, France
| | - Warren Kim
- Service de chirurgie orthopédique et traumatologie, CHU Pontchaillou, Rennes, France
| | - Maud Ebalard
- Service de chirurgie orthopédique et traumatologie, CHU Pontchaillou, Rennes, France
| | - Mickaël Ropars
- Service de chirurgie orthopédique et traumatologie, CHU Pontchaillou, Rennes, France
- Université de Rennes-1 UFR Médecine, Rennes, France
| | - Thierry Dreano
- Service de chirurgie orthopédique et traumatologie, CHU Pontchaillou, Rennes, France
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Moran TE, Akinleye SD, Demers AJ, Forster GL, DeGeorge BR. Opioid Prescribing for Proximal Row Carpectomy versus Four-Corner Arthrodesis. J Wrist Surg 2022; 11:54-61. [PMID: 35127265 PMCID: PMC8807101 DOI: 10.1055/s-0041-1731821] [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: 04/24/2021] [Accepted: 06/01/2021] [Indexed: 10/20/2022]
Abstract
Background Proximal row carpectomy (PRC) and four-corner arthrodesis (4-CA) represent motion-sparing procedures for addressing degenerative wrist pathologies. While both procedures demonstrate comparable functional outcomes, postoperative pain presents a surgical challenge that often necessitates the use of opioids. Objectives The aim of this study was to (1) compare opioid prescribing patterns surrounding PRC and 4-CA, (2) identify risk factors predisposing patients to increased perioperative and prolonged postoperative opioids, and (3) examine the association between opioids and perioperative health care utilization. Patients and Methods PearlDiver Patients Records Database was used to retrospectively identify patients undergoing primary PRC and 4-CA between 2010 and 2018. Patient demographics, comorbidities, prescription drug usage, and perioperative health care utilization were evaluated. Perioperative opioid prescriptions and post-operative opioid prescriptions were recorded. Logistic regression analysis evaluated the association of patient risk factors. Results There was no significant difference in perioperative (PRC [odds ratio {OR}: 0.84, p = 0.788]; 4-CA [OR: 0.75, p = 0.658]) or prolonged postoperative opioid prescriptions (PRC [OR: 0.95, p = 0.927]; 4-CA [OR: 0.99, p = 0.990]) between PRC and 4-CA. Chronic back pain and use of benzodiazepines or anticonvulsants were associated with increased risks of prolonged postoperative opioids. Prolonged postoperative opioids presented increased risks of emergency department visits (OR: 2.09, p = 0.019) and hospital readmissions (OR: 10.2, p = 0.003). Conclusion No significant differences exist in the prescription of opioids for PRC versus 4-CA. Both procedures have high amounts of prolonged postoperative opioid use, which is associated with increased risks of emergency department visits and hospital readmissions. Level of Evidence This is a level III, retrospective comparative study.
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Affiliation(s)
- Thomas E. Moran
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Sheriff D. Akinleye
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Alex J. Demers
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Grace L. Forster
- Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia
| | - Brent R. DeGeorge
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
- Department of Plastic Surgery, University of Virginia, Charlottesville, Virginia
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22
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Oluyede DO, Werner FW, Esper G, Schreck M. Biomechanical Comparison of Dart-Throw Motions after Partial Wrist Fusions. J Wrist Surg 2022; 11:69-75. [PMID: 35127267 PMCID: PMC8807096 DOI: 10.1055/s-0041-1732412] [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: 02/16/2021] [Accepted: 06/15/2021] [Indexed: 10/20/2022]
Abstract
Background Multiple partial wrist fusions exist for the management of arthritic disease. Limited information is available on their effect on wrist range of motion in the dart-throwing direction of wrist motion, even though it is used in most activities of daily living. Purpose The purpose of this study was to measure the retained motion for different orientations of dart-throwing motion for seven different partial wrist fusions and proximal row carpectomy (PRC). Methods Eight fresh frozen right cadavers were tested with the wrist intact and followed simulated fusions. Fusions were performed using an external fixation technique and included scaphocapitate, scapholunate (SL), capitolunate, radiolunate, radioscapholunate, scaphotrapeziotrapezoid, 4 corner fusion, and PRC. Results In the intact wrist, the average arc of wrist motion with the wrist oriented at 20 degrees away from the flexion-extension axis was significantly larger than at any other orientation of motion. All partial wrist fusions and the PRC had significantly smaller average dart-throw arc of motion compared with intact at an orientation 20 and 25 degrees away from flexion-extension. The SL fusion provided a significantly larger arc of motion than most of the other fusions at most orientations. Conclusion/Clinical Relevance This study provides a comprehensive compilation of the range of motion in a functional plane, "the dart-throw motion," for limited wrist fusions and PRC. These data provide the clinician with important information that can be used to educate patients regarding expectations after surgery.
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Affiliation(s)
- Dami O. Oluyede
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York
| | - Frederick W. Werner
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York
| | - Garrett Esper
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York
| | - Michael Schreck
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York
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23
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Melibosky FR, Jorquera RA, Saxton FZ, Orellana P, Junqueras D, Azócar C. Four-Corner Fusion with Locking Dorsal Circular Plate versus Headless Compression Screws: A Clinico-Radiological Comparative Study. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2021. [DOI: 10.1055/s-0041-1739239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Introduction Four-corner fusion is a technique for the treatment of carpal advanced collapse. It consists of scaphoid excision and arthrodesis of the lunate, triquetrum, hamate, and capitate bones. This can be accomplished with different kinds of osteosynthesis. In the first reports of the use of a circular plate, poor outcomes are described, with high rates of non-union, which decreased in later studies, which highlight certain aspects of the surgical technique.
Objective To report our experience with four-corner fusion with the use of a dorsal locking plate (Xpode, Trimed Inc., Santa Clarita, CA, US), and compare it with another traditional fixation method (3.0-mm headless compression screws [HCSs], Synthes, Slothurn, Switzerland), with an emphasis on union, an assessment of the fincitonal outcomes, and the presence of complications.
Material and Methods A comparative study of two prospective series of patients operated on through two fixation techniques for four-corner fusion using autologous bone graft from the iliac crest.The first group of patients, evaluated between 2010 and 2012, underwent osteosynthesis with 2 HCSs, with a minimum follow up of 18 months. The second group, evaluated between 2011 and 2014, underwent osteosynthesis with a dorsal locking plate, with a minimium foloow up of 12 months. The patients were operated on by four different surgeons in four centers.The patients were evaluated with radiographs to establish the presence of union and the time it took to occur. In case of doubt, union was confirmed through a computed tomography (CT) scan at 8 weeks postoperatrively. We also assessed the range of motion, the presence of complications, and function through the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and a grip strength score.
Results We achieved a union rate of 100% in both groups at similar times. In the dorsal locking plate group, we obtained better full range of motion, particularly in wrist extension, which was statistically significant (p = 0.0016), as well as lower DASH scores, which was also statistically significant (p = 0.0066). Complications were only present in two patients in the HCS group.
Conclusion Both techniques are valid and reproducible for the treatment of wrists with scapholunate advanced collapse (SNAC) and scaphoid non-union advanced collapse (SLAC). Based on the outcomes, with the Xpode plate, the patients presented better ranges of motion and DASH scores; therefore it may be an excellent fixation option in the open four-corner fusion surgical technique. The entry point and configuration of the HCS are fundamental variables to analyze.The union rate of 100% obtained in the present study contrasts with the high rates of non-union reported in the literature published in the early 2000s.
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Affiliation(s)
- Francisco R. Melibosky
- Hand Surgery and Microsurgery Unit, Department of Traumatology and Orthopedics, Clínica Indisa – Facultad de Medicina de la Universidad de Valparaíso, Santiago, Chile
| | - Rene A. Jorquera
- Hand Surgery and Microsurgery Unit, Department of Traumatology and Orthopedics, Clínica Indisa – Facultad de Medicina de la Universidad de Valparaíso, Santiago, Chile
| | - Felipe Z. Saxton
- Hand Surgery and Microsurgery Unit, Department of Traumatology and Orthopedics, Facultad de Medicina Clínica Alemana de Santiago – Universidad del Desarrollo, Santiago, Chile
| | - Pablo Orellana
- Hand Surgery and Microsurgery Unit, Department of Traumatology and Orthopedics, Clínica Indisa – Facultad de Medicina de la Universidad de Valparaíso, Santiago, Chile
| | - Diego Junqueras
- Hand Surgery and Microsurgery Unit, Department of Traumatology and Orthopedics, Facultad de Medicina Clínica Alemana de Santiago – Universidad del Desarrollo, Santiago, Chile
- Hand Surgery Unit, Department of Traumatology and Orthopedics, Hospital de la Florida, Santiago, Chile
| | - Camila Azócar
- Hand Surgery and Microsurgery Unit, Department of Traumatology and Orthopedics, Clínica Indisa – Facultad de Medicina de la Universidad de Valparaíso, Santiago, Chile
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Saiz A, Delman CM, Haffner M, Wann K, McNary S, Szabo RM, Bayne CO. The Biomechanical Effects of Simulated Radioscapholunate Fusion With Distal Scaphoidectomy, 4-Corner Fusion With Complete Scaphoidectomy, and Proximal Row Carpectomy Compared to the Native Wrist. J Hand Surg Am 2021; 46:1125.e1-1125.e8. [PMID: 33934922 DOI: 10.1016/j.jhsa.2021.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 12/12/2020] [Accepted: 02/24/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the effect of simulated radioscapholunate fusion with distal scaphoid excision (RSLF+DSE), 4-corner fusion with scaphoidectomy (4-CF), and proximal row carpectomy (PRC) on the wrist's range of motion (ROM), contact pressure, and contact force in a cadaveric model. METHODS Ten freshly frozen cadaveric wrists were tested under 4 sequential conditions: native wrist, RSLF+DSE, 4-CF, and PRC. The simulated fusions were performed using two 1.6-mm Kirschner wires. The ROM in the flexion-extension and radioulnar deviation planes was evaluated. Contact area, contact pressure, and contact force were measured at the scaphocapitolunate joint for the RSLF+DSE simulation and radiocarpal joint for the 4-CF and PRC simulations. Mechanical testing was performed using a 35-N uniaxial load and pressure-sensitive film. RESULTS The RSLF+DSE and 4-CF groups had a decreased wrist arc ROM compared with the native wrist. The PRC group had a greater wrist arc ROM compared with the RSLF+DSE and 4-CF groups, but compared to the native wrist, it demonstrated a mildly decreased wrist arc ROM. The carpal pressure and contact force were significantly increased in the RSLF+DSE, 4-CF, and PRC groups compared with those in the native wrist. The RSLF+DSE group had the smallest increase in the carpal pressure and contact force, whereas the PRC group had the greatest increase. CONCLUSIONS Our study validates previous findings that PRC is motion-conserving but has the greatest contact force, whereas RSLF-DSE and 4-CF may cause a decrease in the ROM but have lower contact forces. CLINICAL RELEVANCE Understanding the underlying native wrist biomechanics and alterations following different surgical treatments may assist hand surgeons in their clinical decision making for the treatment of stage II scapholunate advanced collapse.
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Affiliation(s)
- Augustine Saiz
- Department of Orthopaedic Surgery, University of California, Davis Medical Center, Sacramento, CA
| | - Connor M Delman
- Department of Orthopaedic Surgery, University of California, Davis Medical Center, Sacramento, CA.
| | - Max Haffner
- Department of Orthopaedic Surgery, University of California, Davis Medical Center, Sacramento, CA
| | - Kathy Wann
- Department of Orthopaedic Surgery, University of California, Davis Medical Center, Sacramento, CA
| | - Sean McNary
- Department of Orthopaedic Surgery, University of California, Davis Medical Center, Sacramento, CA
| | - Robert M Szabo
- Department of Orthopaedic Surgery, University of California, Davis Medical Center, Sacramento, CA
| | - Christopher O Bayne
- Department of Orthopaedic Surgery, University of California, Davis Medical Center, Sacramento, CA
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Lee SJ, Rabinovich RV, Kim A. Proximal Row Carpectomy Using Decellularized Dermal Allograft: Preliminary Results. J Wrist Surg 2021; 10:116-122. [PMID: 33815946 PMCID: PMC8012091 DOI: 10.1055/s-0040-1718912] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
Objective The purpose of this study was to evaluate the short-term outcomes of patients undergoing proximal row carpectomy (PRC) with interposition arthroplasty using a decellularized dermal allograft. Methods Patients with a minimum of 1-year follow-up after undergoing a PRC using decellularized dermal allograft were contacted for clinical evaluation, radiographs, and postoperative outcome questionnaires, including the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire as well as the modified Likert scale for patient satisfaction. Nine of ten (90%) consecutive patients who were treated using this surgical technique were available for follow-up. Results At a mean follow-up of 18 months, a total of nine patients achieved a mean flexion-extension arc of 113 degrees, pronosupination of 170.5 degrees, grip strength of 68 Ibs and pinch strength of 17 Ibs. Relative to the contralateral side, these values were 95, 100, 84 and 82%, respectively. There was significant improvement in the mean DASH score from 63.5 preoperatively to 23.8 postoperatively. Patient satisfaction postoperatively achieved a mean modified Likert score of 1.5. There was no evidence of radiocarpal joint space degeneration or dislocation in any of the patients. No patient suffered wound-related issues, foreign-body reaction to the graft, or other complications. Conclusion PRC with interposition arthroplasty using a decellularized dermal allograft in patients with degenerative changes at the lunate fossa or capitate demonstrates short-term outcomes comparable to what has been reported for routine PRC in patients without degenerative changes affecting the radiocapitate joint. This method of interposition arthroplasty expands the indications for PRC and may help avoid salvage, motion-sacrificing procedures in select patients with late-stage wrist arthritis. Level of Evidence This is a level IV, therapeutic study.
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Affiliation(s)
- Steven J. Lee
- Department of Orthopaedic Surgery, Nicholas Institute of Sports Medicine and Athletic Trauma (NISMAT), Lenox Hill Hospital, New York, New York
| | - Remy V. Rabinovich
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York
| | - Andrew Kim
- Department of Orthopaedic Surgery, Nicholas Institute of Sports Medicine and Athletic Trauma (NISMAT), Lenox Hill Hospital, New York, New York
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Campbell CC, Neustein TM, Daly CA, Wagner ER. Surgical Treatment of Wrist Arthritis in Young Patients. JBJS Rev 2021; 8:e0078. [PMID: 32149931 DOI: 10.2106/jbjs.rvw.19.00078] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Surgical treatment of wrist arthritis in the younger patient population remains a challenging issue, and various surgical options need to be carefully considered for each patient. Proximal row carpectomy and 4-corner arthrodesis have proven to be reliable options for reducing pain and restoring adequate function in most young high-demand patients if the lunate facet is spared. Selective neurectomy has proven to be a promising stand-alone or complementary procedure for the treatment of pain that is associated with wrist arthritis in patients of all ages, with spared motion and the opportunity to perform additional procedures if pain continues. Alternative procedures, including capitolunate arthrodesis, total wrist arthrodesis, radial styloidectomy, total wrist arthroplasty, and wrist hemiarthroplasty, have considerable strengths and weaknesses and need to be studied further in younger patients.
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Marie C, Aribert M, Bouyer M, Forli A, Corcella D. Clinical, functional, and radiological results of the Amandys® interposition arthroplasty in 13 cases of wrist osteoarthritis. HAND SURGERY & REHABILITATION 2021; 40:420-426. [PMID: 33689925 DOI: 10.1016/j.hansur.2021.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 12/21/2022]
Abstract
Amandys® pyrocarbon interposition arthroplasty is intended for widespread arthritis of the wrist. The aim of this study was to assess the clinical, functional, and radiological results of this arthroplasty with a minimum follow-up of 12 months. This retrospective single-center study brought together all osteoarthritis indications that can benefit from an Amandys® arthroplasty. Twenty-one implants were used between January 2011 and October 2018. There were seven cases of distal radius malunion, eight SLAC wrists, two SNAC wrists, two cases of Kienböck's disease at Lichtman's stage 4, and two aftermaths of inflammatory arthritis. Twenty-four percent of patients had previously undergone another type of surgery for this wrist arthritis. Six implants were removed, five early for dislocation and one after 6 years for chronic pain. Thirteen patients were reviewed with an average follow-up of 40.7 months (21-90). The average pain level on a visual analog scale was 3.1/10 (0-7). The mean range motion was 36° flexion (10-60) and 33° extension (15-50). The mean grip strength at the last follow-up was 14.8 kg (2-30) (43% of contralateral). The average QuickDASH and PRWE functional scores were 37.9/100 (0-80) and 29.6/100 (0-83.5), respectively. Amandys® interposition arthroplasty is an interesting alternative to total wrist fusion or total wrist prosthesis for widespread arthritis of the wrist. For the implant to be stable, the capsulo-ligamentous systems must be intact.
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Affiliation(s)
- C Marie
- SOS Main Grenoble, Unité de Chirurgie Réparatrice, de la Main et des Brûlés, Hôpital A - Michallon, CHU de Grenoble, Avenue du Marquis de Grésivaudan, BP 217, 38043 Grenoble cedex 09, France.
| | - M Aribert
- SOS Main Grenoble, Unité de Chirurgie Réparatrice, de la Main et des Brûlés, Hôpital A - Michallon, CHU de Grenoble, Avenue du Marquis de Grésivaudan, BP 217, 38043 Grenoble cedex 09, France.
| | - M Bouyer
- SOS Main Grenoble, Unité de Chirurgie Réparatrice, de la Main et des Brûlés, Hôpital A - Michallon, CHU de Grenoble, Avenue du Marquis de Grésivaudan, BP 217, 38043 Grenoble cedex 09, France.
| | - A Forli
- SOS Main Grenoble, Unité de Chirurgie Réparatrice, de la Main et des Brûlés, Hôpital A - Michallon, CHU de Grenoble, Avenue du Marquis de Grésivaudan, BP 217, 38043 Grenoble cedex 09, France.
| | - D Corcella
- SOS Main Grenoble, Unité de Chirurgie Réparatrice, de la Main et des Brûlés, Hôpital A - Michallon, CHU de Grenoble, Avenue du Marquis de Grésivaudan, BP 217, 38043 Grenoble cedex 09, France.
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Keating C, McCombe D, Powell CA, Maloney P, Ek ET, Tham SK. Reconstruction of the Proximal Scaphoid With a Medial Femoral Trochlea Osteochondral Graft: Minimum 2-Year Results. J Hand Surg Am 2021; 46:248.e1-248.e9. [PMID: 33257054 DOI: 10.1016/j.jhsa.2020.10.014] [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: 07/24/2019] [Revised: 07/26/2020] [Accepted: 10/06/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To report the clinical and radiological outcomes after medial femoral trochlear (MFT) osteochondral graft for the salvage of proximal scaphoid fractures with a minimum 2-year follow-up. METHODS A retrospective review was performed of patients with comminuted fractures of the proximal scaphoid treated by excision of the proximal pole and replacement with free vascularized MFT osteochondral graft. Demographic data, objective and radiographic measurements, and patient-reported outcome measures of the upper limb and knee were collected. Pain was assessed by completion of a visual analog scale (VAS). RESULTS Between February 2014 and May 2015, 12 MFT osteochondral grafts were performed. Eight patients were available for follow-up at a mean of 34 months (range, 28-39 months). The mean range of wrist flexion was 31° (range, 15°-60°), extension was 34° (range, 5°-60°), radial deviation was 9° (range, 0°-20°), ulnar deviation was 28° (range, 10°-45°) and grip strength was 42 kg (range, 25-53 kg). The median wrist pain, as measured by VAS, was 0.7 (mean, 1.3; range, 0-6). The average follow-up scapholunate, radiolunate, and radioscaphoid angles were 58.9° (range, 44°-93°), 12.9° (range, 0°-30°), and 46.0° (range, 35°-63°), respectively. The mean Disabilities of the Arm, Shoulder, and Hand (DASH) score was 13.9 (range, 3-43) and Patient Rated Wrist Evaluation (PRWE) score was 22.4 (range, 2-68). The mean postoperative Oxford Knee Score was 42 (range, 14-48). One patient suffered notable knee pain at 37-month follow-up. One patient suffered notable pain on the radial side of the wrist and underwent scaphoid excision and 4-corner arthrodesis. CONCLUSIONS Replacement of the fragmented proximal scaphoid by MFT graft is an alternative to other salvage options and most patients can expect pain relief and acceptable wrist motion. These results need to be balanced against the potential for donor-site morbidity. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Affiliation(s)
- Cameron Keating
- Hand Surgery Unit, Department of Plastic Surgery, St. Vincent's Hospital, Melbourne, Australia
| | - David McCombe
- Hand Surgery Unit, Department of Plastic Surgery, St. Vincent's Hospital, Melbourne, Australia; Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, St. Vincent Institute, Melbourne, Australia
| | - Christopher A Powell
- Hand Surgery Unit, Department of Plastic Surgery, St. Vincent's Hospital, Melbourne, Australia
| | - Peter Maloney
- Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash University, Melbourne, Australia
| | - Eugene T Ek
- Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, St. Vincent Institute, Melbourne, Australia; Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash University, Melbourne, Australia
| | - Stephen K Tham
- Hand Surgery Unit, Department of Plastic Surgery, St. Vincent's Hospital, Melbourne, Australia; Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, St. Vincent Institute, Melbourne, Australia; Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Monash University, Melbourne, Australia.
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Fan S, Padmore C, Kadar A, Chambers S, Langohr GDG, Suh N. The effect of four-corner fusion and proximal row carpectomy on uniplanar and multiplanar wrist motion: A biomechanical study. J Orthop 2021; 24:102-110. [PMID: 33679035 DOI: 10.1016/j.jor.2021.02.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/14/2021] [Indexed: 12/21/2022] Open
Abstract
Purpose To compare changes in wrist kinematics after scaphoidectomy and four-corner fusion (4CF), and proximal row carpectomy (PRC). Methods Six cadaveric specimens underwent flexion-extension, radial-ulnar deviation and circumduction in an active motion wrist simulator. Native state, "anatomic 4CF", "radial 4CF", and PRC were compared. Results Radial 4CF reduced wrist extension, while PRC reduced radial deviation. Fusion groups had similar motion profiles. 44%, 41%, and 32% of native circumduction was maintained in PRC, anatomic, and radial 4CF. Conclusions Both fusion positions resulted in comparable motion outcomes. Anatomic 4CF was restricted in wrist extension compared to PRC but provided favourable radial deviation.
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Affiliation(s)
- Stacy Fan
- Division of Plastic and Reconstructive Surgery, University of Western Ontario, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, ON, Canada
| | - Clare Padmore
- Bioengineering Research Laboratory, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care London, London, ON, Canada
| | - Assaf Kadar
- Division of Orthopaedic Surgery, University of Western Ontario, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, ON, Canada
- Department of Orthopaedic Surgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Spencer Chambers
- Division of Plastic and Reconstructive Surgery, University of Western Ontario, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, ON, Canada
| | - G Daniel G Langohr
- Bioengineering Research Laboratory, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care London, London, ON, Canada
| | - Nina Suh
- Division of Plastic and Reconstructive Surgery, University of Western Ontario, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, ON, Canada
- Bioengineering Research Laboratory, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care London, London, ON, Canada
- Division of Orthopaedic Surgery, University of Western Ontario, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, ON, Canada
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Wagner ER, Barras LA, Harstad C, Elhassan BT, Moran SL. Proximal Row Carpectomy in Young Patients. JBJS Essent Surg Tech 2021; 11:ST-D-19-00054. [PMID: 34123554 DOI: 10.2106/jbjs.st.19.00054] [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] Open
Abstract
Background There continues to be controversy regarding the treatment of early-stage arthritis of the wrist, particularly in young patients, because of the large number of techniques, the poor long-term results for many of these techniques, and the overall paucity of high-level scientific data. Proximal row carpectomy (PRC) and 4-corner arthrodesis (4CA) have been established as the mainstay motion-sparing surgical treatment options in cases of early scapholunate advanced collapse and scaphoid nonunion advanced collapse arthritis. However, there is marked controversy surrounding the best treatment option for younger patients with greater physical demands because of the questionable outcomes associated with these motion-sparing options in such patients1-9. Traditionally, many surgeons prefer 4CA over PRC for young, high-demand patients, in part because studies have suggested that young age and work status as a laborer are important risk factors for worse outcomes following PRC1,8. However, the concern for symptomatic nonunion and potential for radiolunate arthritis in 4CA, as well as the lack of medium to long-term comparative studies in this subset, make this recommendation controversial10. Description The wrist is accessed via the dorsal approach, creating a retinacular flap and a radially based ligament-sparing capsulotomy. The scaphoid, lunate, and triquetrum are then excised en bloc. The radioscapholunate ligament is protected. The capsule and retinaculum and then repaired. Alternatives Alternatives to PRC include nonoperative treatment, 4CA, capitolunate arthrodesis, posterior and anterior interosseous neurectomies, total wrist arthroplasty, and total wrist arthrodesis. Rationale A recent study by Wagner et al. compared patients <45 years old who underwent either PRC or 4CA11. Overall, PRC and 4CA had similar complication rates, postoperative pain levels, wrist function, and long-term outcomes free of conversion to arthrodesis. Patients who underwent PRC had improved motion and fewer complications, whereas patients who underwent 4CA had slightly lower rates of radiocarpal arthritis. Therefore, in this technique article, we describe PRC for wrist arthritis in patients <45 years old.
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Affiliation(s)
- Eric R Wagner
- Department of Orthopedic Surgery, Emory University, Atlanta, Georgia
| | - Laurel A Barras
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Chelsea Harstad
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Steven L Moran
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Pomares G. Trapeziometacarpal osteoarthritis and arthritis of the wrist. HAND SURGERY & REHABILITATION 2021; 40S:S135-S142. [PMID: 33482390 DOI: 10.1016/j.hansur.2020.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 12/21/2022]
Abstract
Although the simultaneous occurrence of arthritis of the wrist and the base of the thumb is rare, it is nonetheless imperative to carry out a preoperative clinical and radiological assessment of the wrist when managing trapeziometacarpal osteoarthritis. The presence of pre-arthritic lesions or established wrist arthritis, even if treated, must be taken into consideration when treating osteoarthritis at the base of the thumb. The coexistence of these lesions determines the entire surgical strategy. Failure to take them into account during the surgical treatment often results in a compromised postoperative course and it often adversely impacts the outcome of secondary surgeries.
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Affiliation(s)
- G Pomares
- European Hand Institute Luxembourg - Kirchberg Hospital, 9, Edward Steichen Street, 2540 Luxembourg, Luxembourg.
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Zhang Y, Gillis JA, Moran SL. Management of scapholunate advanced collapse and scaphoid nonunion advanced collapse without proximal row carpectomy or four corner fusion. J Hand Surg Eur Vol 2021; 46:50-57. [PMID: 33202162 DOI: 10.1177/1753193420973322] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Four corner arthrodesis and proximal row carpectomy are the most common techniques for the management of advanced radiocarpal arthritis due to longstanding scapholunate instability and scaphoid nonunion. The advantages and short comings of each technique have been well defined in the literature. Advancements in joint replacement and arthroscopic surgery have resulted in new operations to manage radiocarpal and midcarpal arthritis. Most of these new procedures are modifications of the two classical operations, but some use modern implants and newer materials. New individualized options, like osteochondral grafting in combination with proximal row carpectomy or (arthroscopic) distal resection of the scaphoid, allowed us to improve our treatment and offer patients less invasive but equally effective procedures. We consider that four corner arthrodesis and proximal row carpectomy should not always be standard management for advanced radiocarpal arthritis.
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Affiliation(s)
- Yiyang Zhang
- Division of Orthopedic Surgery, Roth
- McFarlane Hand and Upper Limb Centre, London, ON, Canada
| | - Joshua A Gillis
- Division of Plastic and Reconstructive Surgery, Roth
- McFarlane Hand and Upper Limb Centre, London, ON, Canada
| | - Steven L Moran
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA
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Long-term radiological changes and functional outcomes after proximal row carpectomy: Retrospective study with 3 years' minimum follow-up. Orthop Traumatol Surg Res 2020; 106:1589-1595. [PMID: 33289656 DOI: 10.1016/j.otsr.2020.03.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 03/10/2020] [Accepted: 03/27/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The aim of this study was to analyze the radiological changes and determine the clinical and functional outcomes of proximal row carpectomy (PRC) over the long term. HYPOTHESIS Radiological changes after PRC occur in every patient while the clinical and functional outcomes remain stable over time. METHODS This was a retrospective single-center study of patients who underwent PRC between January 2004 and December 2014. A clinical assessment (range of motion, grip strength), functional assessment (Mayo Wrist score and QuickDASH) and radiographic assessment (radiocapitate osteoarthritis, radiocapitate congruency) was done in every patient at the longest follow-up. RESULTS Thirty-one patients were reviewed with a mean follow-up of 97.9 months. The indications for PRC were SLAC (n=10), SNAC (n=5), Kienböck disease (n=9) and other conditions (n=7). The radiocapitate index, which is the radius of curvature of the tip of the capitate divided by the mean radius of curvature of the lunate fossa, went from 0.68 immediately postoperative to 0.74 at the final assessment (p=0.035). The mean flexion/extension arc was 93°. The mean grip strength was 25 kg. The mean QuickDASH was 29 and the mean Mayo Wrist score was 69. Fifteen patients had radiocapitate osteoarthritis. Seven patients (22%) required revision surgery for wrist fusion after a mean of 18.6 months. CONCLUSION Radiological adaptation in the radiocapitate joint after PRC was found in this study. PRC is a reliable solution and yields stable outcomes over time for treating radiocarpal osteoarthritis, except in young adults and manual laborers who had a notable early revision rate. LEVEL OF EVIDENCE IV - retrospective study.
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Cost-Effectiveness Analysis of Motion-Preserving Operations for Wrist Arthritis. Plast Reconstr Surg 2020; 146:588e-598e. [PMID: 33141535 DOI: 10.1097/prs.0000000000007260] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The authors conducted a cost-effectiveness analysis to answer the question: Which motion-preserving surgical strategy, (1) four-corner fusion, (2) proximal row carpectomy, or (3) total wrist arthroplasty, used for the treatment of wrist osteoarthritis, is the most cost-effective? METHODS A simulation model was created to model a hypothetical cohort of wrist osteoarthritis patients (mean age, 45 years) presenting with painful wrist and having failed conservative management. Three initial surgical treatment strategies-(1) four-corner fusion, (2) proximal row carpectomy, or (3) total wrist arthroplasty-were compared from a hospital perspective. Outcomes included clinical outcomes and cost-effectiveness outcomes (quality-adjusted life-years and cost) over a lifetime. RESULTS The highest complication rates were seen in the four-corner fusion cohort: 27.1 percent compared to 20.9 percent for total wrist arthroplasty and 17.4 percent for proximal row carpectomy. Secondary surgery was common for all procedures: 87 percent for four-corner fusion, 57 percent for proximal row carpectomy, and 46 percent for total wrist arthroplasty. Proximal row carpectomy generated the highest quality-adjusted life-years (30.5) over the lifetime time horizon, compared to 30.3 quality-adjusted life-years for total wrist arthroplasty and 30.2 quality-adjusted life-years for four-corner fusion. Proximal row carpectomy was the least costly; the mean expected lifetime cost for patients starting with proximal row carpectomy was $6003, compared to $11,033 for total wrist arthroplasty and $13,632 for four-corner fusion. CONCLUSIONS The authors' analysis suggests that proximal row carpectomy was the most cost-effective strategy, regardless of patient and parameter level uncertainties. These are important findings for policy makers and clinicians working within a universal health care system.
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Low-Calcium, Porous, Alkali-Activated Materials as Novel pH Stabilizers for Water Media. MINERALS 2020. [DOI: 10.3390/min10110935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Due to the increase of water consumption, water treatment systems become more actual and innovative materials for water treatment are welcomed. Traditionally, alkalizing agents, such as lime or caustic soda, have been employed to increase the pH levels, which induce chemical clarification of wastewater. Some innovative ideas of using low-calcium, alkali-activated materials (AAM) for this purpose have been considered previously. In this study, the low-calcium, porous, alkali-activated material (pAAM) was characterized to understand the impact of the aluminum silicate source and heat treatment on basic properties for material that might be used in water treatment systems as a softener by stabilizing the pH. The studied porous alkali-activated materials may ensure stable and long-lasting (30 days) pH (pH 10.3–11.6) in water media depending on the composition and amount of activation solution used for AAM preparation. Heat treatment does not have an impact on the mineralogical composition and structural properties of the pAAM, but it does change the leaching ability of alkalis from the material structure.
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Athlani L, Sabau S, Pauchard N, Dap F, Dautel G. Four-corner arthrodesis with a dorsal locking plate: 4-9-year follow-up. J Hand Surg Eur Vol 2020; 45:673-678. [PMID: 32536296 DOI: 10.1177/1753193420930587] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report the outcomes of four-corner arthrodesis for advanced wrist collapse in 50 patients (51 wrists) using a dorsal locking plate. At a mean follow-up of 6 years (range 4-9), pain was significantly reduced and wrist function was significantly improved compared with preoperative status. After four-corner arthrodesis, grip strength was 80% of the contralateral side, and wrist motion averaged 50° flexion-extension and 30° radioulnar deviation. Immobilization time was 5 weeks (4-6) and sick-leave was 3 months (2-5) following surgery. There were seven nonunions (14%) that underwent repeat arthrodesis. Three wrists were later converted to total arthrodesis due to persisting pain. Radiographic dorsal impingement was found in five wrists after four-corner arthrodesis and did not require reoperation. The outcomes appear not remarkably different from those reported using other fixation methods other than an apparent earlier return to activities.Level of evidence: IV.
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Affiliation(s)
- Lionel Athlani
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre chirurgical Emile Gallé, CHU Nancy, France
| | - Sophie Sabau
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre chirurgical Emile Gallé, CHU Nancy, France
| | - Nicolas Pauchard
- Service de chirurgie de la main - SOS main, Hôpital privé Dijon, Bourgogne, France
| | - François Dap
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre chirurgical Emile Gallé, CHU Nancy, France
| | - Gilles Dautel
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre chirurgical Emile Gallé, CHU Nancy, France
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Garcia BN, Lu CC, Stephens AR, Kazmers NH, Chen W, Leng J, Li L, Sauer BC, Tyser AR. Risk of Total Wrist Arthrodesis or Reoperation Following 4-Corner Arthrodesis or Proximal Row Carpectomy for Stage-II SLAC/SNAC Arthritis: A Propensity Score Analysis of 502 Wrists. J Bone Joint Surg Am 2020; 102:1050-1058. [PMID: 32187124 DOI: 10.2106/jbjs.19.00965] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND For stage-II scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) patterns of wrist arthritis, the optimal method of surgical treatment remains unclear. Previous literature has demonstrated similar clinical outcomes between proximal row carpectomy (PRC) and 4-corner arthrodesis (FCA), making the risk of reoperation a focus of particular interest. In the present study, the primary null hypothesis was that there would be no difference in the rate of conversion to total wrist arthrodesis between PRC and FCA. Additionally, we hypothesized that the rate of secondary surgical procedures would be similar between the 2 procedures. METHODS The national Veterans Health Administration Corporate Data Warehouse was utilized to identify 2,449 patients who underwent either PRC or FCA between 1992 and 2016. With use of operative reports to identify the arthritis pattern, only cases of stage-II SLAC/SNAC were included. All complications and subsequent surgical procedures were confirmed by manual chart review. Propensity score analyses with matching weights were utilized to balance the PRC and FCA cohorts. The rates of conversion to wrist arthrodesis and secondary surgical procedures were calculated. RESULTS Of the 1,168 patients with stage-II SLAC/SNAC arthritis, 933 wrists underwent PRC and 257 wrists underwent FCA. Ten-year survival free of total wrist arthrodesis in the matching PRC (251 procedures) and FCA (251 procedures) cohorts was 94.3% (95% confidence interval [CI], 92.3% to 96.3%) and 94.1% (95% CI, 90.8% to 97.4%), respectively. Survival free of a secondary surgical procedure other than wrist arthrodesis was 99.7% (95% CI, 99.3% to 100.0%) for PRC and 83.5% (95% CI, 78.2% to 88.8%) for FCA. CONCLUSIONS PRC and FCA demonstrated similarly low rates of conversion to total wrist arthrodesis. In contrast, the rate of secondary surgical procedures following FCA was significantly higher compared with PRC. Given the historically similar clinical outcomes between PRC and FCA, the results of the present study show that PRC may be a preferable treatment for stage-II SLAC/SNAC wrist arthritis. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Brittany N Garcia
- Department of Orthopaedic Surgery, University of Utah Hospital, Salt Lake City, Utah
| | - Chao-Chin Lu
- HSR&D IDEAS Center, Salt Lake City George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Team VERITAS, Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Andrew R Stephens
- Department of Orthopaedic Surgery, University of Utah Hospital, Salt Lake City, Utah
| | - Nikolas H Kazmers
- Department of Orthopaedic Surgery, University of Utah Hospital, Salt Lake City, Utah
| | - Wei Chen
- HSR&D IDEAS Center, Salt Lake City George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Team VERITAS, Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Jianwei Leng
- HSR&D IDEAS Center, Salt Lake City George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Team VERITAS, Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Liang Li
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brian C Sauer
- HSR&D IDEAS Center, Salt Lake City George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Team VERITAS, Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Andrew R Tyser
- Department of Orthopaedic Surgery, University of Utah Hospital, Salt Lake City, Utah
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Yoo M, Nelson RE, Illing DA, Martin BI, Tyser AR, Kazmers NH. Cost-Effectiveness Analysis Comparing Proximal Row Carpectomy and Four-Corner Arthrodesis. JB JS Open Access 2020; 5:e0080. [PMID: 33123669 PMCID: PMC7418915 DOI: 10.2106/jbjs.oa.19.00080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: The optimal surgical treatment for scapholunate advanced collapse (SLAC) and
scaphoid nonunion advanced collapse (SNAC) remains unclear. To inform
clinical decision-makers, we conducted a cost-effectiveness analysis
comparing proximal row carpectomy (PRC) and four-corner arthrodesis
(FCA). Methods: A Markov microsimulation model was used to compare clinical outcomes, costs,
and health utilities between PRC and FCA. The model used a 10-year time
horizon and a 1-month cycle length, and it was evaluated from the societal
perspective. Utilities and clinical parameters including transition
probabilities for debridement for infection, removal of implants, conversion
to total wrist arthrodesis, revision FCA, and revision total wrist
arthrodesis were obtained from published literature. Timing of complications
was estimated from the literature. Direct medical costs were derived from
Medicare ambulatory surgical cost data, and indirect costs for missed work
due to surgical procedures and complications were included. The
effectiveness outcome was quality-adjusted life years (QALYs). Probabilistic
sensitivity analysis and 1-way threshold analysis for utilities were
performed. Results: In the base-case model, PRC dominated FCA (i.e., PRC had lower cost and
greater effectiveness). The mean (and standard deviation) for the total cost
and QALYs per patient were $30,970 ± $5,931 and 8.24 ± 1.28,
respectively, for PRC and $44,526 ± $11,205 and 8.23 ± 1.26,
respectively, for FCA. In the probabilistic sensitivity analysis, PRC
dominated FCA in 57% of the 1 million iterations. The cost-effectiveness
acceptability curve indicated that PRC is the most cost-effective strategy
regardless of the willingness-to-pay threshold up to $100,000/QALY. Conclusions: PRC dominated FCA in the base-case analysis and in the probabilistic
sensitivity analysis. These results suggest that PRC is the optimal strategy
for Stage-I or II SLAC and for SNAC in patients ≥55 years of age. Level of Evidence: Economic Level IV. See Instructions for Authors for a
complete description of levels of evidence.
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Affiliation(s)
- Minkyoung Yoo
- Departments of Economics (M.Y.) and Orthopaedics (D.A.I., B.I.M., A.R.T., and N.H.K.), and Division of Epidemiology (R.E.N.), University of Utah, Salt Lake City, Utah
| | - Richard E Nelson
- Departments of Economics (M.Y.) and Orthopaedics (D.A.I., B.I.M., A.R.T., and N.H.K.), and Division of Epidemiology (R.E.N.), University of Utah, Salt Lake City, Utah.,VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - Damian A Illing
- Departments of Economics (M.Y.) and Orthopaedics (D.A.I., B.I.M., A.R.T., and N.H.K.), and Division of Epidemiology (R.E.N.), University of Utah, Salt Lake City, Utah
| | - Brook I Martin
- Departments of Economics (M.Y.) and Orthopaedics (D.A.I., B.I.M., A.R.T., and N.H.K.), and Division of Epidemiology (R.E.N.), University of Utah, Salt Lake City, Utah
| | - Andrew R Tyser
- Departments of Economics (M.Y.) and Orthopaedics (D.A.I., B.I.M., A.R.T., and N.H.K.), and Division of Epidemiology (R.E.N.), University of Utah, Salt Lake City, Utah
| | - Nikolas H Kazmers
- Departments of Economics (M.Y.) and Orthopaedics (D.A.I., B.I.M., A.R.T., and N.H.K.), and Division of Epidemiology (R.E.N.), University of Utah, Salt Lake City, Utah
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Four-Corner Arthrodesis Versus Proximal Row Carpectomy for Scapholunate Advanced Collapse: A Systematic Literature Review and Meta-analysis. Ann Plast Surg 2020; 85:699-703. [PMID: 32384352 DOI: 10.1097/sap.0000000000002398] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Scapholunate advanced collapse (SLAC) of the wrist is one of the most common patterns of degenerative arthritis in the wrist. Surgical intervention is warranted for individuals with symptomatic SLAC and degenerative disease that affects the radioscaphoid joint. The most popular options for motion-preserving reconstruction and treatment of this disease include 4-corner arthrodesis and proximal row carpectomy. The purpose of this article was to conduct a systematic literature review and meta-analysis to identify any differences in the clinical outcomes of 4-corner arthrodesis and proximal row carpectomy for the treatment of SLAC. METHODS An electronic literature search of PubMed, Embase, OVID, and the Cochrane Library was conducted to identify studies evaluating the clinical outcomes of 4-corner arthrodesis versus proximal row carpectomy for the treatment of SLAC. Primary outcome measures included flexion/extension range of motion, grip strength, and level of pain. RESULTS Eight studies encompassing 311 patients met the inclusion criteria for the meta-analysis. Our meta-analysis indicated that when compared with 4-corner arthrodesis, patients who underwent proximal row carpectomy had statistically significantly increased flexion/extension range of motion by 6.2 degrees, significantly increased grip strength by 1.52%, and reduced level of pain by 0.3. CONCLUSIONS This study demonstrated that in comparative studies, there was a statistical difference favoring proximal row carpectomy to 4-corner arthrodesis for the treatment of SLAC. Although these differences were statistically significant, they remain very small and lack clinical relevance. This study further supports that both of these treatment options are equivalent for the treatment of this disease. Although not clinically significant, compared with 4-corner arthrodesis, patients treated with proximal row carpectomy had increased range of motion, increased grip strength, and decreased pain. Limitations to these findings are the small number of studies available and the increased heterogeneity between the studies. Further studies need to be conducted to confirm these findings.
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Proximal Row Carpectomy Versus 4-Corner Fusion: Incidence, Conversion to Fusion, and Cost. J Hand Surg Am 2020; 45:427-432. [PMID: 32089379 DOI: 10.1016/j.jhsa.2019.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 10/26/2019] [Accepted: 12/31/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The primary objective of this study was to compare incidence, demographic trends, and rates of subsequent fusion between proximal row carpectomy (PRC) and 4-corner fusion (4CF) among patients in the United States. METHODS A total of 3,636 patients who underwent PRC and 5,047 who underwent 4CF were identified from the years 2005 through 2014 among enrollees in the PearlDiver database. Regional distribution, demographic characteristics, annual incidence, comorbidities, and subsequent wrist fusion were compared between the 2 groups. Of the patients identified, 3,512 from each group were age- and sex-matched and subsequently compared for rates of converted fusion, 30- and 90-day readmission rates, and average direct cost. RESULTS Patients undergoing 4CF and PRC did not have statistically significant differences in comorbidities. The incidence of the procedures among all subscribers increased for both PRC (1.8 per 10,000 to 2.6 per 10,000) and 4CF (1.2 per 10,000 to 2.0 per 10,000) from 2005 to 2014. Comparing the matched cohorts, patients who underwent 4CF had a higher rate of subsequent fusion than those who underwent PRC (2.67% vs 1.79%). Readmission rates were not significantly different at 30 or 90 days. Average direct cost was significantly greater for 4CF than for PRC. CONCLUSIONS Both PRC and 4CF have been utilized at increasing rates in the past decade. Wrist fusion rates and average costs are higher in the 4CF group without a significant difference in readmission rates. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
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Goyal N, Akram F, Wysocki RW. Return to golf after proximal row carpectomy and four-corner arthrodesis for scapholunate and scaphoid nonunion advanced collapse. J Hand Surg Eur Vol 2020; 45:201-202. [PMID: 31684780 DOI: 10.1177/1753193419883637] [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)
- Nitin Goyal
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Faisal Akram
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Robert W Wysocki
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Abstract
Background: Scapholunate advanced collapse (SLAC) is the most common pattern of wrist arthritis. Sparse data exist regarding the SLAC wrist pattern of arthritis. This study aimed to document the epidemiology of advanced SLAC in terms of patients' sociodemographics and possible association with trauma. Methods: Sixty-one patients with severe SLAC wrist were included. Baseline sociodemographic characteristics were reviewed. To evaluate the relationship to injury, this group of cases was compared with a control group of 61 patients with first carpometacarpal osteoarthritis (CMC OA). The following data were collected for both groups: age, gender, history of traumatic injury, history of manual labor, duration of symptoms, and dominant hand involvement. Pearson chi-square tests for categorical variables and independent samples t test for continuous variables were performed to determine differences between groups. Results: Patients with SLAC wrist were more likely to be male (80.3% vs 31.1%; p<0.001), have a history of a traumatic injury (69.5% vs 25.9%, P < .001), have longer symptom duration (10.3 ± 13.3 vs 3.5 ± 2.5 years, P = .001), be involved in a manual labor job (49.0% vs 20.0%, P = .002), and be younger (53.1 ± 10.4 vs 58.3 ± 9.8; P = .006) compared with patients with CMC OA. There was no difference in dominant hand involvement (49.2% vs 53.3%; P = .571) between the groups. Conclusions: This study identified the characteristics of patients with advanced SLAC wrist. Compared with a control cohort of CMC OA, patients with SLAC wrist were more likely to be male, have a history of a traumatic injury, and be younger.
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Affiliation(s)
| | | | | | | | - Steven J. McCabe
- University of Toronto, Ontario,
Canada,Steven J. McCabe, Division of Plastic and
Reconstructive Surgery, Toronto Western Hospital, 399 Bathurst Street, 2 East
Wing, Toronto, ON M5T 2S8, Canada.
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Liechti R, Beeres FJP, Hug U. Triquetrum Excision in Radioscapholunate Arthrodesis for Posttraumatic Radiocarpal Osteoarthritis With Ulnar Impaction Syndrome. Tech Hand Up Extrem Surg 2019; 23:182-185. [PMID: 31157735 DOI: 10.1097/bth.0000000000000251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Dependent on fracture type, concomitant carpal injuries, and operative treatment, distal radius fractures can lead to symptomatic radiocarpal osteoarthritis. In addition, radial shortening can cause ulnar impaction syndrome. Radiocarpal arthrodesis and ulnar shortening osteotomy are known and frequently applied surgical procedures for each of those pathologies. There are limited data concerning treatment options for a combined disorder. The presented technique in this article demonstrates that radioscapholunate arthrodesis with distal pole scaphoidectomy and total triquetrum excision successfully treats both symptomatic radiocarpal osteoarthritis and ulnar impaction syndrome without further surgery on the ulna.
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Affiliation(s)
| | - Frank J P Beeres
- Orthopedic and Trauma Surgery, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Urs Hug
- Departments of Hand and Plastic Surgery
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Mayfield CK, Gould DJ, Dusch M, Mostofi A. Distal Scaphoid Excision in Treatment of Symptomatic Scaphoid Nonunion: Systematic Review and Meta-analysis. Hand (N Y) 2019; 14:508-515. [PMID: 29463128 PMCID: PMC6760077 DOI: 10.1177/1558944718760002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Current treatment options for persistent scaphoid nonunion are limited to salvage procedures such as proximal row carpectomy (PRC) or 4-corner fusion (4CF). Several small studies have demonstrated that distal scaphoid excision may provide a simpler alternative with faster recovery. The purpose of this study was to determine the efficacy of distal scaphoid excision as a treatment option for symptomatic scaphoid nonunion. Methods: The MEDLINE and PubMed databases were searched for the use of distal scaphoid excision in scaphoid nonunions. Studies included reported on either the functional or patient-centered outcomes following distal scaphoid excision for symptomatic scaphoid nonunion. Results: Six articles described the outcomes of 70 patients with an average of 11.7 patients per study. Functional outcomes including flexion-extension arc, radial-ulnar deviation, and grip strength improved by an average of 98.95%, 58.96%, and 131.08%, respectively. Patient-derived outcomes included the Modified Mayo Wrist Score, which improved by 92.6%, and the Disabilities of the Arm, Shoulder and Hand, which improved by 137.17%. An average of 68.75% of patients experience complete relief of pain with 20.83% of patients experiencing pain with strenuous activity. The average postoperative visual analog scale (0-10) was 0.71. On average, 93.33% of patients returned to work with an average time of return being 6.89 weeks. Complete satisfaction was reported by 87.80% of patients. Complications included progression into 4CF or PRC and newly developed midcarpal arthritis. Conclusions: Given favorable outcomes, our analysis suggests that distal scaphoid excision may be a favorable, low-risk treatment for scaphoid nonunion without eliminating more extensive options such as 4CF and wrist arthrodesis.
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Affiliation(s)
- Cory K. Mayfield
- University of Southern California, Los Angeles, USA,Cory K. Mayfield, Keck School of Medicine, University of Southern California, 1975 Zonal Avenue, Los Angeles, CA 90033, USA.
| | | | - Marie Dusch
- University of Southern California, Los Angeles, USA
| | - Amir Mostofi
- University of Southern California, Los Angeles, USA
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Montiel V, Payo-Ollero J, Amillo S. Proximal row carpectomy in patients older than 50 years: 3 to 16 years of follow-up. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019. [DOI: 10.1016/j.recote.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Erne HC, Broer PN, Weiss F, Loew S, Cerny MK, Schmauss D, Ehrl DC. Four-corner fusion: Comparing outcomes of conventional K-wire-, locking plate-, and retrograde headless compression screw fixations. J Plast Reconstr Aesthet Surg 2019; 72:909-917. [DOI: 10.1016/j.bjps.2018.12.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 11/08/2018] [Accepted: 12/09/2018] [Indexed: 12/21/2022]
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Vihanto A, Kotkansalo T, Pääkkönen M. The Learning Curve and Pitfalls of Arthroscopic Four-Corner Arthrodesis. J Wrist Surg 2019; 8:202-208. [PMID: 31192041 PMCID: PMC6546492 DOI: 10.1055/s-0039-1678673] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 01/07/2019] [Indexed: 02/07/2023]
Abstract
Background Midcarpal "four-corner" wrist arthrodesis may be done from an open arthrotomy or arthroscopically. Purpose This study aimed to examine the results of the recently described arthroscopic four-corner arthrodesis and whether the procedure seems to have any merit compared with the open technique. Patients and Methods We retrospectively identified eight patients with nine cases of arthroscopic four-corner arthrodesis performed at our institution, 2014 to 2017. The underlying pathologies were scapholunate advanced collapse ( n = 6), Preiser's disease ( n = 1), radioscaphoid ( n = 1), or capitolunar ( n = 1) osteoarthritis. Osteosynthesis was done with cannulated compression screws. Results Operating time for the first surgery was 198 minutes while the final one lasted 132 minutes. All patients achieved fusion. Three patients required a reoperation; one for screw malposition with screw removal, one for tendon reconstruction and screw removal due to a tendon injury induced by a retracted screw, and one for scaphoid impingement with removal of the scaphoid remnants. One patient experienced a probable superficial radial nerve injury. The follow-up time was 5 to 16 months. Conclusion The arthroscopic approach is technically extremely demanding and has a learning curve. Thorough resection of the scaphoid is recommended to avoid potential impingement. Level of Evidence This is a level IV, retrospective case series.
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Affiliation(s)
- Aleksi Vihanto
- Division of Diseases of the Musculoskeletal System, Department of Hand Surgery, Turku University Hospital and the University of Turku, Turku, Finland
| | - Tero Kotkansalo
- Division of Diseases of the Musculoskeletal System, Department of Hand Surgery, Turku University Hospital and the University of Turku, Turku, Finland
| | - Markus Pääkkönen
- Division of Diseases of the Musculoskeletal System, Department of Hand Surgery, Turku University Hospital and the University of Turku, Turku, Finland
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Daar DA, Shah A, Mirrer JT, Thanik V, Hacquebord J. Proximal Row Carpectomy versus Four-Corner Arthrodesis for the Treatment of Scapholunate Advanced Collapse/Scaphoid Nonunion Advanced Collapse Wrist: A Cost-Utility Analysis. Plast Reconstr Surg 2019; 143:1432-1445. [PMID: 31033826 DOI: 10.1097/prs.0000000000005558] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Two mainstay surgical options for salvage in scapholunate advanced collapse and scaphoid nonunion advanced collapse are proximal row carpectomy and four-corner arthrodesis. This study evaluates the cost-utility of proximal row carpectomy versus three methods of four-corner arthrodesis for the treatment of scapholunate advanced collapse/scaphoid nonunion advanced collapse wrist. METHODS A cost-utility analysis was performed in accordance with the Second Panel on Cost-Effectiveness in Health and Medicine. A comprehensive literature review was performed to obtain the probability of potential complications. Costs were derived using both societal and health care sector perspectives. A visual analogue scale survey of expert hand surgeons estimated utilities. Overall cost, probabilities, and quality-adjusted life-years were used to complete a decision tree analysis. Both deterministic and probabilistic sensitivity analyses were performed. RESULTS Forty studies yielding 1730 scapholunate advanced collapse/scaphoid nonunion advanced collapse wrists were identified. Decision tree analysis determined that both four-corner arthrodesis with screw fixation and proximal row carpectomy were cost-effective options, but four-corner arthrodesis with screw was the optimal treatment strategy. Four-corner arthrodesis with Kirschner-wire fixation and four-corner arthrodesis with plate fixation were dominated (inferior) strategies and therefore not cost-effective. One-way sensitivity analysis demonstrated that when the quality-adjusted life-years for a successful four-corner arthrodesis with screw fixation are lower than 26.36, proximal row carpectomy becomes the optimal strategy. However, multivariate probabilistic sensitivity analysis confirmed the results of our model. CONCLUSIONS Four-corner arthrodesis with screw fixation and proximal row carpectomy are both cost-effective treatment options for scapholunate advanced collapse/scaphoid nonunion advanced collapse wrist because of their lower complication profile and high efficacy, with four-corner arthrodesis with screw as the most cost-effective treatment. Four-corner arthrodesis with plate and Kirschner-wire fixation should be avoided from a cost-effectiveness standpoint.
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Affiliation(s)
- David A Daar
- From the Hansjörg Wyss Department of Plastic Surgery and the Department of Orthopedic Surgery, New York University School of Medicine; All Florida Orthopedics; and the Department of Orthopaedic Surgery, University of Pennsylvania Health System
| | - Ajul Shah
- From the Hansjörg Wyss Department of Plastic Surgery and the Department of Orthopedic Surgery, New York University School of Medicine; All Florida Orthopedics; and the Department of Orthopaedic Surgery, University of Pennsylvania Health System
| | - Joshua T Mirrer
- From the Hansjörg Wyss Department of Plastic Surgery and the Department of Orthopedic Surgery, New York University School of Medicine; All Florida Orthopedics; and the Department of Orthopaedic Surgery, University of Pennsylvania Health System
| | - Vishal Thanik
- From the Hansjörg Wyss Department of Plastic Surgery and the Department of Orthopedic Surgery, New York University School of Medicine; All Florida Orthopedics; and the Department of Orthopaedic Surgery, University of Pennsylvania Health System
| | - Jacques Hacquebord
- From the Hansjörg Wyss Department of Plastic Surgery and the Department of Orthopedic Surgery, New York University School of Medicine; All Florida Orthopedics; and the Department of Orthopaedic Surgery, University of Pennsylvania Health System
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49
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Montiel V, Payo-Ollero J, Amillo S. Proximal row carpectomy in patients older than 50 years: 3 to 16 years of follow-up. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 63:295-299. [PMID: 30926416 DOI: 10.1016/j.recot.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/22/2019] [Accepted: 02/01/2019] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To analyze the long-term results and the prognosis of patients who have undergone proximal row carpectomy (PRC) in our hospital. MATERIAL AND METHOD This is a retrospective study of 14 patients undergoing PRC with a follow-up of 3 to 16 years. The ability to perform daily activities, mobility and functional capacity after the surgery were assessed using the Patient-Rated Wrist Evaluation questionnaire (PRWE). RESULTS The range of movement was satisfactory. The mean score on the PRWE scale was 20.9±17.2 for the pain subscale and 39±35.5 for the functional capacity subscale. None of the patients required revision surgery or developed complications. Eighty percent of the patients were satisfied or very satisfied. Ninety percent of the patients would undergo surgery again. DISCUSSION The wrist's range of movement achieved with this technique is similar to that obtained with other mobility preservation techniques. Secondary arthritic changes in the radio-capitate joint do not necessarily produce pain. Some authors have described that the degree of satisfaction after PRC is equivalent to that of other procedures such as arthrodesis in 4 corners with circular plate arthrodesis or middle-carpal arthrodesis. CONCLUSION PRC achieved high satisfaction rates among the patients providing pain relief, good mobility and post-operative functionality of the wrist. In addition, it presented few complications.
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Affiliation(s)
- V Montiel
- Departamento Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, Navarra, España.
| | - J Payo-Ollero
- Departamento Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - S Amillo
- Departamento Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, Navarra, España
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50
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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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