1
|
Briotti J, Wilson S, Goh G, Lawson-Smith M. Wrist Arthrodesis Using the Medartis Carpometacarpal Joint Sparing Plate. Hand (N Y) 2024; 19:607-613. [PMID: 36541766 PMCID: PMC11141422 DOI: 10.1177/15589447221141474] [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: 12/24/2022]
Abstract
BACKGROUND Total wrist arthrodesis is a well-established surgical technique that provides reliable pain relief in patients with advanced wrist disease. Key limitations of existing plating systems include hardware pull-out, hardware failure, and nonunion. There is limited literature on the newer style carpometacarpal joint (CMCJ) sparing plating system, produced by Medartis. The objective of this study was to determine the long-term clinical and radiological outcomes of wrist arthrodesis with a CMCJ sparing wrist plate. METHODS This study retrospectively identified 23 wrist arthrodeses using the Medartis CMCJ sparing plate for review. This study assessed the outcomes of 18 unilateral wrist fusions and 1 bilateral wrist fusion. The study group consisted of 12 men and 5 women with an average age of 56 years (range: 29-82 years) with a mean follow-up period of 17 months. RESULTS At the time of follow-up, all patients' wrists had fused without postsurgical complication. The final grip strength in the operative hand was 28.2 kg/cm2, which was 87% of the contralateral side. The mean Quick Disabilities of the Arm, Shoulder, and Hand score at follow-up was 23.9, with all patients returning to daily living activities and work. Patients reported minimal pain (1.3/10), with almost all (17/18) satisfied with the outcome of the surgery and describing that they would recommend this procedure. CONCLUSION Our case series highlights that the Medartis wrist arthrodesis plate is a newer design that is a well-tolerated option for wrist arthrodesis based on clinical assessment, functional hand assessment, and patient satisfaction, when compared with the existing literature on traditional plating systems.
Collapse
Affiliation(s)
- Joshua Briotti
- Royal Perth Hospital, WA, Australia
- University of Notre Dame Australia, Fremantle, WA, Australia
| | | | | | - Matthew Lawson-Smith
- University of Notre Dame Australia, Fremantle, WA, Australia
- Fremantle Hospital, WA, Australia
| |
Collapse
|
2
|
Cioffi A, Rovere G, Bosco F, Sinno E, Stramazzo L, Liuzza F, Ziranu A, Romeo M, Vigni GE, Galvano N, Maccauro G, Farsetti P, Rossello MI, Camarda L. Treatment of Scaphoid Non-Unions with Custom-Made 3D-Printed Titanium Partial and Total Scaphoid Prostheses and Scaphoid Interosseous Ligament Reconstruction. Healthcare (Basel) 2023; 11:3123. [PMID: 38132013 PMCID: PMC10743063 DOI: 10.3390/healthcare11243123] [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: 07/30/2023] [Revised: 12/02/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE Treatment of scaphoid fracture sequelae is still an unsolved problem in hand surgery. Custom-made 3D-printed titanium partial and total scaphoid prosthesis and scaphoid interosseous ligament reconstruction (SLIL) are performed in cases of non-union and isolated aseptic necrosis of the proximal scaphoid pole and when it is impossible to save the scaphoid bone, respectively. This study aims to evaluate the clinical, functional and radiographic results after these two prosthesis implantations. METHODS Between January 2019 and July 2020, nine partial and ten total scaphoid prostheses were implanted using custom-made 3D-printed titanium implants. Evaluation criteria included carpal height ratio (CHR), radioscaphoid angle, wrist extension and flexion, radial deviation and ulnar deviation of the wrist, grip strength and pinch strength, Visual Analogue Scale (VAS), the Disabilities of Arm, Shoulder, and Hand (DASH) score, and the Patient-Rated Wrist Evaluation (PRWE). RESULTS Clinical, functional, and radiographic improvements were found in all outcomes analyzed for both patient groups. The VAS pain scale obtained the most remarkable improvement at the one-year follow-up. The results of the DASH scores and the PRWE were good, with a great rate of patient satisfaction at the end of the follow-up. SLIL reconstruction also provided excellent stability and prevented a mid-carpal bone collapse in the short- and medium-term follow-up. CONCLUSIONS A custom-made 3D-printed titanium partial or total scaphoid prosthesis is a viable solution for patients with scaphoid non-union and necrosis or complete scaphoid destruction in whom previous conservative or surgical treatment has failed.
Collapse
Affiliation(s)
- Alessio Cioffi
- Department of Orthopaedic Surgery (DICHIRONS), University of Palermo, 90133 Palermo, Italy; (A.C.); (L.S.); (M.R.); (G.E.V.); (N.G.)
| | - Giuseppe Rovere
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.R.); (F.L.); (A.Z.); (G.M.)
- Department of Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Francesco Bosco
- Department of Orthopaedics and Traumatology, University of Turin, 10126 Turin, Italy;
| | - Ennio Sinno
- Orthopaedic and Traumatology Department, S. Spirito Hospital, 00193 Rome, Italy;
| | - Leonardo Stramazzo
- Department of Orthopaedic Surgery (DICHIRONS), University of Palermo, 90133 Palermo, Italy; (A.C.); (L.S.); (M.R.); (G.E.V.); (N.G.)
| | - Francesco Liuzza
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.R.); (F.L.); (A.Z.); (G.M.)
| | - Antonio Ziranu
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.R.); (F.L.); (A.Z.); (G.M.)
| | - Michele Romeo
- Department of Orthopaedic Surgery (DICHIRONS), University of Palermo, 90133 Palermo, Italy; (A.C.); (L.S.); (M.R.); (G.E.V.); (N.G.)
| | - Giulio Edoardo Vigni
- Department of Orthopaedic Surgery (DICHIRONS), University of Palermo, 90133 Palermo, Italy; (A.C.); (L.S.); (M.R.); (G.E.V.); (N.G.)
| | - Nicolò Galvano
- Department of Orthopaedic Surgery (DICHIRONS), University of Palermo, 90133 Palermo, Italy; (A.C.); (L.S.); (M.R.); (G.E.V.); (N.G.)
| | - Giulio Maccauro
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.R.); (F.L.); (A.Z.); (G.M.)
| | - Pasquale Farsetti
- Department of Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Mario Igor Rossello
- Hand Surgery Department “Renzo Mantero”, Ospedale San Paolo, 17100 Savona, Italy;
| | - Lawrence Camarda
- Department of Orthopaedic Surgery (DICHIRONS), University of Palermo, 90133 Palermo, Italy; (A.C.); (L.S.); (M.R.); (G.E.V.); (N.G.)
| |
Collapse
|
3
|
Owen DH, Wang D, Cong X, Mowbray C, Perriman DM, Roberts CJ, Smith PN, Drobetz H, Ackland D. Biomechanical Performance of Total Wrist Arthrodesis Plates With and Without Arthrodesis of the Carpometacarpal Joint. Hand (N Y) 2023:15589447231198263. [PMID: 37804161 DOI: 10.1177/15589447231198263] [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: 10/09/2023]
Abstract
BACKGROUND It is unknown whether total wrist arthrodesis (TWA) should be performed with or without arthrodesis of the carpometacarpal joint (CMCJ). The aim of this study is to compare CMCJ-spanning TWA plates using 3D printed wrist arthrodesis model with and without arthrodesis of the CMCJ. METHODS Total wrist arthrodesis plates mounted to 3D printed models were tested under a 4-N bending load at 4 Hz for 50 000 cycles, increased by 15% every 10 000 cycles until failure. RESULTS Plates with arthrodesis CMCJ were stiffer and failed at a significantly greater load and number of cycles than plates mounted to models without CMCJ arthrodesis. The Synthes stainless steel locking TWA plate performed better than the Trimed plate applied to the model without CMCJ arthrodesis and the Acumed plate applied to the model with CMCJ arthrodesis. Based on these findings, we recommend arthrodesis of the CMCJ in TWA. CONCLUSIONS Incorporation of the CMCJ in TWA may protect against plate failure. If arthrodesis of the CMCJ is not performed, plate removal should be considered before breakage occurs. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- David H Owen
- Canberra Hospital, ACT, Australia
- Australian National University Medical School, Canberra, ACT, Australia
| | | | - Xu Cong
- The University of Melbourne, VIC, Australia
| | | | - Diana M Perriman
- Canberra Hospital, ACT, Australia
- Australian National University Medical School, Canberra, ACT, Australia
| | - Chris J Roberts
- Canberra Hospital, ACT, Australia
- Australian National University Medical School, Canberra, ACT, Australia
| | - Paul N Smith
- Canberra Hospital, ACT, Australia
- Australian National University Medical School, Canberra, ACT, Australia
| | - Herwig Drobetz
- Lismore Base Hospital, NSW, Australia
- Bond University, Robina, QLD, Australia
| | | |
Collapse
|
4
|
Rioux-Forker D, Patel RS, Hinchcliff KM, Shin AY. The Effect of 3rd Carpometacarpal Arthrodesis in the Outcomes of Total Wrist Fusion Using Modern Plate Technology. J Wrist Surg 2023; 12:400-406. [PMID: 37841357 PMCID: PMC10569833 DOI: 10.1055/s-0043-1768945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/28/2022] [Indexed: 10/17/2023]
Abstract
Background The inclusion of the third carpometacarpal (CMC) joint in the fusion mass in total wrist fusion (TWF) remains controversial. Our goal was to evaluate the clinical outcomes and effects of third CMC joint arthrodesis compared with bridging the CMC joint during TWF. A retrospective chart review was performed. Outcomes assessed included hardware loosening, hardware failure, symptomatic hardware necessitating removal, and need for revision arthrodesis. Case Description/Literature Review We found that concomitant third CMC joint arthrodesis was associated with a significantly reduced rate of radiocarpal and midcarpal joint nonunion, hardware loosening, and symptomatic hardware removal when compared to bridging of the CMC joint. There was no significant difference in hardware failure rates or the need for revision arthrodesis. Clinical Relevance When using a contoured dorsal spanning plate, concomitant CMC joint arthrodesis should be considered during TWF to mitigate against hardware loosening and symptomatic hardware. Level of Evidence Level IV.
Collapse
Affiliation(s)
- Dana Rioux-Forker
- Division of Plastic Surgery, Department of Surgery, Saint Luke's Hospital, Kansas City, Missouri
| | - Raahil S. Patel
- Department of Orthopedic Surgery, University of South Florida, Tampa, Florida
| | - Katharine M. Hinchcliff
- Division of Plastic Surgery, Department of Surgery, University of California San Diego, San Diego, California
| | - Alexander Y. Shin
- Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
5
|
Rodríguez-Nogué L, Martínez-Villén G. Results of the total wrist arthrodesis with contoured plate in a series of 41 wrists with median follow-up of 6 years. Acta Orthop Belg 2022; 88:636-641. [PMID: 36791719 DOI: 10.52628/88.3.10158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
We present a comparative analysis between the pre and postoperative status of 41 wrists subjected to total arthrodesis with contoured plate, analysing the functional and radiological results, subjective satisfaction and return to work. The indications for surgery were post-traumatic arthritis (56.1%), Kien- böck's disease (17.1%), rheumatic disease (14.6%) or other reasons (12.2%). In 75.6% of the procedures, proximal row carpectomy took place prior to or at the same time as the surgical fusion procedure. The median follow-up was 6 years. Postoperatively, pain decreased by 7.5 points on the Visual Analogue Scale and grip strength increased by 6.3 kg. The improvement in the Quick Disabilities of the Arm, Shoulder and Hand was 43.5 points and 53.2 in the Patient- Rated Wrist Evaluation. All changes were statistically significant. There were postoperative complications in 14.6% of the arthrodesis procedures. Radiocarpal fusion was complete in 97.6% of cases. Finally, 62.5% of patients were able to return to work, with 92.5% being satisfied or very satisfied. These results allow us to conclude that, in the medium term, total wrist arthrodesis with contoured plate is a reliable and safe technique for the treatment of advanced radiocarpal arthritis.
Collapse
|
6
|
Kachooei AR, Jones CM, Beredjiklian P. Locked Intramedullary Total Wrist Arthrodesis: A Report of Three Patients With Distal Screw Migration. Cureus 2022; 14:e27420. [PMID: 36051714 PMCID: PMC9420041 DOI: 10.7759/cureus.27420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 11/19/2022] Open
Abstract
Intramedullary (IM) fixation for the total wrist arthrodesis (TWA) is supposed to lower the hardware complication rate by eliminating soft tissue irritation. In this report, we present three patients with distal metacarpal screw migration requiring unplanned secondary surgery for screw removal in one patient while it was managed nonoperatively in the other two. All three patients had complete radiocarpal fusion by four months postop. There was no attempted third carpometacarpal (CMC) fusion in any of our patients. Screw migration was found between 1.5-3.5 months postop and remained stable until the final follow-up in the nonoperatively managed patients. One patient with screw removal continued to have mild tenderness over the third CMC, which was managed nonoperatively.
Collapse
|
7
|
Owen DH, Perriman DM, Policinski I, Damiani M, Smith PN, Roberts CJ. Total wrist arthrodesis with and without arthrodesis of the carpoMetacarpal joint (WAWWAM): study protocol. BMC Musculoskelet Disord 2021; 22:766. [PMID: 34496832 PMCID: PMC8425134 DOI: 10.1186/s12891-021-04644-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background It is controversial whether or not the carpometacarpal joint (CMCJ) should be included in total wrist arthrodesis (TWA). Complications commonly occur at this site and studies examining its inclusion and exclusion are conflicting. A randomised clinical trial comparing wrist arthrodesis with CMCJ arthrodesis and spanning plate to wrist arthrodesis with CMCJ preservation and non-CMCJ spanning plate has not been performed. Method A single centre randomised clinical trial including 120 adults with end-stage isolated wrist arthritis will be performed to compare TWA with and without the CMCJ included in the arthrodesis. The primary outcome is complications in the first post-operative year. Secondary outcomes are Disabilities of the Arm, Shoulder and Hand (DASH) score, Patient Rated Wrist Evaluation (PRWE) and grip strength measured at 1, 2 and 5 years. Late complications, return to work and satisfaction will also be recorded. Discussion It is unknown whether the CMCJ should be included in TWA. This trial will contribute to an improved understanding of optimal management of the CMCJ in total wrist arthrodesis. Trial registration This trial was prospectively registered with the Australia New Zealand Clinical Trials Registry with identifying number ACTRN12621000169842 on the 16th February 2021. WHO: U1111–12626523. ANZCTR: ACTRN12621000169842 Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04644-4.
Collapse
Affiliation(s)
- David H Owen
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Building 6 Level 1, PO Box Woden ACT, Canberra, 2606, Australia. .,Australian National University Medical School, Level 2 Peter Baume Building 42, Linneaus Way, Canberra, 0200, Australia.
| | - Diana M Perriman
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Building 6 Level 1, PO Box Woden ACT, Canberra, 2606, Australia.,Australian National University Medical School, Level 2 Peter Baume Building 42, Linneaus Way, Canberra, 0200, Australia
| | - Igor Policinski
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Building 6 Level 1, PO Box Woden ACT, Canberra, 2606, Australia.,Australian National University Medical School, Level 2 Peter Baume Building 42, Linneaus Way, Canberra, 0200, Australia
| | - Maurizio Damiani
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Building 6 Level 1, PO Box Woden ACT, Canberra, 2606, Australia.,Australian National University Medical School, Level 2 Peter Baume Building 42, Linneaus Way, Canberra, 0200, Australia
| | - Paul N Smith
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Building 6 Level 1, PO Box Woden ACT, Canberra, 2606, Australia.,Australian National University Medical School, Level 2 Peter Baume Building 42, Linneaus Way, Canberra, 0200, Australia
| | - Chris J Roberts
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Building 6 Level 1, PO Box Woden ACT, Canberra, 2606, Australia.,Australian National University Medical School, Level 2 Peter Baume Building 42, Linneaus Way, Canberra, 0200, Australia
| |
Collapse
|
8
|
Le Nen D, Kerfant N, Dellestable A, Andro C, Letissier H. Wrist fusion in peripheral paralysis. HAND SURGERY & REHABILITATION 2021; 41S:S98-S104. [PMID: 34487861 DOI: 10.1016/j.hansur.2021.01.010] [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: 10/05/2019] [Revised: 01/17/2021] [Accepted: 01/19/2021] [Indexed: 11/19/2022]
Abstract
In cases of paralysis of the upper limb, wrist fusion is useful in selected indications, especially when there are little to no tendon transfers available to restore finger function and wrist extension. Wrist fusion is particularly useful in the sequelae of brachial plexus lesions and in total paralysis of the radial nerve with hand drop and preserved wrist flexors. Numerous fusion techniques have been proposed. In cases of sequelae of brachial plexus lesions, locking of pronation-supination is associated with the wrist fusion. The use of anatomical plates has dropped the non-union and complication rates.
Collapse
Affiliation(s)
- D Le Nen
- Service de Chirurgie de la Main et du Membre Supérieur, CHU, Hôpital de la Cavale Blanche, Boulevard Tanguy Prigent, 29200 Brest, France.
| | - N Kerfant
- Service de Chirurgie Plastique et Reconstructrice, CHU, Hôpital de la Cavale Blanche, Boulevard Tanguy Prigent, 29200 Brest, France
| | - A Dellestable
- Service de Chirurgie de la Main et du Membre Supérieur, CHU, Hôpital de la Cavale Blanche, Boulevard Tanguy Prigent, 29200 Brest, France
| | - C Andro
- Service de Chirurgie de la Main et du Membre Supérieur, CHU, Hôpital de la Cavale Blanche, Boulevard Tanguy Prigent, 29200 Brest, France
| | - H Letissier
- Service de Chirurgie de la Main et du Membre Supérieur, CHU, Hôpital de la Cavale Blanche, Boulevard Tanguy Prigent, 29200 Brest, France
| |
Collapse
|
9
|
Van Handel AC, Galvez MG, Brogan DM, Boyer MI, Cipriano CA, Hirbe AC, Pet MA. Vascularized Ulnar Transposition and Radioulnoscapholunate Fusion With Volar Locking Plate in a Dorsal Position Following Resection of Giant Cell Tumor of the Distal Radius. Tech Hand Up Extrem Surg 2020; 24:142-150. [PMID: 32841989 DOI: 10.1097/bth.0000000000000282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Giant cell tumor of the distal radius is a rare, locally destructive, and frequently recurrent tumor. We present a case of Campanacci Grade III giant cell tumor of the distal radius with pathologic fracture and cortical destruction which was treated with neoadjuvant denosumab. This facilitated en-bloc resection of the entire distal radius, including the articular surface, while minimizing tumor contamination. Reconstruction was accomplished using a vascularized ulnar transposition flap to facilitate radioulnoscapholunate fusion, which was fixated using a long-stem contralateral variable angle locking volar distal radius plate in a dorsal position. This case illustrates multidisciplinary management of a challenging reconstructive problem and demonstrates a novel strategy for fixation which repurposes familiar and readily available hardware to provide optimal osteosynthesis.
Collapse
Affiliation(s)
| | - Michael G Galvez
- Division of Plastic Surgery, Valley Children's Hospital, Madera, CA
| | | | | | | | - Angela C Hirbe
- Division of Oncology, Washington University in St. Louis, St. Louis, MO
| | | |
Collapse
|