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Safoury Y, Afifi A, Farghaly A, Khalid O. Outcomes after radioscapholunate arthrodesis for intra-articular malunion of distal radius fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2493-2500. [PMID: 38652314 PMCID: PMC11291562 DOI: 10.1007/s00590-024-03934-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/25/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE To study the clinical, radiological, and functional outcomes after of radioscapholunate (RSL) fusion for intra-articular malunion of the distal radius. METHODS This retrospective study included 26 patients (17 males and 9 females) with intra-articular malunion of distal radius fractures who underwent RSL arthrodesis using locked miniplates (without distal scaphoid excision) between 2012 and 2020. Their mean age was 43 years (range, 32-56). Patients were assessed radiographically for union and clinically for range of motion, grip strength, and pain (assessed by Visual Analogue Scale (VAS) for pain). Functional evaluation was performed by using the Mayo modified wrist score (MMWS) and the Disabilities for the Arm, Shoulder, and Hand (DASH) questionnaire. RESULTS All patients showed complete healing at the fusion site after a mean of 8.7 weeks (range, 8-12). The mean follow-up period was 72 months (range, 60-84). The pinch strength improved from a mean of 6.2 kg (range, 3-12) to a mean of 9.8 kg (range, 5-18) which represents 80% of the contralateral side. The mean pinch strength was 7 kg (range, 5-18) which presents 80% of the other side. VAS for pain showed a mean improvement of 72.6%. The DASH score improved to a mean of 19.2 (range, 14-24). The MMWS improved to a mean of 68 (range, 45-86). At the final follow-up period, no degenerative changes were detected in the midcarpal joint. CONCLUSION RSL arthrodesis (using locked miniplates without distal scaphoid excision) is a reliable surgical procedure to manage cases of radiocarpal OA after intra-articular malunion of distal radius fractures with good clinical and radiological outcomes. LEVEL OF EVIDENCE Level IV- therapeutic.
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Affiliation(s)
- Yasser Safoury
- Hand, Upper Limb, and Microsurgery Unit, Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Afifi
- Hand, Upper Limb, and Microsurgery Unit, Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Ahmed Farghaly
- Hand, Upper Limb, and Microsurgery Unit, Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Omar Khalid
- Hand, Upper Limb, and Microsurgery Unit, Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
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Deguchi H, Komura S, Hirakawa A, Satake T, Sohmiya K, Hirose H, Masuda T, Ito Y, Akiyama H. Radioscapholunate arthrodesis using a dorsal locking plate for neglected un-united distal radius fractures; a report of two cases. J Orthop Sci 2023; 28:1169-1174. [PMID: 33414029 DOI: 10.1016/j.jos.2020.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/05/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Hiroaki Deguchi
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Shingo Komura
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan.
| | - Akihiro Hirakawa
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takashi Satake
- Department of Orthopaedic Surgery, Gifu Seiryu Hospital, Gifu, Japan
| | - Kazuki Sohmiya
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hitoshi Hirose
- Department of Orthopaedic Surgery, Kizawa Memorial Hospital, Gifu, Japan
| | - Takahiro Masuda
- Department of Orthopaedic Surgery, Kizawa Memorial Hospital, Gifu, Japan
| | - Yoshiki Ito
- Department of Orthopaedic Surgery, Kizawa Memorial Hospital, Gifu, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
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Radiocarpal Fusion: Indications, Technique, and Modifications. J Hand Surg Am 2022; 47:772-782. [PMID: 35641389 DOI: 10.1016/j.jhsa.2022.04.002] [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: 01/28/2020] [Revised: 01/24/2022] [Accepted: 04/02/2022] [Indexed: 02/02/2023]
Abstract
Degenerative disorders of the wrist may affect isolated joints and inhibit normal functions of the wrist secondary to pain and stiffness. These processes that affect only the radiocarpal joint may be secondary to posttraumatic osteoarthritis, primary osteoarthritis, or rheumatoid arthritis. Radiocarpal wrist arthrodesis may help preserve some of the native wrist kinematics while alleviating pain and improving the range of motion. However, the surgeon must ensure that the patient's pathologic process primarily affects the radiocarpal articulations while relatively sparing the midcarpal articulations. Depending on the location of the pathology, isolated radiolunate or radioscapholunate arthrodesis have been described to preserve some motion in the midcarpal joint. To maximize motion in the midcarpal joint after radiocarpal arthrodesis, techniques for distal scaphoid and triquetrum excision have been described. We report patient outcomes for various techniques and describe our preferred technique for radioscapholunate arthrodesis using distal scaphoid excision.
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Coskun T, Arik HO. Mid-term radiological results of intra-articular penetration of the screw used in scaphoid surgery. Niger J Clin Pract 2022; 25:1158-1162. [DOI: 10.4103/njcp.njcp_1833_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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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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A Biomechanical Comparison of Modified Radioscapholunate Fusion Constructs for Radiocarpal Arthritis. J Hand Surg Am 2020; 45:983.e1-983.e7. [PMID: 32327339 DOI: 10.1016/j.jhsa.2020.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 01/30/2020] [Accepted: 03/04/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE This biomechanical study compared fixation constructs used in radioscapholunate (RSL) arthrodesis. We hypothesized that plates and screws, pin plate, and headless screws would all provide similarly stable fixation constructs. METHODS We chose 27 fresh-frozen cadaveric extremities, 14 of which were matched pairs and randomized them into 3 groups to match age, body mass index, and sex. An RSL arthrodesis was simulated with plates and screws, pin plates, or headless compression screws via a standard dorsal approach to the wrist. Specimens were mounted into a custom jig and cycled through an arc of 120° for 5,000 cycles to simulate 6 weeks range of motion (ROM). A 9-mm stroke differential variable reluctance transducer recorded continuous displacement, and gross hardware failure in the form of screw or pin cutout was investigated after the simulation. RESULTS Greater distraction across the RSL articulation was observed in the headless screws compared with the plate-and-screws and pin-plate constructs, with no difference between the plates and screws and pin plates. Greater average displacement was observed in the headless screws compared with the plate-and-screws and pin-plate constructs, with no difference between the pin plates and plates and screws. Gross hardware failure was observed least in plates and screws followed by pin plates. CONCLUSIONS Plate-and-screw and pin-plate constructs are biomechanically superior in resisting RSL distraction compared with headless compression screws for RSL arthrodesis over 6 weeks of simulated ROM in the absence of healing. CLINICAL RELEVANCE The results of this study demonstrated negligible arthrodesis site distraction in the plate-and-screws and pin-plate constructs when 6 weeks of ROM was simulated. When translated to a clinical scenario, these findings may allow earlier discontinuation of external immobilization after surgery.
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Spies CK, Ayache A, Löw S, Langer MF, Hohendorff B, Müller LP, Oppermann J, Unglaub F. [Revision surgery after failed (partial-) arthrodesis of the wrist]. DER ORTHOPADE 2020; 49:784-796. [PMID: 32809041 DOI: 10.1007/s00132-020-03967-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
(Partial) arthrodeses of the wrist have been proven cornerstones to treat many lesions for decades, especially in the case of revision surgery. Four-corner, scapho-trapezo-trapezoidal (STT), radio-scapho-lunate (RSL) and total wrist fusions are very common techniques in hand surgery. However, even these proven surgical procedures have significant non-fusion rates. Prior to revising a failed arthrodesis, it is essential to analyse the latter failure precisely. A technically adequate revision is only feasible when based on a correct and meticulous analysis. The understanding of the biological processes and technical aspects of the implants are the basis for solving this issue.
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Affiliation(s)
- C K Spies
- Handchirurgie, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Deutschland.
| | - A Ayache
- Handchirurgie, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Deutschland
| | - S Löw
- Praxis für Handchirurgie und Unfallchirurgie, Bad Mergentheim, Deutschland
| | - M F Langer
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | - B Hohendorff
- Abteilung für Hand‑, Ästhetische und Plastische Chirurgie, Elbe Klinikum Stade, Stade, Deutschland
| | - L P Müller
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Köln, Deutschland
| | - J Oppermann
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Köln, Deutschland
| | - F Unglaub
- Handchirurgie, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Deutschland.,Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
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Degeorge B, Montoya-Faivre D, Dap F, Dautel G, Coulet B, Chammas M. Radioscapholunate Fusion for Radiocarpal Osteoarthritis: Prognostic Factors of Clinical and Radiographic Outcomes. J Wrist Surg 2019; 8:456-462. [PMID: 31815059 PMCID: PMC6892650 DOI: 10.1055/s-0039-1688939] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/09/2019] [Indexed: 10/26/2022]
Abstract
Background Radioscapholunate (RSL) fusion is a surgical option to manage radiocarpal osteoarthritis. Many authors upgrade the procedure by adding distal scaphoid excision with or without excision of the triquetrum. Our objective was to identify the prognostic factors for good clinical and radiographic outcomes of RSL arthrodesis. Purpose Distal scaphoid excision improves both scaphotrapeziotrapezoidal osteoarthritis and radiocarpal fusion, and excision of the triquetrum is not critical to achieving satisfactory outcomes. Methods In this retrospective and bicentric investigation, all wrists were managed with RSL fusion for posttraumatic radiocarpal osteoarthritis. A total of 85 patients were included and evaluated at the revision by clinical (pain, wrist motion, and strength), functional (Disabilities of the Arm, Shoulder, and Hand questionnaire, Patient-Related Wrist Evaluation score, and Modified Mayo Wrist Score), and radiological (scaphotrapeziotrapezoidal, midcarpal osteoarthritis, and radiocarpal nonunion) examinations. We assessed prognostic factors for clinical and radiographic (osteoarthritis and nonunions) outcomes. Results The average follow-up was 9.1 years (1-21.4). Work-related accidents adversely impacted the clinical outcomes, and distal scaphoid excision significantly improved them and decreased scaphotrapeziotrapezoidal osteoarthritis and nonunion. Neither distal scaphoid excision nor excision of the triquetrum influenced midcarpal osteoarthritis. Radiocarpal fusion was significantly promoted by memory staples and bone grafting. Discussion Distal scaphoid excision should be preferred to improve the functional results while decreasing scaphotrapeziotrapezoidal osteoarthritis and radiocarpal nonunion rates. Excision of the triquetrum appears to be an alternative to radioulnar resection-arthroplasty to solve ulnocarpal impaction syndrome. Strict surgical procedure must be observed to promote RSL fusion combining solid bone fixation and the use of bone graft. Level of evidence This is a level IV, case series, retrospective series.
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Affiliation(s)
- Benjamin Degeorge
- Department of Hand and Upper Extremity Surgery, Peripheral Nerves Surgery, Lapeyronie University Hospital of Montpellier, Montpellier, France
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, University Hospital of Nancy, Nancy, France
| | - David Montoya-Faivre
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, University Hospital of Nancy, Nancy, France
| | - François Dap
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, University Hospital of Nancy, Nancy, France
| | - Gilles Dautel
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, University Hospital of Nancy, Nancy, France
| | - Bertrand Coulet
- Department of Hand and Upper Extremity Surgery, Peripheral Nerves Surgery, Lapeyronie University Hospital of Montpellier, Montpellier, France
| | - Michel Chammas
- Department of Hand and Upper Extremity Surgery, Peripheral Nerves Surgery, Lapeyronie University Hospital of Montpellier, Montpellier, France
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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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Comparison of radiographic and functional results of die-punch fracture of distal radius between volar locking plating (VLP) and external fixation (EF). J Orthop Surg Res 2019; 14:373. [PMID: 31735162 PMCID: PMC6859611 DOI: 10.1186/s13018-019-1442-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/31/2019] [Indexed: 12/21/2022] Open
Abstract
Purpose The aim of this study is to investigate the radiographic and functional results of die-punch fracture of distal radius treated by volar locking plate (VLP) or external fixation (EF). Methods Between January 2015 and June 2018, 87 patients who were treated with EF or VLP were included in this study. At postoperative 6 months and at least 12 months, radiographic and functional outcomes were evaluated, and compared between two groups using SPSS 21.0. Results The follow-up period was 15.6 months in average, and at the mean 8.5 weeks bony union was achieved in all patients. At 6-month visit, patients in VLP group had significantly better wrist flexion (79.2° vs. 71.8°) and pronation (79.5° vs. 75.2°) than those in EF group, but the difference was non-significant at the last visit (> 12 months); as for other parameters, no significant differences were observed. No significant difference was found between both groups in term of volar tilt, radial inclination, radial height, ulnar variance, or Gartland–Werley score and DASH. The articular step-off was significantly greater in EF than VLP group (0.6 mm vs. 0.3 mm, p < 0.001). The overall incidence of complications seemed higher in EF group (25% vs. 14%), but not approaching to the statistical significance level. Conclusions Patients with VLP fixation of die-punch fractures had better wrist flexion and pronation at 6-month visit and more favorable wrist joint congruence at the last visit, but ultimately their outcome was comparable with those treated by EF.
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Yu X, Yu Y, Shao X, Bai Y, Zhou T. Volar locking plate versus external fixation with optional additional K-wire for treatment of AO type C2/C3 fractures: a retrospective comparative study. J Orthop Surg Res 2019; 14:271. [PMID: 31455394 PMCID: PMC6712714 DOI: 10.1186/s13018-019-1309-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/07/2019] [Indexed: 12/28/2022] Open
Abstract
Purpose This study aimed to compare the radiographic and functional results of Arbeitsgemeinschaftfür Osteosynthesefragen (AO) type C2/C3 fracture of distal radius between volar locking plate (VLP) and external fixation (EF). Methods It was a retrospective comparative study. Between January 2015 and March 2018, a total of 62/117 patients who underwent EF (23) or VLP fixation (39) for AO type C2/C3 distal radius fractures were assessed. The follow-up period was at least 12 months. Gartland–Werley scale and the disabilities of the arm, shoulder, and hand (DASH) scale were used to evaluate the overall functional outcomes; wrist range of motion and grip strength were measured. The radiographic parameters included radial inclination, volar tilt, radial length, ulnar variance, and articular step-off. All of the comparisons were performed using SPSS 21.0. Results The mean follow-up time was 17.1 months. At final visit, VLP performed better in wrist flexion (69.7° vs 62.3°, p < 0.001), forearm pronation (73.1° vs 64.8°, p = 0.027) and supination (70.6° vs 63.1°, p = 0.033) than EF, but not different with regard to other kinematic parameters. No significant difference was found between two groups, in term of Gartland-Werley or DASH score (p > 0.05). The ulnar variance and articular step-off was significantly more improved in VLP than EF group, being 0.6 vs 1.6 mm (p = 0.002) and 0.5 vs 1.2 mm (p = 0.007). The overall rate of complications did not differ in both groups (28.2% vs 34.5%) (p = 0.587). Conclusions Compared to EF, VLP fixation showed better performance in wrist mobility, correction of ulnar variance, and improving articular congruence, but with the comparable overall functional outcomes and complication rate.
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Affiliation(s)
- Xiaofei Yu
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yadong Yu
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China. .,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.
| | - Xinzhong Shao
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yanbin Bai
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Tong Zhou
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
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McNary SM, Heyrani N, Volk I, Szabo RM, Bayne CO. The Effect of Radioscapholunate Fusion With and Without Distal Scaphoid and Triquetrum Excision on Capitolunate Contact Pressures. J Hand Surg Am 2019; 44:420.e1-420.e7. [PMID: 30241977 DOI: 10.1016/j.jhsa.2018.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 05/29/2018] [Accepted: 07/17/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the effects of motion-increasing modifications to radioscapholunate (RSL) arthrodesis on capitolunate contact pressure in cadaveric wrist specimens. METHODS Ten fresh-frozen cadaveric wrists were dissected of all superficial soft tissue, potted in polymethyl-methacrylate, and the carpus exposed via a ligament-sparing capsulotomy. An RSL arthrodesis was simulated using 2 2.4-mm distal radius plates with locking screws. The distal scaphoid pole and triquetrum were removed with an osteotome and rongeur, respectively. Contact area, pressure, and force were measured in the capitolunate joint during the application of a 35-N uniaxial load using pressure-sensitive film. Measurements were obtained before and after simulated RSL fusion, following distal scaphoidectomy and after triquetrectomy. RESULTS The combination of RSL fusion with distal scaphoid excision (DSE) increased contact forces in the capitolunate joint by 50% over controls. An RSL fusion, and RSL fusion with DSE and triquetrum excision (TE), exhibited intermediate levels of contact force between controls and RSL fusion with DSE. Capitolunate contact pressures were similar between all experimental groups. Contact area in the capitolunate joint increased by 43% after RSL fusion with DSE over intact specimen controls. Lastly, contact area in wrists with RSL fusion, and RSL fusion with DSE and TE, were elevated, but not significantly different from intact controls. CONCLUSIONS A DSE performed at the time of RSL fusion results in increased midcarpal joint contact force and area, with resultant contact pressures unchanged. Triquetrectomy, which has been previously shown to improve range of motion, did not increase contact forces in the capitolunate joint. CLINICAL RELEVANCE If a surgeon is contemplating performing an RSL arthrodesis with DSE, we recommend adding a triquetrectomy to improve motion because this does not add to the potentially deleterious effects of increased midcarpal contact force.
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Affiliation(s)
- Sean M McNary
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA
| | - Nasser Heyrani
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA
| | - Ido Volk
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA
| | - Robert M Szabo
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA
| | - Christopher O Bayne
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA.
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Abstract
PURPOSE OF REVIEW Malunion remains a common complication in the treatment of distal radius fractures. The purpose of this review was to discuss the various approaches in planning and surgical management for extra- and intra-articular distal radius malunions. RECENT FINDINGS Several recent studies have reported good results with surgical correction of distal radius malunions utilizing a number of preoperative planning methods and surgical approaches. Three-dimensional models and custom cutting guides have recently become more popular, but their benefit in comparison to other methods remains unclear. Regardless of preoperative planning method or surgical approach, good results can be achieved with correction of distal radius malunion with careful attention to patient selection, indications, and surgical technique.
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Affiliation(s)
- Brady T Evans
- Department of Orthopaedic Surgery, Division of Hand and Upper Extremity Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jesse B Jupiter
- Department of Orthopaedic Surgery, Division of Hand and Upper Extremity Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Ha NB, Phadnis J, MacLean SBM, Bain GI. Radioscapholunate fusion with triquetrum and distal pole of scaphoid excision: long-term follow-up. J Hand Surg Eur Vol 2018; 43:168-173. [PMID: 28820008 DOI: 10.1177/1753193417724139] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED The purpose of this study was to assess the long-term outcomes of radioscapholunate fusion, with and without distal pole of scaphoid excision and excision of the triquetrum. These compromised three operative groups. Seventeen patients were identified with a minimum of 10 years follow-up, with a mean of 15 years (range 10-19). Fifteen of the 17 patients were satisfied with their outcome. Two were converted to total wrist fusion. The mean outcomes scores were; pain visual analogue scale score 2.1/10, Quick Disabilities of the Arm, Shoulder, and Hand 29 and Modified Mayo Wrist score 60. Patients with excision of the triquetrum had a mean radial-ulnar arc increase of 10° compared with the other two groups, but this was not statistically significant. The mean space for the scaphocapitate joint was 1.7 mm and lunocapitate joint was 1.3 mm at latest follow-up. Close adherence to the indications and surgical technique provided a sustainable good clinical outcome. Patients who obtained a good result at 2 years were likely to achieve a good long-term outcome. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ngoc B Ha
- 1 Department of Orthopaedic Surgery, Flinders University, Adelaide, South Australia
| | - Joideep Phadnis
- 2 Department of Trauma and Orthopaedics, Brighton and Sussex University Hospital, Brighton, UK
| | - Simon B M MacLean
- 1 Department of Orthopaedic Surgery, Flinders University, Adelaide, South Australia
| | - Gregory I Bain
- 1 Department of Orthopaedic Surgery, Flinders University, Adelaide, South Australia
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15
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Volar Radioscapholunate Arthrodesis and Distal Scaphoidectomy After Malunited Distal Radius Fractures. J Hand Surg Am 2017; 42:754.e1-754.e8. [PMID: 28676150 DOI: 10.1016/j.jhsa.2017.05.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 05/17/2017] [Accepted: 05/24/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to assess range of motion (ROM), pain, and incidence of radiographic degenerative joint disease (DJD) after volar radioscapholunate (RSL) arthrodesis and distal scaphoidectomy (DSE) following malunited distal radius fractures (DRF). METHODS Fourteen patients with malunited DRF and DJD limited to the radiocarpal joint underwent RSL arthrodesis and DSE between 2006 and 2014. These were retrospectively analyzed both clinically and radiologically. Eleven patients with a mean follow-up of 63 months (range, 30-97 months) were included in the final analysis because 1 was unavailable and 2 had died. The outcome was evaluated using parameters of pain, ROM, grip strength, nonunion rate, and DJD of the adjacent joints. In addition, self-assessment by patients was registered on the Disability of the Arm, Shoulder and Hand score, Patient-Rated Wrist Evaluation score, and Michigan Hand Outcomes Questionnaire. To investigate DJD and union, a computed tomography (CT) scan at the final follow-up visit was performed. RESULTS All patients showed union and no midcarpal DJD in the CT scans at final follow-up. The mean ROM in extension was 53°, flexion 42°, supination 81°, pronation 85°, radial deviation 10° and ulnar deviation 25°. The ROM in extension, extension/flexion arc, and supination improved significantly after surgery. Patients achieved a mean of 80% of grip strength compared with the other hand. CONCLUSIONS Volar angular stable plate RSL arthrodesis with resection of the distal scaphoid pole is a safe and effective method for treating malunited DRF. This leads to an improved ROM and low pain level. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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16
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Quadlbauer S, Pezzei C, Jurkowitsch J, Keuchel T, Hausner T, Leixnering M. Spontaneous radioscapholunate fusion after septic arthritis of the wrist: a case report. Arch Orthop Trauma Surg 2017; 137:579-584. [PMID: 28255620 DOI: 10.1007/s00402-017-2659-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Indexed: 12/28/2022]
Abstract
Bacterial septic arthritis rarely occurs in the upper extremities. Yet, early diagnosis and treatment is important, as a delay in diagnosis results in pain, impaired hand function, and degenerative joint disease. Radioscapholunate (RSL) arthrodesis is a well-established procedure for treating inflammatory arthritis and osteoarthritis (primary or posttraumatic), primarily to achieve pain relief. The wrist deformity correction offers an alternative option to total wrist arthrodesis. Indications for a RSL arthrodesis are osteoarthritis of the radiolunate and radioscaphoid joint with a concomitant intact midcarpal joint. We present a case study of spontaneous RSL fusion post wrist infection caused by a dog bite.
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Affiliation(s)
- S Quadlbauer
- Department of Traumatology, AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria. .,Ludwig Boltzmann Institute for Experimental und Clinical Traumatology, AUVA Research Center, 1200, Vienna, Austria. .,Austrian Cluster for Tissue Regeneration, 1200, Vienna, Austria.
| | - Ch Pezzei
- Department of Traumatology, AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - J Jurkowitsch
- Department of Traumatology, AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - T Keuchel
- Department of Traumatology, AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
| | - T Hausner
- Department of Traumatology, AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria.,Ludwig Boltzmann Institute for Experimental und Clinical Traumatology, AUVA Research Center, 1200, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, 1200, Vienna, Austria
| | - M Leixnering
- Department of Traumatology, AUVA Trauma Hospital Lorenz Böhler - European Hand Trauma Center, Donaueschingenstrasse 13, 1200, Vienna, Austria
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17
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Galvis EJ, Kumar KK, Özyurekoglu T. Radioscapholunate arthrodesis using low-profile dorsal pi plate. Tech Hand Up Extrem Surg 2013; 17:80-83. [PMID: 23689853 DOI: 10.1097/bth.0b013e318280e9cc] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Radioscapholunate arthrodesis is a desirable method to treat isolated radiolunate arthritis or ulnar translocation of the carpal bones. An intact midcarpal joint is a prerequisite for functional range of motion. Previously, high rates of nonunion were observed with these procedures, as rigid fixation was difficult to obtain with simple Kirschner wires and screws. A successful outcome depends on bringing the scaphoid, lunate, and the radius to an anatomic alignment, and rigid fixation of the arthrodesis. We describe a technique for the arthrodesis of the radioscapholunate joint from the dorsal side using a low-profile locking Pi plate. We observed the advantages of an easy approach, better visualization of the joint, and easier manipulation of the carpal bones. The Pi plate fits on the scaphoid, lunate, and the radius with minimal adjustment. It is not necessary to remove the Lister's tubercle. Pi plate allows for rigid fixation and compression between the scaphoid, lunate, and the radius by 1 compression and 1 locking screw in scaphoid and lunate, and by 2 eccentric compression screws in the radius. Rectangular retinacular flaps were used under and over the extensor tendons. We performed these arthrodeses in patients with lunate fossa arthritis after a distal radius fracture, and with ulnar translocation of the carpus. We have observed excellent clinical results with about 50% of wrist motion preserved and no cases of nonunion or delayed union.
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Affiliation(s)
- Elkin J Galvis
- Kleinert and Kutz Hand Care Center, Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY 40202, USA
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18
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Biswas D, Wysocki RW, Cohen MS, Fernandez JJ. Radioscapholunate arthrodesis with compression screws and local autograft. J Hand Surg Am 2013; 38:788-94. [PMID: 23537444 DOI: 10.1016/j.jhsa.2013.01.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 09/04/2012] [Accepted: 01/21/2013] [Indexed: 02/02/2023]
Abstract
Radioscapholunate arthrodesis is performed for patients who experience pain and disability from radiocarpal arthritis. Initial reports from the 1980s demonstrated high nonunion rates and marginal clinical outcomes. Improvements in surgical technique and clearly defined indications have reduced nonunion rates and improved patient satisfaction. We present a technique using headless compression screws inserted through a dorsal approach, which optimizes hardware placement and incorporates local bone graft harvested from the insertion site to supplement the arthrodesis.
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Affiliation(s)
- Debdut Biswas
- Section of Hand and Elbow Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA
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19
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Holleran AM, Quigley RJ, Rafijah GH, Lee TQ. Radioscapholunate arthrodesis with excision of the distal scaphoid: comparison of contact characteristics to the intact wrist. J Hand Surg Am 2013; 38:706-11. [PMID: 23474154 DOI: 10.1016/j.jhsa.2013.01.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 01/14/2013] [Accepted: 01/17/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the midcarpal contact characteristics at the lunocapitate (LC) and scaphotrapezio-trapezoidal (STT) joints in 3 wrist conditions: intact, after simulating a radioscapholunate (RSL) arthrodesis, and after an RSL arthrodesis with distal scaphoid excision (DSE). METHODS Eight fresh-frozen cadaveric specimens were tested using a custom jig with the wrist in neutral, 15° and 30° flexion and extension, 10° radial deviation, and 20° ulnar deviation. The RSL arthrodesis was performed using 2.4-mm distal radius plates with locking screws. Using a pressure sensor, contact force, average pressure, peak pressure, and contact area at the STT and LC joints were measured for 3 conditions: intact wrist, RSL arthrodesis, and RSL arthrodesis with DSE. RESULTS Following RSL arthrodesis, average and peak pressure at the LC joint increased significantly compared to the intact wrist. In the STT joint, the average and peak contact pressure increased significantly compared to the intact wrist. Following DSE, average and peak pressure at the LC joint increased further compared to the RSL arthrodesis condition. CONCLUSIONS Our findings showed increased contact pressures in the STT and LC joint following RSL arthrodesis, which may explain the clinical findings of midcarpal arthritis. Also, although DSE may improve short-term range of motion and clinical incidence of midcarpal arthritis, our findings showed that this comes at a cost, as the remaining portions of the midcarpal joint are subject to higher forces and pressures following DSE. CLINICAL RELEVANCE Radioscapholunate arthrodesis results in increased midcarpal contact pressures that may explain the clinical incidence of midcarpal arthritis. Excision of the distal scaphoid further increases contact pressures in the remaining midcarpal joint and may further increase the incidence of midcarpal arthritis. These alterations in contact characteristics of the midcarpal joint should be considered when excising the distal scaphoid for improved range of motion.
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Affiliation(s)
- Adam M Holleran
- Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System, Long Beach, CA 90822, USA
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20
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Wysocki RW, Biswas D, Bayne CO. Injection Therapy in the Management of Musculoskeletal Injuries: Hand and Wrist. OPER TECHN SPORT MED 2012. [DOI: 10.1053/j.otsm.2012.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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21
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Abstract
Reports of coexisting avascular necrosis of more than one carpal bone are rare. We report coexisting avascular necrosis of the scaphoid and lunate in a 56-year-old woman with no history of using steroids or injury. We treated her with a radioscapholunate fusion with two angled 2.4 mm distal radius plates to stabilise the locking plate. At her 12-month follow up there was no evidence of non-union.
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Affiliation(s)
- Il-Jung Park
- Department of Orthopaedic Surgery, Bucheon St. Mary's Hospital, Catholic University of Korea, Bucheon, Korea
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22
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Berkhout MJ, Shaw MN, Berglund LJ, An KN, Berger RA, Ritt MJPF. The effect of radioscapholunate fusion on wrist movement and the subsequent effects of distal scaphoidectomy and triquetrectomy. J Hand Surg Eur Vol 2010; 35:740-5. [PMID: 20427404 DOI: 10.1177/1753193410370926] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Radioscapholunate arthrodesis is a salvage procedure indicated for osteoarthritis of the radiocarpal joint involving the lunate facet of the radius. This cadaver study examines changes in wrist motion resulting from radioscapholunate arthrodesis, and the effects of surgical techniques to improve the range of motion. Simulated radioscapholunate arthrodesis, distal scaphoidectomy and triquetrectomy were carried out sequentially on six cadaver forearms and measurements (maximum flexion/extension and radial/ulnar deviation) were taken in the intact situation and after each surgical step using a magnetic tracking device. Radioscapholunate arthrodesis diminishes the amplitudes of movements of the wrist in all directions, but range of motion in the radioscapholunate fused wrist improves after scaphoidectomy and improves further after triquetrectomy (88% of original flexion/extension and 98% of original radial/ulnar deviation). Radioscapholunate arthrodesis causes a significant change in kinematics between the hamate and the triquetrum in flexion/extension.
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Affiliation(s)
- M J Berkhout
- Department of Plastic, Reconstructive and Hand Surgery, VU University Hospital, Amsterdam, The Netherlands.
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23
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Argintar E, Edwards S. Volar radioscapholunate arthrodesis for malunited distal radius fracture with unsalvageable wrist articular degeneration: case report. J Hand Surg Am 2010; 35:1089-92. [PMID: 20610053 DOI: 10.1016/j.jhsa.2010.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 04/08/2010] [Accepted: 04/14/2010] [Indexed: 02/02/2023]
Abstract
Fractures of the distal radius occur commonly, and volar plating has emerged as a current, successful, and popular treatment for this injury. When this technology fails, salvage procedures must be selected that aim to maximize wrist motion and minimize pain. We present a case of volar radioscapholunate wrist arthrodesis in the setting of unfeasible intraoperative volar osteotomy to treat a malunited distal radius fracture.
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Affiliation(s)
- Evan Argintar
- Department of Orthopedics, Georgetown University, Washington, DC
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24
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Bain GI, Ondimu P, Hallam P, Ashwood N. Radioscapholunate arthrodesis - a prospective study. ACTA ACUST UNITED AC 2010; 14:73-82. [PMID: 20135732 DOI: 10.1142/s021881040900427x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Revised: 09/15/2009] [Accepted: 10/13/2009] [Indexed: 11/18/2022]
Abstract
The purpose of this prospective study was to evaluate pain levels, range of motion, patient activity and satisfaction after radioscapholunate (RSL) arthrodesis. This was in association with distal scaphoid excision and complete resection of the triquetrum. The non-union rate for radioscapholunate arthrodesis was examined and the results compared with previous studies. Twenty-three patients (14 males and nine females) with an average age of 47 (range 26-73) years underwent RSL fusion for post-traumatic osteoarthritis, rheumatoid arthritis and Kienböck's disease of the lunate with a mean follow-up of 32 (range 13-70) months. The absolute prerequisite for any of these groups of patients was a functional midcarpal joint which was assessed pre-operatively with radiographs and intra-operatively prior to RSL fusion. The average flexion to extension motion changed from 66 degrees to 57 degrees . The ulnoradial range of motion also increased to 43 degrees from a pre-operative value of 22 degrees . The patients visual analogue pain scores reduced from an average of 64 to 28 (p = 0.01). Nineteen patients had no restriction in activity and all but one was satisfied with the outcome. All patients remained in full time employment with ten returning to some form of sport. RSL fusion with excision of the distal pole of the scaphoid and the entire triquetrum led to minimal reduction in the flexion-extension arc of motion and an increase in the ulnoradial arc. There was also good pain relief and maintenance of a patient's function. Memory staples are also an effective method of securing fusion in the wrist obtaining similar results to that seen in forefoot surgery.
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Affiliation(s)
- Gregory Ian Bain
- Department of Orthopaedic Surgery, Modbury Public Hospital, Modbury, South Australia, Australia.
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25
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Givissis PK, Antonarakos P, Vafiades VE, Christodoulou AG. Management of posttraumatic arthritis of the wrist with radiolunate fusion enhanced with a sliding autograft: a case report and description of a novel technique. Tech Hand Up Extrem Surg 2009; 13:90-93. [PMID: 19516134 DOI: 10.1097/bth.0b013e3181960675] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Although in rheumatoid cases radiolunate fusion presents with satisfying results, in cases with posttraumatic carpal distortion, the variability of injury pattern can influence the type of fixation and the rate of bony union. In this case report, we present an alternative technique of radiolunate fusion for the management of posttraumatic arthritis, which combines the traditional procedure with a corticocancellous autograft, created from the dorsal side of the radius that slides over the bones to be fused. That procedure provides the best environment for the bones to heal and an additional stabilizing effect on the radiolunate construct, thus better preserving the normal intercarpal relationships and wrist height. Patient's clinical and radiological outcome was very satisfactory until the last follow-up.
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Affiliation(s)
- Panagiotis K Givissis
- First Orthopaedic Department, Aristotle University of Thessaloniki G Papanikolaou Hospital, Exohi, Thessaloniki, Greece.
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Pervaiz K, Bowers WH, Isaacs JE, Owen JR, Wayne JS. Range of motion effects of distal pole scaphoid excision and triquetral excision after radioscapholunate fusion: a cadaver study. J Hand Surg Am 2009; 34:832-7. [PMID: 19410986 DOI: 10.1016/j.jhsa.2009.02.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Revised: 02/05/2009] [Accepted: 02/06/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE Radioscapholunate (RSL) fusion is an effective surgical procedure for the treatment of isolated radiocarpal arthritis. Although functional wrist motion is typically preserved through the midcarpal joint, many patients are still frustrated by postoperative limitations. The purpose of this study was to evaluate motion of cadaver wrists after simulated RSL fusion with excision of the distal pole of the scaphoid and the triquetrum. METHODS Ten fresh-frozen cadaver upper extremities were mounted on a custom testing apparatus after isolation of the flexor carpi radialis, flexor carpi ulnaris, extensor carpi radialis longus, and extensor carpi ulnaris tendons. Sequential loading of these tendons resulted in flexion, extension, radial, and ulnar deviation. We subsequently measured range of motion with the use of digital photography. All specimens were tested in 4 states: intact (normal), RSL fusion (simulated), RSL fusion with distal scaphoid pole excision, and RSL fusion with distal scaphoid pole and triquetrum excision. The results were statistically analyzed using a repeated measures analysis of variance. RESULTS Range of motion decreased to 39% to 46% of normal for flexion and extension and 65% to 71% of normal for radial and ulnar deviation after simulated RSL fusion. The addition of distal pole of scaphoid excision resulted in flexion and extension returning to 72% to 79% of normal, and radial and ulnar deviation returning to 84% to 89% of normal. Excision of the triquetrum further increased flexion and extension to 87% to 97% of normal, and radial and ulnar deviation to 119% to 137% of normal. CONCLUSIONS The combination of triquetral and distal scaphoid pole excision after RSL fusion improves wrist motion to levels close to normal in the cadaver model.
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Affiliation(s)
- Khurram Pervaiz
- Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia 23284-3067, USA
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Radioscapholunate arthrodesis for advanced degenerative radiocarpal osteoarthritis. Tech Hand Up Extrem Surg 2008; 12:65. [PMID: 18388759 DOI: 10.1097/bth.0b013e3181638215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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