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Ossowski D, Thomsen NOB, Clementson M, Besjakov J, Jörgsholm P, Björkman A. Long-term outcomes after capitate fractures: a median 16-year follow-up. Arch Orthop Trauma Surg 2024; 144:3885-3893. [PMID: 39174766 PMCID: PMC11417065 DOI: 10.1007/s00402-024-05495-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 08/06/2024] [Indexed: 08/24/2024]
Abstract
INTRODUCTION The long-term effects of a capitate fracture are unknown. The aim of this study was to assess both clinical and radiological long-term outcomes after a capitate fracture. MATERIALS AND METHODS From a cohort of 526 consecutive patients with post traumatic radial sided wrist pain, 23 were identified diagnosed with a capitate fracture. 16 of these (11 males and 5 females) with a median age at injury of 17.5 years (range 11-27 years) were eligible for a follow-up after a median of 16 years (range 8 to 17 years). In this study patients were examined using conventional radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) at the time of injury and with CT at the follow-up. At follow-up radiological signs of osteoarthritis were graded in four stages and clinical outcome was evaluated by measuring range of wrist motion and grip and pinch strength. The subjective outcome was assessed using DASH and PRWE questionnaires. RESULTS Five patients had isolated capitate fractures and 11 had concomitant fractures, 10 of which had a simultaneous scaphoid fracture. 14 patients had been treated non-surgically in a cast and two patients were treated surgically. None of the fractures were visible on conventional radiographs at the time of injury. At follow-up all fractures had healed without signs of avascular necrosis. In one patient, CT examination revealed osteoarthritis between the capitate and lunate. This did not cause clinical symptoms. Functional impairments and pain scores were low: median DASH score 0, median PRWE 3 and median VAS pain score 0. We found no impairment in range of motion or grip and pinch strength. CONCLUSIONS At a median of 16-year follow-up, patients with a capitate fracture report normal self-assessed hand function as well as good wrist motion and strength. The risk of development of posttraumatic arthritis in the joints around the capitate is low.
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Affiliation(s)
- Daniel Ossowski
- Department of Hand Surgery, Institute of Translational Medicine, Skåne University Hospital Malmö and Lund University, Jan Waldenströms gata 5, Malmö, 205 02, Sweden.
| | - Niels O B Thomsen
- Department of Hand Surgery, Institute of Translational Medicine, Skåne University Hospital Malmö and Lund University, Jan Waldenströms gata 5, Malmö, 205 02, Sweden
| | - Martin Clementson
- Department of Hand Surgery, Institute of Translational Medicine, Skåne University Hospital Malmö and Lund University, Jan Waldenströms gata 5, Malmö, 205 02, Sweden
| | - Jack Besjakov
- Department of Hand Surgery, Institute of Translational Medicine, Skåne University Hospital Malmö and Lund University, Jan Waldenströms gata 5, Malmö, 205 02, Sweden
| | - Peter Jörgsholm
- Department of Hand Surgery, Institute of Translational Medicine, Skåne University Hospital Malmö and Lund University, Jan Waldenströms gata 5, Malmö, 205 02, Sweden
- Mölholm Private Hospital, Brummersvej 1, Vejle, DK-7100, Danmark
| | - Anders Björkman
- Department of Hand Surgery, Institute of Translational Medicine, Skåne University Hospital Malmö and Lund University, Jan Waldenströms gata 5, Malmö, 205 02, Sweden
- Department of Hand Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Box 100, Göteborg, 405 30, Sweden
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Trentadue TP, Thoreson A, Lopez C, Breighner RE, Leng S, Holmes DR, Kakar S, Rizzo M, Zhao KD. Morphology of the scaphotrapeziotrapezoid joint: A multi-domain statistical shape modeling approach. J Orthop Res 2024. [PMID: 38956833 DOI: 10.1002/jor.25918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 07/04/2024]
Abstract
The scaphotrapeziotrapezoid (STT) joint is involved in load transmission between the wrist and thumb. A quantitative description of baseline STT joint morphometrics is needed to capture the variation of normal anatomy as well as to guide staging of osteoarthritis. Statistical shape modeling (SSM) techniques quantify variations in three-dimensional shapes and relative positions. The objectives of this study are to describe the morphology of the STT joint using a multi-domain SSM. We asked: (1) What are the dominant modes of variation that impact bone and articulation morphology at the STT joint, and (2) what are the morphometrics of SSM-generated STT joints? Thirty adult participants were recruited to a computed tomography study of normal wrist imaging and biomechanics. Segmentations of the carpus were converted to three-dimensional triangular surface meshes. A multi-domain, particle-based entropy system SSM was used to quantify variation in carpal bone shape and position as well as articulation morphology. Articular surface areas and interosseous proximity distributions were calculated between mesh vertex pairs on adjacent bones within distance (2.0 mm) and surface-normal angular (35°) thresholds. In the SSM, the first five modes of variation captured 76.2% of shape variation and contributed to factors such as bone scale, articular geometries, and carpal tilt. Median interosseous proximities-a proxy for joint space-were 1.39 mm (scaphotrapezium), 1.42 mm (scaphotrapezoid), and 0.61 mm (trapeziotrapezoid). This study quantifies morphological and articular variations at the STT joint, presenting a range of normative anatomy. The range of estimated interosseous proximities may guide interpretation of imaging-derived STT joint space.
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Affiliation(s)
- Taylor P Trentadue
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic Medical Scientist Training Program, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic Graduate Program in Biomedical Engineering and Physiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew Thoreson
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Cesar Lopez
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan E Breighner
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, New York, USA
| | - Shuai Leng
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Radiology, Mayo Clinic Computed Tomography Clinical Innovation Center, Mayo Clinic, Rochester, Minnesota, USA
| | - David R Holmes
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Biomedical Imaging Resource Core Facility, Mayo Clinic, Rochester, Minnesota, USA
| | - Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Marco Rizzo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kristin D Zhao
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic Graduate Program in Biomedical Engineering and Physiology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
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Myllykoski J, Räisänen MP, Kotkansalo T, Juntunen M, Pääkkönen M. Arthroscopic Scaphotrapeziotrapezoid Joint Fusion for Osteoarthritis. J Hand Surg Asian Pac Vol 2023; 28:580-586. [PMID: 37905364 DOI: 10.1142/s2424835523500613] [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] [Indexed: 11/02/2023]
Abstract
Background: Arthroscopic scaphotrapeziotrapezoid (STT) fusion (ASTTF) has emerged in the recent decade as an option for traditional open surgery. This retrospective study describes our technique and results of ASTTF. Methods: Medical records and radiological data of patient who had undergone ASTTF between 2014 and 2022 in two tertiary hospitals were reviewed. Results: Five ASTTF in four patients were identified. The mean age of the patients were 52.4 years. Fusion was achieved in four out of five wrists (80%). The mean postoperative radio-scaphoid angle was 48°, grip 32 kg (70% compared to contralateral hand), extension 54° (86%) and flexion 46° (93%). The mean follow-up time was 18 months (range 5 months to 4 years). One wrist (20%) developed STT non-union requiring a reoperation 2 years after index surgery. Conclusions: ASTTF is a technically challenging procedure with a long learning curve and surgery time. However, ASTTF is less invasive compared to the open procedure and our results were like the open procedures described in literature. Further studies are needed to compare the benefits and results of open and ASTTF in a prospective and randomised setup. Level of Evidence: Level IV (Therapeutic).
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Affiliation(s)
- Jan Myllykoski
- Department of Hand Surgery, Division of Diseases of the Musculoskeletal System, Turku University Hospital, and CoE TYKS ORTO, Turku, Finland
| | - Mikko P Räisänen
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | | | - Matti Juntunen
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Markus Pääkkönen
- Department of Hand Surgery, Division of Diseases of the Musculoskeletal System, Turku University Hospital, and CoE TYKS ORTO, Turku, Finland
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Alder KD, Feroe AG, Karim KE. Management of Scaphotrapeziotrapezoid Osteoarthritis: A Critical Analysis Review. JBJS Rev 2023; 11:01874474-202310000-00007. [PMID: 38096476 DOI: 10.2106/jbjs.rvw.23.00093] [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: 12/18/2023]
Abstract
» The scaphotrapeziotrapezoid (STT) joint is a common location of degenerative osteoarthritis (OA) in the wrist.» STT OA may occur in isolation or with concomitant thumb carpometacarpal joint (CMCJ) OA or scapholunate advanced collapse (SLAC) and other wrist OA patterns.» Nonoperative management strategies include activity modification, bracing, anti-inflammatory medications, occupational therapy, and injections.» Surgical treatment may be determined by whether the STT OA occurs in isolation or with concomitant thumb CMCJ or SLAC OA and includes STT arthrodesis, distal scaphoid excision with or without interposition or implant arthroplasty, trapeziectomy with proximal trapezoid excision, four-corner fusion in combination with scaphoid/radial column excision, and proximal row carpectomy.
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Affiliation(s)
- Kareme D Alder
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Swärd E, Wilcke M. Effects of intra-articular Platelet-Rich Plasma (PRP) injections on osteoarthritis in the thumb basal joint and scaphoidtrapeziotrapezoidal joint. PLoS One 2022; 17:e0264203. [PMID: 35259167 PMCID: PMC8903265 DOI: 10.1371/journal.pone.0264203] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 02/05/2022] [Indexed: 11/19/2022] Open
Abstract
Intra-articular injection of platelet rich plasma (PRP) has been reported to decrease pain and improve function in knee osteoarthritis. There are few reports on the effect of PRP in the treatment of osteoarthritis in the hand. Our aim was to evaluate the effect of PRP-injections on pain and functional outcome in the short-term for osteoarthritis in the thumb basal joint and scaphoidtrapeziotrapezoidal (STT) joint. A retrospective analysis was performed of 29 patients treated with intra-articular PRP injection for painful osteoarthritis in the thumb basal joint (21 patients) or STT joint (eight patients). The patients received two consecutive, radiologically guided PRP injections at an interval of 3–4 weeks. Pain at rest and on load (numerical rating scale (NRS) 0–10), Patient-rated Wrist and Hand Evaluation (PRWHE) score (0–100), grip strength (Jamar) and key pinch were recorded pre-injection and 3 months after the second injection. Mean age was 63 (range 34–86) years and 17 patients were women. We used generalized estimating equations (GEE) to analyze the effect on the outcome variables. Possible predictors were included in the model (high pain level pre-injection, gender, age, manually demanding work, affected joint (thumb base or STT) and use of analgesic). The GEE analysis showed that PRP injections had no effect on reported pain, PRWHE score, grip strength or key pinch. 16/28 patients experience a positive effect according to a yes/no question. The short-term effect of PRP for osteoarthritis in the thumb base and STT-joint is doubtful and needs to be properly investigated in placebo-controlled studies.
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Affiliation(s)
- Elin Swärd
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Department for Hand Surgery, Södersjukhuset, Stockholm, Sweden
| | - Maria Wilcke
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Department for Hand Surgery, Södersjukhuset, Stockholm, Sweden
- * E-mail:
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Fram BR, Hozack B, Ilyas AM, Jones C, Rivlin M. Scaphotrapezoid Assessment during Thumb Carpometacarpal Arthroplasty: A Cadaveric Study. J Wrist Surg 2021; 10:528-532. [PMID: 34881109 PMCID: PMC8635814 DOI: 10.1055/s-0041-1729992] [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: 07/26/2020] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
Background Due to limited sensitivity of radiographs for scaphotrapeziotrapezoid (STT) arthritis and the high rate of concurrence between thumb carpometacarpal (CMC) and STT arthritis, intraoperative visualization of the STT joint is recommended during CMC arthroplasty. Purpose We quantified the percentage of trapezoid facet of the scaphotrapezoid (ST) joint that could be visualized during this approach, and compared it to the degree of preoperative radiographic STT arthritis. Methods We performed dorsal surgical approach to the thumb CMC joint after obtaining fluoroscopic anteroposterior, lateral, and oblique wrist radiographs of 11 cadaver wrists. After trapeziectomy, the ST joint was inspected and the visualized portion of the trapezoid articulation marked with an electrocautery. The trapezoid was removed, photographed, and the marked articular surface area and total surface area were independently measured by two authors using an image analysis software. The radiographs were analyzed for the presence of STT arthritis. Results The mean visualized trapezoid surface area during standard approach for CMC arthroplasty was 60.3% (standard deviation: 24.6%). The visualized percentage ranged widely from 16.7 to 96.5%. There was no significant correlation between degree of radiographic arthritis and visualized percentage of the joint ( p = 0.77). Conclusions: On average, 60% of the trapezoid joint surface was visualized during routine approach to the thumb CMC joint, but with very large variability. Direct visualization of the joint did not correlate with the degree of radiographic STT arthritis. Clinical Relevance A combination of clinical examination, pre- and intraoperative radiographs, and intraoperative visualization should be utilized to assess for STT osteoarthritis and determine the need for surgical treatment. Level of Evidence This is a Cadaveric Research Article.
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Affiliation(s)
- Brianna R. Fram
- Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
- Division of Hand Surgery, The Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | - Bryan Hozack
- Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
- Division of Hand Surgery, The Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | - Asif M. Ilyas
- Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
- Division of Hand Surgery, The Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | - Christopher Jones
- Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
- Division of Hand Surgery, The Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | - Michael Rivlin
- Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
- Division of Hand Surgery, The Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
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Eeckhoudt A, Hollevoet N. Results of treatment of osteoarthritis of the scaphotrapeziotrapezoidal joint with tendon allograft interposition. Acta Orthop Belg 2021. [DOI: 10.52628/87.3.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of the study was to determine if the use of tendon allografts in combination with distal scaphoid resection for the treatment of isolated STT arthrosis is a save procedure. We reviewed the postoperative complications, re-operations, clinical and radiological results of this treatment modality. A retrospective cohort study was conducted. Investigated parameters include wrist mobility (wrist extension and -flexion), strength (grip- and pinch strength), patient-reported outcome scores : Visual Analogue Scale (VAS), Quick Disabilities of the Arm, Shoulder and Hand score (Q-DASH) and Patient Rated Wrist/Hand Evaluation score (PRWHE) and radiographic measurements : scapholunate (SL) angle, radiolunate (RL) angle and capitolunate (CL) angle. Ten wrists were included in nine patients. No revision surgery was performed. Two patients had transient neuropraxia of the radial nerve. Postoperative flexion-extension arc was 112°. Grip-strength was significantly increased after surgery (20 to 28kg). The average VAS score the past week was 1.75 (range 0-6.7), the average maximum VAS score was 3.0 (range 0-10). The mean PRWHE score was 16.6 (range 0- 69). The mean Q-DASH score was 17.95 (range 0-51). The current study indicates that distal scaphoid resection for isolated STT arthritis is a save procedure with minimal complications. It significantly improves grip strength. Mobility of the wrist was similar to contralateral wrist after surgery. Pain postoperatively was very limited (low VAS scores) and good functional scores (Q-DASH and PRWHE) were noted. Our findings support the prior findings that excisional arthroplasty might worsen carpal instability.
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Obert L, Pluvy I, Zamour S, Menu G, El Rifai S, Garret J, Cognet JM, Goubau J, Loisel F. Scaphotrapeziotrapezoid osteoarthritis: From the joint to the patient. HAND SURGERY & REHABILITATION 2021; 40:211-223. [PMID: 33631391 DOI: 10.1016/j.hansur.2020.12.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 12/09/2020] [Accepted: 12/16/2020] [Indexed: 11/17/2022]
Abstract
Scaphotrapeziotrapezoid osteoarthritis (STT OA) is common and often associated with thumb basal joint arthritis. Pain at the base of the thumb on the volar aspect and during resisted extension is characteristic of symptomatic STT OA. If conservative treatment fails, surgical treatment may be offered. In case of STT OA, treatment may range from arthrodesis to trapeziectomy (isolated or associated with ligament reconstruction and/or interposition). Any preoperative intracarpal instability (DISI) can be exacerbated by resecting more than 3 or 4 mm of the distal pole of scaphoid. For peritrapezial osteoarthritis, trapeziectomy is the logical solution, but it exposes the patient to known complications: loss of strength, long recovery, trapeziometacarpal impingement. Initial treatment of thumb basal joint arthritis by arthroplasty is also an option. Treatment of both sites is also possible by interposition of pyrocarbon implants. In all cases (isolated or associated STT OA) and no matter the technique chosen, maintaining the scaphoid height (arthrodesis, resection < 3 mm and/or associated interposition) and performing oblique trapezoidal osteotomy (to prevent scaphoid-metacarpal impingement) are the two crucial elements of surgical treatment.
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Affiliation(s)
- L Obert
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique et assistance Main CHU Jean Minjoz, Boulevard Fleming, 25000 Besançon, France.
| | - I Pluvy
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique et assistance Main CHU Jean Minjoz, Boulevard Fleming, 25000 Besançon, France
| | - S Zamour
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique et assistance Main CHU Jean Minjoz, Boulevard Fleming, 25000 Besançon, France
| | - G Menu
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique et assistance Main CHU Jean Minjoz, Boulevard Fleming, 25000 Besançon, France
| | - S El Rifai
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique et assistance Main CHU Jean Minjoz, Boulevard Fleming, 25000 Besançon, France
| | - J Garret
- Clinique du Parc, 155 bis Boulevard de Stalingrad, 69006 Lyon, France
| | - J-M Cognet
- Clinique Courtancy, 36 rue de Coutancy, 51100 Reims, France
| | - J Goubau
- Dienst Orthopedie & Traumatologie, Buitenring Sint-Denijs 30, 9000 Gent, Belgium; Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - F Loisel
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique et assistance Main CHU Jean Minjoz, Boulevard Fleming, 25000 Besançon, France
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Oliveira RKD, Aita M, Brunelli J, Carratalá V, Delgado PJ. Introducing the “SOAC Wrist”: Scaphotrapeziotrapezoid Osteoarthritis Advanced Collapse. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2020. [DOI: 10.1055/s-0040-1721045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
AbstractDespite being the second most common osteoarthritis of the wrist, little is known about scaphotrapeziotrapezoid osteoarthritis. Not all patients with this type of osteoarthritis have symptoms, and, even in those symptomatic patients, the intensity of the complaint is not proportional to the severity of the degeneration. In symptomatic patients, when the conservative treatment fails, grading classifications to help define the surgical treatment are solely based on the joint characteristics, and fail to assess the rest of the carpus.In general, most carpal degenerative processes show the same evolution pattern, which varies according to the initial injury, along with the type of deformity and the inherent instabilities. Thus, we hypothesize that the degenerative evolution due to primary osteoarthritis of the scaphotrapeziotrapezoid joint also follows a logical evolutionary sequence, similar to the one that occurs in cases of scapholunate advanced collapse (SLAC), scaphoid nonunion advanced collapse (SNAC), scaphoid malunion advanced collapse (SMAC), and scaphoid chondrocalcinosis advanced collapse (SCAC), thus resulting in scaphotrapeziotrapezoid osteoarthritis advanced collapse (SOAC). We have divided the SOAC into three groups, and considered that their treatment shall be guided by the evolutionary stage of the disease, and not by the surgeon's preferred technique.
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Affiliation(s)
| | - Márcio Aita
- Universidade Federal do ABC, Santo André, SP, Brazil
| | - João Brunelli
- Department of Orthopedics and Traumatology, Cirurgia de Mão e Microcirurgia, Santa Casa de Misericórdia, São Paulo, SP, Brazil
| | - Vicente Carratalá
- Traumatology Service, Hospital Quirónsalud Valencia, Valencia, Spain
| | - Pedro J Delgado
- Hospital Universitário HM Montepríncipe, Universidad CEU San Pablo, Boadilla del Monte, Madrid, Spain
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Rosinsky P, Netzer N, David Y, Kosashvili Y, Been E, Oron A. Fifth metacarpal instability and its effect on hamatometacarpal arthritis patterns–a cadaver study. HAND SURGERY & REHABILITATION 2020; 39:48-52. [DOI: 10.1016/j.hansur.2019.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 09/24/2019] [Accepted: 09/26/2019] [Indexed: 10/25/2022]
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Wu JC, Calandruccio JH. Evaluation and Management of Scaphoid-Trapezium-Trapezoid Joint Arthritis. Orthop Clin North Am 2019; 50:497-508. [PMID: 31466665 DOI: 10.1016/j.ocl.2019.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Degenerative arthritis at the articulation of the scaphoid, trapezium, and trapezoid (STT or triscaphe joint) is a common degenerative disease of the wrist. Pain and weakness with grip strength reduction and functional limitations when performing routine daily tasks are common complaints of patients with STT arthritis. Initial conservative treatments for STT arthritis include splinting, bracing, activity modification, anti-inflammatory medication, and steroid injections for pain relief. Failure of conservative treatment is the main indication for surgery, which may include distal scaphoid excision, with or without filling of the void after excision, trapeziectomy, STT arthrodesis, or STT implant arthroplasty.
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Affiliation(s)
- John C Wu
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA.
| | - James H Calandruccio
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA
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Isolated scaphotrapeziotrapezoid osteoarthritis treatment using resurfacing arthroplasty with scaphoid anchorage. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017. [DOI: 10.1016/j.recote.2017.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Davies JH, Centomo H, Leduc S, Beaumont P, Laflamme GY, Rouleau DM. Preexisting Carpal and Carpometacarpal Osteoarthritis Has No Impact on Function after Distal Radius Fractures. J Wrist Surg 2017; 6:301-306. [PMID: 29085732 PMCID: PMC5658213 DOI: 10.1055/s-0037-1602800] [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: 11/09/2016] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
Abstract
Background Functional outcomes of distal radius fractures vary widely regardless of treatment methods. Purpose This study aims to verify whether preexisting carpal and carpometacarpal (CMC) osteoarthritis (OA) will negatively impact wrist functional outcome in patients with distal radius fractures. Patients and Methods A retrospective case-control study was done using a prospective trauma database. Patients were matched 1:1 in two groups based on the presence of wrist or carpal arthritis (OA). The groups were matched for sex, follow-up, and treatment type. Patients were followed up for a minimum of 1 year and functional outcomes were assessed using validated scores. Results A total of 61 patients were included. Mean age was 63 years (range: 20-85) and average follow-up was 26 months. There were 31 patients in the OA+ group and 30 in the OA- group. Forty-one patients were treated surgically and 20 nonoperatively. None of the patients in the OA- developed OA during follow-up. Both groups were comparable for sex, residual deformity, and follow-up. There was no significant difference for the visual analog scale, Short Form-12, Quick Disability Arm Shoulder Hand, and Patient-rated Wrist Evaluation, or for radiographic outcomes. Conclusion Preexisting OA in the wrist or CMC does not seem to impact outcomes of distal radius fractures, regardless of treatment, age, or sex. Although this is a negative study, the results are important to help counsel patients with distal radius fractures. Further work must be done to identify other potential causes for negative outcomes. Level of Evidence Level III, prognostic study.
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Affiliation(s)
- Jonah Hébert Davies
- Department of Surgery, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
- Université de Montréal, Montréal, Québec, Canada
| | - Hugo Centomo
- Department of Surgery, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
- Université de Montréal, Montréal, Québec, Canada
| | - Stéphane Leduc
- Department of Surgery, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
- Université de Montréal, Montréal, Québec, Canada
| | - Pierre Beaumont
- Department of Surgery, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
- Université de Montréal, Montréal, Québec, Canada
| | - G.-Yves Laflamme
- Department of Surgery, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
- Université de Montréal, Montréal, Québec, Canada
| | - Dominique M. Rouleau
- Department of Surgery, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
- Université de Montréal, Montréal, Québec, Canada
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14
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Clementson M, Thomsen N, Besjakov J, Jørgsholm P, Björkman A. Long-Term Outcomes After Distal Scaphoid Fractures: A 10-Year Follow-Up. J Hand Surg Am 2017; 42:927.e1-927.e7. [PMID: 28733100 DOI: 10.1016/j.jhsa.2017.06.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 05/24/2017] [Accepted: 06/14/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to evaluate the functional, clinical, and radiological outcome 10 years after distal scaphoid fractures. METHODS From a prospective epidemiological study on posttraumatic radial-sided wrist pain, we evaluated 41 cases of distal scaphoid fractures. All cases had been treated nonsurgically in a thumb spica cast. Patients were examined using radiographs, magnetic resonance imaging and computed tomography at the time of injury and with computed tomography after a median of 10 years (range, 8-11 years). Fractures were classified according to a modified Prosser classification system. The primary outcome was assessment of self-reported function using Disabilities of the Arm, Shoulder, and Hand (DASH) and Patient-Reported Wrist Evaluation (PRWE). Secondary outcomes were clinical status (range of motion and grip and pinch strength) and to evaluate fracture healing and arthritis in the scaphotrapezium-trapezoid (STT) joint. RESULTS Functional impairment and pain scores at follow-up were low: median DASH score 2, median PRWE 0, and median visual analog scale (VAS) pain score 0. We found no impairment in range of motion or strength. We found 26 type I fractures, 12 type IIA, 1 type IIC, and 2 type IV. There was 1 asymptomatic nonunion in a type I fracture. Computed tomography revealed arthritis in the STT joint in 7 out of 41 wrists, none of which caused clinical symptoms. CONCLUSIONS From an 8- to 11-year perspective, patients with distal scaphoid fractures report normal self-assessed hand function as well as good wrist motion and strength. The risk for development of posttraumatic STT arthritis was low. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Martin Clementson
- Department of Translational Medicine-Hand Surgery, Lund University, Malmo, Sweden.
| | - Niels Thomsen
- Department of Translational Medicine-Hand Surgery, Lund University, Malmo, Sweden
| | - Jack Besjakov
- Department of Radiology, Skåne University Hospital, Lund University, Malmo, Sweden
| | - Peter Jørgsholm
- Department of Translational Medicine-Hand Surgery, Lund University, Malmo, Sweden
| | - Anders Björkman
- Department of Translational Medicine-Hand Surgery, Lund University, Malmo, Sweden
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15
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Isolated scaphotrapeziotrapezoid osteoarthritis treatment using resurfacing arthroplasty with scaphoid anchorage. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 61:412-418. [PMID: 28890123 DOI: 10.1016/j.recot.2017.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 05/10/2017] [Accepted: 05/22/2017] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The aim of this study is to show the results of scaphotrapeziotrapezoid (STT) joint osteoarthritis treatment performing resurfacing arthroplasty with scaphoid anchorage. MATERIAL AND METHOD An observational, descriptive and retrospective study was performed. Ten patients with isolated STT joint osteoarthritis were studied between 2013 and 2015. The mean follow-up time was 26months. Clinical results, functional and subjective scores were reviewed. RESULTS The patients were satisfied, achieving an average of 2.1 (0-3) on the VAS score and 16 (2 to 28) in the DASH questionnaire, and returning to work in the first three months post-surgery. Recovery of range of motion compared to the contralateral wrist was 96% in extension, 95% in flexion, 87% in ulnar deviation and 91% in radial deviation. The average handgrip strength of the wrist was 95% and pinch strength was 95% compared to the contralateral side. There were no intraoperative complications or alterations in postoperative carpal alignment. CONCLUSION Resurfacing arthroplasty is proposed as a good and novel alternative in treating isolated SST joint arthritis. Achieving the correct balance between the strength and mobility of the wrist, without causing carpal destabilisation, is important to obtain satisfactory clinical and functional results.
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16
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Colio SW, Smith J, Pourcho AM. Ultrasound-Guided Interventional Procedures of the Wrist and Hand: Anatomy, Indications, and Techniques. Phys Med Rehabil Clin N Am 2016; 27:589-605. [PMID: 27468668 DOI: 10.1016/j.pmr.2016.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Acute and chronic wrist and hand conditions are commonly seen by neuromuscular and musculoskeletal specialists. High-frequency diagnostic ultrasonography (US) has facilitated advances in the diagnosis and interventional management of wrist and hand disorders. US provides excellent soft tissue resolution, accessibility, portability, lack of ionizing radiation, and the ability to dynamically assess disorders and precisely guide interventional procedures. This article review the relevant anatomy, indications, and interventional techniques for common disorders of the wrist and hand, including radiocarpal joint arthritis, scaphotrapeziotrapezoidal joint arthritis, trapeziometacarpal joint arthritis, phalangeal joint arthritis, first dorsal compartment tenosynovitis, ganglion cysts, and stenosing tenosynovitis.
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Affiliation(s)
- Sean W Colio
- Department of Physical Medicine and Rehabilitation, Swedish Spine, Sports, and Musculoskeletal Center, Swedish Medical Group, Seattle, WA, USA
| | - Jay Smith
- Departments of Physical Medicine & Rehabilitation, Mayo Clinic Sports Medicine Center, Mayo Clinic, Rochester, MN, USA; Department Radiology, Mayo Clinic Sports Medicine Center, Mayo Clinic, Rochester, MN, USA; Department Anatomy, Mayo Clinic Sports Medicine Center, Mayo Clinic, Rochester, MN, USA
| | - Adam M Pourcho
- Department of Physical Medicine and Rehabilitation, Swedish Spine, Sports, and Musculoskeletal Center, Swedish Medical Group, 600 E. Jefferson Street, Suite 300, Seattle, WA 98112, USA.
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17
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Langenhan R, Hohendorff B, Probst A. Trapeziectomy and ligament reconstruction tendon interposition for isolated scaphotrapeziotrapezoid osteoarthritis of the wrist. J Hand Surg Eur Vol 2014; 39:833-7. [PMID: 24334602 DOI: 10.1177/1753193413514500] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Isolated osteoarthritis of the scaphotrapeziotrapezoid joint is rather rare compared with thumb trapeziometacarpal osteoarthritis. The aim of this retrospective study was to evaluate the outcome of 15 consecutive patients treated with trapeziectomy/ligament reconstruction tendon interposition for isolated scaphotrapeziotrapezoid osteoarthritis of the wrist. After a mean follow-up of 54 months, 14 patients (15 wrists) were available for clinical and radiological examination. The median pain intensity was 0 on a 0-10 visual analogue scale, both at rest and with activity, mean grip strength averaged 24 kg, pinch strength 5 kg. The disabilities of the arm, shoulder and hand (DASH) score was 16, and a modified Mayo Wrist Score 84. Correlation between the degree of scaphotrapezoid osteoarthritis and pain at rest, pain with activity, and DASH score was not significant. The findings from our study suggest that trapeziectomy/ligament reconstruction tendon interposition is an effective procedure for treating isolated scaphotrapeziotrapezoid osteoarthritis, and that additional partial trapezoid excision is not necessary.
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Affiliation(s)
- R Langenhan
- Hegau-Bodensee-Klinikum Singen, Klinik für Orthopädie, Unfall- und Handchirurgie, Virchowstrasse, Singen, Germany
| | - B Hohendorff
- Elbe Kliniken Stade Buxtehude, Abteilung für Hand-, Ästhetische und Plastische Chirurgie, Stade, Germany
| | - A Probst
- Hegau-Bodensee-Klinikum Singen, Klinik für Orthopädie, Unfall- und Handchirurgie, Virchowstrasse, Singen, Germany
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18
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Wollstein R, Werner F, Gilula LA. Isolated lunocapitate osteoarthritis-an alternative pattern of osteoarthritis. J Wrist Surg 2014; 3:139-142. [PMID: 25032079 PMCID: PMC4078103 DOI: 10.1055/s-0034-1372515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction Osteoarthritis (OA) in the wrist usually develops in a pattern described as scapholunate advanced collapse (SLAC). We observed an alternative pattern of OA that involves the lunocapitate joint in isolation with minimal involvement of the radioscaphoid articulation. Case Series The series was observed from a series of 100 wrist radiographs that were retrospectively reviewed. In order to characterize the alternative pattern of OA, we compared demographic data, presentation, and physical and radiographic examination characteristics between the patients with lunocapitate OA and SLAC wrists. Fifteen radiographs showed OA, nine had a SLAC pattern, and six had lunocapitate OA. The demographics were similar, but the clinical presentation was different. The patients with lunocapitate OA had less tenderness over the snuffbox (P < 0.03), and a lower percentage of a positive scaphoid shift test (P < 0.005). Isolated lunocapitate OA had a higher association with scaphotrapeziotrapezoidal (STT) arthritis (P < 0.004). The SLAC group had an increased scapholunate gap (P = 0.0003). Discussion The presentation of lunocapitate OA differs from SLAC wrist in a number of ways. Further study is necessary to understand the clinical implications of this pattern. Level IV evidence Case series.
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Affiliation(s)
- Ronit Wollstein
- Department of Plastic Surgery, Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
- Division of Hand and Upper Extremity Surgery, Department of Orthopedic Surgery, Carmel Lady Davis Medical Center, Haifa, Israel
| | - Frederick Werner
- Department of Orthopedic Surgery SUNY Upstate Medical University, Syracuse, New York
| | - Louis A. Gilula
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri
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19
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Bear DM, Moloney G, Goitz RJ, Balk ML, Imbriglia JE. Joint space height correlates with arthroscopic grading of wrist arthritis. Hand (N Y) 2013; 8:296-301. [PMID: 24426937 PMCID: PMC3745247 DOI: 10.1007/s11552-013-9522-9] [Citation(s) in RCA: 2] [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 Osteoarthritis of the radiocarpal joints is commonly encountered by hand surgeons. To date, there is no well-defined method of radiographically grading osteoarthritis of the wrist. METHODS Preoperative radiographs of 48 patients undergoing wrist arthroscopy were evaluated retrospectively. Images were graded subjectively by five surgeons based on overall severity of arthritis, osteophytes, subchondral cysts, and subchondral sclerosis. The joint space height (JSH) ratio was calculated by measuring the space of the mid-radioscaphoid and mid-radiolunate joints and dividing each by the height of the capitate. Arthroscopic grading of arthritis was obtained from operative records and compared to subjective and objective grades. ANOVA testing evaluated for statistical significance with p < 0.05. Inter-rater and intra-rater reliability was determined using Pearson's correlation analysis and Cohen's kappa coefficient. RESULTS Objective measurement using the JSH ratio demonstrated a significant decrease as arthroscopic arthritis grade increased for both radioscaphoid and radiolunate joints. Subjective grading of radioscaphoid and radiolunate joints was able to detect moderate/severe, but not mild arthritis. Subjective grading underestimated the degree of arthritis, particularly in the radiolunate joint. Inter-rater reliability was better for objective compared to subjective grading. CONCLUSIONS Subjective grading of wrist arthritis can detect moderate/severe radiocarpal arthritis but poorly evaluates early arthritis and underestimates severity. Objective grading using the JSH ratio accurately grades radioscaphoid arthritis and detects early radiolunate arthritis. The JSH ratio more accurately assesses radiocarpal arthritis compared with subjective grading. As there currently is no accepted method to radiographically grade wrist arthritis, the JSH ratio represents a promising option.
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Affiliation(s)
- David M. Bear
- />Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261 USA
| | - Gele Moloney
- />Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261 USA
| | - Robert J. Goitz
- />Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261 USA
| | - Marshall L. Balk
- />Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261 USA
| | - Joseph E. Imbriglia
- />Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261 USA , />Hand and Upper Extremity Center, 6001 Stonewood Dr, Wexford, PA 15090 USA
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20
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Abstract
Resection arthroplasty is an old, and yet reliable, solution for the isolated osteoarthritis (OA) of some joints of the hand. With complication low rates, this technically undemanding option is ideal for scapho-trapezial-trapezoidal joint OA, as well as for the OA of the carpometacarpal joints of the fingers. This paper reviews its indications, surgical technique, and results.
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Affiliation(s)
- Alberto L Lluch
- Institut Kaplan for surgery of the Hand and Upper Extremity, Paseo Bonanova, 9, Barcelona 08022, Spain.
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21
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Osteoarthritis of the Wrist STT Joint and Radiocarpal Joint. ARTHRITIS 2012; 2012:242159. [PMID: 22957252 PMCID: PMC3432518 DOI: 10.1155/2012/242159] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 07/23/2012] [Indexed: 12/21/2022]
Abstract
Our understanding of wrist osteoarthritis (OA) lags behind that of other joints, possibly due to the complexity of wrist biomechanics and the importance of ligamentous forces in the function of the wrist. Scaphotrapeziotrapezoidal (STT) OA is common, but its role in wrist clinical pathology and biomechanics is unclear. We identified the prevalence of radiographic STT joint OA in our hand clinic population and defined the relationship between STT and radiocarpal OA in wrist radiographs. One hundred consecutive wrist clinical and radiographic exams were retrospectively reviewed. Radiographs were evaluated for the presence and stage of OA. The mean age was 61.3 (±14.5) years. The radiographic occurrence of STT joint OA was 59% and of radiocarpal (RC) OA was 29%. Radiographic STT and RC joint OA were inversely related. Tenderness over the STT joint in physical exam was not associated with OA in the STT or other joints. STT OA in our series was not related to wrist pain. These findings support the discrepancy between radiographic and cadaver findings and clinically significant OA in this joint. The inverse relationship between STT and RC OA, as seen in scapholunate advanced collapse (SLAC) wrist, requires further biomechanical study.
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Smith J, Brault JS, Rizzo M, Sayeed YA, Finnoff JT. Accuracy of sonographically guided and palpation guided scaphotrapeziotrapezoid joint injections. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:1509-1515. [PMID: 22039023 DOI: 10.7863/jum.2011.30.11.1509] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The purpose of this study was to determine and compare the accuracies of sonographically guided and palpation guided scaphotrapeziotrapezoid (STT) joint injections in a cadaveric model. METHODS A clinician with 6 years of experience performing sonographically guided procedures injected 1.0 mL of a diluted latex solution into the STT joints of 20 unembalmed cadaveric wrist specimens using a palmar approach. At a minimum of 24 hours after injection, an experienced clinician specializing in hand care completed palpation guided injections in the same specimens using a dorsal approach and 1 mL of a different-colored latex. A fellowship-trained hand surgeon blinded to the injection technique then dissected each specimen to assess injection accuracy. Injections were graded as accurate if the colored latex was found in the STT joint, whereas inaccurate injections resulted in no latex being found in the joint. RESULTS All sonographically guided injections were accurate (100%; 95% confidence interval, 81%-100%), whereas only 80% of palpation guided injections were accurate (95% confidence interval, 61%-99%). Sonographically guided injections were significantly more accurate than palpation guided injections, as determined by the ability to deliver latex into the joint (P < .05). CONCLUSIONS Sonographic guidance can be used to inject the STT joint with a high degree of accuracy and is more accurate than palpation guidance within the limits of this study design. Clinicians should consider using sonographic guidance to perform STT joint injections when precise intra-articular placement is desired. Further clinical investigation examining the role of sonographically guided STT joint injections in the treatment of patients with radial wrist pain syndromes is warranted.
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Affiliation(s)
- Jay Smith
- Departments of Physical Medicine and Rehabilitation and Radiology, Rochester, MN 55905 USA.
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