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Papadopoulos DV, Zafeiris E, Mystidis I, Nikolaou VS, Babis GC, Imbriglia JE. Augmentation of Rotator Cuff Repair Using Umbilical Cord Graft: A Preliminary Observational Study. J Long Term Eff Med Implants 2024; 34:61-68. [PMID: 38305371 DOI: 10.1615/jlongtermeffmedimplants.2023048123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Due to the high rate of rotator cuff re-tear there is an extensive research on augmentation of rotator cuff repairs. The purpose of this single center, prospective study was to evaluate the results of augmentation of the rotator cuff repair with an umbilical cord allograft. The graft group in which the rotator cuff repair was augmented with the graft as an on-lay patch was consisted of 14 patients, while the control group was consisted of 10 patients. The primary outcome of the study was incidence of rotator cuff retears, while secondary outcomes included functional and pain scores. At 6 mo there was a significantly higher incidence of retears in the control group (30%) compared to the graft group (0%; P = 0.028), while at 12 mo the retear rates were statistically similar for the two groups (P = 0.46). The Constant-Murley scores, the ASES scores and the VAS score were similar (P > 0.05) for the two groups at all study times. The results of the study indicated that augmentation of the cuff repair with human umbilical cord graft can result in similar patient reported outcomes compared to a cuff repair without augmentation, but with a lower re-tear rate at 6 mo.
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Affiliation(s)
- Dimitrios V Papadopoulos
- 2nd Academic Department of Orthopaedics, School of Medicine, Konstandopoulio General Hospital, National & Kapodistrian University of Athens, Athens, Greece; Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Evangelos Zafeiris
- 2nd Academic Department of Orthopaedics, School of Medicine, Konstandopoulio General Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Ilias Mystidis
- 2nd Academic Department of Orthopaedics, School of Medicine, Konstandopoulio General Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Vasileios S Nikolaou
- 2nd Academic Department of Orthopaedics, School of Medicine, Konstandopoulio General Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - George C Babis
- 2nd Academic Department of Orthopaedics, School of Medicine, Konstandopoulio General Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Joseph E Imbriglia
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Papadopoulos DV, Nikolaou VS, Masouros P, Babis GC, Imbriglia JE. The impact of glenoid parameters and implant overstuffing on functional outcomes of shoulder hemiarthroplasty in patients with glenohumeral joint arthritis. Eur J Orthop Surg Traumatol 2023; 33:3531-3538. [PMID: 37212913 DOI: 10.1007/s00590-023-03584-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/10/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE The outcomes of shoulder hemiarthroplasty are highly dependent on the baseline glenoid morphology and the rotator cuff integrity. The objective of this study was to assess whether certain glenoid parameters and implant overstuffing are associated with worse clinical outcomes following shoulder hemiarthroplasty. METHODS We retrospectively reviewed 25 patients who underwent shoulder hemiarthroplasty for shoulder arthritis, with a mean follow-up of 5.3 years. The baseline glenoid morphology, the glenoid wear rate, the proximal humeral head migration and implant overstuffing were evaluated radiologically in all patients. The radiological parameters were correlated with the functional outcomes. RESULTS The Constant-Murley score, the ASES score, and the OSS score were significantly better for patients with a concentric baseline glenoid compared to those with an eccentric glenoid. The Constant-Murley score and the ASES score were also improved in patients without implant overstuffing compared to patients with implant overstuffing (p < 0.05). However, glenoid wear was not associated with worse functional outcomes (p = 0.23 for Constant-Murley score, p = 0.15 for ASES score and p = 0.27 for OSS score). Last, a worse Constant-Murley score was strongly correlated with proximal humeral head migration (p < 0.001), while worse ASES and OSS scores were moderately correlated with proximal humeral head migration (p < 0.001). CONCLUSION Our findings indicate that the results of hemiarthroplasty can be improved through careful selection of patients upon the baseline glenoid type morphology and proper implant sizing to avoid implant overstuffing. Moreover, glenoid wear is not associated with worse clinical outcomes, therefore shoulder hemiarthroplasty should be reconsidered as an alternative in younger patients with shoulder arthritis.
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Affiliation(s)
| | - Vasileios S Nikolaou
- 2nd Academic Department of Orthopaedics, School of Medicine, Konstandopoulio General Hospital, National & Kapodistrian University of Athens, 3-5 Konstantopoulou Str, 14233, Athens, Greece
| | | | - George C Babis
- 2nd Academic Department of Orthopaedics, School of Medicine, Konstandopoulio General Hospital, National & Kapodistrian University of Athens, 3-5 Konstantopoulou Str, 14233, Athens, Greece
| | - Joseph E Imbriglia
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Munsch MA, Suszynski TM, Fowler JR, Balk ML, Hagberg WC, Buterbaugh GA, Imbriglia JE. Radiographic Thumb Metacarpal Subsidence Following Ligament Reconstruction With Tendon Interposition and Suture-Only Suspension Arthroplasty in the Treatment of Basal Joint Arthritis. Hand (N Y) 2023; 18:1129-1134. [PMID: 35322694 PMCID: PMC10798194 DOI: 10.1177/15589447221084014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The thumb carpometacarpal (CMC) joint is a common source of osteoarthritis. Following trapeziectomy, ligament reconstruction with tendon interposition (LRTI) is considered a "gold standard" treatment, but suture-only suspension arthroplasty (SSA) has recently emerged as a simpler alternative. Currently, there is no objective radiographic study comparing subsidence following these 2 techniques. METHODS This study is a retrospective review of 23 patients (10 LRTI, 13 SSA) that had at least 6 months of radiographic follow-up following thumb CMC arthroplasty. Posteroanterior radiographs at a preoperative timepoint, and at the 2-week and greater than 6-month postoperative timepoints were evaluated for actual trapezial height, as well as trapezial height normalized to capitate, thumb metacarpal, and proximal phalangeal heights. Normalized trapezial heights were calculated, and preoperative values were compared with greater than 6-month postoperative values. In addition, actual and normalized trapezial heights following LRTI and SSA were compared at each timepoint. RESULTS Mean trapezial height decreased from approximately 12 to 5 mm (reduction of ~60%, P < .05) in both groups with no differences when comparing LRTI and SSA at each timepoint. All normalized trapezial heights revealed differences from preoperative to greater than 6-month postoperative timepoints, but no differences between LRTI and SSA. CONCLUSIONS Ligament reconstruction with tendon interposition and SSA exhibit equivalent actual and normalized trapezial heights over a greater than 6-month postoperative time course.
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Suszynski TM, Fowler JR, Munsch M, Bourne DA, Chow I, Balk ML, Hagberg WC, Buterbaugh GA, Sivak WN, Imbriglia JE. Prospective Cohort Study Comparing Ligament Reconstruction with Tendon Interposition and Suture-Only Suspension Arthroplasty. Plast Reconstr Surg 2023; 152:375-382. [PMID: 36912921 DOI: 10.1097/prs.0000000000010394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
BACKGROUND Basal joint arthritis is a common form of osteoarthritis. There is no consensus procedure for maintenance of trapezial height following trapeziectomy. Suture-only suspension arthroplasty (SSA) is a simple method for stabilizing the thumb metacarpal following trapeziectomy. METHODS This single-institution, prospective, cohort study compares trapeziectomy followed by either ligament reconstruction with tendon interposition (LRTI) or SSA for the treatment of basal joint arthritis. Patients underwent LRTI or SSA from May of 2018 to December of 2019. Visual analogue scale pain scores; Disabilities of the Arm, Shoulder and Hand questionnaire functional scores; clinical thumb range of motion, pinch, and grip strength data; and patient-reported outcomes were recorded and analyzed preoperatively and at 6 weeks and 6 months postoperatively. RESULTS Total number of study participants was 45 (LRTI, n = 26; SSA, n = 19). Mean ± SE age was 62.4 ± 1.5 years; 71% were female patients; and 51% underwent surgery on the dominant side. Visual analogue scale scores improved for LRTI and SSA ( P < 0.0001) over 6 months, with no differences between groups at any time point ( P > 0.3). Disabilities of the Arm, Shoulder and Hand questionnaire scores improved for LRTI and SSA over 6 months ( P < 0.0001), with no differences between groups at any time point ( P > 0.3). Following SSA, opposition improved ( P = 0.02), but not as well for LRTI ( P = 0.16). Grip and pinch strength decreased following LRTI and SSA at 6 weeks but recovered similarly for both groups over 6 months. Patient-reported outcomes were generally no different between groups at all time points. CONCLUSION LRTI and SSA are similar procedures following trapeziectomy relative to pain, function, and strength recovery. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Affiliation(s)
- Thomas M Suszynski
- From the Departments of Surgery (Plastic Surgery) and Orthopedic Surgery, University of Minnesota Medical Center
| | | | | | - Debra A Bourne
- Plastic Surgery, University of Pittsburgh Medical Center
| | - Ian Chow
- Plastic Surgery, University of Pittsburgh Medical Center
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Teunis T, Khurana S, Imbriglia JE. Volar Plate Advancement and Abductor Pollicis Brevis Tenodesis for Thumb Metacarpophalangeal Joint Hyperextension Correction. Arch Bone Jt Surg 2023; 11:68-71. [PMID: 36793661 PMCID: PMC9903312 DOI: 10.22038/abjs.2022.64493.3100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 09/19/2022] [Indexed: 02/17/2023]
Abstract
First carpometacarpal (CMC1) osteoarthritis can be accompanied by the collapse of the first ray, with hyperextension of the first metacarpophalangeal (MCP1) joint. It is suggested that failure to address substantial MCP1 hyperextension during CMC1 arthroplasty may diminish post-operative capability and increase collapse reoccurrence. An arthrodesis is recommended in case of severe MCP1 joint hyperextension (>400). We describe a novel combination of a volar plate advancement and abductor pollicis brevis tenodesis to address MCP1 hyperextension at the time of CMC1 arthroplasty as an alternative to joint fusion. In 6 women, mean MCP1 hyperextension with pinch before surgery was 450 (range 300-850) and improved to 210 (range 150-300) of flexion with pinch six months after surgery. No revision surgery has been necessary to date, and there were no adverse events. Long-term outcome data is needed to establish the longevity of this procedure as an alternative to joint fusion, but early results are promising.
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Affiliation(s)
- Teun Teunis
- University Pittsburgh Medical Center, Pittsburgh, PA, USA
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Geraghty FJ, Anderson L, Mir H, Daniali L, Imbriglia JE, Pulikkottil BJ. Surgical Management of Extensor Digitorum Brevis Manus Anomaly with a Dorsal Ganglion Cyst. J Wrist Surg 2021; 10:436-439. [PMID: 34631297 PMCID: PMC8489985 DOI: 10.1055/s-0040-1722572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
Background The most common soft tissue tumor of the hand is the dorsal ganglion cyst and often is an indication for surgical excision. The differential diagnoses for dorsal hand masses include but are not limited to tenosynovitis, epidermoid cyst, abscess, lipoma, xanthoma, rheumatoid nodule, tophus, carpal boss, myositis ossificans, foreign body granuloma, neoplasm, and anomalous muscles. Case Description Our case report reflects the latter, a 33-year-old female who presented with a 3-year history of a symptomatic dorsal ganglion cyst of her left wrist. She is a female in her 30s, with progressive, worsening pain on wrist extension. Intraoperatively, it was determined that an anomalous extensor digitorum brevis manus (EDBM) was present and may have contributed to her pain and was excised. Literature Review The literature is sparse with the surgical management of EDBM. This case study aims to explore algorithms for managing simultaneous EDBM with a dorsal wrist ganglion, which is clinically relevant for any hand surgeon, when faced with a similar intra-operative management situation.
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Affiliation(s)
- Feargal J. Geraghty
- Kendall General Surgery Residency, National University of Ireland Galway, Galway, Ireland
| | - Lisa Anderson
- Texas A&M Health Science Center College of Medicine, Texas Tech, Lubbock, Texas
| | - Haaris Mir
- Kendall Regional Medical Center, Indiana University School of Medicine, Indianapolis, Indiana
| | - Lily Daniali
- Burn and Reconstructive Centers of America, Swedish Medical Center, Englewood, Colorado
| | - Joseph E. Imbriglia
- Orthopedic Hand Surgery, University of Pittsburgh Medical Center/Hand UpperEx Center, Pittsburgh, Pennsylvania
| | - Benson J. Pulikkottil
- Burn and Reconstructive Centers of America, Swedish Medical Center, Englewood, Colorado
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Sivak WN, Imbriglia JE. Evaluation of Cartilage in the Wrist using Magnetic Resonance Imaging. Curr Rheumatol Rev 2019; 16:170-177. [PMID: 31804162 DOI: 10.2174/1573397115666190819153912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/18/2019] [Accepted: 08/20/2019] [Indexed: 11/22/2022]
Abstract
Wrist pain is a common patient complaint with a myriad of clinical conditions that can explain the underlying cause. Short of wrist arthroscopy, no technique other than formal wrist arthrotomy exists for direct examination of the hyaline cartilage coating the articular surfaces of the carpal bones. Magnetic resonance imaging (MRI) has been proven accurate in evaluating joint surfaces of large joints such as the shoulder, hip, and knee with articular cartilage surface thickness is in excess of 1 mm. However, in the carpus the thickness of the cartilage and the contours present have precluded accurate imaging. Advances in MRI technology over the last several decades are now making imaging of small joint surfaces, such as the carpus, an area worth revisiting. Herein we provide a review of these efforts with a specific focus on the evaluation of the wrist.
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Affiliation(s)
- Wesley N Sivak
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Joseph E Imbriglia
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, United States
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Naghshineh N, Goyal K, Giugale JM, Neral MK, Ferreira JV, Buterbaugh GA, Imbriglia JE. Proximal Interphalangeal Joint Silicone Arthroplasty for Osteoarthritis: Midterm Outcomes. Hand (N Y) 2019; 14:664-668. [PMID: 29619888 PMCID: PMC6759980 DOI: 10.1177/1558944718769427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Osteoarthritis of the proximal interphalangeal (PIP) joint affects a large percentage of the population and can lead to significant functional disability. The purpose of this study is to evaluate the midterm clinical effectiveness of PIP joint arthroplasty for nonrheumatic arthritis. Methods: A single-center retrospective cohort study evaluating preoperative and postoperative objective and subjective measures was conducted. Range of motion (ROM), Disabilities of the Arm, Shoulder and Hand scores, key pinch strength, grip strength, and satisfaction with respect to pain, deformity, function, and strength were measured. Results: Forty-five fingers in 25 patients were followed up for a mean period of 42 months. Preoperative and postoperative mean ROM was equivalent at 59.1° and 59.2°, respectively. Postoperative grip and key pinch strength showed significant improvement and near normalization compared with contralateral extremity. Complication rate was 37% with 20% requiring revision surgery. Patients with diabetes mellitus had higher odds of requiring revision surgery. Pain scores improved from 7.4 to 1.9 on a visual analog scale. Overall satisfaction was high at 84%, and 91% of patients would have the surgery performed again. Conclusions: Silicone arthroplasty for osteoarthritis of the PIP remains a good option for pain relief. Our study presents midterm follow-up data that support significant pain relief, increased grip and key pinch strength, and high satisfaction associated with this implant.
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Affiliation(s)
| | - Kanu Goyal
- The Ohio State University, Columbus,
USA
| | - Juan M. Giugale
- University of Pittsburgh Medical Center,
PA, USA
- Juan M. Giugale, Department of Orthopedics,
University of Pittsburgh Medical Center, Medical Building T, 5th floor, 9104
Babcock Boulevard, Pittsburgh, PA 15213, USA.
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Affiliation(s)
- Hannah H Lee
- 1 Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Joseph E Imbriglia
- 1 Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,2 Hand & UpperEx Center, Wexford, PA, USA
| | - Marshall L Balk
- 1 Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,2 Hand & UpperEx Center, Wexford, PA, USA
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Neral M, Imbriglia JE, Carlson L, Wollstein R. Motor Examination in the Diagnosis of Carpal Tunnel Syndrome. J Hand Microsurg 2017; 9:67-73. [PMID: 28867905 DOI: 10.1055/s-0037-1603346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 04/21/2017] [Indexed: 10/19/2022] Open
Abstract
The relative importance and use of motor evaluation to diagnose carpal tunnel syndrome (CTS) is not clear. Because the ulnar nerve is not affected in CTS, we evaluated comparing the strength of the median-nerve innervated muscles to the ulnar innervated muscles in the same patient, through manual muscle testing (MMT) and a handheld dynamometer. Our purpose was to evaluate whether this method, which takes into account patient-dependent factors that would affect both groups of muscles equally, can provide better assessment of CTS. A retrospective case-control review of MMT and dynamometer-measured strength for CTS was performed. The study was performed retrospectively but prior to surgery or other treatment. There were 28 cases (CTS) and 14 controls (without CTS). Positive nerve conduction tests defined cases. MMT of the thenar musculature was found to be unreliable as a test for CTS. Comparisons to ulnar nerve innervated muscle strength did not improve sensitivity or specificity of the MMT examination. Use of the dynamometer improved sensitivity and specificity of motor testing in CTS over MMT. Motor evaluation is important for the diagnosis of CTS, but further study is warranted, specifically to define the method of motor evaluation and delineate the subgroup of patients (predominantly thenar motor presentation) that would benefit most from motor testing and motor-focused treatment.
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Affiliation(s)
- Mithun Neral
- Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania, United States.,Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Joseph E Imbriglia
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Lois Carlson
- The Hand Center, University of Connecticut School of Medicine, Glastonbury, Connecticut, United States
| | - Ronit Wollstein
- Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania, United States.,Division of Hand and Upper Extremity Surgery, Department of Orthopedics, Technion School of Medicine, Haifa, Israel
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Pulikkottil BJ, Ruane E, Scott ME, Sater AP, Imbriglia JE. Simultaneous Avascular Necrosis of the Lunate and Scaphoid. Eplasty 2017; 17:ic4. [PMID: 28261373 PMCID: PMC5301186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Benson J. Pulikkottil
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa,Correspondence:
| | - Edward Ruane
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Michael E. Scott
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | | | - Joseph E. Imbriglia
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
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Abstract
Background: A case is discussed in which a young girl was born with symbrachydactyly of multiple digits in whom nonvascularized proximal toe phalanges were transferred to the aphalangic digits at the age of four. At 39 years of age, she presented incidentally to our clinic and was observed to have a very functional hand with mobile metacarpophalangeal joints in all reconstructed digits. Methods: We present a case report which is discussed in the context of long-term follow-up, and phalangeal growth in the absence of distraction, and a review of the current literature in regards to outcomes for this modality of treatment. Results: We document growth of the transplanted phalanges, despite surgery occurring after the reported optimum age of before 18 months, and the patient not undergoing distraction. The patient reported no donor site morbidity in regards to function or psychosocial impact. Furthermore, we observed active function at the metacarpophalangeal joints of all operated digits. Conclusions: We report the longest follow-up (35 years) following nonvascularized proximal toe phalangeal transfer for short finger type symbrachydactyly. We highlight the long-term functional outcome of nonvascularized toe phalangeal transfers, and present an overview of the current outcome literature for this type of procedure, advocating that nonvascularized toe phalangeal transfers remain a viable treatment option for select cases of symbrachydactyly.
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Affiliation(s)
| | - Joseph E. Imbriglia
- University of Pittsburgh, PA, USA,Hand & UpperEx Center, Wexford, PA, USA,Joseph E. Imbriglia, 6001 Stonewood Drive, Wexford, PA 15090, USA.
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Abstract
Background: Previous studies using ultrasound for diagnosis of carpal tunnel syndrome have reported on relatively small series of patients, leading to large standard deviations and/or confidence intervals for the mean cross-sectional area of the median nerve. The purpose of this study is to define the CSA of the median nerve in a large cohort of patients. Methods: Patients (n = 175) without history of carpal tunnel release were recruited. All participants were evaluated using the Carpal Tunnel Syndrome-6 questionnaire, a validated clinical diagnostic tool, with a score of 12 or greater considered positive for CTS. Ultrasound examination was performed on both wrists of all participants using a 13-6 MHz linear array transducer. Results: The mean median nerve CSA was significantly larger (P < .001) for patients with a positive (mean = 11.16, SD = 2.51) versus negative CTS-6 result (mean = 6.91, SD = 2.06). There was a significant correlation (.527, P < .001, n = 349) between CSA and CTS-6 score. Logistic regression analysis determined that a CSA of 10 mm2 optimized sensitivity and specificity at 80% and 88%, respectively. Accuracy was 87.9%. Conclusions: A significant difference in mean CSA was found between patients with and without CTS. Median nerve CSA showed a statistically significant positive correlation with CTS-6. Similar to prior studies, a CSA of 10 mm2 was determined to be the optimal cutoff. In this large series of patients, ultrasound was a sensitive, specific, and accurate test for confirmation of a clinical diagnosis of CTS.
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Affiliation(s)
- Tiffany J. Pan
- University of Pittsburgh, Pittsburgh, PA, USA,Tiffany J Pan, Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Medical Building, Suite 1010, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA.
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15
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Awan HM, Imbriglia JE. Silicone Arthroplasty After Ankylosis of Proximal Interphalangeal Joints in Rheumatoid Arthritis: A Case Report. Am J Orthop (Belle Mead NJ) 2016; 45:E221-E223. [PMID: 27327930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Rheumatoid arthritis (RA) can cause severe disability of the hand and fingers. Ankylosis of the finger joints is a known yet underreported manifestation of RA of the hand. We report the case of a patient who had RA and developed autofusion of the proximal interphalangeal (PIP) joints. At presentation, the PIP joints were fused in 15° of flexion. Silicone PIP arthroplasty was performed. Function improved with 60° of PIP joint motion and no pain.
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Affiliation(s)
- Hisham M Awan
- Hand and Upper Extremity Center, Department of Orthopaedics, Wexner Medical Center, Ohio State University, Columbus, OH.
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Goyal KS, Jain S, Buterbaugh GA, Imbriglia JE. The Safety of Hand and Upper-Extremity Surgical Procedures at a Freestanding Ambulatory Surgery Center: A Review of 28,737 Cases. J Bone Joint Surg Am 2016; 98:700-4. [PMID: 27098330 DOI: 10.2106/jbjs.15.00239] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND More procedures are being completed on an outpatient basis at freestanding ambulatory surgery centers. The purpose of our study was to determine the safety and rate of adverse events in outpatient hand and upper-extremity surgical procedures. METHODS A retrospective review of cases at a single, freestanding ambulatory surgery center over an eleven-year period was performed. In our analysis, 28,737 cases were performed and were included. Adverse events were defined as serious complications causing harm to a patient or leading to additional treatment. Using state-reportable adverse events criteria as a guideline, we divided the adverse events into seven categories: infection requiring intravenous antibiotics or return to the operating room, postoperative transfer to a hospital, wrong-site surgical procedure, retention of a foreign object, postoperative symptomatic thromboembolism, medication error, and bleeding complications. These adverse events were then analyzed to determine if they led to additional laboratory testing, hospital admission, return to the operating room, emergency department visits, or physical or mental permanent disability. RESULTS There were fifty-eight reported adverse events, for an overall rate of 0.20%. There were no deaths. There were fourteen infections, eighteen postoperative transfers to a hospital, twenty-one hospital admissions after discharge, one medication error, and four postoperative hematomas. There were no cases of wrong-site surgical procedures or retained foreign bodies. CONCLUSIONS Our study shows that, with a selected patient population, a very low adverse event rate (0.20%) can be achieved. Our review showing few adverse events, no deaths, and no wrong-site surgical procedures supports our view that hand and upper-extremity surgical procedures can be completed safely in the outpatient setting at a freestanding ambulatory surgery center. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kanu S Goyal
- Department of Orthopaedic Surgery, Division of Hand and Upper Extremity, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sameer Jain
- Hand & UpperEx Center, Wexford, Pennsylvania
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Fowler JR, Munsch M, Huang Y, Hagberg WC, Imbriglia JE. Pre-operative electrodiagnostic testing predicts time to resolution of symptoms after carpal tunnel release. J Hand Surg Eur Vol 2016; 41:137-42. [PMID: 25770901 DOI: 10.1177/1753193415576248] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 01/31/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED The purpose of this study was to determine if nerve conduction studies predict time to resolution of symptoms after carpal tunnel release. A total of 56 patients undergoing open carpal tunnel release were prospectively enrolled. Pre-operative presence of nocturnal symptoms and daytime numbness/tingling were documented. Pre-operative nerve conduction studies were reviewed and classified as mild, moderate, or severe. After open carpal tunnel release, patients were contacted by phone within 48 hours, at 1 week, and then at 2-week intervals for up to 9 months or until both nocturnal and daytime symptoms had resolved. This study found that patients with mild or moderate carpal tunnel syndrome experience a faster time to resolution of daytime numbness and tingling when compared with patients with severe carpal tunnel syndrome. Nocturnal symptoms resolved quickly in both groups. The results of this study are in contrast to previous studies that found little to no value of nerve conduction studies in predicting post-operative functional and subjective outcomes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- J R Fowler
- Department of Orthopaedics, University of Pittsburgh, Pittsburgh, PA, USA
| | - M Munsch
- Department of Orthopaedics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Y Huang
- Department of Orthopaedics, University of Pittsburgh, Pittsburgh, PA, USA
| | - W C Hagberg
- Department of Orthopaedics, University of Pittsburgh, Pittsburgh, PA, USA
| | - J E Imbriglia
- Department of Orthopaedics, University of Pittsburgh, Pittsburgh, PA, USA
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Abstract
Degenerative arthrosis of the proximal row remains a challenging problem for both patients and surgeons. Proximal row carpectomy is a motion-preserving treatment option, with studies documenting acceptable long-term outcomes. Proximal row carpectomy is an attractive option because there is no need for fusion to occur between the carpal bones, as in 4-corner fusion. As a result, laborers and smokers may be able to return to work more quickly. However, capitate chondrosis traditionally has been considered a contraindication to proximal row carpectomy. The goal of this study was to review the long-term follow-up of patients who underwent osteochondral resurfacing of capitate chondrosis performed in the same setting as proximal row carpectomy. Final follow-up was obtained in 5 of 8 (63%) patients at an average of 101 months (range, 99-102) after surgery. Grip strength improved at each time point, but wrist flexion and extension decreased. The average Mayo Wrist Score was 74 (range, 65-85) and remained stable or improved in all patients between the 18-month visit and the final visit. The Disabilities of the Arm, Shoulder and Hand (DASH) score was unchanged at final follow-up compared with 18-month follow-up (P=.7). This study found that osteochondral resurfacing of the capitate in the setting of proximal row carpectomy for patients with capitate chondrosis offers good outcomes compared with standard proximal row carpectomy in patients without capitate chondrosis on patient-directed outcome tools (DASH, Mayo Wrist Score) at long-term follow-up of 101 months.
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Fowler JR, Munsch M, Tosti R, Hagberg WC, Imbriglia JE. Comparison of ultrasound and electrodiagnostic testing for diagnosis of carpal tunnel syndrome: study using a validated clinical tool as the reference standard. J Bone Joint Surg Am 2014; 96:e148. [PMID: 25187592 DOI: 10.2106/jbjs.m.01250] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Ultrasound examination is both accurate and cost-effective for the confirmation of a clinical diagnosis of carpal tunnel syndrome. Previous studies have shown electrodiagnostic testing and ultrasound to be similar with regard to sensitivity and specificity. The purpose of this study was to compare the sensitivity and specificity of ultrasound and electrodiagnostic testing by using a validated clinical diagnostic tool as the reference standard. METHODS All consecutive patients referred to an upper-extremity practice for electrodiagnostic testing for any reason over a three-month period were recruited to participate in this study. All patients were evaluated with the use of the Carpal Tunnel Syndrome 6 (CTS-6) clinical diagnostic tool, and a score of ≥12 was considered positive for carpal tunnel syndrome. A positive finding on ultrasound was considered to be a cross-sectional area of the median nerve, measured just proximal to the level of the pisiform, of ≥10 mm(2). A positive finding on electrodiagnostic testing was a distal motor latency of ≥4.2 ms and/or a distal sensory latency of ≥3.2 ms. Sensitivity, specificity, and accuracy were calculated for ultrasound and electrodiagnostic testing with use of the CTS-6 as the reference standard. RESULTS With use of the CTS-6 as the reference standard, ultrasound had a sensitivity of 89% and a specificity of 90% in our series of eighty-five patients. Electrodiagnostic testing had a sensitivity of 89% and a specificity of 80%. The positive predictive value of ultrasound was 94% compared with 89% for electrodiagnostic testing. The negative predictive value of ultrasound was 82% compared with 80% for electrodiagnostic testing. Ultrasound was accurate in seventy-six (89%) of the eighty-five cases whereas electrodiagnostic testing was accurate in seventy-three (86%) of the eighty-five cases (p = 0.5). CONCLUSIONS While ultrasound will not replace electrodiagnostic testing in complicated or unclear cases, in a select group of patients with a positive CTS-6, ultrasound can be used to confirm the diagnosis of carpal tunnel syndrome with better specificity and equal sensitivity as compared with those of electrodiagnostic testing. LEVEL OF EVIDENCE Diagnostic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- John R Fowler
- Department of Orthopaedics, University of Pittsburgh, 3471 Fifth Avenue, Suite 911, Pittsburgh, PA 15213. E-mail address:
| | - Maria Munsch
- Hand & UpperEx Center, 6001 Stonewood Drive, Second Floor, Wexford, PA 15090. E-mail address for M. Munsch: . E-mail address for W.C. Hagberg: . E-mail address for J.E. Imbriglia:
| | - Rick Tosti
- Department of Orthopaedics, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA 19140. E-mail address:
| | - William C Hagberg
- Hand & UpperEx Center, 6001 Stonewood Drive, Second Floor, Wexford, PA 15090. E-mail address for M. Munsch: . E-mail address for W.C. Hagberg: . E-mail address for J.E. Imbriglia:
| | - Joseph E Imbriglia
- Hand & UpperEx Center, 6001 Stonewood Drive, Second Floor, Wexford, PA 15090. E-mail address for M. Munsch: . E-mail address for W.C. Hagberg: . E-mail address for J.E. Imbriglia:
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Neral MK, Pittner DE, Spiess AM, Imbriglia JE. Silicone arthroplasty for nonrheumatic metacarpophalangeal joint arthritis. J Hand Surg Am 2013; 38:2412-8. [PMID: 24183404 DOI: 10.1016/j.jhsa.2013.09.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 09/06/2013] [Accepted: 09/07/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the clinical effectiveness of metacarpophalangeal (MCP) arthroplasty for nonrheumatic arthritis. We hypothesized that MCP arthroplasty would produce significant improvement in objective measures of hand function, pain relief, and overall patient satisfaction. METHODS This retrospective study evaluated 30 patients with 38 MCP arthroplasties for nonrheumatic arthritis over a 12-year period. Follow-up assessment was completed at an average of 56 months after surgery. Objective measures included range of motion; grip and pinch strength; Disabilities of the Arm, Shoulder, and Hand (DASH) score; and visual analog pain score. A subjective patient questionnaire was used to assess patient satisfaction. RESULTS There was marked improvement between preoperative and follow-up range of motion, DASH, and pain. Linear regression showed strong correlations between preoperative measurements and improvement at follow-up. No difference was detected for grip or pinch strength. Results of the questionnaire showed that 73% were very satisfied, 87% would definitely do it again, and 70% experienced rare or no pain. Follow-up x-rays showed 5° mean angulation and 2-mm mean subsidence compared with immediate postoperative x-rays. Four arthroplasties (11%) required revision. CONCLUSIONS This study showed improved range of motion and DASH score, excellent pain relief, and excellent patient satisfaction in patients undergoing MCP arthroplasty for nonrheumatic arthritis. Patients with more severe range of motion limitation, DASH score, and pain score experienced a greater improvement of these measures at follow-up. Strength improvement was limited although it remained comparable to the nonoperated hand. Angulation, subsidence, and complications in the study population were consistent with those reported in the literature. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
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Affiliation(s)
- Mithun K Neral
- Departments of Orthopaedic Surgery and Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh; and the Hand and UpperEx Center, University of Pittsburgh School of Medicine, Wexford, PA
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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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Abstract
Background Proximal row carpectomy (PRC) is a useful treatment option for wrist arthritis, but the operation is contraindicated when there is arthritis of the capitate head. We describe a technique that involves resurfacing of a capitate that has focal chondrosis, using an osteochondral graft harvested from the resected carpal bones. Materials and Methods PRC patients who had a focal area of capitate chondrosis underwent osteochondral grafting of the capitate. Pre- and postoperative pain level, employment status, motion, grip strength, and Modified Mayo Wrist Scores (MMWS) were assessed. Postoperative Disability of the Arm, Shoulder, and Hand (DASH) scores were also calculated. Description of Technique The articular surface of the capitate is assessed for need for grafting. The proximal row is resected with the lunate removed intact. The arthritic area is prepared. The graft is taken from the lunate and placed in the prepared site of the capitate. Results Eight patients (average age of 53 years) were followed for 18 months. Pain: Preoperatively, moderate to severe in 7 patients; postoperatively, mild to no pain in 7 patients. Motion: Preoperative, 84° (74% of the contralateral side); postoperative 75° (66%). Grip Strength: Preoperative, 29 kg (62%); postoperative, 34 kg (71%). Mayo Wrist Score: Preoperative, 51 (poor); postoperative, 68 (fair). Average postoperative DASH score was 19.5. Follow-up radiographs showed that 75% of patients had mild to no degeneration. Conclusions Osteochondral grafting in PRC offers satisfactory results in terms of pain relief, return to work, motion, and grip strength. Level of Evidence Therapeutic IV, Case series.
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Affiliation(s)
- Peter Tang
- Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Joseph E. Imbriglia
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Western Pennsylvania Hand and UpperEx Center, Wexford, Pennsylvania
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Husain SN, Clarke SE, Buterbaugh GA, Imbriglia JE. Recalcitrant trigger finger managed with flexor digitorum superficialis resection. Am J Orthop (Belle Mead NJ) 2011; 40:620-624. [PMID: 22268008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Although trigger finger is a condition commonly treated by orthopedic surgeons, we have not found sufficient studies in the literature addressing the treatment of trigger finger that persists following A1 pulley release. We identified 12 fingers in 11 patients with symptoms of trigger finger following A1 pulley release who subsequently underwent resection of 1 or both slips of the flexor digitorum superficialis tendon. Ten patients (11 fingers) presented for follow-up at a mean of 21 months after surgery. All patients had resolution of their symptoms with a mean visual analog score of 1.5 and a mean DASH score of 17. Grip and pinch strength were comparable to the contralateral side. Mean total active range of motion of the affected digit was 252°. Resection of 1 or both slips of the flexor digitorum superficialis is an effective method for treatment of recalcitrant trigger finger.
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Affiliation(s)
- Sohail N Husain
- Essex Orthopaedics & Optima Sports Medicine, Salem, New Hampshire 03079, USA.
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Abstract
Hand transplantation is the most common form of modern composite tissue allotransplantation. Successful application of this technology requires a multidisciplinary approach incorporating not only skilled hand surgeons, transplant surgeons, and transplant immunologists, but also hand therapists, psychiatrists, medical specialists, anesthesiologists, and others. Functional outcomes can be life changing for properly selected candidates. Hand transplantation is becoming more common, with more centers offering this relatively new reconstructive modality. Its success depends on proper patient selection, a technically successful operation, postoperative rehabilitation, and an immunotherapy protocol that prevents rejection but has minimal or acceptable morbidity.
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Affiliation(s)
- Jaimie T Shores
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
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Bykowski MR, Sivak WN, Cray J, Buterbaugh G, Imbriglia JE, Lee WPA. Assessing the impact of antibiotic prophylaxis in outpatient elective hand surgery: a single-center, retrospective review of 8,850 cases. J Hand Surg Am 2011; 36:1741-7. [PMID: 21975095 DOI: 10.1016/j.jhsa.2011.08.005] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 07/29/2011] [Accepted: 08/07/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE Prophylactic antibiotics have been shown to prevent surgical site infection (SSI) after some gastrointestinal, orthopedic, and plastic surgical procedures, but their efficacy in clean, elective hand surgery is unclear. Our aims were to assess the efficacy of preoperative antibiotics in preventing SSI after clean, elective hand surgery, and to identify potential risk factors for SSI. METHODS We queried the database from an outpatient surgical center by Current Procedural Terminology code to identify patients who underwent elective hand surgery. For each medical record, we collected patient demographics and characteristics along with preoperative, intraoperative, and postoperative management details. The primary outcome of this study was SSI, and secondary outcomes were wound dehiscence and suture granuloma. RESULTS From October 2000 through October 2008, 8,850 patient records met our inclusion criteria. The overall SSI rate was 0.35%, with an average patient follow-up duration of 79 days. The SSI rates did not significantly differ between patients receiving antibiotics (0.54%; 2,755 patients) and those who did not (0.26%; 6,095 patients). Surgical site infection was associated with smoking status, diabetes mellitus, and longer procedure length irrespective of antibiotic use. Subgroup analysis revealed that prophylactic antibiotics did not prevent SSI in male patients, smokers, or diabetics, or for procedure length less than 30 minutes, 30 to 60 minutes, and greater than 60 minutes. CONCLUSIONS Prophylactic antibiotic administration does not reduce the incidence of SSI after clean, elective hand surgery in an outpatient population. Moreover, subgroup analysis revealed that prophylactic antibiotics did not reduce the frequency of SSI among patients who were found to be at higher risk in this study. We identified 3 factors associated with the development of SSI in our study: diabetes mellitus status, procedure length, and smoking status. Given the potential harmful complications associated with antibiotic use and the lack of evidence that prophylactic antibiotics prevent SSIs, we conclude that antibiotics should not be routinely administered to patients who undergo clean, elective hand surgery. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
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Hartzell TL, Benhaim P, Imbriglia JE, Shores JT, Goitz RJ, Balk M, Mitchell S, Rubinstein R, Gorantla VS, Schneeberger S, Brandacher G, Lee WPA, Azari KK. Surgical and technical aspects of hand transplantation: is it just another replant? Hand Clin 2011; 27:521-30, x. [PMID: 22051392 DOI: 10.1016/j.hcl.2011.08.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The ultimate goal of hand allotransplantation is to achieve graft survival and useful long-term function. To achieve these goals, selection of the appropriate patient, detailed preoperative planning, and precise surgical technique are of paramount importance. Transplantation should be reserved for motivated consenting adults in good general heath, who are psychologically stable and have failed a trial of prosthetic use. While the key surgical steps of transplantation are similar to those of replantation, there are major differences. This article describes the steps in hand allotransplantation, and the importance of patient selection as well as preoperative and postoperative care.
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Affiliation(s)
- Tristan L Hartzell
- Division of Plastic Surgery, Department of Orthopedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA 90095, USA.
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Affiliation(s)
- Kevin Roenbeck
- Orthopedic and Neurosurgical Specialists, LLC, Orthopedic Surgery, 807 Haddon Ave., Haddonfield, NJ 08033, USA.
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Azari KK, Imbriglia JE, Goitz RJ, Shores JT, Balk ML, Brandacher G, Schneeberger S, Gorantla V, Lee WPA. Technical aspects of the recipient operation in hand transplantation. J Reconstr Microsurg 2011; 28:27-34. [PMID: 21811969 DOI: 10.1055/s-0031-1285820] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The goal of hand allotransplantation is to achieve graft survival and useful long-term function. To achieve these goals, precise surgical technique is of critical importance. The key surgical steps and sequence of events in hand allotransplantation are similar to major upper extremity replantations, but are modified to accommodate major conceptual differences that exist between the two procedures.
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Affiliation(s)
- Kodi K Azari
- Division of Plastic Surgery, Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA.
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Jacobs BJ, Anzarut A, Imbriglia JE, Gordillo G, Imbriglia JE. Vascular anomalies of the upper extremity. J Hand Surg Am 2010; 35:1703-9; quiz 1709. [PMID: 20888510 PMCID: PMC4643689 DOI: 10.1016/j.jhsa.2010.08.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 08/03/2010] [Indexed: 02/02/2023]
Abstract
The topic of vascular anomalies is uncommon in the hand surgery literature, but hand surgeons do diagnose and treat patients with hemangiomas and vascular malformations. These are separate entities and require different treatment strategies. Proper diagnosis will lead to timely and appropriate treatment.
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Frazier MS, Boardman MJ, Westland M, Imbriglia JE. Surgical treatment of partial distal biceps tendon ruptures. J Hand Surg Am 2010; 35:1111-4. [PMID: 20610056 DOI: 10.1016/j.jhsa.2010.04.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 04/10/2010] [Accepted: 04/22/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE To demonstrate that surgical repair of partial distal biceps tendon ruptures allows return of supination and flexion strength nearly equal to the contralateral side without compromising range of motion. METHODS We performed a retrospective study of 17 patients with unilateral partial biceps tendon ruptures who underwent surgical repair between 2003 and 2009, and who returned for further evaluation and strength testing. The follow-up examination included questionnaires, x-rays, strength testing, and range of motion with comparison to the opposite side. We used the Baltimore Therapeutic Equipment work simulator to objectively test isometric and dynamic elbow flexion and forearm supination strength of both extremities. RESULTS A total of 17 patients returned for additional testing, 14 of whom had failed nonsurgical treatment. One patient had asymptomatic heterotopic ossification. Two patients reported mild lateral antebrachial cutaneous nerve dysesthesias. There was one partial re-rupture 4 years after the original surgery. The second repair consisted of suture anchor fixation; 15 months after re-repair, the patient remains asymptomatic. Average postoperative Disabilities of the Arm, Shoulder, and Hand score was 9 (range, 0-33). One patient had limited pronation (50 degrees degrees). The average isometric and dynamic elbow flexion was 3% and 11% stronger, respectively, compared with the opposite side. Average isometric supination was 6% and average dynamic supination was 10% weaker. CONCLUSIONS After surgical treatment of partial distal biceps tendon tears, most patients achieved good return of strength with full motion. Surgical treatment of partial distal biceps tendon tears is a viable option after failed nonsurgical treatment. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- M Shane Frazier
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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Affiliation(s)
- Matthew J Boardman
- Department of Hand and Upper Extremity Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15203, USA.
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Tang P, Gauvin J, Muriuki M, Pfaeffle JH, Imbriglia JE, Goitz RJ. Comparison of the "contact biomechanics" of the intact and proximal row carpectomy wrist. J Hand Surg Am 2009; 34:660-70. [PMID: 19345868 DOI: 10.1016/j.jhsa.2008.12.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Revised: 11/29/2008] [Accepted: 12/03/2008] [Indexed: 02/02/2023]
Abstract
PURPOSE The proximal row carpectomy (PRC) is a clinically useful motion-preserving procedure for various arthritides of the wrist. However, there are few studies on the "contact biomechanics" after PRC. The purpose of this study is to evaluate the contact biomechanics in terms of pressure, area, and contact location of the intact and PRC wrist. METHODS Six fresh-frozen cadaver forearms were tested in neutral, 45 degrees of flexion, and 45 degrees of extension. In the intact wrist, Fuji UltraSuperLow pressure contact film was placed in the radioulnocarpal joint. The specimen was loaded to a total force of 200 N. We then performed a PRC, and the experiment was repeated using Fuji Low film. The film was scanned and analyzed with a customized MATLAB program. Multivariable analysis of variance with multiple contrast testing and Student's t-test were performed for statistics. RESULTS In the intact wrist, scaphoid contact pressure averaged 1.4 megapascals (MPa), and lunate contact pressure averaged 1.3 MPa. In terms of contact location, scaphoid contact in the intact wrist significantly moved dorsal and ulnar in flexion and significantly moved volar and radial in extension. Lunate contact significantly moved dorsal in flexion. PRC wrist contact pressure was 3.8 times that of the intact wrist, and the contact area was approximately 26% that of the intact wrist. Lastly, in terms of the amount of contact translation after PRC, the capitate contact translated (7.5 mm) more than did the scaphoid contact (5.6 mm) and had about equal translation to that of the lunate (7.3 mm). CONCLUSIONS Contact pressure increased significantly and contact area decreased significantly after PRC. There is significant contact translation after PRC (more than scaphoid translation but equal to lunate translation), which provides quantitative support of the theory that translational motion of the PRC may explain its good clinical outcomes.
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Affiliation(s)
- Peter Tang
- Columbia University, College of Physicians & Surgeons, New York, NY 10032, USA.
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Tang P, Imbriglia JE. Osteochondral resurfacing (OCRPRC) for capitate chondrosis in proximal row carpectomy. J Hand Surg Am 2007; 32:1334-42. [PMID: 17996766 DOI: 10.1016/j.jhsa.2007.07.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Revised: 07/14/2007] [Accepted: 07/17/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE Proximal row carpectomy (PRC) can be an effective treatment option for arthritis of the wrist, but the operation is contraindicated when there is substantial arthritis of the capitate head. We describe a new technique that involves resurfacing of the capitate when there is chondrosis by using osteochondral grafts harvested from the resected carpal bones. The purpose of this study was to assess the outcomes of patients who had osteochondral resurfacing in the setting of PRC (OCRPRC) for capitate chondrosis and to determine how they compare with published results of conventional PRC. METHODS Patients having PRC who had grade II to IV (Modified Outerbridge Scale) capitate chondrosis underwent osteochondral resurfacing of the capitate. Preoperative and postoperative pain level, employment status, range of motion (ROM), grip strength, and Mayo wrist scores were assessed, and Student's t-test was used. Postoperative Disability of the Arm, Shoulder and Hand (DASH) scores were also calculated. RESULTS Eight patients with an average age of 53 years were followed up for 18 months. Preoperatively, 7 patients described their pain as moderate to severe; postoperatively, 7 patients described their pain as mild to no pain. Preoperative arc of motion was 84 degrees (74% of the contralateral side); postoperative arc of motion was 75 degrees (66% of the contralateral side). Preoperative grip strength was 29 kg, or 62% of the contralateral side; postoperative grip strength was 34 kg, or 71% of the contralateral side. Preoperative Mayo wrist score was 51 ("poor"); postoperative Mayo wrist score was 68 ("fair"). Average postoperative DASH score was 19.5. Follow-up radiographs showed that 75% of patients had mild to no degeneration. Magnetic resonance imaging at 21 months postoperatively showed graft incorporation. No complications were encountered. CONCLUSIONS Our results with osteochondral resurfacing compare favorably with the published results of conventional PRC in terms of pain relief, employment status, ROM, and grip strength.
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Affiliation(s)
- Peter Tang
- College of Physicians & Surgeons, Columbia University, New York, NY 10032, USA.
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Affiliation(s)
- Kodi K Azari
- Department of General Surgery, Division of Plastic and Reconstructive Surgery, University of Pittsburgh, Pittsburgh, Pa. (Azari) Department of General Surgery, Division of Plastic and Reconstructive Surgery, Wayne State University, Detroit, Mich. (Spiess) Department of Orthopedics, University of Pittsburgh, Pittsburgh, Pa., Hand and UpperEx Center, Wexford, Pa. (Buterbaugh, Imbriglia)
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Balk ML, Hagberg WC, Buterbaugh GA, Imbriglia JE. Outcome of surgery for lateral epicondylitis (tennis elbow): effect of worker's compensation. Am J Orthop (Belle Mead NJ) 2005; 34:122-6; discussion 126. [PMID: 15828514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
We retrospectively compared the results of extensor origin release for lateral epicondylitis (tennis elbow) against worker's compensation (WC) status. All patients (N = 57) underwent extensor origin release between October 1989 and June 1998. For the 33 patients (37 elbows) who received WC, mean follow-up was 55 months; for the 25 patients (26 elbows) who did not receive WC, mean follow-up was 45 months. Pain relief, symptom recurrence, satisfaction with procedure outcome, and ability to return to work (same or similar job) were evaluated. Pain relief was reliably achieved in the WC and non-WC groups (36/37 and 24/26 elbows, respectively). Symptom recurrence was intermittent in both groups, and few patients sought medical intervention for recurrent symptoms. Patient satisfaction was high in the WC and non-WC groups (35/37 and 26/26 elbows, respectively). A majority of patients in both groups returned to work, but a significantly higher percentage of patients in the WC group changed jobs because of persistent symptoms.
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Affiliation(s)
- Marshall L Balk
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Abstract
PURPOSE To compare the outcomes of wrist arthrodesis and arthroplasty in the treatment of rheumatoid arthritis using validated outcome patient surveys and a review of surgical complications in 2 matched cohorts. METHODS Forty-six patients with 51 operated wrists (24 arthrodeses and 27 arthroplasties) were reviewed retrospectively at a follow-up range of 1 to 5 years. Patients completed the Disabilities of the Arm, Shoulder and Hand (DASH) inventory, the Patient-Rated Wrist Evaluation (PRWE), and a questionnaire designed specifically for this study. Surgical complications were obtained by chart review. RESULTS Treatment groups were well matched by patient characteristics and radiographic staging. There were no statistical differences in the survey scores between the 2 groups. Patients in the arthroplasty group, however, reported a trend toward greater ease with personal hygiene and fastening buttons. Complication rates were similar with a 56% complication rate in the arthrodesis group (22% major, 35% minor) and a 52% complication rate in the arthroplasty group (11% major, 41% minor). CONCLUSIONS The DASH and PRWE may not be designed properly to measure impairment caused by wrist disease in patients with generalized arthritis. The results show that patients with rheumatoid arthritis can and do accommodate to a wrist arthrodesis. It should not be construed, however, that patients with rheumatoid arthritis would not prefer or obtain greater benefit from a wrist arthroplasty [corrected].
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Affiliation(s)
- David M Murphy
- University of Iowa, Department of Orthopedic Surgery, Iowa City, IA 52242, USA
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Zivaljevic N, Kiel JM, Gollatz J, Imbriglia JE. Combining mandatory health insurance and medical savings accounts. Manag Care Interface 2002; 15:63-8. [PMID: 11979708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
The American tradition of freedom of choice is mirrored exceptionally well in the health care industry. The consequences of this system are the highest health care costs in the world and 38.7 million uninsured. Implementation of mandatory, high-deductible health insurance in conjunction with a medical savings account for every resident could have several benefits, and it may engender bipartisan support.
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Abstract
Arthroscopic reduction and internal fixation of tibial plateau fractures has been well documented over the last 15 years. Better visualization, less traumatic surgery, reconstruction of accompanying injuries and early mobilization have encouraged arthroscopic surgeons to use this technique more widely. With experience, surgeons became more comfortable in using arthroscopy-assisted surgery not only in split fractures of the lateral tibial plateau (41-B1) but also in more complex tibial and femoral fractures. In this study, 31 patients with intra-articular fractures of the lateral tibial plateau were operated on between 1991 and 1996. The fractures were classified as follows: x12 AO-type B1, x7 B2, x10 B3, x2 C3. Diagnostic arthroscopy and repair of soft tissue injuries was followed by arthroscopic reduction in all patients and supplemented with internal fixation in 29 patients. Postoperatively, an aggressive physical therapy regimen was performed with immediate mobilization and early partial weight bearing. All patients were examined for follow-up after 15-32 months (mean 25.1). In all cases the fractures were stable and allowed full weight-bearing. At follow-up, 25 patients had anatomic reduction. Anatomical reduction cannot be restored in all cases of open reconstruction because of cartilage defects. Fracture reduction using arthroscopic techniques is a suitable alternative for joint fracture repair because additional soft tissue damage can be minimized.
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Affiliation(s)
- H Kiefer
- Department of Orthopaedic Trauma and Reconstructive Surgery, Lukas Hospital, Hindenburgstr. 56, 32257 Bünde, Germany.
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Abstract
Eighty-eight patients underwent radial shortening for Kienböck's disease. Prerequisites for surgery were radiographic studies positive for Kienböck's disease without evidence of radiocarpal arthritis and wrist pain unrelieved by conservative management. Thirty-nine patients were evaluated by subjective questionnaire at a mean postoperative follow-up of 86 months (range: 24-188 months). Following surgery, a significant decrease was noted in pain severity, frequency, and duration. Functional status improved postoperatively, with the most significant gains noted in the following activities: opening jars, opening car doors, carrying bags, and shoveling. Only 3 of 34 patients employed outside the home were unable to return to their original occupations due to their wrist problems. Seventy-six patients were evaluated by physical examination at a mean postoperative follow-up of 31 months (range: 3-87 months). Objective evaluation by physical examination revealed a significant improvement in wrist motion and grip strength. Seventy-seven patients underwent radiographic evaluation at a mean postoperative follow-up of 31 months (range: 3-180 months). A significant progression in Lichtman stage of Kienböck's disease was noted despite the favorable subjective findings and high satisfaction ratings. Thirty-six of 39 patients stated they would undergo the surgery again. The long-term data demonstrate radial shortening in patients with stage II-IIIA Kienböck's disease provides substantial improvement over preoperative status.
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Affiliation(s)
- B I Wintman
- Hand Center of Western Massachusetts, Springfield 01107, USA
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Abstract
This retrospective study compared plate fixation versus pin fixation in 57 patients with rheumatoid arthritis who underwent wrist arthrodesis. Fixation was achieved by using plates in 32 patients and longitudinal pins in 25 patients. Clinical follow-up averaged 29 months (range: 12-57 months) and radiographic follow-up averaged 16 months (range 12-39 months). Union occurred in 97% of the wrists fixed with plates and in 96% of the wrists fixed with pins. There were 6 (19%) complications in the plate group and 7 (28%) complications in the pin group. Three (12%) wrists fixed with pins moved from the immediate postoperative position to a position of relative volar flexion, while radiographs showed no changes in wrist position in the plate group. With both methods, successful arthrodesis stabilized the wrist in a high percentage of patients. Plate fixation offers an excellent alternative method for arthrodesis of the rheumatoid wrist.
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Affiliation(s)
- D C Rehak
- Hughston Clinic, PC, Columbus, GA, USA
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Abstract
Residual articular incongruity of the distal radius following intraarticular fracture has been correlated with early osteoarthritis (OA) and a poor clinical outcome. We developed a simple in vitro fracture model of the distal radius to investigate the relationship between degree of articular incongruity and the resulting distribution of radiocarpal contact stress. Twelve fresh-frozen cadaver arms were dissected, packets of Fuji Pressensor film were inserted into the wrist, and the wrist was loaded through its flexor and extensor tendons. We created a simple intraarticular fracture that allowed controlled distal radius articular incongruity. Loading trials were performed for the intact distal radius, for a fully reduced case, and for step-offs of 0.4, 1, 2, and 3 mm. Mean contact stress was significantly greater than the anatomically reduced case at only 3 mm of step-off. Contact area was greater than the anatomically reduced case at 0.4, 1, and 2 mm of step-off. The elevations in contact stress that we observed were only modest, suggesting that other factors may be involved in the pathogenesis of radiocarpal OA in the presence of residual articular incongruity.
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Affiliation(s)
- D D Anderson
- Biomechanics Research Laboratory, Allegheny-Singer Research Institute, Pittsburgh, Pennsylvania 15212, USA
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Baratz ME, Des Jardins JD, Anderson DD, Imbriglia JE. Displaced intra-articular fractures of the distal radius: the effect of fracture displacement on contact stresses in a cadaver model. J Hand Surg Am 1996; 21:183-8. [PMID: 8683044 DOI: 10.1016/s0363-5023(96)80098-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Contact stresses in the wrist were measured after simulating displaced fractures of the lunate fossa in the distal radius of eight human cadaver arms. Osteotomies created displaced lunate fossa fractures of 0, 1, 2, and 3 mm. Contact stresses were measured with Fuji pressure-sensitive film after loads of 100 N were applied to the wrist through wrist flexor and extensor tendons. Mean contact stresses were significantly increased with step-offs of 1 mm or more. Maximum stresses and overloaded areas were significantly increased with step-offs of 2 mm or more. As the magnitude of the fracture displacement increased, there was a shift in the focus of the maximum stresses toward the fracture line. In this model, simulated displaced die-punch fractures created alterations in both the magnitude and location of contact stresses in the wrist joint.
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Affiliation(s)
- M E Baratz
- Department of Orthopaedic Surgery, Medical College of Pennsylvania, Allegheny General Hospital, Pittsburgh, USA
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Loebig TG, Anderson DD, Baratz ME, Imbriglia JE. Radial instability of the metacarpophalangeal joint of the thumb. A biomechanical investigation. J Hand Surg Br 1995; 20:102. [PMID: 7759918 DOI: 10.1016/s0266-7681(05)80026-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Human cadaver thumbs were tested to evaluate stability of the radial side of the MP joint. The contributions of the dorsal capsule, radial collateral ligament, accessory collateral ligament, and volar plate were examined with the joint in 0 degrees and 30 degrees of flexion. At 0 degrees flexion, the average joint angulation increased 4 degrees following isolated radial collateral ligament transection and 6 degrees following isolated accessory collateral ligament transection. Release of both the accessory and radial collateral ligaments produced marked instability with joint angulation of at least 46 degrees. The accessory collateral ligament helped to stabilize the extended MP joint. There were no significant contributions to stability from the dorsal capsule and volar plate when the collateral ligaments were intact. In the laboratory setting, radial-side instability of the MP joint of the thumb requires transection of both the proper and accessory radial collateral ligament.
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Affiliation(s)
- T G Loebig
- Allegheny-Singer Research Institute, Medical College of Pennsylvania, Pittsburg, USA
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Abstract
Twenty-four patients were evaluated for complaints of pain in the area of the distal radioulnar joint, decreased forearm rotation, and weakness of grip. All patients had a history of trauma to the involved wrist an average of 40 months prior to presentation. Six patients had undergone previous surgery that was unsuccessful. Twenty-three patients were available for follow-up evaluation at an average of 36 months following hemiresection-interposition arthroplasty. At that time, results were excellent in 13 patients, good in 4 patients, fair in 3, and poor in 3. Two patients developed symptoms of styloidcarpal abutment (poor results), one of whom was upgraded to an excellent result after undergoing a shortening osteotomy of the ulna.
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Affiliation(s)
- J E Imbriglia
- Department of Orthopaedic Surgery, Medical College of Pennsylvania, Pittsburgh 15212
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Anderson DD, Bell AL, Gaffney MB, Imbriglia JE. Contact stress distributions in malreduced intra-articular distal radius fractures. J Biomech 1992. [DOI: 10.1016/0021-9290(92)90210-r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Recent reports have shown that carpal coalition, previously regarded as an asymptomatic congenital anomaly, may be an unusual occult cause of wrist pain. Two cases are presented as the first reported examples of congenital piso-hamate fusion creating symptoms due to associated arthritis or occult fracture.
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Affiliation(s)
- D L Ganos
- Department of Orthopedic Surgery, Allegheny General Hospital, Pittsburgh, PA
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Schneider LH, Imbriglia JE. Radioulnar joint fusion for distal radioulnar joint instability. Hand Clin 1991; 7:391-5. [PMID: 1880172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Each one of this small group of patients illustrates a rare indication for the radioulnar joint fusion procedure in distal radioulnar joint instability. The case histories tell of a last ditch effort to salvage function in an extremity crippled by painful radioulnar instability after excision of the distal ulna. The fusions healed slowly and two required repeat surgery to achieve union. Today we would routinely add iliac bone graft to the fusion area to hasten healing. Rarely indicated, this is a salvage procedure that is done after failure of other procedures geared to preserve the rotation of the forearm. These patients all had successful salvage of their extremities for activities of daily living, but only one returned to his labor job. All were worker's compensation cases in physical jobs. Two patients had had prior radiocarpal fusions, making them even more restricted in function. This procedure should be kept in mind to be used in the rare cases of painful instability of the distal radioulnar joint when traditional motion-preserving procedures have failed.
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Affiliation(s)
- L H Schneider
- Division of Hand Surgery, Thomas Jefferson University Hospital, Jefferson Medical College, Philadelphia, Pennsylvania
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Imbriglia JE, Matthews D. The treatment of chronic traumatic subluxation of the distal ulna by hemiresection interposition arthroplasty. Hand Clin 1991; 7:329-34. [PMID: 1880166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Dorsal and palmar subluxation of the distal ulna can be difficult to both diagnose and treat. Patients often present long after their initial injuries with posttraumatic arthritic changes in the distal radioulnar joint. Hemiresection interposition arthroplasty is a salvage procedure that is reliable for both pain relief and restoration of motion.
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Abstract
Proximal row carpectomy as a treatment of disorders of the radiocarpal joint remains controversial despite numerous reports documenting clinically successful outcomes. Criticism includes postoperative loss of grip strength, unsatisfactory range of motion, prolonged rehabilitation time, and the potential for progressive painful arthritis. Twenty-seven patients were studied to address these concerns. The average length of follow-up was 4 years. Postoperative pain relief was achieved in 26 patients, allowing 24 of the 27 patients to return to their previous activity status within an average of 4.5 months after surgery. In all cases, range of motion matched or surpassed preoperative values. Grip strength improved to an average of 80% of the contralateral side. A detailed radiographic analysis of the radii of curvature of the lunate fossa and the capitate showed that the radius of curvature of the capitate is approximately two thirds of the corresponding value of the lunate. Motion between the capitate and the radius is translational with a moving center of motion, which may dissipate load on the radius and explain the relative success of the procedure.
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Affiliation(s)
- J E Imbriglia
- Department of Orthopedic Surgery, University of Pittsburgh, Allegheny General Hospital, Pa
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