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Patluri RR, Gummadi A. Volar Dislocation of Second Metacarpophalangeal Joint-open Reduction with Volar Approach - A rare Case Report. J Orthop Case Rep 2022; 12:70-73. [PMID: 36874896 PMCID: PMC9983376 DOI: 10.13107/jocr.2022.v12.i10.3372] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/17/2022] [Indexed: 01/20/2023] Open
Abstract
Introduction In most cases, the volar plate interposition renders the complex metacarpophalangeal joint dislocation, commonly known as Kaplan's lesion, intractable, necessitating open reduction. The capsuloligamentous attachments around the joint and the head of the metacarpal are buttonholed in this dislocation, limiting closed reduction. Case Report It is presented here a case of 42-year-old male with the left Kaplan's lesion with open wound. The dorsal technique would have decreased neurovascular compromise and prevented the reduction otherwise by exposing the fibrocartilagenous volar plate directly; however, in this case, the volar route was adopted since an open wound exposed the metacarpal head volarly rather than dorsally. After repositioning the volar plate, a metacarpal head splint was applied and physiotherapy was started a few weeks later. Conclusion Volar technique has been confidently employed because the wound was not related to a fracture and the open wound through which the incision was extended was already existing, allowing for easy access to the lesion and leading to positive outcomes, such as better range of motion postoperatively.
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Affiliation(s)
- Rohit Raj Patluri
- Department of Orthopaedics, Viswabharathi Medical College, Kurnool, Andhra Pradesh, India
| | - Akhila Gummadi
- Department of Orthopaedics, Viswabharathi Medical College, Kurnool, Andhra Pradesh, India
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Abstract
Correction of unequal radial polydactyly in which neither thumb duplicates possess both well-developed proximal and distal components, remains challenging. Current techniques using on-top plasty techniques require circumferential incisions, often resulting in postoperative swelling and dorsal scars. We described our experience using a volar approach to achieve better aesthetic and functional results. Twenty-one patients underwent this surgery between 2008 and 2018, with a mean follow-up of 5.1 years. The mean flexion-extension arc for the metacarpophalangeal joint was 75° and that of the interphalangeal joint was 43°. Mean percentage of key, tripod and tip pinch strength were 77%, 79% and 77%, respectively, when compared with the contralateral side. The Vancouver Scar Scale showed an average score of 1.2. We conclude from our study that the volar approach to on-top plasty is a good technique for the correction of unequal radial polydactyly, with good functional and aesthetic results.Level of evidence: IV.
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Affiliation(s)
- Xia Fang
- Department of Plastic and Reconstructive Surgery, Shanghai Jiaotong University School of Medicine, Shanghai
| | - Ping-Tak Chan
- Department of Orthopaedics and Traumatology, Tuen Mun Hospital, Hong Kong
| | - Shengbo Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai Jiaotong University School of Medicine, Shanghai
| | - Xinyi Dai
- Department of Plastic and Reconstructive Surgery, Shanghai Jiaotong University School of Medicine, Shanghai
| | - Ruiji Guo
- Department of Plastic and Reconstructive Surgery, Shanghai Jiaotong University School of Medicine, Shanghai
| | - Bin Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Jiaotong University School of Medicine, Shanghai
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Geller JS, Taormina DP, Greene JD, Dodds SD. Delayed Presentation of Unstable Triangular Fibrocartilage Complex Tears Treated with Volar Foveal Ligament Repair. J Wrist Surg 2021; 10:144-149. [PMID: 33815950 PMCID: PMC8012092 DOI: 10.1055/s-0040-1721410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/31/2020] [Accepted: 10/19/2020] [Indexed: 10/22/2022]
Abstract
Hypothesis An open volar surgical approach with suture anchor repair of the foveal ligament and temporary pinning of the distal radioulnar joint (DRUJ) is an effective way to treat DRUJ instability associated with chronic foveal tears of the triangular fibrocartilage complex (TFCC). Methods We retrospectively reviewed nine patients with foveal ligament tears of the TFCC and DRUJ instability who underwent open repair of the TFCC using a volar surgical approach, combined with temporary pinning of the DRUJ for 8 weeks. Pain, instability, arc of motion, and functional outcomes scores were evaluated. Results Mean patient age was 40.5 years (range 16.3-56.2). Average time from injury to surgery was 8.4 months (range 2.9-23.3 months). Average final follow-up was 18.9 months from injury (range 12.0-29.3 months), 10.5 months from surgery (range 3.9-18.6 months), and 8.7 months from pin removal (range 1.7-17.2 months). At final follow-up, all patients demonstrated clinically stable DRUJ. Pain scores diminished significantly from pre to final postoperative visits, with averages of 6.8 (range 4.0-9.0) improving to a mean of 0.70 (range 0.0-2.0), respectively. Average postoperative forearm rotation was 71.1 degrees in supination and 76.1 degrees in pronation (average total arc of motion 147.2 degrees, range 90-160 degrees). Average postoperative wrist motion was 68.8 degrees in flexion and 70.6 degrees in extension (average total arc of motion 139.4 degrees, range 110-160 degrees). No patients developed crepitus, recurrent DRUJ instability, or required revision surgery (subsequent to pin removal). Conclusion Volar suture anchor repair of the foveal ligament of the TFCC with DRUJ pinning led to reliable outcomes within this patient group including a stable DRUJ with improved functional outcomes regarding pain, stability, and range of motion in patients with foveal TFCC tears and associated DRUJ instability. These results compare favorably with dorsal repair of the foveal ligament. Level of Incidence This is a Level IV, therapeutic study.
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Affiliation(s)
- Joseph S. Geller
- University of Miami Miller School of Medicine, Department of Orthopedic Surgery and Rehabilitation, Bascom Palmer Institute, Department of Ortho, Miami, Florida
| | - David P. Taormina
- University of Miami Miller School of Medicine, Department of Orthopedic Surgery and Rehabilitation, Bascom Palmer Institute, Department of Ortho, Miami, Florida
| | - Janelle D. Greene
- Yale University School of Medicine, Department of Orthopedic Surgery and Rehabilitation, New Haven, Connecticut
| | - Seth D. Dodds
- University of Miami Miller School of Medicine, Department of Orthopedic Surgery and Rehabilitation, Bascom Palmer Institute, Department of Ortho, Miami, Florida
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Bodmer E, Marks M, Hensler S, Schindele S, Herren DB. Comparison of outcomes of three surgical approaches for proximal interphalangeal joint arthroplasty using a surface-replacing implant. J Hand Surg Eur Vol 2020; 45:608-614. [PMID: 31813305 DOI: 10.1177/1753193419891382] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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] [Indexed: 02/03/2023]
Abstract
The objective was to compare outcomes of the volar, Chamay and tendon splitting approaches for proximal interphalangeal joint arthroplasty using a surface-replacing implant (CapFlex-PIP). One-hundred prospectively documented patients with a 2-year follow-up were included. Range of proximal interphalangeal joint motion, the brief Michigan Hand Outcomes Questionnaire and complications were analysed. Between baseline and follow-up, mean proximal interphalangeal joint motion increased for the volar (53° to 54°), Chamay (38° to 53°) and tendon splitting (40° to 61°) approaches. The volar approach yielded the greatest flexion and the highest extension deficit. The mean brief Michigan Hand Outcomes Questionnaire scores at baseline and 2 years were 45 and 74 (volar), 45 and 66 (Chamay) and 41 and 75 (tendon splitting). Seven patients in the Chamay group and two in the volar group required a reoperation consisting of teno-/arthrolysis. The tendon splitting approach tended to result in the best outcomes that were associated with fewer complications compared with the volar and Chamay approaches. Level of evidence: IV.
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Affiliation(s)
- Elvira Bodmer
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
| | - Miriam Marks
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | - Stefanie Hensler
- Department of Teaching, Research and Development, Schulthess Klinik, Zurich, Switzerland
| | | | - Daniel B Herren
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
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Bergsma M, Doornberg JN, Borghorst A, Kernkamp W, Jaarsma RL, Bain GI. The Watershed Line of the Distal Radius: Cadaveric and Imaging Study of Anatomical Landmarks. J Wrist Surg 2020; 9:44-51. [PMID: 32025354 PMCID: PMC7000252 DOI: 10.1055/s-0039-1698452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 04/23/2019] [Accepted: 09/05/2019] [Indexed: 10/25/2022]
Abstract
Background Placement of volar plates remains a challenge as the watershed line may not be an easy-identifiable distinct line intraoperatively. Objectives The main objective of this article is to define how anatomical landmarks identifiable upon the volar surgical approach to the distal radius relate to the watershed line. Methods We identified anatomical landmarks macroscopically upon standard volar approach to the distal radius in 10 cadaveric forearms and marked these with radiostereometric analysis (RSA) beads in cadaveric wrists. The RSA beads were then referenced against the volar osseous structures using quantification of three-dimensional computed tomography and advanced imaging software. Results The mean measurements were the radial and ulnar prominences 11.1 mm and 2.1 mm proximal to the joint line of the distal radius, respectively. The interfossa sulcus was 0.3 mm proximal and 3 mm dorsal to the ulnar prominence. The watershed line was between 3.5 (minimal) and 7.6 (maximal) mm distal to the distal line of insertion of the pronator quadratus. Conclusion The watershed line is situated distal to the pronator quadratus, but with a wide variability making it an impractical landmark for plate position. The osseous ulnar prominence is a good anatomical reference for safe plate positioning, as it is located on the watershed line and easily palpated at surgery. One should keep in mind the sulcus-the point on the watershed line where the flexor pollicis longus runs-can be situated just proximal to the ulnar prominence. Clinical Relevance To provide anatomical landmarks that are easy to identify upon surgical approach without the direct need for intraoperative imaging.
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Affiliation(s)
- Minke Bergsma
- Department of Orthopaedic Surgery, Flinders Medical Centre/Department of Orthopaedic Trauma Surgery and the Biomechanics & Implants Research Group, Flinders University, Adelaide, Australia
- Department of Orthopaedic Surgery, Amsterdam University Medical Center/University of Amsterdam, Amsterdam, the Netherlands
- Department of Radiology, Noordwest Ziekenhuisgroep Alkmaar, Alkmaar, the Netherlands
| | - Job N. Doornberg
- Department of Orthopaedic Surgery, Flinders Medical Centre/Department of Orthopaedic Trauma Surgery and the Biomechanics & Implants Research Group, Flinders University, Adelaide, Australia
- Department of Orthopaedic Surgery, Amsterdam University Medical Center/University of Amsterdam, Amsterdam, the Netherlands
| | - Annelise Borghorst
- Department of Orthopaedic Surgery, Flinders Medical Centre/Department of Orthopaedic Trauma Surgery and the Biomechanics & Implants Research Group, Flinders University, Adelaide, Australia
| | - W.A. Kernkamp
- Department of General Surgery, Albert Schweizer Hospital, Dordrecht, the Netherlands
- Postdoctoral Research Fellowship, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - R. L. Jaarsma
- Department of Orthopaedic Surgery, Flinders Medical Centre/Department of Orthopaedic Trauma Surgery and the Biomechanics & Implants Research Group, Flinders University, Adelaide, Australia
| | - Gregory I. Bain
- Department of Orthopaedic Surgery, Flinders Medical Centre/Department of Orthopaedic Trauma Surgery and the Biomechanics & Implants Research Group, Flinders University, Adelaide, Australia
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Ceccarelli R, Dumontier C, Camuzard O. Minimally Invasive Fixation With a Volar Approach Using a Cannulated Compression Screw for Acute Hook of Hamate Fractures. J Hand Surg Am 2019; 44:993.e1-993.e6. [PMID: 30797656 DOI: 10.1016/j.jhsa.2019.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 03/10/2018] [Revised: 11/02/2018] [Accepted: 01/14/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Optimal treatment of acute hook of hamate fractures (HHF) remains controversial. Isolated acute HHF can be treated nonsurgically or surgically (with excision of the hook or open reduction internal fixation). The authors present the functional outcomes of a case series of patients who were treated with minimally invasive volar fixation for acute HHF. METHODS This retrospective study reviewed 6 patients with nondisplaced acute HHF treated with a minimally invasive volar approach and cannulated mini-screw fixation. The development of postoperative complications (tendon and ulnar nerve lesions), pain evaluated using a visual analog scale, and radiological union evaluated on computed tomography scan is reported. Wrist range of motion and grip strength were measured bilaterally. Mayo Wrist Score and Quick-Disabilities of the Arm, Shoulder, and Hand were assessed. All outcomes were measured at 1, 2, 3, and 6 months after surgery. RESULTS Fixation of HHF through the volar approach was achieved in all cases with no complications. The clinical and radiological union rate was 100%. All patients were able to return to their work or hobbies after an average of 7 weeks. CONCLUSIONS This study suggests that acute HHF can be treated successfully by open reduction internal fixation using a volar approach with minimal morbidity and complications, a good union rate, and a fast return to daily activities. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Affiliation(s)
- Romain Ceccarelli
- Service de Chirurgie Réparatrice et de la Main, CHU de Nice, Hopital Pasteur 2, Nice
| | - Christian Dumontier
- Centre de la Main, Urgences Main, Clinique les Eaux Claires, Baie-Mahault, Guadeloupe, France
| | - Olivier Camuzard
- Service de Chirurgie Réparatrice et de la Main, CHU de Nice, Hopital Pasteur 2, Nice.
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Abstract
BACKGROUND The dorsal approach to the proximal interphalangeal (PIP) joint provides the advantage of improved visualization of the articular surface, while the disadvantage of a dorsal approach is the disruption of the central slip and extensor mechanism requiring a delay in range of motion exercises. A volar approach keeps the central slip and extensor mechanism intact, allowing for early range of motion. The goal of this study was to evaluate patient outcomes of surface replacement (SR) PIP joint arthroplasty performed through a volar approach. METHODS Twenty-one patients were evaluated with primary osteoarthritis of a single PIP joint and underwent SR arthroplasty using the Stryker SR PIP joint implants. Patients included in this study were exclusively treated through a volar approach. Preoperative range of motion, coronal plan deformity, Disabilities of the Arm, Shoulder and Hand (DASH), and patient satisfaction were measured and compared with postoperative measurements using a paired Student t test. RESULTS The average length of follow-up was 34 months (± 9 months). Postoperative arc of motion for the PIP and distal interphalangeal (DIP) joints measured 87° (±12°) and 36° (±11°), respectively. The average improvement in PIP arc of motion was 58°, DASH score measured 14 (±5), satisfaction measured 4 (±1), and coronal plane deviation measured 2° (±2°). No evidence of implant subsidence was found on postoperative radiographs. Four patients required an extensor tendon tenolysis, and 1 patient suffered a superficial surgical site infection. CONCLUSION SR arthroplasty, when performed through a volar approach, allows for early range of motion and greater improvements in arc of motion, DASH score, and patient satisfaction.
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Affiliation(s)
| | - Dennis J. Heaton
- Pacific Northwest University of Health Sciences, Yakima, WA, USA,Dennis J. Heaton, Pacific Northwest University of Health Sciences, 111 University Parkway, Yakima, WA 98901, USA.
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Atiyya AN, Soliman RA. Simultaneous open and Closed Dislocation of four Metacarpophalangeal Joints: A Case Report and Review of Literature. J Orthop Case Rep 2017; 6:67-69. [PMID: 28116274 PMCID: PMC5245943 DOI: 10.13107/jocr.2250-0685.512] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Multiple simultaneous dislocations of the metacarpophalangeal joints are exceedingly rare. Five cases only were described in the English literature. Only one case necessitated open reduction. A case of simultaneous open and closed dislocation of ipsilateral four metacarpophalangeal joints is presented. The case had a delayed presentation (8 days following the trauma) and needed open reduction. Case presentation: A 33-year-old manual worker sustained dislocation of the ulnar four metacarpophalangeal joints of his non dominant hand. The hand injury was missed for eight days. The injury was successfully managed by open reduction. The patient regained near normal functional outcome. Conclusion: Open reduction may be needed for these injuries. Prompt intervention and early rehabilitation are needed for satisfactory outcome.
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Affiliation(s)
- Ahmed Naeem Atiyya
- Department of Orthopedic, Ain Shams University, Abbasia Square Cairo-Egypt
| | - Ramy Ahmed Soliman
- Department of Orthopedic, Ain Shams University, Abbasia Square Cairo-Egypt
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Vaynrub M, Carey JN, Stevanovic MV, Ghiassi A. Volar percutaneous screw fixation of the scaphoid: a cadaveric study. J Hand Surg Am 2014; 39:867-71. [PMID: 24612834 DOI: 10.1016/j.jhsa.2014.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 09/28/2013] [Revised: 12/30/2013] [Accepted: 01/03/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To test the efficacy of a previously described technique of angiocatheter-assisted instrument positioning in achieving a central screw position in a cadaveric model for volar percutaneous screw fixation (PSF) of the scaphoid and to quantify the damage to surrounding soft tissue and articular cartilage associated with the procedure. METHODS We performed fluoroscopically guided volar PSF of the scaphoid on 10 fresh cadaveric wrists. We then dissected the specimens, analyzed screw position in cross sections of the scaphoid, and described injury to nearby soft tissue structures as well as articular cartilage of the scaphotrapezial joint. RESULTS All 10 screws were positioned within the central third of the scaphoid on at least 2 of 3 cross sections, and 8 of 10 screws were positioned within the central third of the proximal pole. Two wrists required a transtrapezial trajectory for satisfactory screw positioning. None of the specimens sustained visible neurovascular damage, and 2 wrists revealed minor tendon damage. Trajectories involving the scaphotrapezial joint violated, on average, 7% of the scaphoid articular cartilage. With a transtrapezial trajectory, 11% of the trapezial cartilage was violated CONCLUSIONS Central positioning of the screw is biomechanically superior, and screw position within the central one third of the proximal pole has been associated with faster time to union. Volar PSF achieved satisfactory screw position in the scaphoid. The majority of wrists were amenable to PSF via the scaphotrapezial joint, though a transtrapezial approach was a viable alternative for wrists with restrictive anatomy. Both approaches minimally disrupted the scaphotrapezial joint and surrounding soft tissues. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Max Vaynrub
- Department of Orthopaedic Surgery and the Division of Plastic Surgery, Los Angeles County and University of Southern California Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, CA.
| | - Joseph N Carey
- Department of Orthopaedic Surgery and the Division of Plastic Surgery, Los Angeles County and University of Southern California Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - Milan V Stevanovic
- Department of Orthopaedic Surgery and the Division of Plastic Surgery, Los Angeles County and University of Southern California Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - Alidad Ghiassi
- Department of Orthopaedic Surgery and the Division of Plastic Surgery, Los Angeles County and University of Southern California Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, CA
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