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McCarty JC, Cross RE, Laane CLE, Hoftiezer YAJ, Gavagnin A, Regazzoni P, Fernandez Dell'Oca A, Jupiter JB, Bhashyam AR. Teardrop Alignment Changes After Volar Locking Plate Fixation of Distal Radius Fractures With Volar Ulnar Fragments. Hand (N Y) 2024:15589447241233762. [PMID: 38439630 DOI: 10.1177/15589447241233762] [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] [Indexed: 03/06/2024]
Abstract
BACKGROUND We assessed factors associated with change in radiographic teardrop angle following volar locking plate (VLP) fixation of volarly displaced intra-articular distal radius fractures with volar ulnar fragments (VUF) within the ICUC database. The primary outcome was change in radiographic alignment on follow-up imaging, defined as a change in teardrop angle from intra-operative fluoroscopy greater than 5°. METHODS Patients with distal radius fractures treated with a VLP within the ICUC database, an international collaborative and publicly available dataset, were identified. The primary outcome was volar rim loss of reduction on follow-up imaging, defined as a change in radiographic alignment from intra-operative fluoroscopy, teardrop angle less than 50°, or loss of normal radiocarpal alignment. Secondary outcomes were final range of motion (ROM) of the affected extremity. Radiographic Soong classification was used to grade plate position. Descriptive statistics were used to assess variables' distributions. A Random Forest supervised machine learning algorithm was used to classify variable importance for predicting the primary outcome. Traditional descriptive statistics were used to compare patient, fracture, and treatment characteristics with volar rim loss of reduction. Volar rim loss of reduction and final ROM in degrees and as compared with contralateral unaffected limb were also assessed. RESULTS Fifty patients with volarly displaced, intra-articular distal radius fractures treated with a VLP were identified. Six patients were observed to have a volar rim loss of reduction, but none required reoperation. Volar ulnar fragment size, Soong grade 0, and postfixation axial plate position in relation to the sigmoid notch were significantly associated (P < .05) with volar rim loss of reduction. All cases of volar rim loss of reduction occurred when VUF was 10.8 mm or less. CONCLUSIONS The size of the VUF was the most important variable for predicting volar rim loss of reduction followed by postfixation plate position in an axial position to the sigmoid notch and the number of volar fragments in the Random Forest machine learning algorithm. There were no significant differences in ROM between patients with volar ulnar escape and those without.
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Affiliation(s)
- Justin C McCarty
- Hand & Arm Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
- Department of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, USA
| | - Rachel E Cross
- Hand & Arm Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Charlotte L E Laane
- Hand & Arm Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Yannick Albert J Hoftiezer
- Hand & Arm Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
- Department of Plastic, Reconstructive and Hand Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Aquiles Gavagnin
- Department of Orthopedics, Hospital Britanico Montevideo, Uruguay
| | | | | | - Jesse B Jupiter
- Hand & Arm Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
| | - Abhiram R Bhashyam
- Hand & Arm Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, USA
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Liu WC, Hartwich M, Locascio JJ, Regazzoni P, Jupiter JB, Fernandez Dell'Oca A. The association of ICUC trauma score and quick DASH in a distal radius fracture cohort. J Orthop Surg Res 2024; 19:141. [PMID: 38360673 PMCID: PMC10870621 DOI: 10.1186/s13018-024-04623-0] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/11/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND This study evaluates the association between ICUC trauma and short-form Disabilities of the Arm, Shoulder, and Hand Questionnaire (Quick DASH) scores among patients who underwent surgery for distal radius fractures. METHODS This research gathered patient-reported outcomes (PROs) from patients registered in the ICUC database at a single trauma center. The study involved 76 adult patients who underwent surgical treatment for distal radius fractures before 2023. These patients received a volar locking plate for their distal radius fracture. The research utilized two different PROs to evaluate the patients' conditions. The ICUC trauma score measures functional impairment and pain through two 5-point scale questions, allowing patients to self-assess these aspects. The Quick DASH, comprising 11 questions, was used to evaluate symptoms and functionality of the upper extremity. RESULTS For patients aged 55.9 ± 15.3 years and 4.6 ± 3.9 years post-op follow-up, the ICUC trauma score was 0.70 ± 0.95, and Quick DASH was 6.07 ± 10.35. A strong correlation between ICUC and Quick DASH was identified (r = 0.71, P < 0.01). The interaction between the ICUC trauma score and age at the surgery to Quick DASH revealed a significant unstandardized partial regression coefficient of 0.19 (95% confidence interval 0.08-0.31; P < 0.01). CONCLUSION This study demonstrated a strong correlation between the ICUC trauma score and the Quick DASH among patients, especially the elderly. It was noted that an elevation in the ICUC trauma score is linked to a more marked increase in the Quick DASH score, particularly in older patients. Given its simplicity and efficacy, the ICUC trauma score may be a viable alternative to the Quick DASH for assessing the patient's clinical outcomes.
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Affiliation(s)
- Wen-Chih Liu
- Kaohsiung Medical University Hospital, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Hand and Arm Center, Department of Orthopedics, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
| | - Magdalena Hartwich
- Department of Orthopedics, Hospital Britanico Montevideo, Montevideo, Uruguay
- Orthopedics Specialization, Universidad de Montevideo, Montevideo, Uruguay
| | - Joseph J Locascio
- Biostatistics Center, Division of Clinical Research, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Jesse B Jupiter
- Hand and Arm Center, Department of Orthopedics, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Alberto Fernandez Dell'Oca
- Department of Orthopedics, Hospital Britanico Montevideo, Montevideo, Uruguay
- Orthopedics Specialization, Universidad de Montevideo, Montevideo, Uruguay
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Kooi K, Shoji MM, Jupiter JB, Chen NC, Garg R. DRUJ Capsular Release for Forearm Rotational Limitation: Surgical Technique and Case Series. Hand (N Y) 2023:15589447231207911. [PMID: 37946511 DOI: 10.1177/15589447231207911] [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] [Indexed: 11/12/2023]
Abstract
BACKGROUND Forearm stiffness can be caused by distal radioulnar joint (DRUJ) capsular contractures, which can occur after trauma such as a distal radius fracture. In this setting, a DRUJ capsular release may help improve forearm rotation, but the long-term functional outcomes remain unknown. The purpose of this case series is to investigate the short-term improvement in total pronosupination arc range of motion and long-term patient-reported outcomes (PROs) after DRUJ capsular release. METHODS We performed a retrospective review of consecutive patients who underwent DRUJ capsular release. Range of motion prior to surgery and at final short-term follow-up was collected and analyzed with a Wilcoxon signed-rank test. Patient-reported outcomes including QuickDASH and Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE) scores were obtained as medians with interquartile range (IQR), while patient satisfaction was measured on a 4-point Likert scale. RESULTS Five patients met the inclusion criteria with a median short-term follow-up of 5.5 (IQR: 4.3-10.3) months. The median preoperative supination was 25° (IQR: 0°-35°), and the median postoperative supination was 50° (IQR: 40°-60°; P = .03). The median preoperative pronation was 45° (IQR: 10°-60°), and the median postoperative pronation was 70° (IQR: 60°-80°; P = .04). After the long-term median follow-up of 10.9 (IQR 9.7-11.2) years, all the patients were satisfied or very satisfied with the results of the surgery. The median QuickDASH score was 13.6 (IQR: 9.1-20.5), and the median PROMIS UE score was 46.5 (IQR: 43.8-47.7). CONCLUSIONS Distal radioulnar joint capsular release can improve pronation and supination in patients with posttraumatic forearm stiffness and is associated with high long-term patient satisfaction.
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Affiliation(s)
- Kevin Kooi
- Massachusetts General Hospital, Harvard Medical School, Boston, USA
- Department of Plastic, Reconstructive, and Hand surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands
- Musculoskeletal Health, Amsterdam Movement Sciences, The Netherlands
| | - Monica M Shoji
- Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Jesse B Jupiter
- Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Neal C Chen
- Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Rohit Garg
- Massachusetts General Hospital, Harvard Medical School, Boston, USA
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Hazewinkel MHJ, DiGiovanni P, Miyamura S, Lans J, Chen NC, Lunn K, Jupiter JB. Patient-Reported Outcomes After Surgical Treatment of Early Osteoarthritis of the First Carpometacarpal Joint. Hand (N Y) 2023; 18:1275-1283. [PMID: 35549562 PMCID: PMC10617478 DOI: 10.1177/15589447221093669] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The goals of this study are to describe the reoperation rates in patients who underwent Wilson osteotomy compared with patients who underwent carpometacarpal (CMC) arthroplasty for early-stage arthritis and to evaluate the factors influencing the patient-reported outcomes. METHODS Retrospectively, 52 patients who underwent surgery for stage I/II osteoarthritis of the thumb carpometacarpal were identified, consisting of 17 (33%) patients who underwent Wilson osteotomy and 35 (67%) who underwent carpometacarpal arthroplasty. A total of 28 (55%) patients completed the outcome questionnaires, consisting of 11 (39%) patients who underwent Wilson osteotomy and 17 (61%) patients who underwent carpometacarpal arthroplasty. We performed a multivariable linear regression model to identify factors associated with the Numeric Rating Scale (NRS) pain intensity at final follow-up. RESULTS Among the patients who underwent CMC arthroplasty, 2 had a reoperation. Among the patients who underwent Wilson osteotomy, 3 had a reoperation. Among the patients who completed the outcome questionnaires, the median quick Disabilities of the Arm, Shoulder and Hand score was 10 and the median NRS Pain Intensity score was 0. In multivariable analysis, the postoperative Patient-Reported Outcomes Measurement Information System Pain Interference (PROMIS PI) was independently associated with higher postoperative NRS pain scores. CONCLUSION In younger patients with stage I/II CMC osteoarthritis, Wilson osteotomy may be a reasonable alternative to CMC arthroplasty. Outcomes were similar between both groups at mid-term follow-up, with only a slightly higher pain score in the osteotomy group. In patients with stage I/II carpometacarpal osteoarthritis, the PROMIS PI is the main factor indicating successful outcomes.
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de Klerk HH, Doornberg JN, Eygendaal D, Jupiter JB. The management of elbow trauma from a historical perspective. JSES Int 2023; 7:2553-2559. [PMID: 37969509 PMCID: PMC10638554 DOI: 10.1016/j.jseint.2023.01.005] [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] [Indexed: 02/04/2023] Open
Abstract
The origins of contemporary orthopedics can be traced all the way back to antiquity. Despite the absence of modern imaging techniques, a few bright minds were able to lay the groundwork for understanding these fractures. This historical review will cover the process behind the various treatments for elbow fractures, such as splinting and casting, mobilization, amputation, fracture fixation, arthroplasty, and arthroscopy.
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Affiliation(s)
- Huub H. de Klerk
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Orthopedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Amsterdam Shoulder and Elbow Center of Expertise (ASECE), OLVG, Amsterdam, the Netherlands
| | - Job N. Doornberg
- Department of Orthopedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Denise Eygendaal
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center Rotterdam, the Netherlands
| | - Jesse B. Jupiter
- Division of Hand and Upper Extremity Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Regazzoni P, Jupiter JB, Liu WC, Fernández dell’Oca AA. Evidence-Based Surgery: What Can Intra-Operative Images Contribute? J Clin Med 2023; 12:6809. [PMID: 37959274 PMCID: PMC10649165 DOI: 10.3390/jcm12216809] [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: 09/22/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
Evidence-based medicine integrates results from randomized controlled trials (RCTs) and meta-analyses, combining the best external evidence with individual clinical expertise and patients' preferences. However, RCTs of surgery differ from those of medicine in that surgical performance is often assumed to be consistent. Yet, evaluating whether each surgery is performed to the same standard is quite challenging. As a primary issue, the novelty of this review is to emphasize-with a focus on orthopedic trauma-the advantage of having complete intra-operative image documentation, allowing the direct evaluation of the quality of the intra-operative technical performance. The absence of complete intra-operative image documentation leads to the inhomogeneity of case series, yielding inconsistent results due to the impossibility of a secondary analysis. Thus, comparisons and the reproduction of studies are difficult. Access to complete intra-operative image data in surgical RCTs allows not only secondary analysis but also comparisons with similar cases. Such complete data can be included in electronic papers. Offering these data to peers-in an accessible link-when presenting papers facilitates the selection process and improves publications for readers. Additionally, having access to the full set of image data for all presented cases serves as a rich resource for learning. It enables the reader to sift through the information and pinpoint the details that are most relevant to their individual needs, allowing them to potentially incorporate this knowledge into daily practice. A broad use of the concept of complete intra-operative image documentation is pivotal for bridging the gap between clinical research findings and real-world applications. Enhancing the quality of surgical RCTs would facilitate the equalization of evidence acquisition in both internal medicine and surgery. Joint effort by surgeons, scientific societies, publishers, and healthcare authorities is needed to support the ideas, implement economic requirements, and overcome the mental obstacles to its realization.
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Affiliation(s)
- Pietro Regazzoni
- Department of Trauma Surgery, University Hospital Basel, 4031 Basel, Switzerland
| | - Jesse B. Jupiter
- Hand and Arm Center, Department of Orthopedics, Massachusetts General Hospital, Boston, MA 02114, USA;
| | - Wen-Chih Liu
- Hand and Arm Center, Department of Orthopedics, Massachusetts General Hospital, Boston, MA 02114, USA;
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Alberto A. Fernández dell’Oca
- Department of Traumatology, Hospital Britanico, Montevideo 11600, Uruguay;
- Residency Program in Traumatology and Orthopedics, University of Montevideo, Montevideo 11600, Uruguay
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Chen CT, Chou SH, Huang HT, Fu YC, Jupiter JB, Liu WC. Comparison of distal radius fracture plating surgery under wide-awake local anesthesia no tourniquet technique and balanced anesthesia: a retrospective cohort study. J Orthop Surg Res 2023; 18:746. [PMID: 37784158 PMCID: PMC10546761 DOI: 10.1186/s13018-023-04243-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 08/17/2023] [Accepted: 09/27/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Distal radius fractures (DRF) are frequently treated with internal fixation under general anesthesia or a brachial plexus block. Recently, the wide-awake local anesthesia with no tourniquet (WALANT) technique has been suggested as a method that results in higher patient satisfaction. This study aimed to evaluate the functional outcomes, complications, and patient-reported outcomes of DRF plating surgery under both the WALANT and balanced anesthesia (BA). METHODS Ninety-three patients with DRFs who underwent open reduction and plating were included. Regarding the anesthetic technique, 38 patients received WALANT, while 55 received BA, comprised of multimodal pain control brachial plexus anesthesia with light general support. The patient's overall satisfaction in both groups and the intraoperative numerical rating scale of pain and anxiety (0-10) in the WALANT group were recorded. The peri-operative radiographic parameters were measured; the clinical outcomes, including Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, wrist mobility, and grip strength, were recorded in up to 1-year follow-up. Results presented with a mean difference and 95% confidence intervals and mean ± standard deviation. RESULTS The mean age of patients in the WALANT group was higher than in the BA group (63 ± 17 vs. 54 ± 17, P = 0.005), and there were fewer intra-articular DRF fractures in the WALANT group than in the BA group (AO type A/B/C: 30/3/5 vs. 26/10/19, P = 0.009). The reduction and plating quality were similar in both groups. The clinical outcomes at follow-up were comparable between the two groups, except the WALANT group had worse postoperative 3-month pronation (88% vs. 96%; - 8.0% [ - 15.7 to - 0.2%]) and 6-month pronation (92% vs. 100%; - 9.1% [ - 17.0 to - 1.2%]), and better postoperative 1-year flexion (94% vs. 82%; 12.0% [2.0-22.1%]). The overall satisfaction was comparable in the WALANT and BA groups (8.7 vs. 8.5; 0.2 [ - 0.8 to 1.2]). Patients in the WALANT group reported an injection pain scale of 1.7 ± 2.0, an intraoperative pain scale of 1.2 ± 1.9, and an intraoperative anxiety scale of 2.3 ± 2.8. CONCLUSION The reduction quality, functional outcomes, and overall satisfaction were comparable between the WALANT and BA groups. With meticulous preoperative planning, the WALANT technique could be an alternative for DRF plating surgery in selected patients. Trial registration This retrospective study was approved by the Institutional Review Board of Kaohsiung Medical University Hospital (KMUHIRB-E(I)-20210201).
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Affiliation(s)
- Chih-Ting Chen
- Department of Clinical Education, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shih-Hsiang Chou
- Department Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Orthopedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsuan-Ti Huang
- Department Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Orthopedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yin-Chih Fu
- Department Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Orthopedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Orthopedic Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jesse B Jupiter
- Hand and Arm Research Center, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Wen-Chih Liu
- Department Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
- Orthopedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Department of Orthopedic Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
- College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Hand and Arm Research Center, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Chang CC, Lin SY, Lu CK, Jupiter JB, Fu YC, Liu WC. Minimum 5-Year Follow-Up Assessment of Volar Plate Interposition Arthroplasty for Post-Traumatic Osteoarthritis in Proximal Interphalangeal Joints. J Clin Med 2023; 12:4760. [PMID: 37510875 PMCID: PMC10381317 DOI: 10.3390/jcm12144760] [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: 04/21/2023] [Revised: 06/16/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
This is a retrospective study to evaluate the outcome of volar plate interposition arthroplasty for proximal interphalangeal joint post-traumatic osteoarthritis with a minimum 5-year follow-up. We identified patients receiving volar plate interposition arthroplasty for post-traumatic osteoarthritis in proximal interphalangeal joints. The measurements included the numeric pain scale (on a scale of 0-10), the proximal interphalangeal joint active range of motion, the Michigan Hand Outcomes Questionnaire, the perioperative radiograph of the involved digit, proximal interphalangeal joint stability, and pinch strength. Eight patients with a median age of 44 years old (interquartile range (IQR): 29.3-56.8) were included in this study. The median follow-up period was 6.5 years (range of 5-11 years). The median numeric pain scale improved from 5 (IQR: 4.3-6.0) preoperatively to 0 (IQR 0-0.8) at the follow-up evaluation (p = 0.011). All digits demonstrated stability during manual stress testing compared to their noninjured counterparts. The median active proximal interphalangeal joint arc of motion improved from 25° to 55° (p = 0.011). The pinch strength of the fingers on the injured hand was weaker than those on the contralateral hand (2.2 Kg vs. 3.7 Kg, p = 0.012). We suggested that volar plate interposition arthroplasty may be an alternative surgical option for post-traumatic osteoarthritis in the proximal interphalangeal joints.
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Affiliation(s)
- Chung-Chia Chang
- Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Sung-Yen Lin
- Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung 807377, Taiwan
- Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807377, Taiwan
| | - Chun-Kuan Lu
- Department of Orthopedic, Park One International Hospital, Kaohsiung 813017, Taiwan
| | - Jesse B Jupiter
- Hand and Arm Center, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Yin-Chih Fu
- Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung 807377, Taiwan
- Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807377, Taiwan
- Department of Orthopedic Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 801735, Taiwan
- Ph.D. Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
| | - Wen-Chih Liu
- Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung 807377, Taiwan
- Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807377, Taiwan
- Hand and Arm Center, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Ph.D. Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
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Zamri M, Lans J, Eberlin KR, Garg R, Jupiter JB, Chen NC. Reintervention, PROMs, and Factors Influencing PROMs Following Surgery for de Quervain's Tenosynovitis. J Hand Microsurg 2023; 15:165-174. [PMID: 37388568 PMCID: PMC10306984 DOI: 10.1055/s-0041-1731105] [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] [Indexed: 07/01/2023] Open
Abstract
Objective The aims of this study are to describe and identify the factors that influence patient reported outcomes following surgery of de Quervain's tenosynovitis. The secondary objective is to report the rate of reintervention following surgery of de Quervain's tenosynovitis. Patients and Methods Outcomes using the numerical rating scale (NRS) for pain, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Patient-Rated Wrist Evaluation (PRWE), the Patients Reported Outcome Measurement Information System Pain Interference (PROMIS PI), and a custom de Quervain's questionnaire were obtained. A multivariable linear regression analysis was performed to identify independent factors associated with patient-reported outcomes. Results Seventy-six patients who underwent de Quervain's release participated. The average age was 52.8 years (95% confidence interval: 49.6-56.1) and median follow-up age was 7.0 years (interquartile range [IQR]: 4.3-12.0). Outcomes were: NRS of pain was 0 (IQR: 0.0-3.0), the median QuickDASH was 6.82 (IQR: 0.00-28.41), the median PRWE score was 4.0 (IQR: 0.00-18.50), and the median PROMIS PI score was 43.90 (IQR: 38.70-53.90). Eighteen (23.7%) of the patients reported pain with thumb activities, four of whom had a reintervention. Additionally, 21 (26.9%) patients reported decreased strength in the thumb compared to the contralateral side, of which two underwent a reintervention. In total, eight patients underwent reintervention of which seven had a second surgery and one had a cortisone injection. Conclusion Roughly 1 in 20 patients following de Quervain's release undergoes reintervention. Patients with high PROMIS PI scores report poor surgical outcomes more frequently. Patients with high PROMIS PI scores report higher NRS pain scores ( p < 0.05), higher QuickDASH scores ( p < 0.05), and higher PRWE scores ( p < 0.05). In practice, careful consideration of PROMIS PI scores and psychosocial factors are recommended before considering reintervention.
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Affiliation(s)
- Meryam Zamri
- Hand and Upper Extremity Service, Division of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Jonathan Lans
- Hand and Upper Extremity Service, Division of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Kyle R. Eberlin
- Hand Surgery Service, Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Rohit Garg
- Hand and Upper Extremity Service, Division of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Jesse B. Jupiter
- Hand and Upper Extremity Service, Division of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Neal C. Chen
- Hand and Upper Extremity Service, Division of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
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Prommersberger KJ, Ring D, Jupiter JB, Lanz U. [Carpal Malalignment in Malunited Fractures of the Distal Radius]. HANDCHIR MIKROCHIR P 2023. [PMID: 37156512 DOI: 10.1055/a-2074-3095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
PURPOSE To evaluate and classify carpal alignment in malunited fractures of the distal radius. MATERIALS AND METHODS On standardized lateral radiographs of the involved wrist of 72 patients with a symptomatic extra-articular malunion of the distal radius, 43 with a dorsal and 29 with a palmar angulation, radius tilt (RT), radiolunate (RL) and lunocapitate angle were measured. Malposition of the radius was defined as RT plus 11° in dorsal malunion and RT minus 11° in palmar malunion. A palmar tilt of the radius was marked with a minus sign. At the time of corrective osteotomy 9 dorsal malunions underwent for different reasons evaluation of the scapholunate ligament with 4 having a complete scapholunate ligament disruption. RESULTS With respect to the RL-angle, carpal malalignment was categorized as follows: type P with a RL-angle less than -12°, type K with a RL-angle between -12 and 10°, type A with a RL-angle more than 10°, but less than the malposition of the radius, type D with a RL-angle greater than the malposition of the radius. All types of carpal malalignment were found in both, dorsally and palmarly tilted malunion. Type A carpal alignment was identified as the leading type in dorsal malunion (25 out of 43 patients), whilst in palmar malunion colinear subluxation of the carpus (type C) was the dominant type (12 out of 29 patients). To return the hand to a neutral position the rotation of the lunate was compensated by a contrarotation of the capitate in the dorsal malunion. In the palmar malunion a dorsal extension of the capitate returned the hand to a neutral position. In 4 of the 5 patients with type D carpal alignment, who had scapholunate ligament evaluation, a complete ligament tear was found. CONCLUSION In this study four different types of carpal alignment in malunited extra-articular fractures of the distal radius were identified. Based on this data we suspect that type D carpal alignment in dorsal malunion may be associated with a scapholunate ligament tear. Therefore, we recommend wrist arthroscopy for this group of patients.
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Affiliation(s)
| | - David Ring
- Hand Clinic, Massachusetts General Hospital, Boston, United States
| | - Jesse B Jupiter
- Hand Clinic, Massachusetts General Hospital, Boston, United States
| | - Ulrich Lanz
- Klinik für Handchirurgie, Rhön Klinikum AG, Bad Neustadt an der Saale, Germany
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11
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Shen O, Chen CT, Jupiter JB, Chen NC, Liu WC. Functional outcomes and complications after treatment of distal radius fracture in patients sixty years and over: A systematic review and network meta-analysis. Injury 2023:S0020-1383(23)00396-0. [PMID: 37188586 DOI: 10.1016/j.injury.2023.04.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 03/29/2023] [Revised: 04/28/2023] [Accepted: 04/29/2023] [Indexed: 05/17/2023]
Abstract
AIM This network meta-analysis aims to compare functional outcomes and complications between conservative treatment and surgery for distal radius fractures in patients aged 60 years and over. METHODS We searched the PubMed, EMBASE, and Web of Science databases for randomized controlled trials (RCTs) assessing the effect of conservative treatment and surgery for distal radius fractures in patients aged 60 years and over. Primary outcomes included grip strength and overall complications. Secondary outcomes included Disabilities of the Arm, Shoulder, and Hand (DASH) scores, Patient-Rated Wrist Evaluation (PRWE) scores, wrist range of motion and forearm rotation, and radiographic assessment. All continuous outcomes were assessed using standardized mean differences (SMDs) with 95% confidence intervals (CIs), and binary outcomes were assessed using odds ratio (OR) with 95% CIs. The surface under the cumulative ranking curve (SUCRA) was used to determine a hierarchy of treatments. Cluster analysis was performed for grouping treatments based on the SUCRA values of primary outcomes. RESULTS Fourteen RCTs were included to compare conservative treatment, volar lockedplate (VLP), K-wires fixation, and external-fixation. VLP outperformed conservative treatment for 1-year and minimum 2-year grip strength (SMD; 0.28 [0.07 to 0.48] and 0.27 [0.02 to 0.53], respectively). VLP yielded the optimal grip strength at 1-year and minimum 2-year follow-up (SUCRA; 89.8% and 86.7%, respectively). In a subgroup analysis of patients aged 60 to 80 years old, VLP outperformed conservative treatment in DASH and PRWE scores (SMD, 0.33 [0.10, 0.56] and 0.23 [0.01, 0.45], respectively). In addition, VLP had the fewest complications (SUCRA = 84.3%). Cluster analysis suggested that VLP and K-wire fixation were more effective treatment groups. CONCLUSION Evidence to date demonstrates that VLP provides measurable benefits in grip strength and fewer complications to those 60 years of age and over, and that benefit is not reflected in current practice guidelines. There is a subgroup of patients where K-wire fixation outcomes are similar to those of VLP; defining this subgroup may yield substantial societal benefits.
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Affiliation(s)
- Oscar Shen
- Hand and Arm Center, Department of Orthopedics, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
| | - Chih-Ting Chen
- Department of Clinical Education, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
| | - Jesse B Jupiter
- Hand and Arm Center, Department of Orthopedics, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
| | - Neal C Chen
- Hand and Arm Center, Department of Orthopedics, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
| | - Wen-Chih Liu
- Hand and Arm Center, Department of Orthopedics, Massachusetts General Hospital, Harvard Medical School, Boston, USA; Department of Orthopedics, Kaohsiung Medical University Hospital, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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12
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Jupiter JB. ABJS Turns 10 Years. Arch Bone Jt Surg 2023; 11:544. [PMID: 37868138 PMCID: PMC10585478 DOI: 10.22038/abjs.2023.22925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Affiliation(s)
- Jesse B Jupiter
- Emeritus Hansjoerg Wyss/AO Professor, Orthopedic Surgery, Harvard Medical School, MA, USA
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13
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Lans J, Lasa A, Chen NC, Dell'Oca AF, Jupiter JB. An experienced surgeon's take on scapho-lunate diastasis with distal radius fracture: What does this mean? Does this influence functional outcome? Injury 2022; 53:3357-3360. [PMID: 35835594 DOI: 10.1016/j.injury.2022.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/26/2022] [Revised: 06/09/2022] [Accepted: 07/03/2022] [Indexed: 02/02/2023]
Abstract
Radiographic evidence of scapho-lunate diastasis associated with a displaced distal radius fracture has been well recognized yet the clinical significance remains in question. If left untreated, will this progress to both radiographic and clinical changes consistent with intercarpal arthritis? Using the accumulated data of over 400 surgically treated distal radius fractures in the ICUC database, 16 cases of untreated scapho-lunate diastasis were followed on an average of 8 years without evidence of progressive functional or radiographic deterioration. In 50% of these cases, incidental findings of similar scapho-lunate diastasis was noted in the opposite uninjured wrist.
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Affiliation(s)
- Jonathan Lans
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114, USA.
| | - Alejandro Lasa
- Department of Traumatology, British Hospital, Avenida Italia 2420, Montevideo 11600, Uruguay
| | - Neal C Chen
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114, USA
| | | | - Jesse B Jupiter
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114, USA
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14
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Shoji MM, Garcen MH, Fernandez Dell’Oca AA, Jupiter JB. Posteriorly Displaced Radial Head Fractures May Represent the Footprint of an Elbow Dislocation or Subluxation as a Variant of Modified Mason Type 4. Arch Bone Jt Surg 2022; 10:501-506. [PMID: 35928906 PMCID: PMC9295585 DOI: 10.22038/abjs.2021.55486.2764] [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: 02/02/2021] [Accepted: 10/06/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND The purpose of this case series is to describe surgical decision making and clinical outcomes in posteriorly displaced radial head fractures with a major fragment (more than 50% of the head) located behind the humeral condyle. We also document the outcome of open reduction and internal fixation of completely displaced radial head fractures. METHODS A retrospective review of the ICUC® (Integrated Comprehensive Unchanged Complete) database was performed between 2012 and 2020. Patients were included if preoperative radiographs demonstrated a major radial head fracture fragment located posterior to the humeral condyle and a minimum of 2-year follow-up data was available. RESULTS Ten patients met inclusion criteria. Two patients had an associated elbow dislocation whereas 8 patients did not. All patients were found to have disruption of the lateral collateral ligament complex intraoperatively. Nine radial head fractures were successfully fixed with interfragmentary screws. One multi-fragmented radial head fracture could not be successfully stabilized with interfragmentary screw fixation and was resected. The average time to final follow-up was 4.8 years (range 2.2-8.1). At final follow-up, 6 patients demonstrated radiographic evidence of a healed radial head, 1 patient had avascular necrosis, and 2 had post-traumatic arthritis. None demonstrated radiographic instability. The average functional score was 0.64 (SD 0.81) and pain score was 0.45 (SD 0.93). The average elbow extension was 8 degrees (SD 11), elbow flexion was 139 degrees (SD 6), forearm supination was 60 degrees (SD 27), and forearm pronation was 69 degrees (SD 3). CONCLUSION Recognition of a posteriorly displaced radial head fracture is essential, as it may be an indirect sign of elbow instability. This instability should be addressed during surgical intervention.
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Affiliation(s)
- Monica M. Shoji
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, USA
| | | | | | - Jesse B. Jupiter
- Department of Orthopaedic Surgery, Division of Hand and Upper Extremity Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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15
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Abstract
The management of distal radius fractures has evolved considerably in the last two decades. Techniques and hardware have improved so much that the surgeon can usually assure good results in these debilitating fractures. Yet no one method can be used for all injuries, as the personality of each fracture demands a customized approach. Furthermore, what works in one age group may not work in another. For this reason, every available treatment has its own space in our options. The need for surgeons to be well versed in all techniques is critical. We offer a concise update of important evolutionary and current treatment guidelines for this common fracture.
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Affiliation(s)
| | - Jesse B Jupiter
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tamara D Rozental
- Harvard Medical School, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Rohit Arora
- Department of Orthopaedics and Traumatology, Medical University Innsbruck, Innsbruck, Austria
| | - Toshiyasu Nakamura
- Department of Orthopaedic Surgery, International University of Health and Welfare, Tokyo, Japan
| | - Gregory I Bain
- Department of Orthopaedic Surgery, Flinders University, Adelaide, Australia
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16
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Abstract
Background: Vascularized fibula graft (VFG) transfer is an established method of repairing large skeletal defects resulting from trauma, tumor resection, or infection. It obviates the process of creeping substitution that conventional bone grafts undergo and therefore exhibits better healing and improved strength. The aim of this study is to evaluate hypertrophy in VFG. Methods: We retrospectively reviewed patients undergoing VFG and studied immediate and late postoperative radiographs. Orthogonal views were measured for width of graft cortex and intramedullary canal, as well as adjacent recipient bone. Changes were measured for total cross sectional area, cortical area, intramedullary area, and graft width. Results: Thirty patients were included in the analysis, with recipient sites including 3 forearm, 4 humerus, 12 tibia, and 11 femur. Mean follow-up was 7.6 years (0.5-24.9 years). Patients' mean age was 31 (16-59 years). Average hypertrophy was 254% in early postoperative period and 340% in the late postoperative period. There was rapid graft hypertrophy in early postoperative period that plateaued with time. The width of the graft increased over time but didn't exceed the width of the adjacent recipient bone. In the later postoperative period, the size of graft intramedullary canal increased. Upper and lower extremity grafts showed similar hypertrophy. Conclusions: Using VFG to treat large skeletal defects is an attractive option in part due to the graft's ability to hypertrophy. We describe an early period of periosteal hypertrophy, followed by endosteal hypertrophy. These processes have relevance to function, mechanical strength, and surgical decision-making.
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Affiliation(s)
| | - Rohit Garg
- Massachusetts General Hospital, Boston,
USA,Rohit Garg, Department of Orthopaedic
Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit
Street, Yawkey 2C, Boston, MA 02114, USA.
| | - Andrew Jawa
- New England Baptist Hospital, Boston,
MA, USA
| | - Qiaojie Wang
- Shanghai Jiao Tong University Affiliated
Sixth People’s Hospital, P.R. China
| | - Yimin Chai
- Shanghai Jiao Tong University Affiliated
Sixth People’s Hospital, P.R. China
| | - Bingfang Zeng
- Shanghai Jiao Tong University Affiliated
Sixth People’s Hospital, P.R. China
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17
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Folchert MD, Tosti R, Rizzo M, Ladd AL, Jupiter JB, Zelouf DS. Managing Challenges in Thumb Carpometacarpal Arthritis. Instr Course Lect 2022; 71:147-162. [PMID: 35254780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Thumb carpometacarpal osteoarthritis is commonly encountered and multifactorial in etiology, and its management is based on the radiographic stage and surgeon preference. A variety of management strategies exist including ligament reconstruction, arthroscopic débridement, extension osteotomy, open versus arthroscopic total and partial trapeziectomy with or without interposition and/or suspensionplasty, arthrodesis, and total or hemi implant arthroplasty. A review of the literature shows each of these management strategies to be effective in pain relief, but no one procedure has been shown to be superior despite theoretic benefits to preserving trapezial height. The one common denominator is removal of the arthritic contact between the thumb metacarpal and trapezial surfaces.
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18
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Macken AA, Lans J, Özkan S, Kramer S, Jupiter JB, Chen NC. Outcomes of Flexor Pollicis Longus Reconstruction for Volar Plate Related Ruptures. J Hand Microsurg 2021. [DOI: 10.1055/s-0041-1739961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Aim A rare complication following volar plate fixation of a distal radius fracture is flexor pollicis longus (FPL) rupture. This study aims primarily to analyze the radiographic features and secondly to report the patient-reported outcomes of FPL reconstruction after volar plate fixation.
Methods Ten patients were retrospectively identified and contacted for follow-up. Seven patients participated in the study and completed the numeric rating scale (NRS) for pain, patient-reported outcome measurement information system—upper extremity (PROMIS-UE), and quick disability of arm, shoulder, and hand (QuickDASH) questionnaires at a median of 3.4 years following FPL reconstruction. Soong grade was determined on preoperative radiographs.
Results Six patients were classified as Soong grade 1 and two patients had a screw or wire protruding volarly. The median time to tendon rupture was 21.6 months. At final follow-up, the median NRS pain score was 0 (range: 0–7); the median PROMIS-UE score was 47.1 (range: 25.9–61); and the median QuickDASH-score was 12.5 (range: 4.5–75).
Conclusions The outcome of FPL reconstruction after volar plate fixation is highly variable. All ruptures in our cohort occurred in patients with plate positioning classified as Soong grade 1 and occurred at up to 3 years following distal radius fixation.
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Affiliation(s)
- Arno A. Macken
- Department of Orthopedic Surgery, Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Jonathan Lans
- Department of Orthopedic Surgery, Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Sezai Özkan
- Department of Orthopedic Surgery, Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Simon Kramer
- Department of Orthopedic Surgery, Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Jesse B. Jupiter
- Department of Orthopedic Surgery, Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Neal C. Chen
- Department of Orthopedic Surgery, Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
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Zamri M, Lans J, Jupiter JB, Eberlin KR, Garg R, Chen NC. Factors Associated with Prolonged Opioid Use after CMC Arthroplasty. J Hand Microsurg 2021. [DOI: 10.1055/s-0041-1736003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Abstract
Background Higher rates of prolonged opioid use have been reported in patients who undergo thumb carpometacarpal (CMC) arthroplasty compared with other hand procedures. Therefore, the aim of this study is to identify the risk factors associated with prolonged postoperative opioid use after CMC arthroplasty, along with reporting the number of patients who filled an opioid prescription more than 30 days postoperatively.
Materials and Methods Retrospectively, 563 opioid-naïve patients who underwent CMC arthroplasty were included. A manual chart review was performed to collect patient characteristics, and opioid use was determined based on opioid prescription by a physician. Prolonged opioid use was defined as an opioid prescription at 90 to 180 days postoperatively. A multivariable analysis was performed to identify independent factors associated with an opioid prescription at 90 to 180 days postoperatively. Patients had a median age of 60.4 years (interquartile range [IQR]: 55.5–66.9) and had a median follow-up of 7.6 years (IQR: 4.3–12.0).
Results The rates of postoperative opioid use ranged from 6.2% (53 out of 563 patients) at 30 to 59 days postoperatively to 3.9% (22 out of 563 patients) at 150 to 180 days postoperatively. In total, 17.1% (96 out of 563 patients) received a second opioid prescription more than 30 days following surgery, of which 10.8% (61 out of 563 patients) were between 90 and 180 days postoperatively. Older age, defined as a median of 63 years (IQR: 57.10–69.88) (p = 0.027, odds ratio [OR] = 1.04) and a history of psychiatric disease (p = 0.049, OR = 1.86) were independently associated with prolonged opioid use.
Conclusion A prolonged opioid use rate of roughly 11% was found in opioid-naïve patients who underwent CMC arthroplasty. In patients at risk (older patients or psychiatric history) of prolonged opioid use, careful postoperative pain management is recommended.
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Affiliation(s)
- Meryam Zamri
- Hand and Upper Extremity Service, Division of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Jonathan Lans
- Hand and Upper Extremity Service, Division of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Jesse B. Jupiter
- Hand and Upper Extremity Service, Division of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Kyle R. Eberlin
- Hand Surgery Service, Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Rohit Garg
- Hand and Upper Extremity Service, Division of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Neal C. Chen
- Hand and Upper Extremity Service, Division of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
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20
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Gruber JS, Zhang D, Janssen SJ, Blazar P, Jupiter JB, Earp BE. Limited Fasciectomy Versus Collagenase Clostridium histolyticum for Dupuytren Contracture: A Propensity Score Matched Study of Single Digit Treatment With Minimum 5 Years of Telephone Follow-Up. J Hand Surg Am 2021; 46:888-895. [PMID: 34275684 DOI: 10.1016/j.jhsa.2021.05.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Received: 06/16/2020] [Revised: 03/29/2021] [Accepted: 05/28/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to compare reintervention and perceived recurrence, with minimum 5 years of telephone follow-up, after limited fasciectomy or collagenase Clostridium histolyticum (CCH) in the treatment of Dupuytren contracture affecting a single digit. METHODS We performed a retrospective cohort study of 48 patients with single digit treatment who underwent limited surgical fasciectomy at one hospital and 111 patients who underwent CCH treatment at a second hospital from 2010 to 2013. Patients were contacted by telephone about reintervention and perceived recurrence. Average length of telephone follow-up was 7.3 years in the CCH group and 7.4 years in the surgery group. The 2 groups were compared using 2 methods to control for potential confounding bias: (1) propensity score matching and (2) multivariable analysis accounting for potential confounders. RESULTS After propensity score matching, there were 44 patients in each group with similar disease and demographic characteristics. Rates of reintervention and perceived recurrence were significantly higher in the CCH group than the surgery group at a minimum of 5 years following treatment. CONCLUSIONS Long-term overall reintervention and perceived recurrence following treatment of Dupuytren contracture affecting a single digit were higher with CCH treatment than surgical fasciectomy when comparing groups with similar baseline characteristics. Our findings may be used to counsel patients on the durability of the outcomes of treatment when considering treatment options for Dupuytren contractures. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Jillian S Gruber
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Dafang Zhang
- Harvard Medical School, Boston, MA; Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Stein J Janssen
- Department of Orthopaedic Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Philip Blazar
- Harvard Medical School, Boston, MA; Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Jesse B Jupiter
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Brandon E Earp
- Harvard Medical School, Boston, MA; Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA.
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21
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Notermans BJW, Lans J, Ponton RP, Jupiter JB, Chen NC. Factors Associated with Reoperation after Pyrocarbon Proximal Interphalangeal Joint Arthroplasty for the Arthritic Joint: A Retrospective Cohort Study. J Hand Microsurg 2021; 13:132-137. [PMID: 34539129 DOI: 10.1055/s-0040-1709088] [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] [Indexed: 10/24/2022] Open
Abstract
Introduction The rate of reoperation after pyrocarbon proximal interphalangeal (PIP) joint arthroplasty ranges from 5.9 to 37% and complications such as radiographic loosening, deformity, dislocation, and stiffness are common. Because of the limited amount of knowledge around these problems, we evaluated factors associated with reoperation after pyrocarbon PIP arthroplasty. Materials and Methods We retrospectively included all adult patients that underwent primary PIP pyrocarbon implant arthroplasty between 2002 and 2016 at one institutional system. A total of 45 patients, with a mean age of 55 (standard deviation: 14), underwent 66 PIP arthroplasties. To address for within individual correlations, we only included fingers treated at patients' initial surgery ( n = 54) in our statistical analysis. These patients were predominantly diagnosed with noninflammatory arthritis 73% ( n = 33). Arthroplasty was performed upon 10 index, 22 middle, 20 ring, and 2 small fingers. Results The reoperation rate after pyrocarbon PIP arthroplasty was 30% over a median follow-up of 25 months (interquartile range: 8.7-54). Indications for reoperation consisted of subluxation ( n = 6), stiffness ( n = 5), swan-neck deformity ( n = 3), and soft tissue complications ( n = 2). Younger age ( p = 0.025), male sex ( p = 0.017), and noninflammatory arthritis ( p = 0.038) were associated with a higher reoperation rate. Conclusion In this study, our reoperation rate after pyrocarbon PIP arthroplasty was 30%. This study suggested that younger patients, males, and patients with noninflammatory arthritis are at higher risk of reoperation. We recommend considering these factors when selecting candidates for pyrocarbon arthroplasty. Future studies should focus on prospectively researching these factors in comparison with other implants.
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Affiliation(s)
- Bo J W Notermans
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Jonathan Lans
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Ryan P Ponton
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Jesse B Jupiter
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Neal C Chen
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
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22
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Abstract
Background: The aim of this study was to assess factors associated with long-term patient-reported functional, pain, and satisfaction scores in patients who underwent (Bowers) hemiresection interposition technique (HIT) arthroplasty of the distal radioulnar joint (DRUJ). The secondary aims were to determine the complication and reoperation rates. Methods: A retrospective study with long-term follow-up of patients undergoing HIT arthroplasty was performed. Demographic, disease, and treatment characteristics were collected for the 66 included patients. Thirty-one patients completed all surveys, which were the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), our custom-made HIT arthroplasty questionnaire, Numeric Rating Scale (NRS) for pain, and NRS for satisfaction. The mean interval between surgery and follow-up by means of questionnaires was 8.6 ± 3.4 years. Results: The mean QuickDASH score was 31.0 ± 20.2. The mean score of the HIT arthroplasty questionnaire was 2 ± 2. The median NRS for pain was 1 (interquartile range [IQR], 0-3), and the median NRS for satisfaction was 9 (IQR, 8-10). The complication rate and reoperation rate were 14% and 8%, respectively. Conclusion: Overall, patients expressed satisfaction with HIT arthroplasty, despite a mean QuickDASH score of 31.0. In our cohort, patients with inflammatory arthritis had higher satisfaction and lower pain scores. Patients who had prior trauma, prior surgery, or DRUJ subluxation are generally less satisfied. Men, older patients, and posttraumatic patients had higher long-term pain scores; however, posterior interosseous nerve neurectomy is associated with improved pain scores. Our findings support the use of HIT arthroplasty in patients with inflammatory arthritis.
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Affiliation(s)
- Femke Nawijn
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,University Medical Center Utrecht, the Netherlands
| | | | - Jesse B. Jupiter
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Neal C. Chen
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,Neal C. Chen, Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Suite 2100, 55 Fruit Street, Boston, MA 02114, USA.
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Lans J, Westenberg RF, Verhiel SHWL, Garg R, Jupiter JB, Chen NC. An Economic Analysis of Direct Costs of Distal Radius Fixation and the Implications of a Disposable Distal Radius Kit. J Orthop Trauma 2021; 35:e346-e351. [PMID: 33512859 DOI: 10.1097/bot.0000000000002049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Accepted: 12/22/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the direct costs of distal radius fracture volar plate (VP) fixation and to create a model to examine the effect of these cost drivers. MATERIALS AND METHODS Retrospectively, 744 distal radius fractures treated with open reduction and internal fixation (ORIF) were identified. The outcomes assessed included (1) the direct costs related to distal radius ORIF and (2) if a VP alone was amenable. Costs were represented as a cost ratio relative to the average cost of distal radius ORIF, where the average value is set as 1.0. Simulation models were run with all cost drivers (sex, age, open fracture, intra-articular fracture, and ancillary fixation) and with only ancillary fixation as a cost driver. RESULTS The cost ratio ranged from 0.61 to 1.81 and ancillary fixation was associated with increased implant costs in multivariable analysis. In the simulations, the cost ratio ranged from 0.96 to 1.23 when all cost drivers were included and from 0.99 to 1.20 if only ancillary fixation was included as a cost driver, a reduction of the range by 22.2%. Older patients, females, closed fractures, and extra-articular fractures were more amenable to VP fixation alone. CONCLUSIONS Eighty-three percent of the surgically treated distal radius fractures were treated with VP fixation alone. A disposable kit could help limit cost variance per case by roughly 22%, as only ancillary fixation varies these costs. Closed fractures and extra-articular fractures in older patients or female patients are more amenable to VP fixation alone. LEVEL OF EVIDENCE Economic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jonathan Lans
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Wildemann B, Ignatius A, Leung F, Taitsman LA, Smith RM, Pesántez R, Stoddart MJ, Richards RG, Jupiter JB. Non-union bone fractures. Nat Rev Dis Primers 2021; 7:57. [PMID: 34354083 DOI: 10.1038/s41572-021-00289-8] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [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] [Accepted: 06/24/2021] [Indexed: 11/09/2022]
Abstract
The human skeleton has remarkable regenerative properties, being one of the few structures in the body that can heal by recreating its normal cellular composition, orientation and mechanical strength. When the healing process of a fractured bone fails owing to inadequate immobilization, failed surgical intervention, insufficient biological response or infection, the outcome after a prolonged period of no healing is defined as non-union. Non-union represents a chronic medical condition not only affecting function but also potentially impacting the individual's psychosocial and economic well-being. This Primer provides the reader with an in-depth understanding of our contemporary knowledge regarding the important features to be considered when faced with non-union. The normal mechanisms involved in bone healing and the factors that disrupt the normal signalling mechanisms are addressed. Epidemiological considerations and advances in the diagnosis and surgical therapy of non-union are highlighted and the need for greater efforts in basic, translational and clinical research are identified.
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Affiliation(s)
- Britt Wildemann
- Experimental Trauma Surgery, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany. .,Julius Wolff Institute and BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Anita Ignatius
- Institute of Orthopedic Research and Biomechanics, Ulm University, Ulm, Baden Württemberg, Germany
| | - Frankie Leung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, the University of Hong Kong, Hong Kong, Hong Kong
| | - Lisa A Taitsman
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - R Malcolm Smith
- Orthopedic trauma service, University of Massachusetts Medical School, Worcester, MA, USA
| | - Rodrigo Pesántez
- Departamento de Ortopedia Y Traumatología Fundación Santa Fé de Bogotá - Universidad de los Andes, Bogotá, Colombia
| | | | | | - Jesse B Jupiter
- Department of Orthopaedic surgery, Massachussets General Hospital, Boston, MA, USA.
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Abstract
Background: Silicone proximal interphalangeal (PIP) joint arthroplasty has a high revision rate. It has been suggested that persistent ulnar deviation and joint instability influence the durability of PIP silicone arthroplasties. The goal of this study was to evaluate what factors are associated with reoperation after silicone PIP arthroplasty. Methods: We retrospectively evaluated all adult patients who underwent PIP silicone arthroplasty between 2002 and 2016 at one institutional system for inflammatory-, posttraumatic-, and primary degenerative arthritis. After manual chart review, we included 91 patients who underwent 114 arthroplasties. Fingers operated included 14 index, 41 middle, 38 ring, and 21 small fingers. Results: The overall reoperation rate was 14% (n = 16). Non-Caucasian race (P = .040), smoking (P = .022) and PIP silicone arthroplasty for post-traumatic osteoarthritis (P = .021) were associated with reoperation. The 1-, 5- and 10-year implant survival rates were 87%, 85%, and 85%, respectively. Conclusion: Caution should be exercised when considering PIP silicone arthroplasty of the index finger or in patients with post-traumatic osteoarthritis. It may be worthwhile addressing smoking behavior before pursuing silicone PIP arthroplasty.
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Affiliation(s)
| | - Bo J.W. Notermans
- Radboud UMC, Nijmegen, The Netherlands,Bo J.W. Notermans, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.
| | | | - Hang Lee
- Massachusetts General Hospital, Boston, USA
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Moradi A, Binava R, Vahedi E, Ebrahimzadeh MH, Jupiter JB. Distal Radioulnar oint Prosthesis. Arch Bone Jt Surg 2021; 9:22-32. [PMID: 33778112 PMCID: PMC7957108 DOI: 10.22038/abjs.2020.53537.2659] [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] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 11/30/2020] [Indexed: 11/06/2022]
Abstract
The distal radioulnar joint (DRUJ) prostheses have been available for many years and despite their superior outcomes compared to conventional DRUJ reconstructions in both short and long-term follow-ups, they have not become as popular as common hip and knee prostheses. In the current review article, at the first step, we discussed the applied anatomy and biomechanics of the DRUJ, and secondly, we classified DRUJ prostheses according to available literature, and reviewed different types of prostheses with their outcomes. Finally we proposed simple guidelines to help the surgeon to choose the appropriate DRUJ prosthesis.
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Affiliation(s)
- Ali Moradi
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Binava
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ehsan Vahedi
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Jesse B. Jupiter
- Hand and Upper Extremity Service, Massachusetts General Hospital, Department of Orthopaedic Surgery, Yawkey Center for Outpatient Care, Boston, Massachusetts, USA
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Notermans BJW, Lans J, Arnold D, Jupiter JB, Chen NC. Factors Associated With Reoperation After Silicone Metacarpophalangeal Joint Arthroplasty in Patients With Inflammatory Arthritis. Hand (N Y) 2020; 15:805-811. [PMID: 32122171 PMCID: PMC7850254 DOI: 10.1177/1558944719831236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Indexed: 11/15/2022]
Abstract
Background: Silicone metacarpophalangeal (MCP) joint arthroplasty has a high revision rate. It has been suggested that the preoperative degree of ulnar drift and radial wrist deviation influences the durability of MCP silicone arthroplasties. The goal of this study was to evaluate what factors are associated with reoperation after silicone MCP arthroplasty. Materials and Methods: We retrospectively evaluated all adult patients who underwent MCP silicone arthroplasty between 2002 and 2016 at one institutional system for inflammatory arthritis. After manual chart review, we included 73 patients who underwent 252 arthroplasties. Fingers treated included 66 index, 67 long, 60 ring, and 59 small fingers. Results: The overall reoperation rate was 9.1% (N = 23). Indications for reoperation were implant breakage (n = 11), instability (n = 4), soft tissue complications (n = 4), infections (n = 3), and stiffness (n = 1). There was a trend that patients who underwent single-digit arthroplasty had higher rates of revision (19% vs 3.5%, P = .067). Radiographic follow-up demonstrated joint incongruency in 50% of cases, bone erosion in 58% of cases, and implant breakage in 19% of cases. There was a trend toward higher rates of revision in patients without preoperative MCP joint subluxation (19% vs 6.7%, P = .065) The 1-, 5-, and 10-year implant survival rates were 96%, 92%, and 70%, respectively. Revision surgery occurred at <14 months in 15 patients (65%) and after 5 years in 8 (35%) patients. Conclusions: Revision surgery after silicone MCP arthroplasty appears to be bimodal. Patients with greater hand function preoperatively may be at higher risk of revision surgery.
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Affiliation(s)
- Bo J. W. Notermans
- Massachusetts General Hospital, Boston, USA,Bo J. W. Notermans, Kaatstraat 47, Utrecht, 3513 BV, The Netherlands.
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Lu CK, Liu WC, Chang CC, Shih CL, Fu YC, Jupiter JB. A systematic review and meta-analysis of the pronator quadratus repair following volar plating of distal radius fractures. J Orthop Surg Res 2020; 15:419. [PMID: 32938491 PMCID: PMC7493143 DOI: 10.1186/s13018-020-01942-w] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/01/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Distal radius fracture (DRF) is the most common upper extremity fracture that requires surgery. Operative treatment with a volar locking plate has proved to be the treatment of choice for unstable fractures. However, no consensus has been reached about the benefits of pronator quadratus (PQ) repair after volar plate fixation of DRF in terms of patient-reported outcome measures, pronation strength, and wrist mobility. METHODS We searched the PubMed, Embase, Cochrane Central, and China National Knowledge Infrastructure (CNKI) databases up to March 13, 2020, and included randomized-controlled, non-randomized controlled, or case-control cohort studies that compared cases with and without PQ repair after volar plate fixation of DRF. We used a random-effects model to pool effect sizes, which were expressed as standardized mean differences (SMDs) and 95% confidence intervals. The primary outcomes included Disabilities of the Arm, Shoulder, and Hand scores and pronation strength. The secondary outcomes included the SMDs in pain scale score, wrist mobility, and grip strength. The outcomes measured were assessed for publication bias by using a funnel plot and the Egger regression test. RESULTS Five randomized controlled studies and six retrospective case-control studies were included in the meta-analysis. We found no significant difference in primary and secondary outcomes at a minimum of 6-month follow-up. In a subgroup analysis, the pronation strength in the PQ repair group for AO type B DRFs (SMD = - 0.94; 95% CI, - 1.54 to - 0.34; p < 0.01) favored PQ repair, whereas that in the PQ repair group for non-AO type B DRFs (SMD = 0.39; 95% CI, 0.07-0.70; p = 0.02) favored no PQ repair. DISCUSSION We found no functional benefit of PQ repair after volar plate fixation of DRF on the basis of the present evidence. However, PQ muscle repair showed different effects on pronation strength in different groups of DRFs. Future studies are needed to confirm the relationship between PQ repair and pronation strength among different patterns of DRF. REGISTRATION This study was registered in the PROSPERO registry under registration ID No. CRD42020188343 . LEVEL OF EVIDENCE Therapeutic III.
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Affiliation(s)
- Chun-Kuan Lu
- Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Ph.D Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Chih Liu
- Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Ph.D Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Orthopedic Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Chung-Chia Chang
- Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Lung Shih
- Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yin-Chih Fu
- Department of Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jesse B Jupiter
- Hand and Upper Extremity Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Abstract
Aims We quantitatively compared the 3D bone density distributions on CT scans performed on scaphoid waist fractures subacutely that went on to union or nonunion, and assessed whether 2D CT evaluations correlate with 3D bone density evaluations. Methods We constructed 3D models from 17 scaphoid waist fracture CTs performed between four to 18 weeks after fracture that did not unite (nonunion group), 17 age-matched scaphoid waist fracture CTs that healed (union group), and 17 age-matched control CTs without injury (control group). We measured the 3D bone density for the distal and proximal fragments relative to the triquetrum bone density and compared findings among the three groups. We then performed bone density measurements using 2D CT and evaluated the correlation with 3D bone densities. We identified the optimal cutoff with diagnostic values of the 2D method to predict nonunion with receiver operating characteristic (ROC) curves. Results In the nonunion group, both the distal (100.2%) and proximal (126.6%) fragments had a significantly higher bone density compared to the union (distal: 85.7%; proximal: 108.3%) or control groups (distal: 91.6%; proximal: 109.1%) using the 3D bone density measurement, which were statistically significant for all comparisons. 2D measurements were highly correlated to 3D bone density measurements (Spearman’s correlation coefficient (R) = 0.85 to 0.95). Using 2D measurements, ROC curve analysis revealed the optimal cutoffs of 90.8% and 116.3% for distal and proximal fragments. This led to a sensitivity of 1.00 if either cutoff is met and a specificity of 0.82 when both cutoffs are met. Conclusion Using 3D modelling software, nonunions were found to exhibit bone density increases in both the distal and proximal fragments in CTs performed between four to 18 weeks after fracture during the course of treatment. 2D bone density measurements using standard CT scans correlate well with 3D models. In patients with scaphoid fractures, CT bone density measurements may be useful in predicting the likelihood of nonunion. Cite this article: Bone Joint J 2020;102-B(9):1200–1209.
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Affiliation(s)
- Satoshi Miyamura
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita, Osaka, Japan
| | - Jonathan Lans
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Janice J. He
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts, USA
| | - Tsuyoshi Murase
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita, Osaka, Japan
| | - Jesse B. Jupiter
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Neal C. Chen
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Özkan S, Mudgal CS, Jupiter JB, Bloemers FW, Chen NC. Scapholunate Diastasis in Distal Radius Fractures: Fracture Pattern Analysis on CT Scans. J Wrist Surg 2020; 9:338-344. [PMID: 32760613 PMCID: PMC7395844 DOI: 10.1055/s-0040-1712505] [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: 09/10/2018] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Abstract
Objectives Our understanding of distal radius fractures with concomitant scapholunate (SL) diastasis primarily comes from plain radiographs and arthroscopy. The clinical implications of SL diastasis are not clear. The aim of this study is to describe fracture characteristics of distal radius fractures on computed tomography (CT) scans in patients with distal radius fractures and static SL diastasis. Methods We queried our institutional databases to identify patients who were treated for a distal radius fracture, had a CT scan with a wrist-protocol, and static SL diastasis on their CT scan. Our final cohort consisted of 26 patients. We then collected data on their demographics, injury, treatment, evaluated injury patterns, and measured radiographic SL characteristics. Our study cohort consisted of 11 men (42%) and almost half of our cohort ( n = 12; 46%) had a high-energy mechanism of injury. The majority of the patients ( n = 20; 77%) had operative treatment for their distal radius fracture and two patients (7.7%) had operative treatment of their SL injury. Results The mean SL distance was 3.5 ± 1.1 mm. Twenty patients (77%) had an intra-articular fracture. In these patients, we observed three patterns: (1) scaphoid facet impaction; (2) lunate facet impaction; and (3) no relative impaction. We observed other injury elements including rotation of the radial styloid relative to the lunate facet and partial carpal subluxations. Conclusion Static SL dissociation in the setting of distal radius fractures may be an indication of a complex injury of the distal radius, which may not be directly apparent on plain radiography. If these radiographs do not demonstrate impaction of the lunate or scaphoid facet, a CT scan may be warranted to have a more detailed view of the articular surface. Level of Evidence This is a Level III, diagnostic study.
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Affiliation(s)
- Sezai Özkan
- Hand and Upper Extremity Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Boston, Massachusetts
- Department of Trauma Surgery, VU University Medical Center, VU University, Amsterdam, The Netherlands
| | - Chaitanya S. Mudgal
- Hand and Upper Extremity Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Boston, Massachusetts
| | - Jesse B. Jupiter
- Hand and Upper Extremity Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Boston, Massachusetts
| | - Frank W. Bloemers
- Department of Trauma Surgery, VU University Medical Center, VU University, Amsterdam, The Netherlands
| | - Neal C. Chen
- Hand and Upper Extremity Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Boston, Massachusetts
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Affiliation(s)
- Suzanne C Wilkens
- Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael M Meghpara
- Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas
| | - J Henk Coert
- Department of Plastic Surgery and Hand Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jesse B Jupiter
- Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Neal C Chen
- Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Buijze GA, Bachoura A, Mahmood B, Wolfe SW, Osterman AL, Jupiter JB. Reevaluation of the Scaphoid Fracture: What Is the Current Best Evidence? Instr Course Lect 2020; 69:317-330. [PMID: 32017735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Scaphoid fractures are common and notorious for their troublesome healing. The aim of this review is to reevaluate the current best evidence for the diagnosis, classification, and treatment of scaphoid fractures and nonunions. MRI and CT are used to establish a "definitive diagnosis" with comparable diagnostic accuracy although neither is 100% specific. Current classifications cannot reliably predict union or outcomes; hence, a descriptive analysis of fracture location, type, and extent of displacement remains most useful. Treatment of a nondisplaced scaphoid waist fracture remains an individualized decision based on shared decision-making. Open reduction and internal fixation may be preferred when fracture displacement exceeds 1 mm, and the fracture is irreducible by closed or percutaneous means. For unstable nonunions with carpal instability, either non-vascularized cancellous graft with stable internal fixation or corticocancellous wedge grafts will provide a high rate of union and restoration of carpal alignment. For nonunions characterized with osteonecrosis of the proximal pole, vascularized bone grafting can achieve a higher rate of union.
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Bhashyam AR, Fernandez DL, Fernandez dell'Oca A, Jupiter JB. Dorsal Barton fracture is a variation of dorsal radiocarpal dislocation: a clinical study. J Hand Surg Eur Vol 2019; 44:1065-1071. [PMID: 31488008 DOI: 10.1177/1753193419872639] [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] [Indexed: 02/03/2023]
Abstract
Dorsal Barton fractures may be better described as variants of dorsal radiocarpal dislocations. We aimed to better characterize these fractures by reviewing 111 patients in the ICUC® dataset who had a dorsally displaced, intra-articular distal radius fracture. We identified 13 patients with a dorsal Barton fracture on radiographs (dorsal articular margin fracture with radiocarpal subluxation and intact volar cortex). All patients with a dorsal Barton fracture had radial styloid involvement and volar cortical disruption that was subsequently identified on three-dimensional CT. Based on three-dimensional CT and intra-operative findings, none of the patients had classically described dorsal Barton fractures. All patients were treated using a volar exposure. A volar capsular tear was identified intra-operatively in three patients and the volar capsule repaired. This series supports the contention that dorsal Barton fractures are better characterized and treated as a variation of a dorsal radiocarpal dislocation. Level of evidence: IV.
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Affiliation(s)
| | - Diego L Fernandez
- Department Orthopaedic Surgery, Lindenhof Hospital, Bern, Switzerland
| | | | - Jesse B Jupiter
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
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Fayaz HC, Smith RM, Ebrahimzadeh MH, Pape HC, Parvizi J, Saleh KJ, Stahl JP, Zeichen J, Kellam JF, Mortazavi J, Rajgopal A, Dahiya V, Zinser W, Reznik L, Shubnyakov I, Pećina M, Jupiter JB. Improvement of Orthopedic Residency Programs and Diversity: Dilemmas and Challenges, an International Perspective. Arch Bone Jt Surg 2019; 7:384-396. [PMID: 31448318 PMCID: PMC6686073] [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: 05/29/2018] [Accepted: 11/04/2018] [Indexed: 06/10/2023]
Abstract
BACKGROUND To date, little has been published comparing the structure and requirements of orthopedic training programs across multiple countries. The goal of this study was to summarize and compare the characteristics of orthopedic training programs in the U.S.A., U.K., Canada, Australia, Germany, India, China, Saudi Arabia, Russia and Iran. METHODS We communicated with responders using a predetermined questionnaire regarding the national orthopedic training program requirements in each respondent's home country. Specific items of interest included the following: the structure of the residency program, the time required to become an orthopedic surgeon, whether there is a log book, whether there is a final examination prior to becoming an orthopedic surgeon, the type and extent of faculty supervision, and the nature of national in-training written exams and assessment methods. Questionnaire data were augmented by reviewing each country's publicly accessible residency training documents that are available on the web and visiting the official website of the main orthopedic association of each country. RESULTS The syllabi consist of three elements: clinical knowledge, clinical skills, and professional skills. The skill of today's trainees predicts the quality of future orthopedic surgeons. The European Board of Orthopedics and Traumatology (EBOT) exam throughout the European Union countries should function as the European board examination in orthopedics. We must standardize many educational procedures worldwide in the same way we standardized patient safety. CONCLUSION Considering the world's cultural and political diversity, the world is nearly unified in regards to orthopedics. The procedures (structure of the residency programs, duration of the residency programs, selection procedures, using a log book, continuous assessment and final examination) must be standardized worldwide, as implemented for patient safety. To achieve this goal, we must access and evaluate more information on the residency programs in different countries and their needs by questioning them regarding what they need and what we can do for them to make a difference.
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Affiliation(s)
- Hangama C Fayaz
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Raymond M Smith
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Mohammad H Ebrahimzadeh
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Hans-Christoph Pape
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Javad Parvizi
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Khaled J Saleh
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Jens-Peter Stahl
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Johannes Zeichen
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - James F Kellam
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Javad Mortazavi
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Ashok Rajgopal
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Vivek Dahiya
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Wolfgang Zinser
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Leonid Reznik
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Igor Shubnyakov
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Marko Pećina
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Jesse B Jupiter
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Universitaets Spital Zuerich, Switzerland
- Rothman Institute at Thomas Jefferson University, Sheridan Building, Philadelphia, PA, USA
- Michigan Musculoskeletal Institute, Madison Heights, USA
- Department of Trauma, Klinikum Dortmund, Germany
- Department of Trauma, Johannes Wesling Klinikum Minden, Germany
- Department of Orthopedics, University of Texas, USA
- University of Tehran, Tehran, Iran
- Fortis Bone and Joint Institute, India
- Department of Orthopedics, St Vinzenz Hospital Dinslaken, Germany
- Omsk State Medical University, Russia
- R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics. Saint Petersburg, Russia
- Department of Orthopaedic Surgery, School of Medicine University of Zagreb,Croatia
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Research performed at Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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Bhashyam AR, Jupiter JB. Revision Fixation of Distal Humerus Fracture Nonunions in Older Age Patients with Poor Bone Quality or Bone Loss - Is This Viable as a Long-term Treatment Option? Arch Bone Jt Surg 2019; 7:251-257. [PMID: 31312683 PMCID: PMC6578483] [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: 07/05/2018] [Accepted: 08/26/2018] [Indexed: 06/10/2023]
Abstract
BACKGROUND The purpose of this retrospective study was to analyze the long-term results of revision ORIF, joint contracture release, and autogenous bone-grafting in the treatment of distal humerus frac-ture nonunions in older aged patients with poor bone quality or bone loss who would have been candidates for total elbow arthroplasty. METHODS Seven patients (average age at index procedure: 53.3 years, range: 41-75) with a distal humerus fracture nonunion treated with revision ORIF, joint contracture release and autogenous bone grafting between 1989-2000 were available for follow-up. Radiographic union and arthrosis were assessed using the most recent radiograph. Pain-related outcomes were measured using PROMIS Pain Interference scores. Functional outcomes were evaluated using the Mayo Elbow Perfor-mance Index (MEPI). RESULTS After an average follow-up of 22 years (range: 19-27 years), all nonunions were healed after the index procedure and had an average arc of ulnohumeral motion of 80°, flexion of 112°, and flex-ion contracture of 32°. Average arthrosis grade was moderate joint-space narrowing with osteo-phyte formation. One patient had exertional discomfort but none required chronic pain medica-tions. PROMIS-Pain Interference scores were no different than the general population (mean [95%CI] = 49.2 [41.8, 56.6], p =0.83). Per the MEPI, the functional result was excellent in five patients, good in one, and poor in one. CONCLUSION Despite older age and worse bone quality, distal humerus fracture nonunions can be treated using revision ORIF, joint contracture release and autogenous bone-grafting with acceptable long-term outcomes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Abhiram R Bhashyam
- Massachusetts General Hospital, Department of Orthopaedics, Boston, MA, USA
- Research performed at Massachusetts General Hospital, Boston, MA, USA
| | - Jesse B Jupiter
- Massachusetts General Hospital, Department of Orthopaedics, Boston, MA, USA
- Research performed at Massachusetts General Hospital, Boston, MA, USA
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Lans J, Alvarez J, Kachooei AR, Ozkan S, Jupiter JB. Dorsal Lunate Facet Fracture Reduction Using a Bone Reduction Forceps. J Wrist Surg 2019; 8:118-123. [PMID: 30941251 PMCID: PMC6443535 DOI: 10.1055/s-0038-1673407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 02/21/2018] [Accepted: 08/27/2018] [Indexed: 10/28/2022]
Abstract
Background The dorsal lunate facet fragment represents part of a complex articular injury of the distal radius and is challenging to reduce through a standard volar approach. We propose reduction through a standard volar approach and intraoperative dorsal lunate facet reduction using a bone forceps. To evaluate the postoperative reduction, we used computed tomography (CT) scan. Methods We retrospectively included 60 patients with a median follow-up of 44 weeks. Fracture reduction was evaluated using pre- and direct postoperative CT scans of the wrist, measuring the articular gap and step of the sigmoid notch. The range of motion was evaluated clinically by the treating physician. Bivariate analysis was performed to compare pre- and postoperative radiographic measurements and to compare wrist range of motion. Results When comparing the injured with the uninjured wrist, there was a significant difference in flexion, extension, pronation, and supination. In 87% of the patients, there was complete radiographic reduction of the fracture. Conclusion This study shows that dorsal ulnar lunate facet fracture fragments in distal radius fractures can be reduced through a standard volar approach with the help of an intraoperative bone reduction forceps. Using wrist CT, we showed that 87% of the patients with a dorsal ulnar lunate facet fragment had a postoperative articular step or gap of <1 mm. Level of Evidence : This is a level IV, therapeutic study.
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Affiliation(s)
- Jonathan Lans
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Josefina Alvarez
- Department of Traumatology, British Hospital, Montevideo, Uruguay
| | - Amir R. Kachooei
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sezai Ozkan
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jesse B. Jupiter
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Abstract
PURPOSE OF REVIEW Malunion remains a common complication in the treatment of distal radius fractures. The purpose of this review was to discuss the various approaches in planning and surgical management for extra- and intra-articular distal radius malunions. RECENT FINDINGS Several recent studies have reported good results with surgical correction of distal radius malunions utilizing a number of preoperative planning methods and surgical approaches. Three-dimensional models and custom cutting guides have recently become more popular, but their benefit in comparison to other methods remains unclear. Regardless of preoperative planning method or surgical approach, good results can be achieved with correction of distal radius malunion with careful attention to patient selection, indications, and surgical technique.
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Affiliation(s)
- Brady T Evans
- Department of Orthopaedic Surgery, Division of Hand and Upper Extremity Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jesse B Jupiter
- Department of Orthopaedic Surgery, Division of Hand and Upper Extremity Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Abstract
Background Radiocarpal or midcarpal arthritis can occur simultaneously with arthritis of the distal radioulnar joint (DRUJ), leading to functional impairment of the wrist. Treatment often involves wrist arthroplasty or arthrodesis, either with simultaneous or secondary procedures, addressing the DRUJ. Successful treatment of solitary DRUJ arthritis with DRUJ replacement has been reported. However, outcomes in patients with multiple prior wrist surgeries are lacking. Surgery in these wrists is challenging because surgical scarring and advanced bone deformities make implant positioning more difficult. Therefore, the aim of this study was to evaluate the outcomes in patients that underwent total wrist arthrodesis and DRUJ replacement after multiple prior wrist surgeries. Methods We prospectively enrolled patients that underwent total wrist arthrodesis and replacement of the DRUJ, either simultaneously or during separate procedures from 1999 to 2012. We included 14 patients with a median age of 43 years (interquartile range [IQR]: 35-47). As objective outcomes range of motion, weight-bearing ability, grip strength, was measured. For the subjective outcomes, we used an analogue pain score and the disabilities of the arm shoulder and hand (DASH) scores. Results At a median follow-up of 5.6 years (IQR: 3.2-7.1). The average DRUJ range of motion and weight lifting ability significantly improved. As for the subjective evaluations, postoperative pain scores improved significantly, as did the DASH scores. Four of the patients had a postoperative complication, including infection and heterotopic ossification, of which two required reoperations. Additionally, 5 patients developed pisotriquetral arthritis requiring, pisiform excision, triquetrum excision, or the combination of both. Conclusion Distal radioulnar joint replacement with a semiconstrained prosthesis was an effective method to restore the function of the wrist and forearm. As the surgical anatomy and soft tissue envelope were compromised in these patients, additional surgical exposure is necessary, adding to the complexity in these patients. No radiographic loosening Level of Evidence This is a therapeutic level IV study.
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Affiliation(s)
- Jonathan Lans
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Boston, Massachusetts
| | - Shih-Heng Chen
- Christine M. Kleinert Institute for Hand and Microsurgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Jesse B. Jupiter
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Boston, Massachusetts
| | - Luis R. Scheker
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Boston, Massachusetts
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Buijze GA, Leong NL, Stockmans F, Axelsson P, Moreno R, Ibsen Sörensen A, Jupiter JB. Three-Dimensional Compared with Two-Dimensional Preoperative Planning of Corrective Osteotomy for Extra-Articular Distal Radial Malunion: A Multicenter Randomized Controlled Trial. J Bone Joint Surg Am 2018; 100:1191-1202. [PMID: 30020124 DOI: 10.2106/jbjs.17.00544] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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 Malunion is the most frequent complication seen after a fracture of the distal end of the radius. The primary aim of this study was to compare patient-reported outcome measures (PROMs) after corrective osteotomy for malunited distal radial fractures with and without 3-dimensional (3D) planning and use of patient-specific surgical guides. METHODS From September 2010 to May 2015, 40 adult patients with a symptomatic extra-articular malunited distal radial fracture were randomized to 3D computer-assisted planning or conventional 2-dimensional (2D) planning for corrective osteotomy. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) score. Secondary outcomes included the Patient-Rated Wrist Evaluation (PRWE) score, pain and satisfaction scores, grip strength, and radiographic measurements at 3, 6, and 12 months postoperatively. RESULTS From baseline to 12 months of follow-up, the reduction in the mean DASH score was -30.7 ± 18.7 points for the 3D planning group compared with -20.1 ± 17.8 points for 2D planning (p = 0.103). Secondary functional outcome by means of the PRWE resulted in a similar reduction of -34.4 ± 22.9 points for the 3D planning group compared with -26.6 ± 18.3 points for the 2D planning group (p = 0.226). There were no significant differences in pain, satisfaction, range of motion, and grip strength. Radiographic analysis showed significant differences in the mean residual volar angulation (by 3.3°; p = 0.04) and radial inclination (by 2.7°; p = 0.028) compared with the templated side, in favor of 3D planning and guidance. The duration of preoperative planning and surgery as well as complication rates were comparable. CONCLUSIONS Although there was a trend toward a minimal clinically important difference in PROMs in favor of 3D computer-assisted guidance for corrective osteotomy of extra-articular distal radial malunion, it did not attain significance because of (post hoc) insufficient power. Despite the challenge of feasibility, a trial of large magnitude is warranted to draw definitive conclusions regarding clinical advantages of this advanced, more expensive technology. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Geert A Buijze
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, the Netherlands.,Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Natalie L Leong
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Filip Stockmans
- Handgroep Groeninge, AZ Groeninge, Kortrijk, Belgium.,KU Leuven Campus Kortrijk, Kortrijk, Belgium
| | - Peter Axelsson
- Department of Hand Surgery, Institute of Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rodrigo Moreno
- Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, Kentucky
| | - Allan Ibsen Sörensen
- Department of Hand Surgery, Institute of Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jesse B Jupiter
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
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Kim JM, Harris MB, Zurakowski D, Liu W, Jupiter JB, Kim JH, Vrahas MS. Predictors of Carpal Tunnel Release After Open Distal Radius Fracture. J Surg Orthop Adv 2018; 26:227-232. [PMID: 29461195] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The purpose of this investigation was to determine the incidence and identify the predictors of carpal tunnel release (CTR) after open fractures of the distal radius (DRF). Patients with clinical symptoms of persistent median nerve neuropathy that required CTR were analyzed for risk factors. One hundred thirty-nine open DRFs (107 grade I, 23 grade II, 9 grade III) met the inclusion criteria. The incidence of CTR was 13.7% in all open DRFs (19 out of 139). Multivariable logistic regression analysis identified four predictors: male sex [odds ratio (OR) = 8.8, p = .001], type III Gustilo and Anderson grade (OR = 6.2, p = .04), OTA fracture type C (OR = 3.8, p = .03), and the application of external fixation (OR = 14.0, p D .02). The probability of CTR, determined by preoperative variables, was 80% with three factors present and 2% with no risk factors. High-risk patients may be identified who may benefit from closer perioperative surveillance and possibly carpal tunnel release. (Journal of Surgical Orthopaedic Advances 26(4):227-232, 2017).
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Affiliation(s)
- Jaehon M Kim
- Icahn School of Medicine at Mount Sinai, New York, New York. Address correspondence to: Jaehon M. Kim, MD, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, 9th Floor, New York, NY 10029; e-mail:
| | | | | | - Wanjun Liu
- Massachusetts General Hospital, Boston, Massachusetts
| | | | - Joung Heon Kim
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mark S Vrahas
- Massachusetts General Hospital, Boston, Massachusetts
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41
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Alqueza AB, Fostvedt S, Emerson Floyd W, Jupiter JB. Patient Satisfaction After Bilateral Thumb Carpometacarpal Osteoarthritis Surgery. J Surg Orthop Adv 2018; 26:250-256. [PMID: 29461199] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study seeks to determine whether patients with bilateral thumb carpometacarpal osteoarthritis were sufficiently satisfied with their surgeries to choose to undergo surgery again. The null hypothesis is that patients are dissatisfied with the results of the first surgery. Out of 46 living patients meeting enrollment criteria, 41 were enrolled and evaluated using the Disabilities of the Arm, Shoulder and Hand (DASH) score and the Enneking musculoskeletal score. The average DASH score was 17.37. The average Enneking musculoskeletal score was 88.21. Of 41 patients, one expressed unwillingness to undergo the next procedure, three indicated that they would reluctantly do surgery again, and four were satisfied. The remaining 33 subjects were enthused with their functional result, expressing willingness to undergo the procedure again. At an average follow-up of 44.9 months, most patients are satisfied with bilateral thumb carpometacarpal surgery for osteoarthritis. Consent for the contralateral surgery implies that the outcome of the first surgery was sufficiently acceptable to seek surgery on the contralateral thumb. (Journal of Surgical Orthopaedic Advances 26(4):250-256, 2017).
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Affiliation(s)
- Arnold B Alqueza
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts. Address correspondence to: Arnold B. Alqueza, MD, Brigham and Women's Faulkner Hospital, 5 South 1153 Centre Street, Boston, MA 02130; e-mail:
| | | | | | - Jesse B Jupiter
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
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Jupiter JB, Nunez FA, Nunez F, Fernandez DL, Shin AY. Current Perspectives on Complex Wrist Fracture-Dislocations. Instr Course Lect 2018; 67:155-174. [PMID: 31411409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Although perilunate injuries represent only 5% of all carpal injuries, they compose a spectrum of devastating complex wrist injuries. Perilunate injuries result from high-energy trauma to the wrist and may be associated with multiple fractures, dislocations, and ligament injuries. Although the diagnosis of a perilunate injury is made via radiographic assessment, missed diagnosis occurs in 25% of patients with a perilunate injury. Immediate diagnosis of perilunate injuries is critical to optimize patient outcomes. Closed reduction of perilunate injuries is performed to avoid permanent damage to the median nerve and other compromised structures. As swelling subsides, open reduction is performed to restore anatomic alignment, attain stable fixation, and repair the ligaments. Despite optimal management of perilunate injuries, complications, including median nerve dysfunction, complex regional pain syndrome, carpal instability, and late posttraumatic arthritis, may occur. Satisfactory outcomes can be achieved in patients with a perilunate injury via prompt recognition and timely surgical management. Although radiographic signs of arthritis develop in many patients with a perilunate injury, these radiographic signs do not necessarily correlate with functional outcomes. Some patients with a perilunate injury require salvage procedures for the management of persistent complications. Radiocarpal fracture-dislocations are a complex wrist fracture-dislocation pattern. Radiocarpal fracture-dislocations generally result from high-energy trauma and are characterized by a carpal dislocation, which usually involves a small portion of the rim of the dorsal or volar aspect of the distal radius. Neurologic dysfunction and elevated intracompartment pressure may be present in patients with a radiocarpal fracture-dislocation. Wrist fracture-dislocations are associated with a number of complications, including intercarpal instability, later arthrosis, carpal nonunion, and loss of radiocarpal mobility.
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Affiliation(s)
- Jesse B Jupiter
- Hansj�rg Wyss/AO Professor, Department of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Lans J, Lasa A, Chen NC, Jupiter JB. Incidence and Functional Outcomes of Scapholunate Diastases Associated Distal Radius Fractures: A 2-year Follow-Up Scapholunate Dissociation. Open Orthop J 2018; 12:33-40. [PMID: 29456778 PMCID: PMC5806195 DOI: 10.2174/1874325001812010033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 01/20/2018] [Accepted: 01/23/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The Scapholunate Interosseous Ligament (SLIL) is the first intrinsic carpal ligament to be injured in wrist trauma, present in up to 64% of the distal radius fractures. However, it remains unclear what patients develop symptoms, making primary treatment of these injuries accompanying distal radius fractures remains questionable. OBJECTIVE The aim of this study was to evaluate the functional outcomes of patients with scapholunate diastasis associated with distal radius fractures. METHODS We evaluated 391 patients with a distal radius fracture. Using Computer Tomography (CT) scans the scapholunate interval was measured. We identified 14 patients with an SLD (>3mm) of the injured wrist, which underwent a CT-scan of the contralateral wrist. To evaluate the functional outcomes at a mean follow up of 136±90 weeks, we used the Quick Disabilities of the Arm, Shoulder and Hand (qDASH) Score. RESULTS There were 8 patients with bilateral SLD and 6 patients with unilateral SLD. Five patients had a qDASH score of 0 and one patient showed a qDASH score of 18.2. The patient with a poor score had bilateral preexisting osteoarthritis of the wrist. No patient had additional surgery of the SLIL. CONCLUSION In patients with distal radius fractures, more than half of the 14 patients with an SL gap on CT had widening on the contralateral side. It is therefore worthwhile to image the contralateral wrist before diagnosing a SLD. The patients with unilateral SLD should not be surgically treated at initial presentation because they may have good functional outcomes after a follow up of 2 years.
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Affiliation(s)
- Jonathan Lans
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA, 02114, USA
| | - Alejandro Lasa
- Department of Traumatology, British Hospital, Avenida Italia 2420, 11600 Montevideo, Uruguay
| | - Neal C. Chen
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA, 02114, USA
| | - Jesse B. Jupiter
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA, 02114, USA
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Abstract
Arthropathy of the hand is commonly encountered. Contributing factors such as aging, trauma, and systemic illness all may have a role in the evolution of this pathology. Besides rheumatoid arthritis, other diseases affect the small joints of the hand. A review of nonrheumatoid hand arthropathies is beneficial for clinicians to recognize these problems.
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Affiliation(s)
- Jonathan Lans
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| | - Jacques A Machol
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Christian Deml
- Department of Trauma Surgery, Division of Hand and Wrist Surgery, Medical University of Innsbruck, Austria
| | - Neal C Chen
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jesse B Jupiter
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Cheung K, Klausmeyer MA, Jupiter JB. Abductor Digiti Minimi Flap for Vascularized Coverage in the Surgical Management of Complex Regional Pain Syndrome Following Carpal Tunnel Release. Hand (N Y) 2017; 12:546-550. [PMID: 29091494 PMCID: PMC5669332 DOI: 10.1177/1558944716681977] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 11/15/2022]
Abstract
BACKGROUND The development of Complex Regional Pain Syndrome (CRPS) represents a potentially devastating complication following carpal tunnel release. In the presence of a suspected incomplete release of the transverse carpal ligament or direct injury to the median nerve, neurolysis as well as nerve coverage to prevent recurrent scar has been shown to be effective. METHODS Retrospective chart review and telephone interview was conducted for patients who underwent abductor digiti minimi flap coverage and neurolysis of the median nerve for CRPS following carpal tunnel release. RESULTS Fourteen wrists in 12 patients were reviewed. Mean patient age was 64 years (range, 49-83 years), and the mean follow-up was 44 months. Carpal tunnel outcome instrument scores were 47.4 ± 6.8 preoperatively and 27.1 ± 10.6 at follow-up ( P < .001). Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores at follow-up were 29.4 ± 26. No significant postoperative complications were identified. CONCLUSIONS The abductor digiti minimi flap is a reliable option with minimal donor site morbidity. It provides predictable coverage when treating CRPS following carpal tunnel syndrome.
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Affiliation(s)
| | | | - Jesse B. Jupiter
- Massachusetts General Hospital, Boston, MA, USA,Jesse B. Jupiter, Hand and Upper Extremity Service, Massachusetts General Hospital, Yawkey Building 2100, 55 Fruit Street, Boston, MA 02114, USA.
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von Keudell A, Mohamadi A, Bargon CA, Jupiter JB. Open Reduction and Internal Fixation for Lateral Unicondylar Distal Humeral Fractures. JBJS Essent Surg Tech 2017; 7:e12. [PMID: 30233947 DOI: 10.2106/jbjs.st.16.00084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction Unicondylar distal humeral fractures are uncommon, partially intra-articular fractures (OTA/AO type B1) that are among the most complex fractures to treat1,2; however, most displaced distal humeral fractures, including lateral unicondylar distal humeral fractures2-5, can be effectively managed with open reduction and internal fixation. Indications & Contraindications Step 1 Preparation of the Operating Room and the Patient Perform sterile preparation, have the patient brought into the operating room, induce anesthesia, and place the patient in the lateral decubitus or supine position before sterile draping. Step 2 Approach to the Fracture Make a lateral incision, expose the lateral distal part of the humerus, identify the ulnar nerve if necessary, visualize the fracture fragments, and debride the fracture site. Step 3 Reduction of the Fracture Reduce the fracture and fix it temporarily. Step 4 Plate Fixation of the Fracture Determine the plate length; position the plate posterolaterally, posteriorly, or laterally; insert screws; remove provisional Kirschner wires; and obtain intraoperative images. Step 5 Final Radiographic Imaging Make anteroposterior and lateral radiographic images to confirm reduction and adequate anatomic alignment of the elbow and the position of the hardware. Step 6 Closure of the Wound Deflate the tourniquet, irrigate the wound, and apply postoperative dressings. Results The detailed outcome for a cohort of 24 patients who underwent this procedure has been reported elsewhere6. Pitfalls & Challenges
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Affiliation(s)
- Arvind von Keudell
- Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Amin Mohamadi
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Claudia A Bargon
- Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Jesse B Jupiter
- Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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Eberlin KR, Marjoua Y, Jupiter JB. Compressive Neuropathy of the Ulnar Nerve: A Perspective on History and Current Controversies. J Hand Surg Am 2017; 42:464-469. [PMID: 28578769 DOI: 10.1016/j.jhsa.2017.03.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 05/04/2016] [Revised: 08/21/2016] [Accepted: 03/21/2017] [Indexed: 02/02/2023]
Abstract
The untoward effects resulting from compression of the ulnar nerve have been recognized for almost 2 centuries. Initial treatment of cubital tunnel syndrome focused on complete transection of the nerve at the level of the elbow, resulting in initial alleviation of pain but significant functional morbidity. A number of subsequent techniques have been described including in situ decompression, subcutaneous transposition, submuscular transposition, and most recently, endoscopic release. This manuscript focuses on the historical aspects of each of these treatments and our current understanding of their efficacy.
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Affiliation(s)
- Kyle R Eberlin
- Hand Surgery Service, Massachusetts General Hospital, Boston, MA.
| | - Youssra Marjoua
- Hand Surgery Service, Massachusetts General Hospital, Boston, MA
| | - Jesse B Jupiter
- Hand Surgery Service, Massachusetts General Hospital, Boston, MA
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Nunez FA, Luo TD, Jupiter JB, Nunez FA. Scaphocapitate Syndrome With Associated Trans-Scaphoid, Trans-Hamate Perilunate Dislocation: A Case Report and Description of Surgical Fixation. Hand (N Y) 2017; 12:NP27-NP31. [PMID: 28344539 PMCID: PMC5349417 DOI: 10.1177/1558944716668837] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 11/17/2022]
Abstract
Background: Perilunate fracture dislocations are often associated with fractures of the distal pole of the scaphoid or the proximal pole of the capitate. However, the combination of perilunate dislocation with multiple carpal fractures and associated scaphocapitate syndrome is very rare. Methods: We report a unique case of scaphocapitate fracture syndrome with perilunate dislocation and fracture of the hamate resulting from a high-energy injury to the wrist during a dirt-bike competition. Results: Open reduction and internal fixation of the scaphoid fracture with a 3.0-mm headless screw, the head of the capitate with a 1.5-mm lag screw, and the hamate fracture with a 1.3-mm lag screw was performed. The lunotriquetral dissociation was reduced, with the ligament repaired and the joint stabilized using a Kirschner wire. All screw heads are carefully buried under the articulate cartilage. Conclusions: Prompt anatomic reduction and stable osteosynthesis of all fractures in this patient resulted in successful healing and return to activity.
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Affiliation(s)
- Fiesky A. Nunez
- Wake Forest Baptist Medical Center, Winston-Salem, NC, USA,Fiesky A. Nunez Jr, Wake Forest Baptist Medical Center, Medical Center Blvd, Winston-Salem, NC 27157, USA.
| | - T. David Luo
- Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
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Abstract
Radial head fractures are common injuries and are accompanied by clinically relevant associated injuries in over one-third of patients. They are commonly classified by the Mason classification or one of its modifications. Type I fractures are treated conservatively with early mobilization. Type II fractures can be treated conservatively or by open reduction and internal fixation (ORIF), depending on fragment size and dislocation. Bony restriction in forearm rotation is an indication for surgical treatment. Type III fractures are treated surgically, by means of ORIF, prosthetic replacement or excision. Comminuted fractures with more than three fragments are regarded as unsuitable for ORIF. However, optimal treatment of type II and III fractures is still the subject of debate and there is a strong need for randomized clinical trials and uniform fracture classification and outcome measures.
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Affiliation(s)
- Laurens Kaas
- Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands
- Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Jesse B. Jupiter
- Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - C. Niekvan Dijk
- Hand and Upper Limb Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Denise Eygendaal
- Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
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Jayakumar P, Teunis T, Giménez BB, Verstreken F, Di Mascio L, Jupiter JB. AO Distal Radius Fracture Classification: Global Perspective on Observer Agreement. J Wrist Surg 2017; 6:46-53. [PMID: 28119795 PMCID: PMC5258123 DOI: 10.1055/s-0036-1587316] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 04/18/2016] [Accepted: 06/30/2016] [Indexed: 10/21/2022]
Abstract
Background The primary objective of this study was to test interobserver reliability when classifying fractures by consensus by AO types and groups among a large international group of surgeons. Secondarily, we assessed the difference in inter- and intraobserver agreement of the AO classification in relation to geographical location, level of training, and subspecialty. Methods A randomized set of radiographic and computed tomographic images from a consecutive series of 96 distal radius fractures (DRFs), treated between October 2010 and April 2013, was classified using an electronic web-based portal by an invited group of participants on two occasions. Results Interobserver reliability was substantial when classifying AO type A fractures but fair and moderate for type B and C fractures, respectively. No difference was observed by location, except for an apparent difference between participants from India and Australia classifying type B fractures. No statistically significant associations were observed comparing interobserver agreement by level of training and no differences were shown comparing subspecialties. Intra-rater reproducibility was "substantial" for fracture types and "fair" for fracture groups with no difference accounting for location, training level, or specialty. Conclusion Improved definition of reliability and reproducibility of this classification may be achieved using large international groups of raters, empowering decision making on which system to utilize. Level of Evidence Level III.
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Affiliation(s)
| | - Teun Teunis
- Department of General Surgery, OLVG, Amsterdam, The Netherlands
| | - Beatriz Bravo Giménez
- Orthopaedic Upper Extremity Service, Hospital Universitario Doce de Octubre-Universidad Complutense, Madrid, Spain
| | - Frederik Verstreken
- Department of Hand Surgery, Monica Hospital/Antwerp University Hospital, Edegem, Belgium
| | - Livio Di Mascio
- Department of Trauma and Orthopaedic Surgery, Barts and The Royal London Hospital, London, United Kingdom
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