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Kale NN, Foote J, Medvedev G. Use of Wrist Denervation in the Treatment of SLAC and SNAC Wrist by ASSH Members. J Wrist Surg 2023; 12:280-286. [PMID: 37223381 PMCID: PMC10202580 DOI: 10.1055/s-0042-1756498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 06/30/2022] [Indexed: 10/10/2022]
Abstract
Background Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) are common patterns of wrist arthritis, and surgical treatment options include partial and total wrist arthrodesis and wrist denervation, which maintains the current anatomy while relieving pain. Introduction The purpose of this study is to elucidate current practices within the hand surgery community with respect to the use of anterior interosseous nerve/posterior interosseous nerve (AIN/PIN) denervation in the treatment of SLAC and SNAC wrists. Methods An anonymous survey was distributed to 3,915 orthopaedic surgeons via the American Society for Surgery of the Hand (ASSH) listserv. The survey collected information on conservative and operative management, indications, complications, diagnostic block, and coding of wrist denervation. Results In total, 298 answered the survey. 46.3% ( N = 138) of the respondents used denervation of AIN/PIN for every SNAC stage, and 47.7% ( N = 142) of the respondents used denervation of AIN/PIN for every SLAC wrist stage. AIN and PIN combined denervation was the most common standalone procedure ( N = 185, 62.1%). Surgeons were more likely to offer the procedure ( N = 133, 55.4%) if motion preservation had to be maximized ( N = 154, 64.4%). The majority of surgeons did not consider loss of proprioception ( N = 224, 84.2%) or diminished protective reflex ( N = 246, 92.1%) to be significant complications. 33.5%, 90 respondents reported never performing a diagnostic block prior to denervation. Conclusion Both SLAC and SNAC patterns of wrist arthritis can result in debilitating wrist pain. There is a wide range of treatment for different stages of disease. Further investigation is required to identify ideal candidates and evaluate long-term outcomes.
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Affiliation(s)
- Nisha N. Kale
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Jake Foote
- Department of Orthopaedics, MSUCHM Ascension Providence Hospital, Southfield, Michigan
| | - Gleb Medvedev
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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Swärd EM, Franko MA, Wilcke MK. The effects of partial wrist denervation in wrist osteoarthritis: patient-reported outcomes and objective function. J Hand Surg Eur Vol 2022; 47:798-804. [PMID: 35345931 PMCID: PMC9459653 DOI: 10.1177/17531934221088498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This prospective longitudinal study aimed to analyse the effect of partial wrist denervation on patient-reported outcomes, quality of life and objective function in symptomatic wrist osteoarthritis during the first year after surgery. Sixty consecutive patients underwent an anterior and posterior interosseous neurectomy during 2018-2020. Disabilities of the Arm, Shoulder and Hand, Patient-Rated Wrist Evaluation, EuroQol-5D-3L, pain at rest and on load, and objective function were assessed preoperatively and 3, 6 and 12 months postoperatively. Generalized estimating equations were used to analyse the effect on the outcome variables. Disabilities of the Arm, Shoulder and Hand, Patient-Rated Wrist Evaluation and pain scores improved significantly postoperatively with no decline over time, but no patient reported outcome measure reached the minimal clinically important difference. Quality of life, strength and range of motion did not improve. We found no complications. Seventeen patients needed further surgery during the study period. More studies are needed to evaluate whether denervation is truly effective or not.Level of evidence: II.
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Affiliation(s)
- Elin M. Swärd
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
- Department for Hand Surgery Södersjukhuset, Stockholm, Sweden
- Elin Swärd, Handkirurgiska kliniken Södersjukhuset, Sjukhusbacken 10, 11883 Stockholm, Sweden.
| | - Mikael Andersson Franko
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
| | - Maria K. Wilcke
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
- Department for Hand Surgery Södersjukhuset, Stockholm, Sweden
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Mosillo G, Basso MA, Balato G, Bernasconi A, Coviello A, Tamborini F, Poggetti A, Smeraglia F. Adaptive proximal scaphoid implant (APSI): a systematic review of the literature. Orthop Rev (Pavia) 2022; 14:30721. [PMID: 35106130 DOI: 10.52965/001c.30721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 12/03/2021] [Indexed: 11/06/2022] Open
Abstract
Scapholunate advanced collapse collapse (SLAC) is a challenging topic for hand surgeons. The adaptative proximal scaphoid implant (APSI) (Bioprofile-Tornier) is a pyrocarbon ovoid shaped interpositional implant, that allows adaptive mobility during motion. The aim of this systematic review is to analyze the clinical and radiological outcomes of APSI implants and possible complications. We performed a literature search combining the following key-words: "APSI", "Scaphoid's proximal pole", "implant", "scaphoid avascular necrosis", "SLAC", "SNAC", "pyrocarbon", "prosthesis", and "spacer" with no limitations for year of publication. We selected seven studies considered relevant to our systematic review. All studies described an improvement in the grip strength and the flexion extension arch compared to pre-operative values. The percentage of patients who reported progression of osteoarthritis (OA) with APSI was 17.3%, and implant's mobilization has a rate 5.1% (8/156). In conclusion the APSI implant is a reliable alternative for the treatment of SNAC wrist and SLAC wrist.
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Affiliation(s)
- Giuseppe Mosillo
- Department of Orthopaedic Surgery, "Federico II" University, Via S. Pansini 5, bd. 12, 80131, Naples, Italy
| | - Morena Anna Basso
- Department of Orthopaedic Surgery, "Federico II" University, Via S. Pansini 5, bd. 12, 80131, Naples, Italy
| | - Giovanni Balato
- Department of Orthopaedic Surgery, "Federico II" University, Via S. Pansini 5, bd. 12, 80131, Naples, Italy
| | - Alessio Bernasconi
- Department of Orthopaedic Surgery, "Federico II" University, Via S. Pansini 5, bd. 12, 80131, Naples, Italy
| | - Antonio Coviello
- Department of Anesthesia, "Federico II" University, Via S. Pansini 5, bd. 12, 80131, Naples, Italy
| | - Federico Tamborini
- Hand and Reconstructive Microsurgery Unit, Azienda Ospedaliera Careggi, Florence, Italy
| | - Andrea Poggetti
- Plastic and Reconstructive Surgery, University of Insubria, Varese, Italy
| | - Francesco Smeraglia
- Department of Orthopaedic Surgery, "Federico II" University, Via S. Pansini 5, bd. 12, 80131, Naples, Italy
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Pomares G, Lallemand B. Is there still a place for denervation in the treatment of osteoarthritis of the wrist and hand? Orthop Traumatol Surg Res 2021; 107:102986. [PMID: 34118475 DOI: 10.1016/j.otsr.2021.102986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Germain Pomares
- Institut Européen de la Main, Hôpital Kirchberg, 9, rue Edward Steichen, 2540 Luxembourg, Luxembourg
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Fontaine C. A special issue for the editor-in-chief. HAND SURGERY & REHABILITATION 2021; 39:471-473. [PMID: 33158478 DOI: 10.1016/j.hansur.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C Fontaine
- Henri Warembourg faculty of medicine, institute of anatomy, university of Lille, place de Verdun, 59045 Lille cedex, France.
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