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Arenas-Prat J. Scapholunate Ligament Insufficiency in a Patient with Scaphocapitate Coalition. J Hand Microsurg 2023; 15:315-317. [PMID: 37701306 PMCID: PMC10495201 DOI: 10.1055/s-0042-1744210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
We report a case of chronic scapholunate ligament insufficiency in a patient with scaphocapitate coalition. After more than 4 years of mild symptoms, there was no radiological evidence of progression to scapholunate advanced collapse in spite of minimal load-bearing repetitive physical activities undertaken by the patient as a professional guitarist. We believe that scaphocapitate coalition could contribute to mitigate the progression to scapholunate advanced collapse by preventing abnormal flexion of the scaphoid once the ligament is not competent anymore. The biomechanical and surgical implications of this type of carpal coalition are also discussed.
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Affiliation(s)
- Joan Arenas-Prat
- Department of Orthopaedics, Serveis Medics Penedes, Barcelona, Catalonia, Spain
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2
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Athlani L, Cholley-Roulleau M, Blum A, Teixeira PAG, Dap F. Intercarpal arthrodesis: A systematic review. HAND SURGERY & REHABILITATION 2023; 42:93-102. [PMID: 36642245 DOI: 10.1016/j.hansur.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/24/2022] [Accepted: 12/18/2022] [Indexed: 01/15/2023]
Abstract
Intercarpal arthrodesis is a well-established option to treat various disorders of the carpus, such as localized osteoarthritis, carpal instability, and Kienböck's disease. This is a non-conservative procedure aimed at obtaining a stable and congruent interface between the radius and the proximal carpal row, which restores wrist function by minimizing pain and restoring grip strength. These procedures generally yield good predictable results that are maintained over time. However, all intracarpal arthrodesis procedures cause a loss of wrist range of motion. To optimize outcomes and minimize complications, especially nonunion, this surgery may require a learning curve. A precise surgical technique for preparing the bone surfaces, bringing enough bone graft, and using reliable fixation is essential. Since the late 1960s, several intracarpal arthrodesis procedures have been described. Commonly used fusions target the scaphotrapeziotrapezoid, scaphocapitate, four corners, capitolunate or capitohamatolunate regions. Lesser used fusions focus on specific lesions such as the scapholunate, scapholunocapitate, lunotriquetral and triquetrohamate. Here, we propose a systematic review of the various types of intercarpal arthrodesis procedures described in the literature. After having described each arthrodesis, we specify their indications, the variations of the surgical techniques, and then present an overview of the results and complications. Finally, we discuss how these surgeries affect wrist biomechanics. LEVEL OF EVIDENCE: III.
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Affiliation(s)
- Lionel Athlani
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, Nancy University Hospital, 49 rue Hermite, 54000 Nancy, France; Université de Lorraine, IADI Laboratory, INSERM, CIC-IT Nancy, Nancy, France.
| | - M Cholley-Roulleau
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, Nancy University Hospital, 49 rue Hermite, 54000 Nancy, France.
| | - A Blum
- Guilloz Imaging Department, Central Hospital, Nancy University Hospital, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France.
| | - P A Gondim Teixeira
- Guilloz Imaging Department, Central Hospital, Nancy University Hospital, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France; Université de Lorraine, IADI Laboratory, INSERM, CIC-IT Nancy, Nancy, France.
| | - F Dap
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, Nancy University Hospital, 49 rue Hermite, 54000 Nancy, France.
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de Villeneuve Bargemon JB, Peras M, Hasegawa H, Levadoux M. Arthroscopic Scaphocapitate Fusion: Surgical Technique. Arthrosc Tech 2022; 11:e1289-e1294. [PMID: 35936845 PMCID: PMC9353331 DOI: 10.1016/j.eats.2022.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 03/09/2022] [Indexed: 02/03/2023] Open
Abstract
Scapholunate fusion appears to be an interesting surgical solution for carpal pathologies, which are sometimes difficult to manage as Kienbock's disease or chronic scapholunate instability. Open intracarpal fusion is notorious for decreasing joint range of motion due to the fusion of several carpal bones and because of the capsulotomy sectioning important ligamentous elements in carpal biomechanics. Wrist arthroscopy has already demonstrated its effectiveness in preserving joint mobility compared with open procedures. In this work, we present a detailed procedure for performing a scaphocapitate fusion under arthroscopy by specifying the key points of this procedure in our experience.
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Affiliation(s)
- Jean-Baptiste de Villeneuve Bargemon
- Hand, Wrist and Elbow Surgery, Saint Roch Private Hospital, Toulon, Toulon, France
- Address correspondence to Jean-Baptiste de Villeneuve Bargemon, M.D., 191 Boulevard Baille, 13005, Marseille, France.
| | - Matthieu Peras
- Department of Orthopedic Surgery and Traumatology, Teaching Naval Hospital Sainte-Anne, Toulon France
| | - Hideo Hasegawa
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Michel Levadoux
- Hand, Wrist and Elbow Surgery, Saint Roch Private Hospital, Toulon, Toulon, France
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Levy KH, Huddleston H, Kurtzman JS, Aibinder WR, Koehler SM. The 50 most cited papers in chronic scapholunate reconstruction: a bibliometric analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:995-1004. [PMID: 33417053 DOI: 10.1007/s00590-020-02864-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE This study identifies the most impactful papers on scapholunate reconstruction and provides a quantitative assessment of the impact of these papers in order to inform future clinical practice, education, and research of this condition. METHODS The Scopus database was used in May 2020 to identify the 50 most cited clinical articles pertaining solely to chronic scapholunate reconstruction. Citation number and density, publication variables, and Altmetric Attention Scores (AASs) were collected and analyzed. RESULTS The top 50 articles on chronic scapholunate reconstruction produced 1,868 total citations, with an average of 37.36 ± 39.90 citations per article (range 7-196) and an average citation density of 2.44 ± 2.27. US-based publications (n = 20) and articles published in Journal of Hand Surgery (n = 24) were associated with significantly higher citation number and density (p < 0.01 - p = 0.018). In addition, sample size was positively correlated with citation density (rho = 0.312, p = 0.029). Fourteen articles were associated with an AAS (mean score = 4.07 ± 4.70). There was no significant association between AAS and citation number or density, but AAS did significantly predict citation density (coefficient = 0.378, 95% CI: [0.013-0.741], p = 0.043). CONCLUSION Numerous factors, such as journal of publication, location, and sample size, were significantly associated with citation number and/or citation density. Interestingly, AAS was predictive of, but not directly correlated with citation density, suggesting that the impact of scapholunate literature may not be adequately captured with a citation analysis.
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Affiliation(s)
- Kenneth H Levy
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY), 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Hailey Huddleston
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY), 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Joey S Kurtzman
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY), 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - William R Aibinder
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY), 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Steven M Koehler
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY), 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA.
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Reigstad O, Grimsgaard C, Holm-Glad T, Korslund J, Thorkildsen RD, Røkkum M. Satisfactory function 12 years after triscaphoid arthrodesis for chronic scapholunate ligament injury. J Plast Surg Hand Surg 2020; 54:233-239. [PMID: 32410479 DOI: 10.1080/2000656x.2020.1756835] [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] [Indexed: 10/24/2022]
Abstract
Scapholunate ligament (SLL) injury represents a hazard to the wrist and the treatment of these injuries has been the focus of much debate. We performed a long-term follow (>10 years) of triscaphoid arthrodesis for symptomatic chronic SLL injuries in 10 (8 men) patients 37 (22-49) years of age. All arthrodesis healed. One patient was converted to total wrist arthrodesis during the follow-up period, and three had minor additional surgeries. At final follow-up, the patients had reduced active range of motion (AROM, 55%) and grip strength (85%) compared to the opposite side, but reported low Quick Disability of Arm, Shoulder and Hand (QDASH) (11), Patient-Rated Wrist and Hand Evaluation (PRWHE) (25) and visual analog scale (VAS) pain scores (0 and 10 at rest and activity). Radiographs found minimal degenerative changes in four patients, while CT scans demonstrated changes in seven patients, in three of these scaphoid was subluxed on the rim of the radius. The patients working prior to surgery were working at follow-up. A triscaphoid arthrodesis for SLL renders a functional wrist function in most patients for many years and has postponed more extensive surgery like total wrist arthrodesis or wrist arthroplasty. The patients are still young, and the degenerative changes seen especially on CT scans warrants attention.
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Affiliation(s)
- Ole Reigstad
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Trygve Holm-Glad
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Johanne Korslund
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Rasmus D Thorkildsen
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Magne Røkkum
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Crawford K, Owusu-Sarpong N, Day C, Iorio M. Scapholunate Ligament Reconstruction: A Critical Analysis Review. JBJS Rev 2018; 4:e41-8. [PMID: 27487428 DOI: 10.2106/jbjs.rvw.o.00060] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Scapholunate reconstruction procedures are best stratified according to preoperative stages of dissociative instability, injury chronicity, and arthrosis. In general, procedures aimed at correcting scapholunate instability focus on reestablishing ligament continuity in order to normalize carpal biomechanics; however, many existing interventions have shown differential success when performed on patients with varying stages of instability and degrees of carpal malalignment. The Mayo dorsal intercarpal ligament capsulodesis has proven most effective for preserving range of motion, whereas the Blatt capsulodesis has been associated with substantial improvements in terms of the postoperative pain rating and perceived functional capacity.
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Affiliation(s)
- Kayva Crawford
- Division of Plastic Surgery, Department of Surgery, and Division of Hand Surgery, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Abstract
Partial wrist fusion is a useful technique for the treatment of such specific carpal disorders as arthritis, Kienböck's disease, midcarpal instability, scaphoid nonunion, etc.Many techniques have been described by removing arthritic joint surfaces and transfering load, using, for bone fixation, K-wires, screws, staples, and more recently dedicated plates.The goal of this procedure is to maximise wrist motion and strength while minimizing or eliminating pain.The purpose of this article is to discuss the most commonly used combination of intercarpal arthrodeses, to clarify the indications for each fusion, to describe the appropriate surgical technique for each fusion, and to provide an overview of results and current concepts. Cite this article: Houvet, P. Intercarpal fusions: indications, treatment options and techniques. EFORT Open Rev 2016;1:45-51. DOI: 10.1302/2058-5241.1.000019.
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Affiliation(s)
- Patrick Houvet
- Institut Français de Chirurgie de la Main, Paris, France
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8
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De Carli P, Donndorff AG, Torres MT, Boretto JG, Gallucci GL. Combined Tenodesis-Capsulodesis for Scapholunate Instability: Minimum 2-Year Follow-Up. J Wrist Surg 2017; 6:11-21. [PMID: 28119791 PMCID: PMC5258132 DOI: 10.1055/s-0036-1583304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 03/17/2016] [Indexed: 10/21/2022]
Abstract
Background The aim of this study is to evaluate the clinical and radiological midterm results of a combined dorsal tenodesis-capsulodesis for static and reducible scapholunate dissociation (SLD). Patients and Methods We evaluated 20 of 22 consecutive patients with static SLD minimum with follow-up of 2 years operated between 2003 and 2012. The mean age was 40 years (range: 23-65 years). Seventeen were men. Final evaluation included comparative wrist range of motion (ROM) and grip strength, pre- and postoperative pain and function by visual analog scale, and QuickDASH and Wrightington scores. Radiographs included preoperative, early postoperative, and final X-rays. Scapholunate space (SLS) and scapholunate and radioscaphoid angles (SLA and RSA) were measured. Statistical significance was evaluated with Student t-test, considered significant when p < 0.05. Results Mean follow-up was 67 months (range: 24-126 months). Mean final ROM was: flexion 55 degrees (73%), extension 62 degrees (90%), radial deviation 19 degrees (82%), and ulnar deviation 44 degrees (90%). Mean grip strength was 44 kg (92%). Pain at rest improved from 3.4 to 0.5 (p < 0.05). Pain in activity improved from 7 to 1.7 (p < 0.05). Final function was 8.5 (preoperative, 5.2; p < 0.05). Mean QuickDASH score improved from 38 to 8 (p < 0.05). Functional Wrightington score was as follows: 13 excellent, 3 good, 1 regular, and 3 poor. There were three postoperative minor complications. Radiological results (preoperative/early postoperative/final follow-up) were as follows: SLS, 4.7/1.6/1.8 mm; and SLA, 60/50/62 degrees; RSA, 39/45/37 degrees. Four patients showed arthritic changes (two SLAC wrist). Conclusion The clinical and radiological results with more than 2-year follow-up suggest that this technique may be effective, reproducible, and safe for symptomatic static and reducible SLD. Level of Evidence Level IV, case series.
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Affiliation(s)
- Pablo De Carli
- Hospital Italiano de Buenos Aires, “Carlos E. Ottolenghi” Institute, Hand Surgery and Upper Extremity Center, Buenos Aires, Argentina
| | - Agustin G. Donndorff
- Hospital Italiano de Buenos Aires, “Carlos E. Ottolenghi” Institute, Hand Surgery and Upper Extremity Center, Buenos Aires, Argentina
| | - Miguel Tovar Torres
- Hospital Italiano de Buenos Aires, “Carlos E. Ottolenghi” Institute, Hand Surgery and Upper Extremity Center, Buenos Aires, Argentina
| | - Jorge G. Boretto
- Hospital Italiano de Buenos Aires, “Carlos E. Ottolenghi” Institute, Hand Surgery and Upper Extremity Center, Buenos Aires, Argentina
| | - Gerardo L. Gallucci
- Hospital Italiano de Buenos Aires, “Carlos E. Ottolenghi” Institute, Hand Surgery and Upper Extremity Center, Buenos Aires, Argentina
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Abstract
BACKGROUND With progressive lunate collapse, salvage procedures in advanced Kienbock disease attempt to provide pain relief and maintain motion. Scaphocapitate arthrodesis may provide a durable option with comparable outcomes to proximal row carpectomy in the well-selected patient. METHODS We performed a retrospective chart review of all consecutive patients with Lichtman stage IIIA or IIIB Kienbock's disease who underwent either scaphocapitate or scaphotrapeziotrapezoid-capitate arthrodesis from January 2004 to December 2013. RESULTS Twelve patients were included with a mean age of 41.6 years. Ten patients underwent scaphocapitate arthrodesis, while two patients underwent scaphotrapezio-trapezoid-capitate arthrodesis with an average clinical follow-up of 13.1 months. All patients achieved fusion. The average postoperative flexion-extension arc was 53° (range 20-110°). The average ulnar deviation was 9° (range 5-15°), and the average radial deviation was 13° (range 5-25°). Postoperative pain scores were significantly improved, having changed from an average of 6.6 preoperatively to 2.8 on a 10-point scale (W = 18, P < 0.05). CONCLUSIONS Despite a mean flexion-extension arc that is reduced from that of a normal individual, the postoperative range of motion following a midcarpal arthrodesis was not significantly different than that reported in a recent systematic review of proximal row carpectomy (73.5° compared with 53°, respectively) (P = 0.05). Additionally, given the significant postoperative reduction in associated pain symptoms at the time of follow-up, scaphocapitate arthrodesis should be considered as a treatment option for wrist salvage in the patient with advanced Kienbock's disease.
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Affiliation(s)
- Matthew L. Iorio
- Beth Israel Deaconess Medical Center, Division of Plastic and Reconstructive Surgery, Harvard Medical School, Boston, MA USA
| | - Colin D. Kennedy
- Department of Orthopaedics & Sports Medicine, University of Washington Medical Center, 4245 Roosevelt Way NE, Box 354740, Seattle, WA 98105 USA
| | - Jerry I. Huang
- Department of Orthopaedics & Sports Medicine, University of Washington Medical Center, 4245 Roosevelt Way NE, Box 354740, Seattle, WA 98105 USA
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Larson TB, Stern PJ. Reduction and association of the scaphoid and lunate procedure: short-term clinical and radiographic outcomes. J Hand Surg Am 2014; 39:2168-74. [PMID: 25218140 DOI: 10.1016/j.jhsa.2014.07.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 07/15/2014] [Accepted: 07/15/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the success of reduction and association of the scaphoid and lunate with a fibrous union in an effort to evaluate the technique's validity and reproducibility. METHODS A retrospective review was performed on 7 patients (8 wrists) with an average follow-up of 38 months. Static and grip radiographs were examined in the preoperative, immediate postoperative, and final follow-up settings to evaluate scapholunate (SL) diastasis, SL angle, hardware position, and complications. At final follow-up, grip strength and wrist range of motion were recorded, and patients completed the Disabilities of the Arm, Shoulder, and Hand and the Patient-Rated Wrist Evaluation outcome questionnaires. RESULTS Radiographic success, defined by maintenance of corrected SL diastasis, absence of dorsal intercalated segmental instability, and no progression of SL advanced collapse was achieved in 3 of the 8 wrists. One wrist developed radioscaphoid arthritis. No patients required a salvage procedure. Despite the loss of reduction that occurred in all patients, the patients' disability remained minimal as detected by the scores on the outcome measures. CONCLUSIONS The procedure was ineffective in providing stability about the SL interval. With a majority of patients experiencing early radiographic failure of the procedure in the short term, our experience suggests that the reduction and association of the scaphoid and lunate procedure should be abandoned despite the relatively low outcomes measures scores, which may be reflective of the short follow-up duration for this series. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Timothy B Larson
- Department of Orthopaedics, University of Cincinnati College of Medicine, Cincinnati, OH.
| | - Peter J Stern
- Department of Orthopaedics, University of Cincinnati College of Medicine, Cincinnati, OH
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Eng K, Wagels M, Tham SK. Cadaveric scapholunate reconstruction using the ligament augmentation and reconstruction system. J Wrist Surg 2014; 3:192-197. [PMID: 25097813 PMCID: PMC4117697 DOI: 10.1055/s-0034-1384743] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background Untreated scapholunate ligament disruption may lead to progressive wrist arthritis. Current techniques used to treat the disruption may not prevent arthritis because of attenuation of a reconstructive ligament substitute or failure to re-establish normal wrist kinematics. Questions/Purposes This study evaluates a combined synthetic-autologous technique for the treatment of scapholunate dissociation. Methods Scapholunate dissociation was created in six cadaveric wrists. The dorsal and volar components of the scapholunate ligament were reconstructed using the Ligament Augmentation & Reconstruction System (LARS; LARS, Arc-sur-Tille, France) and a modified Blatt capsulodesis performed. Reconstructed wrists were subjected to cyclic passive motion. Outcomes were measured radiologically and compared using Student's t-test. Results Carpal alignment was re-established following scapholunate ligament reconstruction. Carpal alignment was maintained after cyclic loading. Conclusions The technique described corrected the carpal malalignment associated with scapholunate dissociation. Corrected positions were maintained after one thousand cycles of flexion and extension without fraying or loosening of the LARS. Clinical Relevance Current popular techniques for scapholunate reconstruction do not address the important dorsal and palmar components of the ligament that control their intercarpal motion. Reconstruction of the dorsal and palmar components of the scapholunate ligament can be achieved through a dorsal approach to the wrist.
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Affiliation(s)
- Kevin Eng
- Department of Orthopaedics, Barwon Orthopaedic Research Unit, The Geelong Hospital, Geelong, Victoria, Australia
| | - Michael Wagels
- Victorian Hand Surgery Associates, Fitzroy, Victoria, Australia
- St. Vincent's Hand Surgery Unit and Hand and Wrist Biomechanics Laboratory, O'Brien Institute, St. Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Stephen K. Tham
- Victorian Hand Surgery Associates, Fitzroy, Victoria, Australia
- St. Vincent's Hand Surgery Unit and Hand and Wrist Biomechanics Laboratory, O'Brien Institute, St. Vincent's Hospital, Fitzroy, Victoria, Australia
- Department of Orthopaedic Surgery, Dandenong Hospital, Dandenong, Australia
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Load transmission characteristics of limited carpal fusions: a two-dimensional finite element study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 25:305-8. [PMID: 24974194 DOI: 10.1007/s00590-014-1495-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 06/08/2014] [Indexed: 10/25/2022]
Abstract
Although limited carpal fusion is a choice of treatment in several wrist disorders, little is known about the biomechanics of these procedures, especially the loads carried by the ligaments. In a finite element study, four types of limited carpal fusions (scaphotrapeziotrapezoid, capitohamate, four corner fusion with and without scaphoid excision) were simulated and the loads carried by the ligaments were recorded. Measurements were repeated with and without implantation. The load transmission through the ligaments varied by the type of the fusion but, radioscaphoid and long radiolunate ligaments carried significantly more loads if not excised during the operation. Implantation did not affect the results in most cases. The model of the present study may be useful in preoperative planning.
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14
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Biomechanical comparison of the hand-based transplant used in bone-tissue-bone scapho-lunate ligament reconstruction. ACTA ACUST UNITED AC 2014; 33:23-8. [PMID: 24412134 DOI: 10.1016/j.main.2013.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 10/14/2013] [Accepted: 11/01/2013] [Indexed: 11/21/2022]
Abstract
Although work has been published comparing the five most commonly used transplant techniques to the properties of the scapho-lunate interosseous ligament (SLIL), no study has been carried out which compares the biomechanical properties of the different bone-tissue-bone autografts to each other, using a standard methodology of testing. The hypothesis of this study was that mechanically significant differences in the material properties of commonly used bone-tissue-bone exist when compared to each other. We tested the dorsal part of the SLIL and the five most quoted transplants in the literature: capitate to trapezoid; trapezoid to second metacarpal; third metacarpal-carpal; dorsal capitate-hamate; 4-5 extensor retinaculum. For each transplant, we measured failure load, failure displacement, width, and thickness. Anova was used to compare the different results obtained and the level of significance attributed to P<0.05. Load to failure were: SLIL 94.3±42.86N; capitate to trapezoid 37.7±23.13N; trapezoid to second metacarpal 45.43±14.28N; third metacarpal-carpal 60.11±19.94N; dorsal capitate-hamate 63±25.51N; 4-5 retinaculum 15.67±10.7N. Only the dorsal capitate-hamate ligament showed to have no significant (P>0.05) difference in term of load to failure, all the others was significantly weaker (P<0.05). Previous biomechanical studies have identified the dorsal region of the SLIL as the most structurally and functionally important area of the SLIL. As a result, attention has been more specifically brought to the replacement of the dorsal portion of the SLIL. An attempt to achieve a reconstruction that reproduces more closely the SLIL has generated research on the use of bone-tissue-bone composite graft, several donor sites have been used in order to find the most similar. Our results suggest that, using a normalized method to compare the previously described grafts harvested at the wrist level, that the dorsal capitate-hamate ligament has the closest properties to the native dorsal scapho-lunate ligament.
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15
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Luegmair M, Saffar P. Scaphocapitate arthrodesis for treatment of scapholunate instability in manual workers. J Hand Surg Am 2013; 38:878-86. [PMID: 23490313 DOI: 10.1016/j.jhsa.2013.01.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 01/02/2013] [Accepted: 01/04/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the long-term efficacy of scaphocapitate arthrodesis for treatment of chronic scapholunate instability in high-demand patients. METHODS We retrospectively analyzed the clinical and radiographic results of 20 manual workers who underwent scaphocapitate arthrodesis for chronic scapholunate instability at a mean follow-up of 10 years (range, 1-23 y). We measured range of motion and grip strength; pain on a scale of 0 to 5; Quick Disabilities of the Arm, Shoulder, and Hand score; and ability to return to work. We assessed radiographs for union, carpal height and alignment, signs of ulnar translation or radiocarpal arthritis, and hardware problems. RESULTS At most recent follow-up, the arc of motion averaged 87° for flexion-extension and 41° for the radioulnar deviation. The postoperative average maximum grip strength was 21 kg, which was 60% of the opposite, normal wrist. Pain was significantly reduced. The average postoperative Quick Disabilities of the Arm, Shoulder, and Hand score was 19, and the return-to-work rate was 90%. Radiographic analysis showed union in all patients, improvement of carpal height and scaphoid angle, no evidence of ulnar translation, and a 30% rate of radiocarpal osteoarthritis. CONCLUSIONS This report of long-term results demonstrates the efficacy of scaphocapitate limited carpal arthrodesis for the treatment of chronic rotatory subluxation of the scaphoid. We conclude that continued use of this procedure is warranted. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Abstract
Limited wrist fusions are effective surgical procedures for providing pain relief while preserving motion of the wrist in patients with localized arthritis of the carpus. In deciding which motion-preserving procedure to perform, the etiology of the arthritis, which joints are involved, and which are spared should be determined. The main principle is to fuse the involved joints and to allow motion through the uninvolved joints. In this article, we discuss the various traumatic and nontraumatic conditions causing arthritis of the wrist and the treatment options for those conditions. Common indications for limited wrist fusions include scapholunate advanced collapse and scaphoid nonunion advanced collapse. Options for treating these conditions include three- and four-corner fusions as well as a proximal row carpectomy. This paper discusses which procedures are the most appropriate as well as the outcomes of these procedures. If the basic principles of limited wrist fusions are adhered to, a good outcome can be obtained. The authors' surgical technique and decision-making processes are discussed.
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Affiliation(s)
- Gregory Ian Bain
- Department of Orthopedics and Trauma, University of Adelaide, Adelaide, South Australia, Australia
- Discipline of Anatomy and Pathology, University of Adelaide, Adelaide, South Australia, Australia
- Department of Orthopedics and Trauma, Modbury Public Hospital, Adelaide, South Australia, Australia
- Department of Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Duncan Thomas McGuire
- Department of Orthopedics and Trauma, Modbury Public Hospital, Adelaide, South Australia, Australia
- Department of Orthopedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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