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Carlson Strother C, Pulos N. Vascular Supply of the Wrist. Hand Clin 2022; 38:377-384. [PMID: 36244705 DOI: 10.1016/j.hcl.2022.03.001] [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: 02/02/2023]
Abstract
The vascular anatomy of the wrist is vital in the development of multiple disorders at the carpus. Understanding this vascular network may prevent iatrogenic injury to the blood supply and can be used by surgeons through vascularized bone grafts. Multiple surgical techniques take advantage of the vascular network. This article reviews the blood supply of the distal radius, ulna, and carpal bones and its clinical implications.
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Affiliation(s)
| | - Nicholas Pulos
- Department of Orthopaedic Surgery, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
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2
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Abstract
Avascular necrosis is a complicated, multifactorial disease with potentially devastating consequences. Although the underlying root cause is a lack of appropriate vascular perfusion to affected bone, there are often varying patient-specific, anatomic-specific, and injury-specific predispositions. These factors generally fall into 3 categories: direct vascular disruption, intravascular obliteration, or extravascular compression. The initial stages of disease can be insidiously symptomatic because edematous bone marrow progresses to subchondral collapse and subsequent degenerative arthritis. Although much of the current literature focuses on the femoral head, other common areas of occurrence include the proximal humerus, knee, and the carpus. The low-incidence rate of carpal avascular necrosis poses a challenge in establishing adequately powered, control-based validated treatment options, and therefore, optimal surgical management remains a continued debate among hand surgeons. Appreciation for expectant fracture healing physiology may help guide future investigation into carpal-specific causes of avascular necrosis.
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3
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Florczynski MM, Chung KC. Vascularized Bone Flaps for the Treatment of Kienböck Disease. Hand Clin 2022; 38:435-446. [PMID: 36244711 DOI: 10.1016/j.hcl.2022.03.007] [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: 02/02/2023]
Abstract
Of the many treatments for Kienböck disease, only lunate revascularization procedures provide a direct mechanism for reversing the process of osteonecrosis. Owing to the redundant blood supply of the distal radius and carpus, pedicled flaps are versatile solutions for patients with bone loss but intact cartilage. With the advent of free vascularized flaps, the indications for lunate revascularization procedures are expanding. These flaps can be used when the articular cartilage has been compromised and are suitable options to restore native anatomy in patients previously thought to have unreconstructible disease.
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Affiliation(s)
- Matthew M Florczynski
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA; Comprehensive Hand Center Michigan Medicine, 2130 Taubman Center, SPC 5340, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5340, USA.
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de Villeneuve Bargemon JB, Jaloux C, Levet P, Levadoux M. Arthroscopic Treatment of Capitate Nonunion: A New Technique. J Wrist Surg 2022; 11:353-357. [PMID: 35971469 PMCID: PMC9375685 DOI: 10.1055/s-0041-1732410] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/08/2021] [Indexed: 10/20/2022]
Abstract
Isolated fractures of the capitate are very rare which means that their nonunion is even rarer. Repair techniques have always been performed by open surgery which may result in loss of mobility due to the capsulotomy. The typically used surgical techniques such as arthrodesis of the carpal or wrist bones can have irreversible consequences on range of motion. No arthroscopic technique has ever been described for this condition. Here, we describe a case of isolated capitate nonunion without ligament tears or other carpal fractures in a 21-year-old male, following a capitate fracture 10 years prior. We describe our arthroscopic treatment technique for this capitate nonunion.
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Affiliation(s)
| | - Charlotte Jaloux
- Department of Hand Surgery and Limb Reconstructive Surgery, La Timone Adultes Hospital, Aix Marseille University, Marseille, France
| | - Paul Levet
- Department of Hand Surgery and Limb Reconstructive Surgery, La Timone Adultes Hospital, Aix Marseille University, Marseille, France
| | - Michel Levadoux
- Hand, Wrist and Elbow Surgery, Saint Roch Private Hospital, Toulon, France
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5
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Henry M, Lundy FH, Henry GK. Matching Kienböck's Treatment Options to Specific Features of Each Case. J Hand Microsurg 2021; 15:87-97. [PMID: 37020608 PMCID: PMC10070007 DOI: 10.1055/s-0041-1730888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Kienböck's disease is best understood as a continuous interaction between compromised perfusion and structural deterioration that transitions from an early phase to a late phase. Existing literature has failed to identify any one superior treatment for Kienböck's; many studies even demonstrate no advantage for surgery compared with the natural history. Surgical interventions for early and transitional Kienböck's are designed to preserve or reconstruct the lunate. However, in most studies, the only tool used to assess the lunate itself has been plain radiography that neither reveals critical architectural details (demonstrated by computed tomographic scan) nor the vascular status (demonstrated by magnetic resonance imaging). Most articles, therefore, do not adequately define the preoperative status of the lunate or its alteration through surgical intervention. Critical preoperative features that are best demonstrated by these advanced imaging studies have specific anatomic and physiologic relationships that better correspond with certain surgical interventions, which also pair better with specific patient characteristics. This review explains how to identify, analyze, and strategically match these variables with the treatment interventions available for Kienböck's patients through the early, transitional, and late phases of the disease.
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Affiliation(s)
- Mark Henry
- Hand and Wrist Center of Houston, Houston, Texas, United States
- Address for correspondence Mark Henry, MD Hand and Wrist Center of Houston1200 Binz Street, Suite 1390, Houston TX - 77004United Sates
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Distal Radial Access: Consensus Report of the First Korea-Europe Transradial Intervention Meeting. JACC Cardiovasc Interv 2021; 14:892-906. [PMID: 33888235 DOI: 10.1016/j.jcin.2021.02.033] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/28/2021] [Accepted: 02/09/2021] [Indexed: 01/14/2023]
Abstract
Among patients undergoing percutaneous coronary procedures, transradial access, compared with transfemoral access, is associated with a reduced risk for complications including mortality, especially in higher risk patients. However, transradial access is limited by radial artery occlusion (RAO) that despite being mostly asymptomatic because of the extensive anastomoses between the forearm arteries restricts future use of the same radial artery. Distal radial access (DRA) in the anatomic snuffbox or on the dorsum of the hand has recently gained global popularity as an alternative access route for vascular procedures. A strong anatomic and physiological rationale yields potential for significantly reduced risk for RAO and positive impact on procedural outcome for better patient care. Indeed, currently published studies buttress very low rates of RAO after DRA, hence supporting its development. The authors provide an analysis of the foundation of DRA, provide historical background, and offer a critical review of its current status and future directions. Also, given the limited evidence currently available to properly perform DRA in the real world, consensus opinion on what is considered optimal practice is also presented to supplement this document and enhance the implementation of DRA while minimizing its complications.
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Abstract
Kienböck disease, osteonecrosis of the lunate, is a well-known but poorly understood complication seen by hand surgeons. This review presents the background and important patient-specific parameters of the disease and reviews the numerous treatment options that exist for the disease.
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Affiliation(s)
- Dana Rioux-Forker
- From the Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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Hong SW, Roh YH, Gong HS, Baek GH. Idiopathic Avascular Necrosis of Trapezoid in Adolescence: 3-Year Follow-Up. J Hand Surg Am 2020; 45:e11-e16. [PMID: 30733102 DOI: 10.1016/j.jhsa.2018.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/16/2018] [Accepted: 12/12/2018] [Indexed: 02/02/2023]
Abstract
Avascular necrosis (AVN) is relatively uncommon in the carpal bones, although it most frequently involves the lunate and scaphoid. The trapezoid has abundant vascular channels from a rich network of dorsal and palmar vessels, and only a few cases of AVN have been reported in adults who sustained a traumatic insult. We present a rare case of idiopathic AVN of the trapezoid in an adolescent presenting with refractory pain at the second metacarpal base. Over a period of 36 months, follow-up symptom evaluations and serial magnetic resonance images showed prominent gradual improvement, consistent with spontaneous resolution.
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Affiliation(s)
- Seok Woo Hong
- Department of Orthopaedic Surgery, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, South Korea
| | - Young Hak Roh
- Department of Orthopaedic Surgery, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, South Korea.
| | - Hyun Sik Gong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Sungnam, South Korea
| | - Goo Hyun Baek
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
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Prabhakar P, Wessel L, Nguyen J, Stepan J, Carlson M, Fufa D. Factors Associated with Scaphoid Nonunion following Early Open Reduction and Internal Fixation. J Wrist Surg 2020; 9:141-149. [PMID: 32257616 PMCID: PMC7112999 DOI: 10.1055/s-0039-3402769] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
Abstract
Background Nonunion after open reduction and internal fixation (ORIF) of scaphoid fractures is reported in 5 to 30% of cases; however, predictors of nonunion are not clearly defined. Objective The purpose of this study is to determine fracture characteristics and surgical factors which may influence progression to nonunion after scaphoid fracture ORIF. Patients and Methods We performed a retrospective case-control study of scaphoid fractures treated by early ORIF between 2003 and 2017. Inclusion criteria were surgical fixation within 6 months from date of injury and postoperative CT with minimum clinical follow-up of 6 months to evaluate healing. Forty-eight patients were included in this study. Nonunion cases were matched by age, sex, and fracture location to patients who progressed to fracture union in the 1:2 ratio. Results This series of 48 patients matched 16 nonunion cases with 32 cases that progressed to union. Fracture location was proximal pole in 15% (7/48) and waist in 85% (41/48). Multivariate regression demonstrated that shorter length of time from injury to initial ORIF and smaller percent of proximal fracture fragment volume were significantly associated with scaphoid nonunion after ORIF (63 vs. 27 days and 34 vs. 40%, respectively). Receiver operating curve analysis revealed that fracture volume below 38% and time from injury to surgery greater than 31 days were associated with nonunion. Conclusion Increased likelihood for nonunion was found when the fracture was treated greater than 31 days from injury and when fracture volume was less than 38% of the entire scaphoid. Level of Evidence This is a Level III, therapeutic study.
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Affiliation(s)
- Pooja Prabhakar
- Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Lauren Wessel
- Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York
| | - Joseph Nguyen
- Department of Biostatistics, Hospital for Special Surgery, New York, New York
| | - Jeffrey Stepan
- Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York
| | - Michelle Carlson
- Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York
| | - Duretti Fufa
- Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York
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Abstract
The vascular supply of the hand and wrist is derived from the radial and ulnar arteries. This forms a complex network of vessels on the palmar and dorsal surfaces of the hand. Anastomoses and branching patterns of vessels at the level of the carpals, metacarpals, and phalanges form the basis of old and new flap designs. This article provides an overview on the vascular anatomy of the hand and forearm with emphasis on the blood supply to various flaps.
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Affiliation(s)
- Ruth En Si Tan
- Department of Hand and Reconstructive Microsurgery, National University Health System, Level 11, Tower Block 1E Kent Ridge Road, Singapore 119228, Singapore
| | - Amitabha Lahiri
- Department of Hand and Reconstructive Microsurgery, National University Health System, Level 11, Tower Block 1E Kent Ridge Road, Singapore 119228, Singapore.
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11
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Scaphoid fractures: has magnetic resonance imaging become a cost-effective alternative to definitive diagnosis? Ir J Med Sci 2020; 189:949-952. [PMID: 31912455 DOI: 10.1007/s11845-020-02169-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/04/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND A clinical examination finding of anatomical snuffbox tenderness (AST) with plain film radiographs alone yields low sensitivity and specificity in diagnosing scaphoid fractures. International guidelines suggest immediate referral for magnetic resonance imaging (MRI) following one non-diagnostic radiograph in such patients. Perceived cost, high demand and limited capacity of MRI scanners have resulted in few suspected fractures following this pathway in our institution. AIMS Our study aimed to audit cost-effectiveness of immediate MRI referral following one non-diagnostic radiograph in the patient with AST versus current local practice. METHODS Retrospective analysis of all patients with suspected scaphoid fractures referred from the ED to the orthopaedic service over a six-month period was performed. Mean pricing per radiograph, casting, MRI and fracture clinic presentation was obtained from our hospital's Finance department. RESULTS Ninety-seven patients were identified; 26 had scaphoid fractures (26.8%). Seventy-one patients with no fractures cost a mean €82,111.50 (IQR: €55,025, €98,335) having a mean of 3.1 clinic visits, 4.6 radiographs and 4.7 weeks casted, versus €40,115 for early MRI referral as per guidelines (p > 0.05). CONCLUSIONS In conclusion, when compared with current local practice, immediate referral of the patient with AST for MRI following one non-diagnostic ED radiograph is potentially cost-effective in establishing efficient diagnosis of scaphoid fractures. We recommend the implementation of published international guidelines in the investigation of query scaphoid fractures as a pragmatic and cost-effective practice.
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12
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The Use of the Proximal Hamate as an Autograft for Proximal Pole Scaphoid Fractures: Clinical Outcomes and Biomechanical Implications. Hand Clin 2019; 35:287-294. [PMID: 31178087 DOI: 10.1016/j.hcl.2019.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Scaphoid proximal pole fractures remain a surgical challenge because of high propensity for nonunion, osteonecrosis, and ultimately carpal collapse. Options for management of nonsalvageable proximal pole fractures include non-vascularized bone grafts, vascularized pedicled bone grafts, free vascularized bone flaps, and rib cartilage grafts. The proximal pole of the hamate can also serve as a replacement arthroplasty in the setting of proximal pole scaphoid nonunions with collapse, bone loss, and/or osteonecrosis. This novel graft addresses shortcomings of other graft choices by providing a local structural autograft solution with minimal donor site morbidity, correcting carpal collapse, reconstructing the scapholunate ligament, and mitigating the need for microvascular anastomosis.
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13
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Abstract
The scaphoid is the most commonly fractured carpal bone; despite its frequent injury, the diagnosis of fracture can be complicated by the presence of normal radiographs at the time of presentation. Clinical intuition can be increased by physical examination and immediately available modalities such as ultrasound within the emergency department. Definitive diagnosis should be made with computed tomography and magnetic resonance to verify the presence of displacement. This article provides an overview of the incidence and presentation of acute scaphoid fractures with a surgical focus on percutaneous dorsal screw fixation.
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Affiliation(s)
- M Diya Sabbagh
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55902, USA; Division of Plastic Surgery, Mayo 12, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Mohamed Morsy
- Division of Plastic Surgery, Mayo 12, 200 First Street Southwest, Rochester, MN 55905, USA; Department of Orthopedic Surgery, Assiut University Hospital, Assiut University, Assiut, Egypt
| | - Steven L Moran
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55902, USA.
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Patel S, Tiedeken N, Qvick L, Debski RE, Kaufmann R, Fowler JR. Interfragmentary Compression Forces Vary Based on Scaphoid Bone Screw Type and Fracture Location. Hand (N Y) 2019; 14:371-376. [PMID: 29241360 PMCID: PMC6535947 DOI: 10.1177/1558944717745663] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The objective of this study was to determine the interfragmentary compression forces generated in a foam model as a function of headless compression screw type (fully threaded and central threadless) and fracture location. METHODS Eighty-eight polyurethane foam models were fixed across a simulated transverse fracture with either a fully threaded screw or a central threadless screw. The location of the transverse fracture varied along the length of the foam model in 2 mm increments for 11 fracture locations. The force generated at the fracture site upon fixation was utilized to determine the interfragmentary compression. Interfragmentary compression was compared using a paired t test and 2-way analysis of variance, with significance set at P < .05. RESULTS Interfragmentary compression was found to vary based on fracture location and screw type. The fully threaded screw generated significantly greater compression for fracture locations at 12 mm and 18 mm from the top edge of the foam model, while the central threadless screw generated significantly greater compression for fractures located 2 mm from the top edge of the foam model. CONCLUSIONS The central threadless screw and the fully threaded screw had different fracture locations where maximum compression force occurred. The fully threaded screw generated greater compression force toward the screw center due to greater thread purchase. However, the central threadless screw generated greater compression at the most proximal fracture location due to its greater thread pitch toward the screw head. Maximizing interfragmentary compression may aid in reducing nonunion rates associated with the internal fixation of proximal scaphoid fractures.
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Affiliation(s)
- Samik Patel
- Department of Orthopaedics, University
of Pittsburgh School of Medicine, PA, USA
| | - Nathan Tiedeken
- Department of Orthopaedics, University
of Pittsburgh School of Medicine, PA, USA
| | - Lars Qvick
- Department of Orthopaedics, University
of Pittsburgh School of Medicine, PA, USA
| | - Richard E. Debski
- Department of Orthopaedics, University
of Pittsburgh School of Medicine, PA, USA
| | - Robert Kaufmann
- Department of Orthopaedics, University
of Pittsburgh School of Medicine, PA, USA
| | - John R. Fowler
- Department of Orthopaedics, University
of Pittsburgh School of Medicine, PA, USA,John R. Fowler, Suite 1010 Kaufmann
Building, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA.
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Johnson DB, Triplet JJ, Bernhardt L, Buchan DR, Iorio T. Isolated Treatment of a Comminuted Capitate Fracture: A Case Report. JBJS Case Connect 2019; 9:e6. [PMID: 30676344 DOI: 10.2106/jbjs.cc.18.00166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Comminuted fractures of the capitate, in the absence of associated carpal injuries, are exceedingly rare. Treatment of this complex injury is not well-documented in the literature. We describe the case of a comminuted capitate fracture that was successfully managed with Kirschner wire fixation. CONCLUSION Based on this case and a review of the literature, management of a comminuted capitate fracture with Kirschner wire fixation can lead to successful treatment and positive patient outcomes.
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Affiliation(s)
- David B Johnson
- OhioHealth Doctors Hospital, Orthopedic Residency Program, Columbus, Ohio
| | - Jacob J Triplet
- OhioHealth Doctors Hospital, Orthopedic Residency Program, Columbus, Ohio
| | - Logan Bernhardt
- Lake Erie College of Osteopathic Medicine, Bradenton, Florida
| | - Daniel R Buchan
- OhioHealth Doctors Hospital, Orthopedic Residency Program, Columbus, Ohio
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Ichinose H, Nakamura R, Nakao E, Shinohara T, Tatebe M, Yamada H. Wrist Swelling in Kienböck's Disease. J Wrist Surg 2018; 7:389-393. [PMID: 30349751 PMCID: PMC6196096 DOI: 10.1055/s-0038-1661420] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 05/21/2018] [Indexed: 10/28/2022]
Abstract
Background and Purpose Wrist swelling is a frequent clinical manifestation of Kienböck's disease, but no study has reported the site and pathology of wrist swelling in this disease. The aim of this study is to elucidate the site and pathology of wrist swelling in Kienböck's disease. Materials and Methods Dorsal and palmar soft tissue thicknesses of the wrist were measured on standard lateral radiographs of the wrist in 26 patients with Kienböck's disease and 30 subjects without intra-articular lesion. Axial magnetic resonance imaging (MRI) views were examined to detect the site of swelling. The dorsal capsular ligament in three patients with Kienböck's disease underwent histological examination. Results Radiographic study confirmed dorsal wrist swelling in 24 of 26 (92%) patients examined compared with the contralateral unaffected wrists. MRI demonstrated thickening of the dorsal capsular ligament and extensor layer with synovial proliferation. Histological examination revealed nonspecific chronic inflammation. Conclusion Dorsal wrist swelling in Kienböck's disease is a common manifestation and constitutes a part of pathology of Kienböck's disease, although further study is required to clarify the relation between wrist swelling and etiology of Kienböck's disease. Level of Evidence This is a Level III study.
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Affiliation(s)
- Hirofusa Ichinose
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | | | | | | | - Masahiro Tatebe
- Department of Hand Surgery, School of Medicine, Nagoya University, Nagoya, Japan
| | - Harumoto Yamada
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
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APSI scaphoid hemiarthroplasty – long-term results. REVISTA BRASILEIRA DE ORTOPEDIA (ENGLISH EDITION) 2018; 53:582-588. [PMID: 30245998 PMCID: PMC6148075 DOI: 10.1016/j.rboe.2018.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 06/08/2017] [Indexed: 11/29/2022]
Abstract
Objective This study is aimed at evaluating the long-term results of proximal scaphoid hemiarthroplasty for post-traumatic avascular necrosis at this institution. Methods Twelve patients who underwent this procedure were identified, and the mean follow-up time was 6.5 years (range: 5–8 years). All patients were male, with a mean age of 39 years (range: 28–55 years). In eight patients, the non-dominant limb was affected. The procedure was carried out through a dorsal approach and all patients underwent the same rehabilitation protocol. Cases were evaluated regarding complications, pain, range of motion, functional status (Mayo Wrist Score), and disability (QuickDASH Score). Results No immediate post-operative complications, such as infection or dislocation of the implant, were observed. All patients presented with peri-implant osteolysis at follow-up, on a radiograph study. None of the patients was forced to abandon their previous professional activity, although about 50% required some type of adaptation at their workplace. The mean functional capacity was, according to the Mayo Wrist Score, of 67.5 points (range: 50–80), corresponding to a satisfactory degree of function. The QuickDASH disability score presented a mean of 25 (range: 3–47.7). Conclusion The results of this series are in line with previously published studies about this technique. Hemiarthroplasty with a pyrocarbon implant is a safe technique for the treatment of post-fracture avascular necrosis of the scaphoid proximal pole. This technique allowed for satisfactory functional results at a mean follow-up of 6.5 years.
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19
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Avascular necrosis of lunate bone: Kienbock disease. JOURNAL OF SURGERY AND MEDICINE 2018. [DOI: 10.28982/josam.423536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
LEARNING OBJECTIVES After reading this article, the participant should be able to: 1. Understand the epidemiology, classification, and anatomy pertinent to the scaphoid. 2. Appropriately evaluate a patient with suspected scaphoid fracture, including appropriate imaging. 3. Understand the indications for operative treatment of scaphoid fractures, and be familiar with the various surgical approaches. 4. Describe the treatment options for scaphoid nonunion and avascular necrosis of the proximal pole. SUMMARY The goal of this continuing medical education module is to present the preoperative assessment and the formation and execution of a surgical treatment plan for acute fractures of the scaphoid. In addition, secondary surgical options for treatment of scaphoid nonunion and avascular necrosis are discussed.
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Krishna S, Small K, Maetani T, Chepelev L, Schwarz BA, Sheikh A. Musculoskeletal 3D Printing. 3D Print Med 2017. [DOI: 10.1007/978-3-319-61924-8_8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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22
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Spontaneous flexor tendon rupture secondary to capitate non-union. A case report and review of literature. HAND SURGERY & REHABILITATION 2016; 35:292-295. [PMID: 27781995 DOI: 10.1016/j.hansur.2016.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/10/2016] [Accepted: 05/22/2016] [Indexed: 11/22/2022]
Abstract
Rupture of the flexor digitorum profundus and superficialis tendons of the index finger secondary to non-union of the capitate has not yet been reported to our knowledge. We describe the case of a 48-year-old man with rupture of both flexor tendons of the index finger that occurred 15 years after a capitate fracture. The patient was completely asymptomatic before the rupture. Tendon reconstruction was performed using the palmaris longus. One year after surgery, the patient had acceptable range of motion and was pain-free.
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Tait MA, Bracey JW, Gaston RG. Acute Scaphoid Fractures: A Critical Analysis Review. JBJS Rev 2016; 4:01874474-201609000-00003. [PMID: 27760075 DOI: 10.2106/jbjs.rvw.15.00073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Nondisplaced scaphoid fractures can be effectively treated nonoperatively, with union rates approaching or, in some series, exceeding the rates attained with operative intervention. The evidence supports equal outcomes when using a short arm or long arm cast for the closed treatment of nondisplaced scaphoid fractures. Also, equivalent outcomes have been demonstrated with or without a thumb spica component to the cast. Operative intervention is the recommended treatment for displaced scaphoid fractures. Advanced imaging should be obtained if clinical suspicion is present for a scaphoid fracture with negative radiographs more than 2 weeks after the injury. In some settings, it may even be more cost-effective to obtain advanced imaging sooner.
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Affiliation(s)
- Mark A Tait
- OrthoCarolina Hand Center, Charlotte, North Carolina
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Garcia LA, Vaca JB. Avascular Necrosis of the Pisiform. ACTA ACUST UNITED AC 2016; 31:453-4. [PMID: 16618524 DOI: 10.1016/j.jhsb.2006.02.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2005] [Revised: 02/15/2006] [Accepted: 02/23/2006] [Indexed: 11/22/2022]
Abstract
Avascular necrosis of the pisiform bone is a very rare condition. This paper reports a case and discusses this pathology and its diagnosis.
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Affiliation(s)
- L A Garcia
- Hand and Upper Extremity Unit, Department of Orthopaedic Surgery, San Ignacio University Hospital and Roosevelt Institute for Paediatric Orthopaedics, Javeriana University, Bogota, Colombia.
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25
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Salt Ö, Sayhan MB. Avascular necrosis of lunate bone: Kienbock disease. Am J Emerg Med 2015; 34:1185.e5-6. [PMID: 26682674 DOI: 10.1016/j.ajem.2015.11.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 11/07/2015] [Indexed: 10/22/2022] Open
Affiliation(s)
- Ömer Salt
- Department of Emergency Medicine, Trakya University Medicine Faculty, Edirne, Turkey.
| | - Mustafa Burak Sayhan
- Department of Emergency Medicine, Trakya University Medicine Faculty, Edirne, Turkey.
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26
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van Kampen RJ, Bayne CO, Moran SL. A New Technique for Volar Capsulodesis for Isolated Palmar Scapholunate Interosseous Ligament Injuries: A Cadaveric Study and Case Report. J Wrist Surg 2015; 4:239-45. [PMID: 26539326 PMCID: PMC4626223 DOI: 10.1055/s-0035-1556854] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction Most surgical techniques for scapholunate interosseous ligament (SLIL) repair address only the dorsal component of the ligament, potentially leading to high surgical failure rates. We introduce a new technique to reconstruct the volar SLIL using a portion of the long radiolunate ligament (LRL). A biomechanical evaluation was performed to evaluate the rupture strength of this repair, and a subsequent anatomic study was performed to verify that this repair would not compromise the blood supply to either the scaphoid or the lunate. Methods A reconstruction of the volar SLIL was developed utilizing a lunate-based strip of the LRL. Fourteen cadaver arms were injected with red-colored epoxide and latex. The blood supply of the volar wrist capsule was dissected. The vascular supply to the ligaments, scaphoid, and lunate were investigated. The biomechanical strength of this reconstruction was tested on five cadaver arms by potting the scaphoid, lunate, and radius and subjecting the repair to a tensile load using a servohydraulic vertical displacement testing machine. Results In all arms, a branch of the radial artery or radiocarpal arch supplied the radioscapholunate ligament at the medial border of the LRL. The proximal half of the scaphoid was supplied by dorsal branches of the radial artery. In all cases, a vessel entered the lunate on its ulnar volar side, away from the repair. The average strength of the intact LRL strip was 97.4 N, and the average strength of the ligament-suture interface used for the capsulodesis was 43.5 N. Conclusion This volar approach to the SLIL does not compromise the vascularity of the scaphoid or the lunate. This approach allows the possibility of repairing or augmenting the volar SLIL. The strength of this repair appears to be less than the strength of the native SLIL. Further clinical studies are warranted.
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Affiliation(s)
| | | | - Steven L. Moran
- Department of Orthopedics, Mayo Clinic, Rochester, Minnesota
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Ben-Amotz O, Ho C, Sammer DM. Reconstruction of scaphoid non-union and total scaphoid avascular necrosis in a pediatric patient: a case report. Hand (N Y) 2015; 10:477-81. [PMID: 26330781 PMCID: PMC4551645 DOI: 10.1007/s11552-014-9711-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The medial femoral condyle vascularized bone graft has grown in popularity for treating recalcitrant fracture non-unions and has become particularly useful in treating scaphoid non-union with avascular necrosis of the proximal pole. The medial femoral condyle is an excellent source of dense, well-vascularized bone and results in minimal donor site morbidity. METHODS We describe an unusual case of chronic scaphoid non-union and total scaphoid avascular necrosis in a skeletally immature patient. Scaphoid reconstruction was performed with a vascularized medial femoral condyle graft, with successful graft incorporation, and restoration of pain-free wrist motion. CONCLUSIONS Technical considerations for harvest of the medial femoral condyle bone graft in the skeletally immature patient are discussed.
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Affiliation(s)
- Oded Ben-Amotz
- Department of Plastic Surgery, University of Texas Southwestern Medical Center at Dallas, 1801 Inwood Rd., Dallas, TX 75390 USA
| | - Christine Ho
- Department of Orthopedic Surgery, Texas Scottish Rite Hospital for Children-Children’s Medical Center of Dallas, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Douglas M. Sammer
- Department of Plastic Surgery, University of Texas Southwestern Medical Center at Dallas, 1801 Inwood Rd., Dallas, TX 75390 USA
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Abstract
This article reviews the most common complications associated with the management of carpal fractures. Discussion focuses on the recognition of commonly "missed" fractures and fracture patterns and the negative sequelae that can result from these delayed diagnoses. The pitfalls of conservative treatment of specific carpal fractures are reviewed, and the most common complications resulting from the operative management of carpal injuries are described.
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Affiliation(s)
- R Glenn Gaston
- OrthoCarolina, 1915 Randolph Road, Charlotte, NC 28207, USA.
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29
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Tokyay A, Gunal I. Avascular necrosis of the distal pole of the scaphoid. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2015; 2:40-2. [PMID: 27252968 PMCID: PMC4623543 DOI: 10.3109/23320885.2015.1006633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 12/30/2014] [Accepted: 01/07/2015] [Indexed: 11/13/2022]
Abstract
Avascular necrosis (AVN) of the scaphoid predominantly occurs in the proximal pole. Review of the literature revealed only six cases and all are suspect due to the lack of either MRI investigation or investigation of bleeding preoperatively. We report four new cases and one of them appears to be a real distal pole AVN of the scaphoid in the literature.
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Affiliation(s)
- Abbas Tokyay
- Department of Orthopaedics, Dokuz Eylul University Hospital , Izmir, Turkey
| | - Izge Gunal
- Department of Orthopaedics, Dokuz Eylul University Hospital , Izmir, Turkey
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30
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Muramatsu K, Hashimoto T, Tominaga Y, Taguchi T, Kido K. Operative Treatment for Scaphoid Osteonecrosis (Preiser Disease). Ann Plast Surg 2014; 73:516-9. [DOI: 10.1097/sap.0b013e31827fafa1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Peters SJ, Verstappen C, Degreef I, Smet LD. Avascular necrosis of the hamate: three cases and review of the literature. J Wrist Surg 2014; 3:269-274. [PMID: 25364641 PMCID: PMC4208962 DOI: 10.1055/s-0034-1394135] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background Avascular necrosis of the hamate (hamate-AVN) is a seldom reported disease of which little is known on etiology, best treatment modalities, and outcome. Hamate-AVN can occur in multiple locations within the hamate. Case Description Case one was an 8-year-old girl with painful AVN of the hamate hook. Surgical excision of the hook was performed, leading to excellent results (follow-up 8 years). Case two was a 44-year-old man with hamate-AVN of the proximal pole surgically treated with a vascularized bone graft from the radius based on the fifth extensor compartment artery, leading to excellent results (follow-up 7 years). Case three was a 36-year-old woman with hamate-AVN of the proximal pole surgically treated with débridement and cancellous bone grafting, leading to poor results (follow-up 1 year). Literature Review Nine other cases of avascular necrosis of the hamate were found in literature, all but one treated surgically. Etiology, treatment, and results of these cases, combined with our own cases, are reviewed. Clinical Relevance This article summarizes and synthesizes all presented cases of avascular necrosis of the hamate. We hope this will be helpful to physicians in decision making when confronted with this rare entity. Level of Evidence 4.
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Affiliation(s)
- Sebastian J. Peters
- Orthopaedic Department, Hand Unit, University Hospitals Leuven, Pellenberg Campus, Pellenberg, Belgium
- Orthopaedic department, Regional Hospital Heilig Hart Leuven, Leuven, Belgium
| | - C. Verstappen
- Orthopaedic Department, Hand Unit, University Hospitals Leuven, Pellenberg Campus, Pellenberg, Belgium
| | - Ilse Degreef
- Orthopaedic Department, Hand Unit, University Hospitals Leuven, Pellenberg Campus, Pellenberg, Belgium
| | - Luc De Smet
- Orthopaedic Department, Hand Unit, University Hospitals Leuven, Pellenberg Campus, Pellenberg, Belgium
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32
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Abstract
In 1910, Georg Preiser (1876-1913) described five cases of rarifying osteitis. Based on his imaging studies, he diagnosed post-traumatic avascular necrosis (AVN) of the scaphoid without any sign of primary fracture. This was followed by an article in 1911 in which Preiser related his findings to Kienböck's disease and Köhler's disease of the tarsal navicular. Upon searching the literature, we found descriptions and discussions of Preiser's imaging; however, the original images have never been published. We reproduce Preiser's original imaging in this current review. All of these appear to show a fracture and no signs of AVN, suggesting that Georg Preiser misinterpreted his findings. There is no apparent uniformity in the literature regarding the definition, description, or aetiology of Preiser's disease, and it is for this reason that we find the use of eponyms to be confusing.
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Affiliation(s)
- A M Kallen
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - S D Strackee
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Centre, Amsterdam, The Netherlands
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33
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Moraux A, Lefebvre G, Pansini V, Aucourt J, Vandenbussche L, Demondion X, Cotten A. Pisotriquetral joint disorders: an under-recognized cause of ulnar side wrist pain. Skeletal Radiol 2014; 43:761-73. [PMID: 24687844 DOI: 10.1007/s00256-014-1848-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 01/15/2014] [Accepted: 02/10/2014] [Indexed: 02/02/2023]
Abstract
Pisotriquetral joint disorders are often under-recognized in routine clinical practice. They nevertheless represent a significant cause of ulnar side wrist pain. The aim of this article is to present the main disorders of this joint and discuss the different imaging modalities that can be useful for its assessment.
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Affiliation(s)
- A Moraux
- Service d'Imagerie Musculo-Squelettique, Centre de consultation de l'appareil locomoteur, Hôpital Roger Salengro, 2 Bd du Pr E. Laine, CHRU Lille, 59037, Lille Cedex, France,
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Rozen WM, Niumsawatt V, Ross R, Leong JC, Ek EW. The vascular basis of the hemi-hamate osteochondral free flap. Part 1: vascular anatomy and clinical correlation. Surg Radiol Anat 2013; 35:585-94. [PMID: 23508930 DOI: 10.1007/s00276-013-1098-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 03/04/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE The treatment of comminuted fractures of the proximal interphalangeal joint is highly challenging due to the complexities of joint bio-mechanics and stability. The hemi-hamate osteochondral auto-graft has been popularised in this role, able to replace articular loss and restore joint stability. Recent evaluation of their long-term follow-up however has shown the early development of osteoarthritis and potential early cartilage loss, which may be due to the non-vascularised nature of the graft. We offer a new technique that maintains vascularisation of the transferred hamate fragment, and investigate the anatomical vascular basis for the technique. METHODS Dissection and angiographic studies of ten cadaveric specimens were undertaken, exploring the vascular anatomy of the dorsal hamate. A clinical case of hemi-hamate osteochondral free flap is presented, including preoperative, intraoperative and postoperative investigation of the relevant vasculature. RESULTS Cadaveric studies demonstrated dorsal vascular supply to the hamate from the central of three dorsal carpal arches. The arch was supplied by the dorsal branch of the ulnar artery. Multiple supracapsular veins are present for use in flap venous drainage. This vascular pattern was found to be constant. A clinical case of hemi-hamate osteochondral free flap harvest demonstrated the same vascular anatomy intraoperatively. The digital artery was used as a recipient for microvascular anastomosis. Postoperative computed tomographic angiography and nuclear bone scan confirmed flap perfusion. CONCLUSIONS The hemi-hamate osteochondral flap has a reliable anatomical vascular basis, and is clinically feasible as a technique for early vascularisation of the osteochondral fragment to sustain the transferred articular cartilage.
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Affiliation(s)
- Warren M Rozen
- Department of Plastic and Reconstructive Surgery, The Northern Hospital, 185 Cooper St, Epping, VIC, 3076, Australia.
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35
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Abstract
Posttraumatic osteonecrosis of distal pole of scaphoid is an extremely rare with only two reported cases so far. We present a case of a 30-year-old male with a 2-year-old posttraumatic osteonecrosis and nonunion of distal pole of scaphoid left wrist. He presented with complaints of pain and restriction of movements. There was no evidence of radiocarpal arthritis. He was managed with open reduction and internal fixation with k-wires, supplemented by a pronator quadratus based muscle pedicle bone graft. The fracture union was achieved at 6 months. After 2 years, he had almost complete range of wrist motion and had returned to his preinjury level of functional activity. His MRI (magnetic resonance imaging) scans showed evidence of revascularization suggesting successful incorporation of bone graft.
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Affiliation(s)
- Saurabh Kapoor
- Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India,Address for correspondence: Dr. Saurabh Kapoor, C-610 Saraswati Vihar, Pitampura, New Delhi - 110 034, India. E-mail:
| | - Inder Pawar
- Department of Orthopaedics, E.S.I. Hospital, Basaidarapur, New Delhi, India
| | - Sudhir Kapoor
- Department of Orthopaedics, E.S.I. Hospital, Basaidarapur, New Delhi, India
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36
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Goubau J, Benis S, Van Hoonacker P, Berghs B, Kerckhove D, Patonay L. Vascularization of the trapeziometacarpal joint and its clinical importance: Anatomical study. ACTA ACUST UNITED AC 2012; 31:57-61. [DOI: 10.1016/j.main.2012.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2011] [Revised: 01/31/2012] [Accepted: 02/08/2012] [Indexed: 10/28/2022]
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37
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Dubey PP, Chauhan NK, Siddiqui MS, Verma AK. STUDY OF VASCULAR SUPPLY OF LUNATE AND CONSIDERATION APPLIED TO KIENBÖCK DISEASE. ACTA ACUST UNITED AC 2011; 16:9-13. [DOI: 10.1142/s021881041100500x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 10/02/2010] [Accepted: 10/16/2010] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to assess vascularity of the lunate by number of foramina and radiography of vessels of the wrist. The genesis of lunatomalacia requires some vascular risk and mechanical predisposition. The findings were correlated with the cause of Kienböck's disease. The vascular foramina were more than two in 91.33% of the lunate. The lunate had consistent dorsal and palmar branches from radial artery. The additional branches from anterior interosseous artery in 72.22% and a branch of palmar inter carpal arch in 69.44% cases contributed in arterial anastomosis on palmar aspect of lunate. The dorsal blood supply was found by anterior interosseous artery in 85.71% of specimens and dorsal branch from dorsal intercarpal arch in 50% of specimens. The blood supply of lunate comes along with various ligaments which may be disrupted due to trauma or strain leading to avascular necrosis. The present observations are suggestive of rich blood supply of lunate in comparison of other investigations. Therefore Kienböck's disease is less common in northern India.
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Affiliation(s)
- P. P. Dubey
- Department of Anatomy, Era Medical College, Lucknow (U.P.), India
| | - Navneet Kumar Chauhan
- Department of Anatomy, Chhatrapati Shahuji Maharaj Medical University (U.P.), Lucknow (U.P.), India
| | - M. S. Siddiqui
- Department of Anatomy, Era Medical College, Lucknow (U.P.), India
| | - Anoop K. Verma
- Department of Forensic Medicine and Toxicology, Chhatrapati Shahuji Maharaj Medical University (U.P.), Lucknow (U.P.), India
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38
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Abstract
The scaphocapitate fracture syndrome is a rare entity of a perilunate fracture-dislocation. The diagnosis is frequently missed at initial presentation to a physician. Usually, a CT scan is required to reveal the extent of the lesion. Operative treatment consists of open reduction and internal fixation with screws (e.g. headless compression screw) or Kirschner wires. We report on a case of a 19-year-old man who presented to our hospital 2 months after he fell on his left wrist. He complained about persistent pain and a decreased range of motion after conservative treatment in a short arm cast. The diagnosis was finally made by a CT scan and the patient was treated operatively using headless compression screws in both the capitate and the scaphoid. After 12 weeks, fractures were completely healed radiographically and the patient returned to work. At follow-up 16 months after trauma, the patient had no further complaints. Range of motion increased and no avascular necrosis could be observed.
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39
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D'Agostino P, Townley WA, Roulot E. Bilateral avascular necrosis of the trapezoid. J Hand Surg Am 2011; 36:1678-80. [PMID: 21873003 DOI: 10.1016/j.jhsa.2011.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Revised: 07/25/2011] [Accepted: 07/25/2011] [Indexed: 02/02/2023]
Abstract
We present a 5-year follow-up of a patient with bilateral necrosis of the trapezoid that improved clinically and radiographically with nonoperative treatment.
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40
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Abstract
Post traumatic osteonecrosis of distal pole of scaphoid is very rare. We present a case of 34 years old male, drill operator by occupation with nontraumatic osteonecrosis of distal pole of the scaphoid. The patient was managed conservatively and was kept under regular follow-up every three months. The patient was also asked to change his profession. Two years later, the patient had no pain and had mild restriction of wrist movements (less than 15 degrees in either direction). The radiographs revealed normal density of the scaphoid suggesting revascularization.
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Affiliation(s)
- Bhavuk Garg
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India,Address for correspondence: Dr. Bhavuk Garg, Department of Orthopedics, 5th floor, All India Institute of Medical Sciences, New Delhi, India. E-mail:
| | - Himanshu Gupta
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
| | - Prakash P Kotwal
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
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41
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Jones Jr D, Shin A. Medial femoral condyle vascularized bone grafts for scaphoid nonunions. ACTA ACUST UNITED AC 2010; 29 Suppl 1:S93-103. [DOI: 10.1016/j.main.2010.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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42
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Melenhorst WBWH, Maas M, Houpt P, Overgoor MLE. A unique case of partial, radial-sided lunatomalacia. J Hand Surg Eur Vol 2010; 35:586-8. [PMID: 20719888 DOI: 10.1177/1753193409358524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- W. B. W. H. Melenhorst
- Department of Plastic, Reconstructive and Hand Surgery Isala klinieken Zwolle, and Department of Radiology Amsterdam Medical Centre University of Amsterdam, The Netherlands
| | - M. Maas
- Department of Plastic, Reconstructive and Hand Surgery Isala klinieken Zwolle, and Department of Radiology Amsterdam Medical Centre University of Amsterdam, The Netherlands
| | - P. Houpt
- Department of Plastic, Reconstructive and Hand Surgery Isala klinieken Zwolle, and Department of Radiology Amsterdam Medical Centre University of Amsterdam, The Netherlands
| | - M. L. E. Overgoor
- Department of Plastic, Reconstructive and Hand Surgery Isala klinieken Zwolle, and Department of Radiology Amsterdam Medical Centre University of Amsterdam, The Netherlands
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43
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Free-Vascularized Medial Femoral Condyle Bone Transfer in the Treatment of Scaphoid Nonunions. Plast Reconstr Surg 2010; 125:1176-1184. [DOI: 10.1097/prs.0b013e3181d1808c] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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44
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Abstract
Scaphoid fractures are a common problem encountered in clinical practice. This manuscript provides an algorithm for the diagnosis, evaluation, and treatment of acute scaphoid fractures.
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Affiliation(s)
- Julie E Adams
- The Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
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45
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Oehmke MJ, Podranski T, Klaus R, Knolle E, Weindel S, Rein S, Oehmke HJ. The blood supply of the scaphoid bone. J Hand Surg Eur Vol 2009; 34:351-7. [PMID: 19282403 DOI: 10.1177/1753193408100117] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Scaphoid vascularisation was investigated using macroscopic and microscopic techniques in 12 uninjured, formalin fixed cadaver hands. A good blood supply of the scaphoid bone from palmar, dorsal and radial vessel groups with a variety of anastomoses was found which should provide sufficient collateral blood flow from adjacent regions in some patients. Since blood supply is available from the palmar circulation, a dorsal approach to the scaphoid bone is possible.
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Affiliation(s)
- M J Oehmke
- Department of Special Anaesthesia and Pain Control, Medical University of Vienna, Austria
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46
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Avascular necrosis of the carpal bones. CURRENT ORTHOPAEDIC PRACTICE 2008. [DOI: 10.1097/bco.0b013e3283021474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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47
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Abstract
Scaphoid fractures are a common problem encountered in clinical practice. This manuscript provides an algorithm for the diagnosis, evaluation, and treatment of acute scaphoid fractures.
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Affiliation(s)
- Julie E Adams
- The Department of Orthopaedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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48
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Abstract
BACKGROUND Scaphoid fractures are commonly seen in orthopedic practice. An organized and thoughtful approach to diagnosis and treatment can facilitate good outcomes. However, despite optimal treatment, complications may ensue. In the setting of nonunion or an avascular proximal pole, vascularized bone grafting may be needed. METHODS AND RESULTS In this article we review the literature regarding these injuries and describe an approach to diagnosis, treatment, and management of scaphoid fractures and nonunions. CONCLUSION Scaphoid fractures and nonunions may present as challenging problems in practice, but a systematic and deliberate approach can facilitate optimal results.
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Affiliation(s)
- Scott P Steinmann
- Department of Orthopaedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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49
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Weyand B, von Schroeder HP. Bone challenges for the hand surgeon: from basic bone biology to future clinical applications. Clin Plast Surg 2005; 32:537-47, vii. [PMID: 16139627 DOI: 10.1016/j.cps.2005.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Bone is a complex tissue composed of a calcified extracellular matrix with specialized cells that produce, maintain, and resorb the bone. Bone also has a rich vascular and neural supply. Bone has a great capability of regeneration, healing, and remodelling that is influenced by external factors, such as stress forces, and internal regulators that include hormones, vitamins, and growth factors. These factors dictate bone biology, and variations result in pathophysiologic conditions that have clinical implications in hand surgery. Solutions to the challenges in hand surgery rely on a thorough understanding of the biology of bone.
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Affiliation(s)
- Birgit Weyand
- University of Toronto Hand Program and Bone Laboratory, Faculty of Dentistry, University Health Network and University of Toronto, Hand Clinic 2-East, Toronto M5T 2S8, Ontario, Canada
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50
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Abstract
A pain-free, functional wrist joint is critical to many sporting and vocational activities. Assessing the painful wrist requires knowledge of common injury patterns and frequently seen conditions. The primary care physician with an understanding of basic wrist anatomy and biomechanics and a systematic approach to assessing the wrist will be more comfortable and effective with diagnosing and managing the athletically injured wrist.
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Affiliation(s)
- Scott W Eathorne
- Providence Athletic Medicine, Providence Medical Center-Providence Park, 47601 Grand River Avenue, Suite A101, Novi, MI 48374, USA.
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