1
|
Marzella L, Filistad S, Lazzerini A, Cannella A, Sassara G, Caruso L, De Vitis R. Volar locking and angular stability plate for treatment of comminuted scaphoid fractures: a case series of 44 cases. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-04095-2. [PMID: 39304606 DOI: 10.1007/s00590-024-04095-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 09/02/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND The primary method employed worldwide for the treatment of scaphoid fractures is screw fixation. However, in unstable and comminuted fractures, percutaneous fixation could produce complications due to technical challenges, such as improper axis positioning, inaccurate screw length measurement, intra-articular screw penetration, and impingement. Alternative open approaches for the surgical management of scaphoid fractures have been proposed, and in recent years, a new specific volar locking plate for the treatment of scaphoid fractures has been developed. This study aims to present the outcomes of this technique applied to 44 patients with unstable and comminuted fractures of the scaphoid. AIMS The purpose of the study is to verify the effectiveness of the volar plate in the treatment of comminuted scaphoid fractures and the necessity for plate removal when consolidation has occurred. METHODS Between January 2021 and March 2023, a specific volar locking plate for the treatment of scaphoid fractures was used in 44 patients. A retrospective study was conducted involving all patients, consisting of continuous clinical and radiographic assessments, functional evaluations (using QuickDASH and MHQ), and patient satisfaction surveys. RESULTS All patients achieved clinical and radiographic recovery. However, the plate can impinge with nearby structures and should be removed once the fracture is consolidated. After plate removal, further improvement in range of motion was observed. CONCLUSION The plate and screws system is a viable and appropriate method of osteosynthesis in the treatment of unstable and comminuted recent fractures occurring in the middle third of the carpal scaphoid.
Collapse
Affiliation(s)
- L Marzella
- Unit of Hand Surgery, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - S Filistad
- Unit of Hand Surgery, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - A Lazzerini
- Unit of Hand Surgery, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - A Cannella
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - G Sassara
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli, Largo A. Gemelli 8, 00168, Rome, Italy
| | - L Caruso
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli, Largo A. Gemelli 8, 00168, Rome, Italy
| | - R De Vitis
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli, Largo A. Gemelli 8, 00168, Rome, Italy
| |
Collapse
|
2
|
Marcuzzi A, Pederiva D, Pilla F, Canovi A, Corradini A, Adani R, Ruffilli A, Faldini C, Vita F. The use of resurfacing capitate pyrocarbon implants (RCPI) in chronic diseases of the wrist: outcomes of more than 100 cases. Musculoskelet Surg 2024; 108:367-371. [PMID: 38038900 DOI: 10.1007/s12306-023-00803-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/07/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION In advanced chronic post-traumatic wrist pathology, the goal of surgery has always been to reduce pain while trying to preserve the function of the wrist itself as much as possible; numerous interventions have been developed to achieve these goals (partial arthrodesis, 4-angle arthrodesis, the use of prosthetic implants…). PURPOSES The purpose of the study is to evaluate outcomes and complications rate of proximal row carpectomy associated with the resurfacing capitate pyrocarbon implant (RCPI) for chronic diseases of the wrist. MATERIALS AND METHODS A retrospective analysis of the patients operated on between June 2004 and March 2021 was performed. Pain, wrist range of motion in flexion, extension, radial and ulnar deviation and grip strength were compared preoperatively and at 1, 6, 12 and 24 months. Complications and additional procedures were recorded. RESULTS A total of 112 patients underwent surgery for proximal row carpectomy and placement of RCPI with a mean follow-up of 6.6 years. Between the preoperative and the 2-year follow-up, a reduction in pain (VAS from 7.3 to 0.5), an increase in grip strength (from 8 to 17 kg) and an increase in ROM in all planes (flexion from 19° to 44°, extension from 20° to 46°, radial deviation from 7° to 14° and ulnar deviation from 13° to 28°) were recorded. Ten (8.9%) patients required additional surgery, with only 2 (1.8%) patients requiring revision of the implant. CONCLUSIONS Proximal row carpectomy associated with RCPI is an excellent surgical strategy to relieve pain and to improve wrist range of motion and grip strength in patients with chronic diseases of the wrist.
Collapse
Affiliation(s)
- A Marcuzzi
- Hand and Microvascular Unit, Azienda Ospedaliera Policlinico di Modena, Modena, Italy
| | - D Pederiva
- Research Hospital Rizzoli Orthopedic Institute IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
| | - F Pilla
- Research Hospital Rizzoli Orthopedic Institute IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - A Canovi
- Orthopedics and Traumatology, Magati Hospital Scandiano, Scandiano, Italy
| | - A Corradini
- Orthopedics and Traumatology, Santa Maria Bianca Hospital, Mirandola, Italy
| | - R Adani
- Hand and Microvascular Unit, Azienda Ospedaliera Policlinico di Modena, Modena, Italy
| | - A Ruffilli
- Research Hospital Rizzoli Orthopedic Institute IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - C Faldini
- Research Hospital Rizzoli Orthopedic Institute IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - F Vita
- Research Hospital Rizzoli Orthopedic Institute IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| |
Collapse
|
3
|
Lin JS, Moran SL. Proximal row carpectomy or scaphoid excision and four-corner arthrodesis for treatment of scapholunate advanced collapse arthritis. J Hand Surg Eur Vol 2024:17531934241265838. [PMID: 39169776 DOI: 10.1177/17531934241265838] [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: 08/23/2024]
Abstract
Degenerative wrist conditions, such as scapholunate advanced collapse and scaphoid nonunion advanced collapse, often require salvage procedures to reduce pain and improve function. For early stages of disease, both proximal row carpectomy and scaphoid excision four-corner arthrodesis are viable motion-preserving options. There remains controversy on which technique is superior. Selection is a nuanced decision that requires consideration of patient characteristics and stage of disease. The traditional notion that proximal row carpectomy should be reserved for older individuals with low demands has been challenged; long-term studies in younger populations demonstrate similar patient-reported outcomes, pain relief and survivorship without conversion to total wrist arthrodesis between proximal row carpectomy and four-corner arthrodesis. The existing evidence suggests proximal row carpectomy has advantages of greater range of motion, fewer complications and lower costs. Advancements such as arthroscopic techniques for both procedures show potential, although mastery involves a steep learning curve.
Collapse
Affiliation(s)
- James S Lin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Steven L Moran
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
4
|
Gruisen JAE, Schormans PMJ, Punt IM, Roth AK, van Kuijk SMJ, Poeze M, Hannemann PFW. Patient reported and functional outcome measures after surgical salvage procedures for posttraumatic radiocarpal osteoarthritis - a systematic review. BMC Musculoskelet Disord 2024; 25:453. [PMID: 38849773 PMCID: PMC11157883 DOI: 10.1186/s12891-024-07527-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/15/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Posttraumatic wrist osteoarthritis is an irreversible and often progressive condition. Many surgical treatments, used in (daily) practice, aim to relieve symptoms like pain and restore function. The aim of this systematic review is to assess the patient reported and functional outcomes of the most common surgical interventions in patients with posttraumatic wrist osteoarthritis. This overview can help clinicians select the best treatment and manage patient's expectations. METHODS A literature search was performed in Pubmed, Embase and Cochrane for articles published between 1990 and November 2022 according to the PRISMA guidelines. The study protocol has been registered in the PROSPERO database (CRD42017080427). Studies that describe patient reported outcomes (pain and Disability of Arm, Shoulder and Hand (DASH) -score) and functional outcomes (range of motion (ROM) and grip strength) after surgical intervention with a minimal follow-up of 1 year were included. The identified surgical procedures included denervation, proximal row carpectomy, interpositional- and total arthroplasty, and midcarpal-, radiocarpal- and total arthrodesis. The pre-and postoperative outcomes were pooled and presented per salvage procedure. RESULTS Data from 50 studies was included. Pain score improved after all surgeries except denervation. Flexion/extension decreased after radiocarpal arthrodesis, did not show significant changes after proximal row carpectomy, and improved for all other surgeries. DASH score improved after arthroplasty, proximal row carpectomy and midcarpal arthrodesis. Grip strength improved after interposition arthroplasty and partial arthrodesis. CONCLUSION Evidence from this review did not support the indication for denervation in this particular patient population. In patients with SLAC/SNAC II, proximal row carpectomy might be favourable to a midcarpal arthrodesis solely based on better FE ROM of the radiocarpal joint after proximal row carpectomy. In terms of radiocarpal mobility, total wrist arthroplasty might be preferred to radiocarpal arthrodesis in patients with osteoarthritis after a distal radius fracture. More uniform measurements of outcomes would improve the understanding of the effect of surgical treatments of the posttraumatic osteoarthritic wrist.
Collapse
Affiliation(s)
- Jane A E Gruisen
- Department of Trauma and Orthopedic Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Philip M J Schormans
- Department of Surgery, Amphia Hospital Breda, Molengracht 21, 4818 CK Breda, The Netherlands.
| | - Ilona M Punt
- Department of Trauma and Orthopedic Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Alex K Roth
- Department of Trauma and Orthopedic Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Sander M J van Kuijk
- Department of Klinische Epidemiologie en Medical Technology Assessment, Maastricht University, P.Debyelaan 25, Maastricht, 6229 HX, The Netherlands
| | - Martijn Poeze
- Department of Trauma and Orthopedic Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Pascal F W Hannemann
- Department of Trauma and Orthopedic Surgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| |
Collapse
|
5
|
Rieussec C, Caillard G, Helfter L, Girard P, Forli A, Corcella D. Comparison of proximal row carpectomy with RCPI® versus proximal row carpectomy with Eaton's capsular interposition in the management of advanced wrist osteoarthritis. Orthop Traumatol Surg Res 2024; 110:103783. [PMID: 38048904 DOI: 10.1016/j.otsr.2023.103783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 11/15/2023] [Accepted: 11/29/2023] [Indexed: 12/06/2023]
Abstract
INTRODUCTION Proximal row carpectomy (PRC) is one of the recommended techniques for managing wrist osteoarthritis, it implies the integrity of the lunate fossa of the radius and the proximal pole of the capitate. If PRC is not possible, it is suggested to consider combining it with a capsule interposition (such as Eaton's flap) or opting for intra- or radiocarpal arthrodesis. Another alternative is to combine capitate resurfacing with a pyrocarbon implant (RCPi®). The aims of this study was to assessed the results between proximal PRC+Eaton and those associated PRC+RCPi® for advanced wrist osteoarthritis. HYPOTHESIS We hypothesized that there would be no differences in clinical or functional outcome between proximal row carpectomy associated with RCPI® and those associated with Eaton capsular flap. MATERIAL AND METHODS It is a monocentric, retrospective, multi-operator study involving 83 wrists with osteoarthritis, included between January 2000 and December 2020 with a minimum follow-up period of 12 months. Thirty-nine patients underwent PRC+Eaton and 44 patients underwent RCPI® resurfacing. Data such as pain, flexion, extension and strength as well as functional scores (PRWE, Mayo and quick DASH) were collected from the patient files at the last check-up. RESULTS Results were comparable between the two groups in terms pain (VAS), mobility (flexion and extension), strength (GRASP) and functional scores (PRWE, Mayo and quick DASH). Carpal height was better preserved in the PRC+RCPI® group, with a Youm and McMurtry index evaluated at 0.3 in the PRC+Eaton group compared to 0.4 in the PRC+RCPI® group (p-value<0.001). Radiocarpal arthrodesis was required in 16% of the PRC+Eaton group and 6.8% of the PRC+RCPI® group, with a statistically significant difference (p-value=0.023). DISCUSSION This study reports clinical and functional results that suggest RCPI® is an interesting alternative and can be associated with proximal row carpectomy in advanced wrist osteoarthritis. LEVEL OF EVIDENCE IV; retrospective study.
Collapse
Affiliation(s)
- Clémentine Rieussec
- Service de chirurgie de la main, hôpital Nord de la Tronche, CHU de Grenoble-Alpes, Grenoble, France.
| | - Gauthier Caillard
- Service de chirurgie de la main, hôpital Nord de la Tronche, CHU de Grenoble-Alpes, Grenoble, France
| | - Laura Helfter
- Service de chirurgie de la main, hôpital Nord de la Tronche, CHU de Grenoble-Alpes, Grenoble, France
| | - Pierre Girard
- Service de chirurgie de la main, hôpital Nord de la Tronche, CHU de Grenoble-Alpes, Grenoble, France
| | - Alexandra Forli
- Service de chirurgie de la main, hôpital Nord de la Tronche, CHU de Grenoble-Alpes, Grenoble, France
| | - Denis Corcella
- Service de chirurgie de la main, hôpital Nord de la Tronche, CHU de Grenoble-Alpes, Grenoble, France
| |
Collapse
|
6
|
Perry AC, Wilkes C, Curran MWT, Ball BJ, Morhart MJ. Proximal Row Carpectomy Modifications for Capitate Arthritis: A Systematic Review. J Wrist Surg 2023; 12:86-94. [PMID: 36644731 PMCID: PMC9836777 DOI: 10.1055/s-0042-1751013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 05/12/2022] [Indexed: 01/18/2023]
Abstract
Introduction Proximal row carpectomy (PRC) is a motion-sparing procedure for radiocarpal arthritis with reliable results. Traditionally, proximal capitate arthritis is a contraindication to PRC; however, PRC with modifications are proposed to circumvent this contraindication. PRC modifications can be broadly grouped into capitate resurfacing (CR) and capsular interposition (CI) procedures which could expand PRC indications. Our primary question was to characterize the outcomes achievable with various PRC modifications. Our secondary question was to determine which PRC modification was the optimal procedure when capitate arthritis was present. Methods A systematic review was conducted to examine the outcomes of modified PRC procedures. Independent reviewers appraised multiple databases for PRC studies with modifications for capitate arthritis in adult patients (age >18 years) with a minimum of three cases and extractable outcomes. Modified PRC procedures included capsular/allograft interposition, resurfacing capitate pyrocarbon implants, and osteochondral grafting. Pertinent outcomes included patient demographics, range-of-motion, grip strength, patient-reported outcomes, and complications, including salvage rates. Results Overall, 18 studies met the inclusion criteria-10 studies ( n = 147) on CI and 8 studies on CR ( n = 136). PRC with CI had the greatest flexion-extension arc and grip strength. Complications were marginally higher in the CR group (4%), while the CI group had a higher conversion to total wrist arthrodesis (10%). Conclusion Techniques to address capitate arthritis center around resurfacing or soft tissue interposition. PRC modifications with CI produces better range-of-motion and grip strength but higher conversion to total wrist arthrodesis. Higher conversion rates may be attributable to longer follow-up periods in studies examining CI compared with CR. Level of Evidence This is a Level III study.
Collapse
Affiliation(s)
- Alexander C. Perry
- Division of Plastic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Courtney Wilkes
- Division of Plastic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew W. T. Curran
- Division of Plastic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Brandon J. Ball
- Division of Plastic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Michael J. Morhart
- Division of Plastic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
7
|
Kazemi M, Daliri M, Moradi A. A systematic review on the management of idiopathic avascular necrosis of the scaphoid (Preiser's disease). Orthop Traumatol Surg Res 2022; 109:103480. [PMID: 36410658 DOI: 10.1016/j.otsr.2022.103480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 03/31/2022] [Accepted: 05/04/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Treatment options for patients with Preiser's disease are challenging and varied. This article thus provides a systematic review of existing studies on the outcomes of the treatments for patients suffering from Preiser's disease in order to investigate the most appropriate management of Preiser's in each stage of the disease. METHODS We followed PRISMA guidelines while performing the study, and reviewed 107 papers in all languages from 1981 till November 2020 and included 42 studies that met the eligibility criterion. Studies investigating the outcome of one or more treatment options for Preiser's disease were eligible. Besides, quantitative analysis on 130 individuals (135 wrists) of the included studies was performed. RESULTS The results show that in stages II and III, pain score reduces more in surgical approach than in conservative treatment. In stage II of the Preiser's, Vascularized Bone Grafting (VBG) was more effective in pain alleviation and improvement in wrist range of motion (ROM) and Mayo Modified Wrist Score (MMWS) than immobilization. Proximal Row Carpectomy (PRC) in stage III causes more pain relief and ROM improvement than VBG and conservative treatments like prescribing NSAIDs. Inconsistent evidence was found in case studies of stage IV; however, they generally favour PRC and SILASTIC implants. Surgical studies of stage I are not yet enough for making a conclusive assessment. CONCLUSION Surgical treatment outcomes seem more satisfactory in all Preiser's disease stages. Specifically, VBG for patients of stage II provided they have no scaphoid degenerative changes, and PRC seems more satisfactory for stage III. LEVEL OF EVIDENCE IV; systematic review of case reports and case series on Preiser's disease.
Collapse
Affiliation(s)
- Maryam Kazemi
- Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahla Daliri
- Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Moradi
- Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| |
Collapse
|
8
|
MAZZONE VJ, D’ORIO M, MILITERNO A, TERRIBILE F, DE VITIS R. Is adaptive proximal scaphoid implant (APSI) a valid option for SNAC wrist also in young patients? MINERVA ORTHOPEDICS 2022; 73. [DOI: 10.23736/s2784-8469.22.04204-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2024]
|
9
|
Rachunek K, Springer F, Barczak M, Kolbenschlag J, Daigeler A, Medved F. An algorithmic diagnostic approach to scapholunate ligament injuries based on comparison of X-ray examinations and arthroscopy in 414 patients. J Plast Reconstr Aesthet Surg 2022; 75:3293-3303. [PMID: 35725956 DOI: 10.1016/j.bjps.2022.04.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/15/2022] [Accepted: 04/12/2022] [Indexed: 12/21/2022]
Abstract
Conventional X-ray imaging is usually the first diagnostic assessment after clinical examination in case of suspected scapholunate interosseous ligament (SLIL) injury. Nevertheless, there is no consensus on the norms of the scapholunate distance (SLD) or carpal angles. Therefore, we aimed to determine the utility of static and dynamic radiographs in the diagnostic of an SLIL injury in comparison with the reference standard arthroscopy. We retrospectively analyzed the preoperative X-ray series and surgical records of arthroscopies of 414 patients. Radiological assessment included conventional static X-rays in the posteroanterior (PA) projection, clenched fist views in ulnar and radial deviations, in which the SLD at the midportion of the scapholunate (SL) joint was measured. The scapholunate angle (SLA) and radiolunate angle (RLA) were measured on lateral wrist radiographs. Receiver operating characteristic (ROC) curves were created to determine possible cut-off points of the radiological indices for the diagnosis of SLIL injury. Further, a logistic regression with the parameters having the highest area under the curve (AUC) was calculated. We found that SLD in ulnar inclination (AUC= 0.774), SLD in PA projection (AUC = 0.748), and SLA (AUC = 0.737) had the highest diagnostic value. The AUC of the combination of these three parameters was 0.822 for all patients with any SLIL lesion and 0.850 for patients with SLIL lesions of 3-4 Geissler grade. Further investigation of SLIL pathology would be appropriate in the case of SLD in ulnar inclination of 2.7 mm, SLD in PA projection of 1.9 mm and SLA of 63°.
Collapse
Affiliation(s)
- K Rachunek
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany.
| | - F Springer
- Department of Diagnostic and Interventional Radiology, University Hospital, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany
| | - M Barczak
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| | - J Kolbenschlag
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| | - A Daigeler
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| | - F Medved
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany
| |
Collapse
|
10
|
Hung WC, Wang JP, Huang YC, Yin CY, Wu CY, Huang HK. Arthroscopic-assisted radiocarpal ligaments tensioning for dynamic radiocarpal instability. BMC Musculoskelet Disord 2022; 23:158. [PMID: 35177051 PMCID: PMC8851747 DOI: 10.1186/s12891-021-04857-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
Background Dynamic radiocarpal instability is one of the causes of post-trauma radial-sided wrist pain. It is not easy to diagnose and may possibly be overlooked. The key ligaments responsible for dynamic radiocarpal instability are the radioscaphocapitate (RSC) and long radiolunate (LRL) ligaments. Tensioning of these 2 ligaments could be a method of treatment for dynamic carpal instability. We proposed a method for arthroscopic thermal shrinkage of these 2 ligaments, and for setting a landmark arthroscopically to facilitate identification of these 2 ligaments during the combined open suture tensioning procedure. Methods Between January 2016 and May 2020, 12 patients treated with this method were enrolled. The mean age was 33.3 years (range, 18–57 years), and the mean duration from injury to operation was 7.8 months (range, 3–25 months). The diagnosis was mainly depended on the physical examinations and confirmed under arthroscopy. The mean follow-up was 17.7 months (range, 12–26 months). Results All the patients had marked improvement of pain, grip strength, the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), and the radiocarpal stability. The wrist range of motion showed significant decrease around 5o in both flexion and extension and around 4o in the ulnar deviation at the final follow-ups. All patients were able to return to their previous full level of work and activities. Conclusions We conclude that arthroscopic thermal shrinkage combined with open suture tensioning can be effective in treating dynamic carpal instability, while the arthroscopic-assisted landmark setting can help identify the accurate location of the RSC and LRL ligaments without dissecting too much soft tissue.
Collapse
Affiliation(s)
- Wei-Chen Hung
- Department of Orthopaedics, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
| | - Jung-Pan Wang
- Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Chao Huang
- Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Cheng-Yu Yin
- Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Cheng-Yi Wu
- Department of Orthopaedics, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
| | - Hui-Kuang Huang
- Department of Orthopaedics, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan. .,Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan. .,Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. .,Department of Food Nutrition, Chung Hwa University of Medical Technology, Tainan, Taiwan.
| |
Collapse
|