1
|
Shaer SA, van der Palen J, Teunissen J, Fink A, van der Heijden B, Zöphel O. An alternative treatment for degenerative triangular fibrocartilage complex injuries with distal radioulnar joint instability: first experience with 48 patients. J Hand Surg Eur Vol 2024; 49:240-249. [PMID: 37694851 PMCID: PMC10845826 DOI: 10.1177/17531934231197942] [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: 09/20/2023] [Revised: 07/20/2023] [Accepted: 08/13/2023] [Indexed: 09/12/2023]
Abstract
Treatment of ulnar impaction syndrome combined with distal radioulnar joint instability due to irreparable degenerative triangular fibrocartilage complex injuries can be complex. We describe the outcomes of a novel technique for restoring distal radioulnar stability due to ulnar impaction syndrome using a distally based extensor carpi ulnaris tendon strip combined with ulnar shortening osteotomy in 48 patients. Patients were assessed using standardized outcome measurements. The patient-rated wrist/hand evaluation total score improved from 66 (SD 15) at intake to 40 (SD 25) at 3 months, and 28 (SD 23) at 12 months postoperatively (p < 0.001). Wrist extension and flexion improved significantly at 12 months from 53° (SD 11) to 65° (SD 8) (p < 0.001) and from 45° (SD 10) to 56° (SD 12) (p = 0.01), respectively. Adding a distally based longitudinal extensor carpi ulnaris strip to ulnar shortening osteotomy for restoring distal radioulnar joint stability seems to be an effective treatment in patients with irreparable degenerative triangular fibrocartilage complex injuries due to ulnar impaction syndrome. Level of evidence: IV.
Collapse
Affiliation(s)
- Sanharib Al Shaer
- Department of Surgery, UMC Utrecht, Utrecht, The Netherlands
- Hand and Wrist Center, Xpert Clinics, Handtherapy, Enschede, The Netherlands
| | - Job van der Palen
- Department of Epidemiology, Medisch Spectrum Twente, Enschede & Section Cognition, Data and Education, Faculty BMS, University of Twente, Enschede, The Netherlands
| | - Joris Teunissen
- Hand and Wrist Center, Xpert Clinics, Handtherapy, Enschede, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Alexandra Fink
- Hand and Wrist Center, Xpert Clinics, Handtherapy, Enschede, The Netherlands
| | - Brigitte van der Heijden
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Jeroen Bosch Ziekenhuis ‘s-Hertogenbosch, The Netherlands
| | - Oliver Zöphel
- Hand and Wrist Center, Xpert Clinics, Handtherapy, Enschede, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Ziekenhuisgroep Twente, Hengelo, The Netherlands
| | | |
Collapse
|
2
|
Hoogendam L, van der Oest MJW, Vermeulen GM, Feitz R, Hovius SER, Zuidam JM, Slijper HP, Selles RW, Wouters RM. Prevalence of complications and association with patient-reported outcomes after trapeziectomy with a Weilby sling: A cohort study. J Hand Surg Am 2023; 48:469-478. [PMID: 36932010 DOI: 10.1016/j.jhsa.2023.01.022] [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: 03/09/2022] [Revised: 12/28/2022] [Accepted: 01/18/2023] [Indexed: 03/19/2023]
Abstract
PURPOSE The primary aim of this study was to report complications during the first year after trapeziectomy with Weilby sling using a standardized tool designed by the International Consortium for Health Outcome Measures. The secondary aim was to determine the association of complications and patient-reported outcomes 12 months after surgery. METHODS We included patients who underwent trapeziectomy with Weilby sling between November 2013 and December 2018. All complications during the first year were scored using the International Consortium for Health Outcomes Measurement Complications in Hand and Wrist conditions (ICHAW) tool. Pain and hand function were measured before surgery and 12 months after surgery using the Michigan Hand Outcomes Questionnaire (MHQ). Minimally Important Change thresholds of 18.6 for MHQ pain and 9.4 for MHQ function were used to determine clinical importance. RESULTS Of 531 patients after trapeziectomy with Weilby sling, 65% had an uneventful recovery, 16% experienced ICHAW Grade 1 deviations only, and 19% experienced Grade 2 or 3 deviations, including requiring antibiotics, corticosteroid injections, or additional surgery. On average, patients improved in pain and hand function, even in the presence of ICHAW events. Although all ICHAW grades were associated with poorer patient-reported outcomes 12 months after surgery, Grade 2 and 3 exceeded the Minimally Important Change threshold for pain and/or function. CONCLUSIONS In 531 patients, 65% had an uneventful recovery, 16% experienced ICHAW Grade 1 deviations only, and 19% experienced grade 2 or 3 deviations. We recommend describing Grade 1 as "adverse protocol deviations" and grade 2 and 3 as complications, because of clinically relevant poorer patient-reported outcomes 12 months after surgery. The ICHAW is a promising tool to evaluate systematically and compare complications in hand surgery, although we recommend further evaluation. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Lisa Hoogendam
- From the Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands; Xpert Clinics, Hand and Wrist Center, Zeist, the Netherlands.
| | - Mark J W van der Oest
- From the Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands; Xpert Clinics, Hand and Wrist Center, Zeist, the Netherlands
| | | | - Reinier Feitz
- Xpert Clinics, Hand and Wrist Center, Zeist, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Radboudumc University Hospital, Nijmegen, The Netherlands
| | - Steven E R Hovius
- Xpert Clinics, Hand and Wrist Center, Zeist, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Radboudumc University Hospital, Nijmegen, The Netherlands
| | - J Michiel Zuidam
- From the Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Harm P Slijper
- Xpert Clinics, Hand and Wrist Center, Zeist, the Netherlands
| | - Ruud W Selles
- From the Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | - Robbert M Wouters
- From the Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
| |
Collapse
|
3
|
Laane CLE, Oude Nijhuis KD, Spil J, Sierevelt IN, Doornberg JN, Jaarsma RL, Verhofstad MHJ, Wijffels MME. What Surgical Technique to Perform for Isolated Ulnar Shortening Osteotomy After Distal Radius Malunion: A Systematic Review. Hand (N Y) 2023:15589447231152587. [PMID: 36794764 DOI: 10.1177/15589447231152587] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND Unstable fractures of the distal radius fractures (DRFs) may result in malunion, usually consisting of subsequent shortening and angular deviations. Ulnar shortening osteotomy (USO) is assumed to be a simpler procedure than radial correction osteotomy, resulting in fewer complications and comparable outcomes. The aim of this study was to identify the best surgical technique to perform USO to restore distal radioulnar joint congruency after DRF malunion. METHODS A systematic review of the literature is performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines in February 2022 to identify studies reporting outcomes and surgical technique for isolated USO. The primary outcome was complication rates. Secondary outcomes included functional, radiologic, and patient-rated outcomes. The methodological index for nonrandomized studies criteria were used to assess the quality of evidence. RESULTS Included were 12 cohorts (185 participants). Due to substantial heterogeneity, a meta-analysis could not be performed. The overall complication rate was 33% (95% confidence interval, 16% to 51%). The most reported complication was implant irritation (22%), often requiring removal of the implant (13%). Only 3% nonunions were mentioned. Functional and patient-rated outcomes improved in most patients after USO. Quality of evidence of the papers was low to very low. Common methodological flaws were related to retrospective research. CONCLUSION No evident differences in complication rates and functional outcomes between the surgical techniques were observed. Based on this literature, most complications are related to implant irritation. Nonunion and infection rates were rare. Therefore, a surgical technique with a buried implant might be preferred. This hypothesis requires further investigation.
Collapse
Affiliation(s)
- Charlotte L E Laane
- Erasmus MC, Rotterdam, The Netherlands
- Massachusetts General Hospital, Boston, USA
| | | | | | - Inger N Sierevelt
- Xpert Clinics, Amsterdam, The Netherlands
- Spaarne Gasthuis Academy, Hoofddorp, The Netherlands
| | - Job N Doornberg
- University of Groningen, The Netherlands
- Flinders University and Flinders Medical Centre, Adelaide, SA, Australia
| | - Ruurd L Jaarsma
- Flinders University and Flinders Medical Centre, Adelaide, SA, Australia
| | | | | |
Collapse
|
4
|
Teunissen JS, van der Oest MJW, Selles RW, Ulrich DJO, Hovius SER, van der Heijden B. Long-term outcomes after ulna shortening osteotomy: a mean follow-up of six years. Bone Jt Open 2022; 3:375-382. [PMID: 35514114 PMCID: PMC9134835 DOI: 10.1302/2633-1462.35.bjo-2022-0031.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims The primary aim of this study was to describe long-term patient-reported outcomes after ulna shortening osteotomy for ulna impaction syndrome. Methods Overall, 89 patients treated between July 2011 and November 2017 who had previously taken part in a routine outcome evaluation up to 12 months postoperatively were sent an additional questionnaire in February 2021. The primary outcome was the Patient-Rated Wrist and Hand Evaluation (PRWHE) total score. Secondary outcomes included patient satisfaction with treatment results, complications, and subsequent treatment for ulnar-sided wrist pain. Linear mixed models were used to compare preoperative, 12 months, and late follow-up (ranging from four to nine years) PRWHE scores. Results Long-term outcomes were available in 66 patients (74%) after a mean follow-up of six years (SD 1). The mean PRWHE total score improved from 63 before surgery to 19 at late follow-up (difference in means (Δ) 44; 95% confidence interval (CI) 39 to 50; p = <0.001). Between 12 months and late follow-up, the PRWHE total score also improved (Δ 12; 95% CI 6 to 18; p = < 0.001). At late follow-up, 14/66 of patients (21%) reported a PRWHE total score of zero, whereas this was 3/51 patients (6%) at 12 months (p = 0.039). In all, 58/66 patients (88%) would undergo the same treatment again under similar circumstances. Subsequent treatment (total n = 66; surgical n = 57) for complications or recurrent symptoms were performed in 50/66 patients (76%). The most prevalent type of reoperation was hardware removal in 42/66 (64%), and nonunion occurred in 8/66 (12%). Conclusion Ulna shortening osteotomy improves patient-reported pain and function that seems to sustain at late follow-up. While satisfaction levels are generally high, reoperations such as hardware removal are common. Cite this article: Bone Jt Open 2022;3(5):375–382.
Collapse
Affiliation(s)
- Joris S. Teunissen
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
- Hand and Wrist Center, Xpert Clinics, Amsterdam, Noord-Holland, The Netherlands
| | - Mark J. W. van der Oest
- Hand and Wrist Center, Xpert Clinics, Amsterdam, Noord-Holland, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
| | - Ruud W. Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
| | - Dietmar J. O. Ulrich
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
| | - Steven E. R. Hovius
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
- Hand and Wrist Center, Xpert Clinics, Amsterdam, Noord-Holland, The Netherlands
| | - Brigitte van der Heijden
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, Brabant, The Netherlands
| | | |
Collapse
|