Journal of Wrist Surgery最新文献

Background: Distal radius fractures are a common orthopaedic injury with several treatment methods. This systematic review and meta-analysis aims to synthesize the results of the latest randomized controlled trials (RCTs) and compare the functional outcomes and rates of complications in Kirschner's wire (K-wire) fixation versus cast immobilization in the management of distal radius fractures.

Materials and methods: A systematic electronic search of Embase, PubMed, and Scopus was performed from inception through to July 26, 2024. All articles addressing RCTs comparing plaster cast immobilization and K-wire fixation in distal radius fractures were included. This study was performed according to the Preferred Items for Systematic Reviews and Meta-Analysis guidelines. The quality of studies was assessed using the Cochrane Risk-of-Bias 2 tool for RCTs.

Results: A total of nine studies with 1,097 patients (580 and 517 who underwent cast immobilization and K-wire fixation, respectively) were included for analysis. There was a significantly higher risk of complications (risk ratio [RR]: 1.75, 95% confidence interval [CI]: 1.10-2.78; p  = 0.02) and malunion (RR: 9.03, 95% CI: 2.57-31.75; p  = 0.0006) in cast immobilization than K-wiring. There was also a significant difference in Patient-Rated Wrist Evaluation (PRWE) scores at 12 months (mean difference: 0.81; 95% CI: 0.10-1.52; p  = 0.02). There were no significant differences in other outcomes that could be meta-analyzed such as range of motion and grip strength. There was also no significant difference in other complications such as chronic regional pain syndrome, finger stiffness, and osteoarthritis.

Conclusion: This systematic review and meta-analysis found a significantly higher risk of total adverse events and malunion in cast immobilization than K-wiring as well as a significant difference in PRWE scores at 12 months. Our results thus suggest that K-wiring is more favorable than cast immobilization in the management of distal radius fractures.

Purpose  The purpose of this study was to utilize a large multi-institutional database to identify risk factors associated with the need for revision surgery and to determine revision rate in patients who underwent operative treatment of Kienbock's disease (KD). Materials and Methods  The New York Statewide Planning and Research Cooperative System database was reviewed to identify patients who underwent any surgical procedure with a diagnosis of KD from 2011 to 2021. The control cohort diagnoses included primary osteoarthritis of the carpus or wrist. All statistical calculations were performed using R version 4.2.2 (The R Foundation, Vienna, Austria). Results  There were a total of 499 patients in the KD cohort and 6,823 patient controls. The KD cohort was significantly younger, had a greater proportion of females, and higher rates of obesity. The control cohort, on average, had more comorbidities as evidenced by the higher Elixhauser Index compared with the KD cohort. Overall revision rate for KD patients was 12% ( n  = 59). None of the index procedures were more likely to be revised compared with wrist arthrodesis. Compared with the control cohort, patients with KD were less likely to undergo revision surgery. At 1-, 2-, 5-, and 10-year intervals, KD patients maintained a lower revision rate compared with controls. Risk factor for eventual revision included worker's compensation status and protective factors included older age, a diagnosis of Kienbock's, male sex, obesity, and higher Elixhauser Index. Conclusion  In a large multi-institutional analysis, patients who underwent surgical treatment of KD experienced a lower revision rate over a 10-year period compared with arthritic controls. Compared with the single-institution cohorts published, the overall KD revision rate was higher (12%) but similar to the published literature, the KD revision rate is lower than the same procedures for non-KD controls. Level of Evidence  Therapeutic, IV.

Background: This retrospective study aimed to evaluate median nerve displacement observed during hardware removal procedures following volar plating for distal radius fractures.

Materials and methods: We reviewed all cases involving removal of distal radial volar locking plates at our institution by two surgeons from 2016 to 2021. Plating procedures and hardware removals were performed using the flexor carpi radialis (FCR) approach. We examined the position of the median nerve at the time of hardware removal.

Results: Median nerve displacement to the radial side of the FCR occurred in 17 out of 67 cases (25%). There were no significant differences in the degree of fracture severity or involved surgeons between the normal position and displaced groups.

Conclusion: The median nerve may be displaced radially from the FCR during hardware removal, and care should be taken to avoid causing iatrogenic nerve injury.

Level of evidence: Level II.

Introduction: Hardware prominence is one of the major established complications following volar plating of distal radius fractures. The purpose of this cadaveric study is to compare two conventional fluoroscopic imaging views (carpal shoot-through view [CSV] and dorsal horizon view [DHV]) with ultrasound (US) to establish the best intraoperative imaging modality for surgeons to use to identify penetration of screws through the dorsal cortex and/or into the distal radioulnar joint (DRUJ).

Materials and methods: Twelve human cadaveric limbs were included in the study, instrumented with distal radius plates via a volar approach. The three imaging modalities, CSV, DHV, and US, were compared in terms of detecting prominent screws during volar plate fixation. Six surgeons with varying levels of expertise performed the evaluations. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and the area under the receiver operating characteristic curve were computed for every surgeon and imaging method.

Results: The CSV was found to be more sensitive compared with the DHV and US for detecting dorsal cortex penetration (99% vs. 94% vs. 56%, respectively). The DHV was found to be more sensitive in recognizing DRUJ screw penetration compared with CSV and US (89% vs. 78% vs. 11%, respectively). US evaluation demonstrated considerably lower diagnostic utility compared with CSV and DHV. Surgeon's ability to perform as well as confidence in evaluating for screw penetration was highest with the CSV view.

Conclusion: Fluoroscopic imaging, particularly the CSV, demonstrates greater diagnostic reliability compared with US for intraoperative detection of prominent screws following volar plate fixation of the distal radius. CSV was also identified as the most reproducible examination for all levels of expertise with minimal formal training required.

Level of evidence: Therapeutic level V.

Total wrist arthroplasty (TWA) is a surgical option for individuals with end-stage wrist arthritis; however, their longevity remains below that of the hip and the knee. The objective of this study was to examine the muscle forces and articular loading patterns following TWA to better understand possible failure modes. Eight cadaveric specimens underwent active motion simulation representing planar flexion-extension and planar radial/ulnar deviation in both intact and TWA reconstructed states using a custom load sensing TWA. Results showed that muscle forces for extensors increased post-TWA implantation when extending the joint, whereas the flexors remain relatively unchanged. In addition, the articular loading was greater during extension than during flexion and during ulnar deviation than during radial deviation. The increase in muscle forces and high carpal component loading postimplantation may contribute to decreased longevity and early failure of implants.

A systematic literature review was performed to assess the results of modified Brunelli tenodesis modified Brunelli technique (MBT) and three-ligament tenodesis (3LT) in the treatment of chronic scapholunate (SL) ligament injuries reported between 1998 and 2001. This review describes the surgical techniques, clinical outcomes, radiological evaluations, and complication rates among 600 patients. Following adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 15 studies were included (289 MBT and 311 3LT procedures). A heterogeneity in surgical technique was noted. An average pain reduction of 3 points on the visual analog score and a flexion-extension arch compatible with most daily activities were found. Radiographic follow-up showed medium-term improvements, but loss of reduction was observed in the long term. Secondary degeneration was seen in 15% of cases. Radiographic decay did not correlate with clinical outcomes. The overall complication rate was 9%. This review underscores the satisfactory clinical outcome of both procedures. Nonetheless, both interventions pose risks of complications and/or degeneration in the long term.