Journal of Wrist Surgery最新文献

Background  Ulnar impaction syndrome (UIS), also known as ulnar impaction or ulnar abutment, is a degenerative condition causing pain on the ulnar side of the wrist. It can lead to wrist bone necrosis, resulting in wrist joint stability disruption and a significant wrist function impairment. The global understanding of this condition varies, contributing to substantial differences in clinical outcomes. Purposes  This paper underscores the necessity of developing evidence-based clinical guidelines for UIS to guide clinicians in their diagnostic and therapeutic approaches. Materials and Methods  In collaboration with the Asian Pacific Wrist Association, a team of experts from various fields within the Hand Surgery Department at Huashan Hospital has collectively formulated the "Clinical Practice Guidelines for Ulnar Impaction Syndrome (2024)" (hereinafter referred to as the "Guidelines"). The development process adhered to the guidelines outlined in the World Health Organization's handbook for guideline development. Results  Ten key questions and 21 recommendations are formed. The Guidelines provide recommendations for UIS diagnosis, criteria for selecting conservative or surgical interventions, options for surgical procedures, and address various related issues. Conclusions  The collaborative effort aims to standardize clinical practices, enhance diagnostic accuracy, and improve treatment outcomes for individuals affected by UIS, with these recommendations intended to serve as a valuable reference for healthcare professionals.

Background  Few studies have reported the clinical results of arthroscopic debridement and thermal shrinkage for partial lunotriquetral (LT) ligament injury. Purpose  We estimated the outcomes of arthroscopic thermal shrinkage of a traumatic LT ligament incomplete tear without triangular fibrocartilage complex (TFCC) perforation. Methods  We evaluated the results of 24 patients. The mean follow-up was 16 months. Radiographs were examined for ulnar variance (UV) and radioulnar distance on a true lateral radiograph, and wrist function was assessed based on grip strength, Mayo wrist score, and Disabilities of the Arm, Shoulder, and Hand (DASH) score, both pre- and postoperatively. Results  On preoperative magnetic resonance imaging (MRI), no obvious LT ligament tear was observed in any of the patients. The preoperative LT shear test was positive in 19 cases, while the LT ballottement test was positive in 18 cases and the ulnar stress test in 16 cases. Preoperatively, the average radiographic UV was 2.1 mm and the average radioulnar distance was 0.9 mm. The LT tear type was a flap tear in 22 cases and bucket handle tear in 2 cases arthroscopically. The visual analog pain scale score improved postoperatively (from 7.5 to 0.4). The average grip strength improved from 72.7% preoperatively to 89.8% postoperatively. The Mayo wrist score was excellent/good in 6/15 cases and fair in 3 cases, with the scores ranging from 68 to 87. The average DASH score improved from 36.8 to 7. Conclusion  We should be careful to differentiate LT ligament tears from TFCC lesions in the cases with ulnar wrist pain, because LT ligament tears may not be detected by MRI. Arthroscopic thermal shrinkage for traumatic LT ligament tear can be an effective treatment. Level of Evidence  Level IV.

Background  To avoid screw penetration into the joint when using the polyaxial volar locking plate (VLP) for osteosynthesis of distal radius fractures, it is important to note that the optimal screw insertion angles depending on the plate positions. Purpose  The purpose of this study was 2-fold: first, to evaluate the differences of the most distal plate position where the screw does not penetrate into the joint in the three-dimensional (3D) radius models; second, to evaluate the relationship between the plate position and the transverse diameter of the distal radius. Patients and Methods  Thirty plain X-rays and computed tomography (CT) scans of healthy wrists were evaluated. The transverse diameter was measured on plain X-rays. 3D radius models were reconstructed from CT data. A 3D image of polyaxial VLP was used to investigate the most distal plate position at three different screw insertion angles. The linear distance between the volar articular edge and the plate edge was measured and compared among different screw insertion angles. The correlations between the plate positions and the transverse diameter were also evaluated. In addition, the relationship between the most distal screw place and articular surface was confirmed with one case of distal radius fracture. Results  The optimal positions relative to the neutral were 2.7 mm proximal in the distal swing and 1.9 mm distal in the proximal swing. The linear distance was significantly correlated with the transverse diameter in each group. It was confirmed that the relationship between the most distal screw place and articular surface was applicable in the actual case. Conclusion  The results showed that the most distal position of the polyaxial VLP differed depending on the screw insertion angle and became more proximal as the transverse diameter increased. These results may be useful as a reference for preoperative planning. Levels of Evidence  III.

Background  Vaughan-Jackson syndrome (VJS) is the attritional rupture of the extensor tendons secondary to arthritis or inflammation affecting the distal radioulnar joint. The surgical outcomes following Darrach's procedure and tendon transfers are not well described. The primary aim of this study was to report patient-reported functional outcome measures after surgery for VJS. Secondary aims were to report health-related quality-of-life scores, patient satisfaction, and complications Methods  A single-center retrospective study was performed to identify patients who underwent surgical intervention for the management of VJS. Patient-reported outcomes were measured using the Patient-Rated Wrist and Hand Evaluation (PRWHE), Quick version of the Disability of the Arm, Shoulder, and Hand (QuickDASH), EuroQoL 5-dimensions 5-Likert (EQ-5D-5L), and calculation of the Net Promoter Score (NPS). Results  We report postoperative patient-reported functional outcome measures for 12 cases of VJS treated with distal ulna excision and extensor tendon transfer. The mean age was 69 years (range: 45-87 years; standard deviation [SD]: 14.1), and eight patients were females. Five patients had rheumatoid arthritis, and there was one case each of seronegative polyarthritis, ankylosing spondylitis, and CREST (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia.) syndrome; the rest of the patients had osteoarthritis. At a mean of 53 months of follow-up, the mean PRWHE score was 34.5 (SD: 17.9), the mean QuickDASH score was 28.2 (SD: 18.6), and the mean EQ-5D-5L score was 0.71 (SD: 0.203). Ten patients were satisfied and the NPS was 42. Postoperatively eight patients had pain scores reported as none or mild, three as moderate, and one as severe. Two patients required further operations, both undergoing total wrist arthrodesis. Conclusion  Although a degree of functional deficit persists after Darrach's procedure and tendon transfer for treatment of VJS, there are also high levels of patient satisfaction, a good NPS, and a low rate of operative reintervention. Level IV  evidence.

Background  In recent years, the classification and treatment algorithm for adult Kienböck's disease (KD) has expanded. However, the priority of the investigations done in determining its management has not been discussed, as not every patient with KD requires magnetic resonance imaging (MRI) or wrist arthroscopy. Materials and Methods  We discuss the role of these investigations and emphasize the importance of computed tomography (CT) imaging in evaluating the cortical integrity of the lunate and its role in the decision-making process and management of KD. Results  We put forward an investigative algorithm that places into context the investigative roles of MRI, arthroscopy, and CT. Conclusion  KD is a rare condition, and there is a lack of comparative studies to help us choose the preferred treatment. The decision on the management options in adult KD may be made by determining the integrity of the lunate cortex and deciding whether the lunate is salvageable or not by CT scan. MRI may provide useful information on the vascular status if the lunate cortex is intact, and the lunate is salvageable. If the lunate is fragmented, it is not salvageable, and MRI does not provide useful information. Arthroscopy has a role in selective cases.

Background  Fractures of the distal radius that occur bilaterally are comparatively uncommon, with the incidence of these injuries and patient outcomes following different modes of treatment being unknown. Purpose  This article evaluates the demographics, management, and functional outcomes of patients that sustain bilateral distal radius fractures (DRFs). Materials and Methods  We retrospectively identified 85 patients that sustained bilateral DRF and were treated at a single institution from 2016 to 2019. Thirty-four patients were treated operatively, 41 patients were treated nonoperatively, and 10 patients were treated operatively in one extremity and nonoperatively in the other. Fractures were classified by a single fellowship-trained orthopaedic hand surgeon. Range of motion (ROM) data and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores were collected. Differences between the three groups with regards to demographics, mechanism of injury (MOI), and complications were recorded. Results  The pediatric population had significantly higher energy MOIs compared to the adult population. There was no difference between the groups with regard to associated injuries or complications. The pediatric population had significantly more AO type A fractures compared to the adult population, which had a bimodal distribution of AO type A and C fractures. The pediatric population saw significantly more patients undergo nonoperative treatment. Both populations had a higher rate of operative intervention for bilateral DRF than noted in the literature for unilateral. In the adult population there were no significant differences in DASH scores between the operative and nonoperative groups. Conclusion  Bilateral DRFs appear to have a similar bimodal age distribution to unilateral DRF. Younger patients undergo nonoperative management more commonly than operative or mixed management. Postoperative ROM and complications appear to be equivalent across all three groups regardless of age. Level of Evidence  Level IV, Prognostic study.