Background Ulnar-positive variance is widely recognized as a risk factor for idiopathic ulnar impaction syndrome (UIS). However, not all patients with ulnar-positive variance progress to symptomatic UIS. Other factors, such as the shape of the lunate or the distal radioulnar joint (DRUJ), may also play a role. This study aims to elucidate the relationship between the shape of the lunate and the structure of the DRUJ and idiopathic UIS. Patients and Methods A cohort of 40 cases diagnosed with idiopathic UIS (UIS group) and 87 control subjects with ulnar-positive variance but without symptoms were compared. Lunate shape was assessed by measuring the lunate type and radiolunate angle (RLA), whereas DRUJ morphology was evaluated using the sigmoid notch angle, DRUJ subluxation ratio, and DRUJ inclination. Independent t-tests were conducted to analyze differences in radiographic metrics between the two groups, and logistic regression analyses were used to examine risk factors for idiopathic UIS. Receiver operating characteristic curves were utilized to determine the cutoff values for statistically significant variables. Results Significant differences were observed between the two groups in terms of RLA, DRUJ subluxation ratio, and DRUJ inclination (p < 0.05). Logistic multiple regression analysis revealed a negative correlation between idiopathic UIS occurrence and both RLA (odds ratio [OR]: 0.92; 95% confidence interval [CI]: 0.87–0.96; p < 0.001) and the DRUJ subluxation ratio (OR: 0.01; 95% CI: 0–0.07; p = 0.002). Conversely, a positive correlation was found between UIS occurrence and DRUJ inclination (OR: 1.06; 95% CI: 1.01–1.12; p = 0.021). Conclusion In patients with ulnar-positive variance, the incidence of symptomatic UIS decreases when the lunate extends more relative to the radius and when the DRUJ subluxation ratio increases or DRUJ inclination decreases. Level of Evidence Level III, case–control study.
{"title":"Distal Radioulnar Joint Orientation and Lunate Morphology as Protective Factors of Symptomatic Idiopathic Ulnar Impaction Syndrome in Ulnar-Positive Variant Patients","authors":"Seong Kee Shin, Ki Hong Kim, Kyu Jin Kim","doi":"10.1055/s-0044-1788706","DOIUrl":"https://doi.org/10.1055/s-0044-1788706","url":null,"abstract":"\u0000 Background Ulnar-positive variance is widely recognized as a risk factor for idiopathic ulnar impaction syndrome (UIS). However, not all patients with ulnar-positive variance progress to symptomatic UIS. Other factors, such as the shape of the lunate or the distal radioulnar joint (DRUJ), may also play a role. This study aims to elucidate the relationship between the shape of the lunate and the structure of the DRUJ and idiopathic UIS.\u0000 Patients and Methods A cohort of 40 cases diagnosed with idiopathic UIS (UIS group) and 87 control subjects with ulnar-positive variance but without symptoms were compared. Lunate shape was assessed by measuring the lunate type and radiolunate angle (RLA), whereas DRUJ morphology was evaluated using the sigmoid notch angle, DRUJ subluxation ratio, and DRUJ inclination. Independent t-tests were conducted to analyze differences in radiographic metrics between the two groups, and logistic regression analyses were used to examine risk factors for idiopathic UIS. Receiver operating characteristic curves were utilized to determine the cutoff values for statistically significant variables.\u0000 Results Significant differences were observed between the two groups in terms of RLA, DRUJ subluxation ratio, and DRUJ inclination (p < 0.05). Logistic multiple regression analysis revealed a negative correlation between idiopathic UIS occurrence and both RLA (odds ratio [OR]: 0.92; 95% confidence interval [CI]: 0.87–0.96; p < 0.001) and the DRUJ subluxation ratio (OR: 0.01; 95% CI: 0–0.07; p = 0.002). Conversely, a positive correlation was found between UIS occurrence and DRUJ inclination (OR: 1.06; 95% CI: 1.01–1.12; p = 0.021).\u0000 Conclusion In patients with ulnar-positive variance, the incidence of symptomatic UIS decreases when the lunate extends more relative to the radius and when the DRUJ subluxation ratio increases or DRUJ inclination decreases.\u0000 Level of Evidence Level III, case–control study.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141803819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Remodeling or Recurrence? Secondary to Radial Dome Osteotomy in Madelung's Deformity: Comment on the Study by Rus et al","authors":"Sitanshu Barik, V. Raj, Vishal Kumar","doi":"10.1055/s-0044-1788684","DOIUrl":"https://doi.org/10.1055/s-0044-1788684","url":null,"abstract":"","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141803347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Wrist arthroscopy is an efficient tool for the surgical treatment of distal radius fracture (DRF). It could show us the various conditions of the radiocarpal joint, its effectiveness seems to overwhelm that of fluoroscopy. Methods Since July 2005, we have performed wrist arthroscopy and plate presetting arthroscopic reduction technique (PART) for 141 extra-articular and 559 intra-articular DRFs and investigated various kinds of intra-articular conditions and advantages of wrist arthroscopy. Results The pathological conditions clarified and the advantages of PART in the surgical treatment of DRF are: (1) accurate reduction of intra-articular fragments is possible compared with fluoroscopic reduction, (2) intra-articular fragments (free body) undetected with radiograph and CT can be recognized, (3) screw protrusion into joint surface can be monitored, (4) intra-articular soft tissue injury associated with fracture can be evaluated and treated, and (5) debridement of joint hematoma can be performed. Severe complications such as tendon rupture, major neurovascular injury or compartment syndrome from arthroscopy were never encountered. Conclusions The volar locking plate fixation and simultaneous arthroscopic intervention is problematic because vertical traction must be applied and released during surgery. PART can overcome these difficulties and achieved good clinical results.
{"title":"What Have We Learned in the Wrist Joint of Distal Radius Fracture through Wrist Arthroscopy?","authors":"Yukio Abe, Yohei Takahashi, Yoshinori Sugita","doi":"10.1055/s-0044-1788644","DOIUrl":"https://doi.org/10.1055/s-0044-1788644","url":null,"abstract":"\u0000 Background Wrist arthroscopy is an efficient tool for the surgical treatment of distal radius fracture (DRF). It could show us the various conditions of the radiocarpal joint, its effectiveness seems to overwhelm that of fluoroscopy.\u0000 Methods Since July 2005, we have performed wrist arthroscopy and plate presetting arthroscopic reduction technique (PART) for 141 extra-articular and 559 intra-articular DRFs and investigated various kinds of intra-articular conditions and advantages of wrist arthroscopy.\u0000 Results The pathological conditions clarified and the advantages of PART in the surgical treatment of DRF are: (1) accurate reduction of intra-articular fragments is possible compared with fluoroscopic reduction, (2) intra-articular fragments (free body) undetected with radiograph and CT can be recognized, (3) screw protrusion into joint surface can be monitored, (4) intra-articular soft tissue injury associated with fracture can be evaluated and treated, and (5) debridement of joint hematoma can be performed. Severe complications such as tendon rupture, major neurovascular injury or compartment syndrome from arthroscopy were never encountered.\u0000 Conclusions The volar locking plate fixation and simultaneous arthroscopic intervention is problematic because vertical traction must be applied and released during surgery. PART can overcome these difficulties and achieved good clinical results.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141802559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sandie Eiras, Gregorios Bolgouras, Christos Panayiotou, Zacharias Alexandrou, C. Papakostidis
Background Isolated, highly comminuted trapezium fractures are extremely rare. While they can be initially diagnosed with plain radiographs, a computed tomography scan of the wrist will more clearly reveal the fracture details and aid in appropriate preoperative planning. Restoration of the fracture with a congruent reduction of the adjacent joints is mandatory for a favorable prognosis. Case Description A case of a highly comminuted, biarticular, trapezium fracture in a young male patient that was treated operatively with open reduction and internal fixation (ORIF) with a cannulated miniscrew and an additional Kirschner wire (K-wire) is presented. Restoration of a decent intra-articular congruity of the trapezium with both the base of the first metacarpal distally and the scaphoid bone proximally ensured a favorable outcome. Literature Review Various operative techniques are presented in current literature, encompassing ORIF with screws and K-wires, closed reduction and percutaneous fixation with K-wires, mini-external fixation, button fixation, and arthroscopically assisted percutaneous fixation. A favorable prognosis is documented in cases where a congruous reduction of the fracture was achieved and maintained throughout the healing period. Clinical Relevance We feel that a formal ORIF is the procedure of choice for highly comminuted trapezium fractures, as they are not easily amenable to accurate reduction by means of closed methods.
背景 孤立、高度粉碎性梯形骨折极为罕见。虽然可通过普通X光片进行初步诊断，但腕部计算机断层扫描能更清楚地显示骨折细节，有助于制定适当的术前计划。为了获得良好的预后，必须对骨折进行复位，并对相邻关节进行一致的复位。病例描述 本病例是一名年轻男性患者的高度粉碎性、双关节、梯形骨折，采用切开复位和内固定术（ORIF）治疗，使用插管微型螺钉和额外的 Kirschner 线（K 线）。该手术恢复了斜方肌与第一掌骨远端基底和肩胛骨近端的关节内一致性，确保了良好的治疗效果。文献综述 目前的文献介绍了多种手术技术，包括使用螺钉和 K 型钢丝的 ORIF、闭合复位和 K 型钢丝经皮固定、迷你外固定、纽扣固定和关节镜辅助经皮固定。有资料显示，在实现骨折整齐复位并保持整个愈合期的病例中，预后良好。临床意义 我们认为，对于高度粉碎性斜方肌骨折，正式的闭合复位术是首选手术，因为这些骨折不易通过闭合方法进行精确复位。
{"title":"Operative Treatment of an Isolated, Comminuted, Biarticular Trapezium Fracture: A Case Report and Review of the Literature","authors":"Sandie Eiras, Gregorios Bolgouras, Christos Panayiotou, Zacharias Alexandrou, C. Papakostidis","doi":"10.1055/s-0044-1788639","DOIUrl":"https://doi.org/10.1055/s-0044-1788639","url":null,"abstract":"\u0000 Background Isolated, highly comminuted trapezium fractures are extremely rare. While they can be initially diagnosed with plain radiographs, a computed tomography scan of the wrist will more clearly reveal the fracture details and aid in appropriate preoperative planning. Restoration of the fracture with a congruent reduction of the adjacent joints is mandatory for a favorable prognosis.\u0000 Case Description A case of a highly comminuted, biarticular, trapezium fracture in a young male patient that was treated operatively with open reduction and internal fixation (ORIF) with a cannulated miniscrew and an additional Kirschner wire (K-wire) is presented. Restoration of a decent intra-articular congruity of the trapezium with both the base of the first metacarpal distally and the scaphoid bone proximally ensured a favorable outcome.\u0000 Literature Review Various operative techniques are presented in current literature, encompassing ORIF with screws and K-wires, closed reduction and percutaneous fixation with K-wires, mini-external fixation, button fixation, and arthroscopically assisted percutaneous fixation. A favorable prognosis is documented in cases where a congruous reduction of the fracture was achieved and maintained throughout the healing period.\u0000 Clinical Relevance We feel that a formal ORIF is the procedure of choice for highly comminuted trapezium fractures, as they are not easily amenable to accurate reduction by means of closed methods.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141827443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Treatment and Outcomes of Missed Perilunate Dislocations: A Case Series","authors":"Philippe Liverneaux","doi":"10.1055/s-0044-1788626","DOIUrl":"https://doi.org/10.1055/s-0044-1788626","url":null,"abstract":"","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141826043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mikaela H Sullivan, Joshua J Meaike, B. Elhassan, Sanjeev Kakar
Background Salvage procedures for failed total wrist arthroplasty have variable results and limitations such as donor site morbidity, malunion, delayed or nonunion. We present a case of substantial bone loss after failed wrist arthroplasty and a surgical technique in which the distal ulna is transferred and intussuscepted to achieve union between the residual distal radius and metacarpals. Case Description A 48-year-old female with rheumatoid arthritis presented with wrist prosthetic joint infection 16 years after total wrist arthroplasty. With extensive bone loss following implant removal and multiple debridements, the remaining distal ulna was resected and intussuscepted between the residual radius and second and third metacarpals. The patient achieved incorporation of the graft at 12 weeks and fusion at 20 weeks, with resolution of pain and restoration of digit function at 2 years. Literature Review Standard means of wrist arthrodesis utilizing iliac crest autograft and femoral head allograft may be limited to address substantial bone loss following total wrist implant removal. Intussusception has been utilized in the elbow, hip, and diaphysis to optimize graft–host bone contact and achieve union. While ulna-utilizing procedures have been described for oncologic and traumatic indications, to our knowledge, double intussusception has not been described for salvage procedures after failed wrist arthroplasty. Clinical Relevance Intussuscepting the distal ulna within the distal radius and metacarpals as an interpositional arthrodesis provides autologous graft, increased surface contact, and length restoration in cases of poor bone quality and significant bone loss following revision of a total wrist implant.
{"title":"Wrist Arthrodesis with Double Ulna Intussusception for Failed Wrist Arthroplasty","authors":"Mikaela H Sullivan, Joshua J Meaike, B. Elhassan, Sanjeev Kakar","doi":"10.1055/s-0044-1786188","DOIUrl":"https://doi.org/10.1055/s-0044-1786188","url":null,"abstract":"\u0000 Background Salvage procedures for failed total wrist arthroplasty have variable results and limitations such as donor site morbidity, malunion, delayed or nonunion. We present a case of substantial bone loss after failed wrist arthroplasty and a surgical technique in which the distal ulna is transferred and intussuscepted to achieve union between the residual distal radius and metacarpals.\u0000 Case Description A 48-year-old female with rheumatoid arthritis presented with wrist prosthetic joint infection 16 years after total wrist arthroplasty. With extensive bone loss following implant removal and multiple debridements, the remaining distal ulna was resected and intussuscepted between the residual radius and second and third metacarpals. The patient achieved incorporation of the graft at 12 weeks and fusion at 20 weeks, with resolution of pain and restoration of digit function at 2 years.\u0000 Literature Review Standard means of wrist arthrodesis utilizing iliac crest autograft and femoral head allograft may be limited to address substantial bone loss following total wrist implant removal. Intussusception has been utilized in the elbow, hip, and diaphysis to optimize graft–host bone contact and achieve union. While ulna-utilizing procedures have been described for oncologic and traumatic indications, to our knowledge, double intussusception has not been described for salvage procedures after failed wrist arthroplasty.\u0000 Clinical Relevance Intussuscepting the distal ulna within the distal radius and metacarpals as an interpositional arthrodesis provides autologous graft, increased surface contact, and length restoration in cases of poor bone quality and significant bone loss following revision of a total wrist implant.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141828011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Luchetti, Sara Montanari, L. Marcovici, R. Cozzolino, Sanjeev Kakar, A. Atzei
Purpose This study aimed to describe the technique, indications, and advantages of the single-portal arthroscopic approach for the diagnosis and staging of chronic radial-sided disorders, including scapholunate interosseous ligament (SLIL) tear, scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) deformities. Methods The single portal technique was used in 138 patients affected by suspected SLIL lesions, SLAC and SNAC wrist injuries with positive clinical symptoms and inconclusive imaging (X-ray and MRI). It was used to grade the nature of the SLIL lesion and the extension of the osteochondral damage in the SLAC and SNAC wrist deformity to guide appropriate treatment. Results Patients were divided into group 1 (SLIL: 45 cases), group 2a (SLAC: 65 cases), and group 2b (SNAC: 28 cases). In group 1, stage 4 SLIL lesions were confirmed in 36 cases and 9 were assessed as SLAC wrist deformity. In group 2a, single-portal arthroscopy confirmed the preoperative diagnosis in 74% of cases. In the remaining 26% of patients, arthroscopy modified the preoperative diagnosis: 1 case of SLAC 1 resulted in SLAC 2, 14 cases of SLAC 2 resulted in SLAC 3, 1 case of SLAC 3 resulted in SLAC 2. A case of SLAC 2 turned out to be an SLIL lesion stage 4. In group 2b, single-portal arthroscopy confirmed the preoperative diagnosis in 86% of cases. In the remaining 14% (4 cases), it modified the preoperative diagnosis: 1 of SNAC 1 resulted in SNAC 2 and the other in SNAC 3, 1 case of SNAC 2 turned out to be an SNAC 3, and 1 case of SNAC 3 resulted in SNAC 4. Conclusion Single-portal wrist arthroscopy modified the preoperative diagnosis of wrist pathology in 42 patients over 138 cases. The use of single-portal wrist arthroscopy should be considered in the evaluation of the radiocarpal and midcarpal joints to allow accurate visualization of the joint surfaces for surgeon and patient planning. Type of Study/Level of Evidence Observational study level of evidence IV.
{"title":"Single-Portal Arthroscopy Improves the Assessment of Radial-sided Disorders of the Wrist","authors":"R. Luchetti, Sara Montanari, L. Marcovici, R. Cozzolino, Sanjeev Kakar, A. Atzei","doi":"10.1055/s-0044-1788294","DOIUrl":"https://doi.org/10.1055/s-0044-1788294","url":null,"abstract":"\u0000 Purpose This study aimed to describe the technique, indications, and advantages of the single-portal arthroscopic approach for the diagnosis and staging of chronic radial-sided disorders, including scapholunate interosseous ligament (SLIL) tear, scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) deformities.\u0000 Methods The single portal technique was used in 138 patients affected by suspected SLIL lesions, SLAC and SNAC wrist injuries with positive clinical symptoms and inconclusive imaging (X-ray and MRI). It was used to grade the nature of the SLIL lesion and the extension of the osteochondral damage in the SLAC and SNAC wrist deformity to guide appropriate treatment.\u0000 Results Patients were divided into group 1 (SLIL: 45 cases), group 2a (SLAC: 65 cases), and group 2b (SNAC: 28 cases). In group 1, stage 4 SLIL lesions were confirmed in 36 cases and 9 were assessed as SLAC wrist deformity. In group 2a, single-portal arthroscopy confirmed the preoperative diagnosis in 74% of cases. In the remaining 26% of patients, arthroscopy modified the preoperative diagnosis: 1 case of SLAC 1 resulted in SLAC 2, 14 cases of SLAC 2 resulted in SLAC 3, 1 case of SLAC 3 resulted in SLAC 2. A case of SLAC 2 turned out to be an SLIL lesion stage 4. In group 2b, single-portal arthroscopy confirmed the preoperative diagnosis in 86% of cases. In the remaining 14% (4 cases), it modified the preoperative diagnosis: 1 of SNAC 1 resulted in SNAC 2 and the other in SNAC 3, 1 case of SNAC 2 turned out to be an SNAC 3, and 1 case of SNAC 3 resulted in SNAC 4.\u0000 Conclusion Single-portal wrist arthroscopy modified the preoperative diagnosis of wrist pathology in 42 patients over 138 cases. The use of single-portal wrist arthroscopy should be considered in the evaluation of the radiocarpal and midcarpal joints to allow accurate visualization of the joint surfaces for surgeon and patient planning.\u0000 Type of Study/Level of Evidence Observational study level of evidence IV.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141829137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Victor Koltenyuk, Matthew Merckling, Michael Li, Ian Jarin, Matthew Konigsberg
Hypothesis The modified five-factor frailty index (mFI-5) is a better predictor than age alone of increased risk of extended length of stay (LOS) and postoperative complications in patients undergoing total wrist arthrodesis (TWA). Methods The National Inpatient Sample database was queried for patients undergoing elective TWA. Patients were identified using the International Classification of Diseases, 10th Revision procedure codes, excluding nonelective cases, hardware removal, and patients with cerebral palsy or seizure disorders. Frailty was assessed by identifying the variables used in the mFI-5 and patients were categorized as nonfrail (mFI-5 = 0), prefrail (mFI-5 = 1), and frail (mFI-5 ≥ 2). Outcomes assessed included LOS and immediate postoperative complications such as nausea and vomiting requiring admission, acute kidney injury, postoperative hypotension, postoperative hypothyroidism, and urinary tract infection. Logistic regression was used to analyze the association between frailty status and both extended LOS and immediate postoperative complications. Results Between 2015 and 2019, 685 patients underwent TWA, with 49.6% not frail, 33.5% prefrail, and 16.7% frail. Prefrail and frail patients were at increased risk of undergoing extended LOS (OR 2.182, p = 0.001; OR 2.312, p = 0.002, respectively). Age over 65 (OR 1.995, p < 0.001) and female sex (OR 1.605, p = 0.029) were also independent risk factors. Frail patients were found to have an increased likelihood of acquiring any postoperative complication (OR 3.865, p < 0.001), while elderly age was not a significant risk factor (OR 1.361, p = 0.298). Using receiver operating characteristic (ROC) curve analysis, the mFI-5 demonstrated superior discriminatory ability compared with age for extended LOS (Area under the curve (AUC) 0.729 vs. 0.542) and postoperative complications (AUC 0.712 vs. 0.673). Conclusion Our study demonstrates that both elderly age and frailty are independent predictors of extended hospitalization following TWA, while frailty but not age, is a significant predictor of immediate postoperative complications. To our knowledge, our study is the first to report an association between frailty status and immediate postoperative complications following TWA. Incorporating a preoperative frailty screening can allow for more open and informed preoperative discussion about surgical risk for elective procedures such as TWA, as well as allow for enhanced postoperative planning.
{"title":"Frailty is Superior to Age at Predicting Extended Length of Stay and Immediate Postoperative Complications Following Total Wrist Arthrodesis","authors":"Victor Koltenyuk, Matthew Merckling, Michael Li, Ian Jarin, Matthew Konigsberg","doi":"10.1055/s-0044-1788295","DOIUrl":"https://doi.org/10.1055/s-0044-1788295","url":null,"abstract":"\u0000 Hypothesis The modified five-factor frailty index (mFI-5) is a better predictor than age alone of increased risk of extended length of stay (LOS) and postoperative complications in patients undergoing total wrist arthrodesis (TWA).\u0000 Methods The National Inpatient Sample database was queried for patients undergoing elective TWA. Patients were identified using the International Classification of Diseases, 10th Revision procedure codes, excluding nonelective cases, hardware removal, and patients with cerebral palsy or seizure disorders. Frailty was assessed by identifying the variables used in the mFI-5 and patients were categorized as nonfrail (mFI-5 = 0), prefrail (mFI-5 = 1), and frail (mFI-5 ≥ 2). Outcomes assessed included LOS and immediate postoperative complications such as nausea and vomiting requiring admission, acute kidney injury, postoperative hypotension, postoperative hypothyroidism, and urinary tract infection. Logistic regression was used to analyze the association between frailty status and both extended LOS and immediate postoperative complications.\u0000 Results Between 2015 and 2019, 685 patients underwent TWA, with 49.6% not frail, 33.5% prefrail, and 16.7% frail. Prefrail and frail patients were at increased risk of undergoing extended LOS (OR 2.182, p = 0.001; OR 2.312, p = 0.002, respectively). Age over 65 (OR 1.995, p < 0.001) and female sex (OR 1.605, p = 0.029) were also independent risk factors. Frail patients were found to have an increased likelihood of acquiring any postoperative complication (OR 3.865, p < 0.001), while elderly age was not a significant risk factor (OR 1.361, p = 0.298). Using receiver operating characteristic (ROC) curve analysis, the mFI-5 demonstrated superior discriminatory ability compared with age for extended LOS (Area under the curve (AUC) 0.729 vs. 0.542) and postoperative complications (AUC 0.712 vs. 0.673).\u0000 Conclusion Our study demonstrates that both elderly age and frailty are independent predictors of extended hospitalization following TWA, while frailty but not age, is a significant predictor of immediate postoperative complications. To our knowledge, our study is the first to report an association between frailty status and immediate postoperative complications following TWA. Incorporating a preoperative frailty screening can allow for more open and informed preoperative discussion about surgical risk for elective procedures such as TWA, as well as allow for enhanced postoperative planning.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141829560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Meulendijks, Jonathan Lans, Jesse B. Jupiter, Neal C. Chen
Background Proximal row carpectomy (PRC) is a procedure used for pain relief from arthrosis that preserves some degree of range of motion (ROM). Dorsal capsular interposition (DCI) is an option for cases where some chondral loss of the capitate is present. Purposes The aim of this study is to assess what factors influence long-term patient-reported outcomes following PRC and specifically to evaluate the role of DCI. Additionally, this study aims to report the long-term postoperative ROM in patients with DCI. Methods Patients who underwent PRC in the period between 2002 and 2017 were retrospectively identified, resulting in a cohort of 162 patients. Patient-reported outcomes were obtained using validated questionnaires and were completed by 59 patients at a median follow-up time of 8.5 years (interquartile range [IQR]: 6.0–13). Multivariable linear regression was performed to identify factors independently associated with patient-reported outcomes. Results The median PRWE (Patient-Rated Wrist Evaluation) score was 17 (IQR: 5.5–52), the median QuickDASH (Quick Disabilities of the Arm, Shoulder and Hand) score was 16 (IQR: 4.5–39), and the median NRS (Numeric Rating Scale) Pain score was 1 (IQR: 0–3). The mean flexion–extension ROM was 70 ± 24 degrees. After correcting for gender, involvement of the capitate cartilage was independently associated with worse QuickDASH scores. Conclusions PRC is associated with good functional outcomes and pain control at long-term follow-up. This generally also applied to patients who underwent DCI; however, the role of DCI in those with capitate cartilage injury remains unclear. Preexistent damage to the capitate cartilage was associated with worse QuickDASH scores. Level of Evidence II, Prognostic study.
{"title":"Long-Term Patient-Reported Outcomes following Proximal Row Carpectomy","authors":"M. Meulendijks, Jonathan Lans, Jesse B. Jupiter, Neal C. Chen","doi":"10.1055/s-0044-1787178","DOIUrl":"https://doi.org/10.1055/s-0044-1787178","url":null,"abstract":"\u0000 Background Proximal row carpectomy (PRC) is a procedure used for pain relief from arthrosis that preserves some degree of range of motion (ROM). Dorsal capsular interposition (DCI) is an option for cases where some chondral loss of the capitate is present.\u0000 Purposes The aim of this study is to assess what factors influence long-term patient-reported outcomes following PRC and specifically to evaluate the role of DCI. Additionally, this study aims to report the long-term postoperative ROM in patients with DCI.\u0000 Methods Patients who underwent PRC in the period between 2002 and 2017 were retrospectively identified, resulting in a cohort of 162 patients. Patient-reported outcomes were obtained using validated questionnaires and were completed by 59 patients at a median follow-up time of 8.5 years (interquartile range [IQR]: 6.0–13). Multivariable linear regression was performed to identify factors independently associated with patient-reported outcomes.\u0000 Results The median PRWE (Patient-Rated Wrist Evaluation) score was 17 (IQR: 5.5–52), the median QuickDASH (Quick Disabilities of the Arm, Shoulder and Hand) score was 16 (IQR: 4.5–39), and the median NRS (Numeric Rating Scale) Pain score was 1 (IQR: 0–3). The mean flexion–extension ROM was 70 ± 24 degrees. After correcting for gender, involvement of the capitate cartilage was independently associated with worse QuickDASH scores.\u0000 Conclusions PRC is associated with good functional outcomes and pain control at long-term follow-up. This generally also applied to patients who underwent DCI; however, the role of DCI in those with capitate cartilage injury remains unclear. Preexistent damage to the capitate cartilage was associated with worse QuickDASH scores.\u0000 Level of Evidence II, Prognostic study.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141266885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ryan Paul, J. Persitz, Shawn Khan, Michael MacDougall, Andrea Chan
Background It remains unclear whether bone grafting is required during corrective osteotomy of the distal radius. The goal of this systematic review is to determine the union, revision, and complication rates of bone grafting techniques associated with extra-articular corrective osteotomy for dorsally malunited distal radius fractures treated with volar plating. Questions Is bone grafting in distal radius corrective osteotomy associated with increased rates of bone union and reduced rates of revision surgery and complications? Methods A comprehensive search of the MEDLINE, Embase, and Cumulative Index to Nursing and Allied Health Literature databases was completed for studies reporting clinical outcomes of extra-articular corrective osteotomy for dorsally malunited distal radius fractures treated with volar plating. Results A total of 13 studies, with 14 intervention arms and 236 patients, were included. Bone grafting techniques consisted of autograft (6 studies, n = 93), synthetic bone grafts (2 studies, n = 38), allograft (1 study, n = 14), or no grafting (5 studies, n = 91). The overall union rate was 97%, and the mean time-to-union was 12.0 weeks. Larger corrections of dorsal tilt and ulnar variance were performed in the autograft and allograft groups. Complication and revision rates were highest in the synthetic group, 45 and 26.3% respectively. Conclusion Grafting in extra-articular corrective osteotomy for dorsally angulated distal radius malunions treated with volar plating is not associated with an improved union rate in the literature. However, larger corrections were achieved in both the autograft and allograft groups compared to the no-graft and synthetic groups, resulting in similar union rates. Synthetic bone grafting was associated with the highest complication and revision rates. Future comparative prospective trials and proper documentation of whether cortical contact was present or absent are required to assess whether bone grafting warrants consideration in more advanced deformities. Level of Evidence IV.
背景 目前仍不清楚在桡骨远端矫正截骨术中是否需要植骨。本系统性综述的目的是确定在对桡骨远端背侧畸形骨折进行外固定治疗时，与关节外矫正截骨术相关的植骨技术的骨结合率、翻修率和并发症发生率。问题 在桡骨远端矫正截骨术中进行植骨是否能提高骨结合率、降低翻修手术率和并发症发生率？方法 对 MEDLINE、Embase 和 Cumulative Index to Nursing and Allied Health Literature 数据库进行了全面检索，以寻找报告了采用伏氏钢板治疗背侧畸形桡骨远端骨折的关节外矫正截骨术临床结果的研究。结果 共纳入 13 项研究，14 个干预臂，236 名患者。植骨技术包括自体植骨（6 项研究，n = 93）、合成植骨（2 项研究，n = 38）、异体植骨（1 项研究，n = 14）或不植骨（5 项研究，n = 91）。总体愈合率为 97%，平均愈合时间为 12.0 周。自体移植物组和异体移植物组的背倾和尺侧变异的矫正幅度较大。合成组的并发症和翻修率最高，分别为45%和26.3%。结论 在对背侧成角的桡骨远端畸形进行的关节外矫正截骨术中进行移植，并不能提高文献中的愈合率。然而，与无移植物组和合成组相比，自体移植物组和异体移植物组都获得了更大的矫正，从而获得了相似的愈合率。合成骨移植的并发症和翻修率最高。未来需要进行比较性前瞻性试验，并适当记录皮质接触是否存在，以评估在更晚期的畸形中是否需要考虑骨移植。证据等级 IV。
{"title":"The Role of Bone Grafting in Corrective Osteotomy of Distal Radius Malunions","authors":"Ryan Paul, J. Persitz, Shawn Khan, Michael MacDougall, Andrea Chan","doi":"10.1055/s-0044-1787539","DOIUrl":"https://doi.org/10.1055/s-0044-1787539","url":null,"abstract":"\u0000 Background It remains unclear whether bone grafting is required during corrective osteotomy of the distal radius. The goal of this systematic review is to determine the union, revision, and complication rates of bone grafting techniques associated with extra-articular corrective osteotomy for dorsally malunited distal radius fractures treated with volar plating.\u0000 Questions Is bone grafting in distal radius corrective osteotomy associated with increased rates of bone union and reduced rates of revision surgery and complications?\u0000 Methods A comprehensive search of the MEDLINE, Embase, and Cumulative Index to Nursing and Allied Health Literature databases was completed for studies reporting clinical outcomes of extra-articular corrective osteotomy for dorsally malunited distal radius fractures treated with volar plating.\u0000 Results A total of 13 studies, with 14 intervention arms and 236 patients, were included. Bone grafting techniques consisted of autograft (6 studies, n = 93), synthetic bone grafts (2 studies, n = 38), allograft (1 study, n = 14), or no grafting (5 studies, n = 91). The overall union rate was 97%, and the mean time-to-union was 12.0 weeks. Larger corrections of dorsal tilt and ulnar variance were performed in the autograft and allograft groups. Complication and revision rates were highest in the synthetic group, 45 and 26.3% respectively.\u0000 Conclusion Grafting in extra-articular corrective osteotomy for dorsally angulated distal radius malunions treated with volar plating is not associated with an improved union rate in the literature. However, larger corrections were achieved in both the autograft and allograft groups compared to the no-graft and synthetic groups, resulting in similar union rates. Synthetic bone grafting was associated with the highest complication and revision rates. Future comparative prospective trials and proper documentation of whether cortical contact was present or absent are required to assess whether bone grafting warrants consideration in more advanced deformities.\u0000 Level of Evidence IV.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141268030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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