Journal of Wrist Surgery最新文献

Introduction: We report early outcomes of all-dorsal arthroscopic scapholunate ligamentoplasty (ADAL) in 12 patients.

Materials and methods: Dorsal internal brace and capsulodesis were performed in all patients. In half of the patients, a palmaris gracilis tendon graft was used to reconstruct the dorsal aspect of the scapholunate complex. Patients were evaluated for pain, wrist range of motion, grip strength, clinical scores, and radiological appearance at a mean follow-up of 15.9 months.

Results: We obtained similar results in the technique with and without tendon graft. Visual analog scale (VAS 10) score improved from 6 to 1. Wrist range of motion in Flexion-extension increased from 123 to 144 degrees. Postoperative grip strength was 180% more than preoperative, with a mean Mayo wrist score of 79.5 and quick Disabilities of the Arm, Shoulder and Hand (quickDASH) of 14.9. The radiolunate angle decreased from 29 to 10 degrees, the scapholunate (SL) angle from 83 to 52 degrees, and the scapholunate gap from 6 to 3mm.

Conclusion: ADAL has many advantages compared with other scapholunate ligamentoplasties, including minimal invasiveness, association with internal brace and dorsal capsulodesis, and lower risk of carpal fracture or avascular necrosis. Its short-term results are promising.

Background: Dorsal triangular fibrocartilage complex (TFCC) is a newer entity of its family, which was not included in the Palmer classification. We believe that tear of the dorsal TFCC can cause pain and disability. Literature on this type of tear is limited, in addition, outcomes post-repair, especially arthroscopically, are scarce.

Purposes: This article defines dorsal TFCC anatomy and investigates the clinical and functional outcomes post-TFCC dorsal tear arthroscopic repair.

Materials and methods: An 18-year retrospective review of 32 patients with arthroscopic repair of TFCC dorsal tears was performed. We categorised our patients into group (1) with only isolated TFCC dorsal tear and group (2) also with other concomitant TFCC tear. We evaluated their clinical and functional outcomes and also compared the two groups with other cofactors.

Results: The mean follow-up period was 44 months. In the isolated dorsal tear group ( N  = 17), the wrist performance score was improved from 29 to 37 ( p  = 0.01), the Visual Analog Scale (VAS) score was improved from 6 to 3 ( p  < 0.01), Modified Mayo Wrist Score (MMWS) was improved from 60 to 74 ( p  = 0.01), and the hand grip strength was improved from 18 to 28 kg ( p  = 0.05). In the complex tear group ( N  = 9), VAS score was improved from 6 to 3 ( p  = 0.01) and the MMWS was improved from 44 to 79 ( p  = 0.01). Distal radioulnar joint stability was improved in the isolated group, achieving 100% stability after surgery ( p  < 0.01). No prognostic factors were identified. We noticed that patients who had surgery 9 months post-injury, would have the highest improvement on wrist flexion ( p  = 0.03), comparing with those who had surgery at other time points.

Conclusion: We define dorsal TFCC as the area located between the horizontal dorsal superficial radioulnar ligament and the vertical dorsal capsular wall, that is, the extensor carpi ulnaris subsheath and extensor digiti minimi sheath. To our knowledge, internationally, we have operated and collected the largest series of TFCC dorsal tear arthroscopic repair. Our patients were benefited with significant pain relief with improved daily activities performance.

Clinical relevance: Dorsal TFCC tear can cause symptoms and is often missed, even during arthroscopic examination. We should consider offering wrist arthroscopy to patient who suffers from ulnar-sided wrist pain, even with negative radiological findings and 9 months post-injury, for diagnostic and therapeutic purposes.

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.