Pub Date : 2023-11-30eCollection Date: 2024-06-01DOI: 10.1055/s-0043-1777024
Jacqueline S Israel, Stacy R Loushin, Sabine U Tetzloff, Todd Ellenbecker, Kenton R Kaufman, Sanjeev Kakar
Background Tennis players often present with ulnar-sided wrist pain, which may reflect repetitive stress and/or faulty mechanics. There is a role for investigating the biomechanics of tennis strokes and how they may relate to wrist pathology. The purpose of this study was to investigate whether three-dimensional motion capture technology and dynamic electromyography (EMG), when used to study groundstrokes in elite junior tennis players, reveals patterns of upper extremity motion that may correlate with the development of clinically relevant pathology. Case Description Three-dimensional kinematic and EMG data were collected from two United States Tennis Association-ranked adolescent tennis players during groundstrokes. There were several observed differences in the two players' degree and timing of pronation/supination, ulnar/radial deviation, and flexion/extension during their strokes. Clinical Significance Advanced motion capture technology facilitates a nuanced understanding of complex movements involved in groundstroke production. This methodology may be useful for identifying athletes who are at risk for injury and guiding rehabilitation for players experiencing pain. Level of Evidence IV.
{"title":"Wrist Motion Assessment in Tennis Players using Three-Dimensional Motion Capture and Dynamic Electromyography.","authors":"Jacqueline S Israel, Stacy R Loushin, Sabine U Tetzloff, Todd Ellenbecker, Kenton R Kaufman, Sanjeev Kakar","doi":"10.1055/s-0043-1777024","DOIUrl":"10.1055/s-0043-1777024","url":null,"abstract":"<p><p><b>Background</b> Tennis players often present with ulnar-sided wrist pain, which may reflect repetitive stress and/or faulty mechanics. There is a role for investigating the biomechanics of tennis strokes and how they may relate to wrist pathology. The purpose of this study was to investigate whether three-dimensional motion capture technology and dynamic electromyography (EMG), when used to study groundstrokes in elite junior tennis players, reveals patterns of upper extremity motion that may correlate with the development of clinically relevant pathology. <b>Case Description</b> Three-dimensional kinematic and EMG data were collected from two United States Tennis Association-ranked adolescent tennis players during groundstrokes. There were several observed differences in the two players' degree and timing of pronation/supination, ulnar/radial deviation, and flexion/extension during their strokes. <b>Clinical Significance</b> Advanced motion capture technology facilitates a nuanced understanding of complex movements involved in groundstroke production. This methodology may be useful for identifying athletes who are at risk for injury and guiding rehabilitation for players experiencing pain. <b>Level of Evidence</b> IV.</p>","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"13 3","pages":"264-271"},"PeriodicalIF":0.7,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11129886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-22eCollection Date: 2024-02-01DOI: 10.1055/s-0043-1770079
Janice Chin-Yi Liao, David Meng Kiat Tan
Background Midcarpal instability is an uncommon entity characterized by pain and clunking as the wrist moves from radial deviation to ulnar deviation. Management is primarily nonoperative. In patients with persistent symptoms, operative treatments are divided into soft tissue reconstruction and limited midcarpal arthrodesis. Case Description We present a rare case of radial midcarpal instability associated with radioscaphocapitate (RSC) ligament injury. A 20-year-old man presented with radial-sided wrist pain and clunking with radial deviation after a fall. Wrist arthroscopy confirmed the pathology of an RSC ligament injury resulting in an extended posture of the scaphoid and a catch-up clunk from sudden flexion of the scaphoid in radial deviation. His RSC ligament was recessed and he had excellent outcome at 1 year follow-up. Literature Review Midcarpal instability was reported by Lichtman et al as a painful wrist click in ulnar deviation and classified according to the direction of the subluxation. Radial midcarpal instability was later described by Caputo et al in patients with rotatory subluxation of the scaphoid. We present a previously unreported form of radial midcarpal instability as it does not quite fit into the type III midcarpal instability with ligament laxity of the scaphotrapeziotrapezoid joint and type IV with scapholunate ligament disruption. The painful wrist click occurs in radial deviation as the result of an RSC ligament injury. Clinical Relevance We performed arthroscopic thermal capsulorrhaphy of the ulnar arcuate ligaments and dorsal capsule and an open proximal recession of the RSC ligament. The elimination of pain and clunking accompanied by the restoration of scaphoid flexion and return to load-bearing activities validates the pathology and suggests the potential of this soft tissue procedure in the treatment of radial midcarpal instability.
{"title":"Radial Midcarpal Instability Treated with Radioscaphocapitate Ligament Recession: A Case Report.","authors":"Janice Chin-Yi Liao, David Meng Kiat Tan","doi":"10.1055/s-0043-1770079","DOIUrl":"10.1055/s-0043-1770079","url":null,"abstract":"<p><p><b>Background</b> Midcarpal instability is an uncommon entity characterized by pain and clunking as the wrist moves from radial deviation to ulnar deviation. Management is primarily nonoperative. In patients with persistent symptoms, operative treatments are divided into soft tissue reconstruction and limited midcarpal arthrodesis. <b>Case Description</b> We present a rare case of radial midcarpal instability associated with radioscaphocapitate (RSC) ligament injury. A 20-year-old man presented with radial-sided wrist pain and clunking with radial deviation after a fall. Wrist arthroscopy confirmed the pathology of an RSC ligament injury resulting in an extended posture of the scaphoid and a catch-up clunk from sudden flexion of the scaphoid in radial deviation. His RSC ligament was recessed and he had excellent outcome at 1 year follow-up. <b>Literature Review</b> Midcarpal instability was reported by Lichtman et al as a painful wrist click in ulnar deviation and classified according to the direction of the subluxation. Radial midcarpal instability was later described by Caputo et al in patients with rotatory subluxation of the scaphoid. We present a previously unreported form of radial midcarpal instability as it does not quite fit into the type III midcarpal instability with ligament laxity of the scaphotrapeziotrapezoid joint and type IV with scapholunate ligament disruption. The painful wrist click occurs in radial deviation as the result of an RSC ligament injury. <b>Clinical Relevance</b> We performed arthroscopic thermal capsulorrhaphy of the ulnar arcuate ligaments and dorsal capsule and an open proximal recession of the RSC ligament. The elimination of pain and clunking accompanied by the restoration of scaphoid flexion and return to load-bearing activities validates the pathology and suggests the potential of this soft tissue procedure in the treatment of radial midcarpal instability.</p>","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"13 1","pages":"80-85"},"PeriodicalIF":0.7,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10803155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139542031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Purpose This study aimed to present the results of an alternative technique for treating ulnar impaction syndrome, the “reverse wafer procedure,” and assess the mid-term clinical outcomes of patients treated with this technique. Methods A retrospective evaluation was conducted on 14 patients who underwent the reverse wafer procedure for ulnar impaction syndrome between 2013 and 2020. The inclusion criteria for the study were persistent ulnar-sided wrist pain, even after a minimum of 3 months of nonoperative treatment, the presence of a chondral lesion on the lunate, and an intact triangular fibrocartilage complex (TFCC) based on arthroscopic evaluation. Postoperative clinical and subjective functional outcomes were assessed using measures such as wrist range of motion (ROM), grip strength, the Turkish version of the quick disabilities of the arm, shoulder, and hand questionnaire (Quick DASH), and pain levels measured on a visual analog scale (VAS) and were compared with preoperative values. Patient satisfaction was also evaluated postoperatively. Results The mean follow-up period was 42.2 months (range: 24–68 months). Postoperatively, none of the patients experienced any restriction in ROM. Grip measurements significantly increased after the surgery (p = 0.003). Preoperatively, the patients had a grip strength of 41.14 kg (range 28–48 kg), which improved to 44 kg (range 30–52 kg) postoperatively. Postoperative VAS values and QDASH scores significantly decreased compared with the preoperative values (p < 0.001, p = 0.001). The mean VAS score decreased from 6.1 (range 4–8) preoperatively to 0.9 (range 0–5) postoperatively. The mean Quick DASH score decreased from 49.44 (range 25–68.3) preoperatively to 10.13 (range 3.3–36) postoperatively. When asked about their satisfaction with the operation, 13 out of 14 patients reported being highly satisfied with the results. Conclusions The reverse wafer procedure presents an alternative treatment option for ulnar impaction syndrome in cases where the TFCC is intact. The mid-term results of this described technique are promising. However, further comparative studies with longer follow-ups are necessary to support these findings. Level of Evidence IV Therapeutic.
摘要目的本研究旨在介绍一种治疗尺嵌塞综合征的替代技术“反向晶圆手术”的结果，并评估采用该技术治疗的患者的中期临床结果。方法回顾性分析2013 ~ 2020年收治的14例尺侧嵌塞综合征患者的临床资料。该研究的纳入标准是持续的尺侧腕关节疼痛，即使在至少3个月的非手术治疗后，在月骨上存在软骨病变，以及基于关节镜评估的完整三角形纤维软骨复合体(TFCC)。术后临床和主观功能结果通过腕关节活动度(ROM)、握力、土耳其版手臂、肩部和手部快速残疾问卷(quick DASH)以及视觉模拟量表(VAS)测量的疼痛水平进行评估，并与术前值进行比较。术后还对患者满意度进行了评估。结果平均随访时间为42.2个月(24 ~ 68个月)。术后，没有患者出现任何ROM限制。术后握力测量明显增加(p = 0.003)。术前握力为41.14 kg (28 ~ 48 kg)，术后握力为44 kg (30 ~ 52 kg)。术后VAS评分和QDASH评分较术前显著降低(p <0.001, p = 0.001)。平均VAS评分从术前的6.1(范围4-8)下降到术后的0.9(范围0-5)。平均Quick DASH评分由术前49.44分(范围25-68.3)降至术后10.13分(范围3.3-36)。当被问及对手术的满意度时，14名患者中有13名对手术结果非常满意。结论在TFCC完好的情况下，反向晶圆手术是治疗尺侧嵌塞综合征的另一种选择。这种技术的中期结果是有希望的。然而，需要进一步的比较研究和更长的随访来支持这些发现。证据水平IV治疗性。
{"title":"Reverse Wafer Procedure","authors":"Ismail Bulent Ozcelik, Ali Cavit, Aydin Yuceturk","doi":"10.1055/s-0043-1775819","DOIUrl":"https://doi.org/10.1055/s-0043-1775819","url":null,"abstract":"Abstract Purpose This study aimed to present the results of an alternative technique for treating ulnar impaction syndrome, the “reverse wafer procedure,” and assess the mid-term clinical outcomes of patients treated with this technique. Methods A retrospective evaluation was conducted on 14 patients who underwent the reverse wafer procedure for ulnar impaction syndrome between 2013 and 2020. The inclusion criteria for the study were persistent ulnar-sided wrist pain, even after a minimum of 3 months of nonoperative treatment, the presence of a chondral lesion on the lunate, and an intact triangular fibrocartilage complex (TFCC) based on arthroscopic evaluation. Postoperative clinical and subjective functional outcomes were assessed using measures such as wrist range of motion (ROM), grip strength, the Turkish version of the quick disabilities of the arm, shoulder, and hand questionnaire (Quick DASH), and pain levels measured on a visual analog scale (VAS) and were compared with preoperative values. Patient satisfaction was also evaluated postoperatively. Results The mean follow-up period was 42.2 months (range: 24–68 months). Postoperatively, none of the patients experienced any restriction in ROM. Grip measurements significantly increased after the surgery (p = 0.003). Preoperatively, the patients had a grip strength of 41.14 kg (range 28–48 kg), which improved to 44 kg (range 30–52 kg) postoperatively. Postoperative VAS values and QDASH scores significantly decreased compared with the preoperative values (p < 0.001, p = 0.001). The mean VAS score decreased from 6.1 (range 4–8) preoperatively to 0.9 (range 0–5) postoperatively. The mean Quick DASH score decreased from 49.44 (range 25–68.3) preoperatively to 10.13 (range 3.3–36) postoperatively. When asked about their satisfaction with the operation, 13 out of 14 patients reported being highly satisfied with the results. Conclusions The reverse wafer procedure presents an alternative treatment option for ulnar impaction syndrome in cases where the TFCC is intact. The mid-term results of this described technique are promising. However, further comparative studies with longer follow-ups are necessary to support these findings. Level of Evidence IV Therapeutic.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":" 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135290922","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}
Ahmed El-Tayar, Samir El-Ghandour, Adel Ghazal, Ibrahim Rakha, Asser Sallam
Abstract Background The literature presents great challenge in comparing the arthroscopic wafer procedure (AWP) versus ulnar shortening osteotomy (USO) in the treatment of ulnar impaction syndrome (UIS). Purpose We aimed primarily to compare the clinical and functional outcomes of AWP with triangular fibrocartilage complex (TFCC) debridement versus USO in the management of UIS. Methods The study was conducted as a randomized clinical trial including 43 patients with UIS whose ulna variance was less than 4 mm. Patients were randomly allocated to either the AWP group (21 patients) who underwent AWP and TFCC debridement or the USO group (22 patients) who underwent diaphyseal USO. Patients were followed up for at least 12 months. The primary outcome measure was the Modified Mayo Wrist (MMW) score. The Disabilities of the Arm, Shoulder, and Hand (DASH) score, the mean operative time, postoperative complications, and patient satisfaction were our secondary outcomes. Results Radiological correction of variance was achieved in all patients. The mean operative time was significantly shorter in the AWP group. The postoperative MMW and DASH scores were better in the AWP group than in the USO group. Fewer complications occurred in the AWP group (1 of 21 patients) compared with the USO group (3 of 22 patients). Conclusions AWP with TFCC debridement is a reliable and safe method for the management of UIS with a positive variance of less than 4 mm with better clinical and functional results than diaphyseal USO. Type of study/level of evidence Therapeutic type II.
{"title":"Combined Arthroscopic Wafer Procedure and Triangular Fibrocartilage Complex Debridement versus Ulnar Shortening Diaphyseal Osteotomy in Management of Ulnar Impaction Syndrome: A Randomized Clinical Trial","authors":"Ahmed El-Tayar, Samir El-Ghandour, Adel Ghazal, Ibrahim Rakha, Asser Sallam","doi":"10.1055/s-0043-1776399","DOIUrl":"https://doi.org/10.1055/s-0043-1776399","url":null,"abstract":"Abstract Background The literature presents great challenge in comparing the arthroscopic wafer procedure (AWP) versus ulnar shortening osteotomy (USO) in the treatment of ulnar impaction syndrome (UIS). Purpose We aimed primarily to compare the clinical and functional outcomes of AWP with triangular fibrocartilage complex (TFCC) debridement versus USO in the management of UIS. Methods The study was conducted as a randomized clinical trial including 43 patients with UIS whose ulna variance was less than 4 mm. Patients were randomly allocated to either the AWP group (21 patients) who underwent AWP and TFCC debridement or the USO group (22 patients) who underwent diaphyseal USO. Patients were followed up for at least 12 months. The primary outcome measure was the Modified Mayo Wrist (MMW) score. The Disabilities of the Arm, Shoulder, and Hand (DASH) score, the mean operative time, postoperative complications, and patient satisfaction were our secondary outcomes. Results Radiological correction of variance was achieved in all patients. The mean operative time was significantly shorter in the AWP group. The postoperative MMW and DASH scores were better in the AWP group than in the USO group. Fewer complications occurred in the AWP group (1 of 21 patients) compared with the USO group (3 of 22 patients). Conclusions AWP with TFCC debridement is a reliable and safe method for the management of UIS with a positive variance of less than 4 mm with better clinical and functional results than diaphyseal USO. Type of study/level of evidence Therapeutic type II.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"19 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135539775","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}
Abstract Background: Distal radius fractures with dorso-ulnar corner fragments (DUC) pose a surgical challenge due to limited visualization and the risk of hardware prominence. Traditional approaches often result in inadequate reduction and fixation, leading to suboptimal clinical outcomes. Description of Technique: In this study, we introduce an arthroscopic-assisted approach for the fixation of distal radius fractures with DUC fragments. The technique utilizes locked, hooked K-wires to provide a low-profile dorsal capturing mechanism. We outline the step-by-step procedure, which includes pre-operative planning, volar plate application, and arthroscopic reduction of DUC fragments. Patients and Methods: We applied this technique to a 60-year-old female patient with an unstable intra-articular distal radius fracture and a DUC fragment. Closed reduction was initially attempted, followed by arthroscopic-assisted reduction and internal fixation using the locked, hooked K-wire technique. Results: Our technique has demonstrated its ability to withstand early movement rehabilitation protocols without fixation loss, enabling early mobilization. A custom thermoplastic splint was worn for 6 weeks, with favorable supination/pronation and wrist flexion/extension outcomes at clinical review. Conclusions: Arthroscopic-assisted fixation with locked, hooked K-wires offers a reliable solution for accurately reducing challenging DUC fragments in distal radius fractures. This approach complements standard distal radius fixation systems, providing a low-profile dorsal capturing mechanism and addressing the issue of hardware prominence, ultimately improving clinical outcomes.
{"title":"Arthroscopic-assisted Distal Radius Fracture Fixation for Dorsoulnar Corner Fragments Using a Locked, Hooked Kirschner-Wire Technique","authors":"Mark Ross, Matthew J. White, Nicholas Smith","doi":"10.1055/s-0043-1776115","DOIUrl":"https://doi.org/10.1055/s-0043-1776115","url":null,"abstract":"Abstract Background: Distal radius fractures with dorso-ulnar corner fragments (DUC) pose a surgical challenge due to limited visualization and the risk of hardware prominence. Traditional approaches often result in inadequate reduction and fixation, leading to suboptimal clinical outcomes. Description of Technique: In this study, we introduce an arthroscopic-assisted approach for the fixation of distal radius fractures with DUC fragments. The technique utilizes locked, hooked K-wires to provide a low-profile dorsal capturing mechanism. We outline the step-by-step procedure, which includes pre-operative planning, volar plate application, and arthroscopic reduction of DUC fragments. Patients and Methods: We applied this technique to a 60-year-old female patient with an unstable intra-articular distal radius fracture and a DUC fragment. Closed reduction was initially attempted, followed by arthroscopic-assisted reduction and internal fixation using the locked, hooked K-wire technique. Results: Our technique has demonstrated its ability to withstand early movement rehabilitation protocols without fixation loss, enabling early mobilization. A custom thermoplastic splint was worn for 6 weeks, with favorable supination/pronation and wrist flexion/extension outcomes at clinical review. Conclusions: Arthroscopic-assisted fixation with locked, hooked K-wires offers a reliable solution for accurately reducing challenging DUC fragments in distal radius fractures. This approach complements standard distal radius fixation systems, providing a low-profile dorsal capturing mechanism and addressing the issue of hardware prominence, ultimately improving clinical outcomes.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"18 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135539781","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}
Abstract Introduction A systematic review and meta-analysis of randomized controlled trials was conducted to compare surgical treatment using open reduction and internal fixation (ORIF) with volar locking plates (VLP) to conservative treatment with closed reduction and immobilization in elderly patients aged ≥60 years with acute displaced distal radius fractures. Methods A search of the MEDLINE, Scopus, and Central Register of Controlled Trials (CENTRAL) databases was conducted. Clinical and radiographic measures at 12 months were compared between groups by pooling the mean difference. The complication rates were compared by pooling relative risk ratios. Pooled mean differences of Disabilities of the Arm, Shoulder, and Hand (DASH) and Patient-Rated Wrist Evaluation (PRWE) results were compared with the published minimal clinically important difference (MCID) to evaluate the clinical relevance of the results. Results The initial search yielded 766 records, from which 6 articles were selected for the final analysis. The results of the DASH questionnaire at 12 months of follow-up were significantly lower in the surgical treatment group with a mean difference (MD) of –3.61 points (95% confidence interval [CI]: –6.48 to –0.73). No statistically significant difference was found in the PRWE questionnaire (MD = –3.14 points [95% CI: –7.32 to 1.04]). Radiological results were significantly better in the surgical treatment group and no significant difference in the overall complication rate between the groups was detected. Found MD for DASH and PRWE did not reach the published MCIDs. Conclusion This study suggests that for elderly patients aged ≥60 years with acute displaced distal radius fractures, surgical treatment using ORIF with VLP does not provide clinically relevant benefits compared with conservative treatment with closed reduction and immobilization at the 12-month follow-up, despite demonstrating better radiological results.
{"title":"Volar Locking Plate versus Closed Reduction and Immobilization for Distal Radius Fracture in the Elderly: Systematic Review and Meta-Analysis of Randomized Controlled Trials","authors":"Niyaz Latypov, Igor Golubev, Alyona Borisova","doi":"10.1055/s-0043-1774331","DOIUrl":"https://doi.org/10.1055/s-0043-1774331","url":null,"abstract":"Abstract Introduction A systematic review and meta-analysis of randomized controlled trials was conducted to compare surgical treatment using open reduction and internal fixation (ORIF) with volar locking plates (VLP) to conservative treatment with closed reduction and immobilization in elderly patients aged ≥60 years with acute displaced distal radius fractures. Methods A search of the MEDLINE, Scopus, and Central Register of Controlled Trials (CENTRAL) databases was conducted. Clinical and radiographic measures at 12 months were compared between groups by pooling the mean difference. The complication rates were compared by pooling relative risk ratios. Pooled mean differences of Disabilities of the Arm, Shoulder, and Hand (DASH) and Patient-Rated Wrist Evaluation (PRWE) results were compared with the published minimal clinically important difference (MCID) to evaluate the clinical relevance of the results. Results The initial search yielded 766 records, from which 6 articles were selected for the final analysis. The results of the DASH questionnaire at 12 months of follow-up were significantly lower in the surgical treatment group with a mean difference (MD) of –3.61 points (95% confidence interval [CI]: –6.48 to –0.73). No statistically significant difference was found in the PRWE questionnaire (MD = –3.14 points [95% CI: –7.32 to 1.04]). Radiological results were significantly better in the surgical treatment group and no significant difference in the overall complication rate between the groups was detected. Found MD for DASH and PRWE did not reach the published MCIDs. Conclusion This study suggests that for elderly patients aged ≥60 years with acute displaced distal radius fractures, surgical treatment using ORIF with VLP does not provide clinically relevant benefits compared with conservative treatment with closed reduction and immobilization at the 12-month follow-up, despite demonstrating better radiological results.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"15 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135539792","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}
Soo Min Cha, In Ho Ga, Yong Hwan Kim, Seung Won Kim
Abstract Background We hypothesized a treatment guideline for ulna/radius nonunion after failed surgical treatment and propose to verify it in a prospective study. Herein, we report our preliminary findings and review the current trend. Methods Six patients who met the criteria were retrospectively investigated, and we further categorized “nonunion of both the radius/ulna” into four subcategories. For hypertrophic nonunion of the radius, but with stability maintained by a plate, we only reinforced the mechanical stability of the ulna (osteosynthesis, treatment option 1). In oligo- or atrophic nonunion of the radius with stability maintained by a plate, we added cancellous or tricortical bone grafts to the radius after osteosynthesis of the ulna (treatment option 2). In the presence of definitive pseudomotion of the radius (no stability), we performed revision osteosynthesis for the radius only, without (treatment option 3) or with bone graft (treatment option 4). Results Two, one, one, and two patients had corresponding treatment options of 1, 2, 3, and 4, respectively. At a mean postoperative time of 4.3 months, all radii and ulnas showed union. At the final follow-up, clinical outcomes in terms of the range of motion and VAS (visual analog scale)/DASH (disabilities of the arm, shoulder, and hand) scores were satisfactory. We are currently conducting a prospective trial to verify the hypothesized guidelines. For both types of radius/ulna nonunion, first, if the stability of the radius was good, we compared the final outcomes with or without revision osteosynthesis for the radius, in addition to osteosynthesis for the ulna. Second, if stability was absent in the radius, we compared the final outcomes with or without osteosynthesis of the ulna, in addition to revision osteosynthesis of the radius. Conclusions The treatment guidelines for rare nonunion after failed surgical treatment of both the distal radius/ulna were suggested according to the “concept of stability” based on the principles of fracture treatment. This hypothesis could be used to guide prospective studies of revision surgery for nonunion of both the radius and ulna. Level of Evidence Level IV, retrospective case series.
{"title":"A Case Series of Distal Radius and Ulna Nonunion Treated with Minimal Surgical Intervention","authors":"Soo Min Cha, In Ho Ga, Yong Hwan Kim, Seung Won Kim","doi":"10.1055/s-0043-1776353","DOIUrl":"https://doi.org/10.1055/s-0043-1776353","url":null,"abstract":"Abstract Background We hypothesized a treatment guideline for ulna/radius nonunion after failed surgical treatment and propose to verify it in a prospective study. Herein, we report our preliminary findings and review the current trend. Methods Six patients who met the criteria were retrospectively investigated, and we further categorized “nonunion of both the radius/ulna” into four subcategories. For hypertrophic nonunion of the radius, but with stability maintained by a plate, we only reinforced the mechanical stability of the ulna (osteosynthesis, treatment option 1). In oligo- or atrophic nonunion of the radius with stability maintained by a plate, we added cancellous or tricortical bone grafts to the radius after osteosynthesis of the ulna (treatment option 2). In the presence of definitive pseudomotion of the radius (no stability), we performed revision osteosynthesis for the radius only, without (treatment option 3) or with bone graft (treatment option 4). Results Two, one, one, and two patients had corresponding treatment options of 1, 2, 3, and 4, respectively. At a mean postoperative time of 4.3 months, all radii and ulnas showed union. At the final follow-up, clinical outcomes in terms of the range of motion and VAS (visual analog scale)/DASH (disabilities of the arm, shoulder, and hand) scores were satisfactory. We are currently conducting a prospective trial to verify the hypothesized guidelines. For both types of radius/ulna nonunion, first, if the stability of the radius was good, we compared the final outcomes with or without revision osteosynthesis for the radius, in addition to osteosynthesis for the ulna. Second, if stability was absent in the radius, we compared the final outcomes with or without osteosynthesis of the ulna, in addition to revision osteosynthesis of the radius. Conclusions The treatment guidelines for rare nonunion after failed surgical treatment of both the distal radius/ulna were suggested according to the “concept of stability” based on the principles of fracture treatment. This hypothesis could be used to guide prospective studies of revision surgery for nonunion of both the radius and ulna. Level of Evidence Level IV, retrospective case series.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"20 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135539929","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}
Abstract Background Avulsion fracture of the extensor carpi ulnaris (ECU) bony insertion at fifth metacarpal base is a rare injury that may preclude recognition on radiographs. Case Description We report two cases of ECU avulsion fracture, both of which were successfully treated surgically by open reduction and fixation (ORIF). Literature Review Only two cases of ECU avulsion fracture have previously been reported in the literature. Forced motion of the wrist into a position of hyperflexion and/or radial deviation appears to be a common mechanism. Clinical Relevance Clinicians should be aware that ECU avulsion fractures can occur in isolation or in association with other fractures of the hand or wrist. ORIF is warranted due to the prospect of impaired wrist range of motion as well as persistent pain caused by the avulsed fragment.
{"title":"Avulsion Fracture of the Extensor Carpi Ulnaris: A Report of Two Cases","authors":"Evan Fang, Matthew Choi, Michael J. Cooper","doi":"10.1055/s-0043-1776139","DOIUrl":"https://doi.org/10.1055/s-0043-1776139","url":null,"abstract":"Abstract Background Avulsion fracture of the extensor carpi ulnaris (ECU) bony insertion at fifth metacarpal base is a rare injury that may preclude recognition on radiographs. Case Description We report two cases of ECU avulsion fracture, both of which were successfully treated surgically by open reduction and fixation (ORIF). Literature Review Only two cases of ECU avulsion fracture have previously been reported in the literature. Forced motion of the wrist into a position of hyperflexion and/or radial deviation appears to be a common mechanism. Clinical Relevance Clinicians should be aware that ECU avulsion fractures can occur in isolation or in association with other fractures of the hand or wrist. ORIF is warranted due to the prospect of impaired wrist range of motion as well as persistent pain caused by the avulsed fragment.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"18 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135539778","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}
Muntasir Mannan Choudhury, Suraj Sajeev, Brandon Yew Bao Sheng, Dashishka Thanuranga Wijetunga, Andrew Yuan Hui Chin
Abstract Ulnocarpal impaction or ulnar abutment symptom occurs secondary to abnormal load bearing on the ulnar side of the wrist leading to pain symptoms and degeneration of the structures of the ulnocarpal joint. The two classical surgical methods used to address this problem are ulnar shortening osteotomy and the wafer procedure, which can either be open or arthroscopic. With the advent of arthroscopy, with surgeon harboring arthroscopy skills, arthroscopic wafer resection has been intensely popularized which requires a central perforation of the triangular fibrocartilage to approach the ulna dome through the ulnocarpal joint. So, what happens in symptomatic patients with ulnocarpal abutment with an intact triangular fibrocartilage complex who have failed conservative management. Do we perform an open procedure or do we create a perforation in the central disc of the triangular fibrocartilage complex to expose the ulnar dome? Or do we just do an ulnar shortening osteotomy? Here, we describe our arthroscopic technique of conducting arthroscopy in the narrow confines of the space below the triangular fibrocartilage complex above the ulnar dome to carry out an arthroscopic wafer procedure in a triangular fibrocartilage complex with no central perforation. The procedure can produce results similar to those of the classical arthroscopic wafer procedure described explicitly in the literature.
{"title":"Arthroscopic Wafer Procedure for Ulnar Impaction Syndrome in an Intact Triangular Fibrocartilage Complex","authors":"Muntasir Mannan Choudhury, Suraj Sajeev, Brandon Yew Bao Sheng, Dashishka Thanuranga Wijetunga, Andrew Yuan Hui Chin","doi":"10.1055/s-0043-1775799","DOIUrl":"https://doi.org/10.1055/s-0043-1775799","url":null,"abstract":"Abstract Ulnocarpal impaction or ulnar abutment symptom occurs secondary to abnormal load bearing on the ulnar side of the wrist leading to pain symptoms and degeneration of the structures of the ulnocarpal joint. The two classical surgical methods used to address this problem are ulnar shortening osteotomy and the wafer procedure, which can either be open or arthroscopic. With the advent of arthroscopy, with surgeon harboring arthroscopy skills, arthroscopic wafer resection has been intensely popularized which requires a central perforation of the triangular fibrocartilage to approach the ulna dome through the ulnocarpal joint. So, what happens in symptomatic patients with ulnocarpal abutment with an intact triangular fibrocartilage complex who have failed conservative management. Do we perform an open procedure or do we create a perforation in the central disc of the triangular fibrocartilage complex to expose the ulnar dome? Or do we just do an ulnar shortening osteotomy? Here, we describe our arthroscopic technique of conducting arthroscopy in the narrow confines of the space below the triangular fibrocartilage complex above the ulnar dome to carry out an arthroscopic wafer procedure in a triangular fibrocartilage complex with no central perforation. The procedure can produce results similar to those of the classical arthroscopic wafer procedure described explicitly in the literature.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"17 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135539783","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}
John J. Heifner, Robert J. Rowland, Osmanny Gomez, Francisco Rubio, George S. Kardashian
Abstract Background In aggregate, there is varied efficacy for total wrist fusion (TWF) with a locking intramedullary (IM) nail which indicates the need for further investigation. It remains unclear whether preparation of the third carpometacarpal joint (CMCJ) will reduce the risk of complications including distal screw loosening. Purpose Our objectives were (a) to report clinical outcomes for wrist arthrodesis using a locking IM nail and (b) to determine whether maintenance of the native third CMCJ articulation would contribute to short-term complications. Patients and Methods A chart review from 2010 to 2022 was performed at two institutions for cases of TWF fixed with the IMPLATE locking nail (Skeletal Dynamics, Miami, FL). Clinical and radiographic outcomes were collected. Results Radiographic union was achieved in 93.8% of cases, including one case of delayed union. The mean patient-rated wrist evaluation score was 30.4, the mean visual analog scale score for pain at rest was 1.7, and the mean visual analog scale score during activities of daily living was 3.2. There were seven cases of distal screw loosening (21.8%), and three cases of revision surgery (9.4%) which included two implant removals. A long radial nail was used in 24 (75%) of cases and a short metacarpal nail was used in 3 (9%) cases. Conclusion The current series demonstrated satisfactory function with low rates of revision surgery following IM nail TWF without inclusion of the third CMCJ into the fusion mass. Cases with distal screw loosening had variable clinical presentation and our current practice is to offer outpatient screw removal for cases which reach the threshold for intervention. Level of Evidence IV retrospective series.
{"title":"A Dual Center Experience with a Locking Intramedullary Nail for Wrist Fusion","authors":"John J. Heifner, Robert J. Rowland, Osmanny Gomez, Francisco Rubio, George S. Kardashian","doi":"10.1055/s-0043-1776114","DOIUrl":"https://doi.org/10.1055/s-0043-1776114","url":null,"abstract":"Abstract Background In aggregate, there is varied efficacy for total wrist fusion (TWF) with a locking intramedullary (IM) nail which indicates the need for further investigation. It remains unclear whether preparation of the third carpometacarpal joint (CMCJ) will reduce the risk of complications including distal screw loosening. Purpose Our objectives were (a) to report clinical outcomes for wrist arthrodesis using a locking IM nail and (b) to determine whether maintenance of the native third CMCJ articulation would contribute to short-term complications. Patients and Methods A chart review from 2010 to 2022 was performed at two institutions for cases of TWF fixed with the IMPLATE locking nail (Skeletal Dynamics, Miami, FL). Clinical and radiographic outcomes were collected. Results Radiographic union was achieved in 93.8% of cases, including one case of delayed union. The mean patient-rated wrist evaluation score was 30.4, the mean visual analog scale score for pain at rest was 1.7, and the mean visual analog scale score during activities of daily living was 3.2. There were seven cases of distal screw loosening (21.8%), and three cases of revision surgery (9.4%) which included two implant removals. A long radial nail was used in 24 (75%) of cases and a short metacarpal nail was used in 3 (9%) cases. Conclusion The current series demonstrated satisfactory function with low rates of revision surgery following IM nail TWF without inclusion of the third CMCJ into the fusion mass. Cases with distal screw loosening had variable clinical presentation and our current practice is to offer outpatient screw removal for cases which reach the threshold for intervention. Level of Evidence IV retrospective series.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"14 6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136142198","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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