Lea Estermann, Melodi Yong, Blair S. York, Christopher Y. Tham, James Onggo, S. Tham
Background Several surgical techniques for the treatment of the irreparable chronic scapholunate (SL) ligament disruption, without arthritis, have been described using tendon grafts. An alternative technique is the use of retinaculum grafts. A systematic review of the biomechanical and histological properties of the bone–retinaculum–bone (BRB) graft and the clinical results of its use in SL ligament reconstruction was performed. Materials and Methods After abstract screening of 353 articles, a total of eight studies (five laboratory and three clinical) were included. Results Five cadaveric studies showed a lower load to failure and lower stiffness of the BRB compared with the scapholunate interosseous ligament. In patients with dynamic SL instability, treatment with BRB graft resulted in pain relief and an improvement in grip strength but with a reduced range of motion. Radiologically, no SL widening was found 18 months after surgery but with a slight increase after 12 years. The three clinical studies in this review have a level of evidence of 4. There were no studies on graft incorporation and remodeling. Conclusion There is insufficient clinical, histological, and biomechanical data available on the use of BRB grafts for SL ligament reconstruction.
{"title":"Retinaculum Grafts in Scapholunate Ligament Reconstruction: A Systematic Review","authors":"Lea Estermann, Melodi Yong, Blair S. York, Christopher Y. Tham, James Onggo, S. Tham","doi":"10.1055/s-0044-1787180","DOIUrl":"https://doi.org/10.1055/s-0044-1787180","url":null,"abstract":"\u0000 Background Several surgical techniques for the treatment of the irreparable chronic scapholunate (SL) ligament disruption, without arthritis, have been described using tendon grafts. An alternative technique is the use of retinaculum grafts. A systematic review of the biomechanical and histological properties of the bone–retinaculum–bone (BRB) graft and the clinical results of its use in SL ligament reconstruction was performed.\u0000 Materials and Methods After abstract screening of 353 articles, a total of eight studies (five laboratory and three clinical) were included.\u0000 Results Five cadaveric studies showed a lower load to failure and lower stiffness of the BRB compared with the scapholunate interosseous ligament. In patients with dynamic SL instability, treatment with BRB graft resulted in pain relief and an improvement in grip strength but with a reduced range of motion. Radiologically, no SL widening was found 18 months after surgery but with a slight increase after 12 years. The three clinical studies in this review have a level of evidence of 4. There were no studies on graft incorporation and remodeling.\u0000 Conclusion There is insufficient clinical, histological, and biomechanical data available on the use of BRB grafts for SL ligament reconstruction.","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":"141266309","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":"Topology-Optimized Splints: A Novel Approach for Management of Distal Radial Fractures","authors":"Muhammad Talha, Muhammad Hamza Awais Khalid","doi":"10.1055/s-0044-1787182","DOIUrl":"https://doi.org/10.1055/s-0044-1787182","url":null,"abstract":"","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":"141267650","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 Perilunate injuries pose a significant treatment challenge, particularly when initially missed or underestimated. These injuries have a multitude of variations as propagation of the injury may be through ligaments and/or bone, with more recent appreciation given to nondislocated perilunate injuries. Case Description We present a new variant of perilunate injuries, not dislocated (PLIND). This occult ligamentous perilunate injury was associated with ulnar carpal translocation, radiocarpal subluxation, and distal radioulnar subluxation. The extent of injury was fully appreciated intraoperatively, with only subtle clues present on preoperative exam and imaging, emphasizing the high index of suspicion required to identify these injuries. Clinical outcome at 1-year follow-up was very satisfactory. Literature Review PLIND consist a distinct subset within the spectrum of perilunate injuries in which there is no observed disruption of the capitolunate relationship. Based on few cases reported in the literature (attributable to their rare occurrence and likely additional lack of awareness surrounding the injury pattern), current recommendations for surgical management include arthroscopic or open approach to appropriately address osseous and ligamentous injuries. Clinical Relevance Recognition of PLIND injuries is challenging given the lack of frank dislocation of the capitate head on the lunate, as observed in classic perilunate injuries. Heightened clinical suspicion in patients with consistent mechanism and presentation, followed by timely surgical management, may limit sequelae of persistent instability and arthritis. Our case contributed to relevant literature by presenting a previously undescribed PLIND variant combined with radiocarpal instability, ulnar carpal translocation, and distal radioulnar subluxation.
{"title":"Traumatic Ulnar Carpal Translocation, Distal Radioulnar Joint Subluxation with Occult Perilunate Injury","authors":"Timothy Visser, Mikayla Borusiewicz, A. Payatakes","doi":"10.1055/s-0044-1786160","DOIUrl":"https://doi.org/10.1055/s-0044-1786160","url":null,"abstract":"\u0000 Background Perilunate injuries pose a significant treatment challenge, particularly when initially missed or underestimated. These injuries have a multitude of variations as propagation of the injury may be through ligaments and/or bone, with more recent appreciation given to nondislocated perilunate injuries.\u0000 Case Description We present a new variant of perilunate injuries, not dislocated (PLIND). This occult ligamentous perilunate injury was associated with ulnar carpal translocation, radiocarpal subluxation, and distal radioulnar subluxation. The extent of injury was fully appreciated intraoperatively, with only subtle clues present on preoperative exam and imaging, emphasizing the high index of suspicion required to identify these injuries. Clinical outcome at 1-year follow-up was very satisfactory.\u0000 Literature Review PLIND consist a distinct subset within the spectrum of perilunate injuries in which there is no observed disruption of the capitolunate relationship. Based on few cases reported in the literature (attributable to their rare occurrence and likely additional lack of awareness surrounding the injury pattern), current recommendations for surgical management include arthroscopic or open approach to appropriately address osseous and ligamentous injuries.\u0000 Clinical Relevance Recognition of PLIND injuries is challenging given the lack of frank dislocation of the capitate head on the lunate, as observed in classic perilunate injuries. Heightened clinical suspicion in patients with consistent mechanism and presentation, followed by timely surgical management, may limit sequelae of persistent instability and arthritis. Our case contributed to relevant literature by presenting a previously undescribed PLIND variant combined with radiocarpal instability, ulnar carpal translocation, and distal radioulnar subluxation.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140662785","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}
Purpose Operative treatment of triangular fibrocartilage complex (TFCC) tears has been well researched; however, data regarding nonoperative management is mixed and scarce. Our review aimed to utilize available data to formulate conclusions regarding treatment algorithms for this heterogeneous injury group. Methods A thorough literature review was performed in Medline (OVID), Embase, Cochrane Library, and PubMed databases with search terms including “triangular fibrocartilage complex” and variations on the full term including “triangular fibrocartilage” or “TFCC,” alongside “non-operative” and “conservative.” Results were then subject to inclusion criteria, ultimately identifying eight studies. Results The studies involved a total of 425 patients and 427 wrists for analysis. The mean age ranged from 30.7 years to 60.4 years. 53.6% of patients were male. The mean follow-up ranged from 12 months to 7 years, with an overall mean follow-up period of 27 months. Primary endpoints focused on various functional outcome scores, range of motion, grip strength, and pain. The nonoperative management of TFCC tears resulted in noninferior and comparable outcomes to operative management. Conclusion Our review identified that the nonoperative management of Palmer-type IB tears with a short period of above-elbow immobilization was an effective treatment option with good functional outcome scores. The nonoperative management of general TFCC tears resulted in comparable functional outcomes when viewed alongside results from other systematic reviews. Risk factors for developing a poor functional outcome or requiring operative management included distal radioulnar joint subluxation, short-arm immobilization, and full tears of the foveal attachment. However, further randomized controlled trials with homogenous data collection are required to make further conclusions regarding the management of this condition.
{"title":"The Natural History of Non-operatively Treated Traumatic Triangular Fibrocartilage Complex Tears: A Systematic Review","authors":"Seung Il Choi, Simon MacLean, Shabhaz Malik","doi":"10.1055/s-0044-1786164","DOIUrl":"https://doi.org/10.1055/s-0044-1786164","url":null,"abstract":"\u0000 Purpose Operative treatment of triangular fibrocartilage complex (TFCC) tears has been well researched; however, data regarding nonoperative management is mixed and scarce. Our review aimed to utilize available data to formulate conclusions regarding treatment algorithms for this heterogeneous injury group.\u0000 Methods A thorough literature review was performed in Medline (OVID), Embase, Cochrane Library, and PubMed databases with search terms including “triangular fibrocartilage complex” and variations on the full term including “triangular fibrocartilage” or “TFCC,” alongside “non-operative” and “conservative.” Results were then subject to inclusion criteria, ultimately identifying eight studies.\u0000 Results The studies involved a total of 425 patients and 427 wrists for analysis. The mean age ranged from 30.7 years to 60.4 years. 53.6% of patients were male. The mean follow-up ranged from 12 months to 7 years, with an overall mean follow-up period of 27 months. Primary endpoints focused on various functional outcome scores, range of motion, grip strength, and pain. The nonoperative management of TFCC tears resulted in noninferior and comparable outcomes to operative management.\u0000 Conclusion Our review identified that the nonoperative management of Palmer-type IB tears with a short period of above-elbow immobilization was an effective treatment option with good functional outcome scores. The nonoperative management of general TFCC tears resulted in comparable functional outcomes when viewed alongside results from other systematic reviews. Risk factors for developing a poor functional outcome or requiring operative management included distal radioulnar joint subluxation, short-arm immobilization, and full tears of the foveal attachment. However, further randomized controlled trials with homogenous data collection are required to make further conclusions regarding the management of this condition.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140663367","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}
Pedro Alvedro-Ruiz, Ana Trapero-Ovejero, J. Ferràs-Tarragó, A. Pérez-García, Alfonso Valverde-Navarro, A. Thione
Background The cuboid bone (CB) of the foot has been suggested as a potential source of autologous reconstruction of the distal radius (DR). This study sought to examine the feasibility of harvesting the CB as a vascularized bone transfer for DR reconstruction. Purposes We evaluated the feasibility of a vascularized bone transfer of the CB by performing the flap dissection, analyzing its pedicle and demonstrating its perfusion using indocyanine green (ICG) fluorescence angiography. Methods Ten feet from five fresh-frozen cadaver specimens were dissected. The lateral tarsal artery (LTA) mean diameter, length, and emerging point were described. The CB mean length and the mean length of the bone segment harvested were reported. ICG injection was used to demonstrate its blood supply. Results The average length of the pedicle was 68.26 ± 3.12 mm. The mean diameter was 1.43 ± 0.15 mm. The CB had a mean anterior–posterior length of 40.81 ± 5.05 mm. The harvested bone had a mean length of 15.05 ± 2.03 mm. All CBs showed enhancement after ICG injection. Conclusion The CB presented reasonable anatomical similarities with the DR and a long and consistent pedicle with an adequate blood supply observed during ICG injection. Clinical Relevance This study supports the possibility of using the CB as a vascularized bone transfer for autologous reconstruction of the articular surface of the DR. Further study is warranted.
{"title":"Cuboid Bone for Distal Radius Reconstruction: An Anatomical Cadaver Study","authors":"Pedro Alvedro-Ruiz, Ana Trapero-Ovejero, J. Ferràs-Tarragó, A. Pérez-García, Alfonso Valverde-Navarro, A. Thione","doi":"10.1055/s-0044-1786031","DOIUrl":"https://doi.org/10.1055/s-0044-1786031","url":null,"abstract":"\u0000 Background The cuboid bone (CB) of the foot has been suggested as a potential source of autologous reconstruction of the distal radius (DR). This study sought to examine the feasibility of harvesting the CB as a vascularized bone transfer for DR reconstruction.\u0000 Purposes We evaluated the feasibility of a vascularized bone transfer of the CB by performing the flap dissection, analyzing its pedicle and demonstrating its perfusion using indocyanine green (ICG) fluorescence angiography.\u0000 Methods Ten feet from five fresh-frozen cadaver specimens were dissected. The lateral tarsal artery (LTA) mean diameter, length, and emerging point were described. The CB mean length and the mean length of the bone segment harvested were reported. ICG injection was used to demonstrate its blood supply.\u0000 Results The average length of the pedicle was 68.26 ± 3.12 mm. The mean diameter was 1.43 ± 0.15 mm. The CB had a mean anterior–posterior length of 40.81 ± 5.05 mm. The harvested bone had a mean length of 15.05 ± 2.03 mm. All CBs showed enhancement after ICG injection.\u0000 Conclusion The CB presented reasonable anatomical similarities with the DR and a long and consistent pedicle with an adequate blood supply observed during ICG injection.\u0000 Clinical Relevance This study supports the possibility of using the CB as a vascularized bone transfer for autologous reconstruction of the articular surface of the DR. Further study is warranted.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140698031","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}
S. Goeminne, Emiel Salaets, Walter Coudyzer, Darshan Shah, Ilse Degreef, Lennart Scheys
Purpose A technique to measure scapholunate distance based on four-dimensional computed tomography (4D CT)-acquired images is presented. Methods Intra-observer variability was evaluated through a repeated-measures study. A 4D CT of seven patients suspected of scapholunate lesion was performed. Anatomical landmarks were identified on a three-dimensional reconstructed model of the wrist. All 4D CT datasets were evaluated thrice by two observers. Standard deviation of the differences between two measurements, interclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) were calculated. Results Intra-observer variability for the expert observer (ICC > 0.95) was lower than that of the novice observer (ICC > 0.77) and interobserver variability was low (ICC > 0.85). For the expert observer, measurement error (SEM < 0.13 mm and MDC < 0.36 mm) was smaller than that of the novice observer (SEM < 0.45 mm and MDC < 1.24 mm). Both SEM and MDC values were low, compared to the scan resolution and the absolute value of intervals. Conclusion The proposed assessment results in a reproducible and reliable measurement of scapholunate distance.
{"title":"Evaluation of Reliability of Dynamic Scapholunate Distance Measured on 4D CT-Acquired Images","authors":"S. Goeminne, Emiel Salaets, Walter Coudyzer, Darshan Shah, Ilse Degreef, Lennart Scheys","doi":"10.1055/s-0044-1786161","DOIUrl":"https://doi.org/10.1055/s-0044-1786161","url":null,"abstract":"\u0000 Purpose A technique to measure scapholunate distance based on four-dimensional computed tomography (4D CT)-acquired images is presented.\u0000 Methods Intra-observer variability was evaluated through a repeated-measures study. A 4D CT of seven patients suspected of scapholunate lesion was performed. Anatomical landmarks were identified on a three-dimensional reconstructed model of the wrist. All 4D CT datasets were evaluated thrice by two observers. Standard deviation of the differences between two measurements, interclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) were calculated.\u0000 Results Intra-observer variability for the expert observer (ICC > 0.95) was lower than that of the novice observer (ICC > 0.77) and interobserver variability was low (ICC > 0.85). For the expert observer, measurement error (SEM < 0.13 mm and MDC < 0.36 mm) was smaller than that of the novice observer (SEM < 0.45 mm and MDC < 1.24 mm). Both SEM and MDC values were low, compared to the scan resolution and the absolute value of intervals.\u0000 Conclusion The proposed assessment results in a reproducible and reliable measurement of scapholunate distance.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140697099","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}
Pedro Alvedro-Ruiz, Ana Trapero-Ovejero, J. Ferràs-Tarragó, A. Pérez-García, A. Thione
Background Distal radius (DR) reconstruction due to high-energy trauma, degenerative processes, and oncologic resections can be a challenge when the articular surface is destroyed or resected. This study investigates the possibility of using the cuboid bone of the foot to replace the osteoarticular surface of DR. Purposes We compared the three-dimensional (3D) morphology of the articular surface of three foot bones with that of the DR to analyze which one would be the most suitable to replace it. Methods 3D bone models were created from a computed tomography (CT) scan database. The articular surfaces of calcaneus, cuboid bone, and lateral cuneiform bone were compared with that of the DR using the Hausdorff-Besicovitch morphometry analysis. Mean, maximum, and minimum differences were obtained and statistically analyzed. Results The cuboid bone had a mean overall area difference with the DR of 0.72 mm (standard deviation [SD], 0.03 mm). The lateral cuneiform bone showed 0.89 mm (SD, 0.08 mm). The calcaneus presented 1.04 mm (SD, 0.06 mm). The differences and the variability of the articular surface were statistically lower in the cuboid bone. Conclusion The articular surface of the cuboid bone has many similarities to the articular surface of the DR and had the most similarities to the DR of the foot bones study. The cuboid bone could be considered as a replacement for the DR in cases where there is a need for osteoarticular replacement or reconstruction. Further investigations are warranted. Clinical Relevance A vascularized transfer of the cuboid bone may be a suitable option to replace a DR given the anatomical similarities reported.
背景 因高能量创伤、退行性病变和肿瘤切除而导致的桡骨远端(DR)重建,在关节面被破坏或切除时可能是一项挑战。本研究探讨了使用足部立方体骨替代桡骨骨关节面的可能性。目的 我们比较了三种足骨的关节面与 DR 的关节面的三维(3D)形态,以分析哪一种最适合替代 DR。方法 根据计算机断层扫描(CT)数据库创建三维骨骼模型。使用 Hausdorff-Besicovitch 形态测量分析法将小方块骨、立方体骨和外侧楔骨的关节面与 DR 的关节面进行比较。得出了平均值、最大值和最小值差异,并进行了统计分析。结果 立方体骨与 DR 的平均总面积差异为 0.72 毫米(标准差 [SD],0.03 毫米)。外侧楔骨显示 0.89 毫米(标准差,0.08 毫米)。小腿骨为 1.04 毫米(标准差为 0.06 毫米)。据统计,立方体骨关节面的差异和变异性较低。结论 立方体骨的关节面与桡骨的关节面有许多相似之处,而且与足骨研究中的桡骨关节面最为相似。在需要进行骨关节置换或重建的情况下,可考虑用立方体骨替代 DR。还需要进一步研究。临床意义 鉴于所报告的解剖学相似性,长方体骨的血管化转移可能是替代DR的合适选择。
{"title":"Cuboid Bone for Distal Radius Reconstruction: An Anatomical Study by 3D Models","authors":"Pedro Alvedro-Ruiz, Ana Trapero-Ovejero, J. Ferràs-Tarragó, A. Pérez-García, A. Thione","doi":"10.1055/s-0044-1785499","DOIUrl":"https://doi.org/10.1055/s-0044-1785499","url":null,"abstract":"\u0000 Background Distal radius (DR) reconstruction due to high-energy trauma, degenerative processes, and oncologic resections can be a challenge when the articular surface is destroyed or resected. This study investigates the possibility of using the cuboid bone of the foot to replace the osteoarticular surface of DR.\u0000 Purposes We compared the three-dimensional (3D) morphology of the articular surface of three foot bones with that of the DR to analyze which one would be the most suitable to replace it.\u0000 Methods 3D bone models were created from a computed tomography (CT) scan database. The articular surfaces of calcaneus, cuboid bone, and lateral cuneiform bone were compared with that of the DR using the Hausdorff-Besicovitch morphometry analysis. Mean, maximum, and minimum differences were obtained and statistically analyzed.\u0000 Results The cuboid bone had a mean overall area difference with the DR of 0.72 mm (standard deviation [SD], 0.03 mm). The lateral cuneiform bone showed 0.89 mm (SD, 0.08 mm). The calcaneus presented 1.04 mm (SD, 0.06 mm). The differences and the variability of the articular surface were statistically lower in the cuboid bone.\u0000 Conclusion The articular surface of the cuboid bone has many similarities to the articular surface of the DR and had the most similarities to the DR of the foot bones study. The cuboid bone could be considered as a replacement for the DR in cases where there is a need for osteoarticular replacement or reconstruction. Further investigations are warranted.\u0000 Clinical Relevance A vascularized transfer of the cuboid bone may be a suitable option to replace a DR given the anatomical similarities reported.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140701440","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 Axial carpal dislocations (ACDs) are high-impact injuries, involving both proximal and distal carpal rows, adding complexity to the diagnostic and treatment challenges. This article explores a distinctive case of axial radial carpal dislocation, highlighting an irreducible second carpometacarpal joint (CMCJ) and concomitant scapholunate (SL) ligament injury. Understanding the background of axial carpal injuries is crucial for recognizing and addressing these complex cases effectively. Description A 27-year-old man presented with a left wrist injury following a motorcycle accident, revealing an irreducible second CMCJ with a unique ligamentous injury pattern. Despite unsuccessful closed reduction attempts, the surgical intervention involved a dorsal midline incision, fixation of the second CMCJ and SL interval, and ligament repair. Postoperative assessment demonstrated proper alignment with a mild gap in the SL interval, revealing the intricate nature of the injury. Literature Review Existing studies describe a type of axial dislocation starting at the third webspace, traveling through capitate–hamate intervals leading to scaphoid dislocation. However, in the article, we describe a variant of ACD through second CMCJ causing an SL interval instability. Clinical Relevance Recognizing and comprehensively addressing axial radial carpal dislocations are crucial for optimal patient outcomes. The case report contributes valuable insights into the rare pattern of ACD involving SL instability that was missed on initial radiographs but detected through computed tomography scan and thereby managed appropriately. Any CMCJ dislocation should raise a suspicion of axial dislocation unless proved otherwise.
{"title":"Complex Axial Carpal Dislocation with Scapholunate Ligament Injury","authors":"Sathya Vamsi Krishna, Nikunj Gondaliya","doi":"10.1055/s-0044-1785500","DOIUrl":"https://doi.org/10.1055/s-0044-1785500","url":null,"abstract":"\u0000 Background Axial carpal dislocations (ACDs) are high-impact injuries, involving both proximal and distal carpal rows, adding complexity to the diagnostic and treatment challenges. This article explores a distinctive case of axial radial carpal dislocation, highlighting an irreducible second carpometacarpal joint (CMCJ) and concomitant scapholunate (SL) ligament injury. Understanding the background of axial carpal injuries is crucial for recognizing and addressing these complex cases effectively.\u0000 Description A 27-year-old man presented with a left wrist injury following a motorcycle accident, revealing an irreducible second CMCJ with a unique ligamentous injury pattern. Despite unsuccessful closed reduction attempts, the surgical intervention involved a dorsal midline incision, fixation of the second CMCJ and SL interval, and ligament repair. Postoperative assessment demonstrated proper alignment with a mild gap in the SL interval, revealing the intricate nature of the injury.\u0000 Literature Review Existing studies describe a type of axial dislocation starting at the third webspace, traveling through capitate–hamate intervals leading to scaphoid dislocation. However, in the article, we describe a variant of ACD through second CMCJ causing an SL interval instability.\u0000 Clinical Relevance Recognizing and comprehensively addressing axial radial carpal dislocations are crucial for optimal patient outcomes. The case report contributes valuable insights into the rare pattern of ACD involving SL instability that was missed on initial radiographs but detected through computed tomography scan and thereby managed appropriately. Any CMCJ dislocation should raise a suspicion of axial dislocation unless proved otherwise.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140703549","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}
Kazimir Bagdady, Cedar Slovacek, Peter K. Firouzbakht, Brian A. Mailey
Background Surgical options for patients with recurrent wrist pain after salvage procedures, such as proximal row carpectomy (PRC), are limited and primarily result in total wrist arthrodesis (TWA). Osteochondral allografting (OCA) offers an additional option to address refractory wrist pain due to arthritis while preserving some range of motion. Case Description A 65-year-old, right hand dominant male developed chronic wrist pain, secondary to untreated scapholunate and triangular fibrocartilage complex ligament tears. The patient underwent a PRC, radial styloidectomy, and partial wrist denervation with good initial pain relief. Two years later, symptoms returned with radiographs demonstrating capitate sclerosis. A salvage arthroplasty with OCA produced relief of symptoms. Literature Review Refractory wrist pain after salvage procedures have traditionally been managed with TWA or less commonly, wrist arthroplasty. Capitate resurfacing and interposition have expanded indications for PRC. OCA is a chondral replacement procedure that utilizes cadaveric cartilage allograft plugs to replace damaged cartilage in various articular joint surfaces. Although OCA used in the lower extremity and shoulder has demonstrated improved pain relief and return of function, it has not been reported in the wrist. Clinical Relevance There are limited options for refractory wrist pain after salvage procedures. We present an additional alternative to TWA, by resurfacing the radiocarpal joint affected by chondromalacia after a PRC. This option offers another treatment modality for recurrent wrist pain while still preserving some element of range of motion.
背景 对经过近端行腕关节切除术(PRC)等挽救手术后复发腕关节疼痛的患者,手术选择有限,主要是全腕关节置换术(TWA)。骨软骨同种异体移植术(OCA)为解决关节炎引起的难治性腕痛提供了另一种选择,同时保留了一定的活动范围。病例描述 一位 65 岁的右手优势型男性因肩胛骨和三角纤维软骨复合韧带撕裂未得到治疗而引发慢性腕痛。患者接受了PRC、桡侧花键切除术和腕部部分神经支配术,最初疼痛得到了很好的缓解。两年后,症状再次出现,X光片显示头状硬化。使用 OCA 进行抢救性关节成形术后,症状得到缓解。文献综述 传统上,抢救性手术后的难治性腕痛可通过 TWA 或较少见的腕关节成形术来治疗。帽状腱膜复位和内固定术扩大了PRC的适应症。OCA是一种软骨置换术,利用尸体软骨异体移植栓来置换各种关节面的受损软骨。虽然在下肢和肩部使用 OCA 能有效缓解疼痛并恢复功能,但在腕部使用这种方法的报道还不多。临床意义 对于抢救性手术后的难治性腕痛,可供选择的治疗方案有限。我们提出了除 TWA 之外的另一种选择,即在 PRC 术后对受软骨软化症影响的桡腕关节进行再植。这种方法为复发性腕痛提供了另一种治疗方式,同时还保留了一定的活动范围。
{"title":"Radiocarpal Osteochondral Allografts for Wrist Pain Postproximal Row Carpectomy","authors":"Kazimir Bagdady, Cedar Slovacek, Peter K. Firouzbakht, Brian A. Mailey","doi":"10.1055/s-0044-1781429","DOIUrl":"https://doi.org/10.1055/s-0044-1781429","url":null,"abstract":"\u0000 Background Surgical options for patients with recurrent wrist pain after salvage procedures, such as proximal row carpectomy (PRC), are limited and primarily result in total wrist arthrodesis (TWA). Osteochondral allografting (OCA) offers an additional option to address refractory wrist pain due to arthritis while preserving some range of motion.\u0000 Case Description A 65-year-old, right hand dominant male developed chronic wrist pain, secondary to untreated scapholunate and triangular fibrocartilage complex ligament tears. The patient underwent a PRC, radial styloidectomy, and partial wrist denervation with good initial pain relief. Two years later, symptoms returned with radiographs demonstrating capitate sclerosis. A salvage arthroplasty with OCA produced relief of symptoms.\u0000 Literature Review Refractory wrist pain after salvage procedures have traditionally been managed with TWA or less commonly, wrist arthroplasty. Capitate resurfacing and interposition have expanded indications for PRC. OCA is a chondral replacement procedure that utilizes cadaveric cartilage allograft plugs to replace damaged cartilage in various articular joint surfaces. Although OCA used in the lower extremity and shoulder has demonstrated improved pain relief and return of function, it has not been reported in the wrist.\u0000 Clinical Relevance There are limited options for refractory wrist pain after salvage procedures. We present an additional alternative to TWA, by resurfacing the radiocarpal joint affected by chondromalacia after a PRC. This option offers another treatment modality for recurrent wrist pain while still preserving some element of range of motion.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140713452","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 The dorsal intercarpal (DIC) ligament plays a significant role in carpal stability and is often associated with other carpal ligament injuries. Isolated DIC ligament injuries are rare and can present as a ligament avulsion, bony avulsion, or attenuation due to chronic injury. Previously, we described the first isolated DIC ligament avulsion and proposed an arthroscopic repair technique. This article presents an arthroscopic classification of DIC ligament complex injuries and outcomes in a larger series of patients. Methods A retrospective review was conducted on 16 patients who had undergone arthroscopic repair of the DIC ligament from 2018 to 2022. Intraoperative arthroscopic findings were documented, leading to the proposal of a classification system for DIC ligament tears. Pre- and postoperative outcomes, including the range of motion, grip strength, visual analog scale (VAS) pain scores, and Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH) outcomes, were assessed in this cohort. Results At a mean follow-up of 17.8 months, there was a statistically significant improvement in wrist flexion (65.3 to 74.3 degrees), wrist extension (77.8 to 84.5 degrees), comparative grip strength (46.4 to 87% compared with contralateral wrist), VAS score (6.3 to 0.6), and QuickDASH score (54.8 to 4.5). Four out of 16 patients (25%) had isolated DIC ligament tears, and the remaining 12 (75%) had concomitant intercarpal ligament injuries. Conclusion The study highlights the critical role of the DIC ligament in carpal stability and introduces an arthroscopic classification for evaluating this lesion. Surgical options for different types of DIC ligament tears were also discussed. Level of Evidence Level III, Retrospective study.
{"title":"Dorsal Intercarpal Ligament Tears: An Arthroscopic Classification and Clinical Outcomes Study","authors":"L. Merlini, Sze Ryn Chung, M. Caloia","doi":"10.1055/s-0044-1785505","DOIUrl":"https://doi.org/10.1055/s-0044-1785505","url":null,"abstract":"\u0000 Background The dorsal intercarpal (DIC) ligament plays a significant role in carpal stability and is often associated with other carpal ligament injuries. Isolated DIC ligament injuries are rare and can present as a ligament avulsion, bony avulsion, or attenuation due to chronic injury. Previously, we described the first isolated DIC ligament avulsion and proposed an arthroscopic repair technique. This article presents an arthroscopic classification of DIC ligament complex injuries and outcomes in a larger series of patients.\u0000 Methods A retrospective review was conducted on 16 patients who had undergone arthroscopic repair of the DIC ligament from 2018 to 2022. Intraoperative arthroscopic findings were documented, leading to the proposal of a classification system for DIC ligament tears. Pre- and postoperative outcomes, including the range of motion, grip strength, visual analog scale (VAS) pain scores, and Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH) outcomes, were assessed in this cohort.\u0000 Results At a mean follow-up of 17.8 months, there was a statistically significant improvement in wrist flexion (65.3 to 74.3 degrees), wrist extension (77.8 to 84.5 degrees), comparative grip strength (46.4 to 87% compared with contralateral wrist), VAS score (6.3 to 0.6), and QuickDASH score (54.8 to 4.5). Four out of 16 patients (25%) had isolated DIC ligament tears, and the remaining 12 (75%) had concomitant intercarpal ligament injuries.\u0000 Conclusion The study highlights the critical role of the DIC ligament in carpal stability and introduces an arthroscopic classification for evaluating this lesion. Surgical options for different types of DIC ligament tears were also discussed.\u0000 Level of Evidence Level III, Retrospective study.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140363537","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}