Journal of Wrist Surgery最新文献

Introduction: Hardware prominence is one of the major established complications following volar plating of distal radius fractures. The purpose of this cadaveric study is to compare two conventional fluoroscopic imaging views (carpal shoot-through view [CSV] and dorsal horizon view [DHV]) with ultrasound (US) to establish the best intraoperative imaging modality for surgeons to use to identify penetration of screws through the dorsal cortex and/or into the distal radioulnar joint (DRUJ).

Materials and methods: Twelve human cadaveric limbs were included in the study, instrumented with distal radius plates via a volar approach. The three imaging modalities, CSV, DHV, and US, were compared in terms of detecting prominent screws during volar plate fixation. Six surgeons with varying levels of expertise performed the evaluations. Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and the area under the receiver operating characteristic curve were computed for every surgeon and imaging method.

Results: The CSV was found to be more sensitive compared with the DHV and US for detecting dorsal cortex penetration (99% vs. 94% vs. 56%, respectively). The DHV was found to be more sensitive in recognizing DRUJ screw penetration compared with CSV and US (89% vs. 78% vs. 11%, respectively). US evaluation demonstrated considerably lower diagnostic utility compared with CSV and DHV. Surgeon's ability to perform as well as confidence in evaluating for screw penetration was highest with the CSV view.

Conclusion: Fluoroscopic imaging, particularly the CSV, demonstrates greater diagnostic reliability compared with US for intraoperative detection of prominent screws following volar plate fixation of the distal radius. CSV was also identified as the most reproducible examination for all levels of expertise with minimal formal training required.

Level of evidence: Therapeutic level V.

Total wrist arthroplasty (TWA) is a surgical option for individuals with end-stage wrist arthritis; however, their longevity remains below that of the hip and the knee. The objective of this study was to examine the muscle forces and articular loading patterns following TWA to better understand possible failure modes. Eight cadaveric specimens underwent active motion simulation representing planar flexion-extension and planar radial/ulnar deviation in both intact and TWA reconstructed states using a custom load sensing TWA. Results showed that muscle forces for extensors increased post-TWA implantation when extending the joint, whereas the flexors remain relatively unchanged. In addition, the articular loading was greater during extension than during flexion and during ulnar deviation than during radial deviation. The increase in muscle forces and high carpal component loading postimplantation may contribute to decreased longevity and early failure of implants.

A systematic literature review was performed to assess the results of modified Brunelli tenodesis modified Brunelli technique (MBT) and three-ligament tenodesis (3LT) in the treatment of chronic scapholunate (SL) ligament injuries reported between 1998 and 2001. This review describes the surgical techniques, clinical outcomes, radiological evaluations, and complication rates among 600 patients. Following adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 15 studies were included (289 MBT and 311 3LT procedures). A heterogeneity in surgical technique was noted. An average pain reduction of 3 points on the visual analog score and a flexion-extension arch compatible with most daily activities were found. Radiographic follow-up showed medium-term improvements, but loss of reduction was observed in the long term. Secondary degeneration was seen in 15% of cases. Radiographic decay did not correlate with clinical outcomes. The overall complication rate was 9%. This review underscores the satisfactory clinical outcome of both procedures. Nonetheless, both interventions pose risks of complications and/or degeneration in the long term.

Degenerative wrist disease may have varying etiologies, but solutions to deal with this debilitating condition center around several common management pathways. Once nonoperative measures have been exhausted, generally there is a choice between motion sparing procedures or a total wrist arthrodesis. The appropriateness of motion sparing procedures will be dictated by the extent and pattern of degeneration, and midcarpal arthrosis is typically a contraindication to a proximal row carpectomy. One solution to this problem is to employ a Resurfacing Capitate Pyrocarbon Implant. This study aimed to investigate the prevalence and effectiveness of this operation by systematically reviewing the literature. The findings of this review support the use of this implant in the setting of degenerative wrist disease, with reported outcomes comparable to similar operations. However, this is based on overall low numbers of reported outcomes with a reasonable chance of bias. Level of Evidence  Level III.

Background  A retrospective review was performed of 15 adult patients who underwent arthroscopic suture anchor scapholunate capsuloligamentous repair between 2021 and 2023. Materials and Methods  There were 12 male and 3 female patients, with a mean age of 44.9 years. Eight patients had European Wrist Arthroscopy Society (EWAS) II (Geissler II), four patients had EWAS IIIC (Geissler III), and three patients had EWAS IV (Geissler IV). After a follow-up of 12 months (12-26), the mean grip strength significantly improved by 131% compared with presurgery. There was a significant improvement in the visual analog scale score from 6 to 1.2, the Mayo Wrist Score from 43.5 to 86.5, and the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire score from 65.9 to 6.5. Two EWAS IV patients had recurrent symptomatic scapholunate diastasis requiring scapholunate ligamentoplasty. Conclusion  The arthroscopic dorsal scapholunate capsuloligamentous repair with suture anchors is a reliable and safe technique with minimal complications. It is recommended for reducible acute or chronic injury to the scapholunate ligament complex with suspected avulsion injury. Level of Evidence  Level IV.

Background  Negative ulnar variance is a recognized predisposing factor for Kienbock's disease (KD). Radial shortening osteotomy (RSO) reduces radial height, thereby alleviating stress on the lunate. Conversely, radial closed wedge osteotomy (RCWO) involves removing a distal radius wedge to not only decrease radial height but also reduce radial inclination, thereby enhancing lunate coverage. Description  This article outlines a straightforward and minimally invasive approach to RSO utilizing a single cut and stabilization with a single screw. Additionally, it introduces a technique for RCWO comprising two cuts, wedge removal from the distal radius, and fixation using a single headless screw. Literature Review  Traditionally, RSO and RCWO procedures include a volar approach consistent with distal radius fracture fixation techniques. However, the reliance on "free-hand" cuts may necessitate larger hardware for stabilization. Overcorrection poses risks of suboptimal outcomes and often mandates subsequent hardware removal procedures. Clinical Relevance  Both RSO and RCWO techniques offer minimally invasive solutions, which preserve the periosteum, and maintain stability. These techniques only require a single screw and a removable splint. RSO is indicated for KD wrists with negative ulnar variance, while RCWO is preferable for cases with negative ulnar variance and increased radial inclination.

Background  We sought to evaluate the intermediate term outcomes of trapeziectomy with double Mini TightRope suture suspensionplasty and flexor carpi radialis to abductor pollicis longus imbrication for the treatment of basilar thumb joint arthritis. Case Description  We performed a retrospective review of patients from 2012 to 2021 at a single institution within a standardized protocol. Thirty-nine patients (46 thumbs) with a mean age of 61 years and clinical follow-up of 2.8 years met our inclusion criteria. Grip strength increased from 13.8 kg preoperatively to 20.3 kg postoperatively. Appositional pinch strength increased from 3.7 to 5.7 kg, while oppositional pinch strength also increased from 2.8 to 4.4 kg. Trapezial space ratio was well maintained at 0.36 postoperatively compared with 0.46 preoperatively at a mean radiographic follow-up of 2.2 years. Literature Review and Clinical Relevance  Results from our series demonstrate predictable outcomes with reduced pain levels, increased grip and pinch strengths, improved function, and preserved range of motion with few complications. Level of Evidence  III therapeutic. Trial Registration  Not applicable.

Background  Midcarpal fusion is a procedure indicated for midcarpal arthrosis or instability, though the merits of fusing the triquetrohamate joint in addition to the capitolunate joint are not known. The purpose of this study was to compare capitolunate fusion with four-corner fusion with a null hypothesis that no differences would exist in outcomes. Materials and Methods  A retrospective chart review of patients with midcarpal arthrosis who underwent midcarpal fusion between the years 2013 and 2023 was conducted. Patients were separated into groups according to fusion type. Demographics and methods of fixation were recorded. Outcomes evaluated included subjective outcomes, radiographic alignment, success of fusion, range of motion, strength, and complications. Results  In total, 51 patients met inclusion criteria. Of these, 20 had capitolunate fusions and 31 had four-corner fusions. Staples were the most common form of fixation. Postoperative strength and range of motion were relatively preserved from preoperative levels in both groups. Both groups also had similar improvements in Disabilities of Arm, Shoulder, and Hand score. Capitolunate angles were not significantly different between groups; however, ulnar translocation was greater in the four-corner fusion group. Revision surgery was required in 10% of capitolunate fusions versus 29% of four-corner fusions, although this difference was not calculated to be significantly different. Conclusion  Capitolunate fusion and four-corner fusion yielded comparable improvements with respect to clinical and radiographic outcomes. Fusing the triquetrohamate joint does not appear to enhance outcomes.

Background  Combinations of distal radius fractures with scapholunate ligament (SL) injuries are hard to diagnose, and amalunited fractures with ligament damage are rarely discussed. Materials and Methods  Here is presented a case of a 40-year-old man with history of a malunited distal radius fracture and a scapholunate rupture with a time difference of over a decade between assumed traumatic incidents. We present the results of a simultaneous treatment of both conditions with corrective osteotomy and osteosynthesis of the distal radius combined with SL tenodesis. Results  At 2 years after the surgery, there was a significant improvement in the results of the patient's questionnaire on subjective scales, a slight improvement in the range of motion in the wrist joint. Conclusion  Despite the lack of publications on the topic in the literature, isolated problems of malunion of the distal radius fractures and the consequences of scapholunate injuries are still open for discussion. Our results suggest that when these two problems are combined, one-stage treatment can have excellent results.