Bilal Mahmood, Keith Diamond, Omri B Ayalon, N. Paksima, Steven Glickel
Hypothesis Wrist magnetic resonance imaging (MRI) has shown excellent diagnostic accuracy in evaluating soft-tissue pathology of the wrist including ganglion cysts, ligament tears, and triangular fibrocartilage complex (TFCC) pathology. However, it is unclear how often MRI detects synovitis that is subsequently encountered during wrist arthroscopy and may be a source of pain for patients with symptoms unresponsive to conservative treatment. The aim of this study is to assess the diagnostic accuracy of conventional MRI in the detection of wrist synovitis observed intraoperatively with wrist arthroscopy. Materials and Methods A retrospective chart review was performed on 51 patients who underwent arthroscopy for chronic wrist pain and MRI confirmed wrist pathology that did not resolve with nonoperative treatment. Wrist arthroscopy was performed by three fellowship-trained hand surgeons. While the primary pathology like TFCC or scapholunate ligament tear was identified and treated arthroscopically, it was noted that many of the patients had concomitant synovitis observed arthroscopically that was not identified preoperatively on MRI. Therefore, the diagnosis of wrist synovitis on MRI scan was compared with the observed presence of synovitis at the time of wrist arthroscopy. Results of preoperative MRI without contrast were categorized as true positive, false positive, true negative, and false negative, based upon intraoperative arthroscopic findings. Results In total, 45/51 patients were confirmed to have dorsal and ulnar synovitis on wrist arthroscopy. MRI identified 16/51 patients as having synovitis. Of those 16 patients, 2 were false positives. Conclusion The results demonstrate that conventional MRI without contrast has poor diagnostic accuracy in detecting wrist synovitis. Patients with ligament or chondral pathology or no clearly identifiable pathology on MRI whose clinical symptoms persist despite conservative treatment may have underlying dorsal and ulnar wrist synovitis that is not detected on MRI. Wrist arthroscopy facilitates the identification and treatment of synovitis in patients with concomitant wrist pathology and pain refractory to nonoperative treatment. This study suggests that MRI may have a low sensitivity for identifying wrist synovitis when compared with wrist arthroscopy during the evaluation of patients presenting with wrist pain.
{"title":"Accuracy of Wrist MRI in Detecting Synovitis and Correlation with Arthroscopy","authors":"Bilal Mahmood, Keith Diamond, Omri B Ayalon, N. Paksima, Steven Glickel","doi":"10.1055/s-0044-1779742","DOIUrl":"https://doi.org/10.1055/s-0044-1779742","url":null,"abstract":"\u0000 Hypothesis Wrist magnetic resonance imaging (MRI) has shown excellent diagnostic accuracy in evaluating soft-tissue pathology of the wrist including ganglion cysts, ligament tears, and triangular fibrocartilage complex (TFCC) pathology. However, it is unclear how often MRI detects synovitis that is subsequently encountered during wrist arthroscopy and may be a source of pain for patients with symptoms unresponsive to conservative treatment. The aim of this study is to assess the diagnostic accuracy of conventional MRI in the detection of wrist synovitis observed intraoperatively with wrist arthroscopy.\u0000 Materials and Methods A retrospective chart review was performed on 51 patients who underwent arthroscopy for chronic wrist pain and MRI confirmed wrist pathology that did not resolve with nonoperative treatment. Wrist arthroscopy was performed by three fellowship-trained hand surgeons. While the primary pathology like TFCC or scapholunate ligament tear was identified and treated arthroscopically, it was noted that many of the patients had concomitant synovitis observed arthroscopically that was not identified preoperatively on MRI. Therefore, the diagnosis of wrist synovitis on MRI scan was compared with the observed presence of synovitis at the time of wrist arthroscopy. Results of preoperative MRI without contrast were categorized as true positive, false positive, true negative, and false negative, based upon intraoperative arthroscopic findings.\u0000 Results In total, 45/51 patients were confirmed to have dorsal and ulnar synovitis on wrist arthroscopy. MRI identified 16/51 patients as having synovitis. Of those 16 patients, 2 were false positives.\u0000 Conclusion The results demonstrate that conventional MRI without contrast has poor diagnostic accuracy in detecting wrist synovitis. Patients with ligament or chondral pathology or no clearly identifiable pathology on MRI whose clinical symptoms persist despite conservative treatment may have underlying dorsal and ulnar wrist synovitis that is not detected on MRI. Wrist arthroscopy facilitates the identification and treatment of synovitis in patients with concomitant wrist pathology and pain refractory to nonoperative treatment. This study suggests that MRI may have a low sensitivity for identifying wrist synovitis when compared with wrist arthroscopy during the evaluation of patients presenting with wrist pain.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140446987","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: Several operative treatments exist for scaphoid fractures, varying by approach (e.g., ercutaneous, volar, or dorsal), implant type (e.g., screw or Kirschner wire), and bone raft choice (e.g., none, nonvascularized, or vascularized). Many previous systematic eviews and meta-analyses have investigated outcomes following different surgicalÚpproaches, the use of vascularized versus nonvascularized bone graft for scaphoidßracture nonunions, and treatment for specific fracture patterns. However, given the advancements n scaphoid fracture treatment in recent years, there is a need for updated treatment recommendations hat would be beneficial to hand surgeons. Purpose: We present a comprehensive review of the operative treatment of scaphoid fractures based on recent literature and propose a unified treatment algorithm for managing these fractures. Methods: The English-language literature was searched from 2002 to 2023 for high evidence level (e.g., randomized trials), review, and meta-analysis articles with the following search terms: “scaphoid, ”u8220“scaphoid” AND “nonunion, ” and “scaphoid” AND “malunion. ” Each article was creened by the authors to determine the scaphoid fracture scenario addressed and ubsequent treatment recommendations. The findings from article reviews were then rganized by scaphoid fracture types in this manuscript. Results: A total of 95 pertinent articles were ultimately selected and used as the basis for reviewing different scaphoid fracture scenarios. A treatment algorithm was then proposed based on literature review. Conclusion: This summary of the recent literature can guide hand surgeons in addressing scaphoidßractures. Future research in scaphoid fracture treatment, particularly for nonunions, would be most beneficial n the form of systematic review, meta-analysis, or multicenter prospective randomized clinical trials. Level of Evidence: IV
{"title":"Surgical Treatment of Scaphoid Fractures: Recommendations for Management","authors":"R. Samade, Hisham M. Awan","doi":"10.1055/s-0043-1772689","DOIUrl":"https://doi.org/10.1055/s-0043-1772689","url":null,"abstract":"\u0000 Background: Several operative treatments exist for scaphoid fractures, varying by approach (e.g., ercutaneous, volar, or dorsal), implant type (e.g., screw or Kirschner wire), and bone raft choice (e.g., none, nonvascularized, or vascularized). Many previous systematic eviews and meta-analyses have investigated outcomes following different surgicalÚpproaches, the use of vascularized versus nonvascularized bone graft for scaphoidßracture nonunions, and treatment for specific fracture patterns. However, given the advancements n scaphoid fracture treatment in recent years, there is a need for updated treatment recommendations hat would be beneficial to hand surgeons.\u0000 Purpose: We present a comprehensive review of the operative treatment of scaphoid fractures based on recent literature and propose a unified treatment algorithm for managing these fractures.\u0000 Methods: The English-language literature was searched from 2002 to 2023 for high evidence level (e.g., randomized trials), review, and meta-analysis articles with the following search terms: “scaphoid, ”u8220“scaphoid” AND “nonunion, ” and “scaphoid” AND “malunion. ” Each article was creened by the authors to determine the scaphoid fracture scenario addressed and ubsequent treatment recommendations. The findings from article reviews were then rganized by scaphoid fracture types in this manuscript.\u0000 Results: A total of 95 pertinent articles were ultimately selected and used as the basis for reviewing different scaphoid fracture scenarios. A treatment algorithm was then proposed based on literature review.\u0000 Conclusion: This summary of the recent literature can guide hand surgeons in addressing scaphoidßractures. Future research in scaphoid fracture treatment, particularly for nonunions, would be most beneficial n the form of systematic review, meta-analysis, or multicenter prospective randomized clinical trials.\u0000 Level of Evidence: IV","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139788852","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: Several operative treatments exist for scaphoid fractures, varying by approach (e.g., ercutaneous, volar, or dorsal), implant type (e.g., screw or Kirschner wire), and bone raft choice (e.g., none, nonvascularized, or vascularized). Many previous systematic eviews and meta-analyses have investigated outcomes following different surgicalÚpproaches, the use of vascularized versus nonvascularized bone graft for scaphoidßracture nonunions, and treatment for specific fracture patterns. However, given the advancements n scaphoid fracture treatment in recent years, there is a need for updated treatment recommendations hat would be beneficial to hand surgeons. Purpose: We present a comprehensive review of the operative treatment of scaphoid fractures based on recent literature and propose a unified treatment algorithm for managing these fractures. Methods: The English-language literature was searched from 2002 to 2023 for high evidence level (e.g., randomized trials), review, and meta-analysis articles with the following search terms: “scaphoid, ”u8220“scaphoid” AND “nonunion, ” and “scaphoid” AND “malunion. ” Each article was creened by the authors to determine the scaphoid fracture scenario addressed and ubsequent treatment recommendations. The findings from article reviews were then rganized by scaphoid fracture types in this manuscript. Results: A total of 95 pertinent articles were ultimately selected and used as the basis for reviewing different scaphoid fracture scenarios. A treatment algorithm was then proposed based on literature review. Conclusion: This summary of the recent literature can guide hand surgeons in addressing scaphoidßractures. Future research in scaphoid fracture treatment, particularly for nonunions, would be most beneficial n the form of systematic review, meta-analysis, or multicenter prospective randomized clinical trials. Level of Evidence: IV
{"title":"Surgical Treatment of Scaphoid Fractures: Recommendations for Management","authors":"R. Samade, Hisham M. Awan","doi":"10.1055/s-0043-1772689","DOIUrl":"https://doi.org/10.1055/s-0043-1772689","url":null,"abstract":"\u0000 Background: Several operative treatments exist for scaphoid fractures, varying by approach (e.g., ercutaneous, volar, or dorsal), implant type (e.g., screw or Kirschner wire), and bone raft choice (e.g., none, nonvascularized, or vascularized). Many previous systematic eviews and meta-analyses have investigated outcomes following different surgicalÚpproaches, the use of vascularized versus nonvascularized bone graft for scaphoidßracture nonunions, and treatment for specific fracture patterns. However, given the advancements n scaphoid fracture treatment in recent years, there is a need for updated treatment recommendations hat would be beneficial to hand surgeons.\u0000 Purpose: We present a comprehensive review of the operative treatment of scaphoid fractures based on recent literature and propose a unified treatment algorithm for managing these fractures.\u0000 Methods: The English-language literature was searched from 2002 to 2023 for high evidence level (e.g., randomized trials), review, and meta-analysis articles with the following search terms: “scaphoid, ”u8220“scaphoid” AND “nonunion, ” and “scaphoid” AND “malunion. ” Each article was creened by the authors to determine the scaphoid fracture scenario addressed and ubsequent treatment recommendations. The findings from article reviews were then rganized by scaphoid fracture types in this manuscript.\u0000 Results: A total of 95 pertinent articles were ultimately selected and used as the basis for reviewing different scaphoid fracture scenarios. A treatment algorithm was then proposed based on literature review.\u0000 Conclusion: This summary of the recent literature can guide hand surgeons in addressing scaphoidßractures. Future research in scaphoid fracture treatment, particularly for nonunions, would be most beneficial n the form of systematic review, meta-analysis, or multicenter prospective randomized clinical trials.\u0000 Level of Evidence: IV","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139848854","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}
Daisuke Nakajima, M. Ikeda, Yuka Kobayashi, I. Saito
Objective Synovial chondromatosis (SC) is relatively rare, but it often occurs in large joints and can cause osteoarthropathic (OA) changes if left untreated. It is extremely rare for this condition to occur around the wrist joint. We present a case treated by osteophyte resection for restriction of the forearm rotation caused by SC and the resulting OA changes in the distal radioulnar joint (DRUJ). Case Description A 50-year-old woman had progressive OA changes due to SC in the DRUJ, and restriction of forearm rotation. Thorough excision of SC and osteophytes through the dorsal and palmar approaches of the wrist improved the range of rotation of the forearm with no recurrence. Literature Review Although there have been scattered reports of SC occurring in the DRUJ, there have been no reports of management for restriction of forearm rotation caused by OA changes. Clinical Relevance For SC in DRUJ, it is important to make an early definitive diagnosis and perform a synovectomy to prevent the progression of OA changes. Osteophyte resection is effective in the treatment of restriction of the joint motion caused by secondary OA changes.
目标 滑膜软骨瘤病（SC）相对罕见，但常发生于大关节，如不及时治疗，可引起骨关节病（OA）改变。这种疾病发生在腕关节周围的情况极为罕见。我们为您介绍一例因 SC 导致前臂旋转受限而采用骨质增生切除术治疗的病例，以及由此引起的桡尺关节远端（DRUJ）OA 病变。病例描述 一位 50 岁的女性因桡尺关节远端骨质增生而出现渐进性 OA 病变，前臂旋转受限。通过腕部背侧和掌侧入路彻底切除 SC 和骨质增生后，前臂的旋转范围有所改善，且未再复发。文献综述 尽管有关于 SC 发生在 DRUJ 的零星报道，但还没有关于如何治疗 OA 病变导致的前臂旋转受限的报道。临床意义 对于发生在 DRUJ 的 SC，早期明确诊断并进行滑膜切除术以防止 OA 病变的发展非常重要。骨质增生切除术可有效治疗继发性 OA 病变引起的关节活动受限。
{"title":"Synovial Chondromatosis of Distal Radioulnar Joint with Osteoarthropathic Changes","authors":"Daisuke Nakajima, M. Ikeda, Yuka Kobayashi, I. Saito","doi":"10.1055/s-0044-1779625","DOIUrl":"https://doi.org/10.1055/s-0044-1779625","url":null,"abstract":"\u0000 Objective Synovial chondromatosis (SC) is relatively rare, but it often occurs in large joints and can cause osteoarthropathic (OA) changes if left untreated. It is extremely rare for this condition to occur around the wrist joint. We present a case treated by osteophyte resection for restriction of the forearm rotation caused by SC and the resulting OA changes in the distal radioulnar joint (DRUJ).\u0000 Case Description A 50-year-old woman had progressive OA changes due to SC in the DRUJ, and restriction of forearm rotation. Thorough excision of SC and osteophytes through the dorsal and palmar approaches of the wrist improved the range of rotation of the forearm with no recurrence.\u0000 Literature Review Although there have been scattered reports of SC occurring in the DRUJ, there have been no reports of management for restriction of forearm rotation caused by OA changes.\u0000 Clinical Relevance For SC in DRUJ, it is important to make an early definitive diagnosis and perform a synovectomy to prevent the progression of OA changes. Osteophyte resection is effective in the treatment of restriction of the joint motion caused by secondary OA changes.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139860155","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}
Daisuke Nakajima, M. Ikeda, Yuka Kobayashi, I. Saito
Objective Synovial chondromatosis (SC) is relatively rare, but it often occurs in large joints and can cause osteoarthropathic (OA) changes if left untreated. It is extremely rare for this condition to occur around the wrist joint. We present a case treated by osteophyte resection for restriction of the forearm rotation caused by SC and the resulting OA changes in the distal radioulnar joint (DRUJ). Case Description A 50-year-old woman had progressive OA changes due to SC in the DRUJ, and restriction of forearm rotation. Thorough excision of SC and osteophytes through the dorsal and palmar approaches of the wrist improved the range of rotation of the forearm with no recurrence. Literature Review Although there have been scattered reports of SC occurring in the DRUJ, there have been no reports of management for restriction of forearm rotation caused by OA changes. Clinical Relevance For SC in DRUJ, it is important to make an early definitive diagnosis and perform a synovectomy to prevent the progression of OA changes. Osteophyte resection is effective in the treatment of restriction of the joint motion caused by secondary OA changes.
目标 滑膜软骨瘤病（SC）相对罕见，但常发生于大关节，如不及时治疗，可引起骨关节病（OA）改变。这种疾病发生在腕关节周围的情况极为罕见。我们为您介绍一例因 SC 导致前臂旋转受限而采用骨质增生切除术治疗的病例，以及由此引起的桡尺关节远端（DRUJ）OA 病变。病例描述 一位 50 岁的女性因桡尺关节远端骨质增生而出现渐进性 OA 病变，前臂旋转受限。通过腕部背侧和掌侧入路彻底切除 SC 和骨质增生后，前臂的旋转范围有所改善，且未再复发。文献综述 尽管有关于 SC 发生在 DRUJ 的零星报道，但还没有关于如何治疗 OA 病变导致的前臂旋转受限的报道。临床意义 对于发生在 DRUJ 的 SC，早期明确诊断并进行滑膜切除术以防止 OA 病变的发展非常重要。骨质增生切除术可有效治疗继发性 OA 病变引起的关节活动受限。
{"title":"Synovial Chondromatosis of Distal Radioulnar Joint with Osteoarthropathic Changes","authors":"Daisuke Nakajima, M. Ikeda, Yuka Kobayashi, I. Saito","doi":"10.1055/s-0044-1779625","DOIUrl":"https://doi.org/10.1055/s-0044-1779625","url":null,"abstract":"\u0000 Objective Synovial chondromatosis (SC) is relatively rare, but it often occurs in large joints and can cause osteoarthropathic (OA) changes if left untreated. It is extremely rare for this condition to occur around the wrist joint. We present a case treated by osteophyte resection for restriction of the forearm rotation caused by SC and the resulting OA changes in the distal radioulnar joint (DRUJ).\u0000 Case Description A 50-year-old woman had progressive OA changes due to SC in the DRUJ, and restriction of forearm rotation. Thorough excision of SC and osteophytes through the dorsal and palmar approaches of the wrist improved the range of rotation of the forearm with no recurrence.\u0000 Literature Review Although there have been scattered reports of SC occurring in the DRUJ, there have been no reports of management for restriction of forearm rotation caused by OA changes.\u0000 Clinical Relevance For SC in DRUJ, it is important to make an early definitive diagnosis and perform a synovectomy to prevent the progression of OA changes. Osteophyte resection is effective in the treatment of restriction of the joint motion caused by secondary OA changes.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139800544","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 optimal management of established scaphoid nonunion is undecided. Priorities in this setting include the restoration of normal geometry and elimination of any bony defect, provision of adequate stability to allow early mobilization, and the achievement of union. Technique We describe a technique of arthroscopic assessment and debridement, reduction of deformity and autologous cancellous bone grafting, and stabilization via a specifically designed neutralization screw, to realize the above aims. Patients and Methods Consecutive patients undergoing this technique at a single center in Sydney, Australia, underwent pre- and postoperative assessment. Parameters assessed include a range of motion and patient-reported outcome measures. Results In total, 14 patients (11 males and 3 females with a mean age of 22.4 years) underwent treatment of scaphoid nonunion using this technique, at a mean of 105.9 weeks following index injury. The cohort was followed up radiologically for a mean of 20.7 weeks and clinically for 147.3 weeks. Union was achieved in 13 of 14 patients at a mean of 12.4 weeks. Significant improvements were noted in pain visual analogue scale (VAS), while changes were also noted in range of motion and quick disabilities of arm, shoulder and hand (QuickDASH) score. Conclusion This technique of arthroscopic management of scaphoid nonunion using a neutralization screw and cancellous bone graft is simple, easily reproducible, and confers numerous advantages when compared with other treatment modalities.
{"title":"Percutaneous Neutralization Screw with Arthroscopic Bone Grafting for Scaphoid Nonunion","authors":"B. Sivakumar, Soon Ghee Ang, Nicholas Smith","doi":"10.1055/s-0044-1779292","DOIUrl":"https://doi.org/10.1055/s-0044-1779292","url":null,"abstract":"\u0000 Background The optimal management of established scaphoid nonunion is undecided. Priorities in this setting include the restoration of normal geometry and elimination of any bony defect, provision of adequate stability to allow early mobilization, and the achievement of union.\u0000 Technique We describe a technique of arthroscopic assessment and debridement, reduction of deformity and autologous cancellous bone grafting, and stabilization via a specifically designed neutralization screw, to realize the above aims.\u0000 Patients and Methods Consecutive patients undergoing this technique at a single center in Sydney, Australia, underwent pre- and postoperative assessment. Parameters assessed include a range of motion and patient-reported outcome measures.\u0000 Results In total, 14 patients (11 males and 3 females with a mean age of 22.4 years) underwent treatment of scaphoid nonunion using this technique, at a mean of 105.9 weeks following index injury. The cohort was followed up radiologically for a mean of 20.7 weeks and clinically for 147.3 weeks. Union was achieved in 13 of 14 patients at a mean of 12.4 weeks. Significant improvements were noted in pain visual analogue scale (VAS), while changes were also noted in range of motion and quick disabilities of arm, shoulder and hand (QuickDASH) score.\u0000 Conclusion This technique of arthroscopic management of scaphoid nonunion using a neutralization screw and cancellous bone graft is simple, easily reproducible, and confers numerous advantages when compared with other treatment modalities.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139870823","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}
Shirley D. Stougie, Frederique M. Kemme, J. Coert, J. Oonk, Lara Plugge, Margriet H. M. van Doesburg
Background The aim of an Aptis distal radioulnar joint (DRUJ) implant is to reconstruct the DRUJ in patients with a destroyed, painful DRUJ, and gross ulnar instability. The literature is scarce regarding the management of (severe) early complications related to the Aptis implant in wrists with more rare conditions, such as rheumatoid arthritis, congenital malformations, or leiomyosarcoma of the distal ulna. Purpose This paper describes the clinical results, (severe) early complications related to the implant, revision surgery, patient satisfaction with the revision surgery, and esthetic appearance of the affected wrist in this specific cohort. Patients and Methods Retrospective evaluation of five consecutive patients with a short-to-medium follow-up time of 32 months (range: 18–53 months) was carried out. Results The follow-up revealed implant osseointegration failure in two cases, periprosthetic fractures in two cases, and acute carpal tunnel syndrome in one case. Three Aptis DRUJ arthroplasties were converted into a proximal Darrach. In four cases (80%), the patient was satisfied with the revision surgery due to pain reduction. In four cases (80%), the esthetic appearance of the affected wrist was found disappointing. Conclusion This study describes remarkable complications related to the Aptis implants in wrists with more rare conditions. The implant is more likely to fail in wrists with poor bone stock, remodeling of the radius, deformation, and malformation of the radius. The range of indications for the usage of the implant to maintain wrist function may be strict. Level of Evidence IV.
{"title":"Aptis Distal Radioulnar Joint Implant: Management of Remarkable Complications","authors":"Shirley D. Stougie, Frederique M. Kemme, J. Coert, J. Oonk, Lara Plugge, Margriet H. M. van Doesburg","doi":"10.1055/s-0044-1779448","DOIUrl":"https://doi.org/10.1055/s-0044-1779448","url":null,"abstract":"\u0000 Background The aim of an Aptis distal radioulnar joint (DRUJ) implant is to reconstruct the DRUJ in patients with a destroyed, painful DRUJ, and gross ulnar instability. The literature is scarce regarding the management of (severe) early complications related to the Aptis implant in wrists with more rare conditions, such as rheumatoid arthritis, congenital malformations, or leiomyosarcoma of the distal ulna.\u0000 Purpose This paper describes the clinical results, (severe) early complications related to the implant, revision surgery, patient satisfaction with the revision surgery, and esthetic appearance of the affected wrist in this specific cohort.\u0000 Patients and Methods Retrospective evaluation of five consecutive patients with a short-to-medium follow-up time of 32 months (range: 18–53 months) was carried out.\u0000 Results The follow-up revealed implant osseointegration failure in two cases, periprosthetic fractures in two cases, and acute carpal tunnel syndrome in one case. Three Aptis DRUJ arthroplasties were converted into a proximal Darrach. In four cases (80%), the patient was satisfied with the revision surgery due to pain reduction. In four cases (80%), the esthetic appearance of the affected wrist was found disappointing.\u0000 Conclusion This study describes remarkable complications related to the Aptis implants in wrists with more rare conditions. The implant is more likely to fail in wrists with poor bone stock, remodeling of the radius, deformation, and malformation of the radius. The range of indications for the usage of the implant to maintain wrist function may be strict.\u0000 Level of Evidence IV.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139810289","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}
Shirley D. Stougie, Frederique M. Kemme, J. Coert, J. Oonk, Lara Plugge, Margriet H. M. van Doesburg
Background The aim of an Aptis distal radioulnar joint (DRUJ) implant is to reconstruct the DRUJ in patients with a destroyed, painful DRUJ, and gross ulnar instability. The literature is scarce regarding the management of (severe) early complications related to the Aptis implant in wrists with more rare conditions, such as rheumatoid arthritis, congenital malformations, or leiomyosarcoma of the distal ulna. Purpose This paper describes the clinical results, (severe) early complications related to the implant, revision surgery, patient satisfaction with the revision surgery, and esthetic appearance of the affected wrist in this specific cohort. Patients and Methods Retrospective evaluation of five consecutive patients with a short-to-medium follow-up time of 32 months (range: 18–53 months) was carried out. Results The follow-up revealed implant osseointegration failure in two cases, periprosthetic fractures in two cases, and acute carpal tunnel syndrome in one case. Three Aptis DRUJ arthroplasties were converted into a proximal Darrach. In four cases (80%), the patient was satisfied with the revision surgery due to pain reduction. In four cases (80%), the esthetic appearance of the affected wrist was found disappointing. Conclusion This study describes remarkable complications related to the Aptis implants in wrists with more rare conditions. The implant is more likely to fail in wrists with poor bone stock, remodeling of the radius, deformation, and malformation of the radius. The range of indications for the usage of the implant to maintain wrist function may be strict. Level of Evidence IV.
{"title":"Aptis Distal Radioulnar Joint Implant: Management of Remarkable Complications","authors":"Shirley D. Stougie, Frederique M. Kemme, J. Coert, J. Oonk, Lara Plugge, Margriet H. M. van Doesburg","doi":"10.1055/s-0044-1779448","DOIUrl":"https://doi.org/10.1055/s-0044-1779448","url":null,"abstract":"\u0000 Background The aim of an Aptis distal radioulnar joint (DRUJ) implant is to reconstruct the DRUJ in patients with a destroyed, painful DRUJ, and gross ulnar instability. The literature is scarce regarding the management of (severe) early complications related to the Aptis implant in wrists with more rare conditions, such as rheumatoid arthritis, congenital malformations, or leiomyosarcoma of the distal ulna.\u0000 Purpose This paper describes the clinical results, (severe) early complications related to the implant, revision surgery, patient satisfaction with the revision surgery, and esthetic appearance of the affected wrist in this specific cohort.\u0000 Patients and Methods Retrospective evaluation of five consecutive patients with a short-to-medium follow-up time of 32 months (range: 18–53 months) was carried out.\u0000 Results The follow-up revealed implant osseointegration failure in two cases, periprosthetic fractures in two cases, and acute carpal tunnel syndrome in one case. Three Aptis DRUJ arthroplasties were converted into a proximal Darrach. In four cases (80%), the patient was satisfied with the revision surgery due to pain reduction. In four cases (80%), the esthetic appearance of the affected wrist was found disappointing.\u0000 Conclusion This study describes remarkable complications related to the Aptis implants in wrists with more rare conditions. The implant is more likely to fail in wrists with poor bone stock, remodeling of the radius, deformation, and malformation of the radius. The range of indications for the usage of the implant to maintain wrist function may be strict.\u0000 Level of Evidence IV.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139870122","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 optimal management of established scaphoid nonunion is undecided. Priorities in this setting include the restoration of normal geometry and elimination of any bony defect, provision of adequate stability to allow early mobilization, and the achievement of union. Technique We describe a technique of arthroscopic assessment and debridement, reduction of deformity and autologous cancellous bone grafting, and stabilization via a specifically designed neutralization screw, to realize the above aims. Patients and Methods Consecutive patients undergoing this technique at a single center in Sydney, Australia, underwent pre- and postoperative assessment. Parameters assessed include a range of motion and patient-reported outcome measures. Results In total, 14 patients (11 males and 3 females with a mean age of 22.4 years) underwent treatment of scaphoid nonunion using this technique, at a mean of 105.9 weeks following index injury. The cohort was followed up radiologically for a mean of 20.7 weeks and clinically for 147.3 weeks. Union was achieved in 13 of 14 patients at a mean of 12.4 weeks. Significant improvements were noted in pain visual analogue scale (VAS), while changes were also noted in range of motion and quick disabilities of arm, shoulder and hand (QuickDASH) score. Conclusion This technique of arthroscopic management of scaphoid nonunion using a neutralization screw and cancellous bone graft is simple, easily reproducible, and confers numerous advantages when compared with other treatment modalities.
{"title":"Percutaneous Neutralization Screw with Arthroscopic Bone Grafting for Scaphoid Nonunion","authors":"B. Sivakumar, Soon Ghee Ang, Nicholas Smith","doi":"10.1055/s-0044-1779292","DOIUrl":"https://doi.org/10.1055/s-0044-1779292","url":null,"abstract":"\u0000 Background The optimal management of established scaphoid nonunion is undecided. Priorities in this setting include the restoration of normal geometry and elimination of any bony defect, provision of adequate stability to allow early mobilization, and the achievement of union.\u0000 Technique We describe a technique of arthroscopic assessment and debridement, reduction of deformity and autologous cancellous bone grafting, and stabilization via a specifically designed neutralization screw, to realize the above aims.\u0000 Patients and Methods Consecutive patients undergoing this technique at a single center in Sydney, Australia, underwent pre- and postoperative assessment. Parameters assessed include a range of motion and patient-reported outcome measures.\u0000 Results In total, 14 patients (11 males and 3 females with a mean age of 22.4 years) underwent treatment of scaphoid nonunion using this technique, at a mean of 105.9 weeks following index injury. The cohort was followed up radiologically for a mean of 20.7 weeks and clinically for 147.3 weeks. Union was achieved in 13 of 14 patients at a mean of 12.4 weeks. Significant improvements were noted in pain visual analogue scale (VAS), while changes were also noted in range of motion and quick disabilities of arm, shoulder and hand (QuickDASH) score.\u0000 Conclusion This technique of arthroscopic management of scaphoid nonunion using a neutralization screw and cancellous bone graft is simple, easily reproducible, and confers numerous advantages when compared with other treatment modalities.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139810715","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}
Bernadette Tobler-Ammann, Frédéric Schuind, Loïc Voillat, Théophile Gentilhomme, E. Vögelin, Noé Murith, Bernard Masserey
Background The purpose of this study is to optimize conservative treatment of distal radius and scaphoid fracture, in terms of comfort, fracture stabilization, and prevention of cast complications. Description of Technique Advances in additive manufacturing have allowed the development of patient-specific anatomical braces (PSABs) which have the potential to fulfill this purpose. Our specific aims were to develop a model of PSAB, adapted to fracture care, to evaluate if this brace would be well tolerated by healthy volunteers and to determine its mechanical properties as compared with conventional methods of wrist immobilization. Materials and Methods Several three-dimensional-printed splint prototypes were designed by mechanical engineers based on surgeons' and hand therapists' clinical expertise. These experimental braces underwent testing in a preclinical study involving 10 healthy volunteers, assessing comfort, satisfaction, and activities. The final prototype was mechanically compared with a conventional cast and a prefabricated splint, testing different closing systems. A mathematical algorithm was created to automatically adapt the final PSAB model to the patient's anatomy. Results The final prototype achieved an overall satisfaction score of 79%, weighing less than 90 g, made from polyamide, and fixed using hook and loop straps. The PSAB stiffness varied between 0.64 and 0.99 Nm/degree, surpassing the performance of both conventional plaster casts and prefabricated splints. Conclusion The final wrist PSAB model, adapted for fracture treatment, is lightweight, comfortable, and provides anatomical contention. It is currently being tested for the treatment of stable distal radius and scaphoid fractures in comparison to conventional plaster cast.
{"title":"Developing 3D-Printed Wrist Splints for Distal Radius and Scaphoid Fractures","authors":"Bernadette Tobler-Ammann, Frédéric Schuind, Loïc Voillat, Théophile Gentilhomme, E. Vögelin, Noé Murith, Bernard Masserey","doi":"10.1055/s-0044-1779053","DOIUrl":"https://doi.org/10.1055/s-0044-1779053","url":null,"abstract":"\u0000 Background The purpose of this study is to optimize conservative treatment of distal radius and scaphoid fracture, in terms of comfort, fracture stabilization, and prevention of cast complications.\u0000 Description of Technique Advances in additive manufacturing have allowed the development of patient-specific anatomical braces (PSABs) which have the potential to fulfill this purpose. Our specific aims were to develop a model of PSAB, adapted to fracture care, to evaluate if this brace would be well tolerated by healthy volunteers and to determine its mechanical properties as compared with conventional methods of wrist immobilization.\u0000 Materials and Methods Several three-dimensional-printed splint prototypes were designed by mechanical engineers based on surgeons' and hand therapists' clinical expertise. These experimental braces underwent testing in a preclinical study involving 10 healthy volunteers, assessing comfort, satisfaction, and activities. The final prototype was mechanically compared with a conventional cast and a prefabricated splint, testing different closing systems. A mathematical algorithm was created to automatically adapt the final PSAB model to the patient's anatomy.\u0000 Results The final prototype achieved an overall satisfaction score of 79%, weighing less than 90 g, made from polyamide, and fixed using hook and loop straps. The PSAB stiffness varied between 0.64 and 0.99 Nm/degree, surpassing the performance of both conventional plaster casts and prefabricated splints.\u0000 Conclusion The final wrist PSAB model, adapted for fracture treatment, is lightweight, comfortable, and provides anatomical contention. It is currently being tested for the treatment of stable distal radius and scaphoid fractures in comparison to conventional plaster cast.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139869048","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：