Journal of Wrist Surgery最新文献

Background: The purpose of this study was to compare the risk of complex regional pain syndrome (CRPS) following surgical treatment of distal radius fractures (DRFs) with either a volar locking plate (VLP) or an external fixator (EF).

Materials and methods: Data from two randomized controlled trials (RCTs) were merged and analyzed. A logistic regression analysis was conducted to identify independent risk factors for the occurrence of CRPS.

Results: A total of 322 patients were included from the two RCTs; 159 patients were operated upon with VLP and 163 patients with EF. CRPS was diagnosed in 6 patients treated with VLP (4%) and in 16 patients receiving EF (11%), overall 22 cases of CRPS (7%). None of the other independent risk factors had a significant influence on the risk for CRPS (all p  > 0.05).

Conclusion: Patients treated with an EF had a higher risk of developing CRPS compared to those treated with a VLP. We found no other independent variable predicting CRPS.

Level of evidence: III.

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.

Purpose  The purpose of this systematic review is to compare the clinical outcomes of midcarpal arthrodesis with triquetrum excision against midcarpal fusion without the excision of triquetrum performed using modern osteosynthesis technology. Materials and Methods  A systematic review of publications in PubMed, Medline, EMBASE, and Cochrane Database of Systematic Review was conducted. The studies that utilized osteosynthesis techniques other than Kirshner wire, with at least 10 patients, and had a minimum one-year follow-up period in English language were included. The quality of studies were evaluated using validated tools for assessing observational studies. Union rate, functional outcomes and revision/complication rates were collected and analyzed. Results  A meta-analysis was not possible. Based on pooled data the flexion-extension arc improved by 6 degrees for midcarpal arthrodesis group with triquetrum excision, but decreased by 11 degrees in the group without. The radial-ulnar arc improved by 5 degrees in the triquetrum excision group, but decreased by 3 degrees in the triquetrum preserving group. Improvement in grip strength appears to be better in the triquetrum preserving group (10 kg as opposed to 1 kg), while there were no observable difference in pain score. Conclusion  The literature lacked good comparison studies to examine the role of triquetrum excision in midcarpal fusion. While midcarpal fusion with triquetrum excision appeared to yield better ROM in the pooled data, studies with direct comparison of the two techniques are required to fill in the gap. Type of Study/Level of Evidence  Therapeutic IV.

Background  Ulnar impaction syndrome (UIS), also known as ulnar impaction or ulnar abutment, is a degenerative condition causing pain on the ulnar side of the wrist. It can lead to wrist bone necrosis, resulting in wrist joint stability disruption and a significant wrist function impairment. The global understanding of this condition varies, contributing to substantial differences in clinical outcomes. Purposes  This paper underscores the necessity of developing evidence-based clinical guidelines for UIS to guide clinicians in their diagnostic and therapeutic approaches. Materials and Methods  In collaboration with the Asian Pacific Wrist Association, a team of experts from various fields within the Hand Surgery Department at Huashan Hospital has collectively formulated the "Clinical Practice Guidelines for Ulnar Impaction Syndrome (2024)" (hereinafter referred to as the "Guidelines"). The development process adhered to the guidelines outlined in the World Health Organization's handbook for guideline development. Results  Ten key questions and 21 recommendations are formed. The Guidelines provide recommendations for UIS diagnosis, criteria for selecting conservative or surgical interventions, options for surgical procedures, and address various related issues. Conclusions  The collaborative effort aims to standardize clinical practices, enhance diagnostic accuracy, and improve treatment outcomes for individuals affected by UIS, with these recommendations intended to serve as a valuable reference for healthcare professionals.

Introduction  The costo-osteochondral autograft, vascularized medial femoral trochlear osteochondral autograft, and proximal hamate autograft have been used for the reconstruction of unsalvageable proximal pole scaphoid nonunions. Our hypothesis is that there is no difference in carpal kinematics after the proximal pole of the scaphoid is reconstructed with these three graft options. Methods  Wireless sensors were mounted to the carpus that was loaded through cyclical motion. Each specimen was tested under a series of the three reconstructed conditions and their kinematics compared. Results  No significant differences were found in scapholunate and lunocapitate joint motion during wrist flexion-extension and wrist radioulnar deviation between the three reconstructed conditions ( p  > 0.05). Discussion and Conclusion  There are minimal differences in carpal kinematics when comparing reconstruction of the proximal pole of the scaphoid with the costoosteochondral, medial femoral trochlear, and proximal hamate grafts.