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":"139809156","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}
Leland Gossett, Giap H. Vu, Wayne Reizner, Emma Gira, Bowen Qiu, Hani A. Awad, Constantinos Ketonis
Background Volar-locked plating has become a popular treatment option for unstable distal radius fractures. While using locking screws in the distal fragment increases the stability of the fixation, the biomechanical benefits of locking fixation in the proximal fragment have not been definitively established. Purposes This study evaluated the initial mechanical behavior of the volar plating construct with different locking screw configurations in the proximal fragment. Methods Sixteen Sawbones radius models were used. An unstable metaphyseal distal radius fracture was created and fixated with a volar-locked plate. Four different screw configurations in the proximal fragment were tested: all nonlocking screws, locking screw in the distal-most hole, locking screw in the proximal-most hole, and locking screws in both the proximal- and distal-most holes. Initial stiffness, displacement during harmonic loading, and load-to-failure were compared among the three groups. Results The initial stiffness, displacement during harmonic loading, and load-to-failure did not significantly differ among the four proximal screw configurations (p < 0.05). Failure occurred via toggling of the screws in the configuration with all nonlocking screws and through screw breakage or locking mechanism failure in the configurations with locking screws. Conclusions The use of locking screws in the proximal fragment did not significantly affect the initial stability of volar distal radius plating. However, failure modes differed between the nonlocking and locking configurations, consistent with known mechanical properties of locking fixation. Further mechanical studies in cadaveric models and clinical trials are warranted to determine the optimal screw configuration in volar distal radius plating. Level of Evidence To be determined. Biomechanical study on synthetic models.
{"title":"The Role of Proximal Locking Fixation in Volar Distal Radius Fracture Fixation","authors":"Leland Gossett, Giap H. Vu, Wayne Reizner, Emma Gira, Bowen Qiu, Hani A. Awad, Constantinos Ketonis","doi":"10.1055/s-0044-1779342","DOIUrl":"https://doi.org/10.1055/s-0044-1779342","url":null,"abstract":"\u0000 Background Volar-locked plating has become a popular treatment option for unstable distal radius fractures. While using locking screws in the distal fragment increases the stability of the fixation, the biomechanical benefits of locking fixation in the proximal fragment have not been definitively established.\u0000 Purposes This study evaluated the initial mechanical behavior of the volar plating construct with different locking screw configurations in the proximal fragment.\u0000 Methods Sixteen Sawbones radius models were used. An unstable metaphyseal distal radius fracture was created and fixated with a volar-locked plate. Four different screw configurations in the proximal fragment were tested: all nonlocking screws, locking screw in the distal-most hole, locking screw in the proximal-most hole, and locking screws in both the proximal- and distal-most holes. Initial stiffness, displacement during harmonic loading, and load-to-failure were compared among the three groups.\u0000 Results The initial stiffness, displacement during harmonic loading, and load-to-failure did not significantly differ among the four proximal screw configurations (p < 0.05). Failure occurred via toggling of the screws in the configuration with all nonlocking screws and through screw breakage or locking mechanism failure in the configurations with locking screws.\u0000 Conclusions The use of locking screws in the proximal fragment did not significantly affect the initial stability of volar distal radius plating. However, failure modes differed between the nonlocking and locking configurations, consistent with known mechanical properties of locking fixation. Further mechanical studies in cadaveric models and clinical trials are warranted to determine the optimal screw configuration in volar distal radius plating.\u0000 Level of Evidence To be determined. Biomechanical study on synthetic models.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140471551","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}
Hirotaka Sugiura, M. Tatebe, H. Yoneda, T. Nishizuka, Akimasa Morita, Michiro Yamamoto
Background Small proximal bone fragments are a known risk factor for nonunion, but it is not known what ratio of proximal to distal bone fragments actually results in nonunion. Objective We hypothesized that a small proximal ratio of proximal scaphoid fragment volume to distal scaphoid volume as measured by preoperative computed tomography (CT) would be a risk factor for postoperative scaphoid nonunion. Patients and Methods We retrospectively examined the factors that led to postoperative nonunion in 78 patients who underwent surgery using free bone grafts for scaphoid nonunion. Nonunion was defined as no evidence of union on plain radiography or CT more than 3 months after injury. Three-dimensional models of scaphoid fractures were created from the preoperative CT of all cases, and volumes were measured. Other patient characteristics, surgical methods, and imaging were investigated. Results Persistent nonunion was observed in 13 patients after surgery, a rate of 16.7%. A multivariate analysis showed that only the proximal fragment ratio was an independent factor (union group 0.94, persistent nonunion group 0.54, p = 0.03). Receiver operating characteristic analysis showed that a proximal fragment ratio less than 0.66 was associated with persistent nonunion. Conclusion Treatment of scaphoid nonunion with a small proximal fragment ratio should be based on a thorough understanding of the anatomy, blood flow, and carpal kinematics of the scaphoid bone itself. Level of Evidence Level IV, prognostic study.
{"title":"A Small Ratio of Proximal to Distal Bone Fragments Is a Risk Factor for Scaphoid Nonunion: A Volumetric Analysis of Preoperative CT","authors":"Hirotaka Sugiura, M. Tatebe, H. Yoneda, T. Nishizuka, Akimasa Morita, Michiro Yamamoto","doi":"10.1055/s-0044-1779286","DOIUrl":"https://doi.org/10.1055/s-0044-1779286","url":null,"abstract":"\u0000 Background Small proximal bone fragments are a known risk factor for nonunion, but it is not known what ratio of proximal to distal bone fragments actually results in nonunion.\u0000 Objective We hypothesized that a small proximal ratio of proximal scaphoid fragment volume to distal scaphoid volume as measured by preoperative computed tomography (CT) would be a risk factor for postoperative scaphoid nonunion.\u0000 Patients and Methods We retrospectively examined the factors that led to postoperative nonunion in 78 patients who underwent surgery using free bone grafts for scaphoid nonunion. Nonunion was defined as no evidence of union on plain radiography or CT more than 3 months after injury. Three-dimensional models of scaphoid fractures were created from the preoperative CT of all cases, and volumes were measured. Other patient characteristics, surgical methods, and imaging were investigated.\u0000 Results Persistent nonunion was observed in 13 patients after surgery, a rate of 16.7%. A multivariate analysis showed that only the proximal fragment ratio was an independent factor (union group 0.94, persistent nonunion group 0.54, p = 0.03). Receiver operating characteristic analysis showed that a proximal fragment ratio less than 0.66 was associated with persistent nonunion.\u0000 Conclusion Treatment of scaphoid nonunion with a small proximal fragment ratio should be based on a thorough understanding of the anatomy, blood flow, and carpal kinematics of the scaphoid bone itself.\u0000 Level of Evidence Level IV, prognostic study.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140470380","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}
N. Hebel, Kitty Y. Wu, Elizabeth Helsper, Bassem El Hassan, Sanjeev Kakar, Marco Rizzo, Steven L. Moran
Background Hemiarthroplasty may be indicated for patients with distal radioulnar joint (DRUJ) arthritis. Recently, the use of the pyrocarbon metacarpophalangeal implant has been proposed as a novel means of treating DRUJ arthritis due to the materials improved mechanical properties and wear characteristics. Purpose and Questions This study compares midterm outcomes of metallic and pyrocarbon hemiarthroplasties for the treatment of symptomatic DRUJ arthritis. Questions of interest included outcomes and complications. Patients and Methods In total, 32 hemiarthroplasties, 10 metallic and 22 pyrocarbon, were performed between 2010 and 2020 by three surgeons at one tertiary medical center. Patients' retrospective outcomes were extracted from the electronic medical record. Results Postoperatively, the metallic implant group (mean follow-up: 38 months) demonstrated decreased pain but no changes in range of motion. Comparatively, the pyrocarbon group experienced an improved range of motion and postoperative pain (p < 0.05). Radiographic analysis demonstrated 10% of metallic implants and 9% of pyrocarbon implants to have resulted in thinning of the lateral cortex of the radius at the final follow-up. Minor complications in metallic and pyrocarbon implant groups warranting reoperation occurred at rates of 10 and 13.5% while implant failure occurred at a rate of 30 and 18%, respectively. Discussion Within this study, pyrocarbon implants resulted in significant functional improvement with comparable complication and failure rates to the metallic implant. Long-term stability demonstrated efficacy for both techniques in symptomatic DRUJ treatment. Type of Study/Level of Evidence Observational Case Series IV.
{"title":"Comparative Analysis of Two Hemiarthroplasty Techniques for Symptomatic Distal Radial Ulnar Joint Arthritis","authors":"N. Hebel, Kitty Y. Wu, Elizabeth Helsper, Bassem El Hassan, Sanjeev Kakar, Marco Rizzo, Steven L. Moran","doi":"10.1055/s-0044-1779498","DOIUrl":"https://doi.org/10.1055/s-0044-1779498","url":null,"abstract":"\u0000 Background Hemiarthroplasty may be indicated for patients with distal radioulnar joint (DRUJ) arthritis. Recently, the use of the pyrocarbon metacarpophalangeal implant has been proposed as a novel means of treating DRUJ arthritis due to the materials improved mechanical properties and wear characteristics.\u0000 Purpose and Questions This study compares midterm outcomes of metallic and pyrocarbon hemiarthroplasties for the treatment of symptomatic DRUJ arthritis. Questions of interest included outcomes and complications.\u0000 Patients and Methods In total, 32 hemiarthroplasties, 10 metallic and 22 pyrocarbon, were performed between 2010 and 2020 by three surgeons at one tertiary medical center. Patients' retrospective outcomes were extracted from the electronic medical record.\u0000 Results Postoperatively, the metallic implant group (mean follow-up: 38 months) demonstrated decreased pain but no changes in range of motion. Comparatively, the pyrocarbon group experienced an improved range of motion and postoperative pain (p < 0.05). Radiographic analysis demonstrated 10% of metallic implants and 9% of pyrocarbon implants to have resulted in thinning of the lateral cortex of the radius at the final follow-up. Minor complications in metallic and pyrocarbon implant groups warranting reoperation occurred at rates of 10 and 13.5% while implant failure occurred at a rate of 30 and 18%, respectively.\u0000 Discussion Within this study, pyrocarbon implants resulted in significant functional improvement with comparable complication and failure rates to the metallic implant. Long-term stability demonstrated efficacy for both techniques in symptomatic DRUJ treatment.\u0000 Type of Study/Level of Evidence Observational Case Series IV.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140477150","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}
Fraser Taylor, Bradley David Gilpin, B. Sivakumar, Carl Holder, Richard Page, David J Graham
Background and Purpose There is limited literature reporting the long-term results and outcomes of total wrist arthroplasty (TWA). The aim of this study was to describe the incidence, usage, and survival of wrist arthroplasty using data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Methods Data included all primary TWA procedures from 2006 to 2021. The primary outcome assessed was revision surgery. Utilization of TWA, etiology leading to TWA, patient demographics, and surgical factors were also assessed. Results There were 439 primary TWA procedures performed across the 16-year reporting period. Four prostheses (Motec, Universal 2, Freedom, and ReMotion) have been used, with a recent increased usage toward the Motec, which accounted for 97.4% of prostheses implanted in 2021. There has also been an increase in the number of surgeons performing TWA over time. The most common underlying etiology was osteoarthritis (72.7%), followed by rheumatoid arthritis (15.9%). Implantation for inflammatory arthropathy remained relatively constant across time; however, TWA has been utilized with increasing frequency for the treatment of osteoarthritis and other indications more recently. The cumulative percent revision at 10 years was 18.3%. Loosening accounted for 25.6% of all revisions, followed by osteolysis (12.8%), pain (12.8%), and instability (7.7%). Attempted conversion to an arthrodesis occurred in 10.3% of all revisions. Conclusion There has been an increase in both the volume of TWA performed and the number of surgeons undertaking this procedure in Australia over the past 16 years. The Motec system has become the prosthesis of choice. Medium-term revision rates are inferior when compared with Australian data for hip, knee, and shoulder arthroplasty.
{"title":"Increasing Use of Total Wrist Arthroplasty—An Australian National Joint Registry Report","authors":"Fraser Taylor, Bradley David Gilpin, B. Sivakumar, Carl Holder, Richard Page, David J Graham","doi":"10.1055/s-0043-1777408","DOIUrl":"https://doi.org/10.1055/s-0043-1777408","url":null,"abstract":"\u0000 Background and Purpose There is limited literature reporting the long-term results and outcomes of total wrist arthroplasty (TWA). The aim of this study was to describe the incidence, usage, and survival of wrist arthroplasty using data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR).\u0000 Methods Data included all primary TWA procedures from 2006 to 2021. The primary outcome assessed was revision surgery. Utilization of TWA, etiology leading to TWA, patient demographics, and surgical factors were also assessed.\u0000 Results There were 439 primary TWA procedures performed across the 16-year reporting period. Four prostheses (Motec, Universal 2, Freedom, and ReMotion) have been used, with a recent increased usage toward the Motec, which accounted for 97.4% of prostheses implanted in 2021. There has also been an increase in the number of surgeons performing TWA over time. The most common underlying etiology was osteoarthritis (72.7%), followed by rheumatoid arthritis (15.9%). Implantation for inflammatory arthropathy remained relatively constant across time; however, TWA has been utilized with increasing frequency for the treatment of osteoarthritis and other indications more recently. The cumulative percent revision at 10 years was 18.3%. Loosening accounted for 25.6% of all revisions, followed by osteolysis (12.8%), pain (12.8%), and instability (7.7%). Attempted conversion to an arthrodesis occurred in 10.3% of all revisions.\u0000 Conclusion There has been an increase in both the volume of TWA performed and the number of surgeons undertaking this procedure in Australia over the past 16 years. The Motec system has become the prosthesis of choice. Medium-term revision rates are inferior when compared with Australian data for hip, knee, and shoulder arthroplasty.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140473704","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}
Kyle J. Hitchman, A. Anastasio, Anthony N. Baumann, Sarah E. Welch, Kempland C. Walley, Christopher S. Klifto
Introduction Physician-review websites are a commonly used resource by patients when choosing a surgeon. While data exist regarding some surgical specialties, no study has examined negative one-star reviews for orthopaedic-trained hand surgeons. The goal of this study was to investigate one-star reviews regarding orthopaedic-trained hand and upper extremity surgeons in the 10 largest cities in the United States to determine the associated factors behind unsatisfied patients to improve patient care. Methods Patient reviews and narratives of orthopaedic-trained hand surgeons were collected from the 10 largest cities in the United States using Vitals.com. One-star reviews (out of a five-star maximum) with comments were identified and classified as operative or nonoperative. These reviews were further subclassified based on the nature of the comment. Results A total of 830 one-star reviews with 1,662 complaints were included in this study. Of these complaints, 557 (33.5%) were from patients who received operative care and 1,105 (66.5%) were from nonoperative care patients. Nonoperative patient one-star reviews had a significantly higher proportion of complaints related to bedside manners (37.6 to 19.6%, p < 0.001), not enough time spent with the provider (18.1 to 4.5%, p < 0.001), and wait time (13.3 to 3.2%, p < 0.001) as compared with operative patient one-star reviews. Operative patient one-star reviews had a higher proportion of complaints related to disagreement with the physician's decision or plan (15.6 to 10.2%, p = 0.002); uncontrolled pain (14.4 to 7.9%, p < 0.001); and medical staff or institution (17.2 to 12.9%, p = 0.018) as compared with nonoperative patients. Discussion Most one-star reviews regarding orthopaedic-trained hand surgeons referenced nonclinical components—bedside manner was the most common complaint. It was determined that surgical patients were less likely to leave a one-star review; however, if they did, the most common complaint was in reference to a disagreement with the physician's decision or uncontrolled pain postoperatively. Type of Study Outcomes 2c.
{"title":"Examining One-Star Reviews in Orthopaedic Hand Surgeons in Large U.S. Cities","authors":"Kyle J. Hitchman, A. Anastasio, Anthony N. Baumann, Sarah E. Welch, Kempland C. Walley, Christopher S. Klifto","doi":"10.1055/s-0044-1779446","DOIUrl":"https://doi.org/10.1055/s-0044-1779446","url":null,"abstract":"\u0000 Introduction Physician-review websites are a commonly used resource by patients when choosing a surgeon. While data exist regarding some surgical specialties, no study has examined negative one-star reviews for orthopaedic-trained hand surgeons. The goal of this study was to investigate one-star reviews regarding orthopaedic-trained hand and upper extremity surgeons in the 10 largest cities in the United States to determine the associated factors behind unsatisfied patients to improve patient care.\u0000 Methods Patient reviews and narratives of orthopaedic-trained hand surgeons were collected from the 10 largest cities in the United States using Vitals.com. One-star reviews (out of a five-star maximum) with comments were identified and classified as operative or nonoperative. These reviews were further subclassified based on the nature of the comment.\u0000 Results A total of 830 one-star reviews with 1,662 complaints were included in this study. Of these complaints, 557 (33.5%) were from patients who received operative care and 1,105 (66.5%) were from nonoperative care patients. Nonoperative patient one-star reviews had a significantly higher proportion of complaints related to bedside manners (37.6 to 19.6%, p < 0.001), not enough time spent with the provider (18.1 to 4.5%, p < 0.001), and wait time (13.3 to 3.2%, p < 0.001) as compared with operative patient one-star reviews. Operative patient one-star reviews had a higher proportion of complaints related to disagreement with the physician's decision or plan (15.6 to 10.2%, p = 0.002); uncontrolled pain (14.4 to 7.9%, p < 0.001); and medical staff or institution (17.2 to 12.9%, p = 0.018) as compared with nonoperative patients.\u0000 Discussion Most one-star reviews regarding orthopaedic-trained hand surgeons referenced nonclinical components—bedside manner was the most common complaint. It was determined that surgical patients were less likely to leave a one-star review; however, if they did, the most common complaint was in reference to a disagreement with the physician's decision or uncontrolled pain postoperatively.\u0000 Type of Study Outcomes 2c.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140479613","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}
J. Park, Young-Woon Gil, Young Seok Lee, ChangEui Lee
Background In distal radius fractures (DRFs) occurring in nonosteoporotic age groups, it is known that triangular fibrocartilage complex (TFCC) injuries are frequently combined, with some experiencing persistent symptomatic instability. However, a gold standard treatment for these associated lesions has not yet been established. Purpose Our purpose was to investigate the outcomes of primary arthroscopy-assisted transosseous foveal repair of the TFCC associated with DRFs in young adults. Methods Fifteen patients aged <65 years who underwent open reduction and internal fixation for DRF and arthroscopy-assisted repair for foveal tear of the TFCC were included. Those patients were observed to have complete peripheral TFCC tear on preoperative wrist magnetic resonance imaging and intraoperative distal radioulnar joint (DRUJ) stability tests. This was confirmed with an arthroscopic examination. The transosseous technique was used to repair the TFCC after firm fixation of the DRF. The patients were immobilized with the long-arm splint in a neutral position for 2 weeks postoperatively and a removable short-arm splint was applied for another 2 weeks. DRUJ stability, grip strength, and patient-reported outcomes, including disabilities of the arm, shoulder, and hand (DASH) and Patient-Rated Wrist Evaluation scores, were evaluated as primary outcomes at 3, 6, and 12 months postoperatively. Results All patients showed a stable DRUJ throughout the follow-up period. The average grip strength ratio compared to the unaffected side was 69, 83, and 90% at 3, 6, and 12 months after surgery, respectively. The mean DASH score was 26.9, 18.4, and 6.7 at 3, 6, and 12 months postoperatively, respectively. Conclusion Primary arthroscopy-assisted transosseous foveal repair of the TFCC with internal fixation of the distal radius resulted in early recovery and good clinical outcomes in young patients. Level of evidence Therapeutic, level IV.
{"title":"Primary Arthroscopy-Assisted Foveal Repair of Triangular Fibrocartilage Complex Associated with Acute Distal Radius Fractures in Young Adults","authors":"J. Park, Young-Woon Gil, Young Seok Lee, ChangEui Lee","doi":"10.1055/s-0043-1778061","DOIUrl":"https://doi.org/10.1055/s-0043-1778061","url":null,"abstract":"\u0000 Background In distal radius fractures (DRFs) occurring in nonosteoporotic age groups, it is known that triangular fibrocartilage complex (TFCC) injuries are frequently combined, with some experiencing persistent symptomatic instability. However, a gold standard treatment for these associated lesions has not yet been established.\u0000 Purpose Our purpose was to investigate the outcomes of primary arthroscopy-assisted transosseous foveal repair of the TFCC associated with DRFs in young adults.\u0000 Methods Fifteen patients aged <65 years who underwent open reduction and internal fixation for DRF and arthroscopy-assisted repair for foveal tear of the TFCC were included. Those patients were observed to have complete peripheral TFCC tear on preoperative wrist magnetic resonance imaging and intraoperative distal radioulnar joint (DRUJ) stability tests. This was confirmed with an arthroscopic examination. The transosseous technique was used to repair the TFCC after firm fixation of the DRF. The patients were immobilized with the long-arm splint in a neutral position for 2 weeks postoperatively and a removable short-arm splint was applied for another 2 weeks. DRUJ stability, grip strength, and patient-reported outcomes, including disabilities of the arm, shoulder, and hand (DASH) and Patient-Rated Wrist Evaluation scores, were evaluated as primary outcomes at 3, 6, and 12 months postoperatively.\u0000 Results All patients showed a stable DRUJ throughout the follow-up period. The average grip strength ratio compared to the unaffected side was 69, 83, and 90% at 3, 6, and 12 months after surgery, respectively. The mean DASH score was 26.9, 18.4, and 6.7 at 3, 6, and 12 months postoperatively, respectively.\u0000 Conclusion Primary arthroscopy-assisted transosseous foveal repair of the TFCC with internal fixation of the distal radius resulted in early recovery and good clinical outcomes in young patients.\u0000 Level of evidence Therapeutic, level IV.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139596793","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 thumb carpometacarpal joint (CMCJ) osteoarthritis is one of the most common pathologies in the hand with controversial treatment options. Description of Technique Describe the use of arthroscopic technique for thumb CMCJ arthrodesis and the clinical outcome. Patients and Methods Cases with Eaton III thumb CMCJ osteoarthritis treated with arthroscopic arthrodesis were reviewed. Patient evaluations include: grip strength, pinch strength, range of motion, Kapandji score, Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and the visual analog scores for pain. All cases were assessed before the surgery and at 3, 6, 12, and 24 months after surgery. Radiographs were reviewed. Results There were total 16 patients with 18 arthrodesis performed. The average age was 62.2 years with M:F ratio of 2:7. The average follow-up time was 57.2 months. There was improvement of pain score as early as at postop 3 months (p < 0.001) and continued to improve at 6, 12, and 24 months. There was improvement of grip strength and pinch strength at 12 and 24 months (p < 0.001). The DASH score showed improvement as early as at 3 months (p = 0.012). There was a reduction of Kapandji score and interphalangeal joint motion at 3 months postop, but these returned to normal at 6 months. There was no major complication. There was one case of nonunion (5.6%). Conclusion Arthroscopic arthrodesis is a feasible treatment option and provides excellent pain relief, restore thumb strength and stability, retain functional thumb mobility, and hence improvement in hand function.
{"title":"Outcomes of Thumb Carpometacarpal Joint Osteoarthritis Treated with Arthroscopic Fusion","authors":"E. Chow","doi":"10.1055/s-0043-1777764","DOIUrl":"https://doi.org/10.1055/s-0043-1777764","url":null,"abstract":"\u0000 Background The thumb carpometacarpal joint (CMCJ) osteoarthritis is one of the most common pathologies in the hand with controversial treatment options.\u0000 Description of Technique Describe the use of arthroscopic technique for thumb CMCJ arthrodesis and the clinical outcome.\u0000 Patients and Methods Cases with Eaton III thumb CMCJ osteoarthritis treated with arthroscopic arthrodesis were reviewed. Patient evaluations include: grip strength, pinch strength, range of motion, Kapandji score, Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and the visual analog scores for pain. All cases were assessed before the surgery and at 3, 6, 12, and 24 months after surgery. Radiographs were reviewed.\u0000 Results There were total 16 patients with 18 arthrodesis performed. The average age was 62.2 years with M:F ratio of 2:7. The average follow-up time was 57.2 months. There was improvement of pain score as early as at postop 3 months (p < 0.001) and continued to improve at 6, 12, and 24 months. There was improvement of grip strength and pinch strength at 12 and 24 months (p < 0.001). The DASH score showed improvement as early as at 3 months (p = 0.012). There was a reduction of Kapandji score and interphalangeal joint motion at 3 months postop, but these returned to normal at 6 months. There was no major complication. There was one case of nonunion (5.6%).\u0000 Conclusion Arthroscopic arthrodesis is a feasible treatment option and provides excellent pain relief, restore thumb strength and stability, retain functional thumb mobility, and hence improvement in hand function.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139598915","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}
Shelby R. Smith, Karan Dua, R. Wysocki, John J. Fernandez, Mark S. Cohen, Xavier C. Simcock
Background Four corner fusion (4CF) can be performed using various techniques, each with its own efficacy and complication profile. Kirschner wires (K-wires) are a reliable and cost-effective method when performing 4CF. Purpose The purpose of this study was to determine the union rate and complication profile of utilizing K-wires when performing a 4CF. Methods A retrospective chart review was performed studying patients who underwent 4CF from a multisurgeon, single-institution database. Demographic data were collected, and functional outcomes were recorded including wrist range of motion (ROM), fusion rates, time to fusion, and complication rates. Continuous variables were compared via two-tailed t-tests, numerical data via one-way analysis of variance tests, and categorical data via Fisher's Exact test. Results In total, 141 patients underwent 4CF with K-wire fixation with an overall nonunion rate of 3.5% (5/141). Diabetics had a nonunion rate of 11% compared to 3% without diabetes (p = 0.28). Wrist ROM was significantly greater in patients who achieved bony union at 6 weeks after removal of hardware compared to the nonunion group (78.0 degrees ± 14.4 vs. 57.8 degrees ± 21.3, p < 0.05). There was no difference in wrist ROM between the two groups six months after hardware removal. There were no pin-related complications that required revision surgery. Conclusion 4CF utilizing K-wire fixation is a reproducible and cost-effective technique that results in good patient outcomes including bony union and functional wrist ROM. Smoking and diabetes did not significantly increase the risk of nonunion, and K-wire fixation can successfully be used in these patient populations. Level of Evidence Level IV (retrospective study)
背景四角融合术（4CF）可采用多种技术，每种技术都有各自的疗效和并发症情况。Kirschner钢丝（K-wires）是一种可靠且经济有效的四角融合方法。目的 本研究旨在确定使用 K 线进行 4CF 时的结合率和并发症情况。方法 对一个多外科医师、单一机构数据库中接受 4CF 手术的患者进行回顾性病历审查。研究人员收集了人口统计学数据，并记录了功能结果，包括腕关节活动范围（ROM）、融合率、融合时间和并发症发生率。连续变量通过双尾 t 检验进行比较，数字数据通过单因子方差分析检验进行比较，分类数据通过费雪精确检验进行比较。结果 共有141名患者接受了K线固定的4CF手术，总的不愈合率为3.5%（5/141）。糖尿病患者的不愈合率为11%，而非糖尿病患者的不愈合率为3%（P = 0.28）。与未愈合组相比，移除硬件后6周达到骨性愈合的患者的腕关节活动度明显更大（78.0度±14.4比57.8度±21.3，P <0.05）。两组患者在移除硬件6个月后的腕关节活动度没有差异。没有需要进行翻修手术的针相关并发症。结论 利用K线固定的4CF是一种可重复性好、成本效益高的技术，能为患者带来良好的疗效，包括骨性结合和功能性腕关节ROM。吸烟和糖尿病并不会明显增加骨不连的风险，K线固定可成功用于这些患者。证据等级 IV 级（回顾性研究）
{"title":"The Complication and Safety Profile of Utilizing Kirschner Wires in Four Corner Fusions","authors":"Shelby R. Smith, Karan Dua, R. Wysocki, John J. Fernandez, Mark S. Cohen, Xavier C. Simcock","doi":"10.1055/s-0043-1778084","DOIUrl":"https://doi.org/10.1055/s-0043-1778084","url":null,"abstract":"\u0000 Background Four corner fusion (4CF) can be performed using various techniques, each with its own efficacy and complication profile. Kirschner wires (K-wires) are a reliable and cost-effective method when performing 4CF.\u0000 Purpose The purpose of this study was to determine the union rate and complication profile of utilizing K-wires when performing a 4CF.\u0000 Methods A retrospective chart review was performed studying patients who underwent 4CF from a multisurgeon, single-institution database. Demographic data were collected, and functional outcomes were recorded including wrist range of motion (ROM), fusion rates, time to fusion, and complication rates. Continuous variables were compared via two-tailed t-tests, numerical data via one-way analysis of variance tests, and categorical data via Fisher's Exact test.\u0000 Results In total, 141 patients underwent 4CF with K-wire fixation with an overall nonunion rate of 3.5% (5/141). Diabetics had a nonunion rate of 11% compared to 3% without diabetes (p = 0.28). Wrist ROM was significantly greater in patients who achieved bony union at 6 weeks after removal of hardware compared to the nonunion group (78.0 degrees ± 14.4 vs. 57.8 degrees ± 21.3, p < 0.05). There was no difference in wrist ROM between the two groups six months after hardware removal. There were no pin-related complications that required revision surgery.\u0000 Conclusion 4CF utilizing K-wire fixation is a reproducible and cost-effective technique that results in good patient outcomes including bony union and functional wrist ROM. Smoking and diabetes did not significantly increase the risk of nonunion, and K-wire fixation can successfully be used in these patient populations.\u0000 Level of Evidence Level IV (retrospective study)","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139598798","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}
René Jorquera, Francisco Melibosky, Aldo Villavicencio, Camila Azócar, Gonzalo Corvalán, Paula Ramírez, Agustín Paz
Comminuted fractures involving the metacarpophalangeal joint are a real challenge for the hand surgeon due to the complexity of their management and the high frequency of functional sequelae caused by the incongruence of the joint surfaces and the injury of soft tissues requiring repair. Metacarpophalangeal joint arthroscopy is an emerging and useful tool for the upper extremity surgeon allowing assisted reduction and percutaneous fixation of these fractures since it permits a complete evaluation of the joint fragments and enables precision in the reduction with the advantage of being a minimally invasive and safe technique. This technique was performed in two patients with complex fractures of the metacarpophalangeal joint with good functional results. In conclusion, this technique is reproducible, with good results and minimal soft-tissue morbidity. It allows a stable osteosynthesis, enabling early joint mobility and rehabilitation, which is essential for function recovery.
{"title":"Arthroscopic Assistance and Percutaneous Fixation of Complex Intraarticular Metacarpophalangeal Fracture","authors":"René Jorquera, Francisco Melibosky, Aldo Villavicencio, Camila Azócar, Gonzalo Corvalán, Paula Ramírez, Agustín Paz","doi":"10.1055/s-0043-1776978","DOIUrl":"https://doi.org/10.1055/s-0043-1776978","url":null,"abstract":"Comminuted fractures involving the metacarpophalangeal joint are a real challenge for the hand surgeon due to the complexity of their management and the high frequency of functional sequelae caused by the incongruence of the joint surfaces and the injury of soft tissues requiring repair. Metacarpophalangeal joint arthroscopy is an emerging and useful tool for the upper extremity surgeon allowing assisted reduction and percutaneous fixation of these fractures since it permits a complete evaluation of the joint fragments and enables precision in the reduction with the advantage of being a minimally invasive and safe technique. This technique was performed in two patients with complex fractures of the metacarpophalangeal joint with good functional results. In conclusion, this technique is reproducible, with good results and minimal soft-tissue morbidity. It allows a stable osteosynthesis, enabling early joint mobility and rehabilitation, which is essential for function recovery.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139600872","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：