Felicia Rosvall, E. Hagert, Pelle Gustafson, J. Andersson
Purpose Misdiagnosed and maltreated wrist ligament injuries (scapholunate [SL], lunotriquetral, and triangular fibrocartilage complex [TFCC]) filed to the Swedish National Patient Insurance Company (LÖF [“regionernas ömsesidiga försäkringsbolag”]) 2011 to 2018 were analyzed in terms of complications and costs for society. Methods All filed claims are database registered. The database was assessed in June 2019 through injury International Classification of Diseases 10th Revision-SWE diagnoses. Demographics, reasons for avoidance, type of complication, and costs were assessed. Trend analysis was also used to compare the numbers of filed claims of wrist ligament injuries and total injuries. Results The mean age of the 231 extracted patients was 38 years. Females represented 57%. Ninety-eight (42%) of the claims were judged as avoidable, in accordance with the 40% approved patient injuries of all notified injuries during the same time period. Isolated injuries to the TFCC and SL ligament were the most common (n = 185, 80%). One to seven secondary surgical procedures/patient were needed to treat the condition. Sixty-nine (30%) of the 231 patients had medical invalidity due to the avoidable complication(s). Disability was more severe if more than one surgical procedure was needed. There was a significant trend toward decreasing numbers of filed claims for wrist ligament injuries (p = 0.002) over time, in contrast to the total number of filed claims to LÖF, which has increased by an average of 6% annually for a cumulative increase of 60% from 2011 to 2018. Interpretation The total cost for misdiagnosed and mistreated wrist ligament injuries in Sweden from 2011 to 2018 was €2,203,467, and costly for both the patients and society at large. Level of Evidence Level III, therapeutic.
{"title":"Clinical and Socioeconomic Effects of Misdiagnosed Wrist Ligament Injuries","authors":"Felicia Rosvall, E. Hagert, Pelle Gustafson, J. Andersson","doi":"10.1055/s-0043-1776342","DOIUrl":"https://doi.org/10.1055/s-0043-1776342","url":null,"abstract":"\u0000 Purpose Misdiagnosed and maltreated wrist ligament injuries (scapholunate [SL], lunotriquetral, and triangular fibrocartilage complex [TFCC]) filed to the Swedish National Patient Insurance Company (LÖF [“regionernas ömsesidiga försäkringsbolag”]) 2011 to 2018 were analyzed in terms of complications and costs for society.\u0000 Methods All filed claims are database registered. The database was assessed in June 2019 through injury International Classification of Diseases 10th Revision-SWE diagnoses. Demographics, reasons for avoidance, type of complication, and costs were assessed. Trend analysis was also used to compare the numbers of filed claims of wrist ligament injuries and total injuries.\u0000 Results The mean age of the 231 extracted patients was 38 years. Females represented 57%. Ninety-eight (42%) of the claims were judged as avoidable, in accordance with the 40% approved patient injuries of all notified injuries during the same time period. Isolated injuries to the TFCC and SL ligament were the most common (n = 185, 80%). One to seven secondary surgical procedures/patient were needed to treat the condition. Sixty-nine (30%) of the 231 patients had medical invalidity due to the avoidable complication(s). Disability was more severe if more than one surgical procedure was needed. There was a significant trend toward decreasing numbers of filed claims for wrist ligament injuries (p = 0.002) over time, in contrast to the total number of filed claims to LÖF, which has increased by an average of 6% annually for a cumulative increase of 60% from 2011 to 2018.\u0000 Interpretation The total cost for misdiagnosed and mistreated wrist ligament injuries in Sweden from 2011 to 2018 was €2,203,467, and costly for both the patients and society at large.\u0000 Level of Evidence Level III, therapeutic.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139608659","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}
Alexandra Graf, Adil S Ahmed, Dan Thompson, M. Gottschalk, Eric R. Wagner, Nina Suh
Purpose Management of acute distal radioulnar joint (DRUJ) instability is complex and controversial. Common treatment options include prolonged immobilization, stabilization with wires, and acute triangular fibrocartilage complex repair. However, none of these permits an early range of motion. The purpose of this study is to investigate the feasibility of a suture-based stabilization (SBS) technique for acute DRUJ instability to permit early active motion. Methods A biomechanical study utilizing eight cadaveric arms was performed. All specimens were tested in the intact state prior to the creation of bidirectional DRUJ instability. For the SBS group, 2-mm suture tapes with suture button fixation were utilized to recreate the respective contributions of distal oblique bundle and volar and dorsal radioulnar ligaments to DRUJ stability. All specimens were cyclically loaded with a simulated ballottement stress of 20N in forearm positions of neutral, 60 degrees of pronation and 60 degrees of supination. Range of motion and total translation were measured and then compared between the two groups. Results The average range of motion in the intact and SBS specimens was 174 and 175 degrees, respectively. There were no significant differences in displacement between the intact and SBS group in neutral and in supination. However, the SBS group had less translation than the intact group in pronation. Conclusions For acute DRUJ instability, the described SBS technique provides similar stability to the native intact DRUJ without compromising the range of motion in a cadaveric model. Future comparative studies are warranted prior to translation into the clinical arena. Clinical Relevance This is a biomechanical study investigating a treatment technique for acute DRUJ instability that would allow an early range of motion.
目的 急性桡侧远端关节（DRUJ）不稳定的治疗既复杂又有争议。常见的治疗方案包括长期固定、使用钢丝稳定和急性三角纤维软骨复合体修复。然而，这些方法都无法让患者尽早恢复活动范围。本研究的目的是探讨缝合稳定（SBS）技术治疗急性 DRUJ 不稳定的可行性，以允许早期主动运动。方法 利用八只尸体手臂进行生物力学研究。在造成 DRUJ 双向不稳定之前，所有样本都在完整状态下进行了测试。在 SBS 组中，使用带有缝合扣固定的 2 毫米缝合带来重建远端斜束以及桡侧和背侧韧带各自对 DRUJ 稳定性的贡献。在前臂中立、前倾 60 度和上举 60 度的位置上，对所有标本施加 20N 的模拟压球应力进行循环加载。测量两组的活动范围和总平移量，然后进行比较。结果 完整标本和 SBS 标本的平均活动范围分别为 174 度和 175 度。完整组和 SBS 组在中立位和仰卧位时的位移没有明显差异。但是，SBS 组的前屈位移小于完好组。结论 对于急性 DRUJ 不稳定，所描述的 SBS 技术可提供与原生完整 DRUJ 相似的稳定性，且不会影响尸体模型的活动范围。在将其应用于临床之前，有必要进行进一步的比较研究。临床相关性 这是一项生物力学研究，调查了一种治疗急性 DRUJ 不稳定的技术，该技术可使患者尽早恢复活动范围。
{"title":"Suture-Based Distal Radioulnar Joint Stabilization: A Biomechanical Evaluation in a Cadaveric Model","authors":"Alexandra Graf, Adil S Ahmed, Dan Thompson, M. Gottschalk, Eric R. Wagner, Nina Suh","doi":"10.1055/s-0043-1778095","DOIUrl":"https://doi.org/10.1055/s-0043-1778095","url":null,"abstract":"\u0000 Purpose Management of acute distal radioulnar joint (DRUJ) instability is complex and controversial. Common treatment options include prolonged immobilization, stabilization with wires, and acute triangular fibrocartilage complex repair. However, none of these permits an early range of motion. The purpose of this study is to investigate the feasibility of a suture-based stabilization (SBS) technique for acute DRUJ instability to permit early active motion.\u0000 Methods A biomechanical study utilizing eight cadaveric arms was performed. All specimens were tested in the intact state prior to the creation of bidirectional DRUJ instability. For the SBS group, 2-mm suture tapes with suture button fixation were utilized to recreate the respective contributions of distal oblique bundle and volar and dorsal radioulnar ligaments to DRUJ stability. All specimens were cyclically loaded with a simulated ballottement stress of 20N in forearm positions of neutral, 60 degrees of pronation and 60 degrees of supination. Range of motion and total translation were measured and then compared between the two groups.\u0000 Results The average range of motion in the intact and SBS specimens was 174 and 175 degrees, respectively. There were no significant differences in displacement between the intact and SBS group in neutral and in supination. However, the SBS group had less translation than the intact group in pronation.\u0000 Conclusions For acute DRUJ instability, the described SBS technique provides similar stability to the native intact DRUJ without compromising the range of motion in a cadaveric model. Future comparative studies are warranted prior to translation into the clinical arena.\u0000 Clinical Relevance This is a biomechanical study investigating a treatment technique for acute DRUJ instability that would allow an early range of motion.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139609019","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}
Ricardo Kaempf, A. Atzei, J. Brunelli, Pedro J. Delgado
Background Traumatic isolated dislocation of the distal radioulnar joint (DRUJ) has always been an injury recognized for its rarity, misdiagnosis, and possibility of inability to be reduced at emergency care. As a result, little has been discussed so far about the guidelines and routines for its treatment.It is known that some degree of injury to the triangular fibrocartilage (TFC) is required for a DRUJ to be dislocated. However, there is no evidence to prove that this injury will cause any degree of DRUJ instability following reduction. Methods We show a case of a patient with traumatic isolated volar dislocation of the DRUJ in which, after failure in the attempt to reduce it in the emergency room, surgical treatment was performed using an arthroscopic method. Results Computed tomography and magnetic resonance imaging axial sections showed the impaction of the distal ulna, with its groove to the extensor carpi ulnaris tendon blocked in the anterior labrum of the sigmoid notch of the radius. Arthroscopy before reduction showed that the distal portion of the TFC was intact, with damage to the foveal insertion (Palmer Type 1B, Atzei Class 3). After joint reduction, a loop-shaped repair of the TFC foveal lesion was performed through the central disc and attached to the distal ulna footprint. The patient presented good progression, with quick recovery, and no serious complications or the need for a second surery. Conclusion We indicate the use of arthroscopy in patients with irreducible isolated volar dislocation, with subacute or chronic presentation, who have to be managed in the operating room. It is a useful method for diagnosing and repairing the TFC injury. This will prevent possible complications and provide faster recovery, mainly reducing the time of immobilization.
{"title":"Arthroscopic Treatment of Traumatic Isolated Volar Dislocation of the Distal Radioulnar Joint: Case Report and Management Proposal","authors":"Ricardo Kaempf, A. Atzei, J. Brunelli, Pedro J. Delgado","doi":"10.1055/s-0043-1778111","DOIUrl":"https://doi.org/10.1055/s-0043-1778111","url":null,"abstract":"\u0000 Background Traumatic isolated dislocation of the distal radioulnar joint (DRUJ) has always been an injury recognized for its rarity, misdiagnosis, and possibility of inability to be reduced at emergency care. As a result, little has been discussed so far about the guidelines and routines for its treatment.It is known that some degree of injury to the triangular fibrocartilage (TFC) is required for a DRUJ to be dislocated. However, there is no evidence to prove that this injury will cause any degree of DRUJ instability following reduction.\u0000 Methods We show a case of a patient with traumatic isolated volar dislocation of the DRUJ in which, after failure in the attempt to reduce it in the emergency room, surgical treatment was performed using an arthroscopic method.\u0000 Results Computed tomography and magnetic resonance imaging axial sections showed the impaction of the distal ulna, with its groove to the extensor carpi ulnaris tendon blocked in the anterior labrum of the sigmoid notch of the radius. Arthroscopy before reduction showed that the distal portion of the TFC was intact, with damage to the foveal insertion (Palmer Type 1B, Atzei Class 3). After joint reduction, a loop-shaped repair of the TFC foveal lesion was performed through the central disc and attached to the distal ulna footprint. The patient presented good progression, with quick recovery, and no serious complications or the need for a second surery.\u0000 Conclusion We indicate the use of arthroscopy in patients with irreducible isolated volar dislocation, with subacute or chronic presentation, who have to be managed in the operating room. It is a useful method for diagnosing and repairing the TFC injury. This will prevent possible complications and provide faster recovery, mainly reducing the time of immobilization.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139607547","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}
Pub Date : 2024-01-10eCollection Date: 2023-12-01DOI: 10.1055/s-0043-1776327
Toshiyasu Nakamura
{"title":"Finite Element Modeling of the Human Wrist.","authors":"Toshiyasu Nakamura","doi":"10.1055/s-0043-1776327","DOIUrl":"https://doi.org/10.1055/s-0043-1776327","url":null,"abstract":"","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10781515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139425710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-22eCollection Date: 2024-02-01DOI: 10.1055/s-0043-1770079
Janice Chin-Yi Liao, David Meng Kiat Tan
Background Midcarpal instability is an uncommon entity characterized by pain and clunking as the wrist moves from radial deviation to ulnar deviation. Management is primarily nonoperative. In patients with persistent symptoms, operative treatments are divided into soft tissue reconstruction and limited midcarpal arthrodesis. Case Description We present a rare case of radial midcarpal instability associated with radioscaphocapitate (RSC) ligament injury. A 20-year-old man presented with radial-sided wrist pain and clunking with radial deviation after a fall. Wrist arthroscopy confirmed the pathology of an RSC ligament injury resulting in an extended posture of the scaphoid and a catch-up clunk from sudden flexion of the scaphoid in radial deviation. His RSC ligament was recessed and he had excellent outcome at 1 year follow-up. Literature Review Midcarpal instability was reported by Lichtman et al as a painful wrist click in ulnar deviation and classified according to the direction of the subluxation. Radial midcarpal instability was later described by Caputo et al in patients with rotatory subluxation of the scaphoid. We present a previously unreported form of radial midcarpal instability as it does not quite fit into the type III midcarpal instability with ligament laxity of the scaphotrapeziotrapezoid joint and type IV with scapholunate ligament disruption. The painful wrist click occurs in radial deviation as the result of an RSC ligament injury. Clinical Relevance We performed arthroscopic thermal capsulorrhaphy of the ulnar arcuate ligaments and dorsal capsule and an open proximal recession of the RSC ligament. The elimination of pain and clunking accompanied by the restoration of scaphoid flexion and return to load-bearing activities validates the pathology and suggests the potential of this soft tissue procedure in the treatment of radial midcarpal instability.
{"title":"Radial Midcarpal Instability Treated with Radioscaphocapitate Ligament Recession: A Case Report.","authors":"Janice Chin-Yi Liao, David Meng Kiat Tan","doi":"10.1055/s-0043-1770079","DOIUrl":"10.1055/s-0043-1770079","url":null,"abstract":"<p><p><b>Background</b> Midcarpal instability is an uncommon entity characterized by pain and clunking as the wrist moves from radial deviation to ulnar deviation. Management is primarily nonoperative. In patients with persistent symptoms, operative treatments are divided into soft tissue reconstruction and limited midcarpal arthrodesis. <b>Case Description</b> We present a rare case of radial midcarpal instability associated with radioscaphocapitate (RSC) ligament injury. A 20-year-old man presented with radial-sided wrist pain and clunking with radial deviation after a fall. Wrist arthroscopy confirmed the pathology of an RSC ligament injury resulting in an extended posture of the scaphoid and a catch-up clunk from sudden flexion of the scaphoid in radial deviation. His RSC ligament was recessed and he had excellent outcome at 1 year follow-up. <b>Literature Review</b> Midcarpal instability was reported by Lichtman et al as a painful wrist click in ulnar deviation and classified according to the direction of the subluxation. Radial midcarpal instability was later described by Caputo et al in patients with rotatory subluxation of the scaphoid. We present a previously unreported form of radial midcarpal instability as it does not quite fit into the type III midcarpal instability with ligament laxity of the scaphotrapeziotrapezoid joint and type IV with scapholunate ligament disruption. The painful wrist click occurs in radial deviation as the result of an RSC ligament injury. <b>Clinical Relevance</b> We performed arthroscopic thermal capsulorrhaphy of the ulnar arcuate ligaments and dorsal capsule and an open proximal recession of the RSC ligament. The elimination of pain and clunking accompanied by the restoration of scaphoid flexion and return to load-bearing activities validates the pathology and suggests the potential of this soft tissue procedure in the treatment of radial midcarpal instability.</p>","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10803155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139542031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Purpose This study aimed to present the results of an alternative technique for treating ulnar impaction syndrome, the “reverse wafer procedure,” and assess the mid-term clinical outcomes of patients treated with this technique. Methods A retrospective evaluation was conducted on 14 patients who underwent the reverse wafer procedure for ulnar impaction syndrome between 2013 and 2020. The inclusion criteria for the study were persistent ulnar-sided wrist pain, even after a minimum of 3 months of nonoperative treatment, the presence of a chondral lesion on the lunate, and an intact triangular fibrocartilage complex (TFCC) based on arthroscopic evaluation. Postoperative clinical and subjective functional outcomes were assessed using measures such as wrist range of motion (ROM), grip strength, the Turkish version of the quick disabilities of the arm, shoulder, and hand questionnaire (Quick DASH), and pain levels measured on a visual analog scale (VAS) and were compared with preoperative values. Patient satisfaction was also evaluated postoperatively. Results The mean follow-up period was 42.2 months (range: 24–68 months). Postoperatively, none of the patients experienced any restriction in ROM. Grip measurements significantly increased after the surgery (p = 0.003). Preoperatively, the patients had a grip strength of 41.14 kg (range 28–48 kg), which improved to 44 kg (range 30–52 kg) postoperatively. Postoperative VAS values and QDASH scores significantly decreased compared with the preoperative values (p < 0.001, p = 0.001). The mean VAS score decreased from 6.1 (range 4–8) preoperatively to 0.9 (range 0–5) postoperatively. The mean Quick DASH score decreased from 49.44 (range 25–68.3) preoperatively to 10.13 (range 3.3–36) postoperatively. When asked about their satisfaction with the operation, 13 out of 14 patients reported being highly satisfied with the results. Conclusions The reverse wafer procedure presents an alternative treatment option for ulnar impaction syndrome in cases where the TFCC is intact. The mid-term results of this described technique are promising. However, further comparative studies with longer follow-ups are necessary to support these findings. Level of Evidence IV Therapeutic.
摘要目的本研究旨在介绍一种治疗尺嵌塞综合征的替代技术“反向晶圆手术”的结果，并评估采用该技术治疗的患者的中期临床结果。方法回顾性分析2013 ~ 2020年收治的14例尺侧嵌塞综合征患者的临床资料。该研究的纳入标准是持续的尺侧腕关节疼痛，即使在至少3个月的非手术治疗后，在月骨上存在软骨病变，以及基于关节镜评估的完整三角形纤维软骨复合体(TFCC)。术后临床和主观功能结果通过腕关节活动度(ROM)、握力、土耳其版手臂、肩部和手部快速残疾问卷(quick DASH)以及视觉模拟量表(VAS)测量的疼痛水平进行评估，并与术前值进行比较。术后还对患者满意度进行了评估。结果平均随访时间为42.2个月(24 ~ 68个月)。术后，没有患者出现任何ROM限制。术后握力测量明显增加(p = 0.003)。术前握力为41.14 kg (28 ~ 48 kg)，术后握力为44 kg (30 ~ 52 kg)。术后VAS评分和QDASH评分较术前显著降低(p <0.001, p = 0.001)。平均VAS评分从术前的6.1(范围4-8)下降到术后的0.9(范围0-5)。平均Quick DASH评分由术前49.44分(范围25-68.3)降至术后10.13分(范围3.3-36)。当被问及对手术的满意度时，14名患者中有13名对手术结果非常满意。结论在TFCC完好的情况下，反向晶圆手术是治疗尺侧嵌塞综合征的另一种选择。这种技术的中期结果是有希望的。然而，需要进一步的比较研究和更长的随访来支持这些发现。证据水平IV治疗性。
{"title":"Reverse Wafer Procedure","authors":"Ismail Bulent Ozcelik, Ali Cavit, Aydin Yuceturk","doi":"10.1055/s-0043-1775819","DOIUrl":"https://doi.org/10.1055/s-0043-1775819","url":null,"abstract":"Abstract Purpose This study aimed to present the results of an alternative technique for treating ulnar impaction syndrome, the “reverse wafer procedure,” and assess the mid-term clinical outcomes of patients treated with this technique. Methods A retrospective evaluation was conducted on 14 patients who underwent the reverse wafer procedure for ulnar impaction syndrome between 2013 and 2020. The inclusion criteria for the study were persistent ulnar-sided wrist pain, even after a minimum of 3 months of nonoperative treatment, the presence of a chondral lesion on the lunate, and an intact triangular fibrocartilage complex (TFCC) based on arthroscopic evaluation. Postoperative clinical and subjective functional outcomes were assessed using measures such as wrist range of motion (ROM), grip strength, the Turkish version of the quick disabilities of the arm, shoulder, and hand questionnaire (Quick DASH), and pain levels measured on a visual analog scale (VAS) and were compared with preoperative values. Patient satisfaction was also evaluated postoperatively. Results The mean follow-up period was 42.2 months (range: 24–68 months). Postoperatively, none of the patients experienced any restriction in ROM. Grip measurements significantly increased after the surgery (p = 0.003). Preoperatively, the patients had a grip strength of 41.14 kg (range 28–48 kg), which improved to 44 kg (range 30–52 kg) postoperatively. Postoperative VAS values and QDASH scores significantly decreased compared with the preoperative values (p < 0.001, p = 0.001). The mean VAS score decreased from 6.1 (range 4–8) preoperatively to 0.9 (range 0–5) postoperatively. The mean Quick DASH score decreased from 49.44 (range 25–68.3) preoperatively to 10.13 (range 3.3–36) postoperatively. When asked about their satisfaction with the operation, 13 out of 14 patients reported being highly satisfied with the results. Conclusions The reverse wafer procedure presents an alternative treatment option for ulnar impaction syndrome in cases where the TFCC is intact. The mid-term results of this described technique are promising. However, further comparative studies with longer follow-ups are necessary to support these findings. Level of Evidence IV Therapeutic.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135290922","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}
Ahmed El-Tayar, Samir El-Ghandour, Adel Ghazal, Ibrahim Rakha, Asser Sallam
Abstract Background The literature presents great challenge in comparing the arthroscopic wafer procedure (AWP) versus ulnar shortening osteotomy (USO) in the treatment of ulnar impaction syndrome (UIS). Purpose We aimed primarily to compare the clinical and functional outcomes of AWP with triangular fibrocartilage complex (TFCC) debridement versus USO in the management of UIS. Methods The study was conducted as a randomized clinical trial including 43 patients with UIS whose ulna variance was less than 4 mm. Patients were randomly allocated to either the AWP group (21 patients) who underwent AWP and TFCC debridement or the USO group (22 patients) who underwent diaphyseal USO. Patients were followed up for at least 12 months. The primary outcome measure was the Modified Mayo Wrist (MMW) score. The Disabilities of the Arm, Shoulder, and Hand (DASH) score, the mean operative time, postoperative complications, and patient satisfaction were our secondary outcomes. Results Radiological correction of variance was achieved in all patients. The mean operative time was significantly shorter in the AWP group. The postoperative MMW and DASH scores were better in the AWP group than in the USO group. Fewer complications occurred in the AWP group (1 of 21 patients) compared with the USO group (3 of 22 patients). Conclusions AWP with TFCC debridement is a reliable and safe method for the management of UIS with a positive variance of less than 4 mm with better clinical and functional results than diaphyseal USO. Type of study/level of evidence Therapeutic type II.
{"title":"Combined Arthroscopic Wafer Procedure and Triangular Fibrocartilage Complex Debridement versus Ulnar Shortening Diaphyseal Osteotomy in Management of Ulnar Impaction Syndrome: A Randomized Clinical Trial","authors":"Ahmed El-Tayar, Samir El-Ghandour, Adel Ghazal, Ibrahim Rakha, Asser Sallam","doi":"10.1055/s-0043-1776399","DOIUrl":"https://doi.org/10.1055/s-0043-1776399","url":null,"abstract":"Abstract Background The literature presents great challenge in comparing the arthroscopic wafer procedure (AWP) versus ulnar shortening osteotomy (USO) in the treatment of ulnar impaction syndrome (UIS). Purpose We aimed primarily to compare the clinical and functional outcomes of AWP with triangular fibrocartilage complex (TFCC) debridement versus USO in the management of UIS. Methods The study was conducted as a randomized clinical trial including 43 patients with UIS whose ulna variance was less than 4 mm. Patients were randomly allocated to either the AWP group (21 patients) who underwent AWP and TFCC debridement or the USO group (22 patients) who underwent diaphyseal USO. Patients were followed up for at least 12 months. The primary outcome measure was the Modified Mayo Wrist (MMW) score. The Disabilities of the Arm, Shoulder, and Hand (DASH) score, the mean operative time, postoperative complications, and patient satisfaction were our secondary outcomes. Results Radiological correction of variance was achieved in all patients. The mean operative time was significantly shorter in the AWP group. The postoperative MMW and DASH scores were better in the AWP group than in the USO group. Fewer complications occurred in the AWP group (1 of 21 patients) compared with the USO group (3 of 22 patients). Conclusions AWP with TFCC debridement is a reliable and safe method for the management of UIS with a positive variance of less than 4 mm with better clinical and functional results than diaphyseal USO. Type of study/level of evidence Therapeutic type II.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135539775","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}
Abstract Background: Distal radius fractures with dorso-ulnar corner fragments (DUC) pose a surgical challenge due to limited visualization and the risk of hardware prominence. Traditional approaches often result in inadequate reduction and fixation, leading to suboptimal clinical outcomes. Description of Technique: In this study, we introduce an arthroscopic-assisted approach for the fixation of distal radius fractures with DUC fragments. The technique utilizes locked, hooked K-wires to provide a low-profile dorsal capturing mechanism. We outline the step-by-step procedure, which includes pre-operative planning, volar plate application, and arthroscopic reduction of DUC fragments. Patients and Methods: We applied this technique to a 60-year-old female patient with an unstable intra-articular distal radius fracture and a DUC fragment. Closed reduction was initially attempted, followed by arthroscopic-assisted reduction and internal fixation using the locked, hooked K-wire technique. Results: Our technique has demonstrated its ability to withstand early movement rehabilitation protocols without fixation loss, enabling early mobilization. A custom thermoplastic splint was worn for 6 weeks, with favorable supination/pronation and wrist flexion/extension outcomes at clinical review. Conclusions: Arthroscopic-assisted fixation with locked, hooked K-wires offers a reliable solution for accurately reducing challenging DUC fragments in distal radius fractures. This approach complements standard distal radius fixation systems, providing a low-profile dorsal capturing mechanism and addressing the issue of hardware prominence, ultimately improving clinical outcomes.
{"title":"Arthroscopic-assisted Distal Radius Fracture Fixation for Dorsoulnar Corner Fragments Using a Locked, Hooked Kirschner-Wire Technique","authors":"Mark Ross, Matthew J. White, Nicholas Smith","doi":"10.1055/s-0043-1776115","DOIUrl":"https://doi.org/10.1055/s-0043-1776115","url":null,"abstract":"Abstract Background: Distal radius fractures with dorso-ulnar corner fragments (DUC) pose a surgical challenge due to limited visualization and the risk of hardware prominence. Traditional approaches often result in inadequate reduction and fixation, leading to suboptimal clinical outcomes. Description of Technique: In this study, we introduce an arthroscopic-assisted approach for the fixation of distal radius fractures with DUC fragments. The technique utilizes locked, hooked K-wires to provide a low-profile dorsal capturing mechanism. We outline the step-by-step procedure, which includes pre-operative planning, volar plate application, and arthroscopic reduction of DUC fragments. Patients and Methods: We applied this technique to a 60-year-old female patient with an unstable intra-articular distal radius fracture and a DUC fragment. Closed reduction was initially attempted, followed by arthroscopic-assisted reduction and internal fixation using the locked, hooked K-wire technique. Results: Our technique has demonstrated its ability to withstand early movement rehabilitation protocols without fixation loss, enabling early mobilization. A custom thermoplastic splint was worn for 6 weeks, with favorable supination/pronation and wrist flexion/extension outcomes at clinical review. Conclusions: Arthroscopic-assisted fixation with locked, hooked K-wires offers a reliable solution for accurately reducing challenging DUC fragments in distal radius fractures. This approach complements standard distal radius fixation systems, providing a low-profile dorsal capturing mechanism and addressing the issue of hardware prominence, ultimately improving clinical outcomes.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135539781","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}
Abstract Introduction A systematic review and meta-analysis of randomized controlled trials was conducted to compare surgical treatment using open reduction and internal fixation (ORIF) with volar locking plates (VLP) to conservative treatment with closed reduction and immobilization in elderly patients aged ≥60 years with acute displaced distal radius fractures. Methods A search of the MEDLINE, Scopus, and Central Register of Controlled Trials (CENTRAL) databases was conducted. Clinical and radiographic measures at 12 months were compared between groups by pooling the mean difference. The complication rates were compared by pooling relative risk ratios. Pooled mean differences of Disabilities of the Arm, Shoulder, and Hand (DASH) and Patient-Rated Wrist Evaluation (PRWE) results were compared with the published minimal clinically important difference (MCID) to evaluate the clinical relevance of the results. Results The initial search yielded 766 records, from which 6 articles were selected for the final analysis. The results of the DASH questionnaire at 12 months of follow-up were significantly lower in the surgical treatment group with a mean difference (MD) of –3.61 points (95% confidence interval [CI]: –6.48 to –0.73). No statistically significant difference was found in the PRWE questionnaire (MD = –3.14 points [95% CI: –7.32 to 1.04]). Radiological results were significantly better in the surgical treatment group and no significant difference in the overall complication rate between the groups was detected. Found MD for DASH and PRWE did not reach the published MCIDs. Conclusion This study suggests that for elderly patients aged ≥60 years with acute displaced distal radius fractures, surgical treatment using ORIF with VLP does not provide clinically relevant benefits compared with conservative treatment with closed reduction and immobilization at the 12-month follow-up, despite demonstrating better radiological results.
{"title":"Volar Locking Plate versus Closed Reduction and Immobilization for Distal Radius Fracture in the Elderly: Systematic Review and Meta-Analysis of Randomized Controlled Trials","authors":"Niyaz Latypov, Igor Golubev, Alyona Borisova","doi":"10.1055/s-0043-1774331","DOIUrl":"https://doi.org/10.1055/s-0043-1774331","url":null,"abstract":"Abstract Introduction A systematic review and meta-analysis of randomized controlled trials was conducted to compare surgical treatment using open reduction and internal fixation (ORIF) with volar locking plates (VLP) to conservative treatment with closed reduction and immobilization in elderly patients aged ≥60 years with acute displaced distal radius fractures. Methods A search of the MEDLINE, Scopus, and Central Register of Controlled Trials (CENTRAL) databases was conducted. Clinical and radiographic measures at 12 months were compared between groups by pooling the mean difference. The complication rates were compared by pooling relative risk ratios. Pooled mean differences of Disabilities of the Arm, Shoulder, and Hand (DASH) and Patient-Rated Wrist Evaluation (PRWE) results were compared with the published minimal clinically important difference (MCID) to evaluate the clinical relevance of the results. Results The initial search yielded 766 records, from which 6 articles were selected for the final analysis. The results of the DASH questionnaire at 12 months of follow-up were significantly lower in the surgical treatment group with a mean difference (MD) of –3.61 points (95% confidence interval [CI]: –6.48 to –0.73). No statistically significant difference was found in the PRWE questionnaire (MD = –3.14 points [95% CI: –7.32 to 1.04]). Radiological results were significantly better in the surgical treatment group and no significant difference in the overall complication rate between the groups was detected. Found MD for DASH and PRWE did not reach the published MCIDs. Conclusion This study suggests that for elderly patients aged ≥60 years with acute displaced distal radius fractures, surgical treatment using ORIF with VLP does not provide clinically relevant benefits compared with conservative treatment with closed reduction and immobilization at the 12-month follow-up, despite demonstrating better radiological results.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135539792","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}
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