Soo Min Cha, In Ho Ga, Yong Hwan Kim, Seung Won Kim
Abstract Background We hypothesized a treatment guideline for ulna/radius nonunion after failed surgical treatment and propose to verify it in a prospective study. Herein, we report our preliminary findings and review the current trend. Methods Six patients who met the criteria were retrospectively investigated, and we further categorized “nonunion of both the radius/ulna” into four subcategories. For hypertrophic nonunion of the radius, but with stability maintained by a plate, we only reinforced the mechanical stability of the ulna (osteosynthesis, treatment option 1). In oligo- or atrophic nonunion of the radius with stability maintained by a plate, we added cancellous or tricortical bone grafts to the radius after osteosynthesis of the ulna (treatment option 2). In the presence of definitive pseudomotion of the radius (no stability), we performed revision osteosynthesis for the radius only, without (treatment option 3) or with bone graft (treatment option 4). Results Two, one, one, and two patients had corresponding treatment options of 1, 2, 3, and 4, respectively. At a mean postoperative time of 4.3 months, all radii and ulnas showed union. At the final follow-up, clinical outcomes in terms of the range of motion and VAS (visual analog scale)/DASH (disabilities of the arm, shoulder, and hand) scores were satisfactory. We are currently conducting a prospective trial to verify the hypothesized guidelines. For both types of radius/ulna nonunion, first, if the stability of the radius was good, we compared the final outcomes with or without revision osteosynthesis for the radius, in addition to osteosynthesis for the ulna. Second, if stability was absent in the radius, we compared the final outcomes with or without osteosynthesis of the ulna, in addition to revision osteosynthesis of the radius. Conclusions The treatment guidelines for rare nonunion after failed surgical treatment of both the distal radius/ulna were suggested according to the “concept of stability” based on the principles of fracture treatment. This hypothesis could be used to guide prospective studies of revision surgery for nonunion of both the radius and ulna. Level of Evidence Level IV, retrospective case series.
{"title":"A Case Series of Distal Radius and Ulna Nonunion Treated with Minimal Surgical Intervention","authors":"Soo Min Cha, In Ho Ga, Yong Hwan Kim, Seung Won Kim","doi":"10.1055/s-0043-1776353","DOIUrl":"https://doi.org/10.1055/s-0043-1776353","url":null,"abstract":"Abstract Background We hypothesized a treatment guideline for ulna/radius nonunion after failed surgical treatment and propose to verify it in a prospective study. Herein, we report our preliminary findings and review the current trend. Methods Six patients who met the criteria were retrospectively investigated, and we further categorized “nonunion of both the radius/ulna” into four subcategories. For hypertrophic nonunion of the radius, but with stability maintained by a plate, we only reinforced the mechanical stability of the ulna (osteosynthesis, treatment option 1). In oligo- or atrophic nonunion of the radius with stability maintained by a plate, we added cancellous or tricortical bone grafts to the radius after osteosynthesis of the ulna (treatment option 2). In the presence of definitive pseudomotion of the radius (no stability), we performed revision osteosynthesis for the radius only, without (treatment option 3) or with bone graft (treatment option 4). Results Two, one, one, and two patients had corresponding treatment options of 1, 2, 3, and 4, respectively. At a mean postoperative time of 4.3 months, all radii and ulnas showed union. At the final follow-up, clinical outcomes in terms of the range of motion and VAS (visual analog scale)/DASH (disabilities of the arm, shoulder, and hand) scores were satisfactory. We are currently conducting a prospective trial to verify the hypothesized guidelines. For both types of radius/ulna nonunion, first, if the stability of the radius was good, we compared the final outcomes with or without revision osteosynthesis for the radius, in addition to osteosynthesis for the ulna. Second, if stability was absent in the radius, we compared the final outcomes with or without osteosynthesis of the ulna, in addition to revision osteosynthesis of the radius. Conclusions The treatment guidelines for rare nonunion after failed surgical treatment of both the distal radius/ulna were suggested according to the “concept of stability” based on the principles of fracture treatment. This hypothesis could be used to guide prospective studies of revision surgery for nonunion of both the radius and ulna. Level of Evidence Level IV, retrospective case series.","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":"135539929","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 Avulsion fracture of the extensor carpi ulnaris (ECU) bony insertion at fifth metacarpal base is a rare injury that may preclude recognition on radiographs. Case Description We report two cases of ECU avulsion fracture, both of which were successfully treated surgically by open reduction and fixation (ORIF). Literature Review Only two cases of ECU avulsion fracture have previously been reported in the literature. Forced motion of the wrist into a position of hyperflexion and/or radial deviation appears to be a common mechanism. Clinical Relevance Clinicians should be aware that ECU avulsion fractures can occur in isolation or in association with other fractures of the hand or wrist. ORIF is warranted due to the prospect of impaired wrist range of motion as well as persistent pain caused by the avulsed fragment.
{"title":"Avulsion Fracture of the Extensor Carpi Ulnaris: A Report of Two Cases","authors":"Evan Fang, Matthew Choi, Michael J. Cooper","doi":"10.1055/s-0043-1776139","DOIUrl":"https://doi.org/10.1055/s-0043-1776139","url":null,"abstract":"Abstract Background Avulsion fracture of the extensor carpi ulnaris (ECU) bony insertion at fifth metacarpal base is a rare injury that may preclude recognition on radiographs. Case Description We report two cases of ECU avulsion fracture, both of which were successfully treated surgically by open reduction and fixation (ORIF). Literature Review Only two cases of ECU avulsion fracture have previously been reported in the literature. Forced motion of the wrist into a position of hyperflexion and/or radial deviation appears to be a common mechanism. Clinical Relevance Clinicians should be aware that ECU avulsion fractures can occur in isolation or in association with other fractures of the hand or wrist. ORIF is warranted due to the prospect of impaired wrist range of motion as well as persistent pain caused by the avulsed fragment.","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":"135539778","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}
Muntasir Mannan Choudhury, Suraj Sajeev, Brandon Yew Bao Sheng, Dashishka Thanuranga Wijetunga, Andrew Yuan Hui Chin
Abstract Ulnocarpal impaction or ulnar abutment symptom occurs secondary to abnormal load bearing on the ulnar side of the wrist leading to pain symptoms and degeneration of the structures of the ulnocarpal joint. The two classical surgical methods used to address this problem are ulnar shortening osteotomy and the wafer procedure, which can either be open or arthroscopic. With the advent of arthroscopy, with surgeon harboring arthroscopy skills, arthroscopic wafer resection has been intensely popularized which requires a central perforation of the triangular fibrocartilage to approach the ulna dome through the ulnocarpal joint. So, what happens in symptomatic patients with ulnocarpal abutment with an intact triangular fibrocartilage complex who have failed conservative management. Do we perform an open procedure or do we create a perforation in the central disc of the triangular fibrocartilage complex to expose the ulnar dome? Or do we just do an ulnar shortening osteotomy? Here, we describe our arthroscopic technique of conducting arthroscopy in the narrow confines of the space below the triangular fibrocartilage complex above the ulnar dome to carry out an arthroscopic wafer procedure in a triangular fibrocartilage complex with no central perforation. The procedure can produce results similar to those of the classical arthroscopic wafer procedure described explicitly in the literature.
{"title":"Arthroscopic Wafer Procedure for Ulnar Impaction Syndrome in an Intact Triangular Fibrocartilage Complex","authors":"Muntasir Mannan Choudhury, Suraj Sajeev, Brandon Yew Bao Sheng, Dashishka Thanuranga Wijetunga, Andrew Yuan Hui Chin","doi":"10.1055/s-0043-1775799","DOIUrl":"https://doi.org/10.1055/s-0043-1775799","url":null,"abstract":"Abstract Ulnocarpal impaction or ulnar abutment symptom occurs secondary to abnormal load bearing on the ulnar side of the wrist leading to pain symptoms and degeneration of the structures of the ulnocarpal joint. The two classical surgical methods used to address this problem are ulnar shortening osteotomy and the wafer procedure, which can either be open or arthroscopic. With the advent of arthroscopy, with surgeon harboring arthroscopy skills, arthroscopic wafer resection has been intensely popularized which requires a central perforation of the triangular fibrocartilage to approach the ulna dome through the ulnocarpal joint. So, what happens in symptomatic patients with ulnocarpal abutment with an intact triangular fibrocartilage complex who have failed conservative management. Do we perform an open procedure or do we create a perforation in the central disc of the triangular fibrocartilage complex to expose the ulnar dome? Or do we just do an ulnar shortening osteotomy? Here, we describe our arthroscopic technique of conducting arthroscopy in the narrow confines of the space below the triangular fibrocartilage complex above the ulnar dome to carry out an arthroscopic wafer procedure in a triangular fibrocartilage complex with no central perforation. The procedure can produce results similar to those of the classical arthroscopic wafer procedure described explicitly in the literature.","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":"135539783","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}
John J. Heifner, Robert J. Rowland, Osmanny Gomez, Francisco Rubio, George S. Kardashian
Abstract Background In aggregate, there is varied efficacy for total wrist fusion (TWF) with a locking intramedullary (IM) nail which indicates the need for further investigation. It remains unclear whether preparation of the third carpometacarpal joint (CMCJ) will reduce the risk of complications including distal screw loosening. Purpose Our objectives were (a) to report clinical outcomes for wrist arthrodesis using a locking IM nail and (b) to determine whether maintenance of the native third CMCJ articulation would contribute to short-term complications. Patients and Methods A chart review from 2010 to 2022 was performed at two institutions for cases of TWF fixed with the IMPLATE locking nail (Skeletal Dynamics, Miami, FL). Clinical and radiographic outcomes were collected. Results Radiographic union was achieved in 93.8% of cases, including one case of delayed union. The mean patient-rated wrist evaluation score was 30.4, the mean visual analog scale score for pain at rest was 1.7, and the mean visual analog scale score during activities of daily living was 3.2. There were seven cases of distal screw loosening (21.8%), and three cases of revision surgery (9.4%) which included two implant removals. A long radial nail was used in 24 (75%) of cases and a short metacarpal nail was used in 3 (9%) cases. Conclusion The current series demonstrated satisfactory function with low rates of revision surgery following IM nail TWF without inclusion of the third CMCJ into the fusion mass. Cases with distal screw loosening had variable clinical presentation and our current practice is to offer outpatient screw removal for cases which reach the threshold for intervention. Level of Evidence IV retrospective series.
{"title":"A Dual Center Experience with a Locking Intramedullary Nail for Wrist Fusion","authors":"John J. Heifner, Robert J. Rowland, Osmanny Gomez, Francisco Rubio, George S. Kardashian","doi":"10.1055/s-0043-1776114","DOIUrl":"https://doi.org/10.1055/s-0043-1776114","url":null,"abstract":"Abstract Background In aggregate, there is varied efficacy for total wrist fusion (TWF) with a locking intramedullary (IM) nail which indicates the need for further investigation. It remains unclear whether preparation of the third carpometacarpal joint (CMCJ) will reduce the risk of complications including distal screw loosening. Purpose Our objectives were (a) to report clinical outcomes for wrist arthrodesis using a locking IM nail and (b) to determine whether maintenance of the native third CMCJ articulation would contribute to short-term complications. Patients and Methods A chart review from 2010 to 2022 was performed at two institutions for cases of TWF fixed with the IMPLATE locking nail (Skeletal Dynamics, Miami, FL). Clinical and radiographic outcomes were collected. Results Radiographic union was achieved in 93.8% of cases, including one case of delayed union. The mean patient-rated wrist evaluation score was 30.4, the mean visual analog scale score for pain at rest was 1.7, and the mean visual analog scale score during activities of daily living was 3.2. There were seven cases of distal screw loosening (21.8%), and three cases of revision surgery (9.4%) which included two implant removals. A long radial nail was used in 24 (75%) of cases and a short metacarpal nail was used in 3 (9%) cases. Conclusion The current series demonstrated satisfactory function with low rates of revision surgery following IM nail TWF without inclusion of the third CMCJ into the fusion mass. Cases with distal screw loosening had variable clinical presentation and our current practice is to offer outpatient screw removal for cases which reach the threshold for intervention. Level of Evidence IV retrospective series.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136142198","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}
Stephanie A. Kwan, Joseph E. Massaglia, Daren J. Aita, Jonas L. Matzon, Michael Rivlin
Abstract Background de Quervain's tenosynovitis (DeQ) is a clinical diagnosis; however, due to the symptom overlap with other pathologies, it can occasionally be challenging to make an accurate diagnosis, especially for nonorthopaedic trained physicians. Questions/Purposes We hypothesized that the ratio of radial-sided to ulnar-sided soft tissue swelling could serve as a universally accessible diagnostic tool to assist in differentiating DeQ from other upper extremity conditions. Patients and Methods We retrospectively identified patients with isolated DeQ (M65.4), thumb carpometacarpal arthritis (M18.X), or carpal tunnel syndrome (G56.0x) between 2018 and 2019. Five blinded, independent reviewers evaluated anterior–posterior radiographs of the affected wrist. A digital caliper was used to measure the shortest distance from the lateral cortex of the distal radius and the medial cortex of the distal ulna to the outer edge of the radial and ulnar soft tissue shadows, respectively. Results The mean radial:ulnar ratio in the DeQ group was significantly larger than in the control groups. The interclass correlation coefficient showed strong agreement between all measurements. Patients with a radial:ulnar ratio of 1.7 or higher had a 61% chance of having DeQ with a 56.5% sensitivity, 66.3% specificity, 59.3% positive predictive value (PPV), and 63.8% negative predictive value. A ratio of more than 2.5 correlates to a 55% chance of having DeQ with a sensitivity of 12.9%, specificity of 96.9%, and PPV of 78.6%. Conclusion The ratio of radial- to ulnar-sided wrist edema can be used as a novel diagnostic aid in DeQ, especially for those not trained in orthopaedics or hand surgery. Level of Evidence Level IV, diagnostic study.
{"title":"Radiographic Edema Is a Predictor of de Quervain's Tenosynovitis","authors":"Stephanie A. Kwan, Joseph E. Massaglia, Daren J. Aita, Jonas L. Matzon, Michael Rivlin","doi":"10.1055/s-0043-1772713","DOIUrl":"https://doi.org/10.1055/s-0043-1772713","url":null,"abstract":"Abstract Background de Quervain's tenosynovitis (DeQ) is a clinical diagnosis; however, due to the symptom overlap with other pathologies, it can occasionally be challenging to make an accurate diagnosis, especially for nonorthopaedic trained physicians. Questions/Purposes We hypothesized that the ratio of radial-sided to ulnar-sided soft tissue swelling could serve as a universally accessible diagnostic tool to assist in differentiating DeQ from other upper extremity conditions. Patients and Methods We retrospectively identified patients with isolated DeQ (M65.4), thumb carpometacarpal arthritis (M18.X), or carpal tunnel syndrome (G56.0x) between 2018 and 2019. Five blinded, independent reviewers evaluated anterior–posterior radiographs of the affected wrist. A digital caliper was used to measure the shortest distance from the lateral cortex of the distal radius and the medial cortex of the distal ulna to the outer edge of the radial and ulnar soft tissue shadows, respectively. Results The mean radial:ulnar ratio in the DeQ group was significantly larger than in the control groups. The interclass correlation coefficient showed strong agreement between all measurements. Patients with a radial:ulnar ratio of 1.7 or higher had a 61% chance of having DeQ with a 56.5% sensitivity, 66.3% specificity, 59.3% positive predictive value (PPV), and 63.8% negative predictive value. A ratio of more than 2.5 correlates to a 55% chance of having DeQ with a sensitivity of 12.9%, specificity of 96.9%, and PPV of 78.6%. Conclusion The ratio of radial- to ulnar-sided wrist edema can be used as a novel diagnostic aid in DeQ, especially for those not trained in orthopaedics or hand surgery. Level of Evidence Level IV, diagnostic study.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135853447","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}
Lesions of the scapholunate complex represent a varied spectrum of lesions due to the different ligament structures involved and the subtle biomechanics of the carpus.[1] As a result of this biomechanical instability, the scaphoid and lunate will cause joint conflicts, leading to carpal osteoarthritis in the long term. Garcia-Elias, by answering five questions, has provided a classification of Scapholunate (SL) instability that can guide a decision-making algorithm based on the known evolution of scapholunate instability[2]:
{"title":"Injury to the Scapholunate Complex: Shouldn't We Look at the Problem the Other Way Round?","authors":"Jean-Baptiste de Villeneuve Bargemon","doi":"10.1055/s-0043-1775996","DOIUrl":"https://doi.org/10.1055/s-0043-1775996","url":null,"abstract":"Lesions of the scapholunate complex represent a varied spectrum of lesions due to the different ligament structures involved and the subtle biomechanics of the carpus.[1] As a result of this biomechanical instability, the scaphoid and lunate will cause joint conflicts, leading to carpal osteoarthritis in the long term. Garcia-Elias, by answering five questions, has provided a classification of Scapholunate (SL) instability that can guide a decision-making algorithm based on the known evolution of scapholunate instability[2]:","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135853295","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: This study presents mini-invasive indirect distraction in the treatment of neglected distal radioulnar joint (DRUJ) dislocations as a novel surgical technique. Pure DRUJ dislocation is a rare injury caused by over rotation of the forearm. It is often undiagnosed in an acute setting. There is no consensus on the treatment of neglected dislocations. Materials and methods: We present a group of six patients with neglected pure DRUJ dislocation, treated by a single surgeon between 2012 and 2019. Results: Closed reduction was impossible in six of six patients. The indirect distraction allowed the reduction of the DRUJ in all cases with final stable DRUJ. Forearm rotation returned to normal in four patients, one patient had 50%, and another patient had 60% of the range of forearm. Mean pain dropped from 7 to 0.8 on visual analog scale. At the 2-year follow-up, the mean Disabilities of the Arm, Shoulder, and Hand score was 8 (0–37.5), and minor degenerative X-ray changes were observed in four patients. Level of evidence IV
{"title":"Mini-invasive Indirect Distraction in the Treatment of Neglected DRUJ Dislocations—A Novel Surgical Technique","authors":"Martin Czinner, Frederik Verstreken, Radek Kebrle","doi":"10.1055/s-0043-1772712","DOIUrl":"https://doi.org/10.1055/s-0043-1772712","url":null,"abstract":"Abstract Introduction: This study presents mini-invasive indirect distraction in the treatment of neglected distal radioulnar joint (DRUJ) dislocations as a novel surgical technique. Pure DRUJ dislocation is a rare injury caused by over rotation of the forearm. It is often undiagnosed in an acute setting. There is no consensus on the treatment of neglected dislocations. Materials and methods: We present a group of six patients with neglected pure DRUJ dislocation, treated by a single surgeon between 2012 and 2019. Results: Closed reduction was impossible in six of six patients. The indirect distraction allowed the reduction of the DRUJ in all cases with final stable DRUJ. Forearm rotation returned to normal in four patients, one patient had 50%, and another patient had 60% of the range of forearm. Mean pain dropped from 7 to 0.8 on visual analog scale. At the 2-year follow-up, the mean Disabilities of the Arm, Shoulder, and Hand score was 8 (0–37.5), and minor degenerative X-ray changes were observed in four patients. Level of evidence IV","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135853291","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}
Fernando Corella, Montserrat Ocampos, Rafeal Laredo, José Tabuenca, Ricardo Larrainzar-Garijo
Abstract Background: Injuries of the volar ligaments of the wrist are not uncommon, but their arthroscopic treatment presents a significant challenge. The objective of this paper is to introduce a technique for reattaching (in acute injuries) or reinforcing (in chronic injuries) various volar wrist ligaments to the bone, using standard wrist arthroscopic dorsal and volar portals. Methods: There are three common steps for all the arthroscopic volar capsuloligamentous reattachments or reinforcements Step 1 – Volar Portal Establishment: volar radial, volar ulnar and volar central portals are used depending on which structure needs to be reattached or reinforced. Step 2 – Anchor Placement: the anchor is positioned at the site where the ligament has been detached. Step 3 – Capsuloligamentous Suture and Knotting: a knot pusher is introduced inside the joint from the dorsal portal and advanced inside the volar portal where the threads of the anchor are located. The knot pusher is loaded with the threads and retrieved to the dorsal portal. A 16G Abbocath, loaded with a loop is used to pierce the volar ligaments. The loop of the Abbocath is captured from the dorsal portal and loaded with the threads. Both threads are taken to the volar portal and knotted after releasing the traction. This way the knot is placed out of the wrist and the ligaments are reattached or reinforced to the bone. Result: This technique has been used to reinforce and reattach the scapholunate and lunotriquetral ligaments and to reattach the radiocarpal ligaments and the Poirier space. Since this procedure has been performed in various conditions and in conjunction with other ligament treatments (such as perilunate injuries, carpal bone fractures, distal radius fractures, and reinforcement or reattachment of the dorsal portions of intrinsic ligaments), specific results are not presented. Conclusions: The described technique enables the reattachment and reinforcement of most volar ligaments to the bone using standard wrist arthroscopic portals. It can be performed in conjunction with the treatment of the dorsal portion of intrinsic ligaments or other wrist injuries.
{"title":"Arthroscopic Volar Capsuloligamentous Reattachment and Reinforcement to Bone","authors":"Fernando Corella, Montserrat Ocampos, Rafeal Laredo, José Tabuenca, Ricardo Larrainzar-Garijo","doi":"10.1055/s-0043-1775820","DOIUrl":"https://doi.org/10.1055/s-0043-1775820","url":null,"abstract":"Abstract Background: Injuries of the volar ligaments of the wrist are not uncommon, but their arthroscopic treatment presents a significant challenge. The objective of this paper is to introduce a technique for reattaching (in acute injuries) or reinforcing (in chronic injuries) various volar wrist ligaments to the bone, using standard wrist arthroscopic dorsal and volar portals. Methods: There are three common steps for all the arthroscopic volar capsuloligamentous reattachments or reinforcements Step 1 – Volar Portal Establishment: volar radial, volar ulnar and volar central portals are used depending on which structure needs to be reattached or reinforced. Step 2 – Anchor Placement: the anchor is positioned at the site where the ligament has been detached. Step 3 – Capsuloligamentous Suture and Knotting: a knot pusher is introduced inside the joint from the dorsal portal and advanced inside the volar portal where the threads of the anchor are located. The knot pusher is loaded with the threads and retrieved to the dorsal portal. A 16G Abbocath, loaded with a loop is used to pierce the volar ligaments. The loop of the Abbocath is captured from the dorsal portal and loaded with the threads. Both threads are taken to the volar portal and knotted after releasing the traction. This way the knot is placed out of the wrist and the ligaments are reattached or reinforced to the bone. Result: This technique has been used to reinforce and reattach the scapholunate and lunotriquetral ligaments and to reattach the radiocarpal ligaments and the Poirier space. Since this procedure has been performed in various conditions and in conjunction with other ligament treatments (such as perilunate injuries, carpal bone fractures, distal radius fractures, and reinforcement or reattachment of the dorsal portions of intrinsic ligaments), specific results are not presented. Conclusions: The described technique enables the reattachment and reinforcement of most volar ligaments to the bone using standard wrist arthroscopic portals. It can be performed in conjunction with the treatment of the dorsal portion of intrinsic ligaments or other wrist injuries.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135853602","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 : 2023-10-12eCollection Date: 2023-10-01DOI: 10.1055/s-0043-1774335
Toshiyasu Nakamura
{"title":"Complications of Volar Plate for Distal Radius Fracture.","authors":"Toshiyasu Nakamura","doi":"10.1055/s-0043-1774335","DOIUrl":"10.1055/s-0043-1774335","url":null,"abstract":"","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10569852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41239715","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}
Andrew M. Gabig, Hayden L. Cooke, Robert Roundy, Michael B. Gottschalk
Abstract Background Failure of carpal tunnel release is an uncommon occurrence with unique pathologies that may impede proper diagnosis and treatment. Symptoms are most often attributed to an inadequate release of the transverse carpal ligament or pathologic scar tissue resultant of the primary decompression. Case Description In this report, we describe the case of a 79-year-old male with a history of scaphoid lunate advanced collapse and a prior carpal tunnel decompression presenting with worsening right wrist function and new right palmar mass. The patient had no significant antecedent trauma, and clinical workup revealed volar dislocation of the lunate. After failed conservative treatment and multiple ultrasound-guided corticosteroid injections, the patient was successfully treated surgically with carpal tunnel release, tenosynovectomy, and lunate excision. Literature Review Volar lunate dislocation without a traumatic mechanism is rare. Progressive carpal destabilization and volar subluxation is not a commonly reported cause of secondary carpal tunnel symptoms. Isolated reports in the literature have been published with nearly identical presentations. Kamihata et al reported a patient, with a history of carpal tunnel decompression, presenting with numbness and tingling in her right hand without traumatic injury. A displaced lunate was found to abut the flexor tendons and median nerve. Ott et al further reported an atraumatic lunate dislocation and palmar swelling 4 weeks after a carpal tunnel release. Clinical Relevance In the setting of existing arthritic degeneration, carpal tunnel release may destabilize the carpus and predispose patients to carpal dislocation. Further research is required to understand the risks associated with this instability leading to lunate dislocations secondary to carpal tunnel release.
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