Merel J.-L. Berkhout, Sophie R.M. Bosch, Marco J.P.F. Ritt
Abstract Background The treatment of patients with osteoarthritis of the first carpometacarpal joint (CMC-I) aims at pain reduction to improve hand function and quality of life. The CMC-I denervation procedure is relatively new and seems appealing, as it is minimally invasive and has few or no disadvantages. To date, however, little research has been done on the results of a CMC-I denervation. The aim of this study was to investigate whether denervation provides pain reduction in patients with early CMC-I osteoarthritis. Methods A literature search was done using PubMed. Studies were excluded if access to full text was not available, if the articles were written in other languages than Dutch or English, and if preoperative testing, follow-up testing, or reporting were incomplete. Studies were included if patients were older than 18 years, had primary CMC-I osteoarthritis with no other wrist pathology, and had received conservative treatment without sustained benefit. The Critical Appraisal Tools of the Joanna Briggs Institute were used for critical appraisal. Clinical data was gathered retrospectively from the medical records to identify patients who underwent CMC-I denervation in The Hand Clinic, Amsterdam. The data of 20 patients were analyzed. Pre- and postoperative visual analog scale (VAS) scores on pain, patient satisfaction, and complications were evaluated. Patients older than 18 years with primary CMC-I osteoarthritis stage I and II and no other wrist pathology, in whom conservative treatment failed were included in the study. Patients with CMC-I osteoarthritis stage III and IV were excluded. Results All 17 search results were screened for full text access, after which 6 case series, 4 systematic reviews, 1 cohort study, 1 comment, and 1 scoping review was included. All but one study showed pain reduction after surgery. In half of the studies, this difference was statistically significant. The average patient satisfaction in these studies was 84.1% and the complication rate was 13.4%. A total of 20 patients were included between 2019 and 2022, with a mean preoperative VAS for pain at rest of 48.2 ± 29.9. After surgery, this decreased to 35.8 ± 34.1. This difference was not statistically significant. The mean VAS for pain during use before denervation was 79 ± 18.4 and this decreased to 49.8 ± 34.2 postoperatively. This difference did appear to be statistically significant. The average patient satisfaction was 60%, and the complication rate was 10%. Conclusion This study provides a literature overview and a pilot study on pain reduction, patient satisfaction, and complications after denervation of the CMC-I joint in patients with early osteoarthritis. Our retrospective case series roughly mirrored the average results found in the literature. There was a statistically significant decrease in pain during use postoperatively. There was no statistically significant difference in pain at rest before and after surgery. The complications were mi
{"title":"Thumb Carpometacarpal Joint Denervation for Early Osteoarthritis: An Overview of the Literature and a Pilot Study on Pain Reduction and Patient Satisfaction","authors":"Merel J.-L. Berkhout, Sophie R.M. Bosch, Marco J.P.F. Ritt","doi":"10.1055/s-0043-1773777","DOIUrl":"https://doi.org/10.1055/s-0043-1773777","url":null,"abstract":"Abstract Background The treatment of patients with osteoarthritis of the first carpometacarpal joint (CMC-I) aims at pain reduction to improve hand function and quality of life. The CMC-I denervation procedure is relatively new and seems appealing, as it is minimally invasive and has few or no disadvantages. To date, however, little research has been done on the results of a CMC-I denervation. The aim of this study was to investigate whether denervation provides pain reduction in patients with early CMC-I osteoarthritis. Methods A literature search was done using PubMed. Studies were excluded if access to full text was not available, if the articles were written in other languages than Dutch or English, and if preoperative testing, follow-up testing, or reporting were incomplete. Studies were included if patients were older than 18 years, had primary CMC-I osteoarthritis with no other wrist pathology, and had received conservative treatment without sustained benefit. The Critical Appraisal Tools of the Joanna Briggs Institute were used for critical appraisal. Clinical data was gathered retrospectively from the medical records to identify patients who underwent CMC-I denervation in The Hand Clinic, Amsterdam. The data of 20 patients were analyzed. Pre- and postoperative visual analog scale (VAS) scores on pain, patient satisfaction, and complications were evaluated. Patients older than 18 years with primary CMC-I osteoarthritis stage I and II and no other wrist pathology, in whom conservative treatment failed were included in the study. Patients with CMC-I osteoarthritis stage III and IV were excluded. Results All 17 search results were screened for full text access, after which 6 case series, 4 systematic reviews, 1 cohort study, 1 comment, and 1 scoping review was included. All but one study showed pain reduction after surgery. In half of the studies, this difference was statistically significant. The average patient satisfaction in these studies was 84.1% and the complication rate was 13.4%. A total of 20 patients were included between 2019 and 2022, with a mean preoperative VAS for pain at rest of 48.2 ± 29.9. After surgery, this decreased to 35.8 ± 34.1. This difference was not statistically significant. The mean VAS for pain during use before denervation was 79 ± 18.4 and this decreased to 49.8 ± 34.2 postoperatively. This difference did appear to be statistically significant. The average patient satisfaction was 60%, and the complication rate was 10%. Conclusion This study provides a literature overview and a pilot study on pain reduction, patient satisfaction, and complications after denervation of the CMC-I joint in patients with early osteoarthritis. Our retrospective case series roughly mirrored the average results found in the literature. There was a statistically significant decrease in pain during use postoperatively. There was no statistically significant difference in pain at rest before and after surgery. The complications were mi","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135690936","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}
We read this article with interest and agree with Hresko et al[1] on the influence of patient characteristics and operative technique on the overall costs of internal fixation of distal radius fractures in adults, including postoperative admission within 30 days.
{"title":"Comment: Theca Primary Cost Drivers of Outpatient Distal Radius Fracture Fixation: A Cost-Minimalization Analysis of 15,379 Cases.","authors":"Philippe Liverneaux","doi":"10.1055/s-0043-1772688","DOIUrl":"https://doi.org/10.1055/s-0043-1772688","url":null,"abstract":"We read this article with interest and agree with Hresko et al[1] on the influence of patient characteristics and operative technique on the overall costs of internal fixation of distal radius fractures in adults, including postoperative admission within 30 days.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135690420","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}
L. Merlini, J. Maffeis, C. Mathoulin, B.S. Sivakumar
Abstract Background The ideal treatment of stage 3 Kienbock's disease is uncertain, with current open procedures conferring the risk of carpal instability, ulnar translocation, and stiffness. We present our technique of arthroscopic lunate excision, and discuss our short- to medium-term results. Description of Technique Via standard wrist arthroscopic portals, the lunate is excised using a combination of shavers, burrs, and rongeurs. Care is taken to preserve the extreme dorsal and volar cortices of the lunate to prevent carpal instability. A short arm backslab is applied for 2 weeks, after which the patient commences range of motion. Patients and Methods Consecutive patients undergoing arthroscopic lunate excision at a single center in Paris, France, underwent pre- and postoperative assessment. Parameters assessed include range of motion, as well as patient-reported outcome measures (PROMs). Results A cohort of 13 patients (7 females and 6 males with a mean age of 27.2 years) underwent arthroscopic lunate excision, and were followed up for a mean of 1.96 years. Significant improvements were noted in flexion, extension, pronation, grip strength, and PROMs. Conclusions Arthroscopic lunectomy provides significant improvements in clinical and PROMs at short- to medium-term follow-up, and conserves other salvage options in case of failure. Long-term clinical follow-up and further biomechanical studies would be beneficial.
{"title":"Arthroscopic Lunate Excision for Stage 3 Kienbock's Disease","authors":"L. Merlini, J. Maffeis, C. Mathoulin, B.S. Sivakumar","doi":"10.1055/s-0043-1772253","DOIUrl":"https://doi.org/10.1055/s-0043-1772253","url":null,"abstract":"Abstract Background The ideal treatment of stage 3 Kienbock's disease is uncertain, with current open procedures conferring the risk of carpal instability, ulnar translocation, and stiffness. We present our technique of arthroscopic lunate excision, and discuss our short- to medium-term results. Description of Technique Via standard wrist arthroscopic portals, the lunate is excised using a combination of shavers, burrs, and rongeurs. Care is taken to preserve the extreme dorsal and volar cortices of the lunate to prevent carpal instability. A short arm backslab is applied for 2 weeks, after which the patient commences range of motion. Patients and Methods Consecutive patients undergoing arthroscopic lunate excision at a single center in Paris, France, underwent pre- and postoperative assessment. Parameters assessed include range of motion, as well as patient-reported outcome measures (PROMs). Results A cohort of 13 patients (7 females and 6 males with a mean age of 27.2 years) underwent arthroscopic lunate excision, and were followed up for a mean of 1.96 years. Significant improvements were noted in flexion, extension, pronation, grip strength, and PROMs. Conclusions Arthroscopic lunectomy provides significant improvements in clinical and PROMs at short- to medium-term follow-up, and conserves other salvage options in case of failure. Long-term clinical follow-up and further biomechanical studies would be beneficial.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"77 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135982617","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 Surgical management of the painful, arthritic distal radioulnar joint (DRUJ) remains challenging, particularly in young, active patients. Description of Technique Following exposure of the DRUJ through a dorsal longitudinal incision over the DRUJ, suture anchors are evenly placed around the sigmoid notch. The sutures are threaded through the dermal allograft to secure the graft into the sigmoid notch. The volar edges of the allograft are passed from radial to ulnar underneath the distal ulna and secured to the remaining allograft dorsally, reducing the DRUJ and creating a stable interposition arthroplasty. Patients, Methods, and Results We present a case report of a young, manual laborer who had significant improvement in pain, range of motion, and grip strength 6 months following interposition arthroplasty at the DRUJ. He was able to return to work after completing his rehabilitation following surgery. Conclusions Dermal allograft interposition arthroplasty may provide reliable pain relief while maintaining pronosupination and stability of the DRUJ in the appropriately selected patient, without the need for lifting restrictions.
{"title":"Distal Radioulnar Joint Interposition Arthroplasty for Primary Distal Radioulnar Joint Arthritis","authors":"Courtney R. Carlson Strother, Sanjeev Kakar","doi":"10.1055/s-0043-1774330","DOIUrl":"https://doi.org/10.1055/s-0043-1774330","url":null,"abstract":"Abstract Background Surgical management of the painful, arthritic distal radioulnar joint (DRUJ) remains challenging, particularly in young, active patients. Description of Technique Following exposure of the DRUJ through a dorsal longitudinal incision over the DRUJ, suture anchors are evenly placed around the sigmoid notch. The sutures are threaded through the dermal allograft to secure the graft into the sigmoid notch. The volar edges of the allograft are passed from radial to ulnar underneath the distal ulna and secured to the remaining allograft dorsally, reducing the DRUJ and creating a stable interposition arthroplasty. Patients, Methods, and Results We present a case report of a young, manual laborer who had significant improvement in pain, range of motion, and grip strength 6 months following interposition arthroplasty at the DRUJ. He was able to return to work after completing his rehabilitation following surgery. Conclusions Dermal allograft interposition arthroplasty may provide reliable pain relief while maintaining pronosupination and stability of the DRUJ in the appropriately selected patient, without the need for lifting restrictions.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135981833","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. Heifner, Thomas Karadimas, Paul M. DeVito, Osmanny Gomez, G. Kolovich
Abstract Purpose Although indications for four-corner arthrodesis (4CA) and proximal row carpectomy (PRC) are not completely aligned, the surgeon is often tasked with deciding between these options which vary in the surgical technique and complication profile. Patient age is often discussed as a determining factor for treatment; however, outcome data for these procedures are rarely stratified by patient age. Our objective was to perform a systematic review on the age-specific outcomes for 4CA and PRC. Methods A PubMed database search for 4CA and PRC was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The inclusion criteria required individual case reporting of patient age, surgical intervention, and appropriate outcome measures. The data were stratified by procedure and by patients older and younger than 45 years. Results Within the 4CA group, the relative risk for a disabilities of the arm, shoulder, and hand (DASH) score above 30 was 1.94 (95% confidence interval, 1.1–3.67) in patients over 45 years compared with patients under 45 years. Within the PRC group, grip strength as a percentage of the contralateral side was higher in the over 45 age group (mean 75%) compared to the under 45 age group (mean 61%) but did not reach the level of significance. Conclusion Despite satisfactory results for 4CA in aggregate, the distribution of scores indicates the need for setting expectations when treating younger adult patients with 4CA. The current results demonstrate increased disability based on DASH score following 4CA in patients under 45 years compared with patients over 45 years. Although outcomes were comparable between younger and older adults following PRC, recovery of grip strength may occur less frequently in younger adults. Level of evidence IV systematic review.
{"title":"Age Considerations in Four-Corner Arthrodesis and Proximal Row Carpectomy: A Review","authors":"J. Heifner, Thomas Karadimas, Paul M. DeVito, Osmanny Gomez, G. Kolovich","doi":"10.1055/s-0043-1777672","DOIUrl":"https://doi.org/10.1055/s-0043-1777672","url":null,"abstract":"Abstract Purpose Although indications for four-corner arthrodesis (4CA) and proximal row carpectomy (PRC) are not completely aligned, the surgeon is often tasked with deciding between these options which vary in the surgical technique and complication profile. Patient age is often discussed as a determining factor for treatment; however, outcome data for these procedures are rarely stratified by patient age. Our objective was to perform a systematic review on the age-specific outcomes for 4CA and PRC. Methods A PubMed database search for 4CA and PRC was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The inclusion criteria required individual case reporting of patient age, surgical intervention, and appropriate outcome measures. The data were stratified by procedure and by patients older and younger than 45 years. Results Within the 4CA group, the relative risk for a disabilities of the arm, shoulder, and hand (DASH) score above 30 was 1.94 (95% confidence interval, 1.1–3.67) in patients over 45 years compared with patients under 45 years. Within the PRC group, grip strength as a percentage of the contralateral side was higher in the over 45 age group (mean 75%) compared to the under 45 age group (mean 61%) but did not reach the level of significance. Conclusion Despite satisfactory results for 4CA in aggregate, the distribution of scores indicates the need for setting expectations when treating younger adult patients with 4CA. The current results demonstrate increased disability based on DASH score following 4CA in patients under 45 years compared with patients over 45 years. Although outcomes were comparable between younger and older adults following PRC, recovery of grip strength may occur less frequently in younger adults. Level of evidence IV systematic review.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"17 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139341364","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}
Jason H. Kim, John F. Hoy, Samuel L. Shuman, Farhan Ahmad, Xavier C. Simcock
Abstract Purpose This study seeks to evaluate the quality and reliability of information regarding de Quervain's tenosynovitis on YouTube. Methods A search on the YouTube was performed using the keywords de Quervain's tenosynovitis , and the first 50 videos were evaluated. Video characteristics including views, content type, and video upload source were recorded. Video reliability was assessed using the Journal of the American Medical Association ( JAMA ) benchmark criteria. Video quality was assessed using the Global Quality Score (GQS) and a novel de Quervain's Tenosynovitis-Specific Score (DQT-SS). Results The total number of views for all videos evaluated was 5,508,498 (mean, 110,169.96 ± 155,667.07). Video reliability and quality metrics were low, with a mean JAMA score of 2.17 ± 0.82 out of 4, a mean GQS of 2.49 ± 1.28 out of 5, and a mean DQT-SS of 4.53 ± 2.35 out of 11. Significant between-group effects were found for the video source and DQT-SS ( p = 0.027), as well as between content type and JAMA score ( p = 0.027), GQS ( p = 0.003), and DQT-SS ( p = 0.003). Positive independent predictors of DQT-SS included video duration in seconds (β = 0.391) and disease-specific information content type (β = 0.648). Conclusion Videos on YouTube regarding de Quervain's tenosynovitis were frequently viewed; however, the information present was of low quality and reliability. Physician-uploaded videos had the highest mean JAMA scores, GQS, and DQT-SS, but had the second-lowest mean number of views of video sources. Patients should receive proper in-office education and be directed toward reputable resources for their orthopaedic conditions.
{"title":"Quality and Reliability Analysis of YouTube as a Source of Patient Information on de Quervain's Tenosynovitis","authors":"Jason H. Kim, John F. Hoy, Samuel L. Shuman, Farhan Ahmad, Xavier C. Simcock","doi":"10.1055/s-0043-1777017","DOIUrl":"https://doi.org/10.1055/s-0043-1777017","url":null,"abstract":"Abstract Purpose This study seeks to evaluate the quality and reliability of information regarding de Quervain's tenosynovitis on YouTube. Methods A search on the YouTube was performed using the keywords de Quervain's tenosynovitis , and the first 50 videos were evaluated. Video characteristics including views, content type, and video upload source were recorded. Video reliability was assessed using the Journal of the American Medical Association ( JAMA ) benchmark criteria. Video quality was assessed using the Global Quality Score (GQS) and a novel de Quervain's Tenosynovitis-Specific Score (DQT-SS). Results The total number of views for all videos evaluated was 5,508,498 (mean, 110,169.96 ± 155,667.07). Video reliability and quality metrics were low, with a mean JAMA score of 2.17 ± 0.82 out of 4, a mean GQS of 2.49 ± 1.28 out of 5, and a mean DQT-SS of 4.53 ± 2.35 out of 11. Significant between-group effects were found for the video source and DQT-SS ( p = 0.027), as well as between content type and JAMA score ( p = 0.027), GQS ( p = 0.003), and DQT-SS ( p = 0.003). Positive independent predictors of DQT-SS included video duration in seconds (β = 0.391) and disease-specific information content type (β = 0.648). Conclusion Videos on YouTube regarding de Quervain's tenosynovitis were frequently viewed; however, the information present was of low quality and reliability. Physician-uploaded videos had the highest mean JAMA scores, GQS, and DQT-SS, but had the second-lowest mean number of views of video sources. Patients should receive proper in-office education and be directed toward reputable resources for their orthopaedic conditions.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"70 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139342005","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}
Sophie Brackertz, O. Andronic, L. Reissner, Torsten Pastor, Andreas Schweizer, Ladislav Nagy
Abstract The purpose of this study was to identify risk factors for postoperative carpal tunnel syndrome (CTS) in operative management for scaphoid nonunion and secondary fracture dislocation, treated surgically with takedown and bone grafting. We reviewed medical records of all our patients that underwent carpal tunnel release after scaphoid reconstruction surgery from August 2002 to December 2020. We identified a total of 7 out of 191 patients (3.7%). We investigated surgical parameters, pre- to postoperative changes, in three-dimensional measurements of the scaphoid and carpal tunnel morphometry. We found the preoperative intrascaphoid angle (ISA) and the postoperative change in ISA to correlate with an increased risk of postoperative CTS. Patients undergoing operative scaphoid reconstruction that require a high degree of geometric correction can be at risk to develop postoperative CTS, hence they should be subject to a lower threshold decision for prophylactic carpal tunnel release. Level of Evidence Level III.
{"title":"Carpal Tunnel Syndrome as a Complication of Surgical Scaphoid Reconstruction in Nonunion and Secondary Fracture Dislocation","authors":"Sophie Brackertz, O. Andronic, L. Reissner, Torsten Pastor, Andreas Schweizer, Ladislav Nagy","doi":"10.1055/s-0043-1777406","DOIUrl":"https://doi.org/10.1055/s-0043-1777406","url":null,"abstract":"Abstract The purpose of this study was to identify risk factors for postoperative carpal tunnel syndrome (CTS) in operative management for scaphoid nonunion and secondary fracture dislocation, treated surgically with takedown and bone grafting. We reviewed medical records of all our patients that underwent carpal tunnel release after scaphoid reconstruction surgery from August 2002 to December 2020. We identified a total of 7 out of 191 patients (3.7%). We investigated surgical parameters, pre- to postoperative changes, in three-dimensional measurements of the scaphoid and carpal tunnel morphometry. We found the preoperative intrascaphoid angle (ISA) and the postoperative change in ISA to correlate with an increased risk of postoperative CTS. Patients undergoing operative scaphoid reconstruction that require a high degree of geometric correction can be at risk to develop postoperative CTS, hence they should be subject to a lower threshold decision for prophylactic carpal tunnel release. Level of Evidence Level III.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"81 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139348406","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}
David Ananth Samy, Harriet S. Julian, Eindere Zaw Pe, Daniel Brown
Abstract Dislocations of the distal radioulnar joint associated with a fracture of the distal ulna articular surface without an associated radial fracture are extremely rare. We present a case of a fracture of the distal ulna with an associated dislocation of the distal radioulnar joint, where the articular head fragment was displaced anterior to the sigmoid notch. We also present the results of a formal systematic review of these injuries which confirmed this is the first such injury described, although there is a very similar fracture pattern described in the literature with dorsal dislocation. We describe the mechanism of injury and hypothesize about the etiology of the fracture pattern and suggest that it represents the end of a spectrum that also includes the isolated dislocations and those associated with an ulna styloid fracture.
{"title":"Ulnar Head Fracture with Volar Dislocation of the Distal Radioulnar Joint: A Case Series and Systematic Review","authors":"David Ananth Samy, Harriet S. Julian, Eindere Zaw Pe, Daniel Brown","doi":"10.1055/s-0043-1777019","DOIUrl":"https://doi.org/10.1055/s-0043-1777019","url":null,"abstract":"Abstract Dislocations of the distal radioulnar joint associated with a fracture of the distal ulna articular surface without an associated radial fracture are extremely rare. We present a case of a fracture of the distal ulna with an associated dislocation of the distal radioulnar joint, where the articular head fragment was displaced anterior to the sigmoid notch. We also present the results of a formal systematic review of these injuries which confirmed this is the first such injury described, although there is a very similar fracture pattern described in the literature with dorsal dislocation. We describe the mechanism of injury and hypothesize about the etiology of the fracture pattern and suggest that it represents the end of a spectrum that also includes the isolated dislocations and those associated with an ulna styloid fracture.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"45 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139348780","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 Hemiresection interposition arthroplasty (HIA), which can preserve triangular fibrocartilage complex (TFCC) and distal radioulnar joint (DRUJ) function, is one of the surgical options for DRUJ osteoarthritis. Description of Technique An arcuate vertical incision of approximately 8 cm was made, and the flap, including both the extensor retinaculum and dorsal DRUJ capsule, was wrapped around the resected ulnar head. In cases where the TFCC was torn, repair or reconstruction was also performed. Patients and Methods Twenty-one wrists in 20 patients with DRUJ osteoarthritis were treated. Patients with rheumatoid arthritis were excluded. Preoperative ulnar variance value averaged 1.8 mm. The average length of follow-up period was 2 years and 10 months. Functional outcomes were evaluated by visual analog scale (VAS) for wrist pain, Disabilities of the Arm, Shoulder, and Hand, Patient-Rated Wrist Evaluation (PRWE), range of wrist and forearm motion (palmar-dorsal flexion and pronation-supination), and grip strength (% of the contralateral value). X-ray parameters (width of the ulnar head, DRUJ distance) were assessed. Results The postoperative grip strength and range of wrist and forearm motion improved significantly, and VAS for pain and PRWE improved larger than minimum clinical important difference. The DRUJ gap distance was maintained sufficiently in average value of 5.3 mm at the final follow-up. Conclusion The current modified HIA procedure combined with TFCC repair or reconstruction provides feasible short-term functional outcomes for treatment of patients with DRUJ osteoarthritis regardless of preoperative ulnar variance.
{"title":"Hemiresection Capsuloretinacular Interposition Arthroplasty for Distal Radioulnar Joint Osteoarthritis.","authors":"Hideo Hasegawa, Shohei Omokawa, Kenji Kawamura, Yasuhito Tanaka","doi":"10.1055/s-0043-1771341","DOIUrl":"10.1055/s-0043-1771341","url":null,"abstract":"<p><p><b>Background</b> Hemiresection interposition arthroplasty (HIA), which can preserve triangular fibrocartilage complex (TFCC) and distal radioulnar joint (DRUJ) function, is one of the surgical options for DRUJ osteoarthritis. <b>Description of Technique</b> An arcuate vertical incision of approximately 8 cm was made, and the flap, including both the extensor retinaculum and dorsal DRUJ capsule, was wrapped around the resected ulnar head. In cases where the TFCC was torn, repair or reconstruction was also performed. <b>Patients and Methods</b> Twenty-one wrists in 20 patients with DRUJ osteoarthritis were treated. Patients with rheumatoid arthritis were excluded. Preoperative ulnar variance value averaged 1.8 mm. The average length of follow-up period was 2 years and 10 months. Functional outcomes were evaluated by visual analog scale (VAS) for wrist pain, Disabilities of the Arm, Shoulder, and Hand, Patient-Rated Wrist Evaluation (PRWE), range of wrist and forearm motion (palmar-dorsal flexion and pronation-supination), and grip strength (% of the contralateral value). X-ray parameters (width of the ulnar head, DRUJ distance) were assessed. <b>Results</b> The postoperative grip strength and range of wrist and forearm motion improved significantly, and VAS for pain and PRWE improved larger than minimum clinical important difference. The DRUJ gap distance was maintained sufficiently in average value of 5.3 mm at the final follow-up. <b>Conclusion</b> The current modified HIA procedure combined with TFCC repair or reconstruction provides feasible short-term functional outcomes for treatment of patients with DRUJ osteoarthritis regardless of preoperative ulnar variance.</p>","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":" ","pages":"528-533"},"PeriodicalIF":0.7,"publicationDate":"2023-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11606672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42017021","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 : 2023-08-17eCollection Date: 2023-10-01DOI: 10.1055/s-0043-1770790
Sathya Vamsi Krishna, Greg Bain
Background Isolated distal ulna fractures are rare injuries and are commonly associated with distal radius fractures. Though most of them can be managed conservatively, few of them require open reduction due to the interposition of various structures. Case Description In this case report, we report two cases of irreducible isolated distal ulna fractures in adolescents due to the interposition of the extensor retinaculum with its underlying tendons requiring open reduction to achieve bony union and distal radioulnar joint stability. These distal ulna fractures can be best reduced by open reduction with hypersupination and maintaining the distal ulna shaft gothic arch with pins. Literature Review There are very few case reports reported on isolated distal ulna fractures commonly seen in paediatric and adolescent patients leading to growth arrest. The interposition of various structures is a cause of irreducibility requiring open reduction. These fractures are equivalent to TFCC injuries in adults. Clinical Relevance Whenever there is a gross displacement or difficult reduction interposition is to be considered. Open reduction of the fracture and maintenance of DRUJ congruity is sufficient without being critical on articular reduction.
{"title":"Adolescent Distal Ulna Physeal Fracture with Extensor Retinaculum Interposition.","authors":"Sathya Vamsi Krishna, Greg Bain","doi":"10.1055/s-0043-1770790","DOIUrl":"10.1055/s-0043-1770790","url":null,"abstract":"<p><p><b>Background</b> Isolated distal ulna fractures are rare injuries and are commonly associated with distal radius fractures. Though most of them can be managed conservatively, few of them require open reduction due to the interposition of various structures. <b>Case Description</b> In this case report, we report two cases of irreducible isolated distal ulna fractures in adolescents due to the interposition of the extensor retinaculum with its underlying tendons requiring open reduction to achieve bony union and distal radioulnar joint stability. These distal ulna fractures can be best reduced by open reduction with hypersupination and maintaining the distal ulna shaft gothic arch with pins. <b>Literature Review</b> There are very few case reports reported on isolated distal ulna fractures commonly seen in paediatric and adolescent patients leading to growth arrest. The interposition of various structures is a cause of irreducibility requiring open reduction. These fractures are equivalent to TFCC injuries in adults. <b>Clinical Relevance</b> Whenever there is a gross displacement or difficult reduction interposition is to be considered. Open reduction of the fracture and maintenance of DRUJ congruity is sufficient without being critical on articular reduction.</p>","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"12 5","pages":"446-452"},"PeriodicalIF":0.7,"publicationDate":"2023-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10569828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41239712","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}
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