Journal of Wrist Surgery最新文献

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.

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.

Background  Distal radius fractures (DRFs) are the most common fracture of the upper extremity. Given that steroids are one of the most commonly prescribed drugs and are usually prescribed for chronic conditions, steroid use represents a key factor to consider in how to optimize perioperative outcomes. Questions/Purposes  The purpose of this study was to investigate if there are differences in perioperative outcomes for patients undergoing DRF open reduction and internal fixation based on preoperative steroid use. Patients and Methods  Adult patients who underwent operative treatment for DRF from 2007 to 2018 were identified in a national database. Patients were divided into two cohorts as follows: (1) no steroid usage and (2) preoperative steroid usage. In this analysis, various postoperative complications, as well as extended length of stay and reoperation, were assessed. Bivariate analyses and multivariable logistical regression were performed. Results  Among a total of 16,505 patients undergoing operative treatment for DRF, 16,145 patients (97.8%) did not have steroid usage and 360 (2.2%) had steroid usage. Following adjustment, an increased risk of extended length of hospital stay greater than 3 days (odds ratio [OR] = 1.646; p  = 0.012) was seen in the steroid usage group compared with those who did not use steroids within 30 days of surgery. Conclusion  Preoperative steroid use is associated with increased length of stay over 3 days after DRF open reduction and internal fixation surgery but is not associated with any of the other complications that were assessed in this study. Level of Evidence  This is a Level III, retrospective study.

Background  Recalcitrant nonunion following total wrist arthrodesis is a rare but challenging problem. Most commonly, in the setting of failed fusion after multiple attempts of refixation and cancellous bone grafting, the underlying cause for the failure is invariably multifactorial and is often associated with a range of host issues in addition to poor local soft-tissue and bony vascularity. The vascularized medial femoral condyle corticoperiosteal (MFC-CP) flap has been shown to be a viable option in a variety of similar settings, which provides vascularity and rich osteogenic progenitor cells to a nonunion site, with relatively low morbidity. While its utility has been described for many other anatomical locations throughout the body, its use for the treatment of failed total wrist fusions has not been previously described in detail in the literature. Methods  In this article, we outline in detail the surgical technique for MFC-CP flap for the management of recalcitrant aseptic nonunions following failed total wrist arthrodesis. We discuss indications and contraindications, pearls and pitfalls, and potential complications of this technique. Results  Two illustrative cases are presented of patients with recalcitrant nonunions following multiple failed total wrist fusions. Conclusion  When all avenues have been exhausted, a free vascularized corticoperiosteal flap from the MFC is a sound alternative solution to achieve union, especially when biological healing has been compromised. We have been able to achieve good clinical outcomes and reliable fusion in this difficult patient population.

Several abnormal pathologies, such as inflammation or degenerative change, can be causes of ulnar-sided wrist pain. This study demonstrated bilateral accessory extensor carpi ulnaris found in a patient who presented with bilateral wrist pain. The patient was initially treated with all conventional methods but failed to improve. Following the operation by releasing the sixth extensor compartment, the pain was completely relieved. The Disabilities of the Arm, Shoulder, and Hand (DASH) score was remarkably improved and there was no limitation in daily living activities compared with preoperative status. We presented an uncommon condition of ulnar-sided wrist pain caused by bilateral accessory extensor carpi ulnaris which was successfully treated by releasing the extensor compartmental sheath without tendon resection.

Background  The volar lip of the distal radius is the key structure for wrist joint stability. Rigid fixation of the volar lunate facet (VLF) fragment is difficult because of its unique anatomy, and a high rate of postoperative displacement was demonstrated. Purposes  The aim of the study is to identify risk factors for VLF in distal radius fractures (DRFs) and to reconsider the important point for primary fixation. Patients and Methods  One hundred fifty-five patients who underwent open reduction and internal fixation for an DRF were included and classified into one of the following two groups: VLF(+)or VLF(-). Demographic data, including age, sex, body mass index (BMI), laterality, trauma mechanism, and AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification were recorded. Several parameters were investigated using wrist radiographs of the uninjured side and computed tomography scans of the injured side. Univariate and multivariate logistic regression analyses were performed to evaluate the risk factors for VLF. Results  There were 25 patients in the VLF(+) group and 130 patients in the VLF(-) group. The incidence of VLF was 16.1%. The VLF(+) group tended to have a higher BMI and higher energy trauma mechanism. The odds ratio for the sigmoid notch angle (SNA), volar tilt (VT), and lunate facet curvature radius (LFCR) were 0.84, 1.32, and 0.70, respectively, with multivariate analysis, which was significant. A smaller SNA, larger VT, and smaller LFCR are potential risk factors for VLF. Conclusion  Over-reduction of the VT at primary fixation should be avoided because it could place an excess burden on the VLF and cause subsequent postoperative fixation failure and volar carpal subluxation. Level of Evidence  IV.

Background  Synovial cysts (SCs) are the most frequent wrist tumors; the arthroscopic treatment presents good results when surgery is indicated for symptomatic or patients with cosmetic concerns. The tumoral lesion should be arthroscopically decompressed or drained toward the inside of the joint through pedicle opening and resection of a small portion of the capsule. Hence, the cyst pedicle must be found for the success of this technique. Description of Technique  Some tricks have already been described to facilitate SC location during arthroscopy. We describe an indirect technique that employs an 18-G needle to enhance SC pedicle location and drainage. The technique involves a puncture on the interval of the carpal extrinsic ligaments where the pedicle is suspected to be remain. When found, cyst is drained with a single-puncture motion of the need which promotes cyst content extravasation due to pressure toward the joint. Patients and Methods  This method has been employed in 16 patients, including 9 with dorsal cysts, and seven with volar cysts. Results  All patients presented complete recovery and symptom improvement in up to 30 days, with total disappearance of the cyst. There were no relapses or severe complications within the 12-month follow-up. Conclusion  This is a safe, useful technique that facilitates location of intra-articular cyst pedicle, thus avoiding unnecessary damage in healthy tissues with no increased costs.