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Wrist arthrodesis

Jason Silvestre, Joseph Upton, Benjamin Chang, David R Steinberg
BACKGROUND: Hand surgery fellowship programs in the United States are predominately sponsored by departments or divisions of orthopaedic surgery or plastic surgery. This study compares the operative experiences of hand surgery fellows graduating from orthopaedic or plastic surgery hand surgery fellowships. METHODS: Operative case logs of 3 cohorts of hand surgery fellows graduating during the academic years of 2012-2013, 2013-2014, and 2014-2015 were analyzed. The median case volumes were compared by specialty via Mann-Whitney U tests...
March 7, 2018: Journal of Bone and Joint Surgery. American Volume
Cory K Mayfield, Daniel J Gould, Marie Dusch, Amir Mostofi
BACKGROUND: Current treatment options for persistent scaphoid nonunion are limited to salvage procedures such as proximal row carpectomy (PRC) or 4-corner fusion (4CF). Several small studies have demonstrated that distal scaphoid excision may provide a simpler alternative with faster recovery. The purpose of this study was to determine the efficacy of distal scaphoid excision as a treatment option for symptomatic scaphoid nonunion. METHODS: The MEDLINE and PubMed databases were searched for the use of distal scaphoid excision in scaphoid nonunions...
February 1, 2018: Hand: Official Journal of the American Association for Hand Surgery
Rebecca Woehl, Johannes Maier, Sebastian Gehmert, Christoph Palm, Birgit Riebschlaeger, Michael Nerlich, Michaela Huber
BACKROUND: Scaphoidectomy and midcarpal fusion can be performed using traditional fixation methods like K-wires, staples, screws or different dorsal (non)locking arthrodesis systems. The aim of this study is to test the Aptus four corner locking plate and to compare the clinical findings to the data revealed by CT scans and semi-automated segmentation. METHODS: This is a retrospective review of eleven patients suffering from scapholunate advanced collapse (SLAC) or scaphoid non-union advanced collapse (SNAC) wrist, who received a four corner fusion between August 2011 and July 2014...
February 13, 2018: BMC Musculoskeletal Disorders
M P Gaspar, P P Pham, C D Pankiw, S M Jacoby, E K Shin, A L Osterman, P M Kane
AIMS: The aims of this study were to compare the mid-term outcomes of patients with late-stage arthritis of the wrist treated with proximal row carpectomy (PRC) and dorsal capsular interposition (DCI) arthroplasty with a matched cohort treated with routine PRC alone. PATIENTS AND METHODS: A total of 25 arthritic wrists (24 patients) with pre-existing degenerative changes of the proximal capitate and/or the lunate fossa of the radius were treated with PRC + DCI over a ten-year period...
February 2018: Bone & Joint Journal
Timothy J Luchetti, Robert W Wysocki, Mark S Cohen
BACKGROUND: En bloc resection of the distal radius is a common treatment for advanced and recurrent giant cell tumors and less commonly for sarcoma. Various reconstructive options exist, including ulnar transposition, osteoarticular autograft and allograft, and allograft arthrodesis. We present a technique of reconstruction using a distal radius bulk allograft with a step-cut to allow for precise restoration of proper length and to promote bony union. METHODS: Preoperative templating is performed with affected and contralateral radiographs to assess the size of the expected bony defect, location of the step-cut, and the optimal size of the distal radius allograft required...
January 1, 2018: Hand: Official Journal of the American Association for Hand Surgery
John Barton Williams, Hadley Weiner, Andrew R Tyser
Background  Proximal row carpectomy (PRC) and four-corner arthrodesis (FCA) are common surgical procedures used to treat degenerative wrist conditions; however, complications and failures can occur. Purpose  This study aimed to investigate and compare the long-term rate of secondary surgeries including conversion to total wrist arthrodesis in patients who underwent PRC or FCA. Materials and Methods  A retrospective chart review of all patients who underwent PRC or FCA in the past 20 years at a tertiary referral institution and associated Veterans Affairs (VA) hospital was performed...
February 2018: Journal of Wrist Surgery
Philippe Bellemère, Marion Aribert, Hussein Choughri, Marc Leroy, Etienne Gaisne
Purpose  Pisiformectomy is the baseline treatment for pisotriquetral arthritis when medical treatment fails to address the problem. This operation may lead to loss of mobility and strength in the wrist. This study reports the short-term outcomes of a new technique for treating pisotriquetral arthritis using a pisotriquetral interposition arthroplasty with a pyrocarbon implant. Patients and Methods  We performed a clinical and radiographic study on a series of eight patients who received this treatment at a mean follow-up of 2...
February 2018: Journal of Wrist Surgery
Ricardo Monreal
PURPOSE: The one-bone forearm arthrodesis has been performed to change the position of the forearm in children with fixed supination deformity due to upper extremity neurologic deficit. In this article, we present a retrospective review of children with late obstetric brachial plexus palsy who underwent palliative surgery to correct severe supination contracture by one-bone forearm osteodesis and biceps re-routing. This technique has not been described previously. MATERIALS AND METHODS: In this retrospective study, four consecutive patients with upper extremity weakness and severe supination contracture who underwent forearm osteodesis in neutral or slight pronation and biceps re-routing...
January 12, 2018: International Orthopaedics
Lisa Reissner, Stefanie Hensler, Sebastian Kluge, Miriam Marks, Daniel B Herren
PURPOSE: The objective was to investigate the clinical and subjective outcomes of patients after 4-corner arthrodesis (FCA) for scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC) and to analyze complications. Furthermore, we compared the long-term results of a first-generation nonlocking plate (Spider) and a plate with a locking screw design (Flower plate). METHODS: In a retrospective cohort study, we included 39 patients with stage II or III SLAC or SNAC who underwent FCA...
December 14, 2017: Journal of Hand Surgery
Herbert P von Schroeder
PURPOSE: Midcarpal instability (MCI) is a cause of chronic wrist pain for which treatment remains controversial. This study's purpose was to determine the outcome of a treatment algorithm for MCI that included immobilization and surgical interventions. METHODS: We prospectively enrolled 23 consecutive patients (12 males, average age 27 years) with 27 symptomatic wrists. All had generalized wrist pain with an average duration of 22 months. All had MCI and a catch-up clunk that reproduced the symptoms...
December 11, 2017: Journal of Hand Surgery
Per Fischer, Marcus Sagerfors, Ole Brus, Kurt Pettersson
PURPOSE: Management of failed total wrist arthroplasty (TWA) can be challenging; surgical treatment options include salvage arthrodesis, revision arthroplasty, and resection arthroplasty. There are few studies regarding salvage arthrodesis, and revision arthroplasty has been infrequently investigated. The aim of the study was to report the outcome after revision arthroplasty of the wrist. METHODS: A retrospective cohort of 16 revision TWAs was evaluated between 2003 and 2016...
December 7, 2017: Journal of Hand Surgery
Bertrand Coulet, Thomas Waitzenegger, Jacques Teissier, Cyril Lazerges, Michel Chammas, Charles Fattal, Adeline Cambon-Binder
PURPOSE: Constructing a lateral key pinch (KP) is a universal aim of any functional upper limb surgery program for tetraplegia. Three stages are required: (1) activating the pinch mechanism by flexor pollicis longus tenodesis to the radius or by tendon transfer to the flexor pollicis longus, (2) simplifying the polyarticular chain, and (3) positioning the thumb column. We compared 2 techniques for accomplishing the latter stage, 1 utilizing arthrodesis of the carpometacarpal joint (CMC) and 1 that did not require arthrodesis of the CMC...
November 29, 2017: Journal of Hand Surgery
Sarah A Shiga, Frederick W Werner, Marc Garcia-Elias, Brian J Harley
PURPOSE: To create a biomechanical model of palmar midcarpal instability by selective ligament sectioning and to analyze treatment by simulated partial wrist arthrodesis. METHODS: Nine fresh-frozen cadaver arms were moved through 3 servohydraulic actuated motions and 2 passive wrist mobilizations. The dorsal radiocarpal, triquetrohamate, scaphocapitate, and scaphotrapeziotrapezoid ligaments were sectioned to replicate palmar midcarpal instability. Kinematic data for the scaphoid, lunate, and triquetrum were recorded before and after ligament sectioning and again after simulated triquetrohamate arthrodesis (TqHA) and radiolunate arthrodesis (RLA)...
November 14, 2017: Journal of Hand Surgery
Amaury Charre, Stephanie Delclaux, Costel Apredoai, Jean-Emmanuel Ayel, Michel Rongieres, Pierre Mansat
Scaphocapitate arthrodesis with lunate excision was performed for treatment of advanced Kienböck disease in 17 patients (18 wrists). Ten were women and seven men. Five were Lichtmann Stage IIIA, 12 Stage IIIB, and one Stage IV. Minimum follow-up period was 24 months; mean follow-up was 10.7 years (range 2.3 to 22 years, SD 7.1). At the latest follow-up, six patients were very satisfied, nine were satisfied and two were disappointed. Pain was significantly decreased in all cases. Wrist mobility was unchanged...
January 1, 2017: Journal of Hand Surgery, European Volume
Loris Pegoli, Alessandro Pozzi
Scaphoid-trapezium-trapezoid (STT) joint arthritis is a common condition consisting of pain on the radial side of the wrist and base of the thumb, swelling, and tenderness over the STT joint. Common symptoms are loss of grip strength and thumb function. There are several treatments, from symptomatic conservative treatment to surgical solutions, such as arthrodesis, arthroplasties, and prosthesis implant. The role of arthroscopy has grown and is probably the best treatment of this condition. Advantages of arthroscopic management of STT arthritis are faster recovery, better view of the joint during surgery, and possibility of creating less damage to the capsular and ligamentous structures...
November 2017: Hand Clinics
Eva-Maria Baur
Partial wrist arthrodesis (PWA) is a well-known procedure for treating degenerative or posttraumatic wrist conditions. Four-corner fusion (4CF) is mostly used for scapholunate advanced collapse and scaphoid nonunion advanced collapse. The author performed 39 procedures, including 4CFs, 2-corner fusions, 3-corner fusions, scaphoid-capitate/scaphoid-capitate-lunate fusions, scaphoid-trapezium-trapezoid arthrodeses, and radioscapholunate arthroscopic PWAs (A-PWAs). There were 8 revision cases including 4 partial nonunions...
November 2017: Hand Clinics
Simon B M MacLean, Karim Kantar, Gregory I Bain, David M Lichtman
Kienbock disease (KD) is a disease of uncertain etiology, leading to chondral and osseous change in the lunate and wrist. Traditionally, Lichtman's classification of KD, based on radiographic appearances, has been used to direct treatment. Diagnostic wrist arthroscopy allows direct assessment of the lunate and surrounding articulations. Wrist arthroscopy can also serve as a therapeutic tool for performing debridement, resection, or arthrodesis procedures. The new Lichtman-Bain algorithm takes into consideration the status of the lunate, the effect on the wrist, and surgical and patient factors to guide management...
November 2017: Hand Clinics
Francisco Del Piñal, James Clune
Treatment of intra-articular malunion of the distal radius has evolved over the past 20 years, from open treatment to wet then dry arthroscopic techniques that provide excellent results with less morbidity than open approaches. Dry wrist arthroscopy provides a well-visualized surgical space in treating intra-articular malunion and results in less edema than wet techniques. The best results are attained in the first 3 months after injury. Alternative methods for avoiding total wrist arthrodesis in those who present later have been developed...
November 2017: Hand Clinics
Nastaran Sargazi, M Philpott, A Malik, M Waseem
Rheumatoid arthritis is a polyarthropathy affecting approximately 1% of the population worldwide. Wrist involvement is observed around 75% of patients, resulting in substantial disability and morbidity. A multidisciplinary approach to management of such patients is undertaken to prevent disease progression, many go on to develop debilitating disease requiring surgical intervention. Total wrist arthroplasty and arthrodesis are the main options available for those with end-stage disease, with arthroplasty preferred due to its ability to preserve a good degree of wrist function...
2017: Open Orthopaedics Journal
A De Silvestro, K Martini, A S Becker, T D L Kim-Nguyen, R Guggenberger, M Calcagni, T Frauenfelder
AIM: To prospectively investigate digital tomosynthesis (DTS) as an alternative to digital radiography (DR) for postoperative imaging of orthopaedic hardware after trauma or arthrodesis in the hand and wrist. MATERIALS AND METHODS: Thirty-six consecutive patients (12 female, median age 36 years, range 19-86 years) were included in this institutional review board approved clinical trial. Imaging was performed with DTS in dorso-palmar projection and DR was performed in dorso-palmar, lateral, and oblique views...
September 11, 2017: Clinical Radiology
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