Internal Brace for Carpal Instability

Patients presenting with distal end radius fractures may have concomitant carpal instability due to disruption of the scapholunate ligament. This study examined the incidence of static radiographic signs of carpal instability in patients with distal radial fractures before and after fracture treatment. We performed a retrospective radiographic study of 141 patients presenting to Central Middlesex Hospital, London between January 2002–May 2004 with distal end radius fractures. We used abnormal scapholunate angle as the primary indicator of possible carpal dissociation. Abnormal scapholunate angles were noted in 39% of patients at presentation and 35% of patients after treatment with no statistically significant intra-patient variability. Persistent static radiographic signs of carpal instability are high in this subset of patients. The long-term morbidity of persistent wrist instability may be avoided by early radiological diagnosis with clinical correlation to identify carpal ligament injuries and initiate treatment that addresses both the bony and ligamentous components of the injury.

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Correction of Dorsi-Flexed Intercalated Segment Instability after Restoration of Scaphoid Height in a Cadaver Model of Scaphoid Non-Union

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(05)80117-2 ◽

1995 ◽

Vol 20 (5) ◽

pp. 596-602 ◽

Cited By ~ 9

Author(s):

M. YASUDA ◽

M. KUSUNOKI ◽

K. KAZUKI ◽

Y. YAMANO

Keyword(s):

Mechanical Loading ◽

Bone Defect ◽

Carpal Instability ◽

Rigid Fixation ◽

Anatomical Reduction ◽

Non Union ◽

Herbert Screw ◽

Palmar Approach ◽

Wrist Joints

Models of scaphoid non-union with static dorsi-flexed intercalated segment instability were produced in five frozen arms from cadavers or subjects following accidents by repetitive mechanical loading of the wrist joints longitudinally after a bone defect has been made at the mid-portion of the scaphoid. We designed four models of reduction: anatomical reduction; reduction with a shortened scaphoid; anatomical reduction but with the radio-lunate ligament sectioned, and a shortened scaphoid with the radio-lunate ligament sectioned. Results suggested that anatomical reduction with rigid fixation with a Herbert screw was most effective for correction of malalignment with DISI. Preservation of the radio-lunate ligament during the palmar approach to the scaphoid seemed to be important to prevent ligamentous carpal instability.

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Carpal instability

Current Opinion in Orthopedics ◽

10.1097/00001433-199708000-00006 ◽

1997 ◽

Vol 8 (4) ◽

pp. 44-52

Author(s):

Kenneth J. Mroczek ◽

Enrique H. Monsanto

Keyword(s):

Carpal Instability

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Posterior Cruciate Ligament Reconstruction With Internal Brace Augmentation Reduces Posterior Tibial Translation Under Cyclic Loading

Orthopedics ◽

10.3928/01477447-20210621-03 ◽

2021 ◽

Vol 44 (4) ◽

pp. 235-240

Author(s):

Nicholas A. Trasolini ◽

George F. Hatch ◽

David Wright ◽

Bruce A. Levy ◽

Michael J. Stuart ◽

...

Keyword(s):

Cyclic Loading ◽

Posterior Cruciate Ligament ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Posterior Cruciate Ligament Reconstruction ◽

Cruciate Ligament Reconstruction ◽

Posterior Tibial Translation ◽

Posterior Tibial ◽

Internal Brace ◽

Tibial Translation

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Carpal Instability: Anatomy, Kinematics, Imaging, and Classification

RadioGraphics ◽

10.1148/rg.2021210044.pres ◽

2021 ◽

Keyword(s):

Carpal Instability

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Biomechanical Evaluation of Anterolateral Ligament Repair augmented with Internal Brace

The Journal of Knee Surgery ◽

10.1055/s-0041-1726420 ◽

2021 ◽

Author(s):

Ryan P. Roach ◽

David P. Beason ◽

Jonathan S. Slowik ◽

A. Ryves Moore ◽

Ajay C. Lall ◽

...

Keyword(s):

Internal Rotation ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Surgical Techniques ◽

Anterolateral Ligament ◽

Torsional Stiffness ◽

Rotational Stability ◽

Gap Formation ◽

Internal Brace ◽

Acl Deficient

AbstractInjuries to the anterolateral ligament (ALL) of the knee are commonly associated with anterior cruciate ligament (ACL) ruptures. Biomechanical studies have demonstrated conflicting results with regard to the role of the ALL in limiting tibial internal rotation. Clinically, residual pivot shift following ACL reconstruction has been reported to occur up to 25% and has been correlated with poor outcomes. As such, surgical techniques have been developed to enhance rotational stability. Recent biomechanical studies have demonstrated restoration of internal rotational control following ALL reconstruction. The purpose of our study was to understand the biomechanical effects of ACL reconstruction with an ALL internal brace augmentation. We hypothesized that (1) sectioning of the ALL while preserving other lateral extra-articular structures would lead to significant internal rotation laxity and gap formation and (2) ALL repair with internal brace augmentation would lead to reduction in internal rotation instability and gap formation. In total, 10 fresh-frozen cadaveric knees were thawed and biomechanically tested in internal rotation for 10 cycles of normal physiologic torque in the intact, ACL-deficient, ACL/ALL-deficient, ACL-reconstructed, and ALL-repaired conditions. Each condition was tested at 30, 60, and 90 degrees of flexion. Following the final ALL-repaired condition, specimens were additionally subjected to a final internal rotation to failure at 1 degree at the last-tested degree of flexion. Kinematic measurements of angle and linear gap between the femur and tibia were calculated in addition to torsional stiffness and failure torque. As hypothesized, ALL repair with internal brace augmentation significantly reduced internal rotation angular motion and gap formation at flexion angles greater than 30 degrees. Additionally, ALL sectioning produced nonsignificant increases in internal rotation laxity and gap formation compared with ACL-deficient and ACL-reconstructed states, which did not support our other hypothesis.

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