scholarly journals Volar plating: functional recovery of the pronator quadratus

2021 ◽  
Author(s):  
Patrick Porter ◽  
Alasdair MacInnes ◽  
Tim Drew ◽  
Weijie Wang ◽  
Rami Abboud ◽  
...  
Keyword(s):  
Grip Strength ◽  
Functional Recovery ◽  
Elbow Flexion ◽  
Volar Plating ◽  
Level Of Evidence ◽  
Pronator Quadratus ◽  
Measuring Device ◽  
Significant Difference ◽  
Hand Dynamometer

Abstract Purpose The pronator quadratus (PQ) is reflected in the surgical approach to the distal radius. This study explores the functional strength of PQ, 12 months after volar plating without repair of PQ. Methods A total of 135 patients were identified from our prospectively collected database. All volunteers had grip strength and pronation power tested in the treated and contralateral forearms at 45, 90 and 135 degrees of elbow flexion using a custom-built torque measuring device and hydraulic hand dynamometer to evaluate forearm pronation. Results Twenty-seven participants were included in the study. No significant difference was identified in mean peak pronation torque between the volar plated and non-treated forearms. Pronation strength was identified as being independent of angle of elbow flexion. Grip strength was correlated with forearm pronation showing no significant difference between groups. Conclusions Our results suggest adequate long-term (15–32 months) functional recovery of the pronator quadratus after volar plating. Level of Evidence III.

scholarly journals Results of scaphocapitate arthrodesis with lunate excision in advanced Kienböck disease at 10.7-year mean follow-up

2017 ◽  
Vol 43 (4) ◽  
pp. 362-368 ◽  
Author(s):  
Amaury Charre ◽  
Stephanie Delclaux ◽  
Costel Apredoai ◽  
Jean-Emmanuel Ayel ◽  
Michel Rongieres ◽  
...  
Keyword(s):  
Grip Strength ◽  
Stage Iv ◽  
Functional Mobility ◽  
Stage Iiib ◽  
Advanced Stage ◽  
Stage Iiia ◽  
Level Of Evidence ◽  
Kienböck Disease

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. Grip strength was significantly increased. Consolidation of the arthrodesis was confirmed in 17 wrists. We encountered a scaphocapitate nonunion at 12 years follow-up and two cases of styloscaphoid arthritis at 17 and 22 years. Scaphocapitate arthrodesis with lunate excision performed in an advanced stage of Kienböck disease significantly alleviates pain, while preserving functional mobility and satisfactory grip strength in the long term. Level of evidence: IV

scholarly journals Reduction and Association of the Scaphoid and Lunate: A Functional and Radiographical Outcome Study

2018 ◽  
Vol 08 (01) ◽  
pp. 037-042
Author(s):  
William Aibinder ◽  
Ali Izadpanah ◽  
Bassem Elhassan
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
High Rate ◽  
Salvage Procedure ◽  
Level Of Evidence ◽  
Long Term Follow Up ◽  
The Mean ◽  
Ligament Disruption

Background Management of scapholunate (SL) ligament disruption is a challenging problem. The reduction and association of the scaphoid and lunate (RASL) procedure has been described with varying results. This study assessed the outcomes of the RASL procedure. Purpose The objective of this study was to assess the outcomes of patients undergoing the RASL procedure at our institution in regard to pain relief, range of motion, radiographic and functional outcomes, complications, and reoperations. Materials and Methods Twelve patients with symptomatic chronic SL instability underwent the RASL procedure. The mean age was 35 years. The mean time from injury to surgery was 40 weeks. The mean follow-up was 89 months. Outcomes included visual analog score for pain, wrist range of motion, grip strength, and Mayo Wrist Scores. Preoperative and postoperative radiographs were reviewed. Results Pain scores improved in 10 wrists. Range of motion and grip strength worsened. The average Mayo Wrist Score was 63.3. The mean SL diastasis and angle improved, but seven wrists developed progressive degenerative changes, with two requiring a salvage procedure. Symptomatic progressive screw lucency occurred in eight wrists requiring screw removal. Conclusion The RASL procedure can improve SL widening but has a high rate of early failure and reoperation. Following reoperation, long-term follow-up demonstrates reasonable long-term durability in some cases. Level of Evidence This is a Level IV, therapeutic case study.

scholarly journals Long-term and delayed functional recovery in patients with severe cerebrovascular and traumatic brain injury requiring tracheostomy

2019 ◽  
Vol 131 (1) ◽  
pp. 114-121 ◽  
Author(s):  
Rafael Wabl ◽  
Craig A. Williamson ◽  
Aditya S. Pandey ◽  
Venkatakrishna Rajajee
Keyword(s):  
Brain Injury ◽  
Functional Recovery ◽  
Tube Feeding ◽  
Severe Brain Injury ◽  
Eligibility Criteria ◽  
Severe Stroke ◽  
Icu Discharge ◽  
Significant Difference

OBJECTIVEData on long-term functional recovery (LFR) following severe brain injury are essential for counseling of surrogates and for appropriate timing of outcome assessment in clinical trials. Delayed functional recovery (DFR) beyond 3–6 months is well documented following severe traumatic brain injury (sTBI), but there are limited data on DFR following severe cerebrovascular brain injury. The objective of this study was to assess LFR and DFR in patients with sTBI and severe stroke dependent on tracheostomy and tube feeding at the time of discharge from the intensive care unit (ICU).METHODSThe authors identified patients entered into their tracheostomy database 2008–2013 with sTBI and severe stroke, encompassing SAH, intracerebral hemorrhage (ICH), and acute ischemic stroke (AIS). Eligibility criteria included disease-specific indicators of severity, Glasgow Coma Scale score < 9 at time of tracheostomy, and need for tracheostomy and tube feeding at ICU discharge. Assessment was at 1–3 months, 6–12 months, 12–24 months, and 24–36 months after initial injury for presence of tracheostomy, ability to walk, and ability to perform basic activities of daily living (B-ADLs). Long-term functional recovery (LFR) was defined as recovery of the ability to walk or perform B-ADLs by the 24- to 36-month follow-up. Delayed functional recovery (DFR) was defined as progression in functional milestones between any 2 time points beyond the 1- to 3-month follow-up.RESULTSA total of 129 patients met the eligibility criteria. Functional outcomes were available for 129 (100%), 97 (75%), 83 (64%), and 80 (62%) patients, respectively, from assessments at 1–3, 6–12, 12–24 and 24–36 months; 33 (26%) died by 24–36 months. Fifty-nine (46%) regained the ability to walk and 48 (37%) performed B-ADLs at some point during their recovery. Among survivors who had not achieved the respective milestone at 1–3 months, 29/58 (50%) were able to walk and 28/74 (38%) performed B-ADLs at 6–12 months. Among survivors who had not achieved the respective milestone at 6–12 months, 5/16 (31%) were able to walk and 13/30 (43%) performed B-ADLs at 12–24 months. There was no significant difference in rates of LFR or DFR between patients with sTBI and those with severe stroke.CONCLUSIONSAmong patients with severe brain injury requiring tracheostomy and tube feeding at ICU discharge, 46% regained the ability to walk and 37% performed B-ADLs 2–3 years after injury. DFR beyond 1–3 and 6–12 months was seen in over 30% of survivors, with no significant difference between sTBI and severe stroke.

scholarly journals Long-Term Outcomes of All-Arthroscopic Pre-Tied Suture Device Triangular Fibrocartilage Complex Repair

2019 ◽  
Vol 08 (05) ◽  
pp. 403-407 ◽  
Author(s):  
Eric J. Sarkissian ◽  
Matthew B. Burn ◽  
Jeffrey Yao
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Triangular Fibrocartilage Complex ◽  
Study Cohort ◽  
Inclusion Criteria ◽  
Level Of Evidence ◽  
Triangular Fibrocartilage ◽  
Suture Device

Background A pre-tied suture device has been utilized for all-arthroscopic peripheral triangular fibrocartilage complex (TFCC) repairs with promising early clinical results. Purpose The purpose of this study was to evaluate long-term functional outcomes of these repairs. Patients and Methods A retrospective review of patients undergoing arthroscopic TFCC repair was performed. Inclusion criteria were the Palmer type 1B TFCC tears diagnosed on arthroscopy and repaired using the all-arthroscopic pre-tied suture device. Patients with any evidence of concomitant wrist injury at the time of surgery, history of prior wrist surgery, or nonrepairable and nonperipheral TFCC tears were excluded. Postoperative complications, range of motion, grip strength, and outcome assessments were recorded for each patient. Results Eleven patients (mean age, 36 years; range, 20–64 years) satisfied our inclusion criteria and comprised the study cohort. The mean follow-up period was 7.0 years (range, 4.3–10.9 years). Mean range of motion of the wrist revealed flexion of 76 ± 11 degrees and extension of 73 ± 12 degrees. Mean grip strength was 98 ± 15% of the nonsurgical extremity. QuickDASH, modified Mayo, and patient-rated wrist evaluation (PRWE) average scores were 9 ± 8, 80 ± 6, and 12 ± 12, respectively. No surgical complications were observed and no patient required any further surgical intervention. Conclusions Our cohort of patients following all-arthroscopic pre-tied suture device repair of isolated Palmer type 1B TFCC tears demonstrated excellent clinical function at a mean follow-up of 7 years. These findings indicate that the pre-tied suture device is a reliable, safe, effective, and most importantly, durable treatment option for repair of peripheral TFCC tears. Level of Evidence This is a Level IV, therapeutic study.

Prognostic Factors Affecting Clinical Outcomes of Arthroscopic Assisted Reduction and Volar Plating through Preservation of Pronator Quadratus for Intra-Articular Distal Radius Fracture

2020 ◽  
Vol 25 (03) ◽  
pp. 345-352
Author(s):  
Jae-Uk Jung ◽  
Seok-Won Yang ◽  
Jung-Sang Kim ◽  
Jae-Wook Park ◽  
Jong-Pil Kim
Keyword(s):  
Prognostic Factors ◽  
Clinical Outcomes ◽  
Distal Radius ◽  
Univariate Analysis ◽  
Female Gender ◽  
Volar Plating ◽  
Pronator Quadratus ◽  
Radiographic Parameters ◽  
Significant Difference

Background: This study aimed to evaluate the clinical and radiological outcomes following an arthroscopic-assisted reduction and volar plating (AR-VP) surgery through pronator quadratus (PQ) preservation for treating intra-articular distal radius fractures (IA-DRFs) and to assess prognostic factors that affect functional outcomes. Methods: Between March 2014 and February 2017, 54 patients who had intra-articular DRF and underwent AR-VP through the PQ preservation technique and completed 1-year follow-up were enrolled. Patients were divided into the satisfactory group (excellent and good results) and an unsatisfactory group (fair and poor results) based on the modified Mayo Wrist Scoring System (MMWS) scored at 1-year follow-up to determinate prognostic factors that affected clinical outcomes. Patients’ demographics, clinical outcome measures (VAS, DASH, PRWE, etc.), and pre-and post-operative radiographic parameters were analyzed. Results: The outcomes according to MMWS were 10 excellent, 22 good, 14 fair, and 8 poor. A univariate analysis showed a significant difference between the groups (p < .05) for all radiographic parameters, sex, and the presence of an intra-articular comminution. In the multivariate analysis, female gender, presence of an intra-articular comminution, and difference of palmar articular tilt compared to uninjured wrist (> 20.1°) at trauma were considered as significant poor prognostic factors of functional outcome. Conclusions: AR-VP surgery through PQ preservation for intra-articular DRFs has reliable clinical and radiological outcomes. However, female gender, presence of an intra-articular comminution, and difference of palmar articular tilt compared to the uninjured wrist (> 20.1°) at initial injury were considered poor prognostic factors for AR-VP through PQ preservation for intra-articular DRF.

Short-changed during the bacillus Calmette–Guérin shortages?

2020 ◽  
pp. 205141582094178
Author(s):  
Kenneth R MacKenzie ◽  
Sidney D Parker ◽  
Dawn Watson ◽  
Joanne Cresswell
Keyword(s):  
High Risk ◽  
Treatment Strategies ◽  
Disease Free Survival ◽  
Disease Recurrence ◽  
Bacillus Calmette Guerin ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Muscle Invasive ◽  
Long Term Impact

Objective: Intravesical bacillus Calmette–Guérin (BCG) is the first-line treatment of choice for high-risk non-muscle-invasive bladder cancer (NMIBC). Our aim was to evaluate the long-term impact of BCG shortages on oncological outcomes. Methods: All patients undertaking an initial course of intravesical BCG for intermediate or high risk NMIBC at a single UK cancer centre between August 2012 and August 2014 were evaluated. Compliance was defined as completing 12 doses of BCG within the first year following diagnosis. Results: Due to BCG shortages, 25/114 (22%) patients were compliant with planned maintenance treatment. Compared to the compliant cohort, the non-compliant due to BCG shortages cohort had a higher rate of disease recurrence (35.3% vs. 24%), required more additional intravesical treatments (14.7% vs. 12%) and had a higher rate of radical cystectomy (11.8% vs. 4%). Disease-free survival was superior in the compliant cohort at two years (88% vs. 79.5%) and at 4.5 years (72% vs. 56.1%). There was no statistically significant difference, likely due to the sample size. Conclusions: The consequences of undertreatment due to BCG shortages can impact long-term cancer outcomes. Increased vigilance, robust long-term surveillance and alternative treatment strategies are required for NMIBC patients affected by shortages in BCG supplies. Level of evidence: Level 2b

scholarly journals Universal 2 Wrist Arthroplasty in Rheumatoid Arthritis

2017 ◽  
Vol 06 (03) ◽  
pp. 206-215 ◽  
Author(s):  
Giovanni Munz ◽  
Giulia Guidi ◽  
Massimo Ceruso ◽  
Sandra Pfanner
Keyword(s):  
Rheumatoid Arthritis ◽  
Pain Relief ◽  
Grip Strength ◽  
Visual Analogue Scale Pain ◽  
Level Of Evidence ◽  
Flexion Extension ◽  
The Mean ◽  
Wrist Arthroplasty

Purpose The aim of this study was to evaluate the mid- to long-term outcomes and complications in patients affected by rheumatic diseases treated with the Universal 2 (U2) total wrist arthroplasty (TWA). Methods We reviewed, in a retrospective, noncontrolled cohort study, 22 patients affected by rheumatoid arthritis (RA), who underwent U2 total wrist replacement between March 2003 and January 2014 for the treatment of 23 rheumatoid wrists with the aim of obtaining the remission of pain and a range of motion (ROM) useful for daily activities, according to the patients' demands, as an alternative to total wrist arthrodesis. The cohort of patients included 20 females and 2 males, with a mean age of 54.9 years. Residual pain, preoperative ROM, postoperative ROM increases, grip strength, radiographic changes, long-term complications, and reasons for revision or failures were evaluated. Results In this study, 22 patients were evaluated at a mean follow-up of 82.3 months (range: 2–12 years). All patients had good or complete pain relief, the mean visual analogue scale pain score was 0.82. The mean grip strength improved and postoperatively was 11 kg (Jamar). The mean total ROM of flexion–extension was 72.3 degrees; radial–ulnar deviation 24.9 degrees. The mean QuickDASH score of 49 and patient rate wrist/hand evaluation of 41.7 a revision surgical procedure in six cases (26%): in two cases, a carpal component revision procedure and in four cases, total implant failures requiring either conversion to a Swanson spacer or wrist joint fusion. Conclusion TWA provides pain relief, preserves motion, and improves function in severe degenerative RA. Our results at a mid- to long-term follow-up with the U2 prosthesis were encouraging and represent, when indicated, a valid alternative to fusion which is less appealing for RA patients. Level of Evidence Level of evidence is therapeutic IV.

Effects of growth hormone overproduction on grip strength of transgenic mice

1995 ◽  
Vol 133 (6) ◽  
pp. 735-740 ◽  
Author(s):  
Eckhard Wolf ◽  
Rüdiger Wanke ◽  
Emanuel Schenck ◽  
Walter Hermanns ◽  
Gottfried Brem
Keyword(s):  
Growth Hormone ◽  
Body Weight ◽  
Muscle Strength ◽  
Transgenic Mice ◽  
Least Squares ◽  
Grip Strength ◽  
Long Term Effects ◽  
Muscle Weight ◽  
Significant Difference

Wolf E, Wanke R, Schenck E, Hermanns W, Brem G. Effects of growth hormone overproduction on grip strength of transgenic mice. Eur J Endocrinol 1995;133:735–40. ISSN 0804–4643 Growth hormone (GH) is used by athletes like bodybuilders to increase muscle strength and weight gain. On the other hand, chronic hypersecretion of GH in active acromegaly may result in outwardly hypertrophied but functionally weaker muscles. As a model for studying long-term effects of GH on muscle strength, we analysed transgenic mice (TM) carrying rat phosphoenolpyruvate carboxykinasebovine GH (PEPCKbGH) fusion genes, which are expressed in liver and kidney but not in skeletal muscle. Circulating GH levels in TM ranged between 0.5 and 3 μg/ml, resulting in increased (p <0.001) body weight (wt) as well as increased (p <0.01) weights of forelimb and hindlimb muscles. However, muscle weight/body wt ratios of TM were 16–20% smaller than in controls (p<0.05), Forelimb grip strength of hemizygous TM (16 males, 132 ± 45 days old, body wt = 56.8 ± 8.3 g; 32 females, 146 ± 38 days old, body wt = 54.9 ± 6.1 g) and non-transgenic controls (28 males, 127 ± days old, body wt = 40.5±2.9 g; 33 females, 126 ±47 days old, body wt = 32.1 ± 3.6 g) was determined using an automated grip strength meter. Data were computed by analysis of variance, taking into account effects of group, sex and age. Least-squares means estimated for the grip strength (N) of male TM (1.91) and controls (1.92) were significantly (p<0.05) greater than those of female TM (1.78) and controls (1.61). A significant difference between groups was only seen in females (p <0.01). Least-squares means estimated for grip strength/body wt ratios (N/10 g) of male (0.34) and female TM (0.33) were 29% and 35% lower than those of male (0.48) and female controls (0.51), respectively (p <0.001). In summary, long-term elevated GH levels in TM increased muscle weight less efficiently than body weight, and muscle strength did not increase proportionally with muscle weight. Eckhard Wolf, Lehrstuhl für Molekulare Tierzucht und Haustiergenetik, Ludwig-Maximilians-Universität München, Würmtalstraβe 221, 81375 München, Germany

Free functioning gracilis transfer for reanimation of elbow and hand in total traumatic brachial plexopathy in children

2018 ◽  
Vol 43 (6) ◽  
pp. 596-608 ◽  
Author(s):  
Tomas Madura ◽  
Kazuteru Doi ◽  
Yasunori Hattori ◽  
Sotetsu Sakamoto ◽  
Takashi Shimoe
Keyword(s):  
Brachial Plexus ◽  
Elbow Flexion ◽  
Limb Length Discrepancy ◽  
Flexion Contracture ◽  
Brachial Plexopathy ◽  
Brachial Plexus Palsy ◽  
Level Of Evidence ◽  
Old Patients ◽  
Useful Power

The purpose of this study was to evaluate long-term outcomes of the free functioning gracilis transfer in children with traumatic total brachial plexus palsy. We used the free functioning gracilis transfer to reconstruct elbow flexion and prehension in 17 children with a mean age of 13.4 years (range 3–17) who were followed-up over a mean period of 6 years (range 2–16). The transferred gracilis delivered a stable elbow flexion with a useful power, as well as reconstructed active finger motion. In 3–11-year-old patients we noted a tendency towards developing a progressive flexion contracture of the elbow. The limb length discrepancy observed in our patients was not different from the brachial plexus palsy patients treated without the free functioning gracilis transfer. In conclusion, the free functioning gracilis transfer is a reliable reconstructive technique for reanimating upper extremity in children of all ages capable of delivering stable function over a long period of time. Level of evidence: IV

Long-term Follow-up of Cheilectomy for Treatment of Hallux Rigidus

2019 ◽  
Vol 40 (10) ◽  
pp. 1114-1121 ◽  
Author(s):  
Eliezer Sidon ◽  
Ryan Rogero ◽  
Timothy Bell ◽  
Elizabeth McDonald ◽  
Rachel J. Shakked ◽  
...  
Keyword(s):  
Case Series ◽  
Hallux Rigidus ◽  
Long Term Results ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
First Metatarsophalangeal Joint ◽  
Significant Difference ◽  
Long Term Follow Up

Background:Hallux rigidus is the most common arthritic condition in the foot. First metatarsophalangeal joint cheilectomy produces satisfactory results in retrospective studies with reported good to excellent results in up to 97% and pain relief and function in 92%. The results of cheilectomy for higher grades of hallux rigidus are less favorable. The purpose of this study was to evaluate the long-term functional results and survivorship of cheilectomy for treatment of hallux rigidus.Methods:This was a retrospective, questionnaire-based study investigating the long-term results of cheilectomy for treatment of hallux rigidus. The preoperative arthritic grade was graded retrospectively according to the Hattrup and Johnson (H&J) grading system. A questionnaire was administered via email or telephone that included questions regarding pain recurrence following surgery, current functional status, and satisfaction with the operation. Kaplan-Meier survival analysis was performed to estimate survival time between arthritic grades. We reviewed 165 patients (169 feet) with an average follow-up of 6.6 (5.0-10.9) years.Results:The overall survival rate (painless at the time of last follow-up) was 70.4% (119 feet), with no significant difference between the 3 H&J arthritic grades. Most of the recurrences (28 feet, 75%) were at the first 2 years following the surgery. Nine feet (5.3%) had a second procedure at a mean postoperative time of 3.6 (range, 1.6-7.4) years. Of the 169 feet, 117 (69.3%) reported being satisfied or very satisfied and 127 (75.1%) indicated they would repeat the operation under the same circumstances.Conclusion:Our study supports the use of cheilectomy for treatment of hallux rigidus (grade 1-3 Coughlin and Shurnas) as a reliable procedure with favorable results. At long-term follow-up, patients who underwent cheilectomy had a low revision rate and a moderately low rate of pain recurrence.Level of Evidence:Level IV, retrospective case-series.

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