Ligamentous Reconstruction of Scapholunate Dislocation through a Double Dorsal and Palmar Approach

2006 ◽  
Vol 31 (4) ◽  
pp. 445-449 ◽  
Author(s):  
A. MARCUZZI ◽  
A. LETI ACCIARO ◽  
G. CASERTA ◽  
A. LANDI
Keyword(s):  
Dash Score ◽  
Dorsal Approach ◽  
Interosseous Ligament ◽  
Hand Grip ◽  
Active Range Of Motion ◽  
Palmar Approach ◽  
Contralateral Hand ◽  
Ligamentous Reconstruction ◽  
The Mean

Six patients, were treated for scapholunate dissociation by reconstruction of both the palmar and dorsal parts of the scapholunate interosseous ligament through a combined palmar and dorsal approach. The mean active range of motion of the wrist at final follow-up was 44° of flexion and 58° of extension and the mean hand grip strengths was 88% of that of the contralateral hand. The average time to return to work was 105 days and the mean DASH score at a mean follow-up of 32 months was 18. At follow-up, radiographs showed maintenance of the anatomical reduction of the scapholunate articulation in all cases and the scapholunate angle was normal in five patients.

Arthroscopic Debridement and Arthrolysis for the Treatment of Advanced Kienböck's Disease: 18-Month and 5-Year Postoperative Results

2021 ◽  
Author(s):  
Omer Ayik ◽  
Mehmet Demirel ◽  
Necmettin Turgut ◽  
Okyar Altas ◽  
Hayati Durmaz
Keyword(s):  
Grip Strength ◽  
Dash Score ◽  
Arthroscopic Debridement ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Hand Grip ◽  
Case Series Study ◽  
The Mean ◽  
Kienbock’S Disease

Abstract Background Salvage procedures, such as proximal row carpectomy, limited or total wrist arthrodesis, and wrist replacement, are generally preferred to treat advanced Kienböck's disease. However, these procedures are particularly aggressive and may have unpredictable results and potentially significant complications. Questions/Purpose This study aimed to present the short- to mid-term clinical and functional results of arthroscopic debridement and arthrolysis in the management of advanced Kienböck's disease. Patients and Methods Fifteen patients in whom Lichtman Stages IIIA to IIIC or IV Kienböck's disease was diagnosed and treated by arthroscopic wrist debridement and arthrolysis were included in this retrospective study. The mean age was 30 years (range: 21–45). The mean follow-up period duration was 36 months (range: 18–60). The Disabilities of the Arm, Shoulder, and Hand (DASH) score, visual analog scale (VAS), wrist range of motion (ROM), and grip strength were measured preoperatively and then again at the final follow-up visit. Results The mean DASH and VAS scores improved from 41 (range: 31–52) and 7.1 (range: 6–8) preoperatively to 13 (range: 8–21) and 2 (range: 0–3; p < 0.001) at the final follow-up visit, respectively. The mean wrist flexion and extension values increased from 32 (range: 20–60 degrees) and 56 degrees (range: 30–70 degrees; p = 0.009) preoperatively to 34 (range: 10–65 degrees; p = 0.218) and 57 degrees (range: 30–70 degrees; p = 0.296) at the final follow-up appointment, respectively, although these findings were statistically insignificant. The mean strength of the hand grip increased from 22.7 (range: 9–33) to 23.3 (range: 10–34; p = 0.372). Conclusion Arthroscopic debridement and arthrolysis may improve wrist function and quality of life due to the preserved ROM and hand grip strength after short- to mid-term follow-up periods despite the radiographic progression of Kienböck's disease. Level of Evidence This is a Level IV, retrospective case series study.

Midcarpal Arthrodesis with Complete Scaphoid Excision and Interposition Bone Graft in the Treatment of Advanced Carpal Collapse (SNAC/SLAC Wrist): Operative Technique and Outcome Assessment

2000 ◽  
Vol 25 (4) ◽  
pp. 341-345 ◽  
Author(s):  
M. SAUERBIER ◽  
M. TRÄNKLE ◽  
G. LINSNER ◽  
B. BICKERT ◽  
G. GERMANN
Keyword(s):  
Operative Technique ◽  
Dash Score ◽  
Carpal Collapse ◽  
Complete Excision ◽  
Active Range Of Motion ◽  
Reliable Procedure ◽  
The Mean ◽  
Midcarpal Arthrodesis ◽  
Slac Wrist

Thirty-six patients with stage II or III SNAC and SLAC wrists were treated by midcarpal arthrodesis and complete scaphoid excision. When assessed at a mean follow-up of 25 months, pain was significantly reduced both under resting and stress conditions. The active range of motion was 54% of the contralateral wrist and grip strength was 65% of the non-operated hand. The mean DASH score was 28 points, the Mayo wrist score was 63 points, and the Krimmer wrist score was 68. Correlation of the wrist scores with the DASH values demonstrated a significant correlation. Our data demonstrate that midcarpal fusion with complete excision of the scaphoid is a reliable procedure for treating advanced carpal collapse.

Partial trapeziectomy and pyrocarbon interpositional arthroplasty for trapeziometacarpal joint osteoarthritis: results after minimum 2 years of follow-up

2014 ◽  
Vol 39 (6) ◽  
pp. 604-610 ◽  
Author(s):  
M. Mariconda ◽  
S. Russo ◽  
F. Smeraglia ◽  
G. Busco
Keyword(s):  
Pinch Strength ◽  
Dash Score ◽  
Trapeziometacarpal Joint ◽  
Interpositional Arthroplasty ◽  
Contralateral Hand ◽  
Trapeziometacarpal Joint Osteoarthritis ◽  
The Mean ◽  
A Prospective Study

A prospective study was undertaken to assess the outcomes of a series of patients treated using pyrocarbon implant arthroplasty after partial trapeziectomy for trapeziometacarpal joint osteoarthritis. We analysed the results of this procedure in 27 trapeziometacarpal joints of 25 patients. The mean follow-up interval was 34 months (range 26–52). The study showed that pyrocarbon interpositional arthroplasty provided excellent pain relief and high patient satisfaction. Overall function, according to disabilities of the arm, shoulder and hand (DASH) score, improved from 48 points preoperatively to 14 points at the last follow-up assessment. Key pinch strength recorded in the operated hands was comparable with the results obtained in the contralateral hand and in healthy individuals from the same population. No further operations were performed in the study group. Partial trapeziectomy with pyrocarbon arthroplasty may prove to be a successful option for the treatment of trapeziometacarpal joint osteoarthritis. Further long-term comparative studies are warranted.

Vascularized posterior interosseous pedicled bone grafting for infected forearm nonunion

2015 ◽  
Vol 41 (4) ◽  
pp. 441-447 ◽  
Author(s):  
R. S. Kamrani ◽  
A. Farhoud ◽  
M. H. Nabian ◽  
L. O. Zanjani ◽  
M. Farzan
Keyword(s):  
Bone Graft ◽  
Dash Score ◽  
Distal Ulna ◽  
Level Of Evidence ◽  
Posterior Interosseous Artery ◽  
Active Range Of Motion ◽  
Interosseous Artery ◽  
The Mean ◽  
Quick Dash

Infected forearm nonunion is challenging to treat. We have used a vascularized pedicled bone graft from the distal ulna based on the posterior interosseous artery to treat forearm nonunion with current or previous signs of infection in six patients. Bone union was achieved after a mean of 3.8 months. After a mean follow-up of 25.7 months, no signs of persistent or reactivation of infection were seen in any patient. The mean Quick DASH score significantly improved from 77.4 to 17.6. In addition, the active range of motion of the wrist improved significantly after surgery. In our patients, a vascularized posterior interosseous pedicled bone from the distal ulna is a reliable vascularized bone graft for managing infected forearm nonunion. The Level of evidence of this study is 4.

scholarly journals Radiographic and Clinical Assessment of Intramedullary Nail Fixation for the Treatment of Unstable Metacarpal Fractures

Hand ◽  
2017 ◽  
Vol 13 (2) ◽  
pp. 184-189 ◽  
Author(s):  
Ather Mirza ◽  
Justin Mirza ◽  
Chris Healy ◽  
Vishaaq Mathew ◽  
Brian Lee
Keyword(s):  
Intramedullary Nail ◽  
Case Series ◽  
Extensor Tendon ◽  
Dash Score ◽  
Metacarpal Fractures ◽  
Radiographic Outcomes ◽  
Active Range Of Motion ◽  
The Mean ◽  
Flexible Intramedullary Nail

Background: The purpose of the article was to evaluate clinical and radiographic outcomes in a case series of unstable metacarpal fractures treated with flexible intramedullary nail (IMN) fixation. Methods: A total of 55 patients with unstable metacarpal fractures between 2003 and 2010 were treated with IMN fixation and followed for a minimum of 1 year. The outcomes were assessed via a radiological study of longitudinal and angular collapse, Disabilities of the Arm, Shoulder, and Hand (DASH) score, total active range of motion (ROM) of the wrist, and grip strength testing. Results: In the 55 patients, metacarpal fractures were healed by clinical and radiographic assessment at an average of 12.7 weeks. IMNs were removed in all cases at an average of 13.9 weeks. Patients regained full finger ROM at the final follow-up and were capable of 72.4% of motion at 2 weeks postoperatively. The mean DASH score at the final follow-up was 6.5. Complications included 3 cases of extensor tendon irritation that resolved without functional impairment and 2 cases of “backing out” that required reoperation to replace the pin. In one case, a bony exostosis formed on the affected metacarpal that led to tendon irritation and required operative excision. Conclusions: We found that this technique allowed for the stabilization of fractures, early ROM, resumption of usual activities, reduced immobilization, and minimal complications. A removable orthosis, instead of a cast, allowed for earlier mobilization of the wrist, metacarpophalangeal, and proximal interphalangeal joints.

scholarly journals Percutaneous Tennis Elbow Release Under Local Anaesthesia

2012 ◽  
Vol 6 (1) ◽  
pp. 129-132 ◽  
Author(s):  
MA Nazar ◽  
S Lipscombe ◽  
S Morapudi ◽  
G Tuvo ◽  
R Kebrle ◽  
...  
Keyword(s):  
Local Anaesthesia ◽  
Tennis Elbow ◽  
Long Term Results ◽  
Dash Score ◽  
Day Case ◽  
Horse Riding ◽  
Minimal Scarring ◽  
Percutaneous Release ◽  
The Mean

Introduction: When the non-operative treatment of tennis elbow fails to improve the symptoms a surgical procedure can be performed. Many different techniques are available. The percutaneous release of the common extensor origin was first presented by Loose at a meeting in 1962. Despite the simplicity of the operation and its effectiveness in relieving pain with minimal scarring this procedure is still not widely accepted. This study presents the long-term results of percutaneous tennis elbow release in patients when conservative measures including local steroid injections have failed to relieve the symptoms. Patients and Methods: Percutaneous release of the extensor origin was performed in 24 consecutive patients (seven male and seventeen female), providing 30 elbows for this study. The age of the patients ranged from 26 to 71 years with mean age of 55 years. The technique involved a day case procedure in the operating theatre using local anaesthesia without the need for a tourniquet. The lateral elbow was infiltrated with 5mls 1% lignocaine and 5mls 0.5% bupivicaine with 1:200,000 adrenaline. All operations were performed by the senior author. The patients were assessed post operatively by using DASH (disabilities of arm, shoulder and hand) score and Oxford elbow scores. The mean follow up period was 36 months (1-71months). Results: Twenty one patients returned the DASH and Oxford elbow questionnaires. Four patients were lost in the follow up. The post operative outcome was good to excellent in most patients. Eighty seven percent of patients had complete pain relief. The mean post-op DASH score was 8.47 (range 0 to 42.9) and the mean Oxford elbow score was 42.8 (range 16 to 48). There were no complications reported. All the patients returned to their normal jobs, hobbies such as gardening, horse riding and playing musical instruments. Conclusion: In our experience Percutaneous release of the epicondylar muscles for humeral epicondylitis has a high rate of success, is relatively simple to perform, is done as a day case procedure and has been without complications. Percutaneous release is a viable treatment option after failed conservative management of tennis elbow.

scholarly journals Reconstruction of finger joints using autologous rib perichondrium – an observational study at a single Centre with a median follow-up of 37 years

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Daniel Muder ◽  
Ola Nilsson ◽  
Torbjörn Vedung
Keyword(s):  
Range Of Motion ◽  
Young Patients ◽  
Long Term Results ◽  
Dash Score ◽  
Finger Joints ◽  
Joint Reconstruction ◽  
Additional Surgery ◽  
Contralateral Hand ◽  
The Mean

Abstract Background Gratifying long-term results are difficult to achieve when reconstructing osteoarthritic finger joints. Implant surgery is the most commonly used method to restore function and dexterity. However, all types of implant have disadvantages and may be a less favorable option in some cases, especially in young patients with a long expected lifetime and high demands on manual load. Implant related complications as loosening, instability, subsidence and stiffness are the main concerns. In this context, joint reconstruction using rib perichondrium might be a reasonable alternative in selected cases. The aim of the study was to evaluate the long-term results of finger joint reconstruction using rib perichondrial transplantation. Methods The study group (n = 11) consisted of eight individuals reconstructed in the proximal interphalangeal (PIP) joints and three reconstructed in the metacarpophalangeal (MCP) joints during 1974–1981. All patients were evaluated at clinical visits (median: 37 years after perichondrial transplantation, range: 34–41 years) using radiographs, disability in arm-shoulder-hand (DASH) score, Visual Analog Scale (VAS), range-of-motion (ROM) and manual strength (JAMAR). Results None of the 11 patients had undergone additional surgery. All of the PIP-joints (n = 8) were almost pain-free at activity (VAS 0,6) (range 0–4), had an average range-of-motion of 41 degrees (range 5–80) and a mean DASH-score of 8,3 (range 1–51). The mean strength was 41 kg compared to 44 kg in the contralateral hand (93%). The three MCP joints were almost pain-free at activity (VAS 0,7), (range 0–1). The ROM was on average 80 degrees (range 70–90) and the mean DASH-score was 2 (range 1–3). The mean strength was 43 kg compared to 53 kg in the contralateral hand (81%). Conclusions Perichondrium transplants restored injured PIP and MCP joints that remained essentially pain-free and mostly well-functioning without need for additional surgeries up to 41 years after the procedure. Additional studies are needed to evaluate long-term results in comparison to modern implants and to better describe the factors that determine the outcome of these procedures. Level of evidence Level IV, Therapeutic Study.

scholarly journals Clinical and functional outcomes of a novel transosseous device to treat rotator cuff tears: A minimum 2-year follow-up

2019 ◽  
Vol 27 (3) ◽  
pp. 230949901987517 ◽  
Author(s):  
Mehmet Arican ◽  
Yalçın Turhan ◽  
Zekeriya Okan Karaduman ◽  
Tacettin Ayanoğlu
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tear ◽  
Functional Outcomes ◽  
Dash Score ◽  
Open Approach ◽  
Full Thickness ◽  
Gold Standard Method ◽  
Cuff Tear ◽  
The Mean

Purpose: Despite the improvements in the repair equipment techniques of rotator cuff, a gold standard method has not been defined yet and transosseous fixation through deltoid-splitting (mini-open) approach is still regarded as a good option. The primary purpose of this study is to present satisfactory clinical and functional outcomes with a novel transosseous device in full-thickness rotator cuff tear through deltoid-splitting. Materials and Methods: This retrospective study was performed on 70 consecutive patients who underwent surgery by a single surgeon from June 2014 to June 2016 for a full-thickness rotator cuff tear and was managed with a novel transosseous device. Total number of patients, mean age, percentage of male and female patients, mean duration of follow-up, percentage of involvement of the dominant extremity, affected shoulder, and tear size were recorded. Functional and clinical outcomes were assessed baseline and postoperatively at 3 and 6 months and final follow-up using Disabilities of the Arm, Shoulder and Hand (Q-DASH) and Constant-Murley scores. Results: A total of 70 (49 (70%) female, 21 (30%) male) patients whose mean age was 58.66 ± 9.19 (38–77) years were included. The mean surgery time was 35.33 ± 5.34 (28–55) min. The mean follow-up time was 28.31 ± 3.03 (24–36) months. According to the DeOrio and Cofield classification, 15 (21.43%) tears were small, 33 (47.14%) medium, 16 (22.86%) large, and 6 (8.57%) massive. By the final follow-up, the mean Constant-Murley score had significantly improved from 27.67 ± 7.46 (13–41) to 81.25 ± 3.77 (74–87; p = 0.0001) and the Q-DASH score had decreased from 82.34 ± 10.37 (65.91–100) to 10.28 ± 6.88 (0–23.45; p = 0.0001). There were no significant differences in the Constant-Murley or Q-DASH score at baseline–final follow-up between the small, medium, large, and massive tear groups ( p > 0.05). Conclusions: Treatment of full-thickness rotator cuff tear using this novel transosseous device significantly improved functional and clinical scores. However, further long-term prospective randomized multicenter trials involving comparative studies are necessary to confirm these findings.

Anterior Tenoarthrolysis for Severe Flexion Contracture of the Fingers (The “Tata” Operation): A Review of 50 Cases

2007 ◽  
Vol 32 (2) ◽  
pp. 224-229 ◽  
Author(s):  
P. LOREA ◽  
J. MEDINA HENRIQUEZ ◽  
R. NAVARRO ◽  
P. LEGAILLARD ◽  
G. FOUCHER
Keyword(s):  
Flexion Contracture ◽  
Salvage Procedure ◽  
Extension Deficit ◽  
Salvage Operation ◽  
Active Range Of Motion ◽  
Pip Joint ◽  
Distal Interphalangeal ◽  
Joint Flexion ◽  
The Mean

The “hook finger”, with both proximal interphalangeal (PIP) and distal interphalangeal (DIP) joint flexion contractures, often after multiple previous operations, is difficult to treat. This paper reports the results of 50 fingers in 49 patients in which the TATA (Téno-Arthrolyse Totale Antérieure) salvage procedure, described by Saffar in 1978, was carried out. Thirty-seven of 50 (74%) of these fingers had had at least one previous operation, most on the flexor apparatus. The mean PIP and DIP extension deficit pre-operatively was 133° with a mean PIP lag of extension of 83°. With a mean follow-up of 7.8 years, 45 fingers were improved, five were not and none was worsened. The mean PIP and DIP extension deficit postoperatively was 47°, with a mean PIP lack of extension of 31°. The overall gain in extension deficit of both joints was 86° and of the PIP was 52°. One PIP joint developed septic arthritis immediately after surgery. The benefit of this salvage operation is mainly in the change of the active range of motion to a more functional arc.

Biceps-to-Triceps Transfer in Tetraplegia

1999 ◽  
Vol 24 (2) ◽  
pp. 235-237 ◽  
Author(s):  
M. REVOL ◽  
E. BRIAND ◽  
J. M. SERVANT
Keyword(s):  
Range Of Motion ◽  
Nerve Injury ◽  
Radial Nerve ◽  
Elbow Flexion ◽  
Active Range Of Motion ◽  
The Mean ◽  
Radial Nerve Injury

Eight tetraplegic patients (13 elbows) were treated by biceps-to-triceps transfer. To avoid the risk of radial nerve injury, we chose a medial routing of the biceps. The mean follow-up after surgery was 17.8 months (range, 4–47 months). No complications were encountered. Active extension of the elbow was achieved in each case. The mean postoperative active range of motion of the elbow was 6° extension and 137° flexion. After the biceps-to-triceps transfer mean extension torque of the elbow was 3.7 Nm and mean flexion torque was 10 Nm. In eight elbows in which it was measured, there was a 47% reduction in elbow flexion power. Nevertheless no patient complained about that reduction, and all of them were satisfied.

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