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.

Outcomes after Scaphoid Excision and Midcarpal Arthrodesis for SNAC and SLAC Wrist Arthritis

2018 ◽  
Vol 20 (5) ◽  
pp. 389-399
Author(s):  
Andrzej Żyluk ◽  
Agnieszka Mazur-Grzesiuk
Keyword(s):  
Dash Score ◽  
Non Union ◽  
Results Of Treatment ◽  
Mayo Score ◽  
Hand Dexterity ◽  
Mild Reduction ◽  
The Mean ◽  
The Cost ◽  
Midcarpal Arthrodesis ◽  
Slac Wrist

Background. Persistent, long-lasting pseudoarthrosis of the scaphoid or scapholunate dissociation results in arthrosis of the radio-scaphoid joint termed scaphoid non-union advanced collapse (SNAC) or scapholunate advanced collapse (SLAC), which causes pain, reduction in wrist movements and weakness of the hand grip. Scaphoid resection followed by „four-corner” midcarpal arthrodesis is a recognized treatment for this condition. Material and methods. The study evaluated the results of treatment of 27 patients with arthrosis of the wrist type SNAC (n = 15) and SLAC (n = 12) after an average of 4 years after surgery (range from 2 to 8 years) Results. The mean numerical pain score for wrist movements was 3.6 (range: 1-5). The mean active range of wrist movement (affected vs healthy hand) was: flexion 27° vs 58° (46%), extension 27° vs 52° (53%), ulnar deviation 16° vs 26° (62%), radial deviation 9° vs 17° (53%), total grip strength 22 kG vs 29 kG (76%), The mean DASH score was 22 (range: 4-36) and the mean Mayo score was 72 (range: 65-80). None of the patients required revision surgery. Of the 16 patients employed prior to the surgery, 10 returned to work after a mean of 4 months of sick leave. Conclusions. 1. The results of the treatment presented in this stu­dy, after a relatively long follow-up period, show a beneficial effect of the surgery on pain intensity and improvement of hand dexterity, at the cost of a mild reduction in wrist movements. 2. It seems that this technique offers good, predicta­ble outcomes and may be recommended for Wa­t­son 2° and 3° SNAC or SLAC wrist arthrosis.

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.

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 Po laivelio pseudoartrozės įvykusio riešo kolapso eiga ir gydymas

2003 ◽  
Vol 1 (4) ◽  
pp. 0-0
Author(s):  
Arūnas Jankauskas
Keyword(s):  
Treatment Plan ◽  
Scaphoid Nonunion ◽  
Scapholunate Ligament ◽  
Carpal Collapse ◽  
Complete Excision ◽  
Joint Surfaces ◽  
Degenerative Arthrosis ◽  
Three Stages ◽  
Midcarpal Joint ◽  
Midcarpal Arthrodesis

Arūnas JankauskasVilniaus universiteto Ortopedijos, traumatologijosir plastinės chirurgijos klinikaVilniaus greitosios pagalbos universitetinė ligoninėŠiltnamių g. 29, LT-2043 VilniusEl paštas: [email protected] Esant nestabiliai laivelio pseudoartrozei, riešo sąnarys neišvengiamai deformuojasi, prasideda artrozė ir sumažėja sąnario aukštis. Tokia riešo sąnario būklė vadinama riešo kolapsu. Degeneraciniai pokyčiai pasireiškia varginamais skausmais, kontraktūra ir plaštakos jėgos susilpnėjimu. Artrozė prasideda ties stipinkaulio yline atauga ir pasiekusi antrą stadiją išplinta stipininiame laivelio sąnaryje. Trečios stadijos artrozė pažeidžia riešo vidurinį sąnarį, tačiau stipininis mėnulio sąnarys lieka nepakitęs. Dėl antros ir trečios stadijos artrozės išplitimo rekonstruoti laivelį netikslinga. Reikia likviduoti artrozės židinius ir stabilizuoti riešo sąnarį taisyklingoje padėtyje. Pašalinamas laivelis ir atkuriamas riešo aukštis. Atliekama riešo vidurinio sąnario artrodezė. Stipininio mėnulio sąnario judesiai išsaugomi. Prasminiai žodžiai: laivelio pseudoartrozė, riešo kolapsas, riešo vidurinio sąnario artrodezė Scaphoid nonunion advanced collapse: development and treatment plan Arūnas Jankauskas Longstanding and untreatet scaphoid nonunion leads to painful destruction of the wrist with carpal collapse (scaphoid nonunion advanced collapse). The severity of degenerative arthrosis is classified into three stages and can be treated operatively. The reconstruction of the scaphoid or scapholunate ligament in stages II and III is not a reasonable option. With complete excision of the scaphoid and fusion of the midcarpal joint, all arthritic joint surfaces are eliminated and motion is preserved in the radiolunate joint, which is usually spared of degenerative changes. Keywords: scaphoid nonunion, carpal collapse, midcarpal arthrodesis

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.

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.

Sign in / Sign up

Export Citation Format

Share Document