Nonspanning Total Wrist Arthrodesis with a Low-Profile Locking Plate

Purpose This study aims to compare the outcomes and complications of our technique for nonspanning total wrist arthrodesis using a locking plate with the standard carpometacarpal spanning technique. Methods A retrospective review of charts was performed to identify patients who underwent total wrist arthrodesis by the senior author (S.W.W.). We compared the outcomes of 15 cases of nonspanning wrist fusion with a 2.4/2.7 mm locking T plate to 11 cases of spanning wrist fusion with a 2.7/3.5 mm locking compression plate. Minimum follow-up was 3 months. Indications for fusion included rheumatoid arthritis, posttraumatic arthritis, Kienböck's disease, primary osteoarthritis, juvenile inflammatory arthropathy, psoriasis, brachial plexopathy, failed hemi or total wrist arthroplasty, failed four-corner fusion, and failed proximal row carpectomy. The primary outcome was fusion. Secondary outcomes included time to union, patient-rated wrist evaluation score, numerical rating scale pain score, grip strength, and complications. Results All the wrists got fused. There were no significant differences in objective and subjective outcomes between cohorts. There were three complications (27%) in the spanning group, including tendon rupture and peri-implant fracture at the third metacarpal. This was compared with three complications (20%) in the nonspanning group, consisting of hardware removal. Discussion We achieved similar fusion rates employing both spanning and nonspanning total wrist arthrodesis techniques, without necessitating carpometacarpal arthrodesis in the latter. Complications associated with our method were comparably less severe than those reported in the literature. We advocate nonspanning arthrodesis as an alternative method for total wrist fusion with a high union rate and minimal risk of complications at the carpometacarpal joint. Level of Evidence Therapeutic level IV.

Download Full-text

Application of 3D printing and framework internal fixation technology for high complex rib fractures

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-01377-8 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Xuetao Zhou ◽

Dongsheng Zhang ◽

Zexin Xie ◽

Yang Yang ◽

Menghui Chen ◽

...

Keyword(s):

3D Printing ◽

Internal Fixation ◽

Locking Plate ◽

Rating Scale ◽

Preoperative Planning ◽

Numerical Rating Scale ◽

Chest Ct ◽

Rib Fractures ◽

X Rays ◽

With Screws

Abstract Objective To explore the clinical effect of 3D printing combined with framework internal fixation technology on the minimally invasive internal fixation of high complex rib fractures. Methods Total 16 patients with high complex rib fractures were included in the study. Before the procedure, the 3D rib model was reconstructed based on the thin-layer chest CT scan. According to the 3D model, the rib locking plate was pre-shaped, and the preoperative planning were made including the direction of the locking plate, the location of each nail hole and the length of the screw. During the operation, the locking plate was inserted from the sternum to the outermost fracture lines of ribs with screws at both ends. In addition, the locking plate was used as the frame to sequentially reduce the middle fracture segment and fix with screws or steel wires. Chest x-rays or chest CT scans after surgery were used to assess the ribs recovery. All patients were routinely given non-steroidal anti-inflammatory drugs (NSAIDS) for analgesia, and the pain level was evaluated using numerical rating scale (NRS). Results The preoperative planning according to the 3D printed rib model was accurate. The reduction and fixation of each fracture segment were successfully completed through the framework internal fixation technology. No cases of surgical death, and postoperative chest pain was significantly alleviated. Five to 10 months follow up demonstrated neither loosening of screws, nor displacement of fixtures among patients. The lungs of each patients were clear and in good shape. Conclusion The application of 3D printing combined with framework internal fixation technology to the high complex rib fractures is beneficial for restoring the inherent shape of the thoracic cage, which can realize the accurate and individualized treatment as well as reduces the operation difficulty.

Download Full-text

Preliminary Report of Arthroscopically Assisted Sauvé–Kapandji Procedure for Distal Radioulnar Joint Arthritis

Journal of Wrist Surgery ◽

10.1055/s-0040-1721854 ◽

2021 ◽

Author(s):

Yukio Abe ◽

Youhei Takahashi ◽

Kenzo Fujii

Keyword(s):

Rating Scale ◽

Numerical Rating Scale ◽

Kirschner Wire ◽

Distal Radioulnar Joint ◽

Contralateral Side ◽

Level Of Evidence ◽

Radioulnar Joint ◽

Advantages And Disadvantages ◽

Arthroscopically Assisted ◽

Therapeutic Study

Abstract Background The arthroscopically assisted Sauvé–Kapandji (S-K) procedure has been described as a safe and promising technique for distal radioulnar joint (DRUJ) arthrodesis. Our purpose was to investigate the advantages and disadvantages of the arthroscopically assisted S-K procedure. Methods Eight patients underwent an arthroscopically assisted S-K procedure. All patients were diagnosed as DRUJ osteoarthritis (OA), including six primary DRUJ OA, one OA following a distal radius fracture, and one rheumatoid arthritis (RA). Arthroscopy was performed in neutral forearm rotation with vertical traction. The surface of the DRUJ was debrided through arthroscopy to expose the subchondral surface, and the DRUJ was fixed with a cannulated screw and Kirschner wire (K-wire) with zero or minus ulnar variance in the same posture. Bone graft was not performed. Results Bone union was achieved at 2 to 3.5 months postoperatively. At an average of 17-month follow-up, the pain intensity on 10-point numerical rating scale (NRS) decreased from 10 preoperatively to 0.4 postoperatively, average range of pronation significantly improved from 77 degrees to 89 degrees, and average grip strength as a percentage of contralateral side improved from 76 to 104%. Conclusion Satisfactory outcomes were achieved with the arthroscopically assisted S-K procedure. Advantages of this procedure included the ability to achieve union without bone grafting, preservation of the extensor mechanism integrity, and easy reduction of the ulnar head due to its wrist positioning. No major complications were encountered. Disadvantages included its required use of arthroscopic technique and potential contraindication for cases with severe deformity at the sigmoid notch. Level of Evidence This is a Level IV, therapeutic study.

Download Full-text

High revision rates with the metal-on-metal Motec carpometacarpal joint prosthesis

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193415595527 ◽

2015 ◽

Vol 41 (3) ◽

pp. 322-327 ◽

Cited By ~ 16

Author(s):

J. K. Thillemann ◽

T. M. Thillemann ◽

B. Munk ◽

K. Krøner

Keyword(s):

Rating Scale ◽

Revision Rate ◽

Numerical Rating Scale ◽

Elevated Serum ◽

Consecutive Series ◽

Dash Score ◽

Level Of Evidence ◽

Pain Scores ◽

Thumb Carpometacarpal

We retrospectively evaluated a consecutive series of 42 Motec thumb carpometacarpal total joint arthroplasties. The primary endpoint was revision with implant removal and trapeziectomy. At follow-up the disability of the arm shoulder and hand (DASH) score, pain on numerical rating scale at rest and with activity and serum chrome and cobalt concentrations were assessed for both unrevised and revised patients. At a mean follow-up of 26 months, 17 patients had been revised. The 2 year cumulative revision rate was 42% (95% CI, 28–60%). The DASH score and pain scores at rest and with activity were comparable between the patients whose thumbs remained unrevised and those revised. Patients with elevated serum chrome and cobalt levels had significantly higher DASH and pain scores, but elevated levels were not associated with revision. The revision rate in this study is unacceptably high. However, pain and DASH scores after revision are acceptable and comparable with patients with non-revised implants. Level of evidence: IV

Download Full-text

Wrist arthrodesis in adolescents with cerebral palsy

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193415625611 ◽

2016 ◽

Vol 41 (7) ◽

pp. 758-762 ◽

Cited By ~ 10

Author(s):

J. Donadio ◽

P. Upex ◽

M. Bachy ◽

F. Fitoussi

Keyword(s):

Locking Plate ◽

Soft Tissue Release ◽

Bony Union ◽

Wrist Flexion ◽

Flexion Deformity ◽

Proximal Row Carpectomy ◽

Level Of Evidence ◽

Reliable Technique ◽

Wrist Arthrodesis ◽

The Mean

Twenty adolescents with severe spastic deformities of the wrist (Zancolli type 3) and poor function on the House score were operated on between 2009 and 2014, and included in this retrospective cohort study. All were treated by wrist arthrodesis combining a proximal row carpectomy, curetting of the distal radius in order to imbed the capitate and a dorsal locking plate. The primary endpoint was improvement in the House score. Secondary endpoints included pre- and postoperative wrist flexion deformity, bone union, patient satisfaction regarding appearance and complications. The mean follow-up was 22 months. The mean age at the time of surgery was 16.2 years. Additional soft-tissue release was necessary in eight wrists. The mean House score improved significantly from 0.9 to 2.7. Average flexion deformity improved significantly from 66° to 10°. Bony union was achieved in all patients within 6 months. Four of the 20 patients required hardware removal because of fixed extension of the middle metacarpal. Wrist arthrodesis combining proximal row carpectomy with the use of a dorsal locking plate is a safe and reliable technique to improve function and appearance. Level of evidence: IV

Download Full-text

Application of 3D Printing and Framework Internal Fixation Technology for High Complex Rib Fractures

10.21203/rs.3.rs-36125/v1 ◽

2020 ◽

Author(s):

Xuetao Zhou ◽

Dongsheng Zhang ◽

Zexin Xie ◽

Yang Yang ◽

Menghui Chen ◽

...

Keyword(s):

3D Printing ◽

Internal Fixation ◽

Locking Plate ◽

Rating Scale ◽

Preoperative Planning ◽

Numerical Rating Scale ◽

Chest Ct ◽

Rib Fractures ◽

X Rays ◽

With Screws

Abstract Objective To explore the clinical effect of 3D printing combined with framework internal fixation technology on the minimally invasive internal fixation of high complex rib fractures. Methods Total 16 patients with high complex rib fractures were included in the study. Before the procedure, the 3D rib model was reconstructed based on the thin-layer chest CT scan. According to the 3D model, the rib locking plate was pre-shaped, and the preoperative planning were made including the direction of the locking plate, the location of each nail hole and the length of the screw. During the operation, the locking plate was inserted from the sternum to the outermost fracture lines of ribs with screws at both ends. In addition, the locking plate was used as the frame to sequentially reduce the middle fracture segment and fix with screws or steel wires. Chest x-rays or chest CT scans after surgery were used to assess the ribs recovery. All patients were routinely given non-steroidal anti-inflammatory drugs (NSAIDS) for analgesia, and the pain level was evaluated using numerical rating scale (NRS). Results The preoperative planning according to the 3D printed rib model was accurate. The reduction and fixation of each fracture segment were successfully completed through the framework internal fixation technology. No cases of surgical death, and postoperative chest pain was significantly alleviated. Five to ten months follow up demonstrated neither loosening of screws, nor displacement of fixtures among patients. The lungs of each patients were clear and in good shape. Conclusion The application of 3D printing combined with framework internal fixation technology to the high complex rib fractures is beneficial for restoring the inherent shape of the thoracic cage, which can realize the accurate and individualized treatment as well as reduces the operation difficulty.

Download Full-text

Pain Management After Outpatient Foot and Ankle Surgery

Foot & Ankle International ◽

10.1177/1071100717738495 ◽

2017 ◽

Vol 39 (2) ◽

pp. 149-154 ◽

Cited By ~ 24

Author(s):

Akash Gupta ◽

Kanupriya Kumar ◽

Matthew M. Roberts ◽

Austin E. Sanders ◽

Mackenzie T. Jones ◽

...

Keyword(s):

Regional Anesthesia ◽

Rating Scale ◽

Numerical Rating Scale ◽

Thrombosis Prophylaxis ◽

Foot And Ankle ◽

Level Of Evidence ◽

Opioid Prescription ◽

Vein Thrombosis ◽

Pain Scores ◽

Long Acting

Background: The number of opioids prescribed and used has increased precipitously over the past 2 decades for a number of reasons and has led to increases in long-term dependency, opioid-related deaths, and diversion. Most studies examining the role of prescribing habits have investigated nonoperative providers, although there is some literature describing perioperative opioid prescription and use. There are no studies looking at the number of pills consumed after outpatient foot and ankle surgeries, nor are there guidelines for how many pills providers should prescribe. The purpose of this study was to quantify the number of narcotic pills taken by opioid-naïve patients undergoing outpatient foot and ankle surgeries with regional anesthesia. Methods: Eighty-four patients underwent outpatient foot and ankle surgeries under spinal blockade and long-acting popliteal blocks. Patients were given 40 or 60 narcotic pills, a 3-day supply of ibuprofen, deep vein thrombosis prophylaxis, and antiemetics. Patients received surveys at postoperative day (POD) 3, 7, 14, and 56 documenting if they were still taking narcotics, the quantity of pills consumed, whether refills were obtained, their pain level, and their reason for stopping opioids. Results: Patients consumed a mean of 22.5 pills, with a 95% confidence interval from 18 to 27 pills. Numerical Rating Scale pain scores started at 4 on POD 3 and decreased to 1.8 by POD 56. The percentage of patients still taking narcotics decreased from 55% on POD 3 to 2.8% by POD 56. Five new prescriptions were given during the study, with 3 being due to side effects from the original medication. Conclusions: Patients receiving regional anesthesia for outpatient foot and ankle surgeries reported progressively lower pain scores with low narcotic use up to 56 days postoperatively. We suggest that providers consider prescribing 30 pills as the benchmark for this patient population. Level of Evidence: Level II, prospective comparative study.

Download Full-text

Postoperative Pain Is Correlated with Scaphoid Dorsal Translation following Scapholunate Interosseous Ligament Reconstruction

Journal of Wrist Surgery ◽

10.1055/s-0040-1713656 ◽

2020 ◽

Vol 9 (06) ◽

pp. 487-492

Author(s):

Emil S. Vutescu ◽

Scott W. Wolfe ◽

Kevin Sung ◽

Rishabh Jethanandani ◽

Steve K. Lee

Keyword(s):

Postoperative Pain ◽

Rating Scale ◽

Numerical Rating Scale ◽

Level Of Evidence ◽

Interosseous Ligament ◽

Statistical Correlations ◽

Pain Scores ◽

Radiographic Parameters ◽

Radiographic Measurements ◽

Patient Reported

Abstract Background Dorsal scaphoid translation (DST) has been demonstrated to occur in patients with complete scapholunate interosseous ligament (SLIL) tears. Radiographs and magnetic resonance imaging (MRI) have demonstrated ability to detect DST in patients with documented complete scapholunate (SL) disruption, but the relevance of this parameter to outcomes of reconstruction has not been determined. Purpose The purpose of this article is to determine how radiographic parameters of SL dissociation correlate with postoperative pain and functional outcomes of SLIL reconstruction. Methods We performed a retrospective review of prospectively collected data on a cohort of 14 patients who underwent SLIL repair or reconstruction. Preoperative data included radiographic measurements of carpal posture and alignment (SL angle, radiolunate [RL] angle, SL gap, and DST), self-reported measure of average pain on a numerical rating scale (NRS) of 0 to 10, and the patient rated wrist evaluation (PRWE) survey. Postoperatively, the same data were collected at each follow-up visit. Radiographic parameters were statistically compared with postoperative NRS pain score and PRWE scores. Statistical correlations were calculated using Spearman's correlation coefficient, and mean NRS pain scores were compared using Wilcoxon's rank-sum tests, with an α value of p = 0.05. Results Mean NRS pain scores improved significantly after surgery. Mean DST improved significantly after surgery. The presence of postoperative dorsal scaphoid translation (DST) correlated strongly with postoperative pain. SL angle, RL angle, and SL gap showed no correlation with patient reported pain. There was no correlation with any radiographic parameter and PRWE. Conclusions Our study demonstrates that the presence of DST in postoperative radiographs has a strong correlation with patient reported pain following SLIL reconstruction. We conclude that correction of dorsal translation of the scaphoid is a more sensitive predictor of postoperative pain relief than SL gap, RL angle, or SL angle. Level of evidence This is a Level IV study.

Download Full-text

Efficacy of Extracorporeal Shock Wave Therapy for Achilles Tendinopathy: A Meta-analysis

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120903430 ◽

2020 ◽

Vol 8 (2) ◽

pp. 232596712090343

Author(s):

Yifei Fan ◽

Ziyan Feng ◽

Jun Cao ◽

Weili Fu

Keyword(s):

Shock Wave ◽

Energy Level ◽

Rating Scale ◽

Numerical Rating Scale ◽

Extracorporeal Shock Wave Therapy ◽

Achilles Tendinopathy ◽

Shock Wave Therapy ◽

Level Of Evidence ◽

Pain Scores ◽

Extracorporeal Shock Wave

Background: Achilles tendinopathy is a frequent sports injury, and extracorporeal shock wave therapy (ESWT) has been proposed as a treatment. Purpose: To compare outcomes between ESWT and other nonsurgical intervention (including sham shock wave therapy) in Achilles tendinopathy patients. Study Design: Systematic review; Level of evidence, 2. Methods: We included 5 randomized controlled trials and 3 case-control studies published between 2005 and 2018. We analyzed pain scores and other outcomes that were reported in more than 3 of the 8 studies. Results: ESWT was associated with significantly better scores than comparison therapy on the visual analog scale for pain ( P < .01), American Orthopaedic Foot & Ankle Society scale ( P = .01), Likert scale for satisfaction ( P = .03), Roles and Maudsley scale ( P < .01), Victorian Institute of Sports Assessment–Achilles questionnaire ( P < .01), and numerical rating scale ( P = .02). The 2 patient groups did not differ significantly in tenderness ( P = .34) or pain threshold ( P = .24). Subgroup analysis showed that ESWT led to better VAS pain scores than comparison treatments at both low-energy level (0.06-0.11 mJ/mm2) and medium-energy level (0.12-0.25 mJ/mm2) and at both shorter (<6 months) and longer (≥6 months) follow-up. Conclusion: ESWT improves pain and functional outcomes in patients with Achilles tendinopathy. Further research is needed to determine the optimal energy level.

Download Full-text

Application of 3D printing and framework internal fixation technology for high complex rib fractures

10.21203/rs.3.rs-84384/v1 ◽

2020 ◽

Author(s):

Xuetao Zhou ◽

Dongsheng Zhang ◽

Zexin Xie ◽

Yang Yang ◽

Menghui Chen ◽

...

Keyword(s):

3D Printing ◽

Internal Fixation ◽

Locking Plate ◽

Rating Scale ◽

Preoperative Planning ◽

Numerical Rating Scale ◽

Chest Ct ◽

Rib Fractures ◽

X Rays ◽

With Screws

Abstract Objective: To explore the clinical effect of 3D printing combined with framework internal fixation technology on the minimally invasive internal fixation of high complex rib fractures.Methods: Total 16 patients with high complex rib fractures were included in the study. Before the procedure, the 3D rib model was reconstructed based on the thin-layer chest CT scan. According to the 3D model, the rib locking plate was pre-shaped, and the preoperative planning were made including the direction of the locking plate, the location of each nail hole and the length of the screw. During the operation, the locking plate was inserted from the sternum to the outermost fracture lines of ribs with screws at both ends. In addition, the locking plate was used as the frame to sequentially reduce the middle fracture segment and fix with screws or steel wires. Chest x-rays or chest CT scans after surgery were used to assess the ribs recovery. All patients were routinely given non-steroidal anti-inflammatory drugs (NSAIDS) for analgesia, and the pain level was evaluated using numerical rating scale (NRS). Results: The preoperative planning according to the 3D printed rib model was accurate. The reduction and fixation of each fracture segment were successfully completed through the framework internal fixation technology. No cases of surgical death, and postoperative chest pain was significantly alleviated. Five to ten months follow up demonstrated neither loosening of screws, nor displacement of fixtures among patients. The lungs of each patients were clear and in good shape.Conclusion: The application of 3D printing combined with framework internal fixation technology to the high complex rib fractures is beneficial for restoring the inherent shape of the thoracic cage, which can realize the accurate and individualized treatment as well as reduces the operation difficulty.

Download Full-text

Efficacy and safety of treating chronic nonspecific low back pain with radial extracorporeal shock wave therapy (rESWT), rESWT combined with celecoxib and eperisone (C+E) or C+E alone: a prospective, randomized trial

10.1101/2020.11.28.20240119 ◽

2020 ◽

Author(s):

Xuejiao Guo ◽

Lin Li ◽

Zhe Yan ◽

Yunze Li ◽

Zhiyou Peng ◽

...

Keyword(s):

Shock Wave ◽

Low Back Pain ◽

Back Pain ◽

Rating Scale ◽

Numerical Rating Scale ◽

Controlled Trial ◽

Low Back ◽

Shock Wave Therapy ◽

Level Of Evidence ◽

Extracorporeal Shock Wave

AbstractBackgroundTo investigate whether respectively radial extracoporeal shock wave therapy (rESWT) or a combination of rESWT, Celecoxib and Eperisone (rESWT+C+E) are superior in reducing pain in subjects with chronic nonspecific low back pain (cnsLBP) compared to C+E alone (a standard treatment of this condition in China).Methods140 subjects with cnsLBP were randomly allocated to rESWT (n=47), rESWT+C+E (n=45) or C+E alone (n=48) for four weeks. Outcome was evaluated using the Pain Self-Efficacy Questionnaire (PSEQ), Numerical Rating Scale (NRS), Oswestry Low Back Pain Disability Questionnaire and Patient Health Questionnaire 9, collected at one week (W1), W2, W3, W4 and W12 after beginning of the therapy.ResultsAll scores showed a statistically significant improvement over time. The PSEQ and NRS scores showed a significant Time × Treatment effect. Subjects treated with rESWT had significantly lower mean NRS values than subjects treated with rESWT+C+E at W1 and W3, as well as than subjects treated with C+E alone at W3 and W4. No severe adverse events were observed.ConclusionrESWT may be superior to respectively rESWT+C+E or C+E alone in reducing pain in subjects with cnsLBP. Level of Evidence: Level I, prospective, randomized, active-controlled trial.

Download Full-text