scholarly journals Adaptive Proximal Scaphoid Implant: Indications and Long-Term Results

2019 ◽  
Vol 08 (04) ◽  
pp. 344-350 ◽  
Author(s):  
Marie-Anne Poumellec ◽  
Olivier Camuzard ◽  
Jean-Pierre Pequignot ◽  
Nicolas Dreant
Keyword(s):  
Grip Strength ◽  
Functional Results ◽  
Contralateral Side ◽  
Long Term Results ◽  
Carpal Collapse ◽  
Flexion Extension ◽  
The Mean ◽  
Carpal Height

Objective This study aims to define the indications of APSI and to evaluate the long-term results. Patients and Methods This is a monocentric study including patients that underwent an arthroplasty of the scaphoid proximal pole using an APSI between 1994 and 2010. Patients were assessed using autoquestionnaires and measuring ranges of motion, key pinch, and grip strength. X-ray views of the wrist were done to control the mobility of the implant and the evolution of the carpal collapse, if present. Results There were 19 patients included with a mean follow-up of 11 years. The mean range of motion was 106 degrees (65% of contralateral side) in flexion-extension and 33 degrees (78% of contralateral side) in radialulnar deviation. The mean grip strength was 72% of the contralateral side. The mean Mayo wrist score was 69/100, the mean QuickDASH 26/100, and the mean patient-rated wrist evaluation (PRWE) 25/100. After 10 years, evolution to osteoarthritis was noted in 32% of the patients. This was associated with a decrease of the carpal height. More specifically, capito-lunate osteoarthritis was noted after 10 years and two out of three patients were concerned after 20 years of follow-up. No osteoarthritis was diagnosed at the radiolunate articulation. Conclusion APSI is a treatment option that enables patients with scaphoid nonunion advanced collapse (SNAC), scapholunate advanced collapse (SLAC) I or II to preserve the strength and mobility with good functional results. But this arthroplasty does not prevent natural evolution to a carpal collapse after a follow-up of 20 years which is clinically well tolerated.

Long-Term Results After Policization for Congenital Hand Deformities

Hand Surgery ◽  
1997 ◽  
Vol 02 (02) ◽  
pp. 79-85 ◽  
Author(s):  
Toshihiko Ogino ◽  
Seiichi Ishii
Keyword(s):  
Functional Results ◽  
Long Term Results ◽  
Pinch Strength ◽  
Cosmetic Results ◽  
Opposite Hand ◽  
Hand Deformities ◽  
The Mean ◽  
Congenital Hand Deformities

Thirteen patients — 18 hands — have been treated with pollicization and could be followed-up for 2 years to 19 years with an average of 7.9 years. Surgery was performed according to the Buck-Gramcko method. The mean age at the time of pollicization was 1.7 years. The parents were satisfied with the cosmetic results in all cases, and they were satisfied with the functional results in all except 4 hands. At follow-up, all patients could use the pollicized digit for pinch. Excellent pinch function has been achieved in 11 hands, good in 2, and fair in 1. The average percent pinch strength compared to the opposite hand was 55%. Association of a radial club hand and contracture of the pollicized digit and other fingers seemed to influence the postoperative pinch function.

Results of Ray Resection and Amputation for Ring Avulsion Injuries at the Proximal Interphalangeal Joint

2003 ◽  
Vol 28 (6) ◽  
pp. 578-581 ◽  
Author(s):  
E. NUZUMLALI ◽  
E. ORHUN ◽  
K. ÖZTÜRK ◽  
S. CEPEL ◽  
S. POLATKAN
Keyword(s):  
Grip Strength ◽  
Ring Finger ◽  
Functional Results ◽  
Proximal Interphalangeal Joint ◽  
Pinch Strength ◽  
Resection Group ◽  
The Mean ◽  
Ring Avulsion

We investigated the long-term functional results of ray resection (14 cases) and amputation (nine cases) for ring avulsion injuries of ring finger which could not be replanted or underwent failed replantation. The mean follow-up was 37 (range, 24–63) months in the ray resection group and 32 (range, 24–40) months in the amputation group. Grip strength, key pinch strength, chuck pinch strength, hand circumference and palmar volume were decreased in the ray resection group but only grip strength and pulp pinch strength were significantly decreased in the amputation group. These results suggest that ray resection should be avoided in patients with occupations that need strong key and chuck pinch functions.

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.

Long-term results of major upper extremity replantations

2011 ◽  
Vol 37 (3) ◽  
pp. 225-232 ◽  
Author(s):  
A. Gulgonen ◽  
K. Ozer
Keyword(s):  
Grip Strength ◽  
Upper Extremity ◽  
Wrist Joint ◽  
Long Term Results ◽  
Cold Intolerance ◽  
Secondary Operations ◽  
The Mean ◽  
Protective Sensation

We analyzed the long-term functional outcome in patients with major upper extremity replantations. Two patients had amputations proximal to the elbow joint, two had elbow disarticulations and five patients had amputations at the forearm. The mean age was 24 and the mean follow-up time was 18 years. Six patients have undergone secondary operations. The mean grip strength was restored to 34% of the contralateral extremity. Protective sensation was restored in all patients. According to Chen’s functional recovery scale, five patients had excellent, two had good, and two had fair results. Grip strength, two-point discrimination, ranges of motion and Chen’s scale did not improve after 5 years. However, Semmes–Weinstein monofilament testing and cold intolerance continued to improve up to 10 and 12 years, respectively. Replantation of an upper extremity proximal to the wrist joint satisfactorily restored the upper extremity function.

Long-Term Results of Arthroscopic Capsular Shrinkage for Palmar Midcarpal Instability of the Wrist

2021 ◽  
Author(s):  
Matthew Ricks ◽  
Peter Belward ◽  
David Hargreaves
Keyword(s):  
Long Term Results ◽  
Lead Author ◽  
Grading System ◽  
Dash Score ◽  
Anterior Drawer ◽  
Anterior Drawer Test ◽  
Flexion Extension ◽  
The Mean

Abstract Background Midcarpal instability is a term for a collection of poorly understood conditions where the proximal row of the carpus is unstable. The most common type of midcarpal instability is palmar midcarpal instability (PMCI). Treatment for PMCI includes nonoperative proprioceptive retraining of the wrist, splints, and strengthening. If this fails, various authors have suggested several different fusions, tenodesis procedures, or capsular shrinkage. There are no long-term case series in the literature. Objective The aim of this study is to assess the long-term results of arthroscopic capsular shrinkage when used for PMCI of the wrist. Methods A prospective cohort study of patients who underwent arthroscopic capsular shrinkage for PMCI was performed. Ethical board approval was given for this study. All patients were followed up and reviewed independently from the operating surgeon. Assessment included a structured questionnaire, disabilities of the arm, shoulder and hand (DASH) questionnaire, and clinical examination using a goniometer. PMCI was assessed objectively with the anterior drawer test and radiological imaging was only performed if clinically relevant to the residual symptoms. Results Thirteen patients (15 wrists) underwent arthroscopic capsular shrinkage for PMCI. Twelve patients (14 wrists) were available for clinical review with a follow-up rate of 92.3%. The mean time from index procedure to final review was 12 years (range: 10–14years). The symptoms of instability had completely resolved in nine wrists (7 patients). Only 2 of the 14 wrists had symptoms that were reproduced with a positive anterior drawer test. All other wrists were stable on objective assessment. The mean DASH score had improved from pre op of 34 to post op of 12.1 and at 12-year follow-up this had deteriorated minimally to 15.3. Assessment of the range of motion showed an average increase in range of flexion/extension by 22 degrees. Patient satisfaction was excellent. The patients rated that nine wrists were much better than presurgery, three as better, one unchanged, and one worse. Discussion/Conclusion There are no studies looking at the long-term natural history of treatments for PMCI. The lead author proposes a grading system for symptomatic PMCI that has been retrospectively applied to this cohort. It is a grading system from 1 to 4 and is based on a treatment algorithm. This is the first long-term study from any joint, where the results of capsular shrinkage have been maintained over time. In this series, we have not seen any deleterious effect from possible mechanoreceptor injury. We suspect that functioning mechanoreceptors are more relevant in the unstable joint, than the structurally stable joint. The authors propose that thermal capsular shrinkage is an effective and durable option for use in mild-to-moderate forms of PMCI.

Long-term Results of Isolated Anterolateral Bundle Reconstructions of the Posterior Cruciate Ligament

2009 ◽  
Vol 37 (8) ◽  
pp. 1499-1507 ◽  
Author(s):  
Stijn Hermans ◽  
Kristoff Corten ◽  
Johan Bellemans
Keyword(s):  
Cruciate Ligament ◽  
Functional Results ◽  
Long Term Results ◽  
Time Of Surgery ◽  
Anterolateral Bundle ◽  
Graft Choice ◽  
Arthroscopically Assisted ◽  
The Mean

Background Little is known about the parameters that influence the long-term results of isolated arthroscopically assisted reconstructions of the anterolateral bundle of the posterior cruciate ligament (PCL). Hypothesis Chondrosis, time interval from injury to surgery, and graft choice significantly influence the long-term results of single-bundle PCL reconstructions. Study Design Case series; Level of evidence, 4. Methods Between 1995 and 2001, 22 male and 3 female patients with a mean age of 30.8 years (range, 17-52) underwent an anterolateral bundle reconstruction of the PCL for functional instability and pain. Nine were treated with a bone–patellar tendon– bone autograft (BPTB), 15 with a semitendinosus gracilis (STG) autograft, and 1 with an Achilles tendon allograft. Twenty-two patients were clinically and radiographically reviewed at a mean follow-up of 9.1 years (range, 6.5-12.6). Three patients were interviewed by telephone. Thirteen patients had chondrosis at time of surgery. The mean time from injury to surgery was 1.5 years. Results The mean final International Knee Documentation Committee (IKDC), Lysholm, and functional visual analog scale (VAS) scores (65, 75, and 8, respectively) were fair to good and were significantly better than preoperatively (38, 50, and 4, respectively) (P <. 001). The final Tegner (5.7) score was significantly lower than the preinjury score (7.2) (P <. 001). The mean anteroposterior laxity measured by KT-1000 arthrometer and Telos stress radiographs was significantly increased on the operated side (mean side-to-side difference of 2.1 mm and 4.7 mm, respectively). The functional scores were not significantly different between the BPTB and STG reconstructions. Patients without chondrosis at time of surgery and patients operated within the first year from injury had significantly better functional results at final follow-up (P <. 05). Conclusion Arthroscopically assisted reconstructions of the anterolateral bundle of the PCL in patients with symptomatic isolated grade II to IV PCL-deficient knees lead to significantly improved functional results at long term if there is no cartilage damage at time of surgery. Nonoperative treatment should not be extended more than 1 year from injury. Graft choice did not significantly influence the functional outcome at long term.

Long-term results of scapulothoracic arthrodesis with multiple cable method for facioscapulohumeral dystrophy

2018 ◽  
Vol 100-B (7) ◽  
pp. 953-956 ◽  
Author(s):  
A. Erşen ◽  
A. C. Atalar ◽  
S. Bayram ◽  
M. Demirel ◽  
O. Tunalı ◽  
...  
Keyword(s):  
Functional Results ◽  
Long Term Results ◽  
First Year ◽  
Range Of Movement ◽  
Facioscapulohumeral Dystrophy ◽  
Early Improvement ◽  
Shoulder Flexion ◽  
The Mean

AimsThe present study aimed to investigate the long-term functional results of scapulothoracic fusion using multifilament cables in patients with facioscapulohumeral dystrophy (FSHD) to identify if the early improvement from this intervention is maintained.Patients and MethodsWe retrospectively investigated the long-term outcomes of 13 patients with FSHD (18 shoulders) in whom scapulothoracic fusion using multifilament cables was performed between 2004 and 2007. These patients have previously been reported at a mean of 35.5 months (24 to 87). There were eight men and five women with a mean age of 26 years. Their mean length of follow-up of our current study was 128 months (94 to 185). To evaluate long-term functional results, the range of shoulder flexion and abduction, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores were analyzed with a comparison of preoperatively, interim and at the final outcomes. The fusion was examined radiographically in all.ResultsThe complication rate was 33% (six of 18 scapulothoracic fusions) in 13 patients, which comprised failure of fusion in four shoulders (four patients) all occurring within the first year postoperatively. In two shoulders (one patient) wound problems arose due to attribution from the cables which required shortening but the fusion developed satisfactorily. At the final examination, the mean QuickDASH score and range of movement significantly improved in all but one patient (p < 0.001, p < 0.001 and p < 0.001). In the comparison of 13 patients’ mid- and long-term results, the mean QuickDASH score decreased from 9.8 (sd 6.7; 3 to 26) in the third year to 9.1 (sd 5.6; 3 to 22) in the tenth year (p = 0.7); the mean range of shoulder flexion and abduction decreased from 129° (sd 22°; 90° to 160°) and 124° (sd 12; 100° to 150°) at the mid-term to 103° (sd 12°; 80° to 120°) and 101° (sd 8°; 80° to 120°) at the long-term, respectively (p = 0.78 and p = 0.65).ConclusionScapulothoracic fusion using a multiple cabling method can confer a considerable improvement in clinical and functional outcomes for most patients with FSHD after a long follow-up period. The technique requires careful execution to avoid complications. Cite this article: Bone Joint J 2018;100-B:953–6.

Clinical Experience with a New Nitinol Self-Expanding Stent in Peripheral Arteries

1996 ◽  
Vol 3 (4) ◽  
pp. 369-379 ◽  
Author(s):  
Michel Henry ◽  
Max Amor ◽  
Rafael Beyar ◽  
Isabelle Henry ◽  
Jean-Marc Porte ◽  
...  
Keyword(s):  
Long Term Results ◽  
Lesion Length ◽  
Secondary Patency ◽  
Peripheral Arteries ◽  
External Compression ◽  
Nitinol Stent ◽  
Nitinol Stents ◽  
The Mean

Purpose: To evaluate a new self-expanding nitinol coil stent in stenotic or occluded peripheral arteries. Methods: Seventy-three symptomatic patients (58 men; mean age 67 years) were treated with nitinol stents for lesions in the iliac artery (9 stenoses); superficial femoral artery (SFA) (39 stenoses, 6 occlusions); popliteal artery and tibioperoneal trunk (9 stenoses, 7 occlusions); and 3 bypass grafts. Mean diameter stenosis was 84.4% ± 9.9% (range 75% to 100%), and mean lesion length was 45 ± 23 mm (range 20 to 120 mm). Results: Eighty-eight 40-mm-long stents with diameters between 5 and 8 mm were implanted percutaneously for suboptimal dilation (n = 45); dissection (n = 21); and restenosis (n = 7). All stents but one were implanted successfully; the malpositioned stent was removed, and another stent was successfully deployed. There were 3 (4.1%) failures due to thrombosis at 24 hours. During the mean 16-month follow-up (range to 44 months), 4 restenoses (3 femoral, 1 popliteal) have occurred; 2 were treated with repeat dilation and 2 underwent bypass. Primary and secondary patency rates at 18 months were 87% and 90%, respectively, for all lesions (iliac: 100% for both; femoral: 85% and 88%; popliteal: 87% and 100%). Conclusions: This new nitinol stent seems to be safe and effective with favorable long-term results, even in distal SFA lesions and popliteal arteries. Its flexibility and resistance to external compression allow its placement in tortuous arteries and near joints.

scholarly journals Surgical treatment of pulmonary artery sarcoma: a report of 17 cases

2021 ◽  
Vol 11 (1) ◽  
pp. 204589402098639
Author(s):  
Wu Song ◽  
Long Deng ◽  
Jiade Zhu ◽  
Shanshan Zheng ◽  
Haiping Wang ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Survival Rates ◽  
Tumor Resection ◽  
Long Term Results ◽  
Pulmonary Endarterectomy ◽  
Pulmonary Artery Sarcoma ◽  
The Mean ◽  
Operative Findings

Pulmonary artery sarcoma (PAS) is a rare and devastating disease. The diagnosis is often delayed, and optimal treatment remains unclear. The aim of this study is to report our experience in the surgical management of this disease. Between 2000 and 2018, 17 patients underwent operations for PAS at our center. The medical records were retrospectively reviewed to evaluate the clinical characteristics, operative findings, the postoperative outcomes, and the long-term results. The mean age at operation was 46.0 ± 12.4 years (range, 26–79 years), and eight (47.1%) patients were male. Six patients underwent tumor resection alone, whereas the other 11 patients received pulmonary endarterectomy (PEA). There were two perioperative deaths. Follow-up was completed for all patients with a mean duration of 23.5 ± 17.6 months (1–52 months). For all 17 patients, the median postoperative survival was 36 months, and estimated cumulative survival rates at 1, 2, 3, and 4 years were 60.0%, 51.4%, 42.9%, and 21.4%, respectively. The mean survival was 37.0 months after PEA and 14.6 months after tumor resection only ( p = 0.046). Patients who had no pulmonary hypertension (PH) postoperatively were associated with improved median survival (48 vs. 5 months, p = 0.023). In conclusion, PAS is often mistaken for chronic pulmonary thromboembolism. The prognosis of this very infrequent disease remains poor. Early detection is essential for prompt and best surgical approach, superior to tumor resection alone, and PEA surgery with PH relieved can provide better chance of survival.

scholarly journals Clinical results of the Metha short hip stem: a perspective for younger patients?

2013 ◽  
Vol 5 (4) ◽  
pp. 34 ◽  
Author(s):  
Fritz Thorey ◽  
Claudia Hoefer ◽  
Nima Abdi-Tabari ◽  
Matthias Lerch ◽  
Stefan Budde ◽  
...  
Keyword(s):  
Bone Ingrowth ◽  
Long Term Results ◽  
Harris Hip Score ◽  
Femoral Revision ◽  
Term Survival ◽  
Younger Patients ◽  
The Mean ◽  
Short Stems

In recent years, various uncemented proximal metaphyseal hip stems were introduced for younger patients as a bone preserving strategy. Initial osteodensitometric analyses of the surrounding bone of short stems indicate an increase of bone mass with secondary bone ingrowth fixation as a predictor of long-term survival of these types of implants. We report the outcome of 151 modular Metha short hip stem implants in 148 patients between March 2005 and October 2007. The mean follow-up was 5.8±0.7 years and the mean age of the patients was 55.7±9.8 years. Along with demographic data and co-morbidities, the Harris Hip Score (HHS), the Hip dysfunction and Osteoarthritis Outcome Score (HOOS), and also the results of a patient-administered questionnaire were recorded pre-operatively and at follow-up. The mean HHS increased from 46±17 pre-operatively to 90±5 the HOOS improved from 55±16 pre-operatively to 89±10 at the final follow-up. A total of three patients have been revised, two for subsidence with femoral revision and one for infection without femoral revision (Kaplan Meier survival estimate 98%). The radiological findings showed no radiolucent lines in any of the patients. The modular Metha short hip stem was implanted in younger patients, who reported an overall high level of satisfaction. The clinical and radiographic results give support to the principle of using short stems with metaphyseal anchorage. However, long-term results are necessary to confirm the success of this concept in the years to come.

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