The Die Punch Fragment: Analysis of Fragment Geometry and Need for Fixation

2020 ◽  
Author(s):  
Sezai Özkan ◽  
Svenna H. W. L. Verhiel ◽  
Samantha A. Jayasinghe ◽  
Chaitanya S. Mudgal
Keyword(s):  
Fragment Size ◽  
Distal Radioulnar Joint ◽  
Dorsal Approach ◽  
Level Of Evidence ◽  
Locked Plating ◽  
Fragment Analysis ◽  
Number Of Patients ◽  
Preoperative Ct ◽  
Type C ◽  
The Mean

Abstract Introduction Die punch (DP) fragments are among the most common fracture fragments to lose reduction after volar locked plating of articular distal radius fractures (DRFs). We aimed to report the number of patients in our institution who had a computed tomography (CT)-confirmed DP fragment and who had open reduction and internal fixation (ORIF) through a dorsal approach; to report the length of the radioulnar portion of the DP fragment relative to the total distal radioulnar joint (DRUJ) length; and to identify if an association exists between this length and the choice for a volar versus a dorsal operative approach to the DP fragment. Materials and Methods We performed measurements on the preoperative CT scans of 94 skeletally mature patients with a DP fragment. We also collected data related to their demographics, injury, and treatment. Of the 94 patients in this study, 84 (89%) had AO type C fractures. Results Thirteen out of 94 patients (14%) who had ORIF of their DRF with a DP fragment had a separate dorsal incision. The mean proportion of the DP fragment length relative to the total DRUJ length was 0.51 ± 0.19. There was no association between the length of the DP fragment and volar versus dorsal approach. Conclusion DP fragment size is not an indicator of the need for or use of a dorsal approach in DRF fixation. Level of Evidence This is a Level IV,—retrospective study.

scholarly journals Proximal Horizontal Flap Tears of TFCC Diagnosed by Computed Tomography Arthrography: Six Case Series

2020 ◽  
Author(s):  
Sayuri Arimitsu ◽  
Takashi Masatomi ◽  
Atsuo Shigi ◽  
Chikako Yukioka ◽  
Hisao Moritomo
Keyword(s):  
Computed Tomography ◽  
Corrective Osteotomy ◽  
Case Series ◽  
Clinical Results ◽  
Distal Radioulnar Joint ◽  
Level Of Evidence ◽  
Ct Arthrography ◽  
Articular Disk ◽  
Preoperative Ct ◽  
The Mean

Abstract Background Proximal horizontal tears of the triangular fibrocartilage complex (TFCC) represent the tears at the proximal surface of the articular disk with a normal appearance of the distal surface. Preoperative diagnosis of TFCC flap tears is challenging. Objectives This report aims to present a diagnostic method using computed tomography (CT) arthrography for the proximal horizontal flap tears of the TFCC and to report our clinical outcomes. Patients and Methods Six patients were included who were preoperatively suspected to have proximal horizontal flap tears of the TFCC via CT arthrography. Arthrography was conducted by injecting dye into the distal radioulnar joint (DRUJ), and CT images were obtained immediately following arthrography. We performed arthroscopic or direct flap debridement with concomitant surgeries: ulnar shortening with positive ulnar variance and corrective osteotomy with the malunion following distal radius fracture. Results Preoperative CT arthrography clearly revealed the flaps to be flipped over toward the radiopalmar side of the DRUJ in four cases and a teardrop-shaped dye defect in two. We were able to identify the dislocated flap by arthroscopy avulsed from the proximal aspect of the articular disk within the DRUJ in all six cases. The mean pain level decreased from 10 preoperatively to 0.3 postoperatively on the visual analog scale. The mean patient-rated wrist evaluation score decreased from 43.5 preoperatively to 11.2 postoperatively. Conclusions Our study shows that CT arthrography can be a promising method for diagnosing proximal horizontal flap tears of the TFCC. Debridement of the flaps and concomitant surgeries showed satisfactory clinical results. Level of Evidence This is a Level 4, diagnosis study.

Range of Motion after the Sauvé–Kapandji and Darrach Procedures without Extensor Tendon Rupture

2020 ◽  
Author(s):  
Tomoyuki Kato ◽  
Taku Suzuki ◽  
Makoto Kameyama ◽  
Masato Okazaki ◽  
Yasushi Morisawa ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Tendon Rupture ◽  
Extensor Tendon ◽  
Distal Radioulnar Joint ◽  
Wrist Flexion ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
The Mean ◽  
Therapeutic Study ◽  
Loss Of Motion

Abstract Background Previous study demonstrated that distal radioulnar joint (DRUJ) plays a biomechanical role in extension and flexion of the wrist and suggested that fixation of the DRUJ could lead to loss of motion of the wrist. Little is known about the pre- and postoperative range of motion (ROM) after the Sauvé–Kapandji (S-K) and Darrach procedures without tendon rupture. To understand the accurate ROM of the wrist after the S-K and Darrach procedures, enrollment of patients without subcutaneous extensor tendon rupture is needed. Purpose This study aimed to investigate the pre- and postoperative ROM after the S-K and Darrach procedures without subcutaneous extensor tendon rupture in patients with rheumatoid arthritis (RA) and osteoarthritis (OA). Methods This retrospective study included 36 patients who underwent the S-K procedure and 10 patients who underwent the Darrach procedure for distal radioulnar joint disorders without extensor tendon rupture. Pre- and postoperative ROMs after the S-K and Darrach procedures were assessed 1 year after the surgery. Results In the S-K procedure, the mean postoperative ROM of the wrist flexion (40 degrees) was significantly lower than the mean preoperative ROM (49 degrees). In wrist extension, there were no significant differences between the mean preoperative ROM (51 degrees) and postoperative ROM (51 degrees). In the Darrach procedure, the mean postoperative ROM of the wrist flexion and extension increased compared with the mean preoperative ROM; however, there were no significant differences. Conclusion In the S-K procedure, preoperative ROM of the wrist flexion decreased postoperatively. This study provides information about the accurate ROM after the S-K and Darrach procedures. Level of Evidence This is a Level IV, therapeutic study.

Acute blocking of forearm supination secondary to tearing of the triangular fibrocartilage complex

2020 ◽  
Vol 45 (9) ◽  
pp. 939-944
Author(s):  
Taku Suzuki ◽  
Toshiyasu Nakamura ◽  
Yoshihiko Tanino ◽  
Yukihiko Obara ◽  
Yasuhiro Yoshikawa ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Arthroscopic Surgery ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Minor Trauma ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
Open Operation ◽  
Triangular Fibrocartilage ◽  
The Mean

We studied the characteristics of acute blocking of supination of the distal radioulnar joint caused by triangular fibrocartilage complex injuries. Twenty-four patients who were treated for acute blocking of supination were retrospectively assessed. Supination was suddenly blocked after minor trauma to the wrist. Active and passive supination was severely restricted with a mean preoperative range of motion (11°), whereas pronation was almost normal. The cause was identified arthroscopically or at open operation. It was found to be a result of avulsion of the dorsal or palmar portion of the radioulnar ligament, which blocked movement of the ulnar head. Blocking was reduced manually in four cases, by arthroscopic surgery in eight cases and by open surgery in 12 cases. After treatment, forearm supination improved to 84° of the mean range of motion. Distal radioulnar joint blocking from a ruptured triangular fibrocartilage complex should be considered in the differential diagnosis of loss of forearm supination. Level of evidence: IV

Clinical and radiological results of distal radioulnar joint arthroplasty with the Aptis prosthesis

2021 ◽  
pp. 175319342110636
Author(s):  
Delphine Lambrecht ◽  
Wim Vanhove ◽  
Nadine Hollevoet
Keyword(s):  
Distal Radioulnar Joint ◽  
Mean Value ◽  
Joint Arthroplasty ◽  
Wrist Flexion ◽  
Previous Surgery ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
The Mean ◽  
Clinical And Radiological Results

We report the results of the treatment of disorders of the distal radioulnar joint with the semi-constrained Aptis prosthesis. Nineteen patients were assessed at a mean follow-up of 7 years. All patients had been operated on previously at the wrist, forearm or elbow. The Disabilities of Arm, Shoulder and Hand score had a mean value of 40, the Patient-Rated Wrist Evaluation score had a mean of 49 and the visual analogue scale for pain had a mean of 3.9. The mean ranges of pronation, supination, wrist flexion and wrist extension were 78°, 76°, 60° and 51°, respectively. The mean grip strength was 23 kg. Complications were noted in ten patients. Eighteen patients would undergo the operation again. The 10-year cumulative survival rate was 84%. The Aptis prosthesis may be a solution to treat patients in whom previous surgery at the distal radioulnar joint has failed. Level of evidence: IV

Plantar Plate Repair for Lesser Metatarsophalangeal Joint Instability

2016 ◽  
Vol 38 (3) ◽  
pp. 234-242 ◽  
Author(s):  
Wesley W. Flint ◽  
David M. Macias ◽  
James R. Jastifer ◽  
Jesse F. Doty ◽  
Christopher B. Hirose ◽  
...  
Keyword(s):  
Joint Instability ◽  
Case Series ◽  
Metatarsophalangeal Joint ◽  
Retrospective Case ◽  
Dorsal Approach ◽  
Level Of Evidence ◽  
Plantar Plate ◽  
Radiographic Outcomes ◽  
Pull Out ◽  
The Mean

Background: Lesser metatarsophalangeal (MTP) joint instability is a common cause of forefoot pain. Advances in operative technique and instrumentation have made it possible to anatomically treat plantar plate tears through a dorsal approach. Our goal was to evaluate the subjective, functional, and radiographic outcomes of plantar plate repair (PPR) from a dorsal approach. Methods: A prospective case series was performed evaluating the results of PPR in 97 feet with 138 plantar plate tears. Patients underwent PPR from a dorsal approach with a Weil osteotomy. We followed patients at regular intervals for 12 months and collected data preoperatively and postoperatively with respect to visual analog scale (VAS) scores, MTP range of motion (ROM), paper pull-out test, American Orthopaedic Foot & Ankle Society (AOFAS) scores, satisfaction, and radiographic measures. Results: Eighty percent of patients scored “good” to “excellent” satisfaction scores at 12 months. The mean VAS pain score preoperatively was 5.4/10, and postoperatively was 1.5/10. The mean AOFAS scores increased from 49 to 81 points following surgery. The mean MTP ROM preoperatively was 43 degrees and postoperatively 31 degrees. Forty-two percent of toes passed the paper pull out test prior to surgery and 54% at 12 months. Mean metatarsal shortening was 2.4/3.1/1.2 mm for the second, third, and fourth metatarsals, respectively. The mean MTP joint angles preoperatively were 2/4.9/–1.3 degrees and postoperatively were 7.4/9.6/0.2 degrees, respectively, for the second, third, and fourth MTP joints. Conclusion: We found that the plantar plate could be repaired through a dorsal approach with reliable outcomes. PPR was a viable option to anatomically restore the ligamentous support in the unstable lesser MTP joint. Level of Evidence: Level IV, retrospective case series.

Role of Rotation in Total Ankle Replacement

2019 ◽  
Vol 40 (12) ◽  
pp. 1358-1367 ◽  
Author(s):  
Ali-Asgar Najefi ◽  
Yaser Ghani ◽  
Andy Goldberg
Keyword(s):  
Pearson Correlation ◽  
Axial Rotation ◽  
Total Ankle Replacement ◽  
Ct Scans ◽  
Tibial Torsion ◽  
Level Of Evidence ◽  
Ankle Replacement ◽  
Preoperative Ct ◽  
The Mean ◽  
Foot Position

Background: The importance of total ankle replacement (TAR) implant orientation in the axial plane is poorly understood with major variation in surgical technique of implants on the market. Our aim was to better understand the axial rotational profile of patients undergoing TAR. Methods: In 157 standardized computed tomography (CT) scans of patients with end-stage ankle arthritis planning to undergo primary TAR surgery, we measured the relationship between the knee posterior condylar axis, the tibial tuberosity, the transmalleolar axis (TMA), and the tibiotalar angle. The foot position was measured in relation to the TMA with the foot plantigrade. The variation between the medial gutter line and the line bisecting both gutters was assessed. Results: The mean external tibial torsion was 34.5 ± 10.3 degrees (11.8-62 degrees). When plantigrade, the mean foot position relative to the TMA was 21 ± 10.6 degrees (0.7-38.4 degrees) internally rotated. As external tibial torsion increased, the foot position became more internally rotated relative to the TMA (Pearson correlation, 0.6; P < .0001). As the tibiotalar angle became more valgus, the foot became more externally rotated relative to the TMA (Pearson correlation, −0.4; P < .01). The mean difference between the medial gutter line and a line bisecting both gutters was 4.9 ± 2.8 degrees (1.7-9.4 degrees). More than 51% of patients had a difference greater than 5 degrees. The mean angle between the medial gutter line and a line perpendicular to the TMA was 7.5 ± 2.6 degrees (2.8-13.7 degrees). Conclusion: There was a large variation in rotational profile of patients undergoing TAR, particularly between the medial gutter line and the TMA. Surgeon designers and implant manufacturers should develop consistent methods to guide surgeons toward judging the appropriate axial rotation of their implant on an individual basis. We recommend careful clinical assessment and preoperative CT scans to enable the correct rotation to be determined. Level of Evidence: Level IIc, outcomes research.

Results of External Fixation and Metatarsophalangeal Joint Fixation With K-Wire in Brachymetatarsia

2018 ◽  
Vol 39 (8) ◽  
pp. 942-948 ◽  
Author(s):  
Víctor Manuel Peña-Martínez ◽  
Dionisio Palacios-Barajas ◽  
Juan Carlos Blanco-Rivera ◽  
Ángel Arnaud-Franco ◽  
Jorge Alberto Elizondo-Rodríguez ◽  
...  
Keyword(s):  
External Fixator ◽  
Average Length ◽  
Case Series ◽  
Metatarsophalangeal Joint ◽  
Healing Time ◽  
Bone Lengthening ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Number Of Patients ◽  
The Mean

Background: Brachymetatarsia is a rare foot deformity caused by the premature closure of the metatarsal physis. It may result in functional as well as cosmetic alterations, which may require operative management. Methods: A prospective study examining outcomes of 48 cases of brachymetatarsia with gradual bone lengthening at a rate of 1 mm/d using an external fixator and metatarsophalangeal joint fixation was performed. The difference between the length before treatment and after external fixator removal was measured. The patients were assessed at 2, 4, 6, and 8 weeks postoperatively; at the end of the period of distraction; and 1 year after surgery. The total number of patients was 26, and surgery was performed in 48 metatarsals. The mean age was 17.0 ± 4.1 (range, 11-24) years, and all were female. Results: The fourth metatarsal was the most frequently affected, representing 98% of the cases; the third metatarsal represented the other 2%. The average length gained was 18.6 ± 6.7 mm, and the average length gained as a proportion of the original metatarsal length was 38.2% ± 3.1% (range, 13%-24%). The mean healing time was 71.0 (range, 64-104) days, and the mean healing index (healing time divided by centimeters of length gained [d/cm]) was 38.4 (range, 38.2-50.1) d/cm. Conclusion: Gradual bone lengthening at a rate of 1 mm/d using an external fixator and intramedullary nailing was a safe and efficient method, representing a minimally invasive procedure with a low incidence of complications and satisfactory results for the patient. Level of Evidence: Level IV, retrospective case series.

scholarly journals Prophylactic Peritoneal Fenestration during Kidney Transplantation Can Reduce the Type C Lymphocele Formation

2021 ◽  
Vol 10 (23) ◽  
pp. 5651
Author(s):  
Mohammad Golriz ◽  
Mohammadsadegh Sabagh ◽  
Golnaz Emami ◽  
Sara Mohammadi ◽  
Ali Ramouz ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Data Bank ◽  
Digital Data ◽  
Preventive Effect ◽  
Routine Procedure ◽  
Number Of Patients ◽  
Different Types ◽  
Recipient Age ◽  
Type C ◽  
The Mean

Lymphocele is a common complication following kidney transplantation (KTx). We aimed to evaluate the preventive effect of peritoneal fenestration during KTx in reducing lymphocele. From January 2001, the data of all KTx were prospectively gathered in our digital data bank. From 2008, preventive peritoneal fenestration was performed as a routine procedure for all patients with KTx. Between 2001 and 2008, 579 KTx were performed without preventive peritoneal fenestration. To compare the results between with and without peritoneal fenestration, the same number of patients after 2008 (579 patients) was included in this study. The pre-, intra-, and postoperative data of the patients in these two groups were analyzed and compared, especially regarding the postoperative different types of lymphocele formation. The mean recipient age was 52.6 ± 13.8, and 33.7% of the patients were female. Type C lymphocele was significantly lower in the group with preventive fenestration (5.3% vs. 8.8%, p = 0.014 for 31/579 vs. 51/579). Peritoneal dialysis and implantation of the kidney in the left fossa were independently associated with a higher rate of type C lymphocele (OR 2.842, 95% CI 1.354–5.967, p = 0.006 and OR 3.614, 95% CI 1.215–10.747, p = 0.021, respectively). The results of this study showed that intraoperative preventive peritoneal fenestration could significantly reduce type C lymphocele.

scholarly journals Complications of Volar Locked Plating of Distal Radius Fractures: A Prospective Investigation of Modern Techniques

Hand ◽  
2019 ◽  
Vol 15 (5) ◽  
pp. 698-706
Author(s):  
Tyler S. Pidgeon ◽  
Peter Casey ◽  
Rita E. Baumgartner ◽  
Harrison Ferlauto ◽  
David S. Ruch
Keyword(s):  
Distal Radius ◽  
Complication Rate ◽  
Nonoperative Treatment ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Locked Plating ◽  
Type C ◽  
The Mean ◽  
Removal Of Hardware

Although volar locked plating (VLP) of distal radius fractures is common, complications remain a considerable concern for upper extremity specialists using modern techniques. Complications following VLP of DR fractures were recorded prospectively from January 2005 to January 2017. Fractures were characterized using the AO classification, and complications were described by severity. Severe complications required operative treatment and/or resulted in permanent impairment, moderate complications required nonoperative treatment, and mild complications resolved without intervention. The available Current Procedural Terminology data for uncomplicated VLP were used to calculate the complication rate. Statistical analysis compared severe and nonsevere complications. Thirty-seven patients (27 women; 39 radii) experienced complications following VLP of DR fractures, resulting in a complication rate of 13.2%. For those with complications, the mean age was 48.5 ± 13.5 years (range: 19-78 years) and the mean follow-up was 13.7 ± 9.0 months (range: 3-36 months). A majority (28/39: 71.8%) had type C fractures. The most common complications were hardware complication requiring removal (18) and malunion (6). There were only 3 tendon ruptures. There were 25 unplanned returns to the operating room in 24 radii (22 patients). The most common reason was removal of hardware (18). Patients with severe complications more commonly had AO type C fractures and required longer follow-up. Modern VLP of DR fractures has a complication rate of 13.2%. Hardware complication requiring removal was the most notable complication of VLP. Tendon rupture has become rare with modern techniques. AO type C fractures were associated with more severe complications.

Arthroscopic one-tunnel transosseous reconstruction of chronic triangular fibrocartilage complex foveal tears: outcomes in 12 patients

2021 ◽  
pp. 175319342110568
Author(s):  
Wen Zhang ◽  
Peng Hou ◽  
Chunyang Wang ◽  
Tianyi Wu ◽  
Pak-Cheong Ho ◽  
...  
Keyword(s):  
Distal Radioulnar Joint ◽  
Tendon Graft ◽  
Bone Tunnel ◽  
Triangular Fibrocartilage Complex ◽  
Exit Point ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
Improved Stability ◽  
Triangular Fibrocartilage ◽  
The Mean

We report the surgical method and outcomes of a simple arthroscopic-assisted technique of repairing triangular fibrocartilage complex (TFCC) foveal injuries in 12 patients with chronic distal radioulnar joint instability. An ulnar transosseous tunnel was created with its distal exit point located 3 to 4 mm radial to the fovea. A tendon graft was cut into two parts, and both were then passed through the bone tunnel to secure the radioulnar ligament remnants back to the fovea in a ‘V’ shape configuration. At the final follow-up of 13 to 26 months (average 21), all patients had a reduction of wrist pain, with the mean visual analogue scale dropped from 4.6 to 1.6 out of 10. The distal radioulnar joint was completely stable in nine patients and had improved stability in three patients. The mean Mayo modified wrist scores improved from 72 to 89, and the clinical outcomes were excellent in four patients, good in seven and fair in one. No major surgical complications occurred. This simple arthroscopic one-tunnel transosseous approach is effective for chronic foveal tears of the TFCC with intact radioulnar ligament remnants. Level of evidence: IV

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