Difference in Carpal Alignment between Scapholunate Dissociation and Kienbock Disease: A Retrospective Study

2020 ◽  
Author(s):  
Masahiro Tatebe ◽  
Akimasa Morita ◽  
Toshikazu Kurahashi ◽  
Hitoshi Hirata
Keyword(s):  
Retrospective Study ◽  
Ligament Reconstruction ◽  
Scapholunate Dissociation ◽  
Carpal Collapse ◽  
Interosseous Ligament ◽  
Frequent Type ◽  
Wrist Instability ◽  
Arthroscopic Findings ◽  
Kienböck Disease ◽  
The Sacrifice

Abstract Introduction Scapholunate dissociation is the most frequent type of wrist instability and, if untreated, can lead to wrist osteoarthritis, known as scapholunate advanced collapse. Kienbock disease can also lead to wrist osteoarthritis. Both involve carpal instability; however, the possibility of completely different mechanisms underlying each ligamentous state and carpal malalignment must be considered. Materials and Methods We retrospectively reviewed 17 patients with scapholunate dissociation and 14 patients with Kienbock disease. All arthroscopic findings for scapholunate dissociation were classified as Geissler grade 4. All cases of Kienbock disease were treated by lunate resection and vascularized pisiform transfer without interosseous ligament reconstruction. Carpal alignments were evaluated from pre- and postoperative radiographs. Results Scapholunate dissociation showed greater lunate dorsiflexion and more dorsal locations of the scaphoid and capitate compared with Kienbock disease, but preoperative scaphoid flexion was similar in both groups. Eleven of 17 cases of scapholunate dissociation and no cases of Kienbock disease showed dorsal subluxation of the scaphoid preoperatively. Postoperative radiographs revealed no progression of carpal collapse in either groups. Conclusion This study revealed the sacrifice of the scapholunate/lunotriquetral interosseous ligament do not incur static scapholunate dissociation, and that the secondary stabilizers may preserve carpal alignment.

scholarly journals Kinematic analysis of two scapholunate ligament reconstruction techniques

2021 ◽  
Vol 29 (2) ◽  
pp. 230949902110258
Author(s):  
Seungbum Chae ◽  
Junho Nam ◽  
Il-Jung Park ◽  
Steven S. Shin ◽  
Michelle H. McGarry ◽  
...  
Keyword(s):  
Kinematic Analysis ◽  
Clinical Relevance ◽  
Ligament Reconstruction ◽  
Operative Time ◽  
Efficient Technique ◽  
Scapholunate Ligament ◽  
Interosseous Ligament ◽  
Flexion Extension

Purpose: This study compares the kinematic changes after the procedures for scapholunate interosseous ligament (SLIL) reconstruction—the modified Brunelli technique (MBT) and Mark Henry’s technique (MHT). Methods: Ten cadaveric wrists were used. The scapholunate (SL) interval and angle and radiolunate (RL) angle were recorded using the MicroScribe system. The SL interval was measured by dividing the volar and dorsal portions. Four motions of the wrist were performed—neutral, flexion, extension, and clenched fist (CF) positions—and compared among five conditions: (1) intact wrist, (2) volar SLIL resection, (3) whole SLIL resection, (4) MBT reconstruction, and (5) MHT reconstruction. Results: Under the whole SLIL resection condition, the dorsal SL intervals were widened in all positions. In all positions, the dorsal SL intervals were restored after MBT and MHT. The volar SL interval widened in the extension position after volar SLIL resection. The volar SL interval was not restored in the extension position after MBT and MHT. The SL angle increased in the neutral and CF positions under the whole SLIL resection condition. The SL angle was not restored in the neutral and CF positions after MBT and MHT. The RL angle increased in the neutral and CF positions under the whole SLIL resection condition. The RL angle was not restored in the neutral and CF positions after MBT and MHT. Conclusion: The MBT and MHT may restore the dorsal SL interval. No significant differences in restoration of the SL interval between MBT and MHT were found in the cadaveric models. Clinical relevance: No significant differences between MBT and MHT were found in the cadaveric models for SLIL reconstruction. When considering the complications due to volar incision and additional procedures in MHT, MBT may be a more efficient technique in terms of operative time and injury of the anterior structures during surgery, but further research is needed.

Fever of unknown origin in the elderly: nine years experience in China

2008 ◽  
Vol 38 (4) ◽  
pp. 221-222 ◽  
Author(s):  
Minghua Zheng ◽  
Hailong Lin ◽  
Sheng Luo ◽  
Lihua Xu ◽  
Yanjun Zeng ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Connective Tissue ◽  
Connective Tissue Disease ◽  
Older Patients ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
The Elderly ◽  
Medical College ◽  
Frequent Type ◽  
Wenzhou Medical College

This is a retrospective study of older patients admitted to the First and Second Affiliated Hospitals of Wenzhou Medical College, China, with a diagnosis of fever of unknown origin. The study took place from January 1998 to December 2006 among 102 patients who fulfilled the criteria. Infections were responsible for 50 cases (49.1%), followed by no diagnosis in 27 (26.5%), miscellaneous in nine (8.8%), neoplasms in eight (7.8%) and connective tissue disease in another eight (7.8%). Mycobacterium TB was the most frequent type of infection diagnosed.

scholarly journals Hidden Long Head of the Biceps Tendon Instability and Concealed Intratendinous Subscapularis Tears

2020 ◽  
Vol 8 (1) ◽  
pp. 232596711989812
Author(s):  
Sang Hoon Chae ◽  
Tae Wan Jung ◽  
Sang Hyeon Lee ◽  
Myo Jong Kim ◽  
Seung Min Park ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Predictive Value ◽  
Scoring System ◽  
Biceps Tendon ◽  
Arthroscopic Surgery ◽  
Subscapularis Tendon ◽  
Tendon Tear ◽  
Cutoff Value ◽  
Subscapularis Tendon Tear ◽  
Arthroscopic Findings

Background: Few studies have described the characteristics of a concealed intratendinous subscapularis tear (CIST), and there is a lack of research on the preoperative predictability of such lesions. Purpose: To describe the characteristics of a CIST as seen on magnetic resonance imaging (MRI) and intraoperatively and to develop a scoring system for predicting such lesions. Study Design: Case series; Level of evidence, 4. Methods: Retrospectively, we identified 43 patients with CISTs among 442 consecutive patients who had undergone rotator cuff repair from July 2014 to June 2016. Range of motion, visual analog scale results for pain and function, and patient-reported outcome scores were evaluated preoperatively and at 1 and 2 years postoperatively. CISTs were classified arthroscopically as small (<5 mm), medium (5-10 mm), and large (>10 mm). We performed repair (≥50%) or debridement (<50%) depending on the total subscapularis tendon tear size including the CIST. Preoperative MRI findings were analyzed by 2 observers and were correlated with the arthroscopic findings. A 10-point scoring system was developed based on characteristics during the physical examination (anterior tenderness, bear hug sign), MRI (biceps tendon displacement and subluxation, subscapularis signal change just lateral to the lesser tuberosity), and arthroscopic surgery (medial biceps tendon lesion, combined subscapularis tendon tear), with a cutoff value of ≥7 predicting a CIST. After the retrospective study, we prospectively enrolled 95 patients to validate the 10-point CIST scoring system. Results: All 43 patients diagnosed with a CIST during the retrospective study improved both range of motion and functional scores at 1 year postoperatively. The interrater agreement of the 2 observers was substantial for the evaluation of all parameters except for subscapularis tear classification, which was moderate. On arthroscopic surgery, 11 small, 19 medium, and 13 large CISTs were detected. The preliminary prospective study showed a sensitivity of 61.9%, specificity of 94.3%, positive predictive value of 89.0%, negative predictive value of 75.7%, and accuracy of 80.0% when the cutoff value was set at ≥7 on the CIST scoring system. Conclusion: A CIST can be suspected using a combination of preoperative MRI and intra-articular diagnostic arthroscopic findings, but a definitive diagnosis requires an arthroscopic view. On the 10-point CIST scoring system, a score of ≥5 can be suggestive of a CIST, and a score of ≥7 is most likely to predict a CIST.

Dorsal Capsular Defect and Synovial Fistula to the Fourth Extensor Compartment: A Late Complication after Arthroscopic Dorsal Wrist Ganglionectomy

2018 ◽  
Vol 23 (03) ◽  
pp. 404-407
Author(s):  
Ines C. Lin ◽  
Alexander Y. Shin ◽  
Allen T. Bishop
Keyword(s):  
Open Surgery ◽  
Ligament Reconstruction ◽  
Late Complication ◽  
Wrist Pain ◽  
Safe Procedure ◽  
Recurrence Rates ◽  
Arthroscopic Findings ◽  
Extensor Compartment ◽  
Capsular Defect

Arthroscopic dorsal wrist ganglionectomy is demonstrably a safe procedure with recurrence rates comparable to open surgery. We present a patient with wrist pain following arthroscopic ganglion excision. MRI and arthroscopic findings showed a large dorsal capsular defect, synovial fistula to the fourth extensor compartment, and dorsal radiocarpal ligament resection. Ligament reconstruction and capsular imbrication resolved her symptoms. We postulate that this complication resulted from a large capsular resection. Because we feel that it can be difficult to judge the size of the debridement through an arthroscope, the need for adequate capsular resection in dorsal wrist ganglionectomy needs to be balanced by consideration of potential complications from more aggressive capsular debridement, and thus we feel that capsular resection should be limited to no more than 1 cm2.

Comparison of Normal Capitate Mid-Carpal Joint Mechanics With the Effects of Scapholunate Dissociation Injury

2011 ◽  
Author(s):  
Madhan Sai Kallem ◽  
Sang-Pil Lee ◽  
Terence E. McIff ◽  
E. Bruce Toby ◽  
Kenneth J. Fischer
Keyword(s):  
Contact Mechanics ◽  
Surgical Techniques ◽  
Ligament Injury ◽  
Joint Mechanics ◽  
Scapholunate Dissociation ◽  
Carpal Collapse ◽  
Contact Patterns ◽  
Carpal Joint ◽  
Slac Wrist

The wrist is one of the most complicated multibody joints in the human body. It can be subject to many injuries. Scapholunate (SL) dissociation is a relatively common injury that is particularly difficult to diagnose and treat. Without treatment, SL dissociation is known to progress to scapholunate advance collapse (SLAC wrist) and associated osteoarthritis (OA) [1]. Traumatic arthropathy of the wrist due to scapholunate dissociation has a definitive pattern from onset to severe bone and joint degeneration. The altered radiocarpal and SL mechanics with SL dissociation may be accompanied by a secondary carpal collapse between the capitate and lunate [2]. The initial SL disruption causes apparent changes in joint kinematics and contact patterns. Thus, understanding normal and abnormal in vivo contact mechanics as a result of SL ligament injury may lead to more effective treatments that may even prevent the onset of OA. In addition, in vivo contact mechanics data after surgical treatment may help determine the effectiveness of various surgical techniques which are used to correct SL injury.

Sign in / Sign up

Export Citation Format

Share Document