Radiographic Landmarks for Ideal Port Placement in Wrist Arthroscopy

2021 ◽  
Author(s):  
Jacob Thayer ◽  
Greg Lee ◽  
Brian Mailey
Keyword(s):  
Soft Tissue ◽  
Carpal Bone ◽  
Wrist Arthroscopy ◽  
Radiographic Imaging ◽  
Port Placement ◽  
Anatomic Landmarks ◽  
Extensor Tendons ◽  
Ulnar Aspect ◽  
Radiographic Landmarks ◽  
Portal Placement

Abstract Background The placement of wrist arthroscopy portals is traditionally performed using distances from anatomic landmarks. We sought to evaluate the safety of traditional portal placement and determine if radiographic landmarks could provide an additional method of identifying tendon intervals. Methods Six cadaveric specimens were used to evaluate the accuracy of portal placement based on anatomic and radiographic landmarks. Fluoroscopic images were used to document the location of previously described surface landmarks. Soft tissue was dissected away to identify the relationship between the transcutaneously placed portals and the extensor tendons. With soft tissue removed, tendon intervals were identified in relationship to anatomic carpal bone landmarks, and interval distances measured. Portals were then placed under radiographic imaging on the final three specimens and accuracy was examined by the removal of overlying soft tissue to confirm accurate interval placement Results The 3,4 portal was safely placed using only surface anatomic landmarks, however the 4,5 and midcarpal ulnar (MCU) portal sites were not consistently placed in the intended tendon interval, especially in larger wrists. Radiographic interval targets for the 3,4 portal were identified at the ulnar aspect of the scaphoid and the 4,5 portal at the ulnar one-third of the lunate. The radiographic site for the MCR was located at the inferior radial one-third of the capitate and the MCU portal was located at the radial aspect of the hamate. The 6R portal radiographic landmark is at the radial aspect of the triquetrum and 6U at the ulnar aspect of the triquetrum. Conclusion Portal placement in wrist arthroscopy based on anatomic landmarks alone can be unreliable in larger wrists. Radiographic imaging based on carpal bone landmarks provides an additional tool for consistent placement of portals in wrist arthroscopy and may limit unintended injury to extensor tendons. Level of Evidence This is a Level VI study.

The Carpal Detachment Injury of the Triangular Fibrocartilage Complex

2002 ◽  
Vol 27 (1) ◽  
pp. 86-89 ◽  
Author(s):  
S. NISHIKAWA ◽  
S. TOH ◽  
H. MIURA ◽  
K. ARAI
Keyword(s):  
Soft Tissue ◽  
Conservative Therapy ◽  
Articular Surface ◽  
Triangular Fibrocartilage Complex ◽  
Wrist Arthroscopy ◽  
Ulnar Side ◽  
Arthroscopic Findings ◽  
Triangular Fibrocartilage

Triangular fibrocartilage complex (TFCC) injuries were suspected clinically in 22 wrists of 21 patients, but arthrography and MRI assessments of this structure were normal. As conservative therapy for 2 months did not improve their symptoms, wrist arthroscopy was then performed. Although no abnormalities of the TFCC and ligaments were observed, meniscus homologue-like tissue which arose from TFCC was riding on the articular surface of the triquetrum. After resection of this soft tissue with a shaver and a punch, the symptoms disappeared in all cases. The arthroscopic findings suggested that a portion of TFCC that was originally attached to the ulnar side of the triquetrum had become detached.

Measuring Visualized Tendon Length in Peroneal Tendoscopy

2018 ◽  
Vol 39 (8) ◽  
pp. 990-993 ◽  
Author(s):  
Michael Hull ◽  
John T. Campbell ◽  
Clifford L. Jeng ◽  
R. Frank Henn ◽  
Rebecca A. Cerrato
Keyword(s):  
Kirschner Wires ◽  
Anatomic Landmarks ◽  
Muscle Belly ◽  
Peroneal Tendons ◽  
Portal Site ◽  
Peroneus Longus ◽  
First Metatarsal ◽  
Tendon Length ◽  
Peroneus Brevis ◽  
Portal Placement

Background: Despite multiple studies outlining peroneal tendoscopy, no study exists to evaluate how effective tendoscopy is at visualizing the peroneal tendons without missing a lesion. We sought to measure the length of the peroneal tendons that could be visualized using tendoscopy. Methods: Ten fresh cadaveric specimens were evaluated using standard peroneal tendoscopy techniques. Peroneus longus and brevis tendons were pierced percutaneously with Kirschner wires at the edge of what could be seen through the camera. The tendon sheaths were then dissected and the distances from anatomic landmarks were directly measured. During zone 3 peroneus longus tendoscopy, a more distal portal site was created for the final 5 specimens. Results: The peroneus brevis could be visualized through the entirety of zone 1 and up to an average of 19.5 mm (95% confidence interval, 16.5-22.5) from its insertion onto the base of the fifth metatarsal in zone 2. Peroneus longus could be visualized through the entirety of zones 1 and 2 and up to an average of 9.7 mm from its insertion onto the base of the first metatarsal in zone 3. This distance was decreased significantly with a more distal portal. The muscle belly of peroneus brevis terminated an average of 1.8 mm (–3.7 to 7.3) above the tip of the lateral malleolus. Conclusions: Despite limitations, these results suggest that the vast majority of the length of the peroneal tendons can be seen during routine peroneal tendoscopy. A more distal skin portal site may improve visualization of zone 3 of peroneus longus. Clinical Relevance: This study confirms the ability of peroneal tendoscopy to see the entire tendon length with appropriate portal placement.

scholarly journals Review of Use of Amniotic Membrane Allograft in Total Ankle Replacements

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0022
Author(s):  
Andrew Horn ◽  
Jeremy Saller ◽  
Daniel Cuttica ◽  
Steven Neufeld
Keyword(s):  
Soft Tissue ◽  
Amniotic Membrane ◽  
Wound Dehiscence ◽  
Extensor Tendon ◽  
Total Ankle Replacement ◽  
Wound Complications ◽  
Split Thickness Skin Graft ◽  
Medical Comorbidities ◽  
Extensor Tendons ◽  
Ankle Replacement

Category: Ankle Arthritis Introduction/Purpose: Wound complications after total ankle replacement (TAR) lead to increased postoperative morbidity with lasting consequences. Previous studies demonstrate delayed wound healing in 6.6% to 28% of all TARs. Soft tissue breakdown along the anterior incision can cause exposure of anterior tendons and the implants. In addition, adhesions of the extensor tendons can develop causing significant morbidity. Recent publications advocate for the use of dehydrated human amnion/chorion membrane allograft (dHACM) during closure of anterior ankle incisions during TAR. dHACM is shown to promote increased epithelial cell proliferation, recruitment, and differentiation and reduce the likelihood of tendon adhesions. The goal of this study was to review the use of dHACMs in TARs and to investigate the number and type of postoperative wound complications including extensor tendon adhesions. Methods: We retrospectively reviewed 92 TARs performed between April, 2016 through August, 2018 by two board certified, fellowship trained foot and ankle orthopaedic surgeons. A standard anterior approach was done in all cases. All TARs had dHACM graft placed deep to the tibialis anterior and extensor longus tendon and along the extensor retinaculum prior to final closure of the wound. Upon data review, we identified the subset of patients who had anterior wound dehiscence postoperatively requiring an additional procedure(s) for wound coverage. We compared the demographics, medical comorbidities, and operative characteristics of those with and without perioperative wound complications. Results: 12 patients who underwent TARs sustained wound dehiscence below the subcutaneous tissue and required operative intervention (13%). Of these 12 cases, 5 required bipedical or rotational fasciocutaneous flap coverage (5.4%), 6 required less extensive soft tissue surgery (6.5%) and one case involved a deep periprosthetic infection that resulted in explant and antibiotic spacer placement (1.1%). 6 of the 12 cases required a split thickness skin graft application (6.5%) and 2 cases required tenolysis of extensor tendon adhesions (2.2%). Normal excursion of extensor tendons was seen in 90 patients (97.8%). Except for the one infected ankle, there were no cases with wound dehiscence that communicated with the joint. There were no statistically significant differences in medical comorbidities/operative characteristics between patients with wound complications and those without. Conclusion: Wound complications after total ankle replacements often lead to poor long-term outcomes for patients. Our data suggests that the application of the amniotic membrane allograft and its inherent healing potential decreases postoperative tendon adhesions and significant wound dehiscence. This may lead to less deep wound infections that communicate with the joint and may be protective against total ankle replacement failures due to these complications.

Automated Portal Placement for Arthroscopic Hip Surgery

2013 ◽  
Vol 8 (1) ◽  
Author(s):  
Emily Geist
Keyword(s):  
Patient Safety ◽  
Minimally Invasive ◽  
Recent Literature ◽  
Arthroscopic Surgery ◽  
Hip Surgery ◽  
Invasive Technique ◽  
Anatomic Landmarks ◽  
Computer Aided ◽  
Tool Trajectory ◽  
Portal Placement

Placing portal incisions during arthroscopic hip surgery presents challenges for surgeons in terms of anatomic accessibility and patient safety. Based on key anatomic landmarks and portal placement information from recent literature, suggested portal incisions were determined. Guidance in the placement of the three most common portal incision locations (anterior, anterolateral, and posterolateral) for arthroscopic surgery; in addition to visual feedback on tool trajectory to the hip joint is provided in real time by a computer aided system for hip arthroscopy. By simplifying the portal placement process, one of the most challenging aspects of arthroscopic hip surgery, an increased use of this minimally invasive technique could be possible. In addition to portal information, improvements to an existing computer aided system for arthroscopic hip surgery, including a new hip model and redesigned mechanical tracking linkage, were completed.

scholarly journals Assessment of the structures at risk during wrist arthroscopy: a cadaveric study and systematic review

2016 ◽  
Vol 41 (8) ◽  
pp. 852-858 ◽  
Author(s):  
G. Shyamalan ◽  
R. W. Jordan ◽  
P. K. Kimani ◽  
P. A. Liverneaux ◽  
C. Mathoulin
Keyword(s):  
Systematic Review ◽  
At Risk ◽  
Ulnar Nerve ◽  
Radial Nerve ◽  
Cadaveric Study ◽  
Wrist Arthroscopy ◽  
Posterior Interosseous Nerve ◽  
Level Of Evidence ◽  
Extensor Tendons ◽  
Dorsal Branch

We assessed the proximity of neurological structures to arthroscopic portals in a cadaveric study and through a systematic review. Arthroscopy was performed on ten cadaveric wrists. Subsequently the specimens were dissected to isolate the superficial branch of the radial nerve, the dorsal branch of the ulnar nerve, the posterior interosseous nerve and the extensor tendons. We measured the distances from the nerves to common portals. For the systematic review Pubmed and EMBASE were searched on the 31 May 2014 for cadaveric studies reporting the proximity of neurological structures to any arthroscopic wrist portal. In the cadaveric study, partial injuries were seen to six extensor tendons and one posterior interosseous nerve; it was assumed this was due to creation of the portals. Seven published studies were included in the systematic review. The dorsal sensory branch of the ulnar nerve was found to be at risk by performing the 6 Ulnar, 6 Radial and ulnar midcarpal portals, the sensory branch of the radial nerve by the 1–2 and 3–4 portals and the posterior interosseous nerve by the 3–4 and 4–5 portals. Level of evidence: V

Radial carpal bone fracture in dogs

2001 ◽  
Vol 37 (2) ◽  
pp. 173-178 ◽  
Author(s):  
JL Tomlin ◽  
MJ Pead ◽  
SJ Langley-Hobbs ◽  
P Muir
Keyword(s):  
Retrospective Study ◽  
Soft Tissue ◽  
Range Of Motion ◽  
Bone Fracture ◽  
Fracture Mechanism ◽  
Clinical Signs ◽  
Carpal Bone ◽  
Fracture Patterns ◽  
Bone Sclerosis ◽  
Soft Tissue Swelling

In a retrospective study, 11 radial carpal bone (RCB) fractures in nine dogs were studied. Chronic lameness was reported in all dogs. Reduced range of motion and soft-tissue swelling of the carpal joints were clinical signs seen most frequently. Three common fracture patterns were identified: oblique fracture with a large medial fragment, sagittal fracture with a small medial fragment, and comminuted fracture. Radial carpal bone sclerosis and carpal osteoarthritis were identified in all dogs. Pancarpal arthrodesis was used to manage 55% of the RCB fractures in this report. Although RCB fracture is not associated with obvious trauma, the fracture mechanism is unknown.

Os Centrale Carpi Simulating a Scaphoid Waist Fracture

1994 ◽  
Vol 19 (6) ◽  
pp. 754-756 ◽  
Author(s):  
Z. Y. YANG ◽  
L. A. GILULA ◽  
K. JONSSON
Keyword(s):  
Soft Tissue ◽  
Sagittal Plane ◽  
Tissue Injury ◽  
Incidental Finding ◽  
Scaphoid Fracture ◽  
Soft Tissue Injury ◽  
Carpal Bone ◽  
X Ray

The os centrale carpi is a relatively rare accessory carpal bone, and its presence may be confused with a scaphoid fracture. A case is presented which simulated an un-united scaphoid fracture on the plain X-ray film. However, CT in the sagittal plane showed two rounded fragments on the dorsum of the scaphoid with smooth, regular cortical margins differing from an acute scaphoid fracture. Their volume combined with the volume of the scaphoid is more than that of a completely normal scaphoid. There is no evidence of degeneration in the two rounded fragments and scaphoid. Because of these features, the diagnosis of soft tissue injury with an incidental finding of an os centrale carpi was suggested.

Prevalence of Ganglion Cyst Formation After Wrist Arthroscopy: A Retrospective Longitudinal Analysis of 2420 Patients

Hand ◽  
2020 ◽  
pp. 155894472093920
Author(s):  
Danielle H. Rochlin ◽  
David Perrault ◽  
Clifford C. Sheckter ◽  
Paige Fox ◽  
Jeffrey Yao
Keyword(s):  
Ganglion Cyst ◽  
Female Gender ◽  
Cyst Formation ◽  
Wrist Arthroscopy ◽  
Outpatient Services ◽  
Ganglion Cysts ◽  
Triangular Fibrocartilage ◽  
Mean Time ◽  
Dorsal Wrist Ganglion ◽  
Portal Placement

Background Dorsal wrist ganglion cysts arise from the leakage of synovial fluid through tears in the scapholunate ligament and/or dorsal wrist capsule. An analogous disruption of the dorsal capsule is created with routine portal placement during wrist arthroscopy. We hypothesized that wrist arthroscopy would predispose to wrist ganglions. Methods Using the Truven MarketScan Outpatient Services Database from 2015 to 2016, patients who underwent wrist arthroscopy and developed an ipsilateral wrist ganglion were identified. Exclusion criteria included ganglion diagnosis preceding arthroscopy and bilateral pathology. Postoperative ganglion diagnosis was modeled with logistic regression. Predictor variables included age, gender, comorbidities, and arthroscopic procedure. Results In all, 2420 patients underwent wrist arthroscopy. Thirty (1.24%) were diagnosed with an ipsilateral wrist ganglion at a mean time of 4.0 months (standard deviation: 2.4, range: 0.2-9.0). Significant predictors of ganglion diagnosis included female gender (odds ratio [OR]: 4.0, P < .01) and triangular fibrocartilage complex and/or joint debridement (OR: 0.13, P < .01). By comparison, among all 24,718,751 outpatients who had not undergone wrist arthroscopy, 39,832 patients had a diagnosis of a wrist ganglion cyst (0.16%). Conclusions Wrist arthroscopy is associated with a postoperative rate of ganglion cyst formation that is nearly 8 times the rate in the general population. Additional studies are needed to investigate techniques that minimize the risk of this complication.

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