scholarly journals Intra-Articular Fracture of the Base of the First Metacarpal Bone: Treatment Through a Volar Approach

Hand ◽  
2017 ◽  
Vol 13 (1) ◽  
pp. 90-94 ◽  
Author(s):  
Violeta Levy ◽  
Marcelo Mazzola ◽  
Martín Gonzalez
Keyword(s):  
Grip Strength ◽  
Articular Surface ◽  
Visual Analog Scale Score ◽  
Metacarpophalangeal Joint ◽  
Metacarpal Bone ◽  
Volar Approach ◽  
Secondary Displacement ◽  
The Mean ◽  
K Wires

Background: Management of Bennett fractures has been controversial. Early reports supported closed reduction and casting with or without percutaneous pinning. Later, open reduction and internal fixation was advocated. The purpose of this article is to assess the surgical treatment using a direct volar approach. Methods: Between March 2008 and December 2014, 21 patients with intra-articular first metacarpal fractures displaced more than 1 mm were operated on using a direct volar approach. Fixation was done with micro-screws or K-wires, always placed from ulnar to radial during thumb supination. The articular step-off, secondary displacement incidence and consolidation rate time were measured. At final follow-up, we assessed the thumbs for range of motion, residual pain, and grip strength. Sensitive areas around the scar were evaluated. Mean follow-up was 8 months. Results: Anatomical reduction was achieved in all cases. One secondary displacement was registered. The mean distance between the tip of the thumb and the fifth metacarpophalangeal joint was less than 10 mm; reposition was complete. Mean palmar abduction was 63°. Grip strength averaged 84.6% of the opposite side. The mean visual analog scale score was 0. No sensory disturbances around the scar were recorded. Conclusions: The complete visualization of the first metacarpal articular surface is hard to accomplish from the dorsoradial aspect of the hand. The volar approach offers an excellent fracture exposure. It is possible to place the osteosynthesis in ulna-radial fashion from the smaller fragment achieving correct reduction and stabilization. In spite of the proximity to the radial and median nerve branches, we found no complications.

scholarly journals Early Correction of Distal Radius Partial Articular Malunion Leads to Good Long-term Functional Recovery at Mean Follow-up of 4 Years

Hand ◽  
2018 ◽  
Vol 15 (2) ◽  
pp. 276-280 ◽  
Author(s):  
T. David Luo ◽  
Fiesky A. Nunez ◽  
Elizabeth A. Newman ◽  
Fiesky A. Nunez
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Distal Radius ◽  
Articular Surface ◽  
Corrective Osteotomy ◽  
Young Patients ◽  
Posttraumatic Arthritis ◽  
Volar Approach ◽  
Pain Scores

Background: Distal radius articular step-off or deformity may cause posttraumatic arthritis and poor functional outcome. The purpose of this study was to evaluate pain and functional outcomes in patients with malunited partial articular distal radius fractures who underwent corrective osteotomy. We hypothesized that anatomic restoration of distal radius articular surface after a malunited partial articular distal radius fracture results in improvement in pain and functional measures and delays the development of posttraumatic arthritis. Methods: Seven consecutive patients with mean age of 38 years underwent corrective osteotomy via either a standard dorsal approach or combined dorsal and volar approach. Mean time from injury to corrective osteotomy was 10 weeks. Patients were assessed with respect to Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), forearm and wrist range of motion, pain, and grip strength. Results: At mean follow-up of 44 months, significant improvements in pain scores (7.1-0.9, P < .001), QuickDASH (38.7-11.6, P < .001), grip strength (21.4-30.0 kg, P = .01) were achieved. All range of motion measurements demonstrated significant improvements except forearm pronation. One patient demonstrated radiographic evidence of osteoarthritis but had no pain at final follow-up. No patients required secondary surgery for removal of symptomatic hardware. Conclusions: Based on these findings, we recommend that early corrective osteotomies should be considered in young patients with intra-articular distal radius malunions before considering salvage procedures such as partial or complete wrist arthrodesis.

scholarly journals Trapeziectomy for trapeziometacarpal osteoarthritis

2021 ◽  
Vol 2 (3) ◽  
pp. 141-149
Author(s):  
Marc Saab ◽  
Gregoire Chick
Keyword(s):  
Grip Strength ◽  
Meta Analysis ◽  
Metacarpophalangeal Joint ◽  
Modest Improvement ◽  
Mechanical Complications ◽  
Trapeziometacarpal Osteoarthritis ◽  
The Mean ◽  
Meta Analyses ◽  
The Impact

Aims The objective of this systematic review was to describe trapeziectomy outcomes and complications in the context of osteoarthritis of the base of the thumb after a five-year minimum follow-up. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to guide study design, and 267 full-text articles were assessed for eligibility. After exclusion criteria application, 22 studies were included, involving 728 patients and 823 trapeziectomies. Outcomes included pre- and postoperative clinical and radiological characteristics. Complications and revisions were recorded. Results All the studies reported good results regarding pain and range of motion at the last follow-up of 8.3 years (5 to 22); the mean satisfaction rate was 91% (84% to 100%). It was difficult to assess the impact on metacarpophalangeal joint motion in extension with contrary results. The key pinch returned to its preoperative values, whereas tip pinch showed a modest improvement (+14%), with a mild improvement found in grip strength (+25%) at the last follow-up. The mean progressive trapezial collapse was 48% (0% to 85%) and was not correlated with pain, grip strength, or satisfaction. The most represented complications were linked to tendons or nerves affected during additional procedures to stabilize the joint (11.6%; n = 56). Mechanical complications included symptomatic scapho-M1 impingement (3.1%; n = 15/580), leading to nine surgical revisions out of 581 trapeziectomies. Meta-analysis was not possible due to study heterogeneity and limited data. Conclusion After a minimum five-year follow-up, trapeziectomy achieved high patient satisfaction and pain relief. However, strength seemed to be deteriorating with detrimental consequences, but this did not correlate with trapezial collapse. The issues related to underestimating mechanical complications and varying degrees of success should be highlighted in the information given to patients. Evidence-based analyses should help the surgeon in their decision-making. Cite this article: Bone Jt Open 2021;2(3):141–149.

scholarly journals Reduction and Association of the Scaphoid and Lunate: A Functional and Radiographical Outcome Study

2018 ◽  
Vol 08 (01) ◽  
pp. 037-042
Author(s):  
William Aibinder ◽  
Ali Izadpanah ◽  
Bassem Elhassan
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
High Rate ◽  
Salvage Procedure ◽  
Level Of Evidence ◽  
Long Term Follow Up ◽  
The Mean ◽  
Ligament Disruption

Background Management of scapholunate (SL) ligament disruption is a challenging problem. The reduction and association of the scaphoid and lunate (RASL) procedure has been described with varying results. This study assessed the outcomes of the RASL procedure. Purpose The objective of this study was to assess the outcomes of patients undergoing the RASL procedure at our institution in regard to pain relief, range of motion, radiographic and functional outcomes, complications, and reoperations. Materials and Methods Twelve patients with symptomatic chronic SL instability underwent the RASL procedure. The mean age was 35 years. The mean time from injury to surgery was 40 weeks. The mean follow-up was 89 months. Outcomes included visual analog score for pain, wrist range of motion, grip strength, and Mayo Wrist Scores. Preoperative and postoperative radiographs were reviewed. Results Pain scores improved in 10 wrists. Range of motion and grip strength worsened. The average Mayo Wrist Score was 63.3. The mean SL diastasis and angle improved, but seven wrists developed progressive degenerative changes, with two requiring a salvage procedure. Symptomatic progressive screw lucency occurred in eight wrists requiring screw removal. Conclusion The RASL procedure can improve SL widening but has a high rate of early failure and reoperation. Following reoperation, long-term follow-up demonstrates reasonable long-term durability in some cases. Level of Evidence This is a Level IV, therapeutic case study.

scholarly journals Efficacy of threading lasso fixation in repairing partial articular supraspinatus tendon avulsion lesions: a retrospective study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Sun-Yu Chen ◽  
Zhan-Hao Xiao ◽  
Jian-Kun Wang
Keyword(s):  
Los Angeles ◽  
Clinical Outcomes ◽  
Case Series ◽  
Visual Analog Scale Score ◽  
Supraspinatus Tendon ◽  
Fixation Technique ◽  
Retrospective Case ◽  
The Mean ◽  
Tendon Avulsion

Abstract Background The partial articular supraspinatus tendon avulsion (PASTA) lesion repair remains a topic of debate. We have performed in situ repair of PASTA lesions using a potentially viable threading lasso fixation technique. This retrospective case series aimed to evaluate the clinical outcomes of PASTA lesion repair using threading lasso fixation. To the best of our knowledge, this is the first study to review this technique and its outcomes in terms of pain and upper extremity function. Methods Twenty-five patients with PASTA lesions who were treated with threading lasso fixation were reviewed. All patients were followed up for at least 1 year. Preoperative and follow-up data were retrospectively collected and reviewed. Clinical outcomes were assessed to evaluate the efficacy of the surgery. Results There were no postoperative complications. The average follow-up period was 25.7 (22–27) months. At the last follow-up, all patients underwent follow-up magnetic resonance imaging; only two cases showed a partially healed tendon and no case converted to full-thickness tear. Furthermore, shoulder pain decreased and mobility was recovered, with statistically significant differences in all scoring measures. Specifically, the mean visual analog scale score decreased from 5.4 ± 1.2 before surgery to 1.1 ± 0.8 at the last follow-up (t = 14.908, P < 0.01), and the mean American Shoulder and Elbow Surgeons Shoulder Assessment Form score improved significantly from 51.6 ± 6.4 to 89.3 ± 5.2 (t = 22.859, P < 0.01). Additionally, the mean University of California Los Angeles score improved from 17.8 ± 3.5 preoperatively to 32.3 ± 1.4 (t = 19.233, P < 0.01). Conclusions Arthroscopic repair using threading lasso fixation is a novel transtendinous technique for patients with partial articular supraspinatus tendon avulsion. Tendon integrity is preserved with this method, which may result in improved function. Overall, threading lasso fixation technique is an effective treatment.

Arthroscopic Debridement and Arthrolysis for the Treatment of Advanced Kienböck's Disease: 18-Month and 5-Year Postoperative Results

2021 ◽  
Author(s):  
Omer Ayik ◽  
Mehmet Demirel ◽  
Necmettin Turgut ◽  
Okyar Altas ◽  
Hayati Durmaz
Keyword(s):  
Grip Strength ◽  
Dash Score ◽  
Arthroscopic Debridement ◽  
Kienböck’S Disease ◽  
Kienböck's Disease ◽  
Hand Grip ◽  
Case Series Study ◽  
The Mean ◽  
Kienbock’S Disease

Abstract Background Salvage procedures, such as proximal row carpectomy, limited or total wrist arthrodesis, and wrist replacement, are generally preferred to treat advanced Kienböck's disease. However, these procedures are particularly aggressive and may have unpredictable results and potentially significant complications. Questions/Purpose This study aimed to present the short- to mid-term clinical and functional results of arthroscopic debridement and arthrolysis in the management of advanced Kienböck's disease. Patients and Methods Fifteen patients in whom Lichtman Stages IIIA to IIIC or IV Kienböck's disease was diagnosed and treated by arthroscopic wrist debridement and arthrolysis were included in this retrospective study. The mean age was 30 years (range: 21–45). The mean follow-up period duration was 36 months (range: 18–60). The Disabilities of the Arm, Shoulder, and Hand (DASH) score, visual analog scale (VAS), wrist range of motion (ROM), and grip strength were measured preoperatively and then again at the final follow-up visit. Results The mean DASH and VAS scores improved from 41 (range: 31–52) and 7.1 (range: 6–8) preoperatively to 13 (range: 8–21) and 2 (range: 0–3; p < 0.001) at the final follow-up visit, respectively. The mean wrist flexion and extension values increased from 32 (range: 20–60 degrees) and 56 degrees (range: 30–70 degrees; p = 0.009) preoperatively to 34 (range: 10–65 degrees; p = 0.218) and 57 degrees (range: 30–70 degrees; p = 0.296) at the final follow-up appointment, respectively, although these findings were statistically insignificant. The mean strength of the hand grip increased from 22.7 (range: 9–33) to 23.3 (range: 10–34; p = 0.372). Conclusion Arthroscopic debridement and arthrolysis may improve wrist function and quality of life due to the preserved ROM and hand grip strength after short- to mid-term follow-up periods despite the radiographic progression of Kienböck's disease. Level of Evidence This is a Level IV, retrospective case series study.

scholarly journals Clinical Results and MRI Evaluation of Patellar Osteochondral Fracture Fixation following Patellar Dislocation

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Krzysztof Małecki ◽  
Kornelia Pruchnik–Witosławska ◽  
Dominika Gwizdała ◽  
Piotr Grzelak ◽  
Paweł Flont ◽  
...  
Keyword(s):  
Fracture Fixation ◽  
Patellar Dislocation ◽  
Articular Surface ◽  
Clinical Results ◽  
Suture Technique ◽  
Osteochondral Fracture ◽  
Mri Scans ◽  
The Mean ◽  
Reconstructed Surface

Aim. The aim of the study was to analyze the clinical results and MRI scans after transpatellar osteochondral fracture fixation following patellar dislocation. Methods. Our study group comprised 17 patients with patellar dislocation followed by osteochondral fracture of the articular surface of the patella. All patients underwent surgery where the fractured osteochondral fragments of the patella were attached using the transpatellar suture technique. The mean age at the time of surgery was 14.1 years, and the mean follow-up period was 7.5 years. Results. The results of the patellar compression test and the apprehension test were negative in all patients. The mean Lysholm and Kujala scores were 89.2 and 89.6, respectively. The MRI scan revealed healing of the fixed fragment and restoration of the articular surface in all patients. In 16 cases, subchondral bone of the fixed fragment area was described as irregular: its articular cartilage was narrowed and not homogenous. Progressive degenerative changes were observed in the patellofemoral joint at follow-up in three patients. Conclusions. By fixing osteochondral fragments, the patellar articular surface can be restored. The MRI scans show that the cartilage in the reconstructed surface is narrowed after a mean 7.5-year follow-up.

scholarly journals Tethering the Extensor Apparatus Limits PIP Flexion Following K-wire Placement for Pinning Extra-articular Fractures at the Base of the Proximal Phalanx

Hand ◽  
2016 ◽  
Vol 11 (4) ◽  
pp. 433-437 ◽  
Author(s):  
Yaron Sela ◽  
Caitlin Peterson ◽  
Mark E. Baratz
Keyword(s):  
Insertion Site ◽  
Proximal Phalanx ◽  
Extensor Tendon ◽  
Metacarpophalangeal Joint ◽  
Minimally Invasive Surgical ◽  
Articular Fractures ◽  
Pip Joint ◽  
Joint Flexion ◽  
The Mean ◽  
K Wires

Background: Closed reduction with percutaneous Kirschner wires (K-wires) is the most minimally invasive surgical option for stabilizing phalanx fractures. This study examines the effect of K-wire placement on proximal interphalangeal (PIP) joint motion. Methods: PIP joint flexion was measured in the digits of 4 fresh-frozen cadaver hands after placing a suture loop through the flexor tendons and placing tension on the flexors via a mechanical scale. The load necessary to flex the PIP joint to 90° or to maximum flexion was recorded. The load was removed and K-wires were inserted in 3 locations about the metacarpophalangeal joint (MPJ): through the extensor tendon and across the MPJ, adjacent to the extensor tendon insertion site and across the MPJ, and through the sagittal band and into the base of the proximal phalanx (P1). The load on the tendons was reapplied, and angles of PIP joint flexion were recorded for each of the 3 conditions. Results: The mean angle of PIP joint flexion prior to K-wire insertion was 87°, and the mean load applied was 241 g. The angles of flexion were 53° when the K-wire was placed through the extensor tendon, 70° when the K-wire was placed adjacent to the tendon, and 75° when the K-wire was placed into the base of P1 by going through the sagittal band, midway between the volar plate and the extensor tendon. Conclusions: K-wires placed remote from the extensor tendon create less of an immediate tether to PIP joint flexion than those placed through or adjacent to the extensor tendon.

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 Cervical laminoplasty developments and trends, 2003–2013: a systematic review

2015 ◽  
Vol 23 (1) ◽  
pp. 24-34 ◽  
Author(s):  
Stephan Duetzmann ◽  
Tyler Cole ◽  
John K. Ratliff
Keyword(s):  
Neck Pain ◽  
Range Of Motion ◽  
Single Case ◽  
Japanese Orthopaedic Association ◽  
Case Series ◽  
Visual Analog Scale Score ◽  
Open Side ◽  
The Mean ◽  
Axial Neck Pain

OBJECT Despite extensive clinical experience with laminoplasty, the efficacy of the procedure and its advantages over laminectomy remain unclear. Specific clinical elements, such as incidence or progression of kyphosis, incidence of axial neck pain, postoperative cervical range of motion, and incidence of postoperative C-5 palsies, are of concern. The authors sought to comprehensively review the laminoplasty literature over the past 10 years while focusing on these clinical elements. METHODS The authors conducted a literature search of articles in the Medline database published between 2003 and 2013, in which the terms “laminoplasty,” “laminectomy,” and “posterior cervical spine procedures” were used as key words. Included was every single case series in which patient outcomes after a laminoplasty procedure were reported. Excluded were studies that did not report on at least one of the above-mentioned items. RESULTS A total of 103 studies, the results of which contained at least 1 of the prespecified outcome variables, were identified. These studies reported 130 patient groups comprising 8949 patients. There were 3 prospective randomized studies, 1 prospective nonrandomized alternating study, 15 prospective nonrandomized data collections, and 84 retrospective reviews. The review revealed a trend for the use of miniplates or hydroxyapatite spacers on the open side in Hirabayashi-type laminoplasty or on the open side in a Kurokawa-type laminoplasty. Japanese Orthopaedic Association (JOA) scoring was reported most commonly; in the 4949 patients for whom a JOA score was reported, there was improvement from a mean (± SD) score of 9.91 (± 1.65) to a score of 13.68 (± 1.05) after a mean follow-up of 44.18 months (± 35.1 months). The mean preoperative and postoperative C2–7 angles (available for 2470 patients) remained stable from 14.17° (± 0.19°) to 13.98° (± 0.19°) of lordosis (average follow-up 39 months). The authors found significantly decreased kyphosis when muscle/posterior element–sparing techniques were used (p = 0.02). The use of hardware in the form of hydroxyapatite spacers or miniplates did not influence the progression of deformity (p = 0.889). An overall mean (calculated from 2390 patients) of 47.3% loss of range of motion was reported. For the studies that used a visual analog scale score (totaling 986 patients), the mean (cohort size–adjusted) postoperative pain level at a mean follow-up of 29 months was 2.78. For the studies that used percentages of patients who complained of postoperative axial neck pain (totaling 1249 patients), the mean patient number–adjusted percentage was 30% at a mean follow-up of 51 months. The authors found that 16% of the studies that were published in the last 10 years reported a C-5 palsy rate of more than 10% (534 patients), 41% of the studies reported a rate of 5%–10% (n = 1006), 23% of the studies reported a rate of 1%–5% (n = 857), and 12.5% reported a rate of 0% (n = 168). CONCLUSIONS Laminoplasty remains a valid option for decompression of the spinal cord. An understanding of the importance of the muscle-ligament complex, plus the introduction of hardware, has led to progress in this type of surgery. Reporting of outcome metrics remains variable, which makes comparisons among the techniques difficult.

Treatment of unstable proximal interphalangeal joint fractures with hemi-hamate osteochondral autografts

2016 ◽  
Vol 42 (2) ◽  
pp. 188-193 ◽  
Author(s):  
M. Burnier ◽  
T. Awada ◽  
F. Marin Braun ◽  
P. Rostoucher ◽  
M. Ninou ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Articular Surface ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Pinch Strength ◽  
Middle Phalanx ◽  
Level Of Evidence ◽  
Active Flexion ◽  
The Mean

The primary aim of this study was to assess the clinical and radiological results after hemi-hamate resurfacing arthroplasty in patients with acute or chronic unstable fractures of the base of the middle phalanx and to describe technical features that can facilitate the surgical procedure. Hemi-hamate arthroplasties were done in 19 patients (mean age 39 years) with an isolated fracture at the base of the middle phalanx that involved more than 40% of the articular surface. We assessed ten chronic cases (treated >6 weeks after fracture) and nine acute ones (<6 weeks) at a mean of 24 months. Pain scores, QuickDASH scores, grip strengths, range of motion and radiological findings were recorded at follow-up. At follow-up, the mean active flexion at the proximal interphalangeal joint was to 83° with a mean fixed flexion of 17° (active range of motion 66°). The mean active distal interphalangeal motion was 41°. The mean visual analogue scale score was 1.1. The mean QuickDASH score was 11. The mean pinch strength was 82% of the opposite side. Radiographs revealed one partial graft lysis. Level of evidence: IV

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