Four-Corner Arthrodesis Using a Dedicated Dorsal Circular Plate

Background: Scaphoid excision and 4-corner fusion is a standard procedure for advanced carpal collapse. The purpose of this study was to evaluate its effectiveness using a specific designed locking plate of the latest generation. Methods: Between October 2012 and December 2015, 12 patients underwent this procedure using the Flower (KLS Martin Group, Tuttlingen, Germany) circular locking plate. The surgical technique is standardized. Three patients were affected by a scapholunate advanced collapse and 9 patients by a scaphoid nonunion advanced collapse. All patients underwent a computed tomographic scan to study the real achievement of the fusion. Results: Only 2 patients did not show complete fusion. All the patients with successful fusion returned to previous work and manual activities. Conclusions: Four-corner arthrodesis with circular locking plate is an alternative surgical treatment for carpal arthritic collapse.

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Spontaneously Ruptured Pineal Epidermoid Cyst Associated with a Thalamic Germinoma

Neurosurgery ◽

10.1227/00006123-198906000-00027 ◽

1989 ◽

Vol 24 (6) ◽

pp. 933-936 ◽

Cited By ~ 9

Author(s):

Jin Wang ◽

Maozhi Chang ◽

Shiqi Luo

Keyword(s):

Surgical Treatment ◽

Epidermoid Cyst ◽

Rare Case ◽

Definite Diagnosis ◽

Characteristic Absorption ◽

Computed Tomographic ◽

Computed Tomographic Scan

ABSTRACT We describe a rare case of a patient who had a spontaneously ruptured pineal epidermoid cyst concurrent with a thalamic germinoma. Computed tomographic scans led to the detection of both tumors. A definite diagnosis of the free fat in the ventricle was made by its movable feature and characteristic absorption value on computed tomographic scan. Surgical treatment produced a good result.

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Four corner arthrodesis limited to the centre using a scaphoid one piece graft and a dorsal circular plate

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193409349905 ◽

2009 ◽

Vol 35 (1) ◽

pp. 38-42 ◽

Cited By ~ 16

Author(s):

G. Mantovani ◽

C. Mathoulin ◽

W. Y. Fukushima ◽

A. B. Cho ◽

M. A. Aita ◽

...

Keyword(s):

Surgical Technique ◽

Circular Plate ◽

Central Area ◽

Dash Score ◽

Cancellous Bone Graft ◽

Scaphoid Nonunion ◽

Scapholunate Dissociation ◽

Wrist Motion ◽

Technical Modifications

We present 20 patients, who had a four corner arthrodesis, from July 2006 to March 2008, using a dorsal circular plate, to treat scaphoid nonunion and scapholunate dissociation with advanced collapse (SNAC, SLAC). The surgical technique was a fusion restricted to the central area filled with one piece of cancellous bone graft taken from the excised scaphoid. Wrist motion, grip strength, and Disabilities of Arm Shoulder and Hand (DASH) score improved after surgery at a mean follow-up of 20.2 months. Fusion occurred in 19/20 patients. Two patients (10%) had persistent pain. The rest had a good clinical result. We found that four-corner fusion using a dorsal circular plate using the specific technical modifications was successful.

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Surgical Strategy for Scaphoid Nonunion Treatment

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835518300049 ◽

2018 ◽

Vol 23 (04) ◽

pp. 450-462 ◽

Cited By ~ 1

Author(s):

Ji Hyun Yeo ◽

Jin Young Kim

Keyword(s):

Risk Factors ◽

Surgical Treatment ◽

Surgical Procedures ◽

Scaphoid Fracture ◽

Bony Union ◽

Scaphoid Nonunion ◽

Carpal Collapse ◽

Surgical Strategies ◽

Scaphoid Fractures ◽

Fracture Nonunion

Scaphoid fracture is the most common carpal fracture. Nonunion rate has been reported around 10 to 15% of scaphoid fractures. Risk factors for scaphoid nonunion are known as location, displacement, poor vascularity, time to treatment etc. The goals of surgical treatment for scaphoid nonunion are to achieve bony union, to correct carpal deformities and also to prevent progressive carpal instability and arthritis. Scaphoid nonunion can cause scaphoid nonunion advanced collapse (SNAC) which is a pattern of progressive degenerative radiocarpal and midcarpal arthritis secondary to posttraumatic pathomechanics of the scapholunate joint. Achieving bony union is essential to prevent carpal collapse or arthritis. To improve bony union, many surgical procedures including various forms of bone grafting have been developed and attempted. However, there is a controversy about which procedure is the most effective. In this review, we provide an overview of surgical treatment methods for scaphoid nonunion and discuss proper surgical strategies for scaphoid nonunion which requires surgical management.

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Intramedullary Epidermoid Cyst Evaluated by Computed Tomographic Scan and Magnetic Resonance Imaging: Case Report

Neurosurgery ◽

10.1227/00006123-198912000-00017 ◽

1989 ◽

Vol 25 (6) ◽

pp. 955-959 ◽

Cited By ~ 18

Author(s):

Isabelle Penisson-Besnier ◽

Gilles Guy ◽

Yves Gandon

Keyword(s):

Magnetic Resonance Imaging ◽

Case Report ◽

Surgical Treatment ◽

Magnetic Resonance ◽

Epidermoid Cyst ◽

Benign Tumors ◽

Resonance Imaging ◽

Computed Tomographic ◽

Computed Tomographic Scan

Abstract The authors have treated a 20-year-old man with a dorsal intramedullary epidermoid cyst in whom magnetic resonance imaging was performed both before evacuation of the cyst and 3 months later. Intraspinal epidermoid tumors are rare, and the intramedullary location is quite uncommon. To our knowledge, this is the first description of magnetic resonance imaging of an intramedullary epidermoid cyst. The frequency, possibilities, and limits of surgical treatment of such intraspinal benign tumors are reviewed.

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Four-Corner Fusion with Locking Dorsal Circular Plate versus Headless Compression Screws: A Clinico-Radiological Comparative Study

Revista Iberoamericana de Cirugía de la Mano ◽

10.1055/s-0041-1739239 ◽

2021 ◽

Vol 49 (02) ◽

pp. e105-e114

Author(s):

Francisco R. Melibosky ◽

Rene A. Jorquera ◽

Felipe Z. Saxton ◽

Pablo Orellana ◽

Diego Junqueras ◽

...

Keyword(s):

Surgical Technique ◽

Comparative Study ◽

Range Of Motion ◽

Circular Plate ◽

Locking Plate ◽

Plate Versus ◽

Fixation Method ◽

Union Rate ◽

Non Union ◽

Headless Compression Screws

Abstract Introduction Four-corner fusion is a technique for the treatment of carpal advanced collapse. It consists of scaphoid excision and arthrodesis of the lunate, triquetrum, hamate, and capitate bones. This can be accomplished with different kinds of osteosynthesis. In the first reports of the use of a circular plate, poor outcomes are described, with high rates of non-union, which decreased in later studies, which highlight certain aspects of the surgical technique. Objective To report our experience with four-corner fusion with the use of a dorsal locking plate (Xpode, Trimed Inc., Santa Clarita, CA, US), and compare it with another traditional fixation method (3.0-mm headless compression screws [HCSs], Synthes, Slothurn, Switzerland), with an emphasis on union, an assessment of the fincitonal outcomes, and the presence of complications. Material and Methods A comparative study of two prospective series of patients operated on through two fixation techniques for four-corner fusion using autologous bone graft from the iliac crest.The first group of patients, evaluated between 2010 and 2012, underwent osteosynthesis with 2 HCSs, with a minimum follow up of 18 months. The second group, evaluated between 2011 and 2014, underwent osteosynthesis with a dorsal locking plate, with a minimium foloow up of 12 months. The patients were operated on by four different surgeons in four centers.The patients were evaluated with radiographs to establish the presence of union and the time it took to occur. In case of doubt, union was confirmed through a computed tomography (CT) scan at 8 weeks postoperatrively. We also assessed the range of motion, the presence of complications, and function through the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and a grip strength score. Results We achieved a union rate of 100% in both groups at similar times. In the dorsal locking plate group, we obtained better full range of motion, particularly in wrist extension, which was statistically significant (p = 0.0016), as well as lower DASH scores, which was also statistically significant (p = 0.0066). Complications were only present in two patients in the HCS group. Conclusion Both techniques are valid and reproducible for the treatment of wrists with scapholunate advanced collapse (SNAC) and scaphoid non-union advanced collapse (SLAC). Based on the outcomes, with the Xpode plate, the patients presented better ranges of motion and DASH scores; therefore it may be an excellent fixation option in the open four-corner fusion surgical technique. The entry point and configuration of the HCS are fundamental variables to analyze.The union rate of 100% obtained in the present study contrasts with the high rates of non-union reported in the literature published in the early 2000s.

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Prevention of Rebleeding after Operation for Subarachnoid Hemorrhage of Unknown Cause

Neurosurgery ◽

10.1227/00006123-198512000-00012 ◽

1985 ◽

Vol 17 (6) ◽

pp. 942-946 ◽

Cited By ~ 11

Author(s):

Noboru Sakai ◽

Hiromu Yamada ◽

Takashi Ando ◽

Yasuaki Nishimura

Keyword(s):

Subarachnoid Hemorrhage ◽

Surgical Treatment ◽

Arterial Wall ◽

Internal Carotid ◽

Cerebral Arteries ◽

Anterior Communicating Artery ◽

Computed Tomographic ◽

Follow Up Study ◽

Computed Tomographic Scan

Abstract This study is presented to promote prophylactic operation to prevent rebleeding after subarachnoid hemorrhage (SAH) of unknown cause. Twenty-two cases of nontraumatic SAH of unknown cause of a total of 254 cases of SAH treated during a 5-year period (1980-1984) were available for this study. A follow-up study (4 to 61 months after treatment; median, 43 months) revealed a 4.5% mortality rate. Four patients chosen from among the 22 SAH cases underwent prophylactic operation. The decision to operate was based on repeated angiography showing regional cerebral vasospasm corresponding to a limited hyperdense area on the computed tomographic scan at the time of the onset of SAH. Microsurgery revealed a minute protrusion (less than 2 mm in diameter) or thinning of the arterial wall with old hematoma of the surrounding brain in all 4 cases, and treatment required only coating of the abnormal site. All 4 patients are now fully recovered. Frequently, abnormal changes of such cerebral arteries as the anterior communicating artery, the internal carotid artery (C-1 and C-2), and the middle cerebral artery (M-1) may occur. Therefore, the authors emphasize the necessity of surgical treatment for specific cases of SAH with an unknown cause.

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Impact of standardized computed tomographic angiography for minimally invasive mitral and tricuspid valve surgery

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01400-6 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Moritz B. Immohr ◽

Yukiharu Sugimura ◽

Patric Kröpil ◽

Hug Aubin ◽

Jan-Philipp Minol ◽

...

Keyword(s):

Minimally Invasive ◽

Femoral Artery ◽

Axillary Artery ◽

Standard Procedure ◽

Computed Tomographic Angiography ◽

Hospital Death ◽

Imaging Protocol ◽

Operative Strategy ◽

Computed Tomographic ◽

Standardized Imaging Protocol

Abstract Background Femoral cannulation for extracorporeal circulation (ECC) is a standard procedure for minimally invasive cardiac surgery (MICS) of the atrio-ventricular valves. Vascular pathologies may cause serious complications. Preoperative computed tomography-angiography (CT-A) of the aorta, axillary and iliac arteries was implemented at our department. Methods Between July 2017 and December 2018 all MICS were retrospectively reviewed (n = 143), and divided into 3 groups. Results In patients without CT (n = 45, 31.5%) ECC was applied via femoral arteries (91.1% right, 8.9% left). Vascular related complications (dissection, stroke, coronary and visceral ischemia, related in-hospital death) occurred in 3 patients (6.7%). In patients with non-contrast CT (n = 35, 24.5%) only femoral cannulation was applied (94.3% right) with complications in 4 patients (11.4%). CT-angiography (n = 63, 44.1%) identified 12 patients (19.0%) with vulnerable plaques, 7 patients (11.1%) with kinking of iliac vessels, 41 patients (65.1%) with multiple calcified plaques and 5 patients (7.9%) with small femoral artery diameter (d ≤ 6 mm). In 7 patients (11.1%) pathologic findings led to alternative cannulation via right axillary artery, additional 4 patients (6.3%) were cannulated via left femoral artery. Only 2 patients (3.2%) suffered from complications. Conclusions CT-A identifies vascular pathologies otherwise undetectable in routine preoperative preparation. A standardized imaging protocol may help to customize the operative strategy.

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Bone Morphogenetic Protein in Scaphoid Nonunion: A Systematic Review

Journal of Wrist Surgery ◽

10.1055/s-0040-1722332 ◽

2021 ◽

Author(s):

Michael M. Polmear ◽

Ashley B. Anderson ◽

Paul J. Lanier ◽

Justin D. Orr ◽

Leon J. Nesti ◽

...

Keyword(s):

Literature Review ◽

Bone Morphogenetic Protein ◽

Controlled Trial ◽

Scaphoid Nonunion ◽

Journal Articles ◽

Level Of Evidence ◽

Carpal Collapse ◽

Morphogenetic Protein ◽

Combination Of Methods

Abstract Background Scaphoid nonunion can lead to carpal collapse and osteoarthritis, a painfully debilitating problem. Bone morphogenetic protein (BMP) has been successfully implemented to augment bone healing in other circumstances, but its use in scaphoid nonunion has yielded conflicting results. Case Description The purpose of this study is to assess the outcomes and complications of scaphoid nonunion treated surgically with BMP. Literature Review A literature review of all available journal articles citing the use of BMP in scaphoid nonunion surgery from 2002 to 2019 was conducted. We included studies that used BMP as an adjunct to surgical treatment for scaphoid nonunions in both the primary and revision settings with computed tomography determination of union. Demographic information, dose of BMP, tobacco use, outcomes, and complications were recorded. A total of 21 cases were included from four different studies meeting inclusion criteria. Clinical Relevance The union rates were 90.5% overall, 100% for primary surgeries, and 77.8% for revision surgeries. Five patients (24%) experienced 11 complications, including four cases (19%) of heterotrophic ossification. Use of BMP in scaphoid nonunion surgery resulted in a 90.5% overall union rate but was also associated with complications such as heterotopic ossification. All included studies used BMP to augment bone graft, screw or wire fixation, or a combination of methods. The efficacy of BMP in scaphoid nonunion is unclear, and a sufficiently powered, randomized controlled trial is needed to determine optimal fixation methods, dosing, and morbidity of the use of BMP. Level of Evidence This is a Level IC, therapeutic interventional study.

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