Treatment of Scaphoid Non-Unions of the Proximal third with Conventional Bone Grafting and Mini-Herbert Screws: an Analysis of Clinical and Radiological Results

2008 ◽  
Vol 33 (2) ◽  
pp. 179-185 ◽  
Author(s):  
KAI MEGERLE ◽  
XAVIER KEUTGEN ◽  
MIRIAM MÜLLER ◽  
GÜNTER GERMANN ◽  
MICHAEL SAUERBIER
Keyword(s):  
Demographic Data ◽  
Bone Grafts ◽  
Bone Union ◽  
Ct Scans ◽  
Dash Score ◽  
Dorsal Approach ◽  
Carpal Collapse ◽  
Non Union ◽  
Clinical And Radiological Results ◽  
Carpal Height

This study assessed the clinical and radiological outcomes after treatment of scaphoid non-union of the proximal third by non-vascularised bone grafts and stabilisation by Mini-Herbert Screws from a dorsal approach. Thirty-one patients, one woman and 30 men, were reviewed retrospectively at a mean of 42 (12–77) months. All patients received pre- and postoperative CT scans to assess bone union. In addition to demographic data, the range of motion, grip strength, DASH score, Krimmer score, Mayo wrist score and radiological parameters (carpal height, scapholunate and radiolunate angles) were recorded. Bone union was achieved in 21 patients. The average DASH score in patients with bone union was 12 and that in patients with persistent non-union it was 30. No progression into carpal collapse or increase of scapholunate angles was detected. Our study demonstrates that acceptable union rates can be achieved with non-vascularised bone grafts, and this technique compares favourably with other reports in the literature.

Radiolunate Arthrodesis in the Rheumatoid Wrist: A Retrospective Clinical and Radiological Longterm Follow-Up

2002 ◽  
Vol 27 (1) ◽  
pp. 61-72 ◽  
Author(s):  
N. BORISCH ◽  
P. HAUSSMANN
Keyword(s):  
Retrospective Study ◽  
Joint Space ◽  
Carpal Collapse ◽  
Radiological Results ◽  
Rheumatoid Wrist ◽  
Clinical And Radiological Results ◽  
Radiolunate Arthrodesis ◽  
Midcarpal Joint ◽  
Carpal Height

A retrospective study was performed to investigate the clinical and radiological results of radiolunate arthrodesis in the rheumatoid wrist. Ninety-one wrists in 78 patients were assessed at a mean follow-up of 60 months. Most patients were pain-free and content with the overall result. In 68 wrists the carpus had been repositioned or maintained in neutral or slightly ulnar alignment and no further translation occurred. Midcarpal dislocation occured in ten and midcarpal rotation in 13 wrists. The midcarpal joint underwent further arthritic destruction in 34 wrists and secondary arthrosis in 32 wrists. In 25 wrists the midcarpal joint space remained unchanged. Radiolunate arthrodesis can successfully be performed in wrists even with advanced destruction. In cases with fixed carpal collapse, anatomical repositioning of the lunate and restoration of carpal height should not be attempted as this causes midcarpal dislocation or rotation or precipitates secondary arthrosis.

scholarly journals Perilunate Lesions – Clinical and Radiological Results with a Minimum of 2 Years of Follow-up

2021 ◽  
Vol 49 (01) ◽  
pp. 013-018
Author(s):  
Elisabete Ribeiro ◽  
Nuno Oliveira ◽  
Juvenália Ribeiro ◽  
Pedro Varanda ◽  
Luis Filipe Rodrigues
Keyword(s):  
Poor Prognosis ◽  
Contralateral Side ◽  
Pinch Strength ◽  
Dash Score ◽  
Adequate Treatment ◽  
Clinical And Radiological Results ◽  
Carpal Height ◽  
And Cartilage ◽  
Over Time

AbstractPerilunate injuries are complex and rare lesions with circumferential carpal bones, ligamentous and cartilage involvement. Despite optimal surgical treatment, poor prognosis is expected and usually gets worse over time. Our aim was to address clinical and radiological outcomes after 2 years of follow-up. Seven wrists were revised with average age of 35.59 ± 14.01 (range 21–56) years old and mean follow-up of 44.10 ± 14.24 (range 25.60–68.63) months. At the latest follow-up, mean postoperative VAS score for pain was 2.71 ± 3.40 and DASH score was 10.48 ± 10.54. Patients returned to work in 5.00 ± 3.15 months. Strength and Range of Motion (ROM) parameters were ∼80% of the contralateral side, with exception for extension (61%) and radial deviation (73%). After 2 years of follow-up, radiographic arthrosis was observed in 29% of the cases. One of these patients was symptomatic and was proposed for arthrodesis. Mean carpal height was 1.51 ± 0.81 and scapholunate angle was 41.58 ± 22.82°. A correlation was observed between arthritis found at final follow-up and grip (r = −0.8660; p < 0.001) and pinch strength (r = −0.8885; p < 0.001). In conclusion, despite characteristic guarded prognosis, efforts to perform a prompt and adequate treatment are helpful. Clinical and radiological outcomes may not be related. Thus, it is of main importance to understand patients' perception of their sequelae.

X-Ray Analysis after Repair of Scaphoid Non-Union through a Dorsal Approach

1995 ◽  
Vol 20 (4) ◽  
pp. 543-550 ◽  
Author(s):  
G. R. SENNWALD ◽  
M. FISCHER ◽  
R. BENEDETTI
Keyword(s):  
Strong Correlation ◽  
Spearman Correlation ◽  
Dorsal Approach ◽  
X Ray ◽  
Non Union ◽  
Main Indicator ◽  
Before And After ◽  
Carpal Mechanics ◽  
Carpal Ligaments ◽  
Carpal Height

The consequences of non-union of the scaphoid with or without deformity were evaluated before and after surgery with non-parametric tests, MANOVA and discriminant analysis, and Spearman correlation and contingency tables. 18 consecutive cases of scaphoid non-union, operated upon through a dorsal approach preserving the carpal ligaments since 1987, were used for measurements. Carpal height, radio-lunate and radio-scaphoid angles, lunate covering ratio, and apparent translation of the capitate and lunate were analyzed on standard views of the wrist before and after scaphoid repair. We found that the lunate covering ratio combined with the radio-lunate angle was the main indicator of deformity before the repair as suggested by the strong correlation between the radio-lunate angle and lunate covering ratio ( P= 0.0001). After repair, the only indicator of mal-union was the apparent translation of the lunate on frontal views (P= 0.0033) as suggested by the strong correlation between real-union and lunate translation ( P= 0.0001). Translation of both the lunate and capitate correlated well before and after repair. Radio-scaphoid angle and carpal height showed no significant changes and are not informative in the presence of subtle carpal alteration. Repair of the scaphoid produced an improvement in the radio-lunate angle in all cases, even in the presence of mal-union. However, full restoration was never achieved even in the absence of mal-union. More precise techniques of measurement might contribute to a better understanding of the carpal mechanics in relation to wefi-defined diagnoses such as scaphoid non-union.

Comparison of Volar and Dorsal Approach for PIP Arthroplasty

Hand ◽  
2019 ◽  
pp. 155894471986171
Author(s):  
Geneva V. Tranchida ◽  
Scott T. Allen ◽  
Susan M. Moen ◽  
Lauren O. Erickson ◽  
Christina M. Ward
Keyword(s):  
Surgical Approach ◽  
Revision Surgery ◽  
Statistical Difference ◽  
Demographic Data ◽  
Complication Rates ◽  
Hand Therapy ◽  
Dorsal Approach ◽  
Volar Approach ◽  
Significant Difference

Background: No consensus exists about whether a volar approach (VA) or dorsal approach (DA) for proximal interphalangeal (PIP) arthroplasty yields better results. Previously reported range of motion (ROM) and complications vary from study to study. This retrospective review compared the ROM and complication rates of VA and DA approaches to PIP arthroplasty. Methods: The study included 66 adults (88 digits) who underwent PIP arthroplasty from 2000 to 2015, with minimum 30-day follow-up. Demographic data, surgical approach, pre- and post-operative ROM, duration of immobilization, timing and duration of hand therapy (occupational therapy [OT]), and major and minor complications were recorded. We compared mean change in ROM, postoperative ROM, and complication rates, and examined the association of duration of immobilization and time to OT initiation with postoperative ROM. Results: While there was no difference in postoperative ROM between volar and dorsal groups (56° and 54°, respectively, P > .05), there was a greater gain in ROM in the DA group (25° vs 2.7°, P = .017). There was no statistically significant difference in overall incidence of complications (VA: 37.8%, DA: 30.3%; P > .05) or revision surgery (VA: 15.6%, DA: 17.1%; P > .05). There were no differences in duration of immobilization, time to OT initiation, or number of OT sessions between the two groups, and none of these correlated with postoperative ROM. Conclusions: We identified no statistical difference in mean postoperative ROM, incidence of complications or revision surgery between volar and dorsal approaches for PIP arthroplasty.

scholarly journals Clinical and radiological results of the vascularized medial femoral condyle graft for scaphoid non-union

2020 ◽  
Vol 140 (6) ◽  
pp. 835-842 ◽  
Author(s):  
Marco Keller ◽  
Tobias Kastenberger ◽  
Anizar Faizi Anoar ◽  
Peter Kaiser ◽  
Gernot Schmidle ◽  
...  
Keyword(s):  
Femoral Condyle ◽  
Medial Femoral Condyle ◽  
Non Union ◽  
Radiological Results ◽  
Clinical And Radiological Results

scholarly journals P015: Implementing the Canadian CT Head Rule in a community emergency department

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S83-S83
Author(s):  
G. Bock ◽  
R. Setrak ◽  
S. Freeman
Keyword(s):  
Emergency Department ◽  
Demographic Data ◽  
Ct Scans ◽  
P Value ◽  
Relative Reduction ◽  
Exclusion Criteria ◽  
Head Ct ◽  
Preliminary Results ◽  
Ct Head ◽  
Significant Injury

Introduction: The Canadian CT Head Rule (‘the rule’) is widely used across the country and its use is specifically recommended by Choosing Wisely Canada. Studies in Canadian hospitals have shown appropriate declines in CT scans when decision tools have been made readily available and useable at the point of care. Research into the implementation of the Canadian CT Head Rule in particular has shown that barriers to its use include an inability to accurately recall each criteria and forgetting to attempt to apply the rule altogether. In an attempt to provide our clinicians with effective access to the rule, we modified CT requisitions and order procedures to facilitate the use of the rule for every head CT in our emergency department (ED). Methods: A quality improvement (QI) approach was used to pilot, implement, and evaluate the modified CT requisition at our hospital. Several Plan-Do-Study-Act cycles involving stakeholders in the hospital resulted in iterative changes to the requisition leading to the implemented version. The new requisition required physicians to indicate which rules or exclusion criteria were met and this was made mandatory for all head CTs ordered. Demographic data was collected on all patients presenting to the ED on age, gender, CTAS level, disposition, and length of stay. Data on which exclusion criteria were appropriate, the rules met leading to CT scans, whether each requisition was used appropriately, and whether there was a significant injury found was collected for each patient receiving a head CT after implementation. Results: In our primary outcome (% of ED visits receiving a head CT), preliminary results have demonstrated a relative reduction in head CT ordering of 10.9%. Our study at completion is powered to detect a ~10% relative change in ordering behaviour, and a Chi square of the data to date yields a P-value of 0.0147. There are no significant differences in visit volume or any of the demographics collected to date. Final results including analysis are anticipated in March, 2016. Conclusion: Preliminary results on this simple, no-cost intervention are very promising. The reduction in head CTs ordered suggests that with mandated access to an easy-to-use, well validated decision tool, ED physicians have been able to confidently defer scans that have a very low risk of having any significant injury present, reducing cost, radiation exposure, and perhaps time in department.

Surgical treatment of the radial head is critical to the outcome of Monteggia-like lesions

2019 ◽  
Vol 101-B (12) ◽  
pp. 1512-1519 ◽  
Author(s):  
Alexander Klug ◽  
Felix Konrad ◽  
Yves Gramlich ◽  
Reinhard Hoffmann ◽  
Kay Schmidt-Horlohé
Keyword(s):  
Surgical Treatment ◽  
Radial Head ◽  
Type I ◽  
Dash Score ◽  
Type Ii ◽  
Coronoid Fracture ◽  
Radial Head Arthroplasty ◽  
Type Iii ◽  
Clinical And Radiological Results

Aims The aim of this study was to evaluate the outcome of Monteggia-like lesions at midterm follow-up and to determine whether the surgical treatment of the radial head influences the clinical and radiological results. Patients and Methods A total of 78 patients with a Monteggia-like lesion, including 44 women and 34 men with a mean age of 54.7 years (19 to 80), were available for assessment after a mean 4.6 years (2 to 9.2). The outcome was assessed using the Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), Mayo Modified Wrist Score (MMWS), and The Disabilities of the Arm, Shoulder and Hand (DASH) score. Radiographs were analyzed for all patients. A total of 12 Mason type I, 16 type II, and 36 type III fractures were included. Surgical treatment consisted of screw fixation for all type II and reconstructable type III fractures, while radial head arthroplasty (RHA) or excision was performed if reconstruction was not possible. Results The mean MEPS was 88.9 (40 to 100), mean OES was 40.1 (25 to 48), mean MMWS was 88.1 (50 to 100), mean DASH score was 14.7 (0 to 60.2), and mean movement was 114° (sd 27) in extension/flexion and 155° (sd 37) in pronation/supination. Mason III fractures, particularly those with an associated coronoid fracture treated with RHA, had a significantly poorer outcome. Suboptimal results were also identified in patients who had degenerative changes or heterotopic ossification on their latest radiograph. In contrast, all patients with successful radial head reconstruction or excision had a good outcome. Conclusion Good outcomes can be achieved in Monteggia-like lesions with Mason II and III fractures, when reconstruction is possible. Otherwise, RHA is a reliable option with satisfactory outcomes, especially in patients with ligamenteous instability. Whether the radial head should be excised remains debatable, although good results were achieved in patients with ligamentous stability and in those with complications after RHA. Cite this article: Bone Joint J 2019;101-B:1512–1519

scholarly journals The use of pedicled vascularized bone grafts in the treatment of scaphoid nonunion: clinical results, graft options and indications

2020 ◽  
Vol 5 (1) ◽  
pp. 1-8
Author(s):  
Bedri Karaismailoglu ◽  
Mehmet Fatih Guven ◽  
Mert Erenler ◽  
Huseyin Botanlioglu
Keyword(s):  
Bone Mass ◽  
Bone Remodelling ◽  
Bone Grafts ◽  
Clinical Results ◽  
Scaphoid Nonunion ◽  
Proximal Pole ◽  
Challenging Situation ◽  
Clinical And Radiological Results ◽  
Vascularized Bone

Scaphoid nonunion is a challenging situation for orthopaedic surgeons. Nonunion rate is especially high in proximal pole fractures of the scaphoid due to tenuous retrograde blood supply. The use of pedicled vascularized bone grafts for the treatment of scaphoid nonunion provides both good clinical and radiological outcomes. The preserved vascularity of the graft leads to better bone remodelling, less osteopenia, faster incorporation and better maintenance of bone mass compared to the conventional non-vascularized grafting. Pedicled vascularized bone grafts also allow the correction of the carpal alignment and humpback deformity of the scaphoid. Clinical and radiological results have been satisfactory and promising, making us anticipate that the role of vascularized bone grafting for the treatment of carpal diseases will increase. Cite this article: EFORT Open Rev 2020;5:1-8. DOI: 10.1302/2058-5241.5.190021

scholarly journals Outcomes of Surface Replacement Proximal Interphalangeal Joint Arthroplasty Through a Volar Approach: A Prospective Study

Hand ◽  
2016 ◽  
Vol 12 (3) ◽  
pp. 290-296 ◽  
Author(s):  
Thomas E. Trumble ◽  
Dennis J. Heaton
Keyword(s):  
Patient Satisfaction ◽  
Range Of Motion ◽  
Joint Arthroplasty ◽  
Extensor Mechanism ◽  
Dash Score ◽  
Surface Replacement ◽  
Dorsal Approach ◽  
Volar Approach ◽  
Pip Joint ◽  
Central Slip

Background: The dorsal approach to the proximal interphalangeal (PIP) joint provides the advantage of improved visualization of the articular surface, while the disadvantage of a dorsal approach is the disruption of the central slip and extensor mechanism requiring a delay in range of motion exercises. A volar approach keeps the central slip and extensor mechanism intact, allowing for early range of motion. The goal of this study was to evaluate patient outcomes of surface replacement (SR) PIP joint arthroplasty performed through a volar approach. Methods: Twenty-one patients were evaluated with primary osteoarthritis of a single PIP joint and underwent SR arthroplasty using the Stryker SR PIP joint implants. Patients included in this study were exclusively treated through a volar approach. Preoperative range of motion, coronal plan deformity, Disabilities of the Arm, Shoulder and Hand (DASH), and patient satisfaction were measured and compared with postoperative measurements using a paired Student t test. Results: The average length of follow-up was 34 months (± 9 months). Postoperative arc of motion for the PIP and distal interphalangeal (DIP) joints measured 87° (±12°) and 36° (±11°), respectively. The average improvement in PIP arc of motion was 58°, DASH score measured 14 (±5), satisfaction measured 4 (±1), and coronal plane deviation measured 2° (±2°). No evidence of implant subsidence was found on postoperative radiographs. Four patients required an extensor tendon tenolysis, and 1 patient suffered a superficial surgical site infection. Conclusion: SR arthroplasty, when performed through a volar approach, allows for early range of motion and greater improvements in arc of motion, DASH score, and patient satisfaction.

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