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

2009 ◽  
Vol 35 (1) ◽  
pp. 38-42 ◽  
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.

The Modified Mitchell Osteotomy-Bunionectomy: Indications and Technical Considerations

1994 ◽  
Vol 15 (3) ◽  
pp. 103-106 ◽  
Author(s):  
Jerald Leonard Blum
Keyword(s):  
Surgical Technique ◽  
Physical Examination ◽  
Hallux Valgus ◽  
Avascular Necrosis ◽  
Stress Fractures ◽  
Pin Fixation ◽  
Technical Modifications ◽  
Steinmann Pin ◽  
Technical Considerations

A total of 204 modified Mitchell osteotomy-bunionectomy procedures with Steinmann pin fixation were evaluated by radiograph, history, and physical examination with longterm personal follow-up. The specific surgical technique modifications used in this series are discussed. This modified procedure produced 91% good or excellent results in this series. The complications or unsatisfactory results were due to partial avascular necrosis, lateral metatarsalgia, incomplete correction of hallux valgus, or late stress fractures. These unsatisfactory results led to the development of specific preoperative surgical criteria for the procedure in addition to the technical modifications.

Mid-Term Results of the Use of a Suture Anchor Fixation for Chronic Reducible Scapholunate Dissociation

2019 ◽  
Vol 24 (04) ◽  
pp. 440-446
Author(s):  
Reza Shahryar Kamrani ◽  
Behnam PanjaviLee ◽  
Ehsan Vahedi
Keyword(s):  
Grip Strength ◽  
Suture Anchor ◽  
Dash Score ◽  
Scapholunate Dissociation ◽  
Tissue Manipulation ◽  
Quick Dash ◽  
Suture Anchor Fixation ◽  
Anchor Fixation ◽  
Mid Term Results

Background: Scapholunate dissociation (SLD) is a common and sometimes disabling ligamentous injury of the wrist. The aim of the treatment is to restore carpal alignment and to prevent joint degeneration. In the current study, we reported mid-term results of our technique using suture anchor fixation within the SL interface. Methods: Nine male patients with an average age of 35 years underwent scapholunate suture anchor fixation (SLAF) for chronic and symptomatic dynamic or reducible static SLD from 2011 to 2016 with a mean follow-up of 36 months. After dorsal wrist exposure, a 2.8 mm suture anchor was inserted in the dorsoproximal lateral articular surface of the lunate bone. The two ends of the sutures were passed through the two divergent canals in the scaphoid. The sutures were tied over the tuberosity after reducing the SL alignment. Two K-wires supported SL and scaphocapitate (SC) alignment for 8 weeks. Radiographic parameters, wrist range of motion and grip strength were measured. Quick-DASH and Modified Mayo Wrist Score (MMWS) were used to assess the functional outcome. Results: The grip strength and passive motion reached to 75% and 88% of the other side, respectively. The SL gap was 5.4 mm, 2.6 mm and 3.4 mm before surgery, after pin removal, and on the follow-up stress radiographs, respectively. The SL angle was 82, 52 and 65 degrees at any time point, respectively. Average Quick-DASH score was improved from 60 to 25. According to MMWS score, one patient was excellent, one was good, five were fair, and two were poor. Conclusions: SLAF is a simple technique with minimal soft tissue manipulation that enables correction and maintaining of the carpal alignment with favorable mid-term results.

Scapholunate Ligament Repair and Capsulodesis for the Treatment of Static Scapholunate Dissociation

1998 ◽  
Vol 23 (6) ◽  
pp. 776-780 ◽  
Author(s):  
J. D. WYRICK ◽  
B. D. YOUSE ◽  
T. R. KIEFHABER
Keyword(s):  
Grading System ◽  
Scapholunate Ligament ◽  
Scapholunate Dissociation ◽  
Ligament Repair ◽  
Wrist Motion ◽  
Normal Side ◽  
Scapholunate Instability ◽  
Clinical Grading ◽  
Radiographic Grading

Twenty-four patients were treated with scapholunate ligament repair and dorsal capsulodesis for scapholunate dissociation. Seventeen patients were available for follow-up at an average of 30 months. The average interval between injury and surgery was 3 months. At final follow-up, no patients were pain-free. Average total wrist motion was 60% and grip strength 70% of the opposite normal side. The average preoperative scapholunate angle was 78° and was corrected to a normal 47° at surgery. The average final scapholunate angle was 72°, which was not significantly different from the preoperative value. The scapholunate gap likewise was not significantly changed postoperatively. Only two patients had an excellent or good outcome using a clinical grading system, and six out of 17 scored good or excellent using a radiographic grading system. In conclusion, repair of the scapholunate ligament with dorsal capsulodesis failed to provide consistent pain relief and maintain carpal alignment in patients with static scapholunate instability.

Cylinder-Shaped Bone Graft for Scaphoid Nonunion

2018 ◽  
Vol 23 (01) ◽  
pp. 96-101
Author(s):  
Hitoshi Hatanaka ◽  
Minoru Takasaki ◽  
Hiroko Furusho ◽  
Yasuhiro Omori
Keyword(s):  
Retrospective Study ◽  
Surgical Treatment ◽  
Bone Graft ◽  
Iliac Crest ◽  
Bone Grafts ◽  
Scaphoid Nonunion ◽  
Wrist Motion ◽  
Operative Outcomes

Background: Wedge-shaped bone grafts that are internally fixed by a Herbert-type screw are a well-established surgical treatment for scaphoid nonunion. A procedure using cylinder-shaped bone grafts was also reported, but preoperative wrist functions were not assessed. In addition, it was not reported whether the humpback deformity of the scaphoid nonunion was corrected. The purpose of the current study was to compare preoperative wrist functions in cases of scaphoid nonunion with those observed at final follow-up, using cylinder-shaped bone grafts The humpback deformity of the scaphoid nonunion was also evaluated.Methods: We conducted a retrospective study to examine operative outcomes from 2008 to 2015. Twelve wrists in 12 patients (average age, 41 years; range, 17–67), with a mean follow-up of 19 months, were included in the current study. Cylinder-shaped bone grafts were obtained from the iliac crest with a newly designed trephine and fixed with a Herbert-type screw. We reviewed both the preoperative wrist functions and those obtained at final follow-up.Results: Union was achieved in 11 of 12 nonunion cases. Preoperative wrist functions, except for the range of wrist motion, significantly improved by final follow-up.Conclusions: We conclude that the use of cylinder-shaped bone grafts improves preoperative wrist functions in cases of scaphoid nonunion.

scholarly journals Clinical and Radiologic Outcomes of the Matti-Russe Technique for Scaphoid Nonunions in Pediatric Patients

Hand ◽  
2018 ◽  
Vol 14 (1) ◽  
pp. 73-79
Author(s):  
Irshad Shakir ◽  
Ugochi C. Okoroafor ◽  
Joao Panattoni
Keyword(s):  
Internal Fixation ◽  
Pediatric Population ◽  
Radiographic Evaluation ◽  
Dash Score ◽  
Scaphoid Nonunion ◽  
Scaphoid Fractures ◽  
Outcomes Measures ◽  
Classic Technique

Background: Scaphoid fractures are a common injury, and a known complication is nonunion. One option to treat this nonunion is with the Matti-Russe technique, which takes a corticocancellous graft and fits it into the defect without internal fixation. The advent of modern methods of fixation has led the classic Matti-Russe technique to fall out of favor. In this study, we describe the classic technique and evaluate the results of the Matti-Russe method for treatment of scaphoid nonunions specifically for the pediatric population. Our purpose was to evaluate the long-term clinical and radiologic outcomes after surgery for scaphoid nonunion using the Matti-Russe technique in the pediatric population. Methods: A retrospective review was performed of patients less than 17 years of age, with a scaphoid nonunion that was treated with the Matti-Russe technique. This technique consisted of open reduction with intercalated bone graft and no internal fixation with hardware. Union was determined by radiographic evaluation. Computed tomography was obtained in 7 of 10 patients in this series and showed bony bridging in more than 50% of the scaphoid width in 3 different views. Intrascaphoid, scapholunate, and radiolunate angles were calculated. We reviewed wrist range of motion and complications. We obtained postoperative Mayo and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Results: There were 10 patients who underwent the Matti-Russe technique. The average age was 14.7 years old (±1.34, range: 13-17). All 10 of these patients had a scaphoid waist nonunion. There were 9 males and 1 female with an average follow-up of 13 months. The average amount of time to surgery from the date of injury was 12.3 months. All 10 patients went on to radiographic union at or before 6 months from surgery. Preoperative intrascaphoid, scapholunate, and radiolunate angles were 29° (±5.38), 62° (±18.28), and 20° (±9.22). Postoperative intrascaphoid, scapholunate, and radiolunate angles improved to 16° (±6.89), 38° (±8.50), and 10° (±4.69), which was significant. Seven out of 10 patients completed postoperative outcomes measures. The average postoperative Mayo wrist score was 87.9 (±14.10, range: 60-100). The average postoperative DASH score was 1.9 (±2.03, range: 0-4.5). There were no associated complications nor reoperations. Conclusion: The Matti-Russe technique is a safe and effective treatment for scaphoid nonunion in the pediatric population. It facilitates scaphoid union without the need for screw fixation and avoiding potential complications with hardware.

scholarly journals Midterm Results of Four-Corner Fusion Using Dorsal Circular Plate Fixation

2017 ◽  
Vol 07 (03) ◽  
pp. 262-266 ◽  
Author(s):  
Claus Deglmann ◽  
Vanja Celigoj ◽  
Bernhard Lukas ◽  
Ahmed Elgammal
Keyword(s):  
Circular Plate ◽  
Plate Fixation ◽  
Fixation Method ◽  
Dash Score ◽  
Level Of Evidence ◽  
Plate Removal ◽  
Level Ii ◽  
The Mean ◽  
K Wires

Purpose The purpose of this prospective study was to evaluate the results of four-corner fusion using dorsal circular plate. Methods We operated on 20 patients between 2009 and 2011. Results At a mean follow-up period of 30 months (range: 14–62, SD: 16), the mean VAS improved from 8 (range: 4–10, SD: 2) preoperatively to 4 (range: 0–8, SD: 2). Function measured with the DASH score improved from 37 (range: 10–75, SD: 18) to 26 (range: 2.5–64, SD: 19). Eighteen patients in our series showed full consolidation and two patients showed persistent nonunion. Three cases required plate removal due to dorsal impingement. Conclusion  Four-corner fusion using dorsal circular plate showed satisfactory results in this study, but it did not show superior results compared with simpler fixation methods mentioned in the literature, such as K-wires or screw fixation. Currently, we are principally using K-wires as a fixation method of choice in our four-corner fusion procedures. Level of Evidence  Level II.

Four-Corner Arthrodesis Using a Dedicated Dorsal Circular Plate

Hand ◽  
2020 ◽  
pp. 155894472094823
Author(s):  
Massimo Corain ◽  
Roberta Sartore ◽  
Mara Laterza ◽  
Filippo Zanotti ◽  
Paolo Pozza ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Surgical Technique ◽  
Circular Plate ◽  
Locking Plate ◽  
Standard Procedure ◽  
Complete Fusion ◽  
Scaphoid Nonunion ◽  
Carpal Collapse ◽  
Computed Tomographic ◽  
Computed Tomographic Scan

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.

scholarly journals Arthroscopic Wrist Debridement and Radial Styloidectomy for Advanced Scapholunate Advanced Collapse Wrist: Long-term Follow-up

Hand ◽  
2017 ◽  
Vol 13 (6) ◽  
pp. 659-665 ◽  
Author(s):  
Peter C. Noback ◽  
Mani Seetharaman ◽  
Jonathan R. Danoff ◽  
Michael Birman ◽  
Melvin P. Rosenwasser
Keyword(s):  
Return To Work ◽  
Severe Disease ◽  
Contralateral Side ◽  
Pain Patient ◽  
Dash Score ◽  
Wrist Motion ◽  
Relieve Pain ◽  
Flexion Extension ◽  
Long Term Follow Up

Background: Symptomatic stage 2 or 3 scapholunate advanced collapse (SLAC) wrist is aggressively treated with salvage procedures, such as proximal row carpectomy or partial wrist fusion with resultant pain relief but limited motion. We hypothesize that arthroscopic synovectomy, radial styloidectomy, and neurectomy will preserve wrist motion, relieve pain, and delay or avoid salvage procedures. Methods: We evaluated outcomes in 13 wrists through questionnaires and 11 of these through additional physical examination at a mean follow-up of 5.0 years. Eight wrists were stage 2 and 5 were stage 3. Data at final follow-up included mobility/strength measurements, subjective outcome scores (Disabilities of the Arm, Shoulder, and Hand [DASH] and visual analog scale [VAS] pain), patient satisfaction, and return to work statistics. Results: Patients had an average flexion-extension arc of 88.0° in the treated wrist and an average grip strength that was 95.0% of the contralateral side. No patients required revision surgery at follow-up. The 13 wrists reported an average DASH score of 16.4 and mean VAS pain score at rest and with activity of 17.9 and 31.6, respectively. All patients working prior to the procedure (n = 8) were able to immediately return to work. In all, 84.6% of patients were satisfied. Conclusions: The procedure studied may have advantages in relieving pain, while preserving wrist motion for SLAC stage 2 or 3 disease. This procedure does not preclude future salvage procedures in those patients with severe disease who prefer to maintain wrist motion for the short term. Patients experience good functional outcomes with the majority experiencing a reduction in pain with the ability to return to work.

Silastic Duraplasty in Pediatric Patients

Neurosurgery ◽  
1991 ◽  
Vol 29 (5) ◽  
pp. 785-788 ◽  
Author(s):  
Frederick A. Boop ◽  
William M. Chadduck
Keyword(s):  
Surgical Technique ◽  
Spinal Dysraphism ◽  
Late Complications ◽  
Magnetic Resonance Imaging Scan ◽  
Neural Tissues ◽  
Technical Modifications ◽  
Chiari Ii ◽  
Graft Removal

Abstract The role of adhesions in the retethering of the neural elements after surgical treatment of spinal dysraphism has produced refinements in the technique of the closure of the neural tube. Silastic. because of its relative inert property. has been used for duraplasty. but a few reports of late complications of hemorrhage or fibrotic capsule formation have caused concern over its use. We report 33 patients with the following diagnoses-eight spinal lipomyelomeningoceles. three myelomeningoceles. six symptomatic Chiari II malformations, seven tethered cords, six spinal cord tumors, two diastematomyelia. and one cerebellar astrocytoma-in whom Silastic dural grafts were used to prevent the adherence of neural structures to the overlying tissues. Our surgical technique is presented here. The patients have been observed for up to 6 years. Only one became infected, was treated with antibiotics without graft removal, and has remained without sequelae for over 3 years. One had an incidental pseudomeningocele that was noted on follow-up magnetic resonance imaging scan that was not clinically apparent. There have been no hemorrhages. leakage of cerebrospinal fluid. nor other complications from using nonreinforced Silastic sheeting. In one patient. Dacron-reinforced Silastic was used and. upon reexploration. a marked fibroblastic response was noted. A review of the literature suggests that fibrotic complications are related to this Dacron-reinforced Silastic. The hemorrhagic complications that were reported occurred in instances where Silastic grafts were large and no technical modifications were made preventively. We conclude that the use of nonreinforced Silastic dural grafts, with appropriate technical modifications in surgical technique, is safe and may prevent retethering of neural tissues in a variety of neurosurgical lesions.

Intercarpal ligamentoplasty for scapholunate dissociation: comparison of two techniques

2020 ◽  
pp. 175319342094049
Author(s):  
Lionel Athlani ◽  
Nicolas Pauchard ◽  
Gilles Dautel
Keyword(s):  
Surgical Technique ◽  
Original Method ◽  
Surgical Team ◽  
Scapholunate Dissociation ◽  
Level Of Evidence ◽  
Modified Method ◽  
Functional Scores ◽  
Time Periods ◽  
Clinical And Radiological Results

We modified our original surgical technique of scapholunate intercarpal ligamentoplasty for treating chronic scapholunate dissociation. The aim of this study was to compare the outcomes in patients treated by the same surgical team with the original method and the modified method over two different time periods. Nineteen patients with a mean age of 40 years were treated with the original method (mean follow-up of 34 months, range 12–54), and 21 patients with a mean age of 38 years were treated with the modified method (mean follow-up of 27 months, range 13–40). In both groups, we found a significant improvement in pain levels, grip strength, functional scores in terms of QuickDASH and Patient-Rated Wrist Evaluation, and radiographic scapholunate gap and scapholunate angle after surgery. There were no significant differences between the two groups in outcome measures except the scapholunate gap, which was significantly better controlled by the modified procedure. Between the immediate postoperative period and the last follow-up, there was a significant increase in the scapholunate gap and scapholunate angle after the original method, while there only a small increase after the modified method. We conclude that both versions of the scapholunate intercarpal ligamentoplasty yield satisfactory clinical and radiological results in the short to mid-term. The modified method makes the triquetral surgical step easier and seems to better optimize the tension across the ligamentoplasty, thus maintaining the intercarpal correction. Level of evidence: III

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