Wrist arthroscopy for the treatment of scaphoid delayed or nonunions and judging the need for bone grafting

This study reports outcomes of arthroscopy in the treatment of delayed or nonunions of 25 scaphoids (25 patients). The surgery was performed between 8 and 43 weeks after injury. Intraoperatively, 11 fractures were deemed stable to probing and underwent percutaneous screw fixation only; 14 were unstable and received arthroscopic bone grafting with percutaneous screw fixation. All fractures united. At a mean follow-up of 21 months (range 12–48), the mean Mayo wrist score was 96, and patient-rated wrist evaluation was 4, and the flexion–extension arc was 90% of the contralateral wrist. We conclude that arthroscopy is valuable in the treatment of scaphoid delayed or nonunions and in judging the need for bone grafting. Our data indicate that regardless of cystic formation in the scaphoid, bone grafting is not always necessary. Percutaneous fixation alone is sufficient when scaphoid delayed or nonunions are between 8 weeks and 1 year following injury, without scaphoid nonunion advanced collapse or dorsal intercalated segment instability, and when forceful probing confirms stability of the scaphoid arthroscopically. Level of evidence: IV

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Arthroscopic Dorsal Capsuloplasty in Scapholunate Tears EWAS 3: Preliminary Results after a Minimum Follow-up of 1 Year

Journal of Wrist Surgery ◽

10.1055/s-0038-1660446 ◽

2018 ◽

Vol 07 (04) ◽

pp. 324-330

Author(s):

Rémy Coulomb ◽

Pascal Kouyoumdjian ◽

Olivier Mares ◽

Benjamin Degeorge

Keyword(s):

Range Of Motion ◽

Grip Strength ◽

Case Series ◽

Contralateral Side ◽

Wrist Arthroscopy ◽

Level Of Evidence ◽

Test Range ◽

Flexion Extension ◽

Functional Scores

Purpose We retrospectively evaluated the results of all arthroscopic dorsal scapholunate (SL) capsuloplasty without pinning in patients presenting predynamic instability and dorsal capsuloscapholunate septum lesions on arthro–computed tomography scan after failed medical treatment. Materials and Methods Fifteen patients, mean age 34.3 years, underwent all arthroscopically assisted dorsal capsuloplasty. Patients were assessed preoperatively and postoperatively by a clinical (pain, Watson's test, range of motion, and strength), functional (quick disabilities of the arm, shoulder, and hand), patient-rated wrist evaluation, and Mayo wrist score scores), and radiological (SL gap and dorsal intercalated segmental instability [DISI]) examination. SL tears were evaluated during surgery by European Wrist Arthroscopy Society (EWAS) classification. Results The mean follow-up period was 20.2 months (range, 12–41). Preoperatively, positive Watson's test was noted in all cases. DISI deformity was noted in three cases without any SL gap. The SL instability was graded EWAS IIIB (n = 8) or EWAS IIIC (n = 7). Postoperatively, positive Watson's test was noted in only one case. Activity pain decreased from 7.8 preoperatively to 2.4 postoperatively. Range of motion in flexion–extension increased from 92.9 degrees preoperatively to 126.2 degrees postoperatively. Grip strength increased from 24.2 preoperatively to 38.2 postoperatively. At final follow-up, range of motion in flexion–extension and grip strength were estimated at 87 and 91% compared with contralateral side, respectively. All functional scores were significantly improved at the last follow-up. No radiographic SL gapping in grip views or DISI deformity was noted. Discussion Cadaveric studies demonstrated that the dorsal portion of SL ligament is critical for the stability of the SL complex. The entire arthroscopic SL capsuloplasty technique provides reliable results for pain relief, avoiding postoperative stiffness associated with open procedures. It is an alternative technique for patients with predynamic SL instability after failure of medical management and shall not prelude the resort to any further open procedure. Level of Evidence This is a level IV, case series.

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Arthroscopic ligament-specific repair for triangular fibrocartilage complex foveal avulsions: a minimum 2-year follow-up study

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193420957901 ◽

2020 ◽

pp. 175319342095790

Author(s):

Bo Liu ◽

Margareta Arianni ◽

Feiran Wu

Keyword(s):

Patient Reported Outcomes ◽

Triangular Fibrocartilage Complex ◽

Wrist Flexion ◽

Level Of Evidence ◽

Flexion Extension ◽

Patient Reported ◽

Triangular Fibrocartilage ◽

The Mean ◽

Viable Method

This study reports the arthroscopic ligament-specific repair of the triangular fibrocartilage complex (TFCC) that anatomically restores both the volar and dorsal radioulnar ligaments into their individual foveal footprints. Twenty-five patients underwent arthroscopic ligament-specific repair with clinical and radiological diagnoses of TFCC foveal avulsions. The mean age was 28 years (range 14–47) and the mean follow-up was 31 months (range 24–47). Following arthroscopic assessment, 20 patients underwent double limb radioulnar ligament repairs and five had single limb repairs. At final follow-up, there were significant improvements in wrist flexion–extension, forearm pronation–supination and grip strength. There were also significant improvements in pain and patient-reported outcomes as assessed by the patient-rated wrist evaluation, Disabilities of the Arm, Shoulder and Hand score and modified Mayo wrist scores. Arthroscopic ligament-specific repair of the TFCC does not require specialist dedicated equipment or consumables and offers a viable method of treating these injuries. Level of evidence: IV

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Evaluation of Reduction Accuracy of Suture-Button and Screw Fixation Techniques for Syndesmotic Injuries

Foot & Ankle International ◽

10.1177/1071100716661221 ◽

2016 ◽

Vol 37 (12) ◽

pp. 1317-1325 ◽

Cited By ~ 32

Author(s):

Onur Kocadal ◽

Mehmet Yucel ◽

Murad Pepe ◽

Ertugrul Aksahin ◽

Cem Nuri Aktekin

Keyword(s):

Screw Fixation ◽

Ct Scans ◽

Functional Evaluation ◽

Level Of Evidence ◽

Cross Sectional ◽

Suture Button ◽

Fixation Group ◽

Significant Difference ◽

The Mean

Background: Among the most important predictors of functional results of treatment of syndesmotic injuries is the accurate restoration of the syndesmotic space. The purpose of this study was to investigate the reduction performance of screw fixation and suture-button techniques using images obtained from computed tomography (CT) scans. Methods: Patients at or below 65 years who were treated with screw or suture-button fixation for syndesmotic injuries accompanying ankle fractures between January 2012 and March 2015 were retrospectively reviewed in our regional trauma unit. A total of 52 patients were included in the present study. Fixation was performed with syndesmotic screws in 26 patients and suture-button fixation in 26 patients. The patients were divided into 2 groups according to the fixation methods. Postoperative CT scans were used for radiologic evaluation. Four parameters (anteroposterior reduction, rotational reduction, the cross-sectional syndesmotic area, and the distal tibiofibular volumes) were taken into consideration for the radiologic assessment. Functional evaluation of patients was done using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale at the final follow-up. The mean follow-up period was 16.7 ± 11.0 months, and the mean age was 44.1 ± 13.2. Results: There was a statistically significant decrease in the degree of fibular rotation ( P = .03) and an increase in the upper syndesmotic area ( P = .006) compared with the contralateral limb in the screw fixation group. In the suture-button fixation group, there was a statistically significant increase in the lower syndesmotic area ( P = .02) and distal tibiofibular volumes ( P = .04) compared with the contralateral limbs. The mean AOFAS scores were 88.4 ± 9.2 and 86.1 ± 14.0 in the suture-button fixation and screw fixation group, respectively. There was no statistically significant difference in the functional ankle joint scores between the groups. Conclusion: Although the functional outcomes were similar, the restoration of the fibular rotation in the treatment of syndesmotic injuries by screw fixation was troublesome and the volume of the distal tibiofibular space increased with the suture-button fixation technique. Level of Evidence: Level III, retrospective comparative study.

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Arthroscopically Assisted Bone Grafting Reduces Union Time of Scaphoid Nonunions Compared to Percutaneous Screw Fixation Alone

Journal of Wrist Surgery ◽

10.1055/s-0039-1693146 ◽

2019 ◽

Vol 09 (01) ◽

pp. 013-018 ◽

Cited By ~ 1

Author(s):

Robert Gvozdenovic ◽

Rasmus Wejnold Joergensen ◽

Stig Joerring ◽

Claus Hjort Jensen

Keyword(s):

Minimally Invasive ◽

Distal Radius ◽

Bone Grafting ◽

Screw Fixation ◽

Treated Group ◽

P Value ◽

Percutaneous Screw Fixation ◽

Level Of Evidence ◽

Local Bone ◽

Arthroscopically Assisted

Purpose Minimally invasive techniques have been recommended in the treatment of painful but stable scaphoid nonunions. The purpose of this study was to determine if arthroscopically assisted bone grafting provided superior results in healing as compared to percutaneous screw fixation. Materials and Methods One hundred sixty-four consecutive patients with scaphoid nonunions were retrospectively analyzed. One hundred forty-eight patients were treated with the open grafting techniques either with iliac or distal radius bone, leaving 16 patients treated with minimally invasive surgery. In the group treated percutaneously (n = 8), the time from injury to surgery was 2.5 months (range: 2–4 months) and it was 27.3 months (range: 3–180 months) in the arthroscopic group (n = 8). The mean age was 39 years (range: 20–66) in the percutaneous group and 22 years (range: 16–32) in the arthroscopic group. In all cases, the Mini Acutrak headless fully threaded compression screw was used. Healing was assessed clinically and radiographically at a minimum follow-up of 12 weeks, mean 7 months (range: 3–12 months). Data were calculated with two-tailed Mann–Whitney U test based on p-value of < 0.05 that was considered statistically significant. Results We recorded no complications in any of the groups. Patients treated arthroscopically received cancellous bone grafting from the distal radius and all patients but one healed at a median of 7.8 weeks (range: 5–18 weeks). Seven patients in the percutaneous group healed at a mean of 10.5 weeks (range: 7–24 weeks), thus leaving one patient from each group without achieving union. Mann–Whitney U test showed the U value of 11, the critical value of U to be 13 (p < 0.05), thus significantly faster healing was observed in the arthroscopically treated group. Conclusions Arthroscopically treated patients achieved faster healing despite shorter time to surgery in the percutaneous group. Local bone grafting is considered as the main reason for this outcome. Younger population in the arthroscopically treated group may have influenced the result. Level of Evidence This is a Level III comparative study.

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Universal 2 Wrist Arthroplasty in Rheumatoid Arthritis

Journal of Wrist Surgery ◽

10.1055/s-0037-1598637 ◽

2017 ◽

Vol 06 (03) ◽

pp. 206-215 ◽

Cited By ~ 8

Author(s):

Giovanni Munz ◽

Giulia Guidi ◽

Massimo Ceruso ◽

Sandra Pfanner

Keyword(s):

Rheumatoid Arthritis ◽

Pain Relief ◽

Grip Strength ◽

Visual Analogue Scale Pain ◽

Level Of Evidence ◽

Flexion Extension ◽

The Mean ◽

Wrist Arthroplasty

Purpose The aim of this study was to evaluate the mid- to long-term outcomes and complications in patients affected by rheumatic diseases treated with the Universal 2 (U2) total wrist arthroplasty (TWA). Methods We reviewed, in a retrospective, noncontrolled cohort study, 22 patients affected by rheumatoid arthritis (RA), who underwent U2 total wrist replacement between March 2003 and January 2014 for the treatment of 23 rheumatoid wrists with the aim of obtaining the remission of pain and a range of motion (ROM) useful for daily activities, according to the patients' demands, as an alternative to total wrist arthrodesis. The cohort of patients included 20 females and 2 males, with a mean age of 54.9 years. Residual pain, preoperative ROM, postoperative ROM increases, grip strength, radiographic changes, long-term complications, and reasons for revision or failures were evaluated. Results In this study, 22 patients were evaluated at a mean follow-up of 82.3 months (range: 2–12 years). All patients had good or complete pain relief, the mean visual analogue scale pain score was 0.82. The mean grip strength improved and postoperatively was 11 kg (Jamar). The mean total ROM of flexion–extension was 72.3 degrees; radial–ulnar deviation 24.9 degrees. The mean QuickDASH score of 49 and patient rate wrist/hand evaluation of 41.7 a revision surgical procedure in six cases (26%): in two cases, a carpal component revision procedure and in four cases, total implant failures requiring either conversion to a Swanson spacer or wrist joint fusion. Conclusion TWA provides pain relief, preserves motion, and improves function in severe degenerative RA. Our results at a mid- to long-term follow-up with the U2 prosthesis were encouraging and represent, when indicated, a valid alternative to fusion which is less appealing for RA patients. Level of Evidence Level of evidence is therapeutic IV.

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Open vs. Percutaneous Pedicle Screw Insertion for Thoracolumbar Traumatic A3 and A4 AO Fractures - 18-Months Follow-Up

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0037-1607439 ◽

2017 ◽

Vol 36 (04) ◽

pp. 207-212

Author(s):

Flávio Romero ◽

Rodolfo Vieira ◽

Bruno Ancheschi

Keyword(s):

Blood Loss ◽

Pedicle Screw ◽

Screw Fixation ◽

Statistical Significance ◽

Column Height ◽

Intraoperative Blood Loss ◽

Percutaneous Screw Fixation ◽

Significant Difference ◽

The Mean

Purpose To compare the efficacy and safety of the percutaneous screw fixation (PSF) and the open pedicle screw fixation (OPSF) on thoracolumbar (TL) fracture. Methods Sixty-four adult patients with TL vertebral fractures who underwent open or percutaneous posterior short-segment transpedicular screw fixation between January of 2013 and September of 2015 were retrospectively reviewed. All patients underwent clinical, radiological and quality of life follow-up for at least 18 months. Results There was no significant difference in age, gender, time between injury and surgery, and preoperative percentage of anterior column height, preoperative sagittal regional Cobb angle, or kyphotic angle of fractured vertebra between these two groups (p > 0.05). There was significantly less intraoperative blood loss in the PSF (87.6 ± 24.6 mL) than in the OPSF group (271.4 ± 142.6 mL) (p < 0.05). The mean surgery time was 62 minutes (range 42–130 minutes) for open and 58 minutes (range 35 to 128 minutes) for percutaneous screw fixation. The surgery time was shorter in the PSF group, but with no statistical significance (p > 0.05). The mean Oswestry disability index (ODI) scores after 18-months were 23.12 ± 8.2 for the PSF and 24.12 ± 9.2 for the OPSF group, without any statistical significance (p > 0.05). Conclusion Both open and percutaneous screw fixations are safe and effective. The percutaneous techniques significantly reduced the intraoperative blood loss compared with the open techniques.

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Robot-assisted percutaneous scaphoid fracture fixation: a report of ten patients

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193419848595 ◽

2019 ◽

Vol 44 (7) ◽

pp. 685-691 ◽

Cited By ~ 5

Author(s):

Bo Liu ◽

Feiran Wu ◽

Shanlin Chen ◽

Xieyuan Jiang ◽

Wei Tian

Keyword(s):

Scaphoid Fracture ◽

Three Dimensional ◽

Contralateral Side ◽

Level Of Evidence ◽

Robotic Assisted ◽

Scaphoid Fractures ◽

Flexion Extension ◽

The Mean ◽

Set Up

This study reports the technique, efficacy and safety of robotic-assisted, computer-navigated, percutaneous fixation of scaphoid fractures. Ten males with acute undisplaced waist fractures underwent fixation with this method using a commercially available three-dimensional fluoroscopy unit and robotic navigation system. The mean total operative duration was 40 minutes, which comprised of a set-up time of 18 minutes and planning and surgical time of 22 minutes. All patients required only a single guidewire insertion attempt, and there were no screw protuberances or other complications. All fractures united at a mean of 8 weeks. At a mean follow-up of 6.5 months (range 6–8), the mean Mayo wrist score was 96, patient-rated wrist evaluation was 2, flexion-extension arc was 96% and grip strength was 91% of the contralateral side. We conclude from our patients that robotic-assisted percutaneous scaphoid fixation is feasible, safe and accurate, and is a satisfactory method for treating these injuries. Level of evidence: IV

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Avascular necrosis of the capitate: case series of five patients and review of literature

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193419850108 ◽

2019 ◽

Vol 44 (7) ◽

pp. 702-707

Author(s):

Lionel Athlani ◽

Jonathan Granero ◽

François Dap ◽

Gilles Dautel

Keyword(s):

Grip Strength ◽

Avascular Necrosis ◽

Case Series ◽

Wrist Flexion ◽

Level Of Evidence ◽

Radiocarpal Joint ◽

Flexion Extension ◽

Functional Scores ◽

The Mean

Avascular necrosis of the capitate is a rare disorder of unknown aetiology that causes wrist pain and limits function. From 2009 to 2017, we performed scaphocapitolunate arthrodesis on five patients (one male, four females) with a mean age of 35 years (range 30–37) who had idiopathic avascular necrosis of the capitate. All patients had scaphocapitate and lunocapitate arthritis confirmed by arthroscopy. The mean follow-up was 5 years (range 1–9). At the latest follow-up, the mean wrist flexion–extension was 95° (versus 105° before surgery). Grip strength was 90% relative to the contralateral side. Functional scores were all significantly improved following treatment. Radiologically, fusion was achieved in all cases and there was no displacement or fracture of the bone fixation material. None of the patients had signs of midcarpal collapse or narrowing of the radiocarpal joint space. We conclude that scaphocapitolunate arthrodesis is an acceptable treatment for avascular necrosis of the capitate with midcarpal chondral lesions. It provides adequate pain relief and improves grip strength during medium-term follow-up. Level of evidence: IV

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Is revision bone grafting worthwhile after failed surgery for scaphoid nonunion? Minimum 8 year follow-up of 18 patients

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193409346093 ◽

2009 ◽

Vol 34 (6) ◽

pp. 772-777 ◽

Cited By ~ 15

Author(s):

O. REIGSTAD ◽

R. THORKILDSEN ◽

C. GRIMSGAARD ◽

A. REIGSTAD ◽

M. RØKKUM

Keyword(s):

Bone Grafting ◽

Scaphoid Nonunion ◽

Wrist Flexion ◽

Revision Procedure ◽

Visual Analogue Pain ◽

Flexion Extension ◽

Failed Surgery ◽

The Mean ◽

Observation Period

Eighteen patients who underwent revision non-vascularized bone grafting and internal fixation after failed surgery for scaphoid nonunion were reviewed after a minimum of 8.2 years. Eleven of the nonunions were located in the middle and seven in the proximal third of the scaphoid. The mean interval between injury and the revision procedure was 6 years. Sixteen of the 18 nonunions healed, two after a third attempt. Three patients with healed nonunions and one patient with persistent nonunion required salvage procedures for progressive radiocarpal arthrosis. In the remaining 14 cases, the mean loss of wrist flexion/extension arc compared to the contralateral wrist was 36 °. Mean reduction of grip strength and key pinch was 9.3 kg and 0.9 kg respectively. The QuickDASH score was 18 and a visual analogue pain score was 21/100 at follow-up. Wrist degeneration increased in all but one case during the observation period. Thirteen of 16 patients with union and one patient with a persisting nonunion experienced moderate symptoms.

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Outcome of pedicle screw fixation with transpedicular bone grafting in fracture of thoracolumbar vertebrae

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20201732 ◽

2020 ◽

Vol 6 (3) ◽

pp. 587

Author(s):

Harpreet Singh ◽

Aliasgar J. Rampurwala ◽

Tej S. Rudani ◽

Malay P. Gandhi

Keyword(s):

Pedicle Screw ◽

Bone Grafting ◽

Screw Fixation ◽

Body Height ◽

Pedicle Screw Fixation ◽

Vertebral Body Height ◽

Cobb’S Angle ◽

The Mean ◽

Transpedicular Bone Grafting

Background: Posterior short segment instrumentation for thoracolumbar fracture is known for high implant failure rate because of the lack of anterior support. Anterior body augmentation by transpedicular bone grafting has been developed as an alternative to overcome this failure. In this study, we have evaluated the outcome of the cases of the unstable thoracolumbar spine injuries managed surgically with pedicle screws and transpedicular bone grafting.Methods: 20 patients were included in this study and were followed up for up to 6 months postoperatively. We assessed the outcome of each patient with Frankel scale and visual analog score (VAS) post-operatively clinically and radio logically by measuring Cobb’s angle and anterior vertebral body height post-operatively on follow-up at 6 weeks, 12 weeks, and 24 weeks.Results: We found that males had higher incidence with most common mode of injury was fall from height. D12 was single most involved vertebrae. The average Cobb’s angle during preoperative stage was 12 degrees and 22.05 degrees at 6th week and this was maintained till 24th week. The mean difference of anterior vertebral body height between pre-operative and 24th post-operative week was 7.15 mm. The mean VAS pre-operatively was 9.8 which changed to 0.75 at 24 weeks follow up. These were statistically highly significant.Conclusions: Our study established that Pedicle screw fixation with transpedicular bone grafting has a satisfactory result and can restore vertebral height, increase the stability of the injured vertebrae and leads to a significant improvement in the patient’s quality of life.

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