A volar approach to on-top plasty for correction of radial polydactyly: a case series of 21 patients

2021 ◽  
pp. 175319342098185
Author(s):  
Xia Fang ◽  
Ping-tak Chan ◽  
Shengbo Zhou ◽  
Xinyi Dai ◽  
Ruiji Guo ◽  
...  
Keyword(s):  
Case Series ◽  
Functional Results ◽  
Metacarpophalangeal Joint ◽  
Contralateral Side ◽  
Average Score ◽  
Pinch Strength ◽  
Level Of Evidence ◽  
Volar Approach ◽  
Flexion Extension ◽  
Aesthetic Results

Correction of unequal radial polydactyly in which neither thumb duplicates possess both well-developed proximal and distal components, remains challenging. Current techniques using on-top plasty techniques require circumferential incisions, often resulting in postoperative swelling and dorsal scars. We described our experience using a volar approach to achieve better aesthetic and functional results. Twenty-one patients underwent this surgery between 2008 and 2018, with a mean follow-up of 5.1 years. The mean flexion–extension arc for the metacarpophalangeal joint was 75° and that of the interphalangeal joint was 43°. Mean percentage of key, tripod and tip pinch strength were 77%, 79% and 77%, respectively, when compared with the contralateral side. The Vancouver Scar Scale showed an average score of 1.2. We conclude from our study that the volar approach to on-top plasty is a good technique for the correction of unequal radial polydactyly, with good functional and aesthetic results. Level of evidence: IV

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

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.

scholarly journals TERRIBLE TRIAD OF THE ELBOW: FUNCTIONAL RESULTS OF SURGICAL TREATMENT

2017 ◽  
Vol 25 (6) ◽  
pp. 283-286
Author(s):  
ROBERTO YUKIO IKEMOTO ◽  
JOEL MURACHOVSKY ◽  
ROGÉRIO SERPONE BUENO ◽  
LUIS GUSTAVO PRATA NASCIMENTO ◽  
ADRIANO BORDINI CARMARGO ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Case Series ◽  
Functional Results ◽  
Terrible Triad ◽  
Level Of Evidence ◽  
Mayo Elbow Performance Score ◽  
Results Of Treatment ◽  
Type Iv ◽  
Flexion Extension ◽  
Elbow Injuries

ABSTRACT Objective: To evaluate the functional and radiographic results of patients who underwent surgical treatment for terrible triad-type elbow injuries (TTE). Methods: We retrospectively evaluated 20 patients, including one case with bilateral injuries (total of 21 elbows) that were surgically treated from January 2004 to July 2014. We evaluated the functional results of treatment by measuring the restored range of motion (ROM) of the elbow, using the DASH (Disabilities of the Arm, Shoulder and Hand) and MEPS (Mayo Elbow Performance Score) scores. Complications and the development of osteoarthritis and heterotopic ossification (HO) were also evaluated. Results: Eight elbows (38%) required additional surgical treatment; HO was observed in eight elbows (38%) and severe osteoarthritis (Broberg-Morrey type IV) was seen in only one case (4%). Nevertheless, we obtained good functional results, 14.27 on the DASH and 84 on the MEPS. The average ROM for flexion-extension was 101° (20-140°) and for pronation-supination was 112.85° (0-180°). Conclusion: When TTE injuries are treated systematically, even despite variations in these injuries, functional ROM and scores ranging from good to excellent can be obtained. Level of Evidence IV, Case Series.

Description and Clinical Assessment of the Bone Block Tendon Interposition Technique for the Management of Thumb Carpometacarpal Joint Osteoarthritis

2018 ◽  
Vol 23 (04) ◽  
pp. 515-519
Author(s):  
Diego F. Rincon Cardozo ◽  
Wynston J. Alvarez Martinez ◽  
Jhon F. Castañeda Lopez ◽  
Fredy A. Angarita Maldonado ◽  
Juliana A. Rojas Neira ◽  
...  
Keyword(s):  
Case Series ◽  
Functional Results ◽  
Interference Screw ◽  
Pinch Strength ◽  
Bone Block ◽  
Dash Score ◽  
Carpometacarpal Joint ◽  
Thumb Carpometacarpal Joint ◽  
Thumb Carpometacarpal ◽  
And Function

Background: Pellegrini’s surgical technique is the most useful for thumb carpometacarpal joint osteoarthritis. The purpose of this paper is to describe the technique of a modified version using a bone block in the tunnel through which the flexor carpi radialis tendon is passed (BBTI). Methods: Case series of patients diagnosed with osteoarthritis of the thumb carpometacarpal joint, in stage II or higher based on Eaton’s classification, that were intervened using the BBTI technique for a 2-year period. Grip and pinch strength, range of motion, and 1–2 metacarpal angle were evaluated. Pain and function were measured using the visual analogue scale and the Disabilities of the Arm, Shoulder and Hand (DASH) scale. Results: The study included 16 cases in 14 patients (11 women and 3 men), with an average age of 55.7 ± 7.1 years. Encouraging results were obtained, with an average DASH score of 24.3 ± 17.9 and a minimum VAS pain score. A total of 58% showed a grip strength of over 80% and the postoperative movement was equivalent to the contralateral limb. No cases of infection were reported, and only two minor complications were observed. Conclusions: The BBTI technique is a surgical option that incorporates an interference screw, offering good functional results for managing osteoarthritis of the thumb carpometacarpal joint, with a similar complication rate to that of the original technique.

scholarly journals Arthroscopic treatment of anteromedial ankle impingement

2020 ◽  
Vol 14 (3) ◽  
pp. 260-263
Author(s):  
Guillermo Arrondo ◽  
Daniel Gómez ◽  
Germán Joannas ◽  
Xavier Martín-Oliva ◽  
Matías Iglesias ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Range Of Motion ◽  
Case Series ◽  
Functional Results ◽  
Level Of Evidence ◽  
Bony Impingement ◽  
Soft Tissue Impingement ◽  
Arthroscopic Removal ◽  
Physical Impact

Objective: Impingement syndromes are recognized as an important cause of chronic ankle pain, which results from the entrapment of an inflamed soft-tissue component between the osteophytes. The predominant site of occurrence is the anterolateral aspect of the ankle for soft-tissue impingement, and anteromedial aspect for bony impingement. Symptoms related to the physical impact of bone or soft-tissue pain often result in limited ankle range of motion. Methods: We conducted a retrospective study of 34 patients (34 ankles) with anteromedial bony impingement. All patients underwent arthroscopy, with a mean follow-up of 34 months. Results: All osteophytes were removed, and the ankle range of motion improved. The AOFAS score improved from 73 preoperatively to 95 postoperatively. Conclusion: The arthroscopic removal of the anteromedial osteophytes of the ankle had excellent functional results. It is an effective procedure that allows rapid patient recovery. Level of Evidence IV; Therapeutic Studies; Case Series.

Scaphoid Excision and Bicolumnar Carpal Fusion with Retrograde Headless Screws

2021 ◽  
Author(s):  
Sebastian Undurraga ◽  
Kendrick Au ◽  
Johanna Dobransky ◽  
Braden Gammon
Keyword(s):  
Range Of Motion ◽  
Articular Surface ◽  
Statistical Significance ◽  
Pinch Strength ◽  
Neutral Position ◽  
Level Of Evidence ◽  
Wrist Extension ◽  
Flexion Extension ◽  
Patient Reported

Abstract Background/Purpose Scaphoid excision and partial wrist fusion is used for the treatment of scapholunate advanced collapse/scaphoid nonunion advanced collapse wrist arthritis. The purpose of this study was to report midterm functional and radiographic outcomes in a series of patients who underwent bicolumnar fusion of the lunocapitate and triquetrohamate joints using retrograde headless screws. Methods Twenty-three consecutive patients (25 wrists) underwent surgery with this technique from January 2014 to May 2017 with a minimum follow-up of 1 year. Assessment consisted of range of motion, grip, and pinch strength. Patient-reported outcome measures included disabilities of the arm, shoulder, and hand (DASH) and patient-rated wrist evaluation (PRWE) scores. Fusion rates and the radiolunate joint were evaluated radiographically. The relationship between wrist range of motion and midcarpal fusion angle (neutral position vs. extended capitolunate fusion angle > 20 degrees) was analyzed. Results Average follow-up was 18 months. Mean wrist extension was 41 degrees, flexion 36 degrees, and radial-ulnar deviation arc was 43 degrees. Grip strength was 39 kg and pinch 9 kg. Residual pain for activities of daily living was 1.6 (visual analog scale). The mean DASH and PRWE scores were 19 ± 16 and 28 ± 18, respectively. Patients with an extended capitolunate fusion angle trended toward more wrist extension but this did not reach statistical significance (p = 0.17). Conclusions With retrograde headless compression screws, the proximal articular surface of the lunate is not violated, preserving the residual load-bearing articulation. Patients maintained a functional flexion–extension arc of motion with grip-pinch strength close to normal. Capitolunate fusion angle greater than 20 degrees may provide more wrist extension but further studies are needed to demonstrate this. Level of Evidence This is a Level IV study.

scholarly journals Pyrocardan Trapeziometacarpal Joint Arthroplasty—Medium-Term Outcomes

2020 ◽  
Vol 9 (06) ◽  
pp. 509-517
Author(s):  
James Logan ◽  
Susan E. Peters ◽  
Ruby Strauss ◽  
Silvia Manzanero ◽  
Gregory B. Couzens ◽  
...  
Keyword(s):  
Case Series ◽  
Postoperative Outcome ◽  
Preoperative Assessment ◽  
Pinch Strength ◽  
Level Of Evidence ◽  
Original Series ◽  
Surgery Outcome ◽  
Trapeziometacarpal Osteoarthritis ◽  
Patient Reported

Abstract Objective Pyrocardan trapeziometacarpal interposition implant is a free intra-articular spacer composed of pyrocarbon. This biconcave resurfacing implant, both ligament and bone-stock sparing, is indicated for use in early-to-moderate stage trapeziometacarpal osteoarthritis. It was hypothesized that the postoperative outcome measures of the Pyrocardan implant would be comparable to those seen with ligament reconstruction and tendon interposition (LRTI) surgeries and those reported by the designer of the implant, Phillipe Bellemère, but that strength would be greater than for LRTI. Methods In this prospective case series, 40 Pyrocardan implants were performed in 37 patients. Average age was 58 years (range: 46–71). Patients were assessed preoperatively, 3 months, 6 months, 1 year, 2 years, and beyond (long term) wherever possible. Results There have been no major complications or revision surgeries for the series. Average follow-up was 29 months (range: 12 months–7 years). Twenty-eight joints were assessed at over 2 years post index surgery. Outcome measure scores improved from preoperative assessment to the most recent follow-up equal or greater than 2 years. Average grip strength at 2 years was 30 kg, as compared with 19.6 kg in an age-matched cohort who underwent trapeziectomy and 25 kg in Bellemère's original series of Pyrocardan implants. Conclusions Pyrocardan interposition arthroplasty appears to be a safe, effective treatment for trapeziometacarpal arthritis. Patient-reported clinical outcomes were at least equivalent to LRTI and are comparable to Bellemère's original series. Grip and pinch strength appear to be better than LRTI. Level of Evidence This is a Level III, prospective observational cohort study.

scholarly journals Limited Open Reduction and Internal Fixation of Calcaneal Fractures

2019 ◽  
Vol 41 (1) ◽  
pp. 57-62 ◽  
Author(s):  
Anne K. Bremer ◽  
Lukas Kraler ◽  
Lars Frauchiger ◽  
Fabian G. Krause ◽  
Martin Weber
Keyword(s):  
Wound Healing ◽  
Internal Fixation ◽  
Open Reduction ◽  
Case Series ◽  
Functional Results ◽  
High Rate ◽  
Calcaneal Fractures ◽  
Retrospective Case ◽  
Level Of Evidence

Background: The treatment of displaced intra-articular calcaneal fractures remains a challenge and the optimal approach is still controversial. The main reason to avoid the extended lateral approach is the high complication rate due to wound healing problems. We report on 16 years of experience with a standardized limited open reduction and internal fixation technique. Methods: Between 2001 and 2017, we prospectively followed 240 consecutive patients operatively treated for a displaced intra-articular calcaneal fracture. Patients with open, multiple, bilateral, extra-articular, and Sanders IV fractures and those lost to follow-up were excluded. A lateral subtalar approach was used, with a cast for 8 weeks and full weightbearing allowed after 12 weeks. Follow-up examinations were scheduled until 24 months. Subjective and clinical assessment included gait abnormality, subtalar and ankle range of motion, and stability and alignment. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score was calculated. Alignment was analyzed on standard radiographs. In total, 131 patients were excluded. The remaining 109 patients were followed for a minimum of 24 months (34.4 ± 14.2 [range, 24-102] months). Results: The mean AOFAS score was 87 ± 13 (range, 32-100). “Excellent” and “good” results, as well as hindfoot motion with “normal/mild” and “moderate” restrictions, were seen in 80% of patients. Early reoperations were performed for insufficient reduction (2 patients), delayed wound healing (debridement, 3 patients), and hematoma (1 patient). Late revisions were arthrodesis (3 patients), medializing calcaneal osteotomy (1 patient), and implant removal (53 patients; 49%). Conclusion: The presented approach has remained unmodified for 16 years and resulted in consistently good functional results. The main disadvantage was the high rate of heel screw removal. Level of Evidence: Level IV, retrospective case series.

Four-corner arthrodesis with a dorsal locking plate: 4–9-year follow-up

2020 ◽  
Vol 45 (7) ◽  
pp. 673-678
Author(s):  
Lionel Athlani ◽  
Sophie Sabau ◽  
Nicolas Pauchard ◽  
François Dap ◽  
Gilles Dautel
Keyword(s):  
Sick Leave ◽  
Grip Strength ◽  
Locking Plate ◽  
Contralateral Side ◽  
Level Of Evidence ◽  
Wrist Motion ◽  
Flexion Extension ◽  
Preoperative Status ◽  
Wrist Function

We report the outcomes of four-corner arthrodesis for advanced wrist collapse in 50 patients (51 wrists) using a dorsal locking plate. At a mean follow-up of 6 years (range 4–9), pain was significantly reduced and wrist function was significantly improved compared with preoperative status. After four-corner arthrodesis, grip strength was 80% of the contralateral side, and wrist motion averaged 50° flexion–extension and 30° radioulnar deviation. Immobilization time was 5 weeks (4–6) and sick-leave was 3 months (2–5) following surgery. There were seven nonunions (14%) that underwent repeat arthrodesis. Three wrists were later converted to total arthrodesis due to persisting pain. Radiographic dorsal impingement was found in five wrists after four-corner arthrodesis and did not require reoperation. The outcomes appear not remarkably different from those reported using other fixation methods other than an apparent earlier return to activities. Level of evidence: IV

scholarly journals Arthroscopic Modified Bosworth Procedure for Refractory Lateral Elbow Pain With Radiocapitellar Joint Snapping

2020 ◽  
Vol 8 (6) ◽  
pp. 232596712092992
Author(s):  
In-Ho Jeon ◽  
Jae-Man Kwak ◽  
Bin Zhu ◽  
Yucheng Sun ◽  
Hyojune Kim ◽  
...  
Keyword(s):  
Case Series ◽  
Lateral Epicondylitis ◽  
Visual Analog Scale Score ◽  
Annular Ligament ◽  
Level Of Evidence ◽  
Lateral Elbow Pain ◽  
Disease Spectrum ◽  
Flexion Extension ◽  
Articular Pathology

Background: Radiocapitellar joint snapping due to the presence of synovial plica has been described as a contributory intra-articular pathology of lateral epicondylitis (LE). Hypothesis: The arthroscopic modified Bosworth technique can provide a safe and favorable outcome for refractory LE with radiocapitellar snapping. Study Design: Case series; Level of evidence, 4. Methods: Patients treated with the arthroscopic modified Bosworth procedure for refractory LE with radiocapitellar joint snapping were included in this study. The sequential surgical procedures included excision of the upper portion of the anterolateral annular ligament, removal of the synovial plicae, and release of the extensor carpi radialis brevis for all patients. Clinical outcomes were measured at a minimum 1-year follow-up. Results: A total of 22 patients with a mean ± SD age of 51.2 ± 10.4 years were included in this study. The mean follow-up was 29.4 ± 7.7 months (range, 21-42 months). The overall visual analog scale score (from preoperative to final follow-up) was 7.5 ± 1.2 vs 2.5 ± 1.8 ( P < .001); flexion-extension motion arc was 133.8° ± 11.2° vs 146.4° ± 7.1° ( P = .001); pronation-supination motion arc was 101.8° ± 9.2° vs 141.7° ± 10.2° ( P = .001); Disabilities of the Arm, Shoulder and Hand score was 54.5 ± 13.2 vs 3.6 ± 4.1 ( P < .001); and Mayo Elbow Performance Score was 51.9 ± 12.2 vs 84.3 ± 10.3 ( P < .001). Conclusion: Radiocapitellar joint snapping may coexist with LE as a disease spectrum. The arthroscopic modified Bosworth technique provides safe and favorable outcomes for patients with refractory LE associated with radiocapitellar joint snapping.

Extended ray resection for sarcoma of the hand: long-term survival and functional results

2019 ◽  
Vol 45 (2) ◽  
pp. 160-166 ◽  
Author(s):  
Farhad Farzaliyev ◽  
Hans-Ulrich Steinau ◽  
Halil-Ibrahim Karadag ◽  
Alexander Touma ◽  
Lars Erik Podleska
Keyword(s):  
Soft Tissue ◽  
Survival Rates ◽  
Soft Tissue Sarcomas ◽  
Functional Results ◽  
Contralateral Side ◽  
Level Of Evidence ◽  
Term Survival ◽  
Kaplan Meier

In this retrospective study, we analysed the long-term oncological and functional results after extended ray resection for sarcoma of the hand. Recurrence-free and overall survivals were calculated using the Kaplan–Meier method. The function of the operated hand was assessed with the Michigan Hand Questionnaire and compared with the contralateral side. Extended ray resection was performed in 25 out of 168 consecutive patients with soft-tissue and bony sarcomas of the hand. The overall 5- and 10-year, disease-specific survival rates were 86% and 81%, respectively. Local recurrences were observed in two patients. The Michigan Hand Questionnaire score for the affected hand at follow-up in nine patients was 82 points versus 95 for the healthy contralateral hands. We conclude that extended ray resection of osseous sarcomas breaking through the bone into the soft tissue or for soft tissue sarcomas invading bone is a preferable alternative to hand ablation when excision can be achieved with tumour-free margins. Level of evidence: III

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