Occlusive dressing versus local flap coverage for the treatment of fingertip amputations with exposed bone: a comparative study.

We retrospectively reviewed the outcomes of 54 patients treated with occlusive dressings (OD) (27 patients) or local flap (LF) coverage (28 patients) for fingertip amputations with bone exposure. All patients healed completely within a mean of 5 weeks in the OD group and 3.5 weeks in the LF group. At a mean follow-up of 26 months (range 12-38), 2-point discrimination was significantly better in the OD group (4 mm) than the LF group (6 mm). Proximal interphalangeal joint (PIP) stiffness was more common in the LF group, affecting one-third of patients. A cost analysis showed that ODs were 6.5 times less expensive than LFs performed in the operating theatre. OD appears to be a reliable and more cost-effective alternative to LF for treating zone 2 and 3 fingertip amputations with exposed bone, with similar healing time, better tactile discrimination and a lower rate of PIP joint stiffness.Level of evidence: IV.

Comparison between scaphotrapeziotrapezoid arthrodesis and Pyrocardan® implant for isolated scaphotrapeziotrapezoid osteoarthritis.

INTRODUCTION: Scaphotrapeziotrapezoid (STT) arthrodesis and Pyrocardan® implant for painful isolated STT osteoarthritis have shown good results, but no paper has compared their medium-term outcomes. HYPOTHESES: Our main hypothesis would be that the Pyrocardan® implant, by preserving the carpal biomechanics, could lead to better wrist mobility. Our secondary hypotheses would be that no other clinical and radiological differences will be found between these two procedures at a mean 5 years follow-up. PATIENTS: In this non-randomised retrospective study, performed at two healthcare facilities, we report and compare the outcomes of STT arthrodesis with staple fixation versus the Pyrocardan® implant in 38 patients (40 thumbs) from 2 previously published cohorts. Twenty-one patients with a mean age of 68 years (range, 46-79) underwent STT arthrodesis in facility 1. Seventeen patients with a mean age of 61 years (range, 41-80) received a Pyrocardan® implant in facility 2. Patients were reviewed at both facilities by the same examiner who performed a clinical and radiographical assessment. RESULTS: At a mean follow-up of 8 years (range, 2-20 years) for the STT group and 5 years (range 3-8 years) for the Pyrocardan® group, we found no significant differences in the clinical and radiological outcomes between the two procedures except in wrist active extension and ulnar deviation, where Pyrocardan® appears to produce better mobility (extension 58°± 9 vs. 38°± 14 and ulnar deviation 35°[25, 40] versus 45°[40, 50]) (p<.001 and p<.008 respectively). The two surgical techniques led to significantly improvement in terms of pain relief, function, and strength. For the STT arthrodesis group, two complete non-unions were found (9%), while narrowing of the styloscaphoid joint space was found in eight thumbs (36%). For the Pyrocardan® group, four postoperative DISI (22%), four calcifications around the trapezium and/or distal scaphoid (22%) and one asymptomatic dislocation (6%) of the implant were observed. DISCUSSION: Pyrocardan® implant seems to result in better mobility in extension and ulnar deviation. STT arthrodesis and Pyrocardan® implant to treat isolated STT osteoarthritis led to less pain, better strength and functional scores, and restored wrist stability. A future study with a larger population will be needed to confirm these results. LEVEL OF EVIDENCE: IV.

Thumb basal joint arthritis in 2023.

Thumb carpometacarpal or basal joint arthritis is the second most common location for osteoarthritis in the hand. It mainly affects women over 50years of age. Basal joint arthritis causes pain, loss of strength during pinch grips, and eventually stiffness and progressive deformity of the thumb column. Conservative treatment must be implemented first. It aims to spare the joint by using standardized methods. It must be initiated as soon as pain starts, not once the deformity has settled in. There is broad agreement that surgery is indicated when pain relief is not achieved after at least 6months of conservative treatment. The available surgical techniques can be classified as joint-sparing (extra-articular) and joint-sacrificing (intra-articular). The former consists of trapeziometacarpal stabilizing ligament reconstruction, subtraction osteotomy of the first metacarpal and thumb carpometacarpal denervation. The latter consists of trapeziometacarpal fusion, trapeziectomy (and its variants) and implant arthroplasty. Except in very specific cases, trapeziectomy and trapeziometacarpal implant arthroplasty with a total joint prosthesis or an interposition implant are the two main surgical techniques for treating basal joint arthritis. After reviewing the pathophysiology and the diagnosis of thumb basal joint arthritis, we will provide an overview of the available treatment options, with emphasis on the accepted surgical strategies in 2023. LEVEL OF EVIDENCE: III.

Reconstruction of the ulnar artery in Guyon's canal with an arterial graft: Anatomical study.

Ulnar artery thrombosis in Guyon's canal can lead to vascular insufficiency in the fingers. The recommended treatment is resection and reconstruction of the pathological area. A bypass may be necessary, which may be venous or arterial. Arterial bypasses have better long-term patency; however, they are a source of donor-site complications. We carried out an anatomical study on 11 upper limbs and 7 lower limbs from cadavers to identify a technically accessible arterial graft, of a diameter suitable for bypassing the ulnar artery in Guyon's canal and with acceptable scar sequelae (few predicted postoperative complications, discreet size and/or location of scar). Three grafts were considered: anterior interosseous artery, radial recurrent artery and descending genicular artery. The various grafts were dissected and harvested from cadaver specimens, then their lengths and diameters were measured. The diameter of the candidate grafts was compared to the diameter of the distal ulnar artery. The diameter of the descending genicular artery matched the ulnar artery better than the radial recurrent artery or the anterior interosseous artery (103% vs 44% and 67%, respectively). Mean graft length was 6.6 cm. The anatomical configuration of the descending genicular artery allowed Y-shaped bypasses to be performed. Harvesting this artery appears to cause little damage and allows bypasses up to 6 cm to be performed. Despite its smaller diameter making it necessary to perform a microvascular size adjustment, the anterior interosseous artery is a candidate graft because it is long enough (119 mm) and located near the surgical site. LEVEL OF EVIDENCE: V.

Scaphometacarpal arthroplasty with a TOUCH® prosthesis: feasibility and biomechanical impact in a cadaver model.

In this cadaveric study, we compared the performance of the TOUCH® dual mobility trapeziometacarpal prosthesis implanted sequentially in the trapeziometacarpal joint and scaphometacarpal joint. Intraprosthetic mobility, implant dislocation, intraprosthetic impingement and the effect on scaphoid position were evaluated in six hands using radiographic measurements. The standard necks of 6-10 mm were used for trapeziometacarpal arthroplasty. Scaphometacarpal arthroplasty after trapeziectomy was technically feasible but required specially designed prosthetic necks 12-26 mm in length. Compared to trapeziometacarpal arthroplasty, scaphometacarpal arthroplasty increased the intraprosthetic mobility by 7%-39%. While no complications occurred with trapeziometacarpal arthroplasty, there were two instances of implant dislocation and seven instances of intraprosthetic impingement with scaphometacarpal arthroplasty. Unlike trapeziometacarpal arthroplasty, scaphometacarpal arthroplasty altered scaphoid position by translating it in an ulnar and proximal direction relative to the radius.

Assessment of Scapholunate Instability on 4D CT Scans in Patients with Inconclusive Conventional Images.

Background Initial imaging work-up using radiography and CT arthrography sometimes can be insufficient to identify a scapholunate (SL) instability (SLI) in patients suspected of having SL ligament tears. Purpose To determine the diagnostic performance of four-dimensional (4D) CT in the identification of SLI and apply the findings to patients suspected of having SLI and with inconclusive findings on radiographs and CT arthrograms. Materials and Methods This prospective single-center study enrolled participants suspected of having SLI (recent trauma, dorsal pain, positive Watson test results, decreased grip strength) between March 2015 and March 2020. Participants with wrist fractures, substantial joint stiffness, or history of wrist surgery were excluded. Each participant underwent radiography, CT arthrography, and 4D CT on the same day. Participants were divided into three groups: those with no SLI, those with SLI, and those with inconclusive results. SL gap and radioscaphoid and lunocapitate angle were measured using semiautomatic quantitative analysis of 4D CT images by two independent readers. Receiver operating characteristic curves were used to evaluate the diagnostic performance of 4D CT. Thresholds were determined with the Youden index and were applied to the inconclusive group. Results Of the 150 included participants (mean age, 41 years ± 14 [SD]; 102 male, 48 female), there were 63 with no SLI, 48 with SLI, and 39 with inconclusive results. The maximum value and range of SL gap measurements on 4D CT scans showed high sensitivity (83% [40 of 48] and 90% [43 of 48], respectively) and high specificity (95% [59 of 62] and 81% [50 of 62], respectively) in the identification of SLI. At least one of these parameters was abnormal on 4D CT scans in 17 of 39 (44%) participants in the inconclusive group, and 10 of 17 (59%) participants had confirmed SLI. In the 22 participants in the inconclusive group with no indication of SLI at 4D CT, follow-up showed no evidence of SLI in 10 (45%) and enabled confirmation of SLI via arthroscopy in three (14%). Conclusion Scapholunate gap measurements on kinematic 4D CT scans enabled correct identification of SLI in 59% of participants with inconclusive results on conventional images. ClinicalTrials.gov registration no. NCT02401568 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Demehri and Ibad in this issue.

The effect of intercarpal arthrodeses on wrist kinematics during radial and ulnar deviation: a cadaveric study using four-dimensional CT.

In this cadaveric study, we report quantitative dynamic four-dimensional CT evaluation of the effect on wrist kinematics of three intercarpal arthrodeses during radial and ulnar deviation. In five wrists, we successively performed scaphocapitate, four-corner and two-corner fusions. Four-dimensional CT examinations were performed prior to dissection and after each arthrodesis. The lunocapitate gap, posterior lunocapitate angle, radiolunate radial gap, radiolunate ulnar gap and radiolunate angle were assessed. After scaphocapitate arthrodesis, in radial deviation, we noted midcarpal diastasis and dorsal displacement of the capitate. In ulnar deviation, there was correction of that incongruence. After four-corner and two-corner fusions, in radial deviation, we noted radial radiolunate impingement and ulnar radiolunate incongruence. In ulnar deviation, after two-corner fusion, ulnar radiolunate impingement and radial radiolunate incongruence were present contrary to four-corner fusion. Our findings confirm that the constant radiocarpal and midcarpal congruence during radioulnar deviation in normal wrists is no longer possible with intercarpal kinematic modifications after these arthrodeses.

Comparison of the Outcomes of Flexor Tendon Repair in Zone II Using the Original and Adjusted Strickland Scores and the 400-Points Hand Test.

Background: The purpose of this study was to report the outcomes of flexor tendon repair in zone II and compare two analytic tests - the original and adjusted Strickland scores - and a global hand function test, the 400-points test. Methods: We included 31 consecutive patients (35 fingers) with a mean age of 36 years (range 19-82 years) who underwent surgery for a flexor tendon repair in zone II. All patients were treated in the same healthcare facility by the same surgical team. All the patients were followed and evaluated by the same team of hand therapists. Results: At 3 months after the surgery, we found a good outcome in 26% of patients with the original Strickland score, 66% with the adjusted one and 62% with the 400-points test. Among the 35 fingers, 13 of them were evaluated at 6 months after the surgery. All the scores had improved with 31% good outcomes in the original Strickland score, 77% in the adjusted Strickland score and 87% in the 400-points test. The results were significantly different between the original and adjusted Strickland scores. Good agreement was found between the adjusted Strickland score and the 400-points test. Conclusions: Our results suggest that flexor tendon repair in zone II remains difficult to assess based solely on an analytic test. It should be combined with an objective global hand function test, such as the 400-points test, which appears to correlate with the adjusted Strickland score. Level of Evidence: Level IV (Therapeutic).

Hypothenar hammer syndrome: outcomes after ulnar artery reconstruction with autologous vein graft.

The most common surgical procedure for the treatment of hypothenar hammer syndrome (HHS) is resection of the pathological segment followed by arterial reconstruction using a venous bypass. Bypass thrombosis occurs in 30% of cases, with various clinical consequences, ranging from no symptoms to reappearance of the preoperative clinical symptoms. We reviewed 19 patients with HHS who underwent bypass graft, to assess clinical outcomes and graft patency, with a minimum follow-up of 12 months. Objective and subjective clinical evaluation and ultrasound exploration of the bypass were carried out. Clinical results were compared according to bypass patency. At a mean follow-up of 7 years, 47% of patients had complete resolution of symptoms; symptoms were improved in 42% of cases, and unchanged in 11%. Mean QuickDASH and CISS scores were 20.45/100 and 28/100, respectively. Bypass patency rate was 63%. Patients with patent bypass had shorter follow-up (5.7 vs 10.4 years; p = 0.037) and a better CISS score (20.3 vs 40.6; p = 0.038). There were no significant differences between groups for age (48.6 and 46.7 years; p = 0.899), bypass length (6.1 and 9.9 cm; p = 0.081) or QuickDASH score (12.1 and 34.7; p = 0.084). Arterial reconstruction gave good clinical results, with the best results in case of patent bypass. Level of evidence: IV.

Intercarpal arthrodesis: A systematic review.

Intercarpal arthrodesis is a well-established option to treat various disorders of the carpus, such as localized osteoarthritis, carpal instability, and Kienböck's disease. This is a non-conservative procedure aimed at obtaining a stable and congruent interface between the radius and the proximal carpal row, which restores wrist function by minimizing pain and restoring grip strength. These procedures generally yield good predictable results that are maintained over time. However, all intracarpal arthrodesis procedures cause a loss of wrist range of motion. To optimize outcomes and minimize complications, especially nonunion, this surgery may require a learning curve. A precise surgical technique for preparing the bone surfaces, bringing enough bone graft, and using reliable fixation is essential. Since the late 1960s, several intracarpal arthrodesis procedures have been described. Commonly used fusions target the scaphotrapeziotrapezoid, scaphocapitate, four corners, capitolunate or capitohamatolunate regions. Lesser used fusions focus on specific lesions such as the scapholunate, scapholunocapitate, lunotriquetral and triquetrohamate. Here, we propose a systematic review of the various types of intercarpal arthrodesis procedures described in the literature. After having described each arthrodesis, we specify their indications, the variations of the surgical techniques, and then present an overview of the results and complications. Finally, we discuss how these surgeries affect wrist biomechanics. LEVEL OF EVIDENCE: III.

Correlation Between Dynamic 4-Dimensional Computed Tomography Data and Arthroscopic Testing of Scapholunate Instability: A Preliminary Study.

PURPOSE: The aim of this study was to test the validity and reliability of the assessments of scapholunate (SL) instability status on 4-dimensional (4D) computed tomography (CT) using wrist arthroscopy as a reference standard. METHODS: Thirty-three patients (16 men, 17 women; mean age, 48 ± 13 years) with suspected SL instability were evaluated prospectively with 4D-CT and wrist arthroscopy. Based on the arthroscopic testing of SL joint, 2 groups were defined: group 1 (n = 8) consisted of patients who had no, or slight, SL malalignment in the midcarpal space and group 2 (n = 25) consisted of patients who had moderate or severe SL malalignment. Two independent readers, who did not know the arthroscopic findings, used 4D-CT to evaluate the SL gap, lunocapitate angle (LCA), and radioscaphoid angle (mean and range values) during radioulnar deviation. RESULTS: The interobserver reliability was deemed good or excellent for most of the 4D-CT variables, except for the LCA range (moderate) and SL gap range (poor). For both readers, the SL gap mean, maximum, and minimum values were significantly higher (+67%, +78%, and +39%, respectively) and the LCA mean was significantly lower (-17%) in group 2 than in group 1. The radioscaphoid angle range values were lower (-34%) and the radioscaphoid angle mean values slightly higher (+4%) in group 2, but there was no significant difference between the 2 groups. The SL gap range values were also higher (+86% for R1 and +40% for R2) and the LCA range values also lower (-50% for R1 and -31% for R2) in group 2. CONCLUSIONS: Quantitative 4D-CT data corresponded well with the arthroscopic dynamic analysis of the SL joint in patients with suspected chronic SL instability. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic II.

The influence of sagittal deformity of the distal radius on pronosupination: a cadaver study.

We performed a cadaver study using seven fresh-frozen adult upper limbs to assess the impact of increasingly larger distal radial deformity in the sagittal plane on the range of motion in pronation/supination. Three palmar (20°, 30° and 40° angulations) and three dorsal (10°, 20° and 30° angulations) tilt deformities, without any radial shortening, were simulated by performing a radial osteotomy and using custom-made three-dimensional-printed anterior plates. We measured the maximum unconstrained pronation and supination before the osteotomy and after each induced deformation. There was a decrease in the median pronation and supination values for all palmar and dorsal tilt deformities. The pronation range was more impaired than the supination range, and dorsal tilt deformities caused the greatest loss in forearm rotation. Our results suggest that forearm rotation in both pronation and supination is reduced as soon as 10° to 20° distal radial deformity occurs in the palmar or dorsal direction.

Arthroscopic Bone Grafting for Scaphoid Nonunion: A Retrospective Study of 42 Cases.

Background: The purpose of this retrospective study was to report outcomes of arthroscopic bone grafting and K-wire fixation to treat scaphoid non-union. Methods: We included in at two healthcare facilities, 42 consecutive patients (34 men, 8 women) with a mean age of 25 years (range 15-56 years) with scaphoid non-union of the proximal and middle third without intracarpal deformity or SNAC osteoarthritis. All patients were evaluated (pain, range of motion, strength, function, X-rays) by an independent examiner. Results: At the mean follow-up of 18 months (range 12-56), pain was significantly reduced from 7 to 1 on a visual analogue scale (out of 10). The scores on the Quick Disabilities of the Arm, Shoulder and Hand questionnaire and Patient Rated Wrist Evaluation were improved significantly. At the last review, grip strength was 83% of the contralateral side, the average wrist flexion-extension was 125° and the radioulnar deviation was 58°. Bone union was achieved in 37 cases (88%). The mean time of checking the bone union was 3 months (range, 2-8). Four patients required revision surgery because of failed union. Conclusions: Based on our findings, we found that this procedure can be used as a surgical treatment for scaphoid non-union of the proximal and middle third without intracarpal deformity or osteoarthritis. The arthroscopic bone grafting is a reliable, effective, and minimally invasive procedure.

Four-Dimensional CT Analysis of Dorsal Intercalated Segment Instability in patients with Suspected Scapholunate Instability.

Background In this study we sought to evaluate the contribution of dynamic four-dimensional computed tomography (4DCT) relative to the standard imaging work-up for the identification of the dorsal intercalated segment instability (DISI) in patients with suspected chronic scapholunate instability (SLI). Methods Forty patients (22 men, 18 women; mean age 46.5 ± 13.1 years) with suspected SLI were evaluated prospectively with radiographs, arthrography, and 4DCT. Based on radiographs and CT arthrography, three groups were defined: positive SLI ( n = 16), negative SLI ( n = 19), and questionable SLI ( n = 5). Two independent readers used 4DCT to evaluate the lunocapitate angle (LCA) (mean, max, coefficient of variation [CV], and range values) during radioulnar deviation. Results The interobserver variability of the 4DCT variables was deemed excellent (intraclass correlation coefficient = 0.79 to 0.96). Between the three groups, there was no identifiable difference for the LCA mean . The LCA max values were lower in the positive SLI group (88 degrees) than the negative SLI group (102 degrees). The positive SLI group had significantly lower LCA cv (7% vs. 12%, p = 0.02) and LCA range (18 vs. 27 degrees, p = 0.01) values than the negative SLI group. The difference in all the LCA parameters between the positive SLI group and the questionable SLI group was not statistically significant. When comparing the negative SLI and questionable SLI groups, the LCA cv ( p = 0.03) and LCA range ( p = 0.02) values were also significantly different. The best differentiation between patients with and without SLI was obtained with a LCA cv and LCA range threshold values of 9% (specificity of 63% and sensitivity of 62%) and 20 degrees (specificity of 71% and sensitivity of 63%), respectively. Conclusion In this study, 4DCT appeared as a quantitative and reproducible relevant tool for the evaluation of DISI deformity in cases of SLI, including for patients presenting with questionable initial radiography findings. Level of evidence This is a Level III study.

Comparison of simulated key pinch after three surgical procedures for trapeziometacarpal osteoarthritis: a cadaver study.

We performed a cadaver study using 18 fresh-frozen adult forearms and hands to compare the tendon loads required to generate progressively greater key pinch (0.5 kg to 2 kg) after three different surgical procedures to treat trapeziometacarpal osteoarthritis: isolated trapeziectomy, trapeziectomy followed by ligament reconstruction with tendon interposition and total joint arthroplasty using a Touch® implant. Thumb pinch was simulated by loading the main actuator tendons involved in the key pinch. Six specimens were randomly assigned to each of the three surgical procedure groups. Measurements were made before and after the joint surgery. Specimens that underwent trapeziectomy with or without ligament reconstruction with tendon interposition required significantly higher tendon loads than those with the implant to achieve the same pinch force. There was no significant difference between the isolated trapeziectomy and ligament reconstruction groups. Using the implant resulted in similar median tendon loads compared with those of the intact sample. Total joint arthroplasty with a Touch® prosthesis may yield a superior biomechanical profile in which the tendon loads needed to achieve a certain key pinch force are lower and better distributed between the actuator muscles compared with trapeziectomy with or without ligament reconstruction.

Comparison between the MAIA® Implant and Trapeziectomy for Trapeziometacarpal Osteoarthritis: Outcomes at 9 Years' Follow-Up.

Background: The purpose of this retrospective study was to report and compare the outcomes of the MAIA® prosthesis and trapeziectomy for trapeziometacarpal osteoarthritis. Methods: We included 92 consecutive patients (8 men, 84 women) with a mean age of 57 years (range 44-75 years) who underwent trapeziectomy (44 patients) or trapeziometacarpal joint replacement with a MAIA® prosthesis (48 patients) for painful osteoarthritis. All patients were evaluated (pain, range of motion, strength, function, X-rays) by an independent examiner. Results: The two groups of patients had comparable preoperative characteristics. At the mean follow-up of 9 years (range: 8-10), we found a significant reduction in pain levels for each group. In the final data review, there were no significant differences in terms of pain levels, grip strength, thumb active motion and the Quick Disabilities of the Arm, Shoulder and Hand score between the two groups. Pinch strength and the work performance score on the Michigan Hand Questionnaire were significantly better in the MAIA® prosthesis group. The MAIA® group had a shorter postoperative recovery time of 6 weeks and fewer patients required physiotherapy. Postoperatively, the thumb column length was significantly less in the trapeziectomy group. In this group, we found a significant decrease in the trapezial cavity height between the immediate postoperative evaluation and the final assessment, with three patients having painful scaphometacarpal impingement. Two patients required surgical revision for symptomatic meta-carpophalangeal joint hyperextension. In the MAIA® group, we found no implant subsidence, loosening, dislocation or fracture. None of the implants were revised. Conclusions: From this study, we found that the both procedures can be used as a surgical treatment for trapeziometacarpal osteoarthritis. The MAIA® prosthesis is a useful alternative to trapeziectomy and appears to be a reliable and effective implant in the medium- to long-term.

CT angiography and MRI of hand vascular lesions: technical considerations and spectrum of imaging findings.

Vascular lesions of the hand are common and are distinct from vascular lesions elsewhere because of the terminal vascular network in this region, the frequent hand exposure to trauma and microtrauma, and the superficial location of the lesions. Vascular lesions in the hand may be secondary to local pathology, a proximal source of emboli, or systemic diseases with vascular compromise. In most cases, ischaemic conditions are investigated with Doppler ultrasonography. However, computed tomography angiography (CTA) or dynamic contrast-enhanced magnetic resonance angiography (MRA) is often necessary for treatment planning. MR imaging is frequently performed with MRA to distinguish between vascular malformations, vascular tumours, and perivascular tumours. Some vascular tumours preferentially affect the hand, such as pyogenic granulomas or spindle cell haemangiomas associated with Maffucci syndrome. Glomus tumours are the most frequent perivascular tumours of the hand. The purpose of this article is to describe the state-of-the-art acquisition protocols and illustrate the different patterns of vascular lesions and perivascular tumours of the hand.

Intercarpal ligamentoplasty for scapholunate dissociation: comparison of two techniques.

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.

Evaluation of Dorsal Scaphoid Displacement Using Posterior Radioscaphoid Angle in Patients With Suspected Scapholunate Instability: A Preliminary Study.

PURPOSE: To assess the validity and reliability of the posterior radioscaphoid angle (PRSA), an indicator of dorsal displacement of the scaphoid, in distinguishing wrists with and without chronic scapholunate instability (SLI). METHODS: We prospectively evaluated 40 patients (22 men and 18 women; mean age, 46 ± 13 years) with suspected SLI with radiographs and computed tomography arthrography. Based on these data, 3 groups were defined: positive SLI (n = 16), negative SLI (n = 19), and questionable SLI (n = 5). An independent reader measured the PRSA on sagittal computed tomography images using the same procedure. RESULTS: The PRSA median values were significantly lower in the negative SLI group (98°) compared with the positive SLI (110°) and questionable SLI (111°) groups. The difference between the positive SLI and questionable SLI groups was not significant. The best differentiation between patients with and without SLI was obtained with a PRSA threshold value of 103° (specificity of 86% and sensitivity of 79%). CONCLUSIONS: In this preliminary study, PRSA analysis offers a quantitative tool for the evaluation of dorsal scaphoid displacement in cases of SLI, including for patients presenting with questionable initial radiography findings. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic II.