Vascular supply of the metacarpophalangeal joint.

Objective: To describe in detail the arterial vasculature of metacarpophalangeal joints 2-5 on cadaver specimens and to compare it to ultrasound imaging of healthy subjects. Methods: Eighteen hands of donated human cadavers were arterially injected and investigated with either corrosion casting or cryosectioning. Each layer of cryosectioned specimens was photographed in high-resolution. Images were then segmented for arterial vessels of the metacarpophalangeal (MCP) joints 2-5. The arterial pattern of the joints was reconstructed from the segmented images and from the corrosion cast specimens. Both hands of ten adult healthy volunteers were scanned focusing on the vasculature of the same joints with high-end ultrasound imaging, including color Doppler. Measurements were made on both cryosectioned arteries and Doppler images. Results: The arterial supply of MCP joints 2-5 divides into a metacarpal and a phalangeal territory, respectively. The metacarpal half receives arteries from the palmar metacarpal arteries or proper palmar digital arteries, while the phalangeal half is supplied by both proper and common palmar digital arteries. Comparing anatomical and ultrasonographic results, we determined the exact anatomic location of normal vessels using Doppler images acquired of healthy joints. All, except three branches, were found with less than 50% frequency using ultrasound. Doppler signals were identified significantly more frequently in MCP joints 2-3 than on 4-5 (p < 0.0001). Similarly, Doppler signals differed in the number of detectable small, intraarticular vessels (p < 0.009), but not that of the large extraarticular ones (p < 0.1373). When comparing measurements acquired by ultrasound and on cadaver vessels, measurements using the former technique were found to be larger in all joints (p < 0.0001). Conclusion: Using morphological and ultrasonographic techniques, our study provides a high-resolution anatomical maps and an essential reference data set on the entire arterial vasculature of healthy human MCP 2-5 joints. We found that Doppler signal could be detected in less than 50% of the vessels of healthy volunteers except three locations. Intraarticular branches were detected with ultrasound imaging significantly more frequently on healthy MCP 2-3 joints, which should be taken into account when inflammatory and normal Doppler signals are evaluated. Our study also provides reference data for future, higher-resolution imaging techniques.

Which Fracture Types Are Associated with Widening of the Scapholunate Distance? A CT-Scan Study of Acute Intraarticular Distal Radius Fractures.

Background: Scapholunate injuries in distal radius fractures may frequently be overlooked. The aims of this study were to measure the scapholunate distance in intraarticular distal radius fractures and to find out which fracture types were associated with an increased scapholunate width. Methods: Measurements of the scapholunate distance were performed on computed tomography scans of 143 intraarticular distal radius fractures in 140 patients. The fractures were classified according to the AO classification. The morphology of AO type B fractures was further analysed according to the Bain classification. Results: In 43 AO type B fractures mean scapholunate distance measured 2.1 mm and in 100 type C fractures 1.6 mm. The difference between partial and complete intraarticular fractures was significant. A trend towards a greater scapholunate distance was found in AO type B1 and radial styloid oblique fractures. Conclusions: In this study, partial intraarticular distal radius fractures, especially with a sagittal split, had a greater scapholunate distance and may be at risk for ligamentous injury.

Results of treatment of trapeziometacarpal osteoarthritis with trapeziectomy and tendon allograft interposition.

The aim of the study was to evaluate the results of treatment of osteoarthritis of the carpometacarpal joint of the thumb with tendon allograft interposition. Fifty-three patients (61 hands), 13 men and 40 women, were operated on at a mean age of 61 years. A partial trapeziectomy with tendon interposition was performed in 19 hands and with suspension arthroplasty in 24. Seventeen thumbs underwent a total trapeziectomy with suspension arthroplasty. Patients were evaluated at a mean follow-up of 4 years. In 34 patients (41 hands), a mean disability of arm, shoulder and hand score of 19 was found and a mean visual analogue scale for pain of 1.3. The satisfaction rate was 83 %. Revision operations were performed in 8 out of 61 hands. Four of those thumbs had been operated on previously or did not have primary osteoarthritis. No revisions were needed after partial trapeziectomy and tendon allograft interposition with suspension arthroplasty. In conclusion, tendon allograft interposition can be considered as one of the treatment options for osteoarthritis of the carpometacarpal joint of the thumb.

Ten-year outcomes of the Arpe prosthesis for the treatment of osteoarthritis of the trapeziometacarpal joint.

Outcomes of 66 Arpe prostheses in 50 patients treated for osteoarthritis of the trapeziometacarpal joint were investigated with a mean follow-up of ten years. Ten-year survival was 87% when failure was defined as implant removal followed by trapeziectomy and tendon interposition. Ten-year survival was 82% when revision of the cup was also considered as failure and it was 80% when replacement of the neck alone was also chosen as an endpoint. Of the 52 prostheses that were not revised mean DASH score was 11, mean pain score 1.2 and mean score for satisfaction 9.5. It can be concluded that the majority of patients who did not underwent revision surgery were satisfied and had little or no pain. However, long-term survival of the Arpe prosthesis was moderate and patients should be warned that after ten years the risk for reoperation might be up to 20%.

Involvement of the palmar lunate facet in intra-articular distal radius fractures.

BACKGROUND: Small fracture fragments of the palmar lunate facet of the distal radius can be difficult to stabilize and may cause loss of reduction and even subluxation of the radiocarpal joint. MATERIAL & METHODS: The aims of the study were to investigate fracture patterns of the intermediate column in 101 intra-articular distal radius fractures with three-dimensional computed tomography, and to determine the prevalence of palmar lunate facet fracture fragments. The size of the fragments was measured to find out how many fragments were small. RESULTS: The palmar lunate facet fragment was present in 61 fractures. Mean length of the palmar cortex measured 13.5mm (range: 3 to 26.9) and mean area of the lunate facet 115 mm2 (range: 31 to 267). Seventeen percent of intra-articular distal radius fractures had a palmar lunate facet fragment with a short palmar cortex. CONCLUSION: With accurate analysis of the preoperative computed tomography scans the typical fracture patterns of the palmar lunate facet are recognisable and adequate fixation technique can be chosen to avoid loss of reduction. LEVEL OF EVIDENCE: IV.

Treatment of distal radius fractures with palmar plates and locking screws. Comparisson of two different types of plate.

Various plating systems are available to fix distal radius fractures, each with a specific design. The purpose of this study was to compare radiological outcome and complications of the Variable Angle LCP Plate 2.4-mm (DePuy Synthes) with the VariAx volar locking plate (Stryker). One hundred patients (103 wrists) operated on for a distal radius fracture were retrospectively reviewed with a mean follow-up of 3.5 years. Seventy-three wrists were treated with a DePuy Synthes plate and 30 with a VariAx plate. The overall complication rate was 32%. Nineteen cases underwent revision surgery, 18 had malunion and 3 complex regional pain syndrome. Complicaton rate was 43% with DePuy Synthes plates and 27% with Variax plates, but the difference was not significant.

Non-traumatic primary and secondary osteoarthritis of the distal radioulnar joint.

A retrospective radiographic study was conducted to determine the prevalence and severity of non-traumatic primary and secondary osteoarthritis of the distal radioulnar joint in a group of 718 patients. Non-traumatic primary and secondary osteoarthritis was found in 77 patients (11%) with a mean age of 63 years. In 34 cases it was bilateral. Mild signs of osteoarthritis were present in 53, moderate in 17 and severe in seven patients. The prevalence of primary osteoarthritis was 8.2% and 2.5% had secondary non-traumatic osteoarthritis. The prevalence and severity of the osteoarthritis were similar in women and men. Ulnar wrist pain was associated with osteoarthritis of the distal radioulnar joint in 13% of patients with mild, 35% with moderate and 43% with severe radiological degeneration. Level of evidence: IV.

Results of ulnar shortening osteotomy in patients with ulnar wrist pain. A retrospective study.

The aim of the study was to find out if ulnar shortening is effective to treat ulnar wrist pain and which factors influence outcome. Thirty-seven patients were evalua- ted with a mean follow-up of 4.5 years. Thirty patients (81%) would undergo the same operation again although 21 (57%) had residual ulnar wrist pain. Mean disabilities of arm, shoulder and hand (DASH) score was 22 and mean patient rated wrist evaluation score (PRWE) was 33. DASH and PRWE scores were better in smokers, in patients operated on the non- dominant side and when follow-up was longer. PRWE score was worse in posttraumatic cases. Age, gender and type of osteotomy did not influence outcome. Three patients (8%) needed an additional operation for nonunion and in 17 (46%) plate and screws had to be removed. It can be concluded that ulnar shortening can be proposed to treat ulnocarpal wrist pain, but complete pain relief cannot be guaranteed and additional surgery may be required.

The Oblique Metaphyseal Shortening Osteotomy of the Distal Ulna: Surgical Technique and Results of Ten Patients.

Background Ulnocarpal abutment is a common condition following distal radius fractures. There are different surgical methods of treatment for this pathology: open and arthroscopic wafer procedure or an ulnar shortening osteotomy. We describe an oblique metaphyseal shortening osteotomy of the distal ulna using two cannulated headless compression screws. We report the results of 10 patients treated with this method. Materials and Methods Out of 17 patients, 10 could be reviewed retrospectively for this study. Patient-rated outcomes were measured using the VAS (visual analogue scale) for pain, PRWHE (patient-rated wrist and hand evaluation) survey, and Quick-DASH (disability of arm, shoulder and hand) survey for functional outcomes. At the review we measured the range of motion (ROM) of the wrist (extension and flexion, ulnar and radial deviation, pronation and supination). Grip strength, pronation, and supination strength of the forearm was measured using a calibrated hydraulic dynamometer. ROM and strength of the affected wrist was compared with ROM and strength of the unaffected wrist. Surgical Procedure Oblique long metaphyseal osteotomy of the distal ulna (from proximal-ulnar to distal-radial), fixed with two cannulated headless compression screws. Results The average postoperative VAS score for pain was 23.71 (standard deviation [SD] of 30.41). The average postoperative PRWHE score was 32.55 (SD of 26.28). The average postoperative Quick-DASH score was 28.65 (SD of 27.21). The majority of patients had a comparable ROM and strength between the operated side and the non-operated side. Conclusion This surgical technique has the advantage of reducing the amount of hardware and to decrease the potential hinder caused by it on medium term. Moreover, the incision remains smaller, and the anatomic metaphyseal localization of the osteotomy potentially allows a better and rapid healing.