Clinical and Radiological Outcomes of Scaphocapitate Fusion in Kienböck Disease: A Systematic Review and Meta-Analysis.

Purpose: To report the functional and radiological outcomes of scaphocapitate (SC) arthrodesis in the treatment of Kienböck disease. Methods: This meta-analysis was conducted with adherence to PRISMA guidelines. Google Scholar, PubMed, Cochrane and Virtual Health Library were searched from inception until November 2022. All original studies that investigated the outcomes of scaphocapitate fusion in Kienböck disease were included. Exclusion criteria were arthroscopically performed fusions, concomitant radial shortening, traumatic or other etiologies of lunate avascular necrosis, and studies published in languages other than English. Outcomes of interest were pre- and post-operative wrist range of motion, VAS score, functional scores, radiological outcomes, surgical technique, complication rate and reoperation rate. Results: The total number of included participants was 203 from 11 articles. The results showed no significant differences pre- and post-operatively in terms of wrist flexion, extension and ulnar deviation. However, there was a significant reduction in radial deviation after the surgery (WMD -2.30; 95% CI, -4.26 to -0.33). Moreover, a significant increase was noticed in grip strength in Kg (WMD 13.29; 95% CI, 3.21-23.37) and mmHg post-operatively (WMD 23.75; 95% CI, 17.56-29.94). In addition, the models demonstrated significant decrease in carpal height (WMD -0.01; 95% CI, -0.02 to 0.00), scapholunate angle (WMD -12.11; 95% CI, -20.46 to -3.77) and radioscaphoid angle after the surgery (WMD -12.09; 95% CI, -15.51 to -8.67). The pooled overall rate of complication and reoperation rates were 24% (95% CI, 6%-47%) and 14% (95% CI, 3%-31%), respectively. Conclusions: Scaphocapitate arthrodesis is an effective procedure for treatment of Kienböck disease. This procedure is associated with satisfactory functional outcomes and significant improvement in pain scores and grip strength. Further studies with larger sample sizes and reduced heterogeneity are needed for a better evaluation of the results. Clinical relevance: Scaphocapitate arthrodesis is a recommended surgery for Kienböck disease with satisfactory functional and radiological outcomes. However, patients should be counseled on the possible complications and reoperation rate.

Acute irreducible volar distal radioulnar joint dislocation treated with open reduction through dual approaches: A case report and literature review.

Introduction: Acute dislocation of distal radioulnar joint (DRUJ) is a rare pathology. Most cases were managed with closed reduction, and few patients required open reduction through dorsal or volar approaches. We describe a patient who required open reduction using dual approaches. Case presentation: This paper reported a case of acute DRUJ volar dislocation that failed closed reduction. Open reduction was tried using a dorsal approach which failed to achieve joint reduction. A second volar approach to release volar joint capsule had only achieved joint reduction. Discussion and conclusion: This case report highlighted the importance of open reduction when treating acute DRUJ injuries that failed closed reduction. We strongly recommend that surgeons should be ready to utilize dual approaches for this injury and to appraise patients about this possibility.

Locked volar distal radioulnar joint dislocation.

INTRODUCTION: Volar dislocation of the distal radioulnar joint is a rare injury which is commonly missed in the emergency departments. A thorough review of literature showed very few reported cases and the cause for irreducibility varied in different cases, Lack of suspicion and improper X-ray can delay the diagnosis. CASE PRESENTATION: Our article discusses a case 40 year old construction worker, who presented to the Emergency with work-related injury, complaining of left wrist pain, deformity and inability to rotate his forearm. X-rays revealed a volar dislocation of distal ulna which was reducible after manipulation under General Anesthesia (GA). The joint was stable after the reduction. DISCUSSION: Isolated dislocation of the distal radioulnar joint can be either volar or dorsal, although dorsal dislocation is more common. The distal radioulnar articulation plays an important role in the rotational movement of the forearm. It allows pronation and supination which are essential for the function of the upper limb. Pronator Quadratus muscle spasm is an important blockade to reduction and was preventing reduction in this case. METHODS: The work has been reported in line with the CARE criteria [9]. CONCLUSION: Volar locked dislocation of Distal Radio ulnar joint is a rare injury. High degree of clinical suspicion and proper X-ray is required for prompt detection. The importance of this case is to raise the awareness among physicians in treating these kind of injuries by careful assessment of the patient and radiographs, and to consider pronator quadratus as an important cause for the blockade to reduction.