Vertical mandibular asymmetry and hand measurements in patients in growth: cross-sectional study.

Objectives: The aim of this study was to determine the relationship between the vertical mandibular ramus asymmetry and the hand measurements asymmetry in growing patients. Material and Methods: Panoramic radiographs and comparative radiographs of the right and left hands of 40 patients (14 males and 26 females) between 6 and 16 years old (mean age of 11.35±1.99 years) were evaluated. The total height of the mandibular ramus was measured, and the asymmetry index was calculated. The lengths of the proximal, middle and distal phalanges and the metacarpals of the five digits of both hands were measured and the absolute differences R-L were calculated for each one. Results: A statistically significant association between the presence of vertical mandibular ramus asymmetry and the presence of phalanges asymmetry FPII (p=0.016), FPIII (p=0.016), FPIV (p=0.033), FMIII (p=0.031) and FMIV (p=0.016) was observed. Conclusions: Mandibular asymmetry appears not to be isolated but also present in other body districts such as the phalanx bones. The total vertical asymmetry of the mandibular ramus showed an association with the asymmetry of the lengths of the FPIII, FMIII, FPIV, FMIV and FPII in growing individuals, with association between the side of mandibular asymmetry and the side of the phalanx's asymmetry. The asymmetry of this phalanges increases with increasing index of vertical mandibular ramus asymmetry.

Development and stability analysis of carpal kinematic metrics from 4D magnetic resonance imaging.

OBJECTIVE: To develop MRI-derived carpal kinematic metrics and investigating their stability. METHODS: The study used a 4D MRI method to track scaphoid, lunate, and capitate movements in the wrist. A panel of 120 metrics for radial-ulnar deviation and flexion-extension was created using polynomial models of scaphoid and lunate movements relative to the capitate. Intraclass correlation coefficients (ICCs) analyzed intra- and inter-subject stability in 49 subjects, 20 with and 29 without wrist injury history. RESULTS: Comparable degrees of stability were observed across the two different wrist movements. Among the total 120 derived metrics, distinct subsets demonstrated high stability within each type of movement. For asymptomatic subjects, 16 out of 17 metrics with high intra-subject stability also showed high inter-subject stability. The differential analysis of ICC values for each metric between asymptomatic and symptomatic cohorts revealed specific metrics (although relatively unstable) exhibiting greater variability in the symptomatic cohort, thereby highlighting the impact of wrist conditions on the variability of kinematic metrics. CONCLUSION: The findings demonstrate the developing potential of dynamic MRI for assessing and characterizing complex carpal bone dynamics. Stability analyses of the derived kinematic metrics revealed encouraging differences between cohorts with and without wrist injury histories. Although these broad metric stability variations highlight the potential utility of this approach for analyzing carpal instability, further studies are necessary to better characterize these observations.

The use of accelerometer bracelets to evaluate arm motor function over a stroke rehabilitation period - an explorative observational study.

BACKGROUND: Assessments of arm motor function are usually based on clinical examinations or self-reported rating scales. Wrist-worn accelerometers can be a good complement to measure movement patterns after stroke. Currently there is limited knowledge of how accelerometry correlate to clinically used scales. The purpose of this study was therefore to evaluate the relationship between intermittent measurements of wrist-worn accelerometers and the patient's progression of arm motor function assessed by routine clinical outcome measures during a rehabilitation period. METHODS: Patients enrolled in in-hospital rehabilitation following a stroke were invited. Included patients were asked to wear wrist accelerometers for 24 h at the start (T1) and end (T2) of their rehabilitation period. On both occasions arm motor function was assessed by the modified Motor Assessment Scale (M_MAS) and the Motor Activity Log (MAL). The recorded accelerometry was compared to M_MAS and MAL. RESULTS: 20 patients were included, of which 18 completed all measurements and were therefore included in the final analysis. The resulting Spearman's rank correlation coefficient showed a strong positive correlation between measured wrist acceleration in the affected arm and M-MAS and MAL values at T1, 0.94 (p < 0.05) for M_MAS and 0.74 (p < 0.05) for the MAL values, and a slightly weaker positive correlation at T2, 0.57 (p < 0.05) for M_MAS and 0.46 - 0.45 (p = 0.06) for the MAL values. However, no correlation was seen for the difference between the two sessions. CONCLUSIONS: The results confirm that the wrist acceleration can differentiate between the affected and non-affected arm, and that there is a positive correlation between accelerometry and clinical measures. Many of the patients did not change their M-MAS or MAL scores during the rehabilitation period, which may explain why no correlation was seen for the difference between measurements during the rehabilitation period. Further studies should include continuous accelerometry throughout the rehabilitation period to reduce the impact of day-to-day variability.

Incidence of hand and wrist disorders in primary care.

BACKGROUND: The incidence of different types of hand and wrist disorders in primary care is unknown since there are no specific encodings for it. AIMS: To determine the overall incidence and the incidence of specific types of hand and wrist disorders in primary care. DESIGN & SETTING: A healthcare registration database from Dutch general practice, which contains medical records of over 200 000 patients and included approximately 25% of the population of the area of Rotterdam. METHOD: Patients aged ≥18 years with a new diagnosis of hand or wrist disorder from 1 January 2015 to 31 December 2019 were extracted using a search algorithm based on ICPC coding and search terms in free text. RESULTS: The mean incidence over the study period of a hand disorder was 5.9 per 1,000 persons-years and of a wrist disorder 0.3 per 1,000 persons-years. The incidence of trigger finger/thumb, fracture hand/finger, tendon/ligament tendinopathy, mallet finger and ligament injury hand/finger were 3 (2.69-3.15), 1 (1.03-1.33), 1 (0.98-1.28), 0.6 (0.48-0.69) and 0.1 (0.06-0.14) per 1,000 persons-years, respectively. The incidence of a wrist fracture and ligament injury were 0.2 (0.13-0.25) and 0.1 (0.04-0.12) per 1,000 persons-years, respectively. CONCLUSIONS: There is a large difference between the number of patients presenting to the GP with hand and wrist complaints and the number of hand and wrist diagnosis reported in the medical files. Introducing specific ICPC codes for different types of hand and wrist disorders could (potentially) lead to a more accurate registration of a diagnosis and determination of the incidence figures.

Accessory first lumbrical muscle within the carpal tunnel: a case report.

Carpal tunnel syndrome is the most common entrapment neuropathy in the upper extremity. Palmaris longus, flexor digitorum superficialis, and lumbricals have infrequently been reported as causes of nerve compression. During routine Korean cadaver dissection, we incidentally identified an anatomic variant of first lumbrical muscle within the carpal tunnel in both wrists. The aberrant musculature originated from the radial side of the second FDS muscle at distal forearm level, running separately across the wrist beneath the flexor retinaculum. The dissected anomalous muscle was identified as an additional muscle belly of the first lumbrical muscle. Compression of the median nerve at the wrist might rarely be caused by the presence of such a tendon or muscle anomaly found in this study. Surgeons should be aware of possible anatomic variations in the carpal tunnel, and be prepared to modify their surgical plan accordingly.

Detection of scapholunate interosseous ligament injury using dynamic computed tomography-derived arthrokinematics: A prospective clinical trial.

Scapholunate interosseous ligament injuries are a major cause of wrist instability and can be difficult to diagnose radiographically. To improve early diagnosis of scapholunate ligament injuries, we compared injury detection between bilateral routine clinical radiographs, static CT, and dynamic four-dimensional CT (4DCT) during wrist flexion-extension and radioulnar deviation. Participants with unilateral scapholunate ligament injuries were recruited to a prospective clinical trial investigating the diagnostic utility of 4DCT imaging for ligamentous wrist injury. Twenty-one participants underwent arthroscopic surgery to confirm scapholunate ligament injury. Arthrokinematics, defined as distributions of interosseous proximities across radioscaphoid and scapholunate articular surfaces at different positions within the motion cycle, were used as CT-derived biomarkers. Preoperative radiographs, static CT, and extrema of 4DCT were compared between uninjured and injured wrists using Wilcoxon signed rank or Kolmogorov-Smirnov tests. Median interosseous proximities at the scapholunate interval were significantly greater in the injured versus the uninjured wrists at static-neutral and maximum flexion, extension, radial deviation, and ulnar deviation. Mean cumulative distribution functions at the radioscaphoid joint were not significantly different between wrists but were significantly shifted at the scapholunate interval towards increased interosseous proximities in injured versus uninjured wrists in all positions. Median and cumulative distribution scapholunate proximities from static-neutral and 4DCT-derived extrema reflect injury status.

Evaluation of a cadaveric wrist motion simulator using marker-based X-ray reconstruction of moving morphology.

Surgical intervention is a common option for the treatment of wrist joint arthritis and traumatic wrist injury. Whether this surgery is arthrodesis or a motion preserving procedure such as arthroplasty, wrist joint biomechanics are inevitably altered. To evaluate effects of surgery on parameters such as range of motion, efficiency and carpal kinematics, repeatable and controlled motion of cadaveric specimens is required. This study describes the development of a device that enables cadaveric wrist motion to be simulated before and after motion preserving surgery in a highly controlled manner. The simulator achieves joint motion through the application of predetermined displacements to the five major tendons of the wrist, and records tendon forces. A pilot experiment using six wrists aimed to evaluate its accuracy and reproducibility. Biplanar X-ray videoradiography (BPVR) and X-Ray Reconstruction of Moving Morphology (XROMM) were used to measure overall wrist angles before and after total wrist arthroplasty. The simulator was able to produce flexion, extension, radioulnar deviation, dart thrower's motion and circumduction within previously reported functional ranges of motion. Pre- and post-surgical wrist angles did not significantly differ. Intra-specimen motion trials were repeatable; root mean square errors between individual trials and average wrist angle and tendon force profiles were below 1° and 2 N respectively. Inter-specimen variation was higher, likely due to anatomical variation and lack of wrist position feedback. In conclusion, combining repeatable intra-specimen cadaveric motion simulation with BPVR and XROMM can be used to determine potential effects of motion preserving surgeries on wrist range of motion and biomechanics.

Analysis of the relationship between shorter sleep duration and wrist fractures: based on NHANES.

BACKGROUND: Wrist fracture is one of the common limb fractures. Its incidence rate increases with age and osteoporosis. Nowadays, Sleep health is increasingly valued, but the relationship between wrist fractures and sleep time is not yet clear. METHODS: Data in this study were collected and screened from the NHANES from 2005 to 2010 and 2013 to 2014. The variables were extracted from interviews and compared between the wrist fractures and the sleep duration. The data was analyzed by weighted multivariate logistic regression. RESULTS: After excluding individuals who were not eligible and had invalid data, we finally identified 1835 participants for inclusion in this study. We found a negative association between the sleep duration and the fractured of the wrist (OR = 1.027,95% CI (1.027, 1.028), P < 0.00001). CONCLUSION: This study demons that the association between the sleep duration and the fractures of the wrist is significant. Our findings provide a better understanding of the relationship between sleep duration and wrist fractures. This study may help us reducing the incidence of wrist fractures in the population based on healthy sleep management in the future, and improve the quality of life of middle-aged and elderly patients. Provide evidence for clinical patients to manage healthy sleep.

Effectiveness of the static progressive Joint Active System splint in improving upper extremity joint stiffness.

PURPOSE: Injuries to the upper extremity often result in stiffness. The joint capsule may lose its elastic properties, limiting motion. Most modalities for increasing motion are based on capsule stretching, and usually involve physical or occupational therapy. We tested the hypothesis that the Joint Active System static-progressive splint is helpful in increasing range of motion in stiff joints after failure of other treatments. METHODS: Candidates for the Joint Active System splint were mostly patients with upper extremity trauma that required surgery, if they plateaued after therapy but still had stiffness. A retrospective review was performed of all patients from 2015 to 2019 that met our inclusion criteria. Etiologies of stiffness and patient demographics were documented. Range of motion was recorded before and after treatment and, when available, functional scores were calculated. RESULTS: Forty-four patients were treated with the Joint Active System splint; 5 were excluded, leaving 39 for analysis: 15 elbow, 14 wrist and 10 proximal interphalangeal joints. All patients had received therapy before using the Joint Active System and 11 had tried a dynamic splint in addition to therapy. All joints showed significant improvement in motion after treatment: from 66.5° to 95.7° in the elbow, 63.5° to 81.1° in the wrist and 33.2° to 51.8° in the proximal interphalangeal joint. When functional scores were available before and after treatment, there was significant improvement for both elbow and wrist. Even when the Joint Active System was started many months after injury, it was effective. CONCLUSIONS: Despite reaching a plateau with therapy, the Joint Active System static-progressive splint is effective in improving range of motion in elbow, wrist and finger joints with stiffness following injury or surgery. TYPE OF STUDY: Retrospective case series. LEVEL OF EVIDENCE: Therapeutic, level IV.

Dorsal Radiocarpal Dislocation with Radial Styloid Fracture Treated with Arthroscopy-Assisted Reduction and Internal Fixation: A Report of Two Cases.

Radiocarpal dislocation is an uncommon injury that is usually caused by high-energy trauma. Herein, we present two cases of dorsal radiocarpal dislocation with radial styloid fractures that were treated by arthroscopy-assisted reduction and internal fixation. Wrist arthroscopy provides accurate information on intra-articular fractures and carpal and/or intracarpal ligamentous tears of the radiocarpal joint. Furthermore, the procedure enables simultaneous anatomical reduction of intra-articular fractures and radiocarpal and/or intercarpal ligament repair. Arthroscopy-assisted reduction and internal fixation yield satisfactory outcomes for patients presenting with dorsal radiocarpal dislocation and radial styloid fractures.

ERegPose: An explicit regression based 6D pose estimation for snake-like wrist-type surgical instruments.

BACKGROUND: Accurately estimating the 6D pose of snake-like wrist-type surgical instruments is challenging due to their complex kinematics and flexible design. METHODS: We propose ERegPose, a comprehensive strategy for precise 6D pose estimation. The strategy consists of two components: ERegPoseNet, an original deep neural network model designed for explicit regression of the instrument's 6D pose, and an annotated in-house dataset of simulated surgical operations. To capture rotational features, we employ an Single Shot multibox Detector (SSD)-like detector to generate bounding boxes of the instrument tip. RESULTS: ERegPoseNet achieves an error of 1.056 mm in 3D translation, 0.073 rad in 3D rotation, and an average distance (ADD) metric of 3.974 mm, indicating an overall spatial transformation error. The necessity of the SSD-like detector and L1 loss is validated through experiments. CONCLUSIONS: ERegPose outperforms existing approaches, providing accurate 6D pose estimation for snake-like wrist-type surgical instruments. Its practical applications in various surgical tasks hold great promise.

Isolated pisiform dislocation after a seizure episode.

A 31-year-old woman had a seizure episode three weeks before, leading to a fall on her left hand. Following the accident, she had discomfort on the ulnar side of her left wrist. She decided to seek treatment from a local bone setter; however, her hand discomfort continued and she then came to us for treatment. The radiography and computed tomography scan demonstrated a pisiform dislocation. The pisiform bone was surgically removed. The pisiform dislocation should be considered in the differential diagnosis of the ulnar side wrist discomfort following wrist trauma.

Scapholunate Advanced Collapse (SLAC) and Scaphoid Nonunion Advanced Collapse (SNAC): A Review of Treatment Options for Stage II.

Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) represent clinical entities identified by a pattern of predictable degenerative changes. They are the most common causes of wrist arthritis. Both entities can remain asymptomatic for many years and may go undiagnosed. Diagnosis is usually confirmed through clinical examination, which reveals progressive wrist pain and instability. Radiographically, degenerative changes in the radiocarpal and midcarpal joints are present, as well as nonunion of the scaphoid fracture in SNAC. The management differs according to the stage. Particularly in this review article, we reviewed the treatment options for stage II SLAC and SNAC wrist. In addition to the well-described surgical techniques such as proximal row carpectomy and four-corner fusion, alternatives such as capitolunate arthrodesis, three-corner fusion, and soft tissue procedures like capsulodesis and tenodesis are available. Proximal row carpectomy and partial arthrodeses yield comparable results. Soft tissue procedures are viable alternatives and are preferred in younger patients to avoid early salvage operations.

New-Onset Wrist Drop After a Night of Drinking: A Case Report.

This case report highlights the clinical approach to evaluating a patient with substance use disorder presenting with a sudden onset of peripheral neuropathy in the left hand. Our patient had significant cardiovascular risk factors, which further broadened the differential diagnosis beyond common causes of mononeuropathy. The use of detailed and appropriate clinical history, physical examination, and careful selection of relevant laboratory and radiological tests was instrumental in ruling out multiple medical differential diagnoses, including common mononeuropathies and life-threatening ones, such as cerebrovascular accidents, which facilitated the involvement of necessary consults while also treating both the presenting medical complication and underlying severe alcohol use disorder with additional efforts at relapse prevention.

Is hand-wrist radiography still necessary in orthodontic treatment planning?

OBJECTIVES: The aim of our study is to compare the relationship between hand-wrist and cervical vertebra maturation stages with chronological age and to investigate the effect of malocclusion type on the relationship between these methods. MATERIALS AND METHODS: Hand-wrist and cephalometric radiographs of 1000 patients (526 females, 474 males) with a mean age of 13.41 ± 1.83 were analyzed. The methods of Bacetti et al. were used for the cervical vertebra maturation stage, and Björk, Grave and Brown's methods were used for the hand-wrist maturation stage. One-way ANOVA test was applied to compare skeletal classes between them. Tukey post hoc test was used to determine the differences. The relationship between the malocclusion type, cervical vertebra and hand-wrist maturation stages was evaluated with the Spearman correlation test. RESULTS: Spearman's correlation coefficient was 0.831, 0.831 and 0.760 in Class I, II and III females, respectively. In males, it was calculated as 0.844, 0.889 and 0.906, respectively. When sex and malocclusion were not differentiated, the correlation was found to be 0.887. All were statistically significant (P < 0.001). The highest correlation was observed in class III males, while the lowest was found in class III females. CONCLUSION: Cervical vertebrae can be used safely to assess pubertal spurt without hand-wrist radiography. Diagnosing growth and development stages from cephalometric images is important in reducing additional workload and preventing radiation risk.

Enhancing wrist arthroscopy: artificial intelligence applications for bone structure recognition using machine learning.

INTRODUCTION: Wrist arthroscopy is a rapidly expanding surgical discipline, but has a long and challenging learning curve. One of its difficulties is distinguishing the various anatomical structures during the procedure. Although artificial intelligence has made significant progress in recent decades, its potential as a valuable tool in surgery training is largely untapped. MATERIALS AND METHODS: The objective of this study was to develop an algorithm that could accurately recognize the anatomical bone structures of the wrist during arthroscopy. We prospectively included 20 wrist arthroscopies: 10 in patients and 10 in cadavers. For each surgery, we extracted and labeled images of the various carpal bones. These images were used to create a database for training, validating and testing a structure recognition algorithm. The primary criterion used was a Dice loss detection and categorization score for structures of interest, with a threshold greater than 80%. RESULTS: The database contained 511 labeled images (4,088 after data augmentation). We developed a Deeplabv3+ classification algorithm with a U-Net architecture. After training and testing our algorithm, we achieved an average Dice loss score of 89% for carpal bone recognition. CONCLUSION: This study demonstrated reliable detection of different carpal bones during arthroscopic wrist surgery using artificial intelligence. However, some bones were detected more accurately than others, suggesting that additional algorithm training could further enhance performance. Application in real-life conditions could validate these results and potentially contribute to learning and improvement in arthroscopic wrist surgery. LEVEL OF EVIDENCE: IV.

Investigation of the short-term in vivo performance of metal-on-carbon fibre reinforced poly ether ether ketone Motec wrists: an explant analysis.

Total wrist arthroplasty (TWA) aims to restore pain-free motion to diseased joints. One such TWA, the Motec, has demonstrated good results with acceptable complication rates. It has recently been suggested that the metal-on-carbon fibre reinforced poly ether ether ketone (Mo-CFR-PEEK) version of the Motec TWA be implanted instead of the metal-on-metal version. An explant analysis was undertaken on seven Motec Mo-CFR-PEEK TWAs, revised for a variety of reasons, after a mean time of 2 years in vivo. Compared to a new Motec implant, five of the explanted metal heads and three of the CFR-PEEK cups became smoother in vivo, suggesting self-polishing and negative skewness, indicating some material loss in vivo. Two explanted cups showed indentation marks on their rims and one of these was from component impingement with embedded metallic debris. In the short-term, the articulating surfaces of Motec Mo-CFR-PEEK TWAs did not show major damage.Level of evidence: IV.

A modified partial wedge-shaped metaphyseal ulnar osteotomy for the treatment of ulnar impaction syndrome with reverse oblique sigmoid notch.

We describe a modified metaphyseal ulnar osteotomy to treat ulnar impaction syndrome with a reverse oblique sigmoid notch. Based on a computational analysis of radiographs, a modified wedge metaphyseal ulnar osteotomy was devised with its apex positioned at the ulnar styloid base to avoid impaction between the sigmoid notch and ulnar head. Subsequently, nine patients with ulnar impaction syndrome and a reverse oblique sigmoid notch underwent this operation, combined with arthroscopic exploration and transosseous triangular fibrocartilage complex repair. The mean follow-up was 14 months. All patients achieved bone union within 5 weeks, with no degenerative changes being observed during the follow-up assessments. The final follow-up assessments revealed decreases in ulnar variance and in the scores for Visual Analogue Scale, Quick Disabilities of the Arm, Shoulder and Hand questionnaire and the Patient-Rated Wrist Evaluation. All patients achieved excellent or good grades on the Modified Mayo Wrist Score. This technique is effective in treating the ulnar impaction syndrome with a reverse oblique sigmoid notch.Level of evidence: IV.

Cystic soft tissue tumours of the dorsal aspect of the wrist have two distinct histological subtypes.

In total, 38 patients with cystic dorsal wrist tumours managed with surgical excision were prospectively followed up for 2 years. Tissue was examined histologically after primary surgery and at recurrence. Two distinct tissue types were found: ganglion cyst and synovial cyst.