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1.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(3): 352-356, 2020 Mar 15.
Artigo em Chinês | MEDLINE | ID: mdl-32174082

RESUMO

Objective: To evaluate the long-term effectiveness of vascularized fibula flap in radiocarpal joint reconstruction following excision of Campanacci grade Ⅲ giant cell tumor (GCT) of distal radius. Methods: Between December 2010 and December 2014, 10 patients with Campanacci grade Ⅲ GCT of distal radius were treated with en bloc excision and inradiocarpal joint reconstruction using vascularized fibula flap. They were 6 males and 4 females, with an average age of 39.9 years (range, 22-65 years). The disease duration was 1.5-6.0 months (mean, 2.6 months). The length of distal radius defect was 6.0-12.5 cm (mean, 8.4 cm) after en bloc excision of GCT. Vascularized fibula flap with inferior lateral genicular vessels were performed in 6 patients and with inferior lateral genicular vessels and peroneal vessels in 4 cases. Results: All incisions healed by first intention. All patients were followed up 4.4-8.3 years (mean, 6.0 years). There was no tumor recurrence during follow-up. At last follow-up, the mean ranges of motion of wrist joint were 55.0° (range, 25-85°) in extension, 26.5° (range, 15-40°) in flexion, 12.0° (range, 5-25°) in radial deviation, 19.6° (range, 10-30°) in ulnar deviation, 50.5° (range, 5-90°) in pronation, and 66.5° (range, 20-90°) in supination. The mean grip strength of effected wrist was 75% (range, 60%-85%) of the healthy wrist. The mean Musculoskeletal Tumor Society (MSTS) score was 82.7% (range, 75%-90%). X-ray films showed that the fibula flap healed at 12-16 weeks after operation (mean, 14.1 weeks) and there were 9 cases of radiological complications. Conclusion: For Campanacci grade Ⅲ GCT of distal radius, application of the vascularized fibula flap in radiocarpal joint reconstruction after en bloc excision of GCT can obtain good wrist function.


Assuntos
Neoplasias Ósseas/cirurgia , Transplante Ósseo , Fíbula/transplante , Tumor de Células Gigantes do Osso/cirurgia , Articulação do Punho/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Rádio (Anatomia)/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Punho , Adulto Jovem
2.
Orthop Clin North Am ; 51(1): 77-86, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739882

RESUMO

Scapholunate ligament injuries are common and can lead to a predictable pattern of arthritis (scaphoid lunate advanced collapse wrist) if unrecognized or untreated. This article describes the relevant anatomy, biomechanics, and classification system, and provides an up-to-date literature-based review of treatment options, including acute repair and various reconstruction techniques. It also helps guide surgeons in making decisions regarding a systematic treatment algorithm for these injuries.


Assuntos
Ligamentos Articulares/lesões , Ligamentos Articulares/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Traumatismos do Punho/complicações , Artrite/epidemiologia , Artrite/etiologia , Fenômenos Biomecânicos , Articulações do Carpo/lesões , Articulações do Carpo/patologia , Articulações do Carpo/cirurgia , Humanos , Ligamentos Articulares/anatomia & histologia , Osso Semilunar/lesões , Osso Semilunar/patologia , Osso Semilunar/cirurgia , Radiografia/métodos , Amplitude de Movimento Articular , Osso Escafoide/lesões , Osso Escafoide/patologia , Osso Escafoide/cirurgia , Resultado do Tratamento , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/cirurgia , Articulação do Punho/patologia , Articulação do Punho/cirurgia
3.
J Hand Surg Asian Pac Vol ; 24(4): 440-446, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31690193

RESUMO

Background: Scapholunate dissociation (SLD) is a common and sometimes disabling ligamentous injury of the wrist. The aim of the treatment is to restore carpal alignment and to prevent joint degeneration. In the current study, we reported mid-term results of our technique using suture anchor fixation within the SL interface. Methods: Nine male patients with an average age of 35 years underwent scapholunate suture anchor fixation (SLAF) for chronic and symptomatic dynamic or reducible static SLD from 2011 to 2016 with a mean follow-up of 36 months. After dorsal wrist exposure, a 2.8 mm suture anchor was inserted in the dorsoproximal lateral articular surface of the lunate bone. The two ends of the sutures were passed through the two divergent canals in the scaphoid. The sutures were tied over the tuberosity after reducing the SL alignment. Two K-wires supported SL and scaphocapitate (SC) alignment for 8 weeks. Radiographic parameters, wrist range of motion and grip strength were measured. Quick-DASH and Modified Mayo Wrist Score (MMWS) were used to assess the functional outcome. Results: The grip strength and passive motion reached to 75% and 88% of the other side, respectively. The SL gap was 5.4 mm, 2.6 mm and 3.4 mm before surgery, after pin removal, and on the follow-up stress radiographs, respectively. The SL angle was 82, 52 and 65 degrees at any time point, respectively. Average Quick-DASH score was improved from 60 to 25. According to MMWS score, one patient was excellent, one was good, five were fair, and two were poor. Conclusions: SLAF is a simple technique with minimal soft tissue manipulation that enables correction and maintaining of the carpal alignment with favorable mid-term results.


Assuntos
Fios Ortopédicos , Instabilidade Articular/cirurgia , Ligamentos Articulares/cirurgia , Osso Semilunar/cirurgia , Osso Escafoide/cirurgia , Âncoras de Sutura , Articulação do Punho/cirurgia , Adulto , Doença Crônica , Seguimentos , Humanos , Instabilidade Articular/diagnóstico , Instabilidade Articular/fisiopatologia , Osso Semilunar/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia , Amplitude de Movimento Articular , Osso Escafoide/diagnóstico por imagem , Fatores de Tempo , Resultado do Tratamento , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/fisiopatologia , Adulto Jovem
4.
J Hand Surg Asian Pac Vol ; 24(4): 428-434, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31690195

RESUMO

Background: Although there have been many studies of the vascularized bone graft (VBG) or unloading procedures alone for the treatment of Kienböck disease, little information has been reported about patients treated with VBG combined with unloading procedures. The purpose of this study is to 1) describe the outcomes in patients treated with VBG combined with unloading procedures, 2) compare the outcomes according to the unloading procedures and 3) find any radiologic parameters affecting revascularization in Kienböck disease. Methods: A retrospective review was performed involving in 20 patients undergoing 4th and 5th extensor compartmental VBG with unloading procedures for Kienböck disease from 2010-2015. After VBG in all patients, unloading procedures were additionally performed depending on the ulnar variance. These additional operations included joint leveling procedures (radial and capitate shortening osteotomy) or temporary scaphocapitate pinning. Radiologic outcome was evaluated according to Lichtman stage and presence of revascularization evidence. Clinical evaluations included wrist range of motion, grip strength, visual analogue scale (VAS), and Mayo wrist score. Results: VBG with joint leveling procedures was performed in 11 patients (5 radial shortening and 6 capitate shortening) and VBG with temporary scaphocapitate pinning was performed in 9 patients. Although clinical outcomes were not significantly different according to the unloading procedures, there were significantly more patients with evidence of healing of osteonecrosis on radiographs in joint leveling procedure group than temporary scaphocapitate pinning group. Overall, evidence of healing of osteonecrosis was found on plain radiographs in 11 patients and was not found in 9 patients. However, there were no significant preoperative radiological parameters affecting revascularization on radiographs. Conclusions: Not all patients had evidence of revascularization on radiography after VBG combined with unloading procedures for Kienböck disease. However, among the unloading procedures, joint-leveling procedures positively influenced the revascularization process.


Assuntos
Pinos Ortopédicos , Transplante Ósseo/métodos , Capitato/cirurgia , Osteonecrose/cirurgia , Rádio (Anatomia)/transplante , Osso Escafoide/cirurgia , Articulação do Punho/cirurgia , Adolescente , Adulto , Capitato/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteonecrose/diagnóstico , Radiografia , Rádio (Anatomia)/irrigação sanguínea , Amplitude de Movimento Articular , Estudos Retrospectivos , Osso Escafoide/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/fisiopatologia , Adulto Jovem
5.
J Hand Surg Asian Pac Vol ; 24(4): 447-451, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31690205

RESUMO

Background: The objective of this retrospective study was to evaluate the outcomes of ulnar stump stabilization after ulna head resection using the FCU tendon by investigating the rate of postoperative extensor tendon rupture and click on forearm rotation. Methods: Wrist synovectomy (distal radioulnar joint (DRUJ), radiocarpal and midcarpal joints) and ulnar head resection combined with ulnar stump stabilizing procedure were performed in 58 wrists of 53 patients with RA in our hospital. Before operation, the dorsal subluxation ratio (DSR) of the ulnar head was measured with a multi-slice computed tomography (CT) images. The stabilization of ulnar stump after head resection was performed by the value of the DSR or the instability before the operation. Results: There was neither extensor tendon rupture nor click on forearm rotation in all the patients. Smooth forearm rotation was achieved by ulnar head resection and stabilizing procedure for the ulnar stump. The active range of forearm supination and pronation increased significantly from 68° ± 23° (mean ± SD) to 80° ± 10°, and from 69° ± 17° to 74° ± 13°. The grip power increased from 117 ± 62 mmHg to 185 ± 55 mmHg. In the assessment using 3DCT, the preoperative DSR of 54% improved to 8% on the whole (n = 58). In the wrists with extensor tendon rupture (n = 36), the preoperative DSR of 58% improved to 12%. In the wrists without tendon rupture (n = 22), the preoperative DSR of 46% improved to 2%. Conclusions: The operative technique of ulnar stump stabilization using the FCU tendon was one of the suitable procedure to prevent complications after ulnar head resection.


Assuntos
Artrite Reumatoide/cirurgia , Osteotomia/métodos , Tendões/cirurgia , Ulna/cirurgia , Articulação do Punho/cirurgia , Adulto , Idoso de 80 Anos ou mais , Artrite Reumatoide/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Ruptura , Traumatismos dos Tendões/prevenção & controle , Tomografia Computadorizada por Raios X , Ulna/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/fisiopatologia
6.
Pan Afr Med J ; 33: 237, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692731

RESUMO

The wrist is a rare location of septic arthritis. It often involves patients with preexisting joint disease which symptoms could be confused with infection making the diagnosis more difficult and usually delayed. It is often responsible for residual functional impairment and for a high mortality rate among vulnerable patients. We report 6 cases of septic arthritis of the wrist in 3 males and 3 females. The mean age was 32 years in the male patients and 66 in the female patients. All the women were followed for rheumatoid arthritis. Biological results showed elevated rates of white blood cells and c-reactive protein in all the patients. Joint fluid analyses showed elevated white blood cell count. The treatment was medico-surgical consisting in synovectomy, joint debridement and immobilization of the wrist. At the average follow-up of 1 year and 4 months, 3 patients recovered a perfect mobility of the wrist without any limitation of the range of motion nor the strength. Three patients developed stiffness of the wrist.


Assuntos
Artrite Infecciosa/cirurgia , Desbridamento/métodos , Articulação do Punho/cirurgia , Adulto , Idoso , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/patologia , Artrite Reumatoide/complicações , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento , Articulação do Punho/patologia
7.
Acta Orthop Belg ; 85(3): 330-337, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31677629

RESUMO

The purpose of this cadaveric study is to determine safe zones utilizing volar portals for wrist arthroscopy, by quantitatively describing the neurovascular relationships of a volar radial and a volar ulnar wrist arthroscopy portals in comparison with those of a newly described volar central portal (7) , considering the advantages in visualization of volar portals for wrist arthroscopy over the standard dorsal (19) . The neurovascular structures and the tendons of nine frozen human cadaveric upper limbs were exposed, while the aforementioned volar portal sites were pointed out with pins. The horizontal distance between the portals and the closest neurovascular branch or tendon was measured with a digital caliper, followed by statistical analysis of the data. The median interquartile range distances from portals to structures at risk were measured and safe zones around each portal were established. This study provides a safe approach to the volar radial and ulnar aspects of the radiocarpal and midcarpal joints, while volar radial and ulnar portals should be considered for inclusion in the arthroscopic examination of any patient with radial and ulnar sided wrist pain respectively (17,18) . Regarding the volar central portal, it is reproducible, safe and both the above joints can be inspected through one single incision (7) .


Assuntos
Artroscopia/métodos , Articulação do Punho/cirurgia , Artroscopia/efeitos adversos , Cadáver , Cartilagem/cirurgia , Feminino , Humanos , Ligamentos/cirurgia , Masculino , Nervo Mediano/anatomia & histologia , Nervo Mediano/cirurgia , Artéria Radial/anatomia & histologia , Artéria Radial/cirurgia , Nervo Radial/anatomia & histologia , Nervo Radial/cirurgia , Artéria Ulnar/anatomia & histologia , Artéria Ulnar/cirurgia , Nervo Ulnar/anatomia & histologia , Nervo Ulnar/cirurgia , Articulação do Punho/anatomia & histologia , Articulação do Punho/irrigação sanguínea , Articulação do Punho/inervação
8.
BMC Musculoskelet Disord ; 20(1): 440, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31601273

RESUMO

BACKGROUND: Several methods have been reported to correct deformity and shortening of the distal radius. However, the results are not entirely satisfactory. The results of bifocal osteosynthesis were retrospectively analyzed in this study. METHODS: Eight patients treated with bifocal osteosynthesis were evaluated retrospectively. Pre-operative and post-operative clinical and radiographic examinations were performed. Subjective symptoms and objective joint function were assessed. Radiographic data of the extent of radial lengthening and distal radial articular angle were collected. RESULTS: The mean follow-up period was 46 months (37-68 months). Satisfactory wrist appearance and radial lengthening was achieved in all patients. All patients were satisfied with the wrist appearance and willing to undergo the same treatment again. The range of motion (ROM) of the forearm and wrist was significantly improved. Pin-track infections occurred in two patients, for which they received wound care and oral antibiotics. Complications such as fixation device failure, tendon rupture, fracture of regenerated bone or nerve impairment did not occur. The duration of lengthening depended on the shortening of the radius. Delayed union in the docking site was observed in two patients and union was achieved after bone grafting. CONCLUSIONS: Bifocal osteosynthesis using the Ilizarov method provides a useful method for correction of radial shortening deformity with dislocation of the inferior radioulnar joint. Despite the fact that we did not validate pre-and post-operation functional outcome scores, all patients were satisfied with the wrist appearance and function.


Assuntos
Técnica de Ilizarov , Luxações Articulares/cirurgia , Rádio (Anatomia)/cirurgia , Articulação do Punho/cirurgia , Adulto , Feminino , Seguimentos , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/etiologia , Masculino , Satisfação do Paciente , Rádio (Anatomia)/anatomia & histologia , Rádio (Anatomia)/diagnóstico por imagem , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Resultado do Tratamento , Articulação do Punho/fisiopatologia
9.
Eklem Hastalik Cerrahisi ; 30(3): 212-6, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31650916

RESUMO

OBJECTIVES: This study aims to compare endoscopic carpal tunnel release versus mini-open carpal tunnel release regarding volume changes in the carpal tunnel and median nerve by magnetic resonance imaging (MRI). PATIENTS AND METHODS: The study included 17 wrists of 13 patients (1 male, 12 females; mean age 55 years; range, 51 to 64 years) who were diagnosed with carpal syndrome. Ten wrists underwent mini-open carpal tunnel release, while seven wrists underwent uni-portal endoscopic carpal tunnel release. Carpal tunnel and median nerve volumetric changes were evaluated by MRI pre- and postoperatively. RESULTS: Surgical section of transverse carpal ligament significantly increased the postoperative volume of the carpal tunnel and median nerve compared to preoperative (p<0.05). However, the endoscopic and mini-open carpal tunnel techniques had no superiority over one another regarding volume expansion (p>0.05). CONCLUSION: Both methods can be preferred to release the transverse carpal ligament in patients with idiopathic carpal tunnel syndrome. The surgeon should decide on which method to use considering the advantages and disadvantages reported in the literature.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Descompressão Cirúrgica/métodos , Endoscopia , Nervo Mediano/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem , Feminino , Humanos , Ligamentos Articulares/cirurgia , Imagem por Ressonância Magnética , Masculino , Nervo Mediano/cirurgia , Pessoa de Meia-Idade , Articulação do Punho/cirurgia
10.
Turk Neurosurg ; 29(6): 927-932, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31573064

RESUMO

AIM: To evaluate the feasibility of the mini-open incision method in patients who underwent median nerve decompression in the carpal tunnel with a mini incision made proximal to the distal wrist crease. MATERIAL AND METHODS: A total of 80 patients (84 hands) operated by a single surgeon with a mini incision were included. The patients were evaluated postoperatively for the presence of pillar pain, pain on the incision scar, and scar sensitivity in addition to preoperative findings. The Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH) questionnaire was used for clinical scoring. To evaluate the effectiveness of the method, the findings were recorded at and compared between at 12 and 24 months follow-ups. RESULTS: No complications were observed at the wound site in the early postoperative period. Ten patients reported numbness, 5 experienced weakness, and 4 revealed positive Tinel's sign. Keloid formation without pain and scar sensitivity was detected in 2 patients at 6 months. No patient reported night pain, pain on pillar or incision scar, scar sensitivity, recent sensory loss, and disease recurrence. Numbness was present in 7 patients at 12 months and in 3 at 24 months; 3 and 2 patients reported weakness at 12 and 24 months, respectively. The mean Quick DASH score was 72.7 preoperatively, 10.2 at 12 months, and 9.1 at 24 months. CONCLUSION: The median nerve decompression in the carpal tunnel may be performed with a mini incision made proximal to the distal wrist crease is effective and safe method, and provides less complications and higher patient comfort.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Descompressão Cirúrgica/métodos , Nervo Mediano/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Ferida Cirúrgica , Articulação do Punho/cirurgia , Adulto , Idoso , Síndrome do Túnel Carpal/diagnóstico , Feminino , Humanos , Masculino , Nervo Mediano/patologia , Pessoa de Meia-Idade , Dor/diagnóstico , Dor/cirurgia , Medição da Dor/métodos , Ferida Cirúrgica/patologia , Inquéritos e Questionários , Resultado do Tratamento , Articulação do Punho/patologia
11.
Bone Joint J ; 101-B(8): 978-983, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31362548

RESUMO

AIMS: The aim of this study was to compare the clinical effectiveness of Kirschner wire (K-wire) fixation with locking-plate fixation for patients with a dorsally displaced fracture of the distal radius in the five years after injury. PATIENTS AND METHODS: We report the five-year follow-up of a multicentre, two-arm, parallel-group randomized controlled trial. A total of 461 adults with a dorsally displaced fracture of the distal radius within 3 cm of the radiocarpal joint that required surgical fixation were recruited from 18 trauma centres in the United Kingdom. Patients were excluded if the surface of the wrist joint was so badly displaced it required open reduction. In all, 448 patients were randomized to receive either K-wire fixation or locking-plate fixation. In the K-wire group, there were 179 female and 38 male patients with a mean age of 59.1 years (19 to 89). In the locking-plate group, there were 194 female and 37 male patients with a mean age of 58.3 years (20 to 89). The primary outcome measure was the patient-rated wrist evaluation (PRWE). Secondary outcomes were health-related quality of life using the EuroQol five-dimension three-level (EQ-5D-3L) assessment, and further surgery related to the index fracture. RESULTS: At 12 months, 402/448 participants (90%) recruited into the main study provided PRWE scores. At year two, 294 participants (66%) provided scores; at year five, 198 participants (44%) provided scores. There was no clinically relevant difference in the PRWE at any point during the five-year follow-up; at five years, the PRWE score was 8.3 (12.5) in the wire group and 11.3 (15.6) in the plate group (95% confidence interval -6.99 to 0.99; p = 0.139). Nor was there a clinically relevant difference in health-related quality of life. Only three participants had further surgery in the five years after their injury (one in the wire group and two in the plate group). CONCLUSION: This follow-up study continues to show no evidence of a difference in wrist pain, wrist function, or quality of life for patients treated with wires versus locking plates in the five years following a dorsally displaced fracture of the distal radius. Cite this article: Bone Joint J 2019;101-B:978-983.


Assuntos
Placas Ósseas , Fios Ortopédicos , Fratura-Luxação/cirurgia , Fixação Interna de Fraturas/instrumentação , Fraturas do Rádio/cirurgia , Traumatismos do Punho/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Fixação Interna de Fraturas/métodos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Articulação do Punho/cirurgia
12.
BMC Musculoskelet Disord ; 20(1): 354, 2019 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-31366350

RESUMO

BACKGROUND: There are only a few published case reports of irreducible Galeazzi fracture-dislocation, and patients in these studies had undergone reduction by open surgical methods. Arthroscopy for the distal radioulnar joint of the wrist joint has recently been used for wrist pathology. We aim to describe the surgical procedure involved in arthroscopic reduction of irreducible Galeazzi fracture-dislocation and clinical outcome and review the literature. CASE PRESENTATION: We present the case of a 26-year-old man, a professional athlete, who sustained Galeazzi fracture-dislocation during a bicycle race. The distal radioulnar joint was irreducible because the fragment of the ulnar styloid was trapped between the sigmoid notch and ulnar head after a doctor had previously reduced it manually. Operative treatment was performed using a 30° oblique, 1.9-mm arthroscope. Reduction of the fragment of the ulnar styloid was achieved using distal radioulnar joint arthroscopy. The metaphyseal and intra-articular fracture of the radius and the fragment of the ulnar styloid were fixed using a volar locking plate and tension band wiring technique, respectively. A daily injection of parathyroid hormone and low-intensity pulsed ultrasound were used postoperatively. The patient was asymptomatic and returned to the preinjury level of athletic activity 2 months postoperatively, and bone union of the radius and ulna was achieved without distal radioulnar joint instability 15 months postoperatively. CONCLUSIONS: Less invasive reduction of the dorsal anatomical structure enabled our patient to return early to sports. We consider arthroscopic reduction to be superior to the open surgical method in terms of evaluating interpositions; additionally, arthroscopic reduction is minimally invasive and does not need immobilization because it does not cause significant damage to the dorsal capsule and subsheath of the extensor carpi ulnaris, which comprise the triangular fibrocartilage complex.


Assuntos
Artroscopia/métodos , Fratura-Luxação/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas do Rádio/cirurgia , Traumatismos do Punho/cirurgia , Adulto , Artroscopia/instrumentação , Placas Ósseas , Fratura-Luxação/diagnóstico por imagem , Fratura-Luxação/etiologia , Fixação Interna de Fraturas/instrumentação , Humanos , Masculino , Fraturas do Rádio/complicações , Fraturas do Rádio/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Traumatismos do Punho/etiologia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/cirurgia
13.
Tech Hand Up Extrem Surg ; 23(3): 143-145, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31454335

RESUMO

Wrist arthrodesis in the setting of segmental bone loss can have high failure rates. Therefore, vascularized bone grafting has been advocated for select patients. Patients suffering concomitant large soft tissue loss present even greater challenge. To that end, we describe for the first time successful anterolateral thigh-medial femoral condyle chimeric flow-through flap for posttraumatic wrist arthrodesis and soft tissue coverage. This is a case report of a 19-year-old male laborer who suffered a large blast injury resulting in significant bone and soft tissue injury to the dominant right hand and wrist. After multiple debridements, there was a segmental bone defect from the distal radius and ulna to the metacarpal bases, as well as a 12×8 cm dorsal soft tissue defect. This was reconstructed with a anterolateral thigh-medial femoral condyle chimeric flow-through flap and concomitant wrist arthrodesis in a single stage. Besides a donor site thigh seroma, recovery was uneventful with clinical and radiographic evidence of fusion by >9 weeks postoperation.


Assuntos
Artrodese , Fêmur/transplante , Retalhos Cirúrgicos , Articulação do Punho/cirurgia , Traumatismos por Explosões/cirurgia , Humanos , Masculino , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos/irrigação sanguínea , Traumatismos do Punho/cirurgia , Adulto Jovem
14.
J Bone Joint Surg Am ; 101(15): 1388-1396, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31393430

RESUMO

BACKGROUND: Isolated injuries of the scapholunate interosseous ligament (SLIL) are insufficient to produce dorsal intercalated segment instability. There is no consensus about which additional ligamentous stabilizers are critical determinants of dorsal intercalated segment instability. The aim of this study was to evaluate the role of the long radiolunate (LRL), scaphotrapeziotrapezoid (STT), and dorsal intercarpal (DIC) ligaments in preventing dorsal intercalated segment instability. METHODS: Thirty fresh-frozen forearms were randomized to 5 ligament section sequences to study the SLIL, LRL, STT, and DIC ligaments. The DIC-lunate insertion (DIC) and scaphoid insertion (DIC) were studied separately; the DIC insertions on the trapezium and triquetrum were left intact. Loaded posteroanterior and lateral fluoroscopic images were obtained at baseline and repeated after each ligament was sectioned. After each sequence, the wrists were loaded cyclically (71 N). The radiolunate angle was measured with load. Dorsal intercalated segment instability was defined as an increase of >15° in the radiolunate angle compared with baseline. RESULTS: Division of the SLIL did not increase the radiolunate angle. Section of the SLIL+LRL or SLIL+DIC significantly increased the radiolunate angle but did not produce dorsal intercalated segment instability. Section of the SLIL+STT or SLIL+DIC+DIC produced dorsal intercalated segment instability. CONCLUSIONS: In order to produce dorsal intercalated segment instability, complete scapholunate injuries require the disruption of at least 1 critical ligament stabilizer of the scaphoid or lunate (the STT or DIC+DIC). CLINICAL RELEVANCE: When treating SLIL tears with dorsal intercalated segment instability, techniques to evaluate the volar and dorsal critical stabilizers of the proximal carpal row should be considered.


Assuntos
Ossos do Carpo/anatomia & histologia , Articulações do Carpo/cirurgia , Fixadores Internos , Instabilidade Articular/prevenção & controle , Ligamentos Articulares/lesões , Ligamentos Articulares/cirurgia , Adulto , Idoso , Análise de Variância , Fenômenos Biomecânicos , Cadáver , Dissecação , Humanos , Osso Semilunar/anatomia & histologia , Osso Semilunar/cirurgia , Pessoa de Meia-Idade , Procedimentos Ortopédicos/instrumentação , Procedimentos Ortopédicos/métodos , Osso Escafoide/anatomia & histologia , Osso Escafoide/cirurgia , Articulação do Punho/cirurgia , Adulto Jovem
15.
BMC Musculoskelet Disord ; 20(1): 368, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399084

RESUMO

BACKGROUND: Isolated palmar dislocation of distal radioulnar joint is a rare injury. It can easily lead to misdiagnosis. Previous literature reports were all rotation violence. We reported a patient with direct impact violence. CASE PRESENTATION: We report a 31-year-old male laborer presented to our hospital with an acute trauma. Severe tenderness and limited mobility were seen in his right wrist. He received an x-ray film examination and diagnosed as the isolated palmar dislocation of distal radioulnar joint. The treatment was closed reduction and splint fixation. After half a year, the patient gained a functional recovery of his previously afflicted wrist. CONCLUSIONS: To the best of our knowledge, this is the first case of isolated palmar dislocation of distal radioulnar joint caused by a direct impact violence. Patients and physicians should be aware of the properties of this mechanism of injury so that early diagnosis and treatment can be achieved.


Assuntos
Luxações Articulares/etiologia , Traumatismos do Punho/etiologia , Adulto , Humanos , Luxações Articulares/diagnóstico , Luxações Articulares/cirurgia , Masculino , Procedimentos Ortopédicos/instrumentação , Procedimentos Ortopédicos/métodos , Rádio (Anatomia) , Contenções , Ulna , Traumatismos do Punho/diagnóstico , Traumatismos do Punho/cirurgia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/cirurgia
16.
Arch Orthop Trauma Surg ; 139(11): 1641-1647, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31407035

RESUMO

INTRODUCTION: Injury to the scapholunate (SL) ligament represents a common trauma of the wrist but is frequently misdiagnosed because of non-specific pain. Established methods for SL reconstruction mainly focus on reducing pain and maintaining the reposition result at the expense of mobility and strength. This study aimed at restoring stability and reducing pain while simultaneously maintaining mobility and strength using the scapholunate axis method (SLAM). MATERIAL AND METHODS: 22 patients (19 male and 3 female) aged between 26 and 64 years with an SL ligament lesion underwent SLAM reconstruction. Mean duration between injury and operation was 7.9 ± 5 (1-24) months. Hand functions using DASH, Mayo Wrist Score, range of motion, pain (at rest and weight-bearing) and grip strength were assessed prior and 12 months postoperative. Additionally SL angle was collected pre- and postoperative. RESULTS: Each of the 22 patients improved significantly postoperative in DASH and Mayo Wrist Score with regard to pain at rest and under weight-bearing. Additionally, grip strength could be improved up to 31% compared to preoperatively. In contrast, range of motion and SL angle and grip strength did not change essentially. CONCLUSIONS: The secondary SL ligament reconstruction technique SLAM shows promising results. Pain was significantly relieved and grip strength was significantly increased. Additionally, DASH and Mayo Wrist Score could be significantly improved. However, SL angle and range of motion could not be improved in every patient and plane.


Assuntos
Instabilidade Articular/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Osso Escafoide/cirurgia , Articulação do Punho/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Amplitude de Movimento Articular/fisiologia , Traumatismos do Punho/cirurgia
17.
Acta Orthop Belg ; 85(2): 234-239, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31315015

RESUMO

The objective of this study was to determine the percentage of radiographs which showed a fracture of the wrist. Secondary, the fracture characteristics and the received treatment were determined. Additionally, the percentage of operatively treated patients with a distal radius fracture was compared between the hospitals. A retrospective cohort study was performed in three Dutch hospitals in all consecutive adult patients with wrist trauma who presented at the ED. A fracture of the wrist was defined as a fracture of the distal one-third part of the radius, the distal one-third part of the ulna or any carpal bone. Fracture classification according to the AO/OTA classification, the amount of displaced fractures, and the received treatment were recorded. Out of 1740 patients with wrist trauma, 49% sustained one or more fractures of the wrist. The distal radius was most frequently fractured (61%). Almost half of the distal radius fractures was extra-articular (AO/OTA type A2-3) and 61% of fractures was displaced. Of all patients who sustained a distal radius fracture, 14% was treated operatively. Significantly more patients were treated operatively in the academic hospital in comparison to the teaching and non-teaching hospital.


Assuntos
Placas Ósseas , Fixação Interna de Fraturas , Fraturas Ósseas/cirurgia , Traumatismos do Punho/cirurgia , Articulação do Punho/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas Ósseas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Resultado do Tratamento , Traumatismos do Punho/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem , Adulto Jovem
19.
Bone Joint J ; 101-B(7): 852-859, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31256671

RESUMO

AIMS: Plate and screw fixation has been the standard treatment for painful conditions of the wrist in non-rheumatoid patients in recent decades. We investigated the complications, re-operations, and final outcome in a consecutive series of patients who underwent wrist arthrodesis for non-inflammatory arthritis. PATIENTS AND METHODS: A total of 76 patients, including 53 men and 23 women, with a mean age of 50 years (21 to 79) underwent wrist arthrodesis. Complications and re-operations were recorded. At a mean follow-up of 11 years (2 to 18), 63 patients completed questionnaires, and 57 attended for clinical and radiological assessment. RESULTS: Of the 76 patients, 46 (60.5%) had complications, resulting in 65 re-operations, mainly related to the plate and screws. In the 63 patients who completed the questionnaires, the mean Quick Disabilities of Arm, Shoulder and Hand (QuickDASH) score was 36 (0 to 91), the mean Patient-Rated Wrist and Hand Evaluation (PRWHE) score was 40 (0 to 96), and 14 patients (22%) reported no wrist pain. Grip strength, pinch strength, and pronation and supination were significantly reduced compared with the contralateral forearm. The outcome was worse in patients who had previously undergone surgery to the wrist, and those with complications. A total of 13 are awaiting further re-operations, giving a total re-operation rate of 63% (40/63). CONCLUSION: We observed complications and re-operations throughout the follow-up period and therefore consider wrist arthrodesis to be more complicated than previously assumed. Many of the patients never got used to or accepted their stiff wrists and reported a substantial reduction in function and residual pain. Motion-sparing surgery should be offered prior to wrist arthrodesis. Cite this article: Bone Joint J 2019;101-B:852-859.


Assuntos
Artrite/cirurgia , Artrodese/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Reoperação/estatística & dados numéricos , Articulação do Punho/cirurgia , Adulto , Idoso , Artrodese/instrumentação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Resultado do Tratamento
20.
Radiol Clin North Am ; 57(5): 977-1000, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31351545

RESUMO

Imaging has a paramount role in postsurgical assessment. Radiologists need to be familiar with the different surgical procedures to be able to identify expected postsurgical appearances and also detect potential complications. This article reviews the indications, normal expected postsurgical appearances, and complications of the most frequently used surgical procedures in the shoulder, elbow, and wrist. The emphasis is on points that should not be overlooked in the surgical planning.


Assuntos
Diagnóstico por Imagem/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Extremidade Superior/diagnóstico por imagem , Extremidade Superior/cirurgia , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/lesões , Articulação do Cotovelo/cirurgia , Humanos , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/lesões , Articulação do Ombro/cirurgia , Extremidade Superior/lesões , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/cirurgia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/cirurgia
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