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1.
JBJS Case Connect ; 12(1)2022 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-34986126

RESUMO

CASE: We present 2 cases of spontaneous index finger (IF) flexor tendon ruptures because of previously undiagnosed osteonecrosis (OA) of the capitate. Imaging revealed fragmentation of the capitate, and patients were treated with excision or fixation of the bony fragments with tendon repair. At the final follow-up, both patients had functional digital range of motion. CONCLUSIONS: OA of the capitate is relatively rare and may present as atraumatic (IF) flexor tendon ruptures because of attritional wear when associated with bony fragmentation.


Assuntos
Capitato , Osteonecrose , Traumatismos dos Tendões , Humanos , Osteonecrose/diagnóstico por imagem , Osteonecrose/etiologia , Osteonecrose/cirurgia , Ruptura/complicações , Traumatismos dos Tendões/diagnóstico por imagem , Traumatismos dos Tendões/etiologia , Traumatismos dos Tendões/cirurgia , Tendões/cirurgia
2.
Int Orthop ; 45(10): 2635-2641, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34264352

RESUMO

PURPOSE: The study evaluates the procedures of capitate shortening osteotomy with or without vascularized bone grafting (VBG) for the treatment of stage II or IIIA Kienböck's disease with neutral ulnar variance. METHOD: Forty-five patients with stage II (n = 21) and IIIA (n = 24) Kienböck's disease were included in the study. Patients were classified into two groups; isolated capitate shortening (ICS) group included 21 patients (stage II [n = 10] and stage IIIA [n = 11]) treated by capitate shortening without VBG of the lunate. Combined capitate shortening (CCS) group includes 24 patients (stage II [n = 11] and stage IIIA [n = 13]) who treated by capitate shortening combined with VBG of the lunate from the dorsal distal radius based on the fourth + fifth extensor compartment artery. All patients were evaluated pre- and post-operative for pain as measured by visual analogue scale score (VAS), range of motion (ROM), grip strength, modified Mayo wrist score (MMWS), lunate height index (LHI) ratio, and carpal height index (CHI) ratio. RESULTS: The mean operative time for CCS procedure was 85 min (76 to 120) and for ICS was 58 min (47 to 65). The mean follow-up period for all patients was 33 months (29 to 47). Patients with stage IIIA Kienböck's disease treated by CCS procedure had better post-operative VAS, ROM, grip strength, MMWS, LHI, and CHI ratio than patients treated by ICS procedure. ICS procedure reported 28% failure rate versus 8% for CCS. No differences were found between CCS and ICS procedures in patients with stage II Kienböck's disease in the term of clinical, radiographic outcomes, or failure rate. CONCLUSION: Using CCS procedure for the treatment of stage IIIA Kienböck's disease (lunate height collapse) with neutral ulnar variance can restore height and dimensions of the collapsed lunate and subsequently improve the final outcomes with lower failure rate. However, in patients with stage II Kienböck's disease (maintained lunate height), no advantages were noticed for CCS over ICS procedure. Lunate height index might be considered a prognostic factor for the treatment outcomes of Kienböck's disease.


Assuntos
Capitato , Osteonecrose , Transplante Ósseo , Capitato/diagnóstico por imagem , Capitato/cirurgia , Seguimentos , Humanos , Osteonecrose/cirurgia , Osteotomia , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/cirurgia , Amplitude de Movimento Articular , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/cirurgia
3.
J Hand Surg Eur Vol ; 46(10): 1042-1048, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34289733

RESUMO

Surgical options for advanced Kienböck's disease include proximal row carpectomy or lunate reconstruction with a medial femoral trochlea osteochondral flap. This study compares morphology of the proximal capitate and the medial femoral trochlear surfaces to the proximal lunate using three-dimensional geometric morphometric analysis. Virtual articular surfaces were extracted from MRI studies of ten healthy volunteers. Distances between corresponding points on the proximal lunate and proximal capitate or medial femoral trochlear surfaces were measured. In seven subjects, mean inter-surface distance for the medial femoral trochlea-proximal lunate pair was significantly lower than the proximal capitate-proximal lunate pairing. In three subjects, mean proximal capitate-proximal lunate distance was significantly lower. We conclude that the medial femoral trochlear flap was anatomically closer to the shape of the proximal lunate in the majority of the examined subjects. However, we found that in three out of ten cases, the proximal capitate was a better match.


Assuntos
Capitato , Ossos do Carpo , Osso Semilunar , Osteonecrose , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Osso Semilunar/diagnóstico por imagem , Osso Semilunar/cirurgia , Osteonecrose/diagnóstico por imagem , Osteonecrose/cirurgia , Retalhos Cirúrgicos
4.
J Anat ; 239(2): 351-373, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33942895

RESUMO

Morphological variation in the hominoid capitate has been linked to differences in habitual locomotor activity due to its importance in movement and load transfer at the midcarpal joint proximally and carpometacarpal joints distally. Although the shape of bones and their articulations are linked to joint mobility, the internal structure of bones has been shown experimentally to reflect, at least in part, the loading direction and magnitude experienced by the bone. To date, it is uncertain whether locomotor differences among hominoids are reflected in the bone microarchitecture of the capitate. Here, we apply a whole-bone methodology to quantify the cortical and trabecular architecture (separately and combined) of the capitate across bipedal (modern Homo sapiens), knuckle-walking (Pan paniscus, Pan troglodytes, Gorilla sp.), and suspensory (Pongo sp.) hominoids (n = 69). It is hypothesized that variation in bone microarchitecture will differentiate these locomotor groups, reflecting differences in habitual postures and presumed loading force and direction. Additionally, it is hypothesized that trabecular and cortical architecture in the proximal and distal regions, as a result of being part of mechanically divergent joints proximally and distally, will differ across these portions of the capitate. Results indicate that the capitate of knuckle-walking and suspensory hominoids is differentiated from bipedal Homo primarily by significantly thicker distal cortical bone. Knuckle-walking taxa are further differentiated from suspensory and bipedal taxa by more isotropic trabeculae in the proximal capitate. An allometric analysis indicates that size is not a significant determinate of bone variation across hominoids, although sexual dimorphism may influence some parameters within Gorilla. Results suggest that internal trabecular and cortical bone is subjected to different forces and functional adaptation responses across the capitate (and possibly other short bones). Additionally, while separating trabecular and cortical bone is normal protocol of current whole-bone methodologies, this study shows that when applied to carpals, removing or studying the cortical bone separately potentially obfuscates functionally relevant signals in bone structure.


Assuntos
Osso Esponjoso/anatomia & histologia , Capitato/anatomia & histologia , Osso Cortical/anatomia & histologia , Hominidae/anatomia & histologia , Animais , Anisotropia , Biometria , Osso Esponjoso/diagnóstico por imagem , Capitato/diagnóstico por imagem , Osso Cortical/diagnóstico por imagem , Humanos , Microtomografia por Raio-X
5.
J Hand Surg Eur Vol ; 46(6): 581-586, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33752485

RESUMO

We report the short- to medium-term outcomes for patients with Kienböck's disease and ulnar positive or neutral wrists treated by capitate shortening osteotomy combined with a 4 + 5 extensor compartmental artery vascularized bone graft placed in the lunate. This is a retrospective study of seven consecutive patients with Lichtman Stage 2 to 3B. Radiological and clinical outcomes were evaluated. Six patients maintained their Lichtman stage, one progressed. Mean time to union of the capitate was 10 weeks. Five of six lunates were completely revascularized on MRI scans, with one partial revascularization. Mean follow-up for functional scores was 40 months (range 15 to 62). Mean pain score improved significantly from 7.4/10 preoperatively to 1.9/10 postoperatively, and patient satisfaction was 9.2/10. Mean postoperative Quick Disabilities of Arm, Shoulder and Hand, Patient Evaluation Measure and Patient-Rated Wrist Evaluation scores were improved. All patients returned to their previous work. We conclude that this procedure has good short- to medium-term outcomes.Level of evidence: IV.


Assuntos
Capitato , Osso Semilunar , Osteonecrose , Transplante Ósseo , Capitato/diagnóstico por imagem , Capitato/cirurgia , Seguimentos , Humanos , Osso Semilunar/diagnóstico por imagem , Osso Semilunar/cirurgia , Osteonecrose/diagnóstico por imagem , Osteonecrose/cirurgia , Osteotomia , Amplitude de Movimento Articular , Estudos Retrospectivos , Punho
6.
Hand Surg Rehabil ; 40(4): 427-432, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33775890

RESUMO

This study aimed to compare medium-term results for partial capitate shortening (PCS) and radial shortening (RS) osteotomies on lunate bone revascularization and disease progression in patients with stage II or IIIA Kienböck's disease. Patients who underwent surgery for Kienböck's disease between March 2010 and July 2020 were retrospectively evaluated. Clinical evaluation included assessment of pain, joint range of motion, strength, DASH, visual analog scale (VAS) for pain, Modified Mayo Wrist Score (MMWS), satisfaction and time to return to work, with comparison as appropriate to the contralateral side. Preoperative and postoperative plain radiographs and magnetic resonance imaging (MRI) were used for radiological evaluation. Lichtman staging and signal changes in the lunate were evaluated using MRI. Group 1 (PCS) included 14 patients and Group 2 (RS) 14. Mean follow-up was 57.8 months (range 24-102) in Group 1 and 49.4 months (range 36-73) in Group 2. Clinical evaluation included pain on VAS, DASH score, MMWS, range of motion, and grip, palmar and key pinch strength. Regarding lunate bone vascularization, increased signal on final follow-up MRI was observed in 10 of the 14 patients in Group 1 and 7 of the 14 patients in Group 2. There was a positive correlation between revascularization and final follow-up MMWS (p = 0.006). The present study thus showed that functional scores were improved by revascularization in Kienböck's disease. Both osteotomies had clinically and radiologically satisfactory results. However, we believe that PCS osteotomy is preferable, as it leads to higher revascularization rates without increasing ulnolunate load.


Assuntos
Capitato , Osteonecrose , Capitato/diagnóstico por imagem , Capitato/cirurgia , Humanos , Osteonecrose/diagnóstico por imagem , Osteonecrose/cirurgia , Osteotomia/métodos , Rádio (Anatomia)/patologia , Rádio (Anatomia)/cirurgia , Estudos Retrospectivos
7.
J Hand Surg Eur Vol ; 46(6): 587-593, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33784838

RESUMO

We studied the three-dimensional (3-D) shape variations and symmetry of the lunate to evaluate whether a contralateral shape-based approach to design patient-specific implants for treatment of Kienböck's disease is accurate. A 3-D statistical shape model of the lunate was built using the computed tomography scans of 54 lunate pairs and shape symmetry was evaluated based on an intraclass correlation analysis. The lunate shape was not bilaterally symmetrical in (1) the angle scaphoid surface - radius-ulna surface, (2) the dorsal side and the length of the side adjacent to the triquetrum, (3) the orientation of the volar surface, (4) the width of the side adjacent to the scaphoid, (5) the skewness in the coronal plane and (6) the curvature of bone articulating with the hamate and capitate. These findings suggest that using the contralateral lunate to design patient-specific lunate implants may not be as accurate as it is intended.


Assuntos
Capitato , Osso Semilunar , Osteonecrose , Osso Escafoide , Piramidal , Humanos , Osso Semilunar/diagnóstico por imagem , Osso Escafoide/diagnóstico por imagem
8.
Arch. argent. pediatr ; 119(1): e61-e64, feb. 2021. ilus
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1147268

RESUMO

El osteoma osteoide es una lesión ósea benigna que, habitualmente, se acompaña de clínica típica caracterizada por dolor nocturno que mejora con antiinflamatorios no esteroideos. Aunque la presentación clínica es típica, con frecuencia, es común la demora diagnóstica, en especial, en los casos con localización atípica.Se presenta el caso de una paciente de 10 años con dolor en la muñeca izquierda de dos años de evolución con diagnóstico de osteoma osteoide localizado en el hueso grande del carpo. La localización atípica de la lesión conllevó un retraso diagnóstico importante


Osteoid osteoma is a benign bone lesion that is usually accompanied by a typical clinical condition characterized by night pain that improves with non-steroidal anti-inflammatory drugs. Although the clinical presentation is frequently typical, diagnostic delay is common, especially in cases with an atypical location.We report the case of a 10-year-old patient with left wrist pain of two years of evolution with diagnosis of osteoid osteoma located in capitate bone. The atypical location of the lesion led to a significant diagnostic delay.


Assuntos
Humanos , Feminino , Criança , Osteoma Osteoide/diagnóstico por imagem , Osteoma Osteoide/cirurgia , Punho , Curetagem , Capitato
9.
Tech Hand Up Extrem Surg ; 25(4): 213-218, 2021 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-33399388

RESUMO

Proximal row carpectomy (PRC) is a long-time, well-accepted, easy-to-reproduce procedure for the treatment of several painful degenerative conditions of the wrist, when capitate pole and radius lunate fossa are preserved. It has been reported to relieve pain and preserve a substantial wrist range of motion, although a partial loss of strength has to be expected because of the decreased length of the carpus. Since 2010, a new technique has been described in the literature using the resurfacing capitate pyrocarbon implant, combined with PRC. This implant has been designed to perform PRC even in the presence of degenerate joint surfaces, and thus resolves the limited indications of this procedure; however, if a resection of the capitate pole is performed to set up the implant, similar to PRC it may not positively influence the recovery of strength. The authors propose an resurfacing capitate pyrocarbon implant technique without any capitate bone resection, to preserve as much as possible the carpus length and so to improve the functional recovery. The surgical technique, is described in detail and preliminary results are discussed.


Assuntos
Artrite , Capitato , Ossos do Carpo , Capitato/cirurgia , Carbono , Humanos , Amplitude de Movimento Articular , Punho , Articulação do Punho/cirurgia
10.
JBJS Case Connect ; 11(4)2021 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-34669655

RESUMO

CASE: We report a case of bilateral capitate osteonecrosis in a patient who has a history of acute lymphocytic leukemia treated with systemic steroids and other chemotherapeutic agents. After exhausting conservative treatment, the patient underwent surgical management with a right-sided 4-corner arthrodesis and left-sided vascular pedicle graft, providing pain relief and improved function. CONCLUSION: In patients with a history of hematologic malignancy, clinicians should consider osteonecrosis of the capitate as a cause of wrist pain. Salvage procedures and vascularized grafts can provide pain relief in the presence of both early and late capitate osteonecrosis or collapse.


Assuntos
Capitato , Osteonecrose , Artralgia , Artrodese , Capitato/diagnóstico por imagem , Capitato/cirurgia , Humanos , Osteonecrose/diagnóstico por imagem , Osteonecrose/cirurgia , Extremidade Superior
11.
JBJS Case Connect ; 11(3)2021 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-34473665

RESUMO

CASE: We present a case of an isolated palmar, open dislocation of the capitate that occurred after a crush injury from an all-terrain vehicle rollover accident. The capitate was completely dislocated, rotated 90 degrees in the coronal plane with only soft-tissue attachments palmarly, and associated with a 4 cm open wound. A successful outcome was achieved via surgical reduction with percutaneous fixation. A follow-up at 44 months demonstrated good range of motion and no pain. CONCLUSION: Capitate dislocations are extremely rare. Prompt identification and surgical reduction can lead to successful outcomes.


Assuntos
Capitato , Luxações Articulares , Capitato/diagnóstico por imagem , Capitato/lesões , Capitato/cirurgia , Humanos , Luxações Articulares/cirurgia , Amplitude de Movimento Articular , Extremidade Superior
12.
J Hand Surg Am ; 45(11): 1085.e1-1085.e11, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32829960

RESUMO

PURPOSE: The treatment of Kienböck disease (KD) continues to be controversial. In this study, we report the long-term follow-up outcomes of patients who were diagnosed with stage IIIB KD treated with vascularized capitate transposition. METHODS: A total of 16 patients were retrospectively reviewed. Baseline clinical information was extracted from medical records, and wrist function was clinically evaluated, including x-ray images. RESULTS: At the final follow-up, wrist pain was severe in 0 patients, moderate in 2 patients, mild in 5 patients, and absent in 9 patients. The mean postoperative active flexion and extension of the affected wrist was significantly improved after surgery compared with before surgery. The postoperative and preoperative mean grip strength was 35 kg and 27 kg, respectively. The Disabilities of the Arm, Shoulder, and Hand score was significantly improved after surgery compared with before surgery. CONCLUSIONS: Vascularized capitate transposition for the treatment of Lichtman stage IIIB KD is feasible and associated with improvements in wrist function and pain. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.


Assuntos
Capitato , Osteonecrose , Capitato/diagnóstico por imagem , Capitato/cirurgia , Seguimentos , Força da Mão , Humanos , Osteonecrose/diagnóstico por imagem , Osteonecrose/cirurgia , Radiografia , Amplitude de Movimento Articular , Estudos Retrospectivos , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/cirurgia
13.
J Am Acad Orthop Surg ; 28(14): 570-584, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32692092

RESUMO

Kienböck disease, osteonecrosis of the lunate, is a well-known but poorly understood complication seen by hand surgeons. This review presents the background and important patient-specific parameters of the disease and reviews the numerous treatment options that exist for the disease.


Assuntos
Osso Semilunar/cirurgia , Osteonecrose/cirurgia , Adolescente , Adulto , Idoso , Fenômenos Biomecânicos , Transplante Ósseo , Capitato/cirurgia , Tratamento Conservador , Descompressão Cirúrgica , Feminino , Humanos , Imobilização , Isquemia , Osso Semilunar/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Osteonecrose/diagnóstico , Osteonecrose/etiologia , Osteonecrose/terapia , Osteotomia/métodos , Medição de Risco , Adulto Jovem
14.
Ortop Traumatol Rehabil ; 22(2): 143-149, 2020 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-32468994

RESUMO

Capitate and hamate fractures are infrequent injuries and are uncommon in isolation. A capitate fracture is usually associated with a scaphoid fracture. The primary mechanism of injury is a fall with the wrist in hyperextension. Other possible ways for capitate fractures are axial down trauma of the third metacarpal and direct trauma. Hamate fractures have a 2% incidence among carpal bone fractures, probably due to underreporting. They can occur on the hamate body or the hamulus or hook. Combined capitate and hamate fractures are uncommon and relevant studies, especially case reports, are scarce. We present a case report of a combined capitate and hamate fracture in a 44-year-old patient who suffered a direct trauma to the back of the hand during a fall. Following a clinical suspicion based on history and physical examination, radiographic and computed tomography (CT) studies were crucial for elucidating the case and proposed treatment, which involved ensuring absolute stability and performing an open reduction, using interfragmentary compression, with the Herbert bone screw implanted in each bone. After the surgical procedure, the patient wore a forearm plaster cast splint for four weeks. A satisfactory outcome was obtained in three months, with a complete range of motion and preserved force compared to the contralateral hand.


Assuntos
Parafusos Ósseos , Capitato/lesões , Capitato/cirurgia , Moldes Cirúrgicos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Hamato/lesões , Hamato/cirurgia , Adulto , Humanos , Masculino , Amplitude de Movimento Articular , Resultado do Tratamento
15.
J Hand Surg Eur Vol ; 45(4): 403-407, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32102583

RESUMO

This study assessed the functional and radiological results of partial capitate shortening osteotomy in the treatment of Lichtman stage 2 and 3A Kienböck's disease. Nineteen patients who underwent partial capitate shortening osteotomy between 2014 and 2017 were included. Functional and radiological parameters were assessed both pre- and postoperatively. The mean age was 35 years and the mean follow-up was 16 months. Pain scores, wrist range of motion, hand and finger strength, carpal height ratio and lunate height were significantly improved compared with their preoperative values. Sixteen patients were able to return to work. Ten of them had complete and six had partial revascularization. The mean time taken to return to work was 62 days. No vascularity was achieved in three patients who were unable to return to work. Partial capitate shortening osteotomy is effective in the treatment of stage 2 and 3A Kienböck's disease with successful results both functionally and radiologically. Level of evidence: IV.


Assuntos
Capitato , Osso Semilunar , Osteonecrose , Adulto , Capitato/diagnóstico por imagem , Capitato/cirurgia , Seguimentos , Humanos , Osso Semilunar/diagnóstico por imagem , Osso Semilunar/cirurgia , Osteonecrose/diagnóstico por imagem , Osteonecrose/cirurgia , Osteotomia , Radiografia , Rádio (Anatomia) , Amplitude de Movimento Articular
16.
J Hand Surg Am ; 45(2): 148-152, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31585747

RESUMO

Avascular necrosis (AVN) of the carpal bones other than Kienböck disease is a rare cause of chronic pain of the wrist. The scaphoid, capitate, and a smaller percent of lunates are at greater risk to develop AVN because of their peculiar intraosseous circulation; however, AVN has been reported in all the carpal bones. On the plain radiograph, AVN of the carpal bones may evolve through a normal radiograph, sclerosis, fragmentation, cyst formation, fracture, bone collapse, change of the carpal height, and alignment and progressive degenerative changes of the wrist joint. In the early stage of AVN, magnetic resonance imaging enhanced with gadolinium is a more sensitive and specific diagnostic tool than plain radiograph to demonstrate the bone marrow viability. Because of the rarity of case reports, the natural history of AVN of the carpal bones other than Kienböck disease is not well understood. The aims of different treatments are to prevent bone collapse, restore normal carpal height and alignment, and reduce the risk of progressive degenerative changes of the wrist joint.


Assuntos
Capitato , Ossos do Carpo , Osso Semilunar , Osteonecrose , Osso Escafoide , Ossos do Carpo/diagnóstico por imagem , Humanos , Osso Semilunar/diagnóstico por imagem , Osteonecrose/diagnóstico por imagem , Articulação do Punho/diagnóstico por imagem
17.
J Orthop Sci ; 25(3): 428-434, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31279495

RESUMO

BACKGROUND: It is unclear whether lunate fracture types in Kienböck disease correlate with the degree of fracture healing. This study aimed to review the clinical results of stage 3 Kienböck disease treated using partial capitate shortening (PCS) and to evaluate the healing rates of lunate fractures based on the fracture types. METHODS: Twenty-three patients were clinically and radiographically followed up for >2 years after PCS. The preoperative location and postoperative healing of the lunate fracture were evaluated using plain radiography, computed tomography, and/or magnetic resonance imaging. Results were evaluated using the Kienböck scoring system by Nakamura. RESULTS: PCS was clinically effective, demonstrating excellent and good results in 11 and 11 patients, respectively. Pain evaluated using the visual analog scale, wrist extension, flexion motion, and grip strength significantly improved postoperatively (p < 0.01). Fractures were preoperatively detected in all 23 cases. Fracture locations were preoperatively classified into five subtypes based on radiographs: volar pole in five patients, dorsal pole in three, coronal in five, transverse in nine, and ulnar in one. The overall union rate of the lunate fracture was 48%, whereas none of the coronal fractures healed. CONCLUSIONS: PCS was effective in treating stage 3 Kienböck disease. Coronal lunate fractures had a poor healing rate relative to those of the other fracture types. STUDY DESIGN: Clinical, retrospective study.


Assuntos
Capitato/cirurgia , Fraturas Ósseas/fisiopatologia , Osso Semilunar/fisiopatologia , Osteonecrose/fisiopatologia , Adolescente , Adulto , Idoso , Parafusos Ósseos , Feminino , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Amplitude de Movimento Articular , Estudos Retrospectivos , Adulto Jovem
18.
Curr Rheumatol Rev ; 16(3): 210-214, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30520379

RESUMO

BACKGROUND: Morphology may provide the basis for the understanding of wrist mechanics. METHODS: We used classification systems based on cadaver dissection of lunate and capitate types to evaluate a normal database of 70 wrist radiographs in 35 subjects looking for associations between bone shapes. Kappa statistics and a log-linear mixed -effects model with a random intercept were used. RESULTS: There were 39 type-1, 31 type- 2 lunates, 50 spherical, 10 flat and 10 V-shaped capitates. There was a significant difference in lunate and capitate shape between the hands of the same individual p <0.001. This may be due to different loads on the dominant vs. nondominant hands in the same individual. CONCLUSION: Further study to better understand the development of radiographic parameters of the midcarpal joint may aid in our understanding of the morphology and mechanics of the wrist.


Assuntos
Capitato/diagnóstico por imagem , Articulações do Carpo/diagnóstico por imagem , Osso Semilunar/diagnóstico por imagem , Variação Anatômica , Cadáver , Capitato/anatomia & histologia , Humanos , Osso Semilunar/anatomia & histologia , Projetos Piloto , Radiografia , Suporte de Carga
19.
Hand Surg Rehabil ; 39(1): 41-47, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31683037

RESUMO

The aim of this study was to evaluate the long-term outcomes of capitolunate arthrodesis for treating advanced wrist osteoarthritis. The arthrodesis procedures were performed in three women and seven men having a mean age of 59years (range, 20-70). Eight of the patients were manual laborers. The dominant hand was operated on in seven patients. The osteoarthritis was attributed to scapholunate dissociation (SLAC) in six patients and scaphoid nonunion (SNAC) in four patients. The arthrodesis site was stabilized with two vertical compression screws. Patients were reviewed after an average follow-up of 122months (80-172). The clinical and radiological outcomes consisted of measuring pain on a visual analog scale (VAS), determining the QuickDASH and PRWE scores, the patients' satisfaction, the radiolunate and capitolunate angles, carpal height, radiolunate joint condition, and fusion of the arthrodesis site. The mean pain level was reduced from 5 to 1 (P<0.05). The range of motion improved by 20° in flexion-extension and 10° in radioulnar deviation, while strength improved by 8kg relative to the preoperative measurements (P<0.05). The QuickDASH was 15points (±12) and the PRWE was 20 (±32). Relative to the preoperative values, the radiolunate angle was reduced by 4.5° and the capitolunate angle by 6.5°. Carpal height was 6.5mm less on average (P<0.05). None of the patients had a nonunion or deterioration of the radiolunate joint. One patient developed Type II complex regional pain syndrome. The nine other patients were able to return to work. Capitolunate arthrodesis provided pain relief and good function in 9 of the 10patients in our case series. The results was maintained over time, both in terms of mobility and pain relief, which were clearly improved after the surgical treatment. We found no signs of deterioration of the radiolunate joint over 10years. There are very few published studies describing the long-term outcomes of this procedure. Our findings are consistent with those in the literature, which makes capitolunate arthrodesis with scaphoid and triquetrum excision a highly satisfactory and reliable technique in the long term for the treatment of advanced osteoarthritis in the wrist. LEVEL OF EVIDENCE: IV.


Assuntos
Artrodese/métodos , Capitato/cirurgia , Osso Semilunar/cirurgia , Osteoartrite/cirurgia , Osso Escafoide/cirurgia , Piramidal/cirurgia , Articulação do Punho/cirurgia , Adulto , Idoso , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico por imagem , Osteoartrite/fisiopatologia , Satisfação do Paciente , Complicações Pós-Operatórias , Radiografia , Estudos Retrospectivos , Retorno ao Trabalho , Escala Visual Analógica , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/fisiopatologia , Adulto Jovem
20.
J Hum Evol ; 138: 102702, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31805487

RESUMO

Chimpanzees (Pan troglodytes) and gorillas (Gorilla gorilla) both knuckle-walk in adulthood but are known to develop their locomotor strategies differently. Using dentally defined age-groups of both Pan and Gorilla and behavioral data from the literature, this study presents an internal trabecular bone approach to better understand the morphological ontogeny of knuckle-walking in these taxa. Capitate and third metacarpal bones were scanned by µCT at 23-43 µm resolution with scaled volumes of interest placed centrally within the head of the capitate and base of the third metacarpal. Trabecular measures related to activity level (size-adjusted bone volume/total volume, trabecular number, and bone surface area/bone volume) met expectations of decreasing through ontogeny in both taxa. Degree of anisotropy did not show statistical support for predicted species differences, but this may be due to the sample size as observed changes through ontogeny reflect expected trends in the capitate. Analyses of principal trabecular orientation corroborated known behavioral differences related to variation of hand use in these taxa, but only Pan showed directional patterning associated with suggested wrist posture. Assessment of allometry showed that the trabecular bone of larger animals is characterized by fewer and thinner trabeculae relative to bone size. In combination, these findings confirm the efficacy of trabecular bone in reflecting locomotor ontogeny differences between closely related taxa. These techniques show promise for use within the hominin fossil record, particularly for taxa hypothesized to be arboreal in some capacity.


Assuntos
Osso Esponjoso/anatomia & histologia , Capitato/anatomia & histologia , Gorilla gorilla/anatomia & histologia , Ossos Metacarpais/anatomia & histologia , Pan troglodytes/anatomia & histologia , Animais , Marcha , Postura
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