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1.
Bull Hosp Jt Dis (2013) ; 80(2): 155-159, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35643475

RESUMO

Avascular necrosis (AVN) and subsequent fragmentation of the proximal pole of the scaphoid following fracture is a challenging problem to treat. Multiple treatment methods have been described, although they have been shown to have varying degrees of success and are associated with donor site morbidities. This case report demonstrates a technique and the excellent radiographic and clinical outcome at 8 months postoperatively for reconstruction of the proximal pole of the scaphoid using an ipsilateral proximal pole of the hamate autograft.


Assuntos
Fraturas não Consolidadas , Hamato , Osso Escafoide , Autoenxertos , Fraturas não Consolidadas/cirurgia , Hamato/cirurgia , Hamato/transplante , Humanos , Osso Escafoide/diagnóstico por imagem , Osso Escafoide/cirurgia , Tomografia Computadorizada por Raios X
2.
PLoS One ; 17(6): e0269336, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35653348

RESUMO

A preliminary exploration of technical methodology for dynamic analysis of scaphoid, capitate, and lunate during unconstrained movements is performed in this study. A heavily accelerated and fat-saturated 3D Cartesian MRI acquisition was used to capture temporal frames of the unconstrained moving wrist of 5 healthy subjects. A slab-to-volume point-cloud based registration was then utilized to register the moving volumes to a high-resolution image volume collected at a neutral resting position. Comprehensive in-silico error analyses for different acquisition parameter settings were performed to evaluate the performance limits of several dynamic metrics derived from the registration parameters. Computational analysis suggested that sufficient volume coverage for the dynamic acquisitions was reached when collecting 12 slice-encodes at 2.5mm resolution, which yielded a temporal resolution of and 2.6 seconds per volumetric frame. These acquisition parameters resulted in total in-silico errors of 1.9°±1.8° and 3°±4.6° in derived principal rotation angles within ulnar-radial deviation and flexion-extension motion, respectively. Rotation components of the carpal bones in the radius coordinate system were calculated and found to be consistent with earlier 4D-CT studies. Temporal metric profiles derived from ulnar-radial deviation motion demonstrated better performance than those derived from flexion/extension movements. Future work will continue to explore the use of these methods in deriving more complex dynamic metrics and their application to subjects with symptomatic carpal dysfunction.


Assuntos
Osso Escafoide , Fenômenos Biomecânicos , Humanos , Imageamento por Ressonância Magnética , Amplitude de Movimento Articular , Rotação , Osso Escafoide/diagnóstico por imagem
3.
Bone Joint J ; 104-B(6): 709-714, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35638214

RESUMO

AIMS: The aim of this study was to describe the introduction of a virtual pathway for the management of patients with a suspected fracture of the scaphoid, and to report patient-reported outcome measures (PROMs) and satisfaction following treatment using this service. METHODS: All adult patients who presented with a clinically suspected scaphoid fracture that was not visible on radiographs at the time of presentation during a one-year period were eligible for inclusion in the pathway. Demographic details, findings on examination, and routine four-view radiographs at the time of presentation were collected. All radiographs were reviewed virtually by a single consultant hand surgeon, with patient-initiated follow-up on request. PROMs were assessed at a minimum of one year after presentation and included the abbreviated version of the Disabilities of the Arm, Shoulder and Hand Score (QuickDASH), the EuroQol five-dimension five-level health questionnaire (EQ-5D-5L), the Net Promoter Score (NPS), and return to work. RESULTS: A total of 221 patients were referred to the virtual pathway. Their mean age was 41 years (range 16 to 87) and there were 99 male patients (45%). A total of 189 patients (86%) were discharged with advice and 19 (9%) were recalled for clinical review: seven with an undisplaced scaphoid fracture, six with another fracture of the hand or wrist, two with a scapholunate ligament injury, and four in whom no abnormality was detected. A total of 13 patients (6%) initiated follow-up with the hand service: no fracture or ligament injury was identified in this group. PROMs were available for 179 patients (81%) at a mean follow-up of 19 months (range 13 to 33). The median QuickDASH score was 2.3 (interquartile range (IQR) 0 to 15.9), the median EQ-5D-5L was 0.85 (IQR 0.73 to 1.00), the NPS was 76, and 173 patients (97%) were satisfied with their treatment. There were no documented cases of symptomatic nonunion one year following injury. CONCLUSION: We describe the introduction of a virtual pathway for the management of patients with a suspected scaphoid fracture. We found high levels of patient satisfaction, excellent PROMs, and no detrimental effects in the vast majority of cases. Cite this article: Bone Joint J 2022;104-B(6):709-714.


Assuntos
Fraturas Ósseas , Traumatismos da Mão , Osso Escafoide , Traumatismos do Punho , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Osso Escafoide/diagnóstico por imagem , Osso Escafoide/lesões , Osso Escafoide/cirurgia , Adulto Jovem
4.
Acta Biomed ; 92(S3): e2021536, 2022 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-35604271

RESUMO

BACKGROUND AND AIM: Resurfacing Capitate Pyrocarbon Implant has been introduced in the surgical practice as an alternative method to restore wrist motion, strength and functions in patients suffering from wrist osteoarthritis. It has already been well described in the literature as a treatment for advanced stages of degenerative wrist diseases which follow scaphoid's and lunate's injuries such as scapho-lunate advanced collapse, scaphoid non-union advanced collapse, and advanced stages of Kienböck disease. Authors extended the use of RCPI to other selected cases of complicated wrist injuries, spreading out from the classic indications for which this device was designed. METHODS: We discuss 8 cases with serious outcomes of carpal injuries treated with Resurfacing Capitate Pyrocarbon Implant as salvage procedure between 2005 and 2013 by the first author of this paper Results: Among the eight particular selected cases, at a mean 4.3 years follow-up (range 2-11) only one was considered a failure and underwent a total wrist arthrodesis, resolving pain after all. The seven other cases reported good results. Range of Motion, Visual Analogue Scale for pain, subjective satisfaction and radiographical outcomes are reported. CONCLUSIONS: As a result of this heterogeneous clinical experience, validated by long-term follow-ups in most cases, we think that the use of a Resurfacing Capitate Pyrocarbon Implant can be suggested as an option in the outcomes of various carpal injuries.


Assuntos
Capitato , Ossos do Carpo , Osso Escafoide , Artrodese , Capitato/cirurgia , Carbono , Ossos do Carpo/cirurgia , Seguimentos , Humanos , Dor , Amplitude de Movimento Articular , Osso Escafoide/lesões , Osso Escafoide/cirurgia , Articulação do Punho/cirurgia
5.
Sci Rep ; 12(1): 8379, 2022 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-35589911

RESUMO

The treatment of scaphoid nonunion can be challenging with increasing defect size. We evaluated the outcome of scaphoid nonunion with a substantial bone defect treated with a multidirectional locking plate combined with cancellous bone grafting only. Thirteen patients with significant osseous defects measuring 6 mm or more suffering from primary nonunion without treatment (n = 6) or recalcitrant nonunion following Herbert screw osteosynthesis (n = 7) were treated and reviewed retrospectively. The stabilization was performed after debridement, autologous cancellous bone grafting and volar locking plate osteosynthesis. After a mean follow-up period of 12 months, 12 of the 13 patients achieved successful unions with a free range of motion and complete remittance of pain in everyday activity. The mean scapholunate angle decreased from 59.7° ± 11 to 43.9° ± 5 (effect strength d:1.7, p < 0.00001), scaphoid humpback deformity angle from 58.9° ± 8 to 45.1° ± 8 (d:1.8, p < 0.0001), whereas strength of the injured hand increased from 36.4 kg ± 10 to 42.4 kg ± 9 (d:1.4, p < 0.0001). One nonunion persisted without fragment dislocation receiving revision after 1 year. Thus, locking plate osteosynthesis with cancellous bone grafting is a valid alternative in scaphoid nonunions with extensive bone defects. Additionally, stable retention of the fragments prevents dislocation even in delayed or persistent nonunion. Further prospective studies are required to confirm these findings.


Assuntos
Fraturas não Consolidadas , Doenças Musculoesqueléticas , Osso Escafoide , Placas Ósseas , Transplante Ósseo , Fixação Interna de Fraturas , Fraturas não Consolidadas/diagnóstico por imagem , Fraturas não Consolidadas/cirurgia , Humanos , Amplitude de Movimento Articular , Estudos Retrospectivos , Osso Escafoide/diagnóstico por imagem , Osso Escafoide/cirurgia
6.
Acta Orthop Belg ; 88(1): 186-189, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35512170

RESUMO

We describe the case of a 58-year-old woman with AVN of the left trapezium which was treated surgically. This paper aims to review the etiologies leading to the pathology and the different therapeutic options. Avascular necrosis (AVN) of the carpal bones most commonly involves the lunate and the scaphoid . AVN of the trapezium is extremely rare. To our knowledge only 3 cases have been published in the literature so far and they were all treated differently.


Assuntos
Osso Semilunar , Osteonecrose , Osso Escafoide , Trapézio , Feminino , Humanos , Osso Semilunar/patologia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Osteonecrose/diagnóstico por imagem , Osteonecrose/etiologia , Osteonecrose/cirurgia , Trapézio/diagnóstico por imagem , Trapézio/patologia , Trapézio/cirurgia
7.
Hand Clin ; 38(2): 149-160, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35465933

RESUMO

In patients with radial-sided wrist pain, a myriad of possible etiologies exists and as such, a detailed history, examination, and, where indicated, imaging is obtained to try and aid with its diagnosis. The purpose of this article is to provide an overview of radial-sided wrist pain, diagnostic modalities and discuss current treatment options. More detailed information is out-of-scope for this article and if needed, we would guide the reader to seek out other selected texts, as indicated.


Assuntos
Osso Escafoide , Punho , Artralgia/diagnóstico , Diagnóstico Diferencial , Humanos , Rádio (Anatomia) , Articulação do Punho/diagnóstico por imagem
8.
J Hand Surg Eur Vol ; 47(6): 580-589, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35435025

RESUMO

The article reviews key considerations and our preferred methods in treating upper extremity palsies, gunshot wounds and scaphoid nonunion. For these three difficult conditions, I highlight the importance of a team approach when treating upper extremity neuromuscular disease, flexibility and creativity when treating gunshot wounds, and my personal protocol for dealing with scaphoid fracture nonunions.Level of evidence: V.


Assuntos
Fraturas Ósseas , Fraturas não Consolidadas , Osso Escafoide , Ferimentos por Arma de Fogo , Transplante Ósseo/métodos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/terapia , Fraturas não Consolidadas/cirurgia , Humanos , Paralisia , Osso Escafoide/lesões , Osso Escafoide/cirurgia , Extremidade Superior/lesões , Extremidade Superior/cirurgia , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/cirurgia
10.
Plast Reconstr Surg ; 149(6): 1130e-1139e, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35404339

RESUMO

BACKGROUND: Midcarpal osteoarthritis is a debilitating wrist pain, and a mainstay treatment is midcarpal fusion. The accepted standard for midcarpal fusion is four-corner fusion, but lately, two-corner fusion (i.e., capitolunate fusion) has gained popularity. This is the first prospective, multicenter, cohort study comparing capitolunate fusion with four-corner fusion for midcarpal osteoarthritis. METHODS: Patients with scaphoid nonunion advanced collapse or scapholunate advanced collapse wrist of grade 2 to 3 undergoing capitolunate fusion or four-corner fusion between 2013 and 2019 were included. Sixty-three patients (34 with capitolunate fusion, 29 with four-corner fusion) were included. Patient demographics were similar between groups. Patient-Rated Wrist Hand Evaluation questionnaire score, visual analog scale pain score, grip strength, range of motion, and complications were measured at baseline and 3 months and 12 months postoperatively. Complications (i.e., nonunion, hardware migration, conversion to wrist arthrodesis, or arthroplasty) were determined. RESULTS: A significant difference in Patient-Rated Wrist Hand Evaluation or visual analog scale pain score at 3 and 12 months postoperatively between the capitolunate fusion and four-corner fusion groups was not found. There were no differences in grip strength between patient groups preoperatively or 12 months postoperatively. At 12 months postoperatively, capitolunate fusion patients had better flexion compared with that in the four-corner fusion group (p = 0.002); there were no differences in complications and reoperation rates between groups. CONCLUSIONS: Capitolunate fusion and four-corner fusion were comparable in terms of functional scores (i.e., Patient-Rated Wrist Hand Evaluation and visual analog scale pain scores) and complication scores. Capitolunate fusion showed favorable wrist mobility compared with four-corner fusion in treatment of midcarpal osteoarthritis. Capitolunate fusion advantages include use of less material, less need for bone-graft harvesting, and easier reduction of the lunate during fixation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.


Assuntos
Osteoartrite , Osso Escafoide , Artrodese , Estudos de Coortes , Força da Mão , Humanos , Osteoartrite/cirurgia , Dor , Estudos Prospectivos , Amplitude de Movimento Articular , Estudos Retrospectivos , Osso Escafoide/cirurgia , Punho , Articulação do Punho/cirurgia
11.
Hand Surg Rehabil ; 41(3): 334-340, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35283337

RESUMO

This study aimed to evaluate clinical and radiographic outcomes in a consecutive series of patients who underwent open surgery via a radial approach for reconstruction of scaphoid waist non-union. Over a 2-year period, 16 males with scaphoid waist non-union received surgery using a radial approach; we performed limited styloidectomy, biconcave curettage, ovoid bone grafting from the styloidectomy fragment, and placement of a retrograde radial-entry screw. Mean patient age was 25.1 years (range 17-56 years). Bony union was determined on radiographs and computed tomography. Radiographic variables were measured on preoperative and final follow-up radiographs. Mean follow-up was 14 months (range 8-19 months). Subjective and objective outcomes were recorded. Radiographic healing was achieved in 14 of the 16 patients (88%) at a mean 4½ months after surgery (range 3-6 months). Significant postoperative improvements were found in mean carpal height ratio (from 0.48 to 0.53) and radiolunate angle (from 8.2° to 2.8°) compared to preoperative data. Mean postoperative wrist extension was 54° (range 32-67°) and mean flexion 49° (range 2-64°). Mean flexion arc after surgery was 84.1% that of the contralateral side. Mean grip strength was 85.2% that of the contralateral side. Subjective results comprised mean postoperative Modified Mayo Wrist score of 82.3 (range 55-90) and Quick Disabilities of the Arm, Shoulder and Hand score of 11.2 (range 0-36.4). Twelve of the 14 healed wrists were subjectively rated as good or excellent. Repair of scaphoid non-union via a radial approach was safe and effective. Union rates were high and outcomes were good.


Assuntos
Fraturas não Consolidadas , Osso Escafoide , Adolescente , Adulto , Parafusos Ósseos , Transplante Ósseo/métodos , Fraturas não Consolidadas/diagnóstico por imagem , Fraturas não Consolidadas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Rádio (Anatomia) , Osso Escafoide/diagnóstico por imagem , Osso Escafoide/cirurgia , Adulto Jovem
12.
BMC Musculoskelet Disord ; 23(1): 265, 2022 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-35303840

RESUMO

BACKGROUND: The pathology of Preiser disease remains controversial, and treatment for Preiser disease has not yet been standardised. Preiser disease itself is rare, and although it can be found in children, its presentation is even rarer; therefore, the treatment of paediatric patients with Preiser disease is more unclear than adult cases. CASE PRESENTATION: A 10-year-old boy who complained of left wrist pain was diagnosed with Preiser disease from osteosclerosis and segmentation on plain radiography and computed tomography, and low signal intensity on both T1- and T2-weighted images on magnetic resonance imaging. Because the patient was a child whose scaphoid was immature and pre-ossified, we chose a conservative immobilisation treatment with a thumb spica cast followed by an orthosis. After 3 months of immobilisation, the distal pole of the scaphoid showed remodelling. One year after the initial visit, plain radiography showed remodelling of the whole scaphoid, although magnetic resonance T1-weighted image showed that the recovery of intensity change was only observed in the distal pole. Two years after the initial visit, both plain radiography and magnetic resonance imaging showed a normal appearance and 5 years after the initial visit; the scaphoid bone showed normal development. CONCLUSIONS: This is the first case report of Preiser disease before complete ossification of the scaphoid; therefore, we cannot say anything definitive about the treatment strategy. However, our experience suggests that conservative treatment may provide a cure for Preiser disease in children with immature ossification of the scaphoid without carpal collapse.


Assuntos
Osso Escafoide , Adulto , Criança , Humanos , Imageamento por Ressonância Magnética , Masculino , Osteogênese , Radiografia , Osso Escafoide/diagnóstico por imagem , Extremidade Superior
13.
J Orthop Surg Res ; 17(1): 78, 2022 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-35123519

RESUMO

PURPOSE: This study aims to introduce the "tripod" technique using cannulated compression screw and two anti-rotational K-wires for treatment of unstable scaphoid waist fracture nonunion, and to compare it with the single cannulated screw fixation technique in term of scaphoid union and surgical outcomes. METHODS: It was a retrospective study. From January 2014 to March 2020, 103 consecutive patients with scaphoid waist fracture nonunion treated with the tripod fixation and bone grafting (n = 45) or with single cannulated compression screw and bone grafting (n = 58) were included. All the procedures were performed by the same hand surgery team, and autologous cortico-cancellous radius bone graft was used for bony reconstruction. The minimal follow-up period was 12 months. The union rate and the time to union, range of motion (ROM), grip strength, Visual Analogue Scale (VAS), Quick Disabilities of the Arm, Shoulder and Hand (DASH) score and modified Mayo Scores at the last visit were compared. RESULTS: In tripod fixation group, bony union was achieved in all patients at the mean of 14.8 ± 3.8 weeks, while in the single cannulated screw fixation group the bony union rate was 94.8% (55/58) and the time to union was 17.6 ± 3.6 weeks. The difference of time to union was statistically significant (p = 0.027), but not for bony union rate (p = 0.122). At the last visit, no significant difference was found with respect to any clinical and radiographic outcome measures (all p > 0.05). The overall rate of complications was not significantly different between two groups (15.6% vs 10.3%, p = 0.430). CONCLUSIONS: Tripod fixation technique with headless compression screw and two K-wires is a safe and effective technique for treatment of scaphoid nonunion fixation and can be considered to use in practice, especially for those potentially rotationally unstable cases.


Assuntos
Parafusos Ósseos , Transplante Ósseo/métodos , Fixação Interna de Fraturas , Fraturas não Consolidadas/cirurgia , Osso Escafoide/lesões , Adulto , Feminino , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Fraturas não Consolidadas/diagnóstico por imagem , Humanos , Masculino , Amplitude de Movimento Articular , Estudos Retrospectivos , Osso Escafoide/cirurgia , Resultado do Tratamento
14.
Handchir Mikrochir Plast Chir ; 54(1): 28-37, 2022 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-35168267

RESUMO

BACKGROUND: Ultrasound has not yet been established in the diagnostic workup of scapholunate ligament lesions. We aimed to develop a standardised examination procedure to visualise and evaluate the SL ligament. PATIENTS AND METHODS: Forty patients (70 hands) were examined prospectively with ultrasonography and the results were compared with arthroscopy and MRI findings. We studied the visibility of the SL ligament and the SL distance on side-to-side comparison and performed a method comparison between MRI/arthroscopy and ultrasound, testing for distinction and accordance. Cut-off values for the SL distance indicating a lesion were determined and all parameters were used for developing a score. RESULTS: An intact ligament appears as a hyperechogenic, fibrillary structure and shows discontinuity or a hypoechogenic space when injured. An intact ligament was visible dorsally in 89.6 % and palmarly in 83.3 %. The SL distance for an intact ligament was 5/2/5.1 mm for the dorsal/middle/palmar aspect (range 3.2-6.7/0.9-4/3.1-7.8 mm) and 6.4/3/6.3 mm (range 5-9.4/2-6.2/4-9.3 mm) for a lesion. The difference between the right and left hand with an intact ligament was a maximum of 2.1/1.1/1.8 mm, an average of 0.4/0.2/0.2 mm; in case of an injury, the maximum difference was 1.2/0.9/1.1 mm. Distance values for radial and ulnar deviation were physiological but partly unpredictable. The cut-off values determined for a lesion are 5.05 mm for the dorsal aspect (sensitivity/specificity 0.95/0.60), 1.95 mm for the middle (1/0.62) and 6.15 mm for the palmar aspect (0.55/0.85). The created sonographic SL ligament score has a high AUC (area under the curve) of 0.93, a sensitivity of 85 % and a specificity of 90 %. CONCLUSION: The parameters, especially when combined to a score, allow to state whether the SL ligament is intact or not. Ultrasound can, therefore, be recommended as a diagnostic and screening method for an SL ligament lesion und should be used as a routine tool. The criteria must be checked from a perspective with high case numbers.


Assuntos
Osso Semilunar , Osso Escafoide , Traumatismos do Punho , Humanos , Ligamentos Articulares/diagnóstico por imagem , Osso Semilunar/diagnóstico por imagem , Rádio (Anatomia) , Osso Escafoide/diagnóstico por imagem , Ultrassonografia , Traumatismos do Punho/diagnóstico por imagem , Articulação do Punho
15.
BMC Musculoskelet Disord ; 23(1): 158, 2022 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-35177051

RESUMO

BACKGROUND: Dynamic radiocarpal instability is one of the causes of post-trauma radial-sided wrist pain. It is not easy to diagnose and may possibly be overlooked. The key ligaments responsible for dynamic radiocarpal instability are the radioscaphocapitate (RSC) and long radiolunate (LRL) ligaments. Tensioning of these 2 ligaments could be a method of treatment for dynamic carpal instability. We proposed a method for arthroscopic thermal shrinkage of these 2 ligaments, and for setting a landmark arthroscopically to facilitate identification of these 2 ligaments during the combined open suture tensioning procedure. METHODS: Between January 2016 and May 2020, 12 patients treated with this method were enrolled. The mean age was 33.3 years (range, 18-57 years), and the mean duration from injury to operation was 7.8 months (range, 3-25 months). The diagnosis was mainly depended on the physical examinations and confirmed under arthroscopy. The mean follow-up was 17.7 months (range, 12-26 months). RESULTS: All the patients had marked improvement of pain, grip strength, the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), and the radiocarpal stability. The wrist range of motion showed significant decrease around 5o in both flexion and extension and around 4o in the ulnar deviation at the final follow-ups. All patients were able to return to their previous full level of work and activities. CONCLUSIONS: We conclude that arthroscopic thermal shrinkage combined with open suture tensioning can be effective in treating dynamic carpal instability, while the arthroscopic-assisted landmark setting can help identify the accurate location of the RSC and LRL ligaments without dissecting too much soft tissue.


Assuntos
Osso Escafoide , Traumatismos do Punho , Adulto , Artroscopia , Humanos , Ligamentos Articulares/diagnóstico por imagem , Ligamentos Articulares/lesões , Ligamentos Articulares/cirurgia , Amplitude de Movimento Articular , Traumatismos do Punho/cirurgia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/cirurgia
16.
Zhonghua Yi Xue Za Zhi ; 102(7): 513-517, 2022 Feb 22.
Artigo em Chinês | MEDLINE | ID: mdl-35184505

RESUMO

To investigate the feasibility and the clinical efficiency of robot navigation combined with wrist arthroscopy in minimally invasive treatment of nondisplaced type Herbert D1 scaphoid fracture. A retrospective analysis was performed on 9 patients who underwent nondisplaced type Herbert D1 scaphoid fracture in Xuzhou Renci Hospital from December 2019 to January 2021. Before the operation and at the last follow-up, grip strength, pinching force, modified wrist Mayo score and visual analogue scale (VAS) of wrist pain were recorded and compared. The average follow-up time was 14.1 months (7.5-24.0 months). All the fractures achieved primary healing after an average of 13.3 weeks (10-18 weeks). The average flexion and dorsal extension activity of the injured wrist was 51.2°±9.4°, 68.0°±7.3°, and the radial and ulnar deviation was 19.3°±6.2°, 45.7°±7.8°, respectively. At the final follow-up, there were statistically significant differences in grip strength, pinch strength, wrist Mayo score and VAS when compared with those before the operation (all P<0.05). The results demonstrated that robot navigation combined with wrist arthroscopy for nondisplaced type Herbert D1 scaphoid fracture is effective and minimally invasive with a short recovery time and satisfactory healing rate.


Assuntos
Fraturas Ósseas , Robótica , Osso Escafoide , Artroscopia , Fixação Interna de Fraturas , Fraturas Ósseas/cirurgia , Humanos , Amplitude de Movimento Articular , Estudos Retrospectivos , Osso Escafoide/cirurgia , Resultado do Tratamento , Punho
17.
Med Glas (Zenica) ; 19(1): 75-78, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-35112563

RESUMO

Aim To describe the technique of the four-corner fusion with two retrograde crossed headless screws in cases of carpal collapse. Methods This technique is a consolidated procedure performed in cases of scaphoid non- union advanced collapse (SNAC) type II and III, scapholunate advanced collapse (SLAC) type II and III and in other cases of carpal collapse. Between 2017 and 2019 we treated six male patients (a mean age of 55.0 years) with radiocarpal osteoarthritis. Our technique involves the use of two retrograde crossed headless screws; the first screw was placed distally proximally from the uncinate to the lunate and the second screw from the pyramidal to the capitate, crossed at approximately 90 degrees. Clinical and radiographic two-year follow-up was performed. Before the treatment and during the follow-ups VAS, PRWE and DASH Quick score scales, measured wrist range of motion (WROM) were administered and evaluated. Results In all cases the X-ray consolidation of arthrodesis within five months was noticed; in 50% patients already under 3-month control. No observed signs of mobilization of screws and inflammatory or infectious processes were found. All patients were satisfied (reduction/disappearance of pain). All surgically treated patients resumed normal daily activities. These improvements were confirmed by the results of the evaluation scale and clinical examination. Conclusion This technique, in our opinion, represents a gold standard. Its low costs of the material used (especially comparing to other technique), a low prevalence of complications of materials and fusion in 100% of cases should be also considered.


Assuntos
Osso Escafoide , Articulação do Punho , Artrodese , Parafusos Ósseos , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular
19.
J Pediatr Orthop ; 42(5): 260-264, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35153287

RESUMO

BACKGROUND: The optimal management of pediatric scaphoid fracture nonunions is controversial. We hypothesize that pediatric patients with scaphoid fracture nonunions will have favorable functional outcomes with the utilization of nonvascularized distal radius cancellous autograft with open reduction and internal fixation (ORIF). METHODS: A review was performed from 2012 to 2017 identifying skeletally immature patients with scaphoid fracture nonunions treated with ORIF and nonvascularized distal radius cancellous autograft, including demographic data, mechanism of injury, length of time from injury to treatment, operative procedure, length of immobilization, time to union, and complications. RESULTS: Ten patients (9 males, 1 female) met inclusion criteria. Mean age was 14.3 SD 1.5 years. The majority of fractures were sustained during sports or secondary to a fall. Mean time between injury and orthopaedic evaluation was 33 weeks (SD 20 wk). Eight fractures occurred at the waist, and 2 occurred at the proximal pole. Four patients had a humpback deformity, and three presented with a dorsal intercalated segmental instability deformity. Nine patients were treated with a single cannulated compression screw with distal radius autograft. One patient also received a single Kirschner wire fixation in addition to a single cannulated screw and graft. Patients underwent a mean postoperative immobilization period of 14 SD 5 weeks. Two patients received a bone stimulator postoperatively. Radiographic union was documented after initial surgery in nine patients, with mean time to union of 17 SD 5 weeks. The 1 patient with persistent radiographic nonunion underwent revision fixation and repeat nonvascularized distal radius autograft, achieving union and resolution of symptoms. All patients ultimately reported full return to activity. CONCLUSIONS: Pediatric scaphoid fracture nonunions that undergo ORIF using nonvascularized distal radius cancellous autograft have favorable rates of consolidation and functional outcomes. Surgeons should consider this source of grafting in operative management of scaphoid nonunions in children and adolescents. LEVEL OF EVIDENCE: Level IV, therapeutic.


Assuntos
Fraturas Ósseas , Fraturas não Consolidadas , Doenças Musculoesqueléticas , Osso Escafoide , Traumatismos do Punho , Adolescente , Autoenxertos , Transplante Ósseo/métodos , Criança , Feminino , Fixação Interna de Fraturas/métodos , Consolidação da Fratura , Fraturas não Consolidadas/diagnóstico por imagem , Fraturas não Consolidadas/cirurgia , Humanos , Masculino , Rádio (Anatomia)/cirurgia , Estudos Retrospectivos , Osso Escafoide/lesões , Osso Escafoide/cirurgia
20.
Plast Reconstr Surg ; 149(4): 901-910, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35157627

RESUMO

BACKGROUND: Numerous surgical reconstructive techniques have been described for chronic scapholunate and lunotriquetral interosseous ligament instability. METHODS: The authors retrospectively reviewed 16 consecutive patients who underwent bone-ligament-bone reconstruction for scapholunate or lunotriquetral intraosseous ligament predynamic and dynamic instability at a single tertiary care institution from 2013 to 2019. Clinical and radiographic outcomes, and complications, were recorded. RESULTS: Eleven patients had bone-ligament-bone reconstruction for scapholunate ligament injuries and five for lunotriquetral instability. Fourteen patients (87.5 percent) underwent diagnostic arthroscopy before bone-ligament-bone reconstruction, with nine of 14 having grade 3 and four of 14 having grade 4 injury. Capitohamate bone-ligament-bone grafts were used in nine patients (56 percent) and the graft was taken from Lister tubercle in seven (44 percent). The average age at surgery was 37 years. The average follow-up was 60.6 weeks. There were no significant differences between preoperative and postoperative radiographic parameters. Median postoperative wrist flexion was 45 degrees, and mean postoperative wrist extension was 53 degrees, which were significantly less than contralateral flexion (85 degrees; p < 0.0001) and extension (78 degrees; p < 0.0001). Thirty-eight percent of patients complained of persistent pain at final follow-up, and two patients (13 percent) underwent salvage procedures, both at approximately 6.5 months after the index reconstruction. CONCLUSION: Short-term outcomes of bone-ligament-bone reconstruction for early-stage scapholunate and lunotriquetral ligament injuries reveal many patients with residual postoperative wrist pain and disability, and almost uniform limitations in flexion-extension motion. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Instabilidade Articular , Osso Semilunar , Osso Escafoide , Traumatismos do Punho , Artralgia , Humanos , Instabilidade Articular/complicações , Instabilidade Articular/cirurgia , Ligamentos Articulares/lesões , Ligamentos Articulares/cirurgia , Osso Semilunar/diagnóstico por imagem , Osso Semilunar/cirurgia , Estudos Retrospectivos , Osso Escafoide/lesões , Osso Escafoide/cirurgia , Traumatismos do Punho/complicações , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/cirurgia , Articulação do Punho/cirurgia
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