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1.
Hand Surg Rehabil ; 40(4): 519-523, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33864940

RESUMO

Fractures of the hamate are rare, and a clear treatment algorithm does not exist. Nonetheless, surgical treatment is generally recommended for displaced fractures using a dorsal approach. There is also a lack of data on hamate malunion. We present a case of a 28-year-old female with a coronal malunion of the hamate and hamate hook fracture. Because the triquetrum prevented direct access to the fracture, we planned and undertook a transtriquetral coronal osteotomy based on three-dimensional computed tomography imaging data. After removing the bone callus, reduction was possible with subsequent fixation. We recommend performing a transtriquetral osteotomy to treat an otherwise inaccessible fracture or malunion of select hamate fractures.


Assuntos
Fraturas Ósseas , Hamato , Piramidal , Traumatismos do Punho , Adulto , Feminino , Fraturas Ósseas/cirurgia , Hamato/diagnóstico por imagem , Hamato/cirurgia , Humanos , Osteotomia , Traumatismos do Punho/cirurgia
2.
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
3.
J Hand Surg Am ; 46(1): 71.e1-71.e7, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33168276

RESUMO

PURPOSE: Distal scaphoid and triquetrum excisions can improve the range of wrist motion after radioscapholunate (RSL) fusion, but little is known about the kinematics of dart-throwing and global circumduction motions. We hypothesized that these excisions could increase the range of motion without causing midcarpal instability. METHODS: Seven fresh-frozen cadaver upper extremities were mounted on a testing apparatus after isolation and preloading of the tendons of the flexor carpi radialis, flexor carpi ulnaris, extensor carpi radialis, and extensor carpi ulnaris. Sequential loadings of the flexor carpi ulnaris and extensor carpi radialis simulated active dart-throwing motion. Passive circumferential loading produced the wrist circumduction motion. We measured the range of wrist motions with an electromagnetic tracking system in 4 experiments: intact, simulated RSL fusion, RSL fusion with distal scaphoid excision, and RSL fusion with distal scaphoid and total triquetrum excisions. To evaluate midcarpal stability, we conducted passive mobility testing of the distal carpal row in the radial, volar, ulnar, and dorsal directions. RESULTS: Radioscapholunate fusion decreased the dart-throwing motion to a mean of 46% of the baseline value; distal scaphoid and triquetrum excisions increased the mean arc to 50% and 62%, respectively. Radioscapholunate fusion diminished the wrist circumduction to a mean of 43% of the baseline value, which increased to a mean of 58% and 74% after distal scaphoid and triquetrum excision, respectively. A significant increase in radial deviation was noted after distal scaphoid excision, and subsequent triquetrum excision significantly increased motion in the ulnar-palmar direction. Regarding midcarpal stability, dorsal translation significantly increased after distal scaphoid and triquetrum excisions. CONCLUSIONS: Distal scaphoid and triquetrum excision after RSL fusion improved both dart-throwing and circumduction motions, but dorsal midcarpal instability occurred. CLINICAL RELEVANCE: Subsequent carpal excisions may improve short-term outcome by increasing motions in a RSL-fused wrist; however, a potential risk of midcarpal instability should be considered.


Assuntos
Osso Escafoide , Piramidal , Artrodese , Fenômenos Biomecânicos , Humanos , Amplitude de Movimento Articular , Osso Escafoide/cirurgia , Piramidal/cirurgia , Punho , Articulação do Punho/cirurgia
4.
Rev. bras. ortop ; 55(6): 796-799, Nov.-Dec. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1156192

RESUMO

Abstract Gout is a crystalline arthropathy frequent in the population, but gouty spondyloarthropathy, also called axial gout, is uncommon. The current case report presents a rare case of cervical myelopathy secondary to axial gout. A 50-year-old female patient, without previous pathologies, presented with loss of strength, altered sensitivity, and pyramidal release for 2 years. The computed tomography showed a lytic image in the spinous process of C7, and signs of myelopathy with myelomalacia on magnetic resonance imaging of the cervical spine. After the surgical procedure and biopsy of the material, the diagnosis was gout, and treatment for the pathology was started, with complete improvement of the condition. The diagnosis of axial gout should be included in the spectrum of the differential diagnosis of diseases that affect the spine. Although gouty spondyloarthritis (or spondylitis) is uncommon, there is an underestimated occurrence due to the lack of investigation of the cases. The early diagnosis and treatment of the pathology can prevent patients from presenting complications of the disease, as reported in the present study.


Resumo A gota é uma artropatia cristalina frequente na população; entretanto, a espondiloartropatia gotosa, também chamada de gota axial, é incomum. O presente relato de caso apresenta um caso raro de mielopatia cervical secundária a gota axial. Uma paciente de 50 anos de idade, sem patologias prévias, apresentou quadro de perda de força, alteração de sensibilidade e liberação piramidal há 2 anos. A tomografia computadorizada evidenciou imagem lítica no processo espinhoso de C7, e sinais de mielopatia com mielomalácia foram observados na ressonância magnética da coluna cervical. Após o procedimento cirúrgico e biópsia do material, o diagnóstico foi de gota, e o tratamento para a patologia foi iniciado, com melhora completa do quadro. O diagnóstico de gota axial deve ser incluído no espectro do diagnóstico diferencial das doenças que acometem a coluna vertebral. Apesar de a espondiloartrite gotosa ser incomum, há uma ocorrência subestimada devido a não investigação dos casos. O diagnóstico precoce e tratamento da patologia pode evitar que pacientes apresentem complicações da doença, como a relatada no presente estudo.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Compressão da Medula Espinal , Doenças da Medula Espinal , Biópsia , Imageamento por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Paraparesia , Espondiloartropatias , Diagnóstico Diferencial , Piramidal , Gota , Artropatias
5.
Hand Surg Rehabil ; 39(5): 375-382, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32439484

RESUMO

The aim of this study was to assess the clinical and radiographic outcomes after radioscapholunate (RSL) fusion for posttraumatic osteoarthritis. This was a retrospective, dual-center study of all patients who underwent RSL fusion between 1995 and 2015 for posttraumatic radiocarpal osteoarthritis. Patients were assessed at the final review to determine clinical (pain, wrist range of motion and strength), self-reported (QuickDASH, PRWE and MWS scores) and radiological (degenerative osteoarthritis in the scaphotrapeziotrapezoid (STT) or midcarpal joint and radiocarpal fusion) outcomes. We analyzed three groups: RSL fusion alone, RSL fusion with distal scaphoid excision (DSE) and RSL fusion with DSE and triquetrum excision (TE). Eighty-five patients were included; 10 were lost to follow-up and 11 required conversion to total wrist fusion before the final review. Finally, 64 patients had both clinical and radiographic evaluations. The mean follow-up was 9.1 years (range 1-21.4). RSL fusion alone was performed in 29 patients, RSL fusion with DSE in 23 and RSL fusion with DSE and TE in 12. At the final follow-up, the three groups did not differ in their pain or wrist motion. Overall, 47 (73%) patients were satisfied or very satisfied with the procedure. DSE significantly decreased STT osteoarthritis and radiocarpal non-union. The total wrist osteoarthritis rate after RSL fusion was 55%. RSL fusion is an effective procedure to preserve some motion in wrists with posttraumatic radiocarpal osteoarthritis. DSE prevents STT osteoarthritis by removing bony impingement and increases the fusion rate. LEVEL OF EVIDENCE: Level IV, Case series, Therapeutic studies.


Assuntos
Artrodese , Osso Semilunar/cirurgia , Osteoartrite/cirurgia , Rádio (Anatomia)/cirurgia , Osso Escafoide/cirurgia , Piramidal/cirurgia , Avaliação da Deficiência , Feminino , Seguimentos , Força da Mão , Humanos , Osso Semilunar/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico por imagem , Satisfação do Paciente , Radiografia , Rádio (Anatomia)/diagnóstico por imagem , Estudos Retrospectivos , Osso Escafoide/diagnóstico por imagem , Escala Visual Analógica
6.
JBJS Case Connect ; 10(4): e20.00132, 2020 12 10.
Artigo em Inglês | MEDLINE | ID: mdl-33512929

RESUMO

CASE: We report the case of a 15-year-old male patient presenting with persistent wrist pain after surgical treatment of a triquetral osteoid osteoma. The patient was found to have a persistent nidus. These tumors are difficult to observe intraoperatively or through fluoroscopy, limiting adequate resection and resulting in continued pain. CONCLUSION: The nidus was excised successfully through an unusual technique using tetracycline for intraoperative identification. The patient remains asymptomatic without recurrence at 31 months postoperative. Difficulties visualizing and removing carpal lesions leading to recurrence are described.


Assuntos
Neoplasias Ósseas/cirurgia , Procedimentos Ortopédicos/métodos , Osteoma Osteoide/cirurgia , Reoperação , Tetraciclina , Piramidal/cirurgia , Adolescente , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/patologia , Humanos , Masculino , Osteoma Osteoide/diagnóstico por imagem , Osteoma Osteoide/patologia , Tomografia Computadorizada por Raios X , Piramidal/diagnóstico por imagem , Piramidal/patologia
7.
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
9.
Acta Reumatol Port ; 44(3): 218-224, 2019 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-31300634

RESUMO

INTRODUCTION/AIM: Rheumatoid Arthritis (RA) an autoimmune, chronic, and disabling disease if untreated, affects wrist joints, with a diagnostic delay of up to 2 years. Triquetral bone allows rotational movement that pivots over the rest wrist bones, and maintains physiological loads during mobility. Magnetic Resonance Imaging (MRI) is the most sensitive (96%) method for diagnosis, evidencing lesions as early as in the initial RA stages. Our aim was to determine the most frequently affected structures in the hand-wrist joint by MRI using the OMERACT-RAMRIS Score (2003) in three different RA stages, including clinically suspicious arthralgia (CSA) that haven't reported before. METHODS: We performed an exploratory, transverse, observational, descriptive study in 60 patients enrolled and classified by rheumatologists as: CSA, early rheumatoid arthritis (ERA), and established RA, prior to performing a dominant hand-wrist MRI for evaluation and descriptive analysis by an expert radiologist. RESULTS: Female predominance 83% (50), with a mean age 42+13.5 years; A total of 1,731 hand-wrist bone and joint sites were evaluated using EULAR-OMERACT Atlas (2005), identifying 56% (964 sites) with typical RA lesions: synovitis, erosions, and bone marrow edema (BME or osteitis); synovitis was the most frequent with 46% (445 site-lesion), and triquetral synovitis the most frequent each clinical group: CSA 87% (20/23), ERA 91% (20/22), and RA 93% (14/15). CONCLUSION: Synovitis and triquetral synovitis were the most prevalent lesion in three-studied phases. This could suggest the triquetrum as the first morphological site to be affected by RA; so it's assessment should be considered in the RA evaluation when it´s clinically suspected.


Assuntos
Artrite Reumatoide/diagnóstico por imagem , Imageamento por Ressonância Magnética , Sinovite/diagnóstico por imagem , Piramidal/diagnóstico por imagem , Adulto , Artralgia/etiologia , Artrite Reumatoide/complicações , Estudos Transversais , Diagnóstico Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sinovite/etiologia
10.
Tech Hand Up Extrem Surg ; 23(4): 182-185, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31157735

RESUMO

Dependent on fracture type, concomitant carpal injuries, and operative treatment, distal radius fractures can lead to symptomatic radiocarpal osteoarthritis. In addition, radial shortening can cause ulnar impaction syndrome. Radiocarpal arthrodesis and ulnar shortening osteotomy are known and frequently applied surgical procedures for each of those pathologies. There are limited data concerning treatment options for a combined disorder. The presented technique in this article demonstrates that radioscapholunate arthrodesis with distal pole scaphoidectomy and total triquetrum excision successfully treats both symptomatic radiocarpal osteoarthritis and ulnar impaction syndrome without further surgery on the ulna.


Assuntos
Artrodese/métodos , Osso Semilunar/cirurgia , Osteoartrite/cirurgia , Rádio (Anatomia)/cirurgia , Osso Escafoide/cirurgia , Piramidal/cirurgia , Articulação do Punho/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
11.
Hand Surg Rehabil ; 38(3): 165-168, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30904496

RESUMO

Pisiformectomy is the gold standard treatment for pisotriquetral arthritis resistant to conservative treatment. We evaluated the long-term clinical and functional outcomes after pisiformectomy in resistant pisotriquetral arthritis cases. We retrospectively evaluated 11 patients (12 wrists), mean age of 59 years (49-69) treated by pisiformectomy using a standardized surgical technique. Pisiformectomy was performed for primary osteoarthritis in 10 cases, for post-traumatic osteoarthritis in 1 case and for pisotriquetral instability in 1 case. The clinical and functional evaluation was carried out by an independent examiner. Mean time to review was 90 months (63-151). Pain on a Visual Analog Scale (/10) decreased significantly to 1.1 from 6.8 preoperatively. Mean range of motion was 79° in flexion, 61.5° in extension, 18° in ulnar deviation and 36° in radial deviation. Mean grip strength of the operated wrist was 86% of the non-operated wrist. Functional scores significantly improved with a gain of 40 points for the QuickDASH and 53 points for the PRWE. Based on this long-term follow-up study, pisiformectomy seems to alleviate wrist pain and improve the quality of life in a low-demand population with pisotriquetral osteoarthritis resistant to conservative treatment. When compared to the pisotriquetral arthrodesis, pisiformectomy is easier to perform, allows quicker mobilization of the wrist and leads to good functional outcomes.


Assuntos
Articulações do Carpo/fisiopatologia , Osteoartrite/cirurgia , Pisciforme/cirurgia , Piramidal/fisiopatologia , Idoso , Seguimentos , Força da Mão/fisiologia , Humanos , Pessoa de Meia-Idade , Osteoartrite/fisiopatologia , Pisciforme/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Escala Visual Analógica
12.
Ugeskr Laeger ; 181(4)2019 Jan 21.
Artigo em Dinamarquês | MEDLINE | ID: mdl-30722834

RESUMO

This is a case report of a seven-year-old boy with fractures of the capitate and triquetral bone. An X-ray revealed fractures of the capitate and triquetral bone, and a CT scan showed non-dislocated fractures suitable for conservative treatment. The patient was treated with a shin cast for four weeks and had full recovery. Fractures of both the capitate and triquetral bone in children under the age of ten have not previously been reported. Fractures of the carpal bones should be suspected and examined in children with relevant trauma and symptoms.


Assuntos
Capitato , Ossos do Carpo , Fraturas Ósseas , Piramidal , Capitato/lesões , Criança , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/terapia , Humanos , Masculino , Radiografia , Piramidal/lesões
13.
J Hand Surg Am ; 44(5): 420.e1-420.e7, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30241977

RESUMO

PURPOSE: To determine the effects of motion-increasing modifications to radioscapholunate (RSL) arthrodesis on capitolunate contact pressure in cadaveric wrist specimens. METHODS: Ten fresh-frozen cadaveric wrists were dissected of all superficial soft tissue, potted in polymethyl-methacrylate, and the carpus exposed via a ligament-sparing capsulotomy. An RSL arthrodesis was simulated using 2 2.4-mm distal radius plates with locking screws. The distal scaphoid pole and triquetrum were removed with an osteotome and rongeur, respectively. Contact area, pressure, and force were measured in the capitolunate joint during the application of a 35-N uniaxial load using pressure-sensitive film. Measurements were obtained before and after simulated RSL fusion, following distal scaphoidectomy and after triquetrectomy. RESULTS: The combination of RSL fusion with distal scaphoid excision (DSE) increased contact forces in the capitolunate joint by 50% over controls. An RSL fusion, and RSL fusion with DSE and triquetrum excision (TE), exhibited intermediate levels of contact force between controls and RSL fusion with DSE. Capitolunate contact pressures were similar between all experimental groups. Contact area in the capitolunate joint increased by 43% after RSL fusion with DSE over intact specimen controls. Lastly, contact area in wrists with RSL fusion, and RSL fusion with DSE and TE, were elevated, but not significantly different from intact controls. CONCLUSIONS: A DSE performed at the time of RSL fusion results in increased midcarpal joint contact force and area, with resultant contact pressures unchanged. Triquetrectomy, which has been previously shown to improve range of motion, did not increase contact forces in the capitolunate joint. CLINICAL RELEVANCE: If a surgeon is contemplating performing an RSL arthrodesis with DSE, we recommend adding a triquetrectomy to improve motion because this does not add to the potentially deleterious effects of increased midcarpal contact force.


Assuntos
Artrodese , Capitato/fisiologia , Articulações do Carpo/fisiologia , Osso Semilunar/fisiologia , Osso Escafoide/cirurgia , Piramidal/cirurgia , Idoso , Idoso de 80 Anos ou mais , Cadáver , Articulações do Carpo/cirurgia , Feminino , Humanos , Osso Semilunar/cirurgia , Masculino , Pressão , Rádio (Anatomia)/cirurgia , Suporte de Carga/fisiologia , Articulação do Punho/cirurgia
14.
Acta Orthop Belg ; 84(1): 68-72, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30457502

RESUMO

Long-standing scapholunate instability frequently leads to progressive deterioration of the adjacent joint cartilages in a consistent repetitive sequence of arthritis. The purpose of this study was to investigate whether the capitate-triquetrum distance is related with the occurrence of carpal collapse in cases of static scapholunate instability. In this retrospective study, 41 patients formed two groups based on the capitate-triquetrum distance; twenty-four with distance of less than 5mm and 17 with distance of 5mm or more. No significant difference was detected with respect to age, sex distribution, dominant hand involvement, initial treatment and time from injury to final x-rays. Three patients (3/24, 12.5%) of the C-T < 5mm group and 10 patients (10/17, 58.8%) of the C-T ≥ 5mm group had no sign of carpal collapse. This difference was statistically significant (p=0.017). Capitate-triquetrum distance could reliably contribute in the decision making process in difficult cases of static scapholunate instability.


Assuntos
Capitato/diagnóstico por imagem , Articulações do Carpo/diagnóstico por imagem , Instabilidade Articular/diagnóstico por imagem , Ligamentos Articulares/diagnóstico por imagem , Piramidal/diagnóstico por imagem , Adulto , Feminino , Humanos , Masculino , Osteoartrite/diagnóstico por imagem , Estudos Retrospectivos , Adulto Jovem
15.
J Hand Surg Am ; 43(7): 683.e1-683.e5, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29510891

RESUMO

A 40-year-old woman presented with Madelung deformity and severe arthritic changes at both the radiocarpal and the distal radioulnar joints. She was treated by using her lunate as an osteochondral graft into the radius allowing reconstruction of the lunate fossa. The scaphoid and triquetrum were removed concomitantly and a Sauve-Kapandji procedure was performed. Complete bone healing was achieved. Ten years later, an excellent functional result was maintained, with a pain-free wrist, an acceptable wrist joint range of motion, as well as a favorable aesthetic appearance. This procedure may be indicated for patients with severe Madelung deformity with painful radiocarpal and distal radioulnar joints associated with severe arthritis changes.


Assuntos
Osso Semilunar/transplante , Rádio (Anatomia)/anormalidades , Rádio (Anatomia)/cirurgia , Adulto , Artrite/cirurgia , Feminino , Humanos , Osteocondrodisplasias/cirurgia , Amplitude de Movimento Articular , Osso Escafoide/cirurgia , Piramidal/cirurgia , Ulna/anormalidades , Articulação do Punho/cirurgia
16.
J Hand Surg Asian Pac Vol ; 23(1): 121-124, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29409413

RESUMO

Asymptomatic pisotriquetral arthroses caused ruptures of the flexor digitorum profundus tendon of the little finger in 2 elderly patients. Ruptures occurred with unnoticeable onset, and bilateral ruptures separately occurred with interval of several years in one patient. The tendon was ruptured in zone IV with perforation of the gliding floor through which the degenerative pisiform was visible. The gliding floor was repaired followed with excision of the pisiform, and the ruptured tendon was then transferred to the profundus tendon of the ring finger. Asymptomatic pisotriquetral arthrosis in old age can be an aspect of the pathological background of flexor tendon ruptures of the little finger that occur unnoticed.


Assuntos
Traumatismos dos Dedos/etiologia , Osteoartrite/complicações , Pisciforme , Traumatismos dos Tendões/etiologia , Piramidal , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Feminino , Traumatismos dos Dedos/cirurgia , Humanos , Osteoartrite/cirurgia , Pisciforme/cirurgia , Ruptura/etiologia , Ruptura/cirurgia , Traumatismos dos Tendões/cirurgia
18.
J Hand Surg Eur Vol ; 43(2): 168-173, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28820008

RESUMO

The purpose of this study was to assess the long-term outcomes of radioscapholunate fusion, with and without distal pole of scaphoid excision and excision of the triquetrum. These compromised three operative groups. Seventeen patients were identified with a minimum of 10 years follow-up, with a mean of 15 years (range 10-19). Fifteen of the 17 patients were satisfied with their outcome. Two were converted to total wrist fusion. The mean outcomes scores were; pain visual analogue scale score 2.1/10, Quick Disabilities of the Arm, Shoulder, and Hand 29 and Modified Mayo Wrist score 60. Patients with excision of the triquetrum had a mean radial-ulnar arc increase of 10° compared with the other two groups, but this was not statistically significant. The mean space for the scaphocapitate joint was 1.7 mm and lunocapitate joint was 1.3 mm at latest follow-up. Close adherence to the indications and surgical technique provided a sustainable good clinical outcome. Patients who obtained a good result at 2 years were likely to achieve a good long-term outcome. LEVEL OF EVIDENCE: IV.


Assuntos
Artrite/cirurgia , Artrodese , Articulação da Mão , Osso Escafoide/cirurgia , Piramidal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite/diagnóstico por imagem , Artrite/fisiopatologia , Feminino , Seguimentos , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Amplitude de Movimento Articular , Fatores de Tempo , Resultado do Tratamento
19.
J Hand Surg Am ; 43(4): 331-338.e2, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29146508

RESUMO

PURPOSE: To create a biomechanical model of palmar midcarpal instability by selective ligament sectioning and to analyze treatment by simulated partial wrist arthrodesis. METHODS: Nine fresh-frozen cadaver arms were moved through 3 servohydraulic actuated motions and 2 passive wrist mobilizations. The dorsal radiocarpal, triquetrohamate, scaphocapitate, and scaphotrapeziotrapezoid ligaments were sectioned to replicate palmar midcarpal instability. Kinematic data for the scaphoid, lunate, and triquetrum were recorded before and after ligament sectioning and again after simulated triquetrohamate arthrodesis (TqHA) and radiolunate arthrodesis (RLA). RESULTS: Following ligament sectioning, the model we created for palmar midcarpal instability was characterized by significant increases in (1) lunate angular velocity, (2) lunate flexion-extension, and (3) dorsal/volar motion of the capitate during dorsal/volar mobilizations. Simulated TqHA caused significantly more scaphoid flexion and less extension during the wrist radioulnar deviation motion. It also increased the amount of lunate and triquetral extension during wrist flexion-extension. Simulated RLA significantly reduced scaphoid flexion during both wrist radioulnar deviation and flexion-extension. CONCLUSIONS: Both simulated arthrodeses eliminate wrist clunking and may be of value in treating palmar midcarpal instability. However, simulated RLA reduces proximal row motion whereas simulated TqHA alters how the proximal row moves. Long-term clinical studies are needed to determine if these changes are detrimental. CLINICAL RELEVANCE: Palmar midcarpal instability is poorly understood, with most treatments based on pathomechanical assumptions. This study provides information that clinicians can use to design better treatment strategies for this unsolved condition.


Assuntos
Artrodese , Fenômenos Biomecânicos/fisiologia , Articulações do Carpo/cirurgia , Instabilidade Articular/cirurgia , Articulação do Punho/cirurgia , Idoso , Idoso de 80 Anos ou mais , Cadáver , Articulações do Carpo/fisiopatologia , Feminino , Hamato/fisiopatologia , Hamato/cirurgia , Humanos , Instabilidade Articular/fisiopatologia , Ligamentos Articulares/lesões , Masculino , Pessoa de Meia-Idade , Piramidal/fisiopatologia , Piramidal/cirurgia , Articulação do Punho/fisiopatologia
20.
J Hand Surg Eur Vol ; 43(4): 380-386, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29228850

RESUMO

The purpose of this study was to investigate the differences in three-dimensional carpal kinematics between type 1 and 2 lunates. We studied 15 instances of wrist flexion to extension (nine type 1, six type 2), 13 of radial to ulnar deviation (seven type 1, six type 2), and 12 of dart-throwing motion (six each of type 1 and 2) in 25 normal participants based on imaging with computerized tomography. Mean proximal translation of the distal articular midpoint of the triquetrum relative to type 2 lunates during wrist radioulnar deviation was 2.9 mm (standard deviation (SD) 0.7), which was significantly greater than for type 1 lunates, 1.6 mm (SD 0.6). The hamate contacted the lunate in ulnar deviation and ulnar flexion of wrists with type 2 lunates but not with type 1. We conclude that the four-corner kinematics of the wrist joint are different between type 1 and 2 lunates.


Assuntos
Capitato/fisiologia , Hamato/fisiologia , Osso Semilunar/fisiologia , Piramidal/fisiologia , Adulto , Fenômenos Biomecânicos , Capitato/diagnóstico por imagem , Feminino , Hamato/diagnóstico por imagem , Humanos , Osso Semilunar/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Tomografia Computadorizada por Raios X , Piramidal/diagnóstico por imagem
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