Using a reverse engineering capability to quantify the factors that control the rigid body mechanics of the wrist, a mathematical forward animation capability and model of wrist motion that allows the
Aim: Because of the low prevalence, there is a poor evidence on the effective management of bone and joint infections of the
Background: Osteoid Osteomas were first described by Bergstrand (1930), and were later elaborated by Jaffe (1935). They account for 12% of all benign bone tumors. Approximately 6–8% of lesions occur in the hand, and can be extremely difficult to diagnose. Aims: A retrospective review of osteoid osteomas from the Scottish Bone Tumor Registry is presented focusing on the unusual clinical features of lesions of the
Purpose: The synovectomy-reaxation-stabilisation (SRS) procedure classically involves tenosynovectomy of the extensors, articulr synovectomy, partial deinnervation of the wrist, and tendon transfer. The purpose of this study was to: 1) evaluate functional and radiographic results, 2) search for possible correlations between results and the extent of articular synovectomy or type of tendon transfer. Material and methods: Between 1984 and 1998, an SRS procedure was performed in 75 patients, 14 were excluded: seven had died, five were lost to folow-u and two had had wrist arthrodesis. A total of 73 wrists were analysed in 61 patients. Mean follow-up was 70 months and mean patient age was 53 years. Functional assessment was based on the Gschwend pain scale. Results: Before surgery, 94% of the patients had grade III or IV pain. At last follow-up, 93% of them grade 0 or I. The gain in pain was greatest for patients with severe carpitis. At last follow-up, the wrist was stiff; stiffness basically involved flexion with 43° pre and 27° postoperatively, radial inclination 13° pre and 9° postoperatively, and pronation in patients with advanced Larsen grade preoperatively. Extension, ulnar inclination, and supination were improved 5° to 10°. Extension of the synovectomy to carpal joints had a stiffening effect. Before the operation, 25 wrists were in Larsen grades 0, 1 and 2 and 48 wrists were in Larsen grades 3 or 4. At last follow-up, there were nine wrists in Larsen grades 0, 1, or 2 and 64 in Larsen grades 3 or 4. Carpitis thus continued to evolve and the height of the
Aim: The
Introduction and Aims: Kinematic and morphologic suggests the scaphoid may be moved differently between individuals. This study therefore aims to determine to what extent the morphology and ligamentous support of the scaphoid supports the suggestion of variable scaphoid motion. The influence of scaphoid motion on the remainder of the
Aim. Skeletal tuberculosis (TB) accounts for up to one third of cases of extra-pulmonary TB but comprises a minority of osteoarticular infection in areas with low TB incidence. Consequently, unexpected cases may receive surgical management targeted at non-tuberculous orthopaedic infections. This study reviewed treatment and outcomes of non-spinal osteoarticular TB to assess outcomes from modern surgical techniques. Method. All patients with a diagnosis of non-spinal osteoarticular TB between 2009–2017 from one tertiary referral centre were included. Retrospective review of surgical intervention, antibiotic treatment and outcome was conducted. Results. Fourteen patients with an average age of 48 (range 20–77) were identified; all were HIV-negative. Articular infections affected 7 patients, including one prosthetic joint infection. Osteomyelitis affecting the
Purpose of the study: Appropriate management of chronic sprains of the scapholunate joint remains a subject of debate. Different surgical techniques have been proposed, from partial arthrodesis of the
Purpose: We reviewed a series of pollicizations in children with congenital thumb malformations. The purpose of this study was to assess the influence of anatomic or technical factors on functional and cosmetic outcome. Material: The series included 33 operations in 26 children. The Blauth classification was: grade IIIA (n=1), grade IIIB (n=8), grade IV (n=8), grade V (n=13), mirror hand (n=8). We noted the type of skin incision, technique used to fix the metacarpal head on the
Purpose: Transscaphoretrolunate dislocation is the most frequent perilunate dislocation of the
Purpose: We report the long-term outcome after treatment of scaphoid nonunion using a graft harvested on the anterior aspect of the radius and vascularised with the anterior
Introduction: Image based navigation is able to increase precision and reduce intraoperative radiation time in drilling procedures in orthopeadic trauma indications. Due to specific anatomic conditions and necessary adequate fluoroscopic visualizing, specific indications need intraoperative 3-D fluoroscopy based navigation modalities. This kind of navigation has already been successfully used in several orthopaedic interventions. The complex anatomic structure of the scaphoid, the suggested minimal invasiveness and misplacement rates of the screws make 2-D based fluoroscopic navigation impossible. Missing options for a stable reference marker fixation at the scaphoid or
Occult (clinical) injuries represent 15% of all scaphoid fractures, posing significant challenges to the clinician. MRI has been suggested as the gold standard for diagnosis, but remains expensive, time-consuming, and is in high demand. Conventional management with immobilization and serial radiography typically results in multiple follow-up attendances to clinic, radiation exposure, and delays return to work. Suboptimal management can result in significant disability and, frequently, litigation. We present a service evaluation report following the introduction of a quality-improvement themed, streamlined, clinical scaphoid pathway. Patients are offered a removable wrist splint with verbal and written instructions to remove it two weeks following injury, for self-assessment. The persistence of pain is the patient’s guide to ‘opt-in’ and to self-refer for a follow-up appointment with a senior emergency physician. On confirmation of ongoing signs of clinical scaphoid injury, an urgent outpatient ‘fast’-wrist protocol MRI scan is ordered, with instructions to maintain wrist immobilization. Patients with positive scan results are referred for specialist orthopaedic assessment via a virtual fracture clinic.Aims
Methods
This observational cross-sectional study aimed to answer the following questions: 1) how has nonunion incidence developed from 2009 to 2019 in a nationwide cohort; 2) what is the age and sex distribution of nonunions for distinct anatomical nonunion localizations; and 3) how high were the costs for surgical nonunion treatment in a level 1 trauma centre in Germany? Data consisting of annual International Classification of Diseases (ICD)-10 diagnosis codes from German medical institutions from 2009 to 2019, provided by the Federal Statistical Office of Germany (Destatis), were analyzed. Nonunion incidence was calculated for anatomical localization, sex, and age groups. Incidence rate ratios (IRRs) were determined and compared with a two-sample z-test. Diagnosis-related group (DRG)-reimbursement and length of hospital stay were retrospectively retrieved for each anatomical localization, considering 210 patients.Aims
Methods
Aim:. To assess the clinical outcomes of patients that had perilunate or lunate dislocations treated with either open or closed reduction and wiring without repair of the scapholunate interosseous ligament (SLIL). Background:. Current literature states that acute perilunate dislocations should be treated with open reduction and repair of the dorsal scapholunate ligament. This is to prevent dissociative carpal instability and potential long term degenerative arthrosis. Methods:. A retrospective review of patients who sustained a perilunate or lunate dislocation, with no associated radial or carpal fracture was conducted. All were treated by reduction and percutaneous wiring without repair of the SLIL. Patients were examined and data was collected regarding patient's pain, range of motion, grip strength, instability and return to work. All patients had a Mayo wrist score. Pre and post-surgical radiographs were assessed and the scapholunate distance, scapholunate angle and the radiolunate angle were measured. The presence of a high riding scaphoid and osteoarthritis was recorded. Results:. A total of 13 patients were included in the study, with an average follow up of 32 months. 92% of patients had no pain in their wrist at final follow up. Range of movement was 78% of the normal side. 70% of patients returned to work. 92% of patients had no clinical wrist instability. Grip strength was 82% of the opposite side. Radiographic assessment showed an average scapholunate distance of 2.6 mm, a scapholunate angle of 65° and radiolunate angle of 11°. One of the 13 patients had a high riding scaphoid. 23% of patients had arthritic changes of the
The ligamentous anatomy of the
Acute osteomyelitis of the radius or ulna in children is rare and may be associated with complications including pathological fracture, growth disturbance and cosmetic problems. Purpose:. To highlight the outcome of acute pyogenic osteomyelitis of the forearm bones in children. Methods:. Eleven children were treated for osteomyelitis of the radius (6) and ulna (5) over 15 years. Staphylococcus aureus was cultured following initial incision and drainage. Two had signs of compartment syndrome. Late complications included gap defects of 2–6 cm (radius 1 and ulna 2). Larger defects with physeal involvement were seen in the distal ulna (4) proximal radius (1) and whole radius (1). The late clinical features included pseudarthrosis (9), distal radioulnar instability (3), radial head dislocation (3) and “radial clubhand” type deformity (1). Treatment:. Gap defects <2 cm were filled with autogenous grafts (3). Segmented iliac crest grafts threaded over a K wire were used in 1 patient with an 8 cm gap defect. Radio-ulnar synostosis was performed in 4 cases. The
EH of bone is a rare vascular neoplasm, subtype of hemangioendothelioma, characterized by mesenchimal cells that have an epithelioid endothelial appearance. There are different kinds of EH: the benign epithelioid hemangioma, and the malignant epithelioid angiosarcoma. This tumors can occurs in soft tissue, lung, liver and bones and often are multicentric. EH generally involve the bone of the spine and lower limb and is very rare in the upper limb and the hands. The main symptom is pain; pathological fracture may occur in aggressive lesions. Radiographically the EH is a ostelytic lesion with variable peripheral sclerosis, cortical destruction and periosteal new bone. Treatment of EH is curettage and local adjuvants in benign lesion, en bloc resection in the low-grade forms and wide or radical surgery in the high-grade forms. Radiation therapy is suggest in inoperable situations. In the present report we describe the clinical features, the oncological treatment and the reconstructive solutions of two cases of EH of the hand treated in the Orthopedic Oncological Center of Gaetano Pini Institute of Milan. Both cases had multiple locations in the
Lesions of the fibrocartilaginous triangle of the