The wrist is the ”key-stone” of hand function. Painless stability is a prerequisite for the rheumatoid wrist to perform various manual tasks. Synovectomy of the extensor tendons and the wrist joint with a Darrach procedure is offered for painful wrists, which are not controlled by conservative treatment with medication and orthosis. Radiolunate arthrodesis is performed on wrists with an unstable radiocarpal joint and preserved midcarpal joint space. This study describes the long-term (more than 10 years) follow-up of these operative procedures.
The follow-up study was performed on 25 wrists in 25 rheumatoid patients (22 women and 3 men), whose average age was 52 years (range, 33 to 66 years) with an average disease duration of 12 years (range, 1 to 38 years). The average follow-up period was 12. 5 years (range, 10 to 18 years). Five wrists were Larsen-Dale-Eek’s grade II, 14 were grade III, and 6 were grade IV. Depending on the severity of bone destruction, the scaphoid in 6 wrists and the triquetrum in 3 wrists were included in the fusion site.
Preoperative pain (88%) and swelling (96%) decreased remarkably at follow-up (12%, 4%). Average grip strength increased significantly from 100mmHg to 140mmHg (p<
0. 01). The total arc of wrist extension/ flexion decreased to two-thirds of the preoperative arc with a major loss in flexion (preop. : 26/28degrees, follow-up: 23/13degrees). The range of forearm rotation increased due to a Darrach procedure. In periodical X-ray assessments of 23 wrists, carpal collapse initially improved following the operation, however, it returned to the preoperative level after 5 years. Ulnar carpal shift improved significantly after the operation (p<
0. 01), and the position remained unchanged over 10 years. In palmar carpal subluxation, no remarkable change was noted. Bone union occurred in 87% of the operated wrists and the remaining 13% had fibrous union. Widening at the lunocapitate joint (>
2mm) was noted in 4 wrists (17%) and progressive instability at the midcarpal joint occurred in one wrist with the mutilating type of disease. Narrowing (<
1mm) was noted in 5 wrists (22%) and 3 wrists were totally fused in the functional position.
Radiolunate arthrodesis provides good stability with some motion for the moderately deteriorated rheumatoid wrist more than 10 years after the operation, in spite of some radiological progression of the disease. This operation is considered to convert the natural course of the rheumatoid wrist from the unstable form to the stable form.
The wrist is the ”key-stone” of hand function. Painless stability is a prerequisite for the rheumatoid wrist to perform various manual tasks. Synovectomy of the extensor tendons and the wrist joint with a Darrach procedure is offered for painful wrists, which are not controlled by conservative treatment with medication and orthosis. Radiolunate arthrodesis is performed on wrists with an unstable radiocarpal joint and preserved midcarpal joint space. This study describes the long-term (more than 10 years) follow-up of these operative procedures.
The follow-up study was performed on 25 wrists in 25 rheumatoid patients (22 women and 3 men), whose average age was 52 years (range, 33 to 66 years) with an average disease duration of 12 years (range, 1 to 38 years). The average follow-up period was 12. 5 years (range, 10 to 18 years). Five wrists were Larsen-Dale-Eek’s grade II, 14 were grade III, and 6 were grade IV. Depending on the severity of bone destruction, the scaphoid in 6 wrists and the triquetrum in 3 wrists were included in the fusion site.
Preoperative pain (88%) and swelling (96%) decreased remarkably at follow-up (12%, 4%). Average grip strength increased significantly from 100mmHg to 140mmHg (p<
0. 01). The total arc of wrist extension/ flexion decreased to two-thirds of the preoperative arc with a major loss in flexion (preop. : 26/28degrees, follow-up: 23/13degrees). The range of forearm rotation increased due to a Darrach procedure. In periodical X-ray assessments of 23 wrists, carpal collapse initially improved following the operation, however, it returned to the preoperative level after 5 years. Ulnar carpal shift improved significantly after the operation (p<
0. 01), and the position remained unchanged over 10 years. In palmar carpal subluxation, no remarkable change was noted. Bone union occurred in 87% of the operated wrists and the remaining 13% had fibrous union. Widening at the lunocapitate joint (>
2mm) was noted in 4 wrists (17%) and progressive instability at the midcarpal joint occurred in one wrist with the mutilating type of disease. Narrowing (<
1mm) was noted in 5 wrists (22%) and 3 wrists were totally fused in the functional position.
Radiolunate arthrodesis provides good stability with some motion for the moderately deteriorated rheumatoid wrist more than 10 years after the operation, in spite of some radiological progression of the disease. This operation is considered to convert the natural course of the rheumatoid wrist from the unstable form to the stable form.
Midfoot arthrodesis is the conventional surgical intervention for midfoot arthritis.
Abstract. Background. Multiple devices can stabilise the MTP joint for arthrodesis. The ideal implant should be easy to use, provide reproducible and high quality results, and ideally enable early rehabilitation to enable faster return to function, whilst lessening soft tissue irritation. We prospectively evaluated the combination of the IO-Fix (Extremity Medical, NJ, USA) device which consists of an intra-osseous post and lag screw that offers these features with full bearing of weight after surgery. Methods. 67 feet in 65 patients were treated over 31 months. After excluding patients lost to follow-up, undergoing revision arthrodesis, or concomitant first ray procedures, there were 54 feet in 52 patients available with a minimum 12 month follow-up with clinical and radiographic outcomes. All patients were treated using a similar operative technique with immediate bearing of weight in a rigid soled shoe. Results. The mean MOXFQ score improved from 46.4 (range 18 – 64) before surgery to 30.2 (range 0 – 54) at 6 months after surgery (p=0.02), and 18.4 (range 0 – 36) (p< 0.001) at latest follow-up.
Anatomically specific fixation devices have become mainstream, yet there are anatomical regions and clinical conditions where no pre-contoured plates are available, such as for glenohumeral arthrodesis. In a case series of 4 glenohumeral arthrodesis patients, a consultant orthopaedic surgeon at GCUH implemented 3D printing technology to create reconstructions of each patient's shoulder girdle to pre-contour arthrodesis plates. Our aim was to quantify the cost-benefit & intra-operative time savings of this technique in glenohumeral arthrodesis. We hypothesized that the use of 3D printing for creating patient specific implants through pre-operative contouring of plates will lead to intra-operative time and cost savings by minimising time spent bending plates during surgery. This study analysed 4 patients who underwent shoulder arthrodesis by a single consultant orthopaedic surgeon at GCUH between 2017-2021. A CT-based life-size model of each patient's shoulder girdle was 3D printed using freely available computer software programs: 3D Slicer, Blender, Mesh Mixer & Cura. Once the patient's 3D model was created, plate benders were used to contour the plate pre-op, which was then sterilised prior to surgery.
Aim & introduction. Infected knee with bone defect resulting from failed total knee arthroplasty (TKA) or destruction of native joint can necessitate restoration of segmental defect and arthrodesis for therapy of infection and maintenance of walking ability. In segmental knee defect external fixators or KAFO are not suitable, not comfortable and poor tolerated by elderly patients. Both custom-made Femoro-Tibial Nail (FTN) combined with acrylic cement spacer and Knee
Ankle arthrodesis is the gold standard for treatment of end stage ankle arthritis. We analysed the data of 124 Ankle
Background. There is a general assumption amongst many patients – and some Surgeons- that 1. Metatarsophalangeal Joint
Osteomyelitis is an inflammatory condition accompanied by the destruction of bone and caused by an infecting microorganism. Open contaminated fractures can lead to the development of osteomyelitis of the fractured bone in 3-25% of cases, depending on fracture type, degree of soft-tissue injury, degree of microbial contamination, and whether systemic and/or local antimicrobial therapies have been administered. Untreated, infection will ultimately lead to non-union, chronic osteomyelitis, or amputation. We report a case series of 10 patients that presented with post-operative infected non-union of the distal femur with or without prior surgery. The cases were performed at Padmashree Dr. D. Y. Patil Hospital, Nerul, Navi Mumbai, India. All the patients’ consents were taken for the study which was carried out in accordance with the Helsinki Declaration. The methodology involved patients undergoing a two-stage procedure in case of no prior implant or a three-stage procedure in case of a previous implant. Firstly, debridement and implant removal were done. The second was a definitive procedure in form of knee arthrodesis with ring fixator and finally followed by limb lengthening surgery.
Introduction:
Introduction:
There have only been a few studies in the literature which reported on the outcome of ankle arthrodesis in patients with hemophilia, furthermore the number of patients is usually low and the operative technique is not uniform. The aim of this study is to evaluate the outcome of surgery in hemophilic arthropathy of the hindfoot, using internal fixation. From 1983 to 2006, 20 fusions were performed in 13 consecutive patients due to advanced hemophilic arthropathy of the hindfoot. There were 11 ankle fusions, 1 isolated subtalar fusion and 8 ankle and subtalar fusions, 3 of the latter on a second operation. The mean age at operation was 38.7 years and the mean followup was 9.4 years. Preoperativelly the mean modified Mazur score was 47.7. In the majority of cases the ankle fusion was achieved by two crossing screws, while, for the subtalar fusion either staples were used, or the tibiotalar screws were extended to the os calsis.
Background. Clinical and anatomical complications from total knee replacement (TKR) procedures are debilitating, and include weakness, damage, and the loss of native anatomy. As the annual number of primary TKR surgeries in the United States has continued to rise, to a projected 3.48 million in 2030, there has been a concomitant rise in revision surgery. Damage to or loss of native knee anatomy as a result of TKR revision can leave the patient with irreversible knee dysfunction, which is a contra-indication for most TKR systems on the market. This leaves the multi-revision patient with limited medical options. Complete fusion of the joint, known as arthrodesis, is indicated in some cases.
Introduction.
Aim. The incidence of deep infections after internal fixation of ankle and lower leg fractures is estimated 1 to 2%. Hindfoot arthrodesis by retrograde intramedullary nailing (IMN) is a potential alternative to external fixation for post-infectious ankle destruction. The aim of this study was to evaluate the clinical results, complications and effects of soft tissue management with this treatment modality. Method. This is a single-center retrospective review of routine hospital data from 21 patients (15 men, 6 women, median age 65 [range, 21 to 87] years) undergoing IMN arthrodesis of the hindfoot for post-traumatic infections between January 1st, 2012 and March 15, 2018. We observed four bimalleolar, eight trimalleolar, three pilon fractures, and six distal lower leg fractures. Six and three patients had sustained second- and third degree open fractures, respectively. Early- and late-onset surgical infections were observed in 8 and 13 cases. Four participants had diabetes mellitus, two arterial occlusive disease, and four had both. Six patients were smokers. Results. Intraoperative cultures before implanting the nail revealed staphylococcus aureus in 12, staphylococcus epidermidis in five, and enterococcus faecalis in eight cases. After a median follow-up of 21 months, infection was considered cured in 19 / 21 subjects (90%, 95% confidence interval 70 – 99%). Soft tissue comminution required coverage with a suralis flap in five patients, and with a latissimus dorsi flap in another three. Mesh graft was necessary in 8 / 21 reconstructions. Conclusions. Tibiotalocalcaneal fusion by IMN is an effective salvage procedure for post-traumatic ankle infections.
Purpose of the study:
There is an incidence of failures of total wrist arthroplasties. We review our experiences in revising total wrist implant arthroplasties to arthrodeses. The most common mode of failure of the arthroplasties in our series was metacarpal loosening with dorsal perforation of the stem. We used for the revision arthrodesis in all our cases tricortical iliac crest bone grafts and additional spongiosa transplants from this donor site region. In one case we used a vascularized iliac crest bone graft to bridge the bone defect because of a bad host quality of the recipient area. Fixation was achieved with plates and screws. Our average follow-up period was 28 month. 14 patients with 15 failed wrist implants were treated with this technique. 14 patients undergoing arthrodesis attained a solid painless fusion after a single operation. In one case a non-union with a loosening of the screws due to using a non-rigid plate was seen. In this case a revision was necessary to achieve a bone healing. All patients were pain free and achieved an increased grip strength after bony fusion.
Purpose: Total ankle arthroplasty remains a difficult procedure. Some patients require revision surgery for arthrodesis. Material and methods: We report nine patients with total ankle arthroplasties mainly implanted for post-traumatic osteoarthritis whose results deteriorated, requiring arthrodesis. One of these patients had rheumatoid arthritis. Revision surgery was performed six months to seven years after arthroplasty.