Purpose:
Aims. We conducted a study to determine whether radiological parameters
correlate with patient reported functional outcome, health-related
quality of life and physical measures of function in patients with
a fracture of the distal radius. Patients and Methods. The post-operative palmar tilt and ulnar variance at six weeks
and 12 months were correlated with the Patient Rated Wrist Evaluation,
Disabilities of the Arm, Shoulder and Hand, and EuroQol scores,
grip
Our aim was to correlate the health status with objective and radiological outcomes in patients treated by open reduction and internal fixation for fractures of both bones of the forearm. We assessed 23 patients (24 fractures) subjectively, objectively and radiologically at a mean of 34 months (11 to 72). Subjective assessment used the disability of the arm, shoulder and hand (DASH) and musculoskeletal functional attachment (MFA) questionnaires. The range of movement of the forearm and wrist, grip and
Thumb Carpometacarpal (CMC) arthritis is a common pathology of the hand. Surgical treatment with thumb reconstruction is well described. Retrospective outcomes have been described for multiple techniques, suggesting patient satisfaction with multiple different techniques. The Thompson technique uses a slip of Abductor Pollicis Longus for suspension and interposition as well as excision of the trapezium. Retrospective outcomes suggest good patient satisfaction. We describe the improvement in Patient rated outcomes scores (PROS) and changes in pinch and grip strength in a prospectively collected cohort of patients treated with a modification of the Thompson technique. To assess changes in Patient-Rated Wrist Evaluation (PRWE) and Disabilities of the Arm, Shoulder, and Hand (QDASH) scores, as well as to determine the percentage of patients that surpassed the Minimal Clinically Important Difference (MCID) figure that has been described in the literature for these tests. In addition, measurements for evaluation of pinch and grip strength prior to surgery, at six, and at twelve months follow-up were done. Between June 2016 and February 2019, a consecutive prospective series of Thirty-seven LRTI procedures with APL suspension arthroplasty (Thompson technique) were performed on 34 patients with osteoarthritis of the thumb CMC joint (24 women / 13 men; age 63±8.553). All surgeries were performed by the senior surgeon. Data was collected as part of a wrist pain database. Patients failing conservative treatment and electing surgical management of thumb arthritis were enrolled into the database. Patients were evaluated pre-operatively with the PRWE and QDASH questionnaires and grip and
Longstanding un-united scaphoid fractures or scapholunate insufficiency can progress to degenerative wrist osteoarthritis (termed scaphoid non-union advanced collapse (SNAC) or scapho-lunate advanced collapse (SLAC) respectively). Scaphoid excision and partial wrist fusion is a well-established procedure for the surgical treatment of this condition. In this study we present a novel technique and mid-term results, where fusion is reserved for the luno-capitate and triquetro-hamate joints, commonly referred to as bicolumnar fusion. The purpose of this study was to report functional and radiological outcomes in a series of patients who underwent this surgical technique. This was a prospective study of 23 consecutive patients (25 wrists) who underwent a bicolumnar carpal fusion from January 2014 to January 2017 due to a stage 2 or 3 SNAC/SLAC wrist, with a minimum follow-up of one year. In all cases two retrograde cannulated headless compression screws were used for inter-carpal fixation. The clinical assessment consisted of range of motion, grip and
Aims. Plate and screw fixation has been the standard treatment for painful conditions of the wrist in non-rheumatoid patients in recent decades. We investigated the complications, re-operations, and final outcome in a consecutive series of patients who underwent wrist arthrodesis for non-inflammatory arthritis. Patients and Methods. A total of 76 patients, including 53 men and 23 women, with a mean age of 50 years (21 to 79) underwent wrist arthrodesis. Complications and re-operations were recorded. At a mean follow-up of 11 years (2 to 18), 63 patients completed questionnaires, and 57 attended for clinical and radiological assessment. Results. Of the 76 patients, 46 (60.5%) had complications, resulting in 65 re-operations, mainly related to the plate and screws. In the 63 patients who completed the questionnaires, the mean Quick Disabilities of Arm, Shoulder and Hand (QuickDASH) score was 36 (0 to 91), the mean Patient-Rated Wrist and Hand Evaluation (PRWHE) score was 40 (0 to 96), and 14 patients (22%) reported no wrist pain. Grip
Introduction. Despite the rising popularity of 1st carpometacarpal joint (CMCJ) arthrodesis as one of the surgical options for basilar thumb arthritis, the available literature on this is poor. This study aims to investigate post-operative pinch and grip strength following 1st CMCJ arthrodesis, at a minimum of 1 year follow-up. Complication rates, range of motion and patient reported scores were also evaluated. Methods. A retrospective cohort (2012–2020) was used, which included patients who had arthrodesis performed by the Hands surgeons at Counties Manukau DHB. In a 15 minute visit, we took the measurements using our standard dynamometer and pinch gauge, and collected three questionnaires [QuickDASH, PRWHE, PEM]. For analysis, we compared our results to the preoperative measures, contralateral hand, and to a previous study on a similar cohort looking at thumb strength following trapeziectomy. Results. 42 arthrodesis were performed, and 24 were available for follow-up. The average follow-up time was 77 months and the average age was 51 years old. Overall, we found a statistically significant improvement in thumb strength following surgery. Mean preoperative grip strength was 21.4kg and 32.5kg postoperatively (= +11kg). Preoperative
Background. Traditional teaching recommends against arthroplasty in the index finger, due to concerns over failure with pinch stress, and prefers arthrodesis is for its stability. We aim to allay these fears and present the results of our series of index finger silastic PIPJ arthroplasties. Methods: Between 2007 & 2018 48 silastic index finger PIPJ arthroplasties were undertaken in 37 patients at our Hand Unit. All were performed under local anaesthetic ring block. Eleven patients underwent PIPJ arthroplasty in both Index fingers. Thirty-five women and two men made up the cohort with a mean age of 69 years. A retrospective analysis of all patients has been undertaken to determine the clinical results including patient satisfaction, grip and
Aims. We performed a systematic review of the current literature regarding
the outcomes of unconstrained metacarpophalangeal joint (MCPJ) arthroplasty. Materials and Methods. We initially identified 1305 studies, and 406 were found to be
duplicates. After exclusion criteria were applied, seven studies
were included. Outcomes extracted included pre- and post-operative
pain visual analogue scores, range of movement (ROM), strength of
pinch and grip, satisfaction and patient reported outcome measures
(PROMs). Clinical and radiological complications were recorded.
The results are presented in three groups based on the design of
the arthroplasty and the aetiology (pyrocarbon-osteoarthritis (pyro-OA),
pyrocarbon-inflammatory arthritis (pyro-IA), metal-on-polyethylene
(MoP)). Results. Results show that pyrocarbon implants provide an 85% reduction
in pain, 144% increase of pinch grip and 13° improvements in ROM
for both OA and IA combined. Patients receiving MoP arthroplasties
had a reduction in
We report a new surgical technique of open carpal
tunnel release with subneural reconstruction of the transverse carpal
ligament and compare this with isolated open and endoscopic carpal
tunnel release. Between December 2007 and October 2011, 213 patients with carpal
tunnel syndrome (70 male, 143 female; mean age 45.6 years; 29 to
67) were recruited from three different centres and were randomly
allocated to three groups: group A, open carpal tunnel release with
subneural reconstruction of the transverse carpal ligament (n =
68); group B, isolated open carpal tunnel release (n = 92); and
group C, endoscopic carpal tunnel release (n = 53). At a mean final follow-up of 24 months (22 to 26), we found no
significant difference between the groups in terms of severity of
symptoms or lateral grip strength. Compared with groups B and C,
group A had significantly better functional status, cylindrical
grip
We report a long-term follow-up of abduction-extension osteotomy of the first metacarpal, performed for painful trapeziometacarpal osteoarthritis. Of a consecutive series of 50 operations, 41 thumbs (82%) were reviewed at a mean follow-up of 6.8 years. Good or excellent pain relief was achieved in 80%, and 93% considered that surgery had improved hand function, while 82% had normal grip and
A total of 179 adult patients with displaced intra-articular fractures of the distal radius was randomised to receive indirect percutaneous reduction and external fixation (n = 88) or open reduction and internal fixation (n = 91). Patients were followed up for two years. During the first year the upper limb musculoskeletal function assessment score, the SF-36 bodily pain sub-scale score, the overall Jebsen score,
Introduction: In recent years both patients and clinicians have benefitted from using volar locking plates (VLPs) to treat otherwise difficult to stabilise displaced distal radius fractures. However, it is not clear whether the newer VLP systems offer real clinical advantages over the original systems. AIM: To assess the clinical outcome of patients treated using two VLP systems. Methods: Two cohorts of patients treated with a distal radius VLP were assessed prospectively by an independent assessor at 6 months following surgery using Visual Analogue Scales (pain &
function), range of movement, grip and
We randomly allocated 60 consecutive patients with fractures of the waist of the scaphoid to percutaneous fixation with a cannulated Acutrak screw or immobilisation in a cast. The range of movement, the grip and
Many different surgical procedures have been used to alleviate the pain of first carpometacarpal joint osteoarthritis. The most common procedure involves removal of the trapezium with, or without, suspension of the base of the first metacarpal. This operation may also include a soft tissue interposition. A novel technique using the whole of FCR as a soft tissue arthroplasty after trapezectomy is described. Fifty-two trapezectomies with suspension arthroplasty using the whole of FCR were performed on 48 patients by one surgeon over a six year period. Average follow-up was 1.8 years. Grip and
Background. A randomised prospective study has already demonstrated that at 1-year follow-up, palmaris longus interposition or flexor carpi radialis (FCR) ligament reconstruction and tendon interposition do not improve the outcome of trapeziectomy for the treatment of painful osteoarthritis of the trapeziometacarpal joint. This study consisted of 183 thumbs in 162 women. Aims. 114 of the 183 thumbs have now completed their 5-year follow-up and this study reports their results. Patients and methods. The patients had been prospectively randomised for treatment by simple trapeziectomy without interposition or ligament reconstruction (T; n=45), trapeziectomy with palmaris longus interposition (T+PL; n=31) or ligament reconstruction and tendon interposition (T+LRTI; n=38) using 50% of the FCR tendon. Each patient had undergone assessments of thumb pain, stiffness and strength pre-operatively, at 3 months, at 1 year and after a minimum of 5 years post-operatively. Results. The three treatment groups were well matched for age and hand dominance. At the 5 year follow-up, 76% (T=80%; T+PL=71%; T+LRTI=76%) of the 114 patients had no pain or only mild pain after use. Thumb key
We report the outcome at a mean of 93 months (73 to 110) of 71 patients with an acute fracture of the scaphoid who were randomised to Herbert screw fixation (35) or below-elbow plaster cast immobilisation (36). These 71 patients represent the majority of a randomised series of 88 patients whose short-term outcome has previously been reported. Those patients available for later review were similar in age, gender and hand dominance. There was no statistical difference in symptoms and disability as assessed by the mean Patient Evaluation Measure (p = 0.4), or mean Patient-Rated Wrist Evaluation (p = 0.9), the mean range of movement of the wrist (p = 0.4), mean grip strength (p = 0.8), or mean
Introduction: Osteoarthritis of the thumb basal joint is a very common and disabling condition that frequently affects middle-aged women, sometimes bilaterally. The purpose of this work is to present the methodology of the preoperative and postoperative assessment carried out in 52 patients who underwent a trapeziometacarpal joint replacement procedure (Roseland prosthesis). Material and Methods: Total joint arthoplasty of the trapeziometacarpal joint was performed on 52 thumbs in 44 patients (15 dominants hands) to treat osteoarthritis (Eaton-Littler stages II and III) between 1995 and 2007. 18 patients were missed for follow-up purposes. Average age of 59,4 years. The Roseland trapeziometacarpal joint prosthesis was used in this study. We analyzed the ROM for abduction-adduction, flexo-extension of the trapeziometacarpal joint and the opposition of the thumb by the modified Kapandji test. We also measured radiographic distance of the TMC space in preoperative radiographies and compared it with the postoperative ones. Finally, strength was quantified for the lateral, tip-to-tip, and tridigital pinch in the treated hands. Pain was measured with VAS and the DASH questionnaire was completed by all the patients. The average follow-up period was of 5,3 years (range, 1,1–12,1 years). Results: At the final follow-up visit we obtained the following Results: for thumb abduction average 66°, thumb opposition to the base of the smaller finger was present in 58%, and thumb flexo-extension average 59°. The average tip-to-tip
Purpose: To evaluate retrospectively the functional and radiographic outcome of patients who had a thumb trapeziometacarpal (TM) joint arthrodesis using a T-plate, chevron bone cuts and autologous punch graft harvested from ipsilateral distal radius. Material and Methods: Between 2001 and 2006, 32 trapeziometacarpal (TM) joint fusions were performed in 24 patients using the above technique. The study group comprised of 16 females and 8 males with average age 52 years (range 42–62 years). Average follow-up was 14.8 months (range 14–60 months). Indications for surgery were: failure of conservative treatment; severe pain; and diminished thumb function hampering everyday life. All patients had radiological evidence of advanced TM joint arthritis (Eaton and Littler grade II to III). In all cases, chevron bone cuts have been used. The fixation has progressed from K-wires, through single and double lag screws, tension-band wire, to an AO mini T-plate which is the present technique. With the K-wire, or simple screw methods, the failure rates were up to 50%, leading to many revision operations. Bone graft is used; in first 15 cases this was ‘Allomatrix’ but we now use local bone from the distal radius, taken with an AO tap guide used as a trephine. Functional outcomes were assessed using Quick DASH score, and Gartland and Werley score. There was also a radiographic review. The grip and
Purpose: To evaluate retrospectively the functional and radiographic outcome of patients who had a thumb trapeziometacarpal (TM) joint arthrodesis using a T-plate, chevron bone cuts and autologous punch graft harvested from ipsilateral distal radius. Material and Methods: Between 2001 and 2006, 32 trapeziometacarpal (TM) joint fusions were performed in 24 patients using the above technique. The study group comprised of 16 females and 8 males with average age 52 years (range 42–62 years). Average follow-up was 14.8 months (range 14–60 months). Indications for surgery were: failure of conservative treatment; severe pain; and diminished thumb function hampering everyday life. All patients had radiological evidence of advanced TM joint arthritis (Eaton and Littler grade II to III). In all cases, chevron bone cuts have been used. The fixation has progressed from K-wires, through single and double lag screws, tension-band wire, to an AO mini T-plate which is the present technique. With the K-wire, or simple screw methods, the failure rates were up to 50%, leading to many revision operations. Bone graft is used; in first 15 cases this was ‘Allomatrix’ but we now use local bone from the distal radius, taken with an AO tap guide used as a trephine. Functional outcomes were assessed using Quick DASH score, and Gartland and Werley score. There was also a radiographic review. The grip and
Trapeziometacarpal arthritis is a common condition, causing symptoms in up to ten percent of women and one percent of men¹. LRTI is the most commonly used surgical technique for this condition however, long-term studies have shown persistent weakness of pinch strength² after surgery. The Ascension® PyroDisk is a pyrocarbon disk shaped implant designed to articulate against the trapezium and metacarpal, preserving the height of the articulation. The objective of this study was to determine whether treatment with a pyrocarbon implant resulted in comparable pain relief and range of motion, whilst providing superior gains in
Introduction and Aims: While successful long-term results have been shown for ligament reconstruction–tendon interposition arthroplasty for treatment of thumb basal joint osteoarthritis, the need for invasive ligament reconstruction has not been established. In this study we describe long-term results utilising the technique of tendon interposition arthroplasty with dynamic tendon transfer and capsulorrhaphy. Method: Twenty-four thumbs (21 patients) were evaluated at an average of 7.1 years (1.8–19.5 years) post-procedure. Capsulorrhaphy was performed utilising APL tendon slips where tissue was insufficient. The APB origin was advanced via tendon transfer (FCR to APB), providing a stabilising abductor moment. Subjective assessment was performed using Visual Analogue Scores (VAS), Disabilities of Arm, Shoulder, Hand (DASH) scores, and patient satisfaction scales. Objective assessment included post-operative range of motion (ROM), grip/
Aims: We evaluated a novel modification of a technique presented by Drey and Eaton (1993). The need of temporary K-wire fixation of the MP joint was questioned by randomisation. Methods: 30 consecutive patients with late instability of the thumb UCL were randomised in two groups (group1: K-wire fixation of the MP joint for 6 weeks, group 2: no internal fixation) and operated on. External immobilisation was used for 6 weeks in both groups. The follow-ups including clinical examination, X-rays and MRI study (10 patients) were at 8 weeks, 12 and 24 months. So far 26 patients have been followed up for 1 year and 15 patients for 2 years. Results: Stability of the MP joint improved from preop.(average yield) 58o (56°vs.59°= group 1 vs. group 2, n.s.) to 18° (17° vs. 19°n.s.) at one year and to 26°(20°vs. 30°n.s.) at 2 years. Compared to the uninjured hand key
The osteoinductive properties of demineralised
bone matrix have been demonstrated in animal studies. However, its therapeutic
efficacy has yet to be proven in humans. The clinical properties
of AlloMatrix, an injectable calcium-based demineralised bone matrix
allograft, were studied in a prospective randomised study of 50
patients with an isolated unstable distal radial fracture treated
by reduction and Kirschner (K-) wire fixation. A total of 24 patients
were randomised to the graft group (13 men and 11 women, mean age
42.3 years (20 to 62)) and 26 to the no graft group (8 men and 18
women, mean age 45.0 years (17 to 69)). At one, three, six and nine weeks, and six and 12 months post-operatively,
patients underwent radiological evaluation, assessments for range
of movement, grip and
Ten cases of complete rupture of the collateral ligaments of the metacarpophalangeal finger joints are reported. The nature of this injury, the pre-operative morbidity and the intra-operative pathology are analysed. In all cases surgery was performed with satisfactory results. Operation is indicated for joint stability, grip and
Ostoearthritis of the trapeziometacarpal (TMC) joint, the key joint in thumb opposition, is one of the most common diseases involving the hand, especially among middle-aged and elderly women, and can seriously impair overall hand function. Material and Methods: The purpose of this study was to analyze our experience in the treatment of trapezio-metacarpal (TMC) osteoarthritis with a cemented surface replacement arthroplasty (SR Avantis prosthesis). We did a retrospective study of 34 patients with 43 hands operated on with this technique, with a follow-up evaluation of 36 months. We analyzed the preoperative stage, the postoperative clinical results, measured the radiographic changes found at the end of the study. For outcome, Quick-DASH (Disabilies of the Arm, Shoulder and Hand Score) scores was used. A Jamar dynamometer was used to assess the grip and
Background: Median nerve motor branch compression in patients with Carpal Tunnel Syndrome is usually characterised by reduced finger grip and
Hand function was evaluated in 105 patients who had been operated on in early infancy for brachial plexus birth palsy. The mean follow-up after surgery was for 13.4 years (5.0 to 31.5). Fine sensation, stereognosis, grip and
Despite the variety of implants or techniques that exist to treat displaced distal radial fractures, the majority fail to provide sufficient stability to permit early functional recovery. However, locking plates have the advantage over other implants in that locking screws add considerably to the overall stability. The aim of this study was to assess the functional outcome of patients with displaced distal radial fractures treated with a volar distal radial locking plate (Synthes). During a two year period, details of 98 patients admitted to our unit with inherently unstable dorsally displaced distal radial fractures treated with volar locking plates were collected prospectively. For the purpose of this analysis, only those patients (55) with unilateral fracture, able to attend the study clinic at 6 months post-injury were considered. Patients were immobilised in wool and crepe for a 2 week period. The group consisted of 15 males and 40 females with an average age of 54 (28 to 83). At 6 months, patients' perceived functional recovery averaged 80%. Objective assessment was considered in relation to the uninjured side: grip
AIM: We present the results of scaphoid non-unions treated with open reduction, bone grafting and internal fixation with biodegradable implants on active heavy labour workers. MATERIAL AND METHODS: Between 2002 to 2004, 20 patients with scaphoid non-unions were treated by open reduction, bone grafting and internal fixation using self-reinforced poly-L-lactic acid screws. The mean prospective follow-up was 24 months (range, 12–38 months). The mean age was 28 years (range, 18–42 years). All patients were male and heavy-labour workers. The patients were assessed clinically (modified Mayo wrist score) and radiograhically. The grip and
Objective. The aim of this retrospective study is to assess the functional and radiological outcome of a multi-planar corrective osteotomy, distraction and locking fixed angle volar plate as the standard of treatment of distal radius mal-unions that require multi-planar correction. Methods. We conducted a retrospective study on 13 consecutive patients – 4 males, 9 females (mean age 49). All patients underwent volar approach, open wedge distraction osteotomy locking fixed angle volar plate and cancellous bone grafting Radiographic measurements and functional assessments were taken preoperatively, 3, 6 months and one year. Results. Time to surgery from the original fracture had a mean of 17.4 months (range 8–36 months). Mean follow-up was 16.4 months (range from 6 to 45 months). Osteotomy healing time was 11.3 weeks on average. All radiographic measurements improved postoperatively, ten patients had an average of 18.84 degrees of dorsal tilt which was corrected to a volar tilt of 9.17 degrees on average. Ulna variance was initially positive in all patients with an average of 2.6 mm which was corrected to less than one (0.96 mm); three patients had radial angulations of 20.6 degrees on average, which were fully corrected postoperatively. Flexion-extension arc has improved with significant difference and so has the grip and
Introduction: Osteoarthritis of the thumb is the second most common site of arthritis in humans. There are numerous operations for the condition, but perhaps the commonest is trapeziectomy, which can be supplemented with a suspension procedure generally using FCR. It was the aim of this study to determine whether there is an advantage of one procedure over the other. Materials and methods: 60 patients with either Eaton and Littler grade III or IV arthritis of the CMCJ of their thumbs were randomised into either having a traditional trapeziectomy (with no wiring), or a trapeziectomy with FCR suspension. The surgery was performed by the senior surgeon. All patients were assessed pre- and post operatively (at 3,6 and 12 months) by a physiotherapist measuring pain on visual analogue scores doing various activities, range of movement and grip and
Osteoarthritis of the first trapeziometacarpal joint (TMCJ) is a disabling disease which reduces the function of the thumb and the hand. Replacement arthroplasty offers a pain free joint as well as mobility, stability and strength. This study reviews the results of TMCJ arthroplasty using a cemented metal-on-polyethylene implant (Sr TMC, Avanta®). Between 2001–2005 seventy two (n = 72) TMCJ cemented Arthroplasties were performed by a single surgeon. Patients were followed in the clinics for up to six years (median follow up 36 months, range 24–72). Patients were reviewed clinically and radiologically by two independent assessors. For outcome, Sollerman and Quick-DASH scores were used. A Jamar dynamometer was used to assess the grip and
Systemic inflammatory conditions frequently affect both the small joints of the hand and the eye. Uveitis and scleritis is common in this group and patients are required to apply regular eye drops. Ophthalmic conditions are also common in patients with Osteoarthritis of the thumb CMCJ who have weakness and pain on pinch grip. Poor compliance with therapy due to difficulties in administering eye drops can cause permanent ocular and visual morbidity. A laboratory based biomechanical study was performed to replicate the pinch forces applied to the 20 most frequently used eye drops. The minimum force required to disperse a drop from a full bottle held in the inverted vertical position was assessed on three occasions by placing the eye drop bottles between a finger and thumb simulator attached to a load cell. Recordings of two bottle types were repeated using 2 different ergonomic ‘aids’ produced by the pharmaceutical companies. The data was compared to published data for
AIM: The scaphoid resection with four-corner fusion is an effective procedure for treatment of postraumatic and degenerative wrist osteoarthritis. Few studies that evaluated the functional and workers compensation results are available in the literature. We presented the results of 4-corner fusion on active heavy labour workers. MATERIAL AND METHODS: A prospective study to evaluate 38 patients (37 male and 1 female) who underwent 4-corner fusion, between 2002 to 2005, with an average of 24 months of follow-up (range, 12–48 months) were made. The mean age of the patients were 32 years (range, 25–48 years). All patients were heavy-labour workers. The aethiology in 77% of the patients was SNAC wrist. Dominant limb was involved in 65% of the patients. All patients were immobilised in a cast for 4 weeks after surgery. Patients were assessed clinically and radiographically. Functional analysis of grip and pinch strenght were performed. RESULTS: Consolidation was obtained in all cases at 10 weeks. Pain evaluation score was 77 at pre-op and 19 on post-op time. The range of flexion – extension movement postoperative was 57°. Average lost of
Purpose. Handgrip dynamometry has previously been used to detect pre - operative malnutrition and predict the likelihood of post - operative complications. This study explored whether a relationship exists between pre-operative pinch and power grip strength and length of hospital stay in patients undergoing hip and knee arthroplasty. We investigated whether handgrip dynamometry could be used pre - operatively to identify patients at greater risk of longer inpatient stays. Methods. 164 patients (64 male, 100 female) due to undergo lower limb arthroplasty (83 Total Knee Replacement, 81 Total Hip Replacement) were assessed in pre - admission clinic. Average measurements of pinch grip and power grip were taken from each patient using the Jamar hydraulic dynamometer (Jamar, USA). Duration of each inpatient stay was recorded. Patients with painful or disabling conditions involving the upper limb were excluded. Other clinical variables such as age and ASA grade were investigated as potential confounders of the relationship of interest and adjusted for. Results. Average duration of hospital stay was 9.4 days. Average pinch grip was 6.3kg, average power grip 25.4 kg. Both average
Distal radial fractures represent 17% of fractures in the Italian E.R. In the last years many different techniques accompanied the traditional treatment of closed reduction and cast immobilization such as closed reduction + pinning + cast, “epi-block” fixation, ORIF with dorsal and/or volar plates, screws and external fixation. These techniques are mostly followed by a period of immobilization with cast which is optional in A.O. type A fractures and is usually necessary in type B and C fractures. At the University Hospital “Policlinico Umberto I” of Rome E.R. we have started treating these fractures with a new fixation system which we projected. This system provides a non-bridging external fixation. The synthesis is guaranteed by two or more K-wires which can be intramedullary or x-crossing the cortex and/or inter-fragmentary. These K-wires are connected with two radial pins by an external bar. This radial to radial system gives stability to the fracture and allows the patient to move the wrist immediately. We remove this fixation system after 40 days. From July 2008 to August 2009 we treated 56 distal radial fractures. Clinical assessment was performed every seven days until removal of external fixation system, then at 2, 3, 6 and 12 months. Radiographic assessment was performed at 30 and 40 days, consequently at 2, 3, 6 and 12 months. Outcome was measured on the basis of range of motion, grip and
We reviewed 23 patients who had had 25 Darrach procedures for traumatic or post-traumatic disorders of the wrist at a mean follow-up of 75.5 months (36 to 121). The mean age at the time of operation was 61.1 years (34 to 82). All patients were reviewed in person. Assessment included a history, a questionnaire on patient satisfaction and a detailed physical examination. Standardised radiographs of both wrists were taken with the patient’s hands in a resting position and during maximal grip. Convergence of the distal ulnar stump towards the distal radius during maximal grip (dynamic radio-ulnar convergence) was seen in 14 wrists including five with actual contact (dynamic radio-ulnar impingement), but this produced symptoms in only two cases. The presence of dynamic radio-ulnar convergence did not correlate with grip
Introduction: The aim of the study was to assess the efficacy of the distal radius π-plate in the surgical treatment of acute, dorsally displaced, unstable distal radius fractures. Material: 37 patients with an average age of 41 yrs included in the study. Upon dorsal exposure of the fracture and provisional reduction with the aid of a distractor and K-wires, a bending template was used to verify plate length and contour. The plate was then applied and the type, number and location of screws and buttress pins to be used were determined. Eight patients had supplementary fixation. Autologus bone graft was used to fill defects in 28 patients. Results: The average follow up was 21 months. Radiographic evidence of union was documented at an average of 6 weeks postop. No loss of reduction occurred in any of the patients and no patient complained of residual deformity. The average ROM was 79% of the contralateral side, the average grip strength was 64% of the contralateral wrist and the average
Background: Osteoarthritis of the first trapeziometacarpal (TMC) joint is a disabling disease which reduces the function of the thumb and the hand. Replacement arthroplasty offers good range of joint motion and also maintains thumb length thus improving tip pinch grip. Aims: This study reviews the results of TMCJ arthroplasty using a cemented metal-on-polyethylene implant (Sr TMC, Avanta. ®. ). Methods and Results: Between 2001–2005 seventy two (n = 72) TMCJ cemented Arthroplasties were performed by a single surgeon. Patients were followed in the clinics for up to seven years (median follow up 36 months, range 24–84). Patients were reviewed clinically and radiologically by two independent assessors. For outcome, Sollerman and Quick-DASH (Disabilies of the Arm, Shoulder and Hand Score) scores were used. A Jamar dynamometer was used to assess the grip and
The aim of this prospective, randomised study is to compare outcomes within three groups of patients undergoing either open, one-portal or two-portal endoscopic carpal tunnel release. The study population consisted of 90 hands in 59 patients presenting with idiopathic carpal tunnel syndrome and symptom duration greater than 6 months, or those patients who had not gained satisfactory symptomatic relief from conservative treatments. Only patients with positive nerve conduction studies were included in the study. All patients were assessed using a standardised protocol which included a questionnaire on activities of daily living and symptoms experienced rated using a visual analogue scale. An examination followed which included; provocative tests; grip, pinch and abduction strengths; light touch; moving two-point discrimination; and vibration testing. Each patient was subsequently randomly allocated to one of the three surgical groups. All patients were assessed postoperatively, using a standa. We found no significant differences between the three surgical groups with regard to postoperative pain, level of satisfaction and objective return of grip and
Purpose: To present results of a series of patients treated with Trapeziectomy, Ligament Reconstruction and Tendon Interposition for treatment of 1st CMC joint arthritis. Methods: 59 patients (65 thumbs) from Single surgeons’ practice were prospectively followed by 2 independent observers who did not participate in the study. Patient demographics, occupation, handedness, symptoms and clinical findings were recorded. Objective assessment including pinch and grip strength was carried out by the Occupational therapists. Functional outcome assessment was done using questionnaire designed by senior author. Patients were asked to evaluate the operation using the subjective assessment component of Buck-Gramcko score. Radiographs were studied for Trapezial space and arthroplasty space. Analysis was carried out using SPSS statistical software. Results: A total of 59 patients at an average age of 62 years were followed up for an average of 25 months. Six patients had bilateral procedures. Average follow up was 3.5 years with minimum follow up being 3 years. Osteoarthritis was the commonest diagnosis accounting for 53 (91%) patients and rheumatoid arthritis in 6 (9%) of patients. 48 cases (82%) were Stage IV and 15 cases (18%) Stage V. Mean duration of symptomsbefore the surgical intervention was 36 months. 3 patients developed superficial wound infection and 4 patients developed reflex sympathetic dystrophy. The results suggested
Introduction: Osteoarthritis of thumb CMC joint is a common pathology. Several non-prosthetic surgical options exist. There is abundant literature both in favour of and against combining trapeziectomy with ligament reconstruction and/or tendon interposition (LRTI). This study provides qualitative and quantitative outcomes assessment of a single surgeon series of consecutively operated 65 patients with trapezio-metacarpal joint arthritis using Trapeziectomy with LRTI. Methods: 50 female and 15 male patients at an average age of 63 at the time of surgery were followed up for a mean of 3 years, 4 months. Radial half of flexor carpi radialis is dissected using a Carroll tendon retriever and passed through a transosseous hole in the thumb metacarpal base to exit on its dorsum. Patients were put in a full below elbow cast for a period of 4 weeks following which hand therapy was instituted. Patients were evaluated using quick DASH score and objective data like thumb opposition, radiographic scaphometacarpal mobility and gap, pinch and grasp strength. All operations were carried out by senior author. Results: Good to excellent results were obtained in 59 cases with satisfactory opposition.
Purpose: Distal radius fractures are common and rising in incidence as orthopaedists treat an increasingly aged population. Both external fixation and volar plating have demonstrated satisfactory results, however the orthopaedic literature lacks comparative data on radial column plating. The purpose of this prospective study was to compare functional and radiographic data from patients randomized to three surgical modalities – external fixation, volar plating, and radial column plating. Method: This study included 40 patients with closed, unilateral, unstable distal radius fractures distributed as follows: 20 patients treated with external fixation, 10 patients with volar plating, and 10 patients with radial column plating. When classified according to the OTA system, the fractures included types A3, B3, and C1 C3. Patients were followed post-operatively at 2, 4, 6, 12, 24, and 52 weeks. At each visit, patients completed a DASH questionnaire, grip and lateral
Dislocation of the distal radioulnar joint (DRUJ) in association with fractures of both bones of the forearm has received relatively little attention in the literature. The purpose of this study was to evaluate the integrity of DRUJ and evaluate the association between the level of fracture and instability of DRUJ following fracture both bones of forearm. This was a prospective study of 65 patients, over 3 years followed up for 12 months. All patients were treated with open reduction and internal fixation of radius and ulna. The mean age of the patients was 34.8 years (15–68 yrs). There were 51 males and 14 females. There were 18 fractures involving distal third of forearm, 42 fractures in the middle third and 5 fractures of the proximal third. 38 fractures (58.4%) had subluxation of the DRUJ and 27 had no DRUJ subluxation. All subluxations were dorsal. Post-operatively, 30 of the 38 fractures (78.9%) had persistent DRUJ subluxation. Of the 27 fractures, which had no pre-operative DRUJ subluxation, 10 fractures (37%) revealed dorsal subluxation in the post-operative radiographs. All fractures were immobilised in above elbow plaster casts for 6 weeks. All patients were followed up at 3, 6 and 12 months. Patients were assessed clinically, radiologically with standardised radiographs and functional assessment of grip and
Surgical results following proximal row carpectomy modified with proximal capitate resection and dorsal capsule interposition are presented. A consecutive cohort of thirteen patients was operated upon, and outcomes measured by radiograph, physical examination and DASH questionnaire. AROM values of 50° to 105° for the flexion/extension arc, restoration of grip strength to 72% of the contralateral extremity, and an improved functional outcome can be expected; and patients’ perceptions of functional outcome, as measured by the DASH, are significantly improved as early as six weeks. The results of PRC with interposition for stages II and III SLAC wrist were uniformly favorable. Eaton has described two modifications to the proximal row carpectomy (PRC) procedure: partial capitate resection and dorsal capsular interpositional arthroplasty. The objective is to enlarge the radiocarpal interface to form a broad mobile pseudoarthrosis that would disperse compressive forces across the wrist more effectively. We present the first consecutive cohort of patients (n=13) who have undergone this procedure,. We extend the indications for PRC in this series to include those wrists with stage III SLAC deformity; approximately 67% of wrists had capitolunate arthritis. AROM values of 50° to 105° for the flexion/extension arc, restoration of grip strength to 72% of the contralateral extremity, and an improved functional outcome can be expected from PRC with dorsal capsular interpositional arthroplasty. Patients’ perceptions of functional outcome, as measured by the DASH, are significantly improved as early as six weeks following the procedure. Mean flexion/extension arc achieved was 86° (range, 50° to 105°). Radial deviation averaged 13° (range, 10° to 20°), and ulnar deviation averaged 21° (range, 15° to 25°). Grip strength averaged 72% of the contralateral extremity. The mean decline in the revised carpal height ratio was 24%. The mean DASH score was 20.8 (range, 10 to 29). Visual analog pain improved from 9.25 to 2.67 on average, with one patient reporting no pain with heavy exertion. Patients were evaluated by active range of motion ; grip and
Objective: The purpose of this study was to compare the functional and workers compensation results of displaced intra-articular distal radius fractures treated with three diferent type of treatments. Material and Methods: A randomized prospective study to evaluate 70 patients with displaced intraarticular distal radius fractures. The mean age were 40 years (range, 22–65 years) and all patients were medium or high level workers (40% dominant-hand). Three randomized groups were treated: 19 patients with close reduction and a cast (group 1); 24 patients with close reduction, percutaneous fixation with Kw and a cast (group 2); and 27 patiens with close reduction and external fixation and Kw (group 3). Postoperative complications, pain (visual analogue scale), clinical and functional outcome based on DASH score, grip strength, X-ray evaluation, time to return to work and activity level were evaluated and compared at 3, 6 and 12 months of prospective follow-up. Results: Consolidation was obtained in all cases at 7 weeks. Results at 12 months of follow-up: Pain evaluation score: 2.3 (group 1), 2.9 (group 2) and 1.5 (group 3); mean lost of ROM was 11° (group 1), 11° (group 2) and 23.9° (group 3); mean DASH score was 7 (group 1), 29 (group 2) and 12 (group 3). Average lost of
PURPOSE: Trapezial excision with ligament reconstruction combined with tendon interposition has proven to be a highly effective technique for the treatment of OA of the CMC joint. We believe the same procedure is possible with use of modern orthobiologics. Methods: 35 patients underwent surgical treatment for CMC arthritis with a new technique using Graft Jacket (Wright Med.) instead of FCR. Graft Jacket is an acellular human collagen (dermis) allograft. It is rapidly revascularized, repopulated with host cells and has high tensile strength. Technique: The Graft Jacket was rehydrated and cut to create a 15cm strip. It was then placed around or sutured to the FCR (the anchor) and passed into the intramedullary cavity of the metacarpal as in the standard LRTI procedure. The remaining Graft Jacket is sutured together as an anchovy to fill the former trapezium gap, so that both suspension and interposition occurred. The mean age of the patients was 56 years and the median follow-up period was 1 year. All patients had marked pain and radiographic evidence of severe arthritis before surgery. Pain, grip and pinch (tip and key) strength, stability and range of motion were measured pre- and post-operatively. Pain was assessed on a VAS (Visual Analog Scale). The ability to perform ADLs (Activities of Daily Living) requiring use of the thumb and to return to work were analyzed as well. Following surgery all thumbs were immobilized in a static splint for 10 days and then were placed into a removable orthoplast splint for 4–6 weeks. Radiographic examination was performed in all patients at the 10th post-op day, and also at 2 and 6 months after surgery. Results: Significants improvements were seen with grip strength (average 25lb) and tip (average 3.5lb) and key (average 4.5lb)
Purpose: 75% of tetraplegic patients consider use of their hands the one function they would most like restored, more important than use of the lower extremities, bladder or bowel control and sexual function. 1. There is strong evidence that reconstructive surgical procedures enhance upper extremity function, and although there is a need for higher quality studies there are ethical and logistical constraints that limit studying this population. 2. The purpose of this study is to assess objective functional outcomes and satisfaction of tetraplegic patients following surgery to restore pinch and grasp and to compare the results of active tendon transfer to tenodesis procedures. Method: An independent retrospective chart review identified 26 procedures in 24 patients over a 12 year period (1994–2006) at an average follow up of 4 years. Objective measurements of pinch and grip strength using three successive measurements was compared to the nonoperative side (control). Hand function was assessed using a validated scoring system (LiNK Hand Function Test). A validated outcome questionnaire specific to this population was administered to assess patient satisfaction in improvements of ADL (mobility dressing, communication, personal care, feeding, miscellaneous ADL) Moberg key pinch reconstruction was performed in all 26 limbs (20 active transfers and 6 tenodesis) and active transfer for hook grip (grasp) was performed in 16 of the 26 limbs (ECRL to FDP). Results: None of the patients had measurable key pinch or grasp prior to reconstruction in the operated limb. Post operative
Traditionally open extensor tendon injuries in zones III to V (PIP to MP joints) have been treated with repair and immobilization in extension for 4 to 6 weeks. Early controlled motion protocols have been successfully used in zones VI and VII of the extensors. An early controlled mobilization protocol combined with strong repair for zones III to V extensor tendon lacerations was studied prospectively. From 1999 to 2003, 27 extensor tendon lacerations in 26 patients, mean age 34 years (range 14–70), were treated using dynamic extension splinting. Inclusion criteria were zone III to V, complete lacerations involving the extensor mechanism and possibly the dorsal capsule (without associated fractures or skin deficits) in patients without healing impairment. All injuries were treated in the emergency department with a core Kessler-Tajima suture and continuous epitendon suture. After an initial immobilization in a static splint ranging from 5 days (for zone V) to 3 weeks (for zone III), controlled mobilization was initiated with a dynamic splint that included only the injured finger. The patient was weaned off the dynamic splint 5 weeks after the initial trauma. The patients were treated in an outpatient basis and did not attend any formal physiotherapy program. The mean follow up was 16 months (range 10–24 months). No ruptures or boutoniere deformities were observed and no tenolysis was necessary. The mean TAM was 242deg for the fingers and 119deg for the thumbs. The mean grip and
In recent years volar locking plates (VLP) have revolutionised the treatment of more complex distal radial fractures, but doubt still exists as to whether this is an operation for all suitably qualified orthopaedic surgeons, in particular experienced trainees, or remains the domain of consultants or better still upper limb surgeons. Aims: To assess changes in a Level 1 Trauma Unit’s practice over a 5 year period and to compare the clinical outcomes of patients operated upon by experienced orthopaedic trainees and consultant surgeons. Methods: Two prospective cohort studies were undertaken using (a) the Synthes VLP (January 2003–January 2005), and (b) the Periloc (Smith &
Nephew) VLP (January 2007–February 2008). All patients were assessed at 6 months following surgery for range of movement, grip and
Numerous procedures have been described for degenerative arthritis of the carpometacarpal joint of the thumb. The sling procedure is technically demanding and involves sacrificing part of a healthy tendon. Silicon arthroplasty is associated with stem fracture and synovitis. We have successfully used external fixation for distraction and correction of adduction deformity following trapeziectomy with S-Quattro (Stockport Serpentine Spring System). Following trapeziectomy specially designed pins are inserted into the base of the 1. st. metacarpal and radial styloid and distracted with 2 serpentine springs. The fixator is removed at six weeks and removable thermoplastic splint applied for further 6 weeks. We reviewed the results of 39 trapeziectomy performed in 32 patients (3 male) with an average follow up of 53 months. ROM, power, pinch, pain score and patient satisfaction were reviewed by an independent hand therapist. Average functional score was 28. 9 post-op (maximum 30) compared to 20. 7 pre operatively. Mean thumb abduction was 48. 9 and extension 49. 2 degrees which increased from 42. 9 and 43. 8 pre-operatively. Span was 19 centimetres and opposition 9. 26 on the Kapandji scale. Average grip strength was 40 lbs,
The June 2024 Wrist & Hand Roundup360 looks at: One-year outcomes of the anatomical front and back reconstruction for scapholunate dissociation; Limited intercarpal fusion versus proximal row carpectomy in the treatment of SLAC or SNAC wrist: results after 3.5 years; Prognostic factors for clinical outcomes after arthroscopic treatment of traumatic central tears of the triangular fibrocartilage complex; The rate of nonunion in the MRI-detected occult scaphoid fracture: a multicentre cohort study; Does correction of carpal malalignment influence the union rate of scaphoid nonunion surgery?; Provision of a home-based video-assisted therapy programme in thumb carpometacarpal arthroplasty; Is replantation associated with better hand function after traumatic hand amputation than after revision amputation?; Diagnostic performance of artificial intelligence for detection of scaphoid and distal radius fractures: a systematic review.
The August 2024 Wrist & Hand Roundup360 looks at: Methotrexate shows potential in reducing pain for hand osteoarthritis with synovitis; Circumferential casting versus plaster splinting in adult distal radius fractures: the CAST study findings; Surgery shows superior long-term success for Dupuytren contracture compared to needle fasciotomy and collagenase injection; Evolving trends in surgical management of wrist arthritis: a decade-long national analysis; Mid-term outcomes of three commonly used surgical reconstructions for scapholunate instability; SLAC and SNAC: what is the evidence for treatment?; Steroids for trapeziometacarpal osteoarthritis?; When is it safe to return to driving after distal radius fracture fixation? A prospective study.
Complete ruptures of the ulnar collateral ligament (UCL) of the thumb are a common injury, yet little is known about their current management in the UK. The objective of this study was to assess the way complete UCL ruptures are managed in the UK. We carried out a multicentre, survey-based cross-sectional study in 37 UK centres over a 16-month period from June 2022 to September 2023. The survey results were analyzed descriptively.Aims
Methods
Aim: Total Wrist fusion is the main procedure for treatment of postraumatic and degenerative wrist osteoarthritis. During the last decade, midcarpal fusion has become more and more popular as it preserves motion. The purpose of this study was to compare the functional and workers compensation results of both treatments on active workers. Material and Methods: A prospective study to evaluate 77 patients (76 male and 1 female) who underwent wrist fusion, between 2002 to 2006, with an average of 28 months of follow-up (range, 12–58 months) were made. The mean age were 32 years (range, 25–48 years) and all patients were medium or high level workers with postraumatic and degenerative wrist osteoarthritis. The aethiology in 67% of the patients was SNAC wrist. Right hand was involved in 65% of the patients. Thirty-eight patients were treated with scaphoid excision and 4-corner fusion using dorsal circular plate. Thirty-nine patients were treated with total wrist fusion using one single, dorsal, precontoured and tapered plate for osteosynthesis and third carpometacarpal joint (CMCJ-3) was included. All patients were immobilised in a cast for 4 weeks after surgery. Postoperative complications, pain (visual analogue scale), clinical and functional outcome based on Green and O’Brien score, grip strength, X-ray evaluation, time to return to work and activity level were evaluated and compared. Results: Consolidation was obtained in all cases at 10 weeks. Pain evaluation score was 19,2 (4-corner) and 13,8 (total fusion) on post-op time. The mean modified Mayo wrist score was 70,4 (4-corner) and 69 (total wrist). Average lost of
The February 2024 Wrist & Hand Roundup360 looks at: Occupational therapy for thumb carpometacarpal osteoarthritis?; Age and patient-reported benefits from operative management of intra-articular distal radius fractures: a meta-regression analysis; Long-term outcomes of nonsurgical treatment of thumb carpometacarpal osteoarthritis: a cohort study; Semi-occlusive dressing versus surgery in fingertip injuries: a randomized controlled trial; Re-fracture in partial union of the scaphoid waist?; The WALANT distal radius fracture: a systematic review; Endoscopic carpal tunnel release with or without hand therapy?; Ten-year trends in the level of evidence in hand surgery.
The April 2024 Wrist & Hand Roundup360 looks at: Lunocapitate versus four-corner fusion in scapholunate or scaphoid nonunion advanced collapse: a randomized controlled trial; Postoperative scaphoid alignment, smoking, and avascular necrosis determine outcomes; Grip strength signals broader health concerns in females with distal radius fractures; Clearing the smoke: how smoking status influences recovery from open carpal tunnel release surgery; Age matters: assessing the likelihood of corrective surgery after distal radius fractures; Is pronator quadratus muscle repair required after anterior plate fixation for distal radius fractures?; Efficacy of total wrist arthroplasty: a comparative analysis of inflammatory and non-inflammatory arthritis outcomes; A comprehensive review of the one-bone forearm as a salvage technique.
The April 2023 Wrist & Hand Roundup360 looks at: MRI-based classification for acute scaphoid injuries: the OxSMART; Deep learning for detection of scaphoid fractures?; Ulnar shortening osteotomy in adolescents; Cost-utility analysis of thumb carpometacarpal resection arthroplasty; Arthritis of the wrist following scaphoid fracture nonunion; Extensor hood injuries in elite boxers; Risk factors for reoperation after flexor tendon repair; Nonoperative versus operative treatment for displaced finger metacarpal shaft fractures.
Introduction Distal radius fractures are the most common in the upper extremities and usually comminuted and unstable. The following techniques are usually used in treating these fractures: osteosynthesis with plates and screws (ORIF), Ilizarov device and the AO- external fixator, K – wires. The main aim of the report is to study the results of surgical treatment of distal radius nonunion, malunion, and pseudarthrosis in cases when different techniques of fixation were used. Material and methods. In 1998–2001 a clinical study of 48 patients (33 males and 15 females) with distal radius injury was conducted in orthopedics department. The mean age of the patients was 42 years (15–69). 28 patients had the injury of their right hand and 20 - of their left hand. 19 patients had distal radius non-union, 15 – malunion, and 14 – pseudarthrosis. The average time from injury to the surgical treatment was 5 months. The mean follow-up was 27,2 Months (12–36). The AO techniques (ORIF with titanium and stainless steel implants) were used in Group I (36 patients). Conventional techniques and fixators were used in 13 patients of Group II: home produced plates and screws, Ilizarov device, external fixator, K- wires. The indications for surgical treatment nonunion were: A3 type, B1 – B3 type, C1 – C3 type, accompanied by more than two criteria of instability. In 10 patients with extraar-ticular fractures we used osteosynthesis with dorsal or palmar T-plates (3.5 mm). Mini-«T» - and «Pi»-Plates (2,7 mm) were used in four patients who had comminuted fractures with tiny distal fragments (‘bursting’ mechanism).The Ilizarov device and K-wires were used in five patients. Radius reduction without rotational and angular deformity was considered to be an indication for shortening osteotomy of the ulna. Internal fixation with a 3.5 mm LC-DCP plate was used in six patients of Group I, and K- wires were used in two patients of Group II. The deformity of the radius required corrective osteotomy with a 3.5 mm T-plate fixation in five patients of Group I, in two patients of Group II we used home produced plates, screws, and bone autoplasty with a spongy graft from the iliac crest (14); in one patient a «Bio-oss» graft was used. In 7 patients we used Ilizarov device and K-wires. Results. Pain relief was achieved in 87% of the reexamined patients from the Group I and in 72% - from the Group II. Bone fragments united in 31 patients of Group I (86%) and in 9 patients (75%). In one case a plate broke resulting in the relapse of pseudarthrosis. Application of the AO fixators allowed early mobilization, which helped to avoid post immobility contractures. Grasping power restoration in Group I was 76% (grip strength) and 82% (pinch strength) of the uninjured side. In Group II grip strength was 55% and
To analyze the short-term outcome of two types of total wrist arthroplasty (TWA) in terms of wrist function, migration, and periprosthetic bone behaviour. A total of 40 patients suffering from non-rheumatoid wrist arthritis were enrolled in a randomized controlled trial comparing the ReMotion and Motec TWAs. Patient-rated and functional outcomes, radiological changes, blood metal ion levels, migration measured by model-based radiostereometric analysis (RSA), bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA), complications, loosening, and revision rates at two years were compared.Aims
Methods
Osteoarthritis (OA) affecting the thumb carpometacarpal joint (CMCJ) is a common painful condition. In this study, we aimed to explore clinicians’ approach to management with a particular focus on the role of specific interventions that will inform the design of future clinical trials. We interviewed a purposive sample of 24 clinicians, consisting of 12 surgeons and 12 therapists (four occupational therapists and eight physiotherapists) who managed patients with CMCJ OA. This is a qualitative study using semi-structured, online interviews. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis.Aims
Methods
We report the use of a free tendon graft in 70 patients to repair lesions of the capsuloligamentous complex of the metacarpophalangeal joint of the thumb. Of these 37 had a lesion of the ulnar collateral ligament, 18 of the radial collateral and 11 of the volar plate. Four patients had combined lesions. We outline our techniques and review 51 of the patients. Of those 47 (92%) were satisfied, and all but one had regained full stability.
Introduction. The role of in-situ decompression in patients with severe ulnar nerve compression is still controversial. The authors present a prospective study on the results of in-situ decompression in this selected group of patients treated through a mini open incision (4cms) and complete decompression by appropriate patient positioning. Material/Methods. Thirty patients (20 Male/10 Female) with severe degree of nerve compression, confirmed clinically by Dellon's classification and by abnormal Nerve Conduction Study, underwent simple in-situ decompression under general anaesthesia as a day-case procedure. Through a 4cms incision and by moving the elbow the nerve is fully visualised and decompressed. Outcome was measured prospectively at three months and one year using Modified Bishop's score, grip strengths and two point discrimination (2PD). Results/Statistics. The average age of patients were 58.3 (26–87) and dominant hand was involved in 13 patients. Patients showed improvement greater at 1year than at 3 months. There was statistically significant improvement in power (p-0.01) and
Purpose: Trapezium excision and arthroplasty combined with ligament reconstruction as a treatment for first carpometacarpal joint arthritis is known to be associated with synovitis, prosthesis subluxation /dislocation and proximal migration of the metacarpal. To determine the effectiveness of our technique we used the objective and subjective outcome scores to assess the long term results. Methods: Ten patients (11 thumbs) underwent trapezium arthroplasty and ligament reconstruction procedure for grade III/ IV Eaton and Glickel arthritis. The FCR tendon was harvested split into half from proximal to its insertion site. The insertion site was left intact, the split tendon was passed through the first metacarpal base, passed along the radial side of the implant, through scaphoid and back to the 1st metacarpal as an entrapment technique. 7 female and 3 male patients with mean age of 53.9 comprised our series. Off the 10 patients 60% had surgery on their dominant hands. Results: All the patients had excellent results at a mean follow up of 33.5 months. The mean score (Buck-Gramco) for the tip
Carpal malalignment after a distal radial fracture occurs due to loss of volar tilt. Several studies have shown that this has an adverse influence on function. We aimed to investigate the magnitude of dorsal tilt that leads to carpal malalignment, whether reduction of dorsal tilt will correct carpal malalignment, and which measure of carpal malalignment is the most useful. Radiographs of patients with a distal radial fracture were prospectively collected and reviewed. Measurements of carpal malalignment were recorded on the initial radiograph, the radiograph following reduction of the fracture, and after a further interval. Linear regression modelling was used to assess the relationship between dorsal tilt and carpal malalignment. Receiver operating characteristic (ROC) analysis was used to identify which values of dorsal tilt led to carpal malalignment.Aims
Methods
The June 2012 Wrist &
Hand Roundup360 looks at; radial osteotomy and advanced Kienböck's disease; fixing the Bennett fracture; PEEK plates and four-corner arthrodesis,;carpal tunnel release and haemodialysis; degloved digits and the reverse radial forearm flap; occupational hand injuries; trapeziometacarpal osteoarthritis; fixing the fractured metacarpal neck and pyrocarbon implants for the destroyed PIPJ.
The December 2015 Wrist &
Hand Roundup
The transfer of part of the ulnar nerve to the musculocutaneous nerve, first described by Oberlin, can restore flexion of the elbow following brachial plexus injury. In this study we evaluated the additional benefits and effectiveness of quantitative electrodiagnosis to select a donor fascicle. Eight patients who had undergone transfer of a simple fascicle of the ulnar nerve to the motor branch of the musculocutaneous nerve were evaluated. In two early patients electrodiagnosis had not been used. In the remaining six patients, however, all fascicles of the ulnar nerve were separated and electrodiagnosis was performed after stimulation with a commercially available electromyographic system. In these procedures, recording electrodes were placed in flexor carpi ulnaris and the first dorsal interosseous. A single fascicle in the flexor carpi ulnaris in which a high amplitude had been recorded was selected as a donor and transferred to the musculocutaneous nerve. In the two patients who had not undergone electrodiagnosis, the recovery of biceps proved insufficient for normal use. Conversely, in the six patients in whom quantitative electrodiagnosis was used, elbow flexion recovered to an M4 level. Quantitative intra-operative electrodiagnosis is an effective method of selecting a favourable donor fascicle during the Oberlin procedure. Moreover, fascicles showing a high-amplitude in reading flexor carpi ulnaris are donor nerves that can restore normal elbow flexion without intrinsic loss.
The October 2014 Wrist &
Hand Roundup360 looks at: pulsed electromagnetic field of no use in acute scaphoid fractures; proximal interphalangeal joint replacement: one at a time or both at once; trapeziometacarpal arthrodesis in the young patient; Tamoxifen and Dupytren’s disease; and endoscopic or open for de Quervain’s syndrome?
The June 2014 Wrist &
Hand Roundup360 looks at: aart throwing not quite as we thought; two-gear, four-bar linkage in the wrist?; assessing outcomes in distal radial fractures; gold standard Swanson’s?; multistrand repairs of unclear benefit in flexor tendon release; for goodness’ sake, leave the thumb alone in scaphoid fractures; horizons in carpal tunnel surgery; treading the Essex-Lopresti tightrope; wrist replacement in trauma? and radial shortening reliable in the long term for Kienbock’s disease
The December 2012 Wrist &
Hand Roundup360 looks at: the imaging of scaphoid fractures; splinting to help Dupuytren’s disease; quality of life after nerve transfers; early failure of Moje thumbs; electra CMCJ arthroplasty; proximal interphalangeal joint replacement; pronator quadratus repair in distal radius fractures; and osteoporosis and wrist fractures.
The October 2012 Wrist &
Hand Roundup360 looks at: osteoarticular flaps to the PIPJ; prognosis after wrist arthroscopy; adipofascial flaps and post-traumatic adhesions; the torn TFCC alone; ulna-shortening osteotomy for ulnar impaction syndrome; Dupuytren’s disease; when a wrist sprain is not a sprain; and shrinking the torn intercarpal ligament.
The purpose of this study was to assess the clinical
and radiological outcomes of dorsal intercarpal ligament capsulodesis
for the treatment of static scapholunate instability at a minimum
follow-up of four years. A total of 59 patients who underwent capsulodesis
for this condition were included in a retrospective analysis after
a mean of 8.25 years (4.3 to 12). A total of eight patients underwent
a salvage procedure at a mean of 2.33 years (0.67 to 7.6) and were
excluded. The mean range of extension/flexion was 88° (15° to 135°)
and of ulnar/radial deviation was 38° (0° to 75°) at final follow-up.
The mean Disabilities of the Arm Shoulder and Hand (DASH) score
and Mayo wrist scores were 28 (0 to 85) and 61 (0 to 90), respectively Capsulodesis did not maintain carpal reduction over time. Although
the consequent ongoing scapholunate instability resulted in early
arthritic degeneration, most patients had acceptable long-term function
of the wrist.
We systematically reviewed all the evidence published
in the English language on proximal interphalangeal joint (PIPJ)
replacement, to determine its effectiveness on the function of the
hand and the associated post-operative complications. Original studies were selected if they reported clinical outcome
with a minimum of one year’s follow-up. Quality was assessed using
the Cowley systematic review criteria modified for finger-joint
replacements. Of 319 articles identified, only five were adequately
reported according to our quality criteria; there were no randomised
controlled trials. PIPJ replacements had a substantial effect size
on hand pain of -23.2 (95% confidence interval (CI) -27.3 to -19.1)
and grip strength 1.2 (95% CI -10.7 to 13.1), and a small effect
on range of movement 0.2 (95% CI -0.4 to 0.8). A dorsal approach
was most successful. Post-operative loosening occurred in 10% (95%
CI 3 to 30) of ceramic and 12.5% (95% CI 7 to 21) of pyrocarbon
replacements. Post-operative complications occurred in 27.8% (95%
CI 20 to 37). We conclude that the effectiveness of PIPJ replacement has not
been established. Small observational case studies and short-term
follow-up, together with insufficient reporting of patient data,
functional outcomes and complications, limit the value of current
evidence. We recommend that a defined core set of patients, surgical and
outcome data for this intervention be routinely and systematically
collected within the framework of a joint registry.
The fracture most commonly treated by orthopaedic surgeons is that of the distal radius. However, as yet there is no consensus on what constitutes an ‘acceptable’ radiological position before or after treatment. This should be defined as the position that will predict good function in the majority of cases. In this paper we review the radiological indices that can be measured in fractures of the distal radius and try to identify potential predictors of functional outcome. In patients likely to have high functional demands, we recommend that the articular reconstruction be achieved with less than 2 mm of gap or step-off, the radius be restored to within 2 mm of its normal length, and that carpal alignment be restored. The ultimate aim of treatment is a pain-free, mobile wrist joint without functional limitation.
We have performed a form of lunate replacement arthroplasty, which included excision of the lunate and insertion of a vascularised radial bone flap wrapped in pronator quadratus, for stage IIIB or stage IV Kienböck’s disease, in 41 patients who have been followed up for more than three years. All patients reported an improvement in their symptoms, and 20 of the 41 became free of pain after the operation. Extension and flexion of the wrist were increased by a mean of 9° and 6°, respectively (p <
0.05). The radioscaphoid angle and the carpal height ratio were not significantly changed and only minimal deterioration was observed due to degenerative change. The size, density or location of the inserted bone did not change with time. A vascularised radial bone flap wrapped in pronator quadratus can be a reliable treatment option for advanced Kienböck’s disease, when the pedicled bone and muscle envelope acts as a stable spacer for the excised lunate.
