Journal of Wrist Surgery最新文献

{"title":"Intermediate and Long-Term Outcomes of the Universal 2 Total Wrist Replacement","authors":"Adam Truss, Geraint Morris, Seif Sawalha, Mohammad Waseem","doi":"10.1055/s-0043-1772714","DOIUrl":"https://doi.org/10.1055/s-0043-1772714","url":null,"abstract":"Abstract Introduction Arthritis of the wrist can lead to severe functionally debilitating pain which, after failed conservative measures, may require treatment with total wrist replacement (TWR). Various prosthetic designs, such as the Universal 2 implant, have been developed in attempts to combat the multitude of complications faced with replacing a complex and highly mobile joint. Having previously published short-term outcome results for the Universal 2 prosthesis, we now present the long-term survival data. Materials and Methods 19 patients underwent 21 TWR using the Universal 2 prosthesis between September 2004 and March 2008. Outcome data were collected in the form of Patient-Rated Wrist Evaluation (PRWE) and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires at short- (mean 4.8 years), intermediate- (mean 11.1 years), and long-term (mean 15.6 years) intervals. Nonparametric and Kaplan–Meier survival analysis was performed. Results At long-term follow-up, 7 out of the original 21 TWRs had required a revision or fusion procedure, or 7 out of 11 when excluding those lost to follow-up or who had died. At the intermediate follow-up, only one patient had required a revision procedure. Kaplan–Meier survival analysis demonstrated a median survival of 12.9 years and a 10-year survival probability of 68.1%. There was a statistically significant improvement from preoperative PRWE at short-term (p = 0.001) and intermediate (p = 0.01) follow-ups. This was not seen at the long-term follow-up (p = 0.068). After an initial improvement in DASH score at short-term follow-up (p = 0.003), the intermediate and long-term DASH scores were not significantly different from preoperative. Conclusion The Universal 2 poses a reasonable TWR implant choice for patients with debilitating arthritis. However, despite excellent short-term follow-up outcomes, longer term follow-up shows the design does continue to be plagued by implant failure and instability.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136101787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aptis Distal Radioulnar Joint Arthroplasty: A Multicenter Evaluation of Functional Outcomes, Complications, and Patient Satisfaction","authors":"Shirley D. Stougie, Leonieke C. van Boekel, Annechien Beumer, Peter Hoogvliet, Simon D. Strackee, J. Henk Coert","doi":"10.1055/s-0043-1774317","DOIUrl":"https://doi.org/10.1055/s-0043-1774317","url":null,"abstract":"Abstract Background The Aptis distal radioulnar joint (DRUJ) implant has been commonly used to replace the DRUJ and restore wrist function in patients with a severely destroyed DRUJ. Objective Promising results have been described in the literature. However, the clinical results in a multicenter setting are sparse and variable. This study evaluates the short- to midterm clinical results of 53 patients with a (mean) follow-up of 51 months. Patients and Methods Fifty-three patients (59 implants) treated between 2011 and 2020 in three different institutions were retrospectively identified in a prospectively collected database. The main indication for Aptis DRUJ arthroplasty was a destroyed DRUJ and gross distal radioulnar instability and isolated DRUJ osteoarthritis. Functional outcome, complications, and patient satisfaction were evaluated. Patients completed the Patient-Rated Wrist Evaluation (PRWE) questionnaire and an additional questionnaire about patient satisfaction and return to hobby/work. Results Implant survival was 92%, the surgical follow-up showed many complications (64,4%), and revision surgery was needed frequently (40.7%). In 13 cases, the follow-up was longer than 5 years. Three reimplantations had to be performed and two implants were permanently explanted. In spite of this all, wrist and forearm motion as well as pain reduction was adequate and patient satisfaction was reasonable (72.2%). Conclusion The Aptis DRUJ arthroplasty is a viable option that can provide adequate wrist and forearm function after secure patient selection and surgical placement of the implant in the wrist with a good bone stock of the radius. The complication rate was found to be high, yet patient satisfaction was reasonable. In the case of secondary surgery, additional surgery seems to be needed. For primary surgery, the implant seems to be successful without complications. Different complications have been described, but further analysis is warranted to find the causes of complications and to objectify the performance of the Aptis DRUJ implant. Level of Evidence IV.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"153 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135690409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thumb Carpometacarpal Joint Denervation for Early Osteoarthritis: An Overview of the Literature and a Pilot Study on Pain Reduction and Patient Satisfaction","authors":"Merel J.-L. Berkhout, Sophie R.M. Bosch, Marco J.P.F. Ritt","doi":"10.1055/s-0043-1773777","DOIUrl":"https://doi.org/10.1055/s-0043-1773777","url":null,"abstract":"Abstract Background The treatment of patients with osteoarthritis of the first carpometacarpal joint (CMC-I) aims at pain reduction to improve hand function and quality of life. The CMC-I denervation procedure is relatively new and seems appealing, as it is minimally invasive and has few or no disadvantages. To date, however, little research has been done on the results of a CMC-I denervation. The aim of this study was to investigate whether denervation provides pain reduction in patients with early CMC-I osteoarthritis. Methods A literature search was done using PubMed. Studies were excluded if access to full text was not available, if the articles were written in other languages than Dutch or English, and if preoperative testing, follow-up testing, or reporting were incomplete. Studies were included if patients were older than 18 years, had primary CMC-I osteoarthritis with no other wrist pathology, and had received conservative treatment without sustained benefit. The Critical Appraisal Tools of the Joanna Briggs Institute were used for critical appraisal. Clinical data was gathered retrospectively from the medical records to identify patients who underwent CMC-I denervation in The Hand Clinic, Amsterdam. The data of 20 patients were analyzed. Pre- and postoperative visual analog scale (VAS) scores on pain, patient satisfaction, and complications were evaluated. Patients older than 18 years with primary CMC-I osteoarthritis stage I and II and no other wrist pathology, in whom conservative treatment failed were included in the study. Patients with CMC-I osteoarthritis stage III and IV were excluded. Results All 17 search results were screened for full text access, after which 6 case series, 4 systematic reviews, 1 cohort study, 1 comment, and 1 scoping review was included. All but one study showed pain reduction after surgery. In half of the studies, this difference was statistically significant. The average patient satisfaction in these studies was 84.1% and the complication rate was 13.4%. A total of 20 patients were included between 2019 and 2022, with a mean preoperative VAS for pain at rest of 48.2 ± 29.9. After surgery, this decreased to 35.8 ± 34.1. This difference was not statistically significant. The mean VAS for pain during use before denervation was 79 ± 18.4 and this decreased to 49.8 ± 34.2 postoperatively. This difference did appear to be statistically significant. The average patient satisfaction was 60%, and the complication rate was 10%. Conclusion This study provides a literature overview and a pilot study on pain reduction, patient satisfaction, and complications after denervation of the CMC-I joint in patients with early osteoarthritis. Our retrospective case series roughly mirrored the average results found in the literature. There was a statistically significant decrease in pain during use postoperatively. There was no statistically significant difference in pain at rest before and after surgery. The complications were mi","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135690936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment: Theca Primary Cost Drivers of Outpatient Distal Radius Fracture Fixation: A Cost-Minimalization Analysis of 15,379 Cases.","authors":"Philippe Liverneaux","doi":"10.1055/s-0043-1772688","DOIUrl":"https://doi.org/10.1055/s-0043-1772688","url":null,"abstract":"We read this article with interest and agree with Hresko et al[1] on the influence of patient characteristics and operative technique on the overall costs of internal fixation of distal radius fractures in adults, including postoperative admission within 30 days.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135690420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthroscopic Lunate Excision for Stage 3 Kienbock's Disease","authors":"L. Merlini, J. Maffeis, C. Mathoulin, B.S. Sivakumar","doi":"10.1055/s-0043-1772253","DOIUrl":"https://doi.org/10.1055/s-0043-1772253","url":null,"abstract":"Abstract Background The ideal treatment of stage 3 Kienbock's disease is uncertain, with current open procedures conferring the risk of carpal instability, ulnar translocation, and stiffness. We present our technique of arthroscopic lunate excision, and discuss our short- to medium-term results. Description of Technique Via standard wrist arthroscopic portals, the lunate is excised using a combination of shavers, burrs, and rongeurs. Care is taken to preserve the extreme dorsal and volar cortices of the lunate to prevent carpal instability. A short arm backslab is applied for 2 weeks, after which the patient commences range of motion. Patients and Methods Consecutive patients undergoing arthroscopic lunate excision at a single center in Paris, France, underwent pre- and postoperative assessment. Parameters assessed include range of motion, as well as patient-reported outcome measures (PROMs). Results A cohort of 13 patients (7 females and 6 males with a mean age of 27.2 years) underwent arthroscopic lunate excision, and were followed up for a mean of 1.96 years. Significant improvements were noted in flexion, extension, pronation, grip strength, and PROMs. Conclusions Arthroscopic lunectomy provides significant improvements in clinical and PROMs at short- to medium-term follow-up, and conserves other salvage options in case of failure. Long-term clinical follow-up and further biomechanical studies would be beneficial.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"77 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135982617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distal Radioulnar Joint Interposition Arthroplasty for Primary Distal Radioulnar Joint Arthritis","authors":"Courtney R. Carlson Strother, Sanjeev Kakar","doi":"10.1055/s-0043-1774330","DOIUrl":"https://doi.org/10.1055/s-0043-1774330","url":null,"abstract":"Abstract Background Surgical management of the painful, arthritic distal radioulnar joint (DRUJ) remains challenging, particularly in young, active patients. Description of Technique Following exposure of the DRUJ through a dorsal longitudinal incision over the DRUJ, suture anchors are evenly placed around the sigmoid notch. The sutures are threaded through the dermal allograft to secure the graft into the sigmoid notch. The volar edges of the allograft are passed from radial to ulnar underneath the distal ulna and secured to the remaining allograft dorsally, reducing the DRUJ and creating a stable interposition arthroplasty. Patients, Methods, and Results We present a case report of a young, manual laborer who had significant improvement in pain, range of motion, and grip strength 6 months following interposition arthroplasty at the DRUJ. He was able to return to work after completing his rehabilitation following surgery. Conclusions Dermal allograft interposition arthroplasty may provide reliable pain relief while maintaining pronosupination and stability of the DRUJ in the appropriately selected patient, without the need for lifting restrictions.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135981833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age Considerations in Four-Corner Arthrodesis and Proximal Row Carpectomy: A Review","authors":"J. Heifner, Thomas Karadimas, Paul M. DeVito, Osmanny Gomez, G. Kolovich","doi":"10.1055/s-0043-1777672","DOIUrl":"https://doi.org/10.1055/s-0043-1777672","url":null,"abstract":"Abstract Purpose  Although indications for four-corner arthrodesis (4CA) and proximal row carpectomy (PRC) are not completely aligned, the surgeon is often tasked with deciding between these options which vary in the surgical technique and complication profile. Patient age is often discussed as a determining factor for treatment; however, outcome data for these procedures are rarely stratified by patient age. Our objective was to perform a systematic review on the age-specific outcomes for 4CA and PRC. Methods  A PubMed database search for 4CA and PRC was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The inclusion criteria required individual case reporting of patient age, surgical intervention, and appropriate outcome measures. The data were stratified by procedure and by patients older and younger than 45 years. Results  Within the 4CA group, the relative risk for a disabilities of the arm, shoulder, and hand (DASH) score above 30 was 1.94 (95% confidence interval, 1.1–3.67) in patients over 45 years compared with patients under 45 years. Within the PRC group, grip strength as a percentage of the contralateral side was higher in the over 45 age group (mean 75%) compared to the under 45 age group (mean 61%) but did not reach the level of significance. Conclusion  Despite satisfactory results for 4CA in aggregate, the distribution of scores indicates the need for setting expectations when treating younger adult patients with 4CA. The current results demonstrate increased disability based on DASH score following 4CA in patients under 45 years compared with patients over 45 years. Although outcomes were comparable between younger and older adults following PRC, recovery of grip strength may occur less frequently in younger adults. Level of evidence  IV systematic review.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"17 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139341364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality and Reliability Analysis of YouTube as a Source of Patient Information on de Quervain's Tenosynovitis","authors":"Jason H. Kim, John F. Hoy, Samuel L. Shuman, Farhan Ahmad, Xavier C. Simcock","doi":"10.1055/s-0043-1777017","DOIUrl":"https://doi.org/10.1055/s-0043-1777017","url":null,"abstract":"Abstract Purpose  This study seeks to evaluate the quality and reliability of information regarding de Quervain's tenosynovitis on YouTube. Methods  A search on the YouTube was performed using the keywords de Quervain's tenosynovitis , and the first 50 videos were evaluated. Video characteristics including views, content type, and video upload source were recorded. Video reliability was assessed using the Journal of the American Medical Association ( JAMA ) benchmark criteria. Video quality was assessed using the Global Quality Score (GQS) and a novel de Quervain's Tenosynovitis-Specific Score (DQT-SS). Results  The total number of views for all videos evaluated was 5,508,498 (mean, 110,169.96 ± 155,667.07). Video reliability and quality metrics were low, with a mean JAMA score of 2.17 ± 0.82 out of 4, a mean GQS of 2.49 ± 1.28 out of 5, and a mean DQT-SS of 4.53 ± 2.35 out of 11. Significant between-group effects were found for the video source and DQT-SS ( p  = 0.027), as well as between content type and JAMA score ( p  = 0.027), GQS ( p  = 0.003), and DQT-SS ( p  = 0.003). Positive independent predictors of DQT-SS included video duration in seconds (β = 0.391) and disease-specific information content type (β = 0.648). Conclusion  Videos on YouTube regarding de Quervain's tenosynovitis were frequently viewed; however, the information present was of low quality and reliability. Physician-uploaded videos had the highest mean JAMA scores, GQS, and DQT-SS, but had the second-lowest mean number of views of video sources. Patients should receive proper in-office education and be directed toward reputable resources for their orthopaedic conditions.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"70 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139342005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carpal Tunnel Syndrome as a Complication of Surgical Scaphoid Reconstruction in Nonunion and Secondary Fracture Dislocation","authors":"Sophie Brackertz, O. Andronic, L. Reissner, Torsten Pastor, Andreas Schweizer, Ladislav Nagy","doi":"10.1055/s-0043-1777406","DOIUrl":"https://doi.org/10.1055/s-0043-1777406","url":null,"abstract":"Abstract The purpose of this study was to identify risk factors for postoperative carpal tunnel syndrome (CTS) in operative management for scaphoid nonunion and secondary fracture dislocation, treated surgically with takedown and bone grafting. We reviewed medical records of all our patients that underwent carpal tunnel release after scaphoid reconstruction surgery from August 2002 to December 2020. We identified a total of 7 out of 191 patients (3.7%). We investigated surgical parameters, pre- to postoperative changes, in three-dimensional measurements of the scaphoid and carpal tunnel morphometry. We found the preoperative intrascaphoid angle (ISA) and the postoperative change in ISA to correlate with an increased risk of postoperative CTS. Patients undergoing operative scaphoid reconstruction that require a high degree of geometric correction can be at risk to develop postoperative CTS, hence they should be subject to a lower threshold decision for prophylactic carpal tunnel release. Level of Evidence  Level III.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"81 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139348406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ulnar Head Fracture with Volar Dislocation of the Distal Radioulnar Joint: A Case Series and Systematic Review","authors":"David Ananth Samy, Harriet S. Julian, Eindere Zaw Pe, Daniel Brown","doi":"10.1055/s-0043-1777019","DOIUrl":"https://doi.org/10.1055/s-0043-1777019","url":null,"abstract":"Abstract Dislocations of the distal radioulnar joint associated with a fracture of the distal ulna articular surface without an associated radial fracture are extremely rare. We present a case of a fracture of the distal ulna with an associated dislocation of the distal radioulnar joint, where the articular head fragment was displaced anterior to the sigmoid notch. We also present the results of a formal systematic review of these injuries which confirmed this is the first such injury described, although there is a very similar fracture pattern described in the literature with dorsal dislocation. We describe the mechanism of injury and hypothesize about the etiology of the fracture pattern and suggest that it represents the end of a spectrum that also includes the isolated dislocations and those associated with an ulna styloid fracture.","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"45 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139348780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}