Journal of Wrist Surgery最新文献

{"title":"Scapholunate Ligament Reconstruction without Immobilization Is Safe and Leads to Better Functional Results.","authors":"Marius A Kemler,&nbsp;Josette J Bootsman,&nbsp;Johan van den Berg","doi":"10.1055/s-0042-1749164","DOIUrl":"https://doi.org/10.1055/s-0042-1749164","url":null,"abstract":"<p><p><b>Background</b> Reconstruction of the scapholunate ligament (SL) is associated with a reduction in range of motion. In this study, we compared SL reconstruction and early mobilization with SL reconstruction and Kirschner wires (K-wire) fixation for 6 weeks. <b>Methods</b> We performed a nonrandomized trial involving patients with an arthroscopically confirmed SL ligament injury. In total, 11 patients were assigned to SL reconstruction with internal brace augmentation and early mobilization and 10 were assigned to standard SL reconstruction and K-wire fixation for 6 weeks before mobilization started. We assessed the range of motion, grip strength, functional status, intensity of pain, global perceived effect, and duration until return to work. <b>Results</b> In both groups, there was one traumatic breakout of the reconstructed ligament and two patients in the control group were lost to follow-up. The 10 patients in the internal brace group had a mean increase in wrist flexion of 1.8 degrees at 1 year compared with a decrease in wrist flexion of 13.4 degrees in the seven patients of the control group. Wrist extension increased by 4.5 degrees in the internal brace group and decreased by 4.5 degrees in the control group. In addition, the internal brace group scored 6.1 (much improved) for the global perceived effect and the control group 4.7 (slightly improved), and treatment without immobilization resulted in an earlier return to work (35.1 vs. 73.6 days). <b>Conclusions</b> In SL reconstruction, internal brace augmentation and early mobilization result in improved wrist flexion and extension, higher satisfaction, and earlier return to work.</p>","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"12 1","pages":"23-27"},"PeriodicalIF":0.7,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9836776/pdf/10-1055-s-0042-1749164.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9953055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Midcarpal Joint Structure Affect Development of Arthritis in the Wrist.","authors":"Paul Tesoriero,&nbsp;Jacob Becker,&nbsp;Brandon Passano,&nbsp;Shengnan Huang,&nbsp;Catherine Petchprapa,&nbsp;Ronit Wollstein","doi":"10.1055/s-0042-1749163","DOIUrl":"https://doi.org/10.1055/s-0042-1749163","url":null,"abstract":"<p><p><b>Background</b>  Degenerative wrist arthritis develops in specific patterns because of forces acting on existing structural configurations. The most common pattern of wrist osteoarthritis is scapholunate advanced collapse (SLAC). Other patterns include isolated scaphotrapezial trapezoid (STT) joint and isolated midcarpal or radiolunate joint arthritis. One predictor of degeneration pattern is the structure of the wrist. <b>Questions/Purposes</b>  Our purpose was to evaluate the relationship between midcarpal joint structure and the pattern of degenerative arthritis. We hypothesized that a wrist type 2 will preferentially develop SLAC degeneration. <b>Patients and Methods</b>  We retrospectively evaluated 195 degenerative wrist radiographs. Radiographs were reviewed for lunate/wrist type, degeneration pattern, ulnar variance, radial and volar tilt, inclination, carpal height, scapholunate angle, gap, and presence of thumb carpometacarpal (CMC) joint, STT joint, and midcarpal joint arthritis. <b>Results</b>  We had 158 radiographs with SLAC degeneration and 37 with atypical patterns, 154 type 2 and 41 type 1 wrists. There was a significant correlation between wrist type and the pattern of wrist degeneration ( <i>p</i>  = 0.02). SLAC degeneration developed in wrists with type 2 lunate while isolated midcarpal arthritis was associated with type 1 wrist. Isolated midcarpal joint arthritis was associated with STT arthritis, <i>p</i>  < 0.01. Radial height, inclination, volar tilt, and ulnar variance, and scapholunate gap and angle were not associated with wrist type. Ulnar variance was associated with thumb CMC and STT joint arthritis while radial height was associated with isolated midcarpal joint arthritis. <b>Conclusion</b>  This study found significant relationships between midcarpal joint structure and pattern of degeneration. This contributes to understanding the development of degeneration and can aid in future prevention of arthritis. <b>Level of Evidence</b>  This is a Level IV, diagnostic study.</p>","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"12 1","pages":"28-31"},"PeriodicalIF":0.7,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9836766/pdf/10-1055-s-0042-1749163.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9953051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical and Patient-Centered Outcomes of Open versus Arthroscopic Ganglion Cyst Excision: A Systematic Review.","authors":"DesRaj M Clark,&nbsp;Sarah Y Nelson,&nbsp;Matthew O'Hara,&nbsp;Robert M Putko,&nbsp;Michael D Bedrin,&nbsp;Christopher M Daniels","doi":"10.1055/s-0042-1749678","DOIUrl":"https://doi.org/10.1055/s-0042-1749678","url":null,"abstract":"<p><p><b>Introduction</b>  As the popularity of wrist arthroscopy grows, it continues to prove useful in the treatment of ganglion cysts. Previous studies comparing an arthroscopic technique to traditional open excision have demonstrated generally equivalent results regarding complications and cyst recurrence. However, this systematic review compares the two treatment methods not only regarding cyst recurrence but also regarding patient-centered outcomes. Additionally, new studies in the available literature may allow for further analysis. <b>Methods</b>  This systematic review identified 23 articles published between 2000 and 2021 that met inclusion criteria. Articles were assessed for quality, and reported cyst recurrence rates, patient satisfaction, patients' preoperative and postoperative pain, and complications associated with either open or arthroscopic excisions were pooled into open excision and arthroscopic excision groups for analysis. <b>Results</b>  In total, 23 studies accounted for 1,670 cases. Pooled data for patient-centered outcomes indicated a significantly higher patient satisfaction rate (89.2 vs 85.6%, <i>p</i>  < 0.001) and higher reported pain relief (69.5 vs. 66.7%, <i>p</i>  = 0.011) associated with arthroscopic excision versus open excision. Recurrence rates were also significantly lower for the arthroscopic excision group (9.4 vs. 11.2%, <i>p</i>  < 0.001). Overall, the complication rate was significantly lower for arthroscopic excision (7.5 vs. 10.7%, <i>p</i>  < 0.001), but the complication profile distinctly differed between the two methods. <b>Conclusions</b>  Both arthroscopic and open excision of dorsal wrist ganglions are viable treatment options. However, the results of this meta-analysis suggest benefits associated with the arthroscopic technique in both patient-centered outcomes and in traditional, surgical outcomes. This may prove advantageous as wrist arthroscopy becomes more common.</p>","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"12 1","pages":"32-39"},"PeriodicalIF":0.7,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9836780/pdf/10-1055-s-0042-1749678.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9614970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Flexor Carpi Radialis Portal for Arthroscopy-Assisted Reduction of the Dorsal Ulnar Fragment in Distal Radius Fractures.","authors":"Ricardo Kaempf de Oliveira,&nbsp;João Pedro Farina Brunelli,&nbsp;Marcio Aurelio Aita,&nbsp;Pedro Jose Delgado Serrano","doi":"10.1055/s-0041-1730344","DOIUrl":"https://doi.org/10.1055/s-0041-1730344","url":null,"abstract":"<p><p><b>Background</b>  The importance of the dorsal ulnar fragment (DUF) for stability and articular congruence of the radius is widely recognized, and standard surgical techniques often fail to ensure its reduction. <b>Description of Technique</b>  We describe a modification of volar wrist portals for arthroscopic management of the DUF of the distal radius. It is made in an outside-in fashion in line with the flexor carpi radialis (FCR) approach for the distal radius. Through this volar portal, we achieve wide and direct visualization of the DUF, with the advantage of protecting important anatomic structures such as the FCR tendon, the radial artery, and the median nerve; all protected with the previously made volar approach for the distal radius. In addition, easy manipulation and reduction of the DUF is obtained with instrumentation through standard dorsal portals. <b>Patients and Methods</b>  We performed this procedure in 23 patients with distal radius fractures (DRF) with displaced DUF. <b>Results</b> Early and late postoperative evaluation demonstrated intraoperative reduction maintenance and adequate range of motion, compatible with the usual findings of standard volar plating, with the benefit of anatomic reduction of the DUF. <b>Conclusion</b>  With our technique, volar plating associated with arthroscopy-assisted dorsal fragment specific fixation with dorsal standard and the FCR portals permits optimal surgical treatment of most DRFs.</p>","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"12 1","pages":"63-66"},"PeriodicalIF":0.7,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9836772/pdf/10-1055-s-0041-1730344.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9100340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified Graner's Technique withwithout Vascularized Capitate Lengthening for Kienböck Disease Stage IIIb-A Pilot Study.","authors":"Ahmed Naeem Atiyya,&nbsp;Abdelrahman Eldiasty,&nbsp;Islam Koriem,&nbsp;Amr Nabil","doi":"10.1055/s-0041-1731328","DOIUrl":"https://doi.org/10.1055/s-0041-1731328","url":null,"abstract":"<p><p><b>Background</b>  Intercarpal fusions are used to treat stage IIIb Kienböck disease. They increase force transfer across the radioscaphoid articulation with predisposition to arthritis. <b>Description of Technique</b>  This technique is excision of lunate followed by proximal transfer of capitate, with scaphocapitate and triquetrocapitate fusion to increase area of load transfer mimicking wrist hemiarthroplasty. Our purpose is to evaluate mid-term results of this technique. <b>Patients and Methods</b>  A prospective case series study was conducted on 11 patients with stage IIIb and IIIc. In seven cases, transfer of the capitate was performed by osteotomizing the capitate just distal to its waist, proximal migration to replace the excised lunate then bone grafting. In four cases, proximal transfer of vascularized pedicled capitate was done. Clinical outcome measures included pain (visual analog scale), grip strength, range of motion, and functional evaluation by modified Mayo wrist score and scoring system of Evans. Radiological outcome measures included healing of fusion mass, progression of the disease, and occurrence of avascular necrosis to the capitate. <b>Results</b>  Follow-up period averaged 54 months. Scaphocapitate fusion healing averaged 11 weeks. Union of the lengthened capitate occurred in 10 patients only. There was postoperative improvement in pain scores, grip, Evans, and modified Mayo wrist score. There was postoperative decrease in wrist flexion and extension. One patient showed resorption of the capitate head with progressive radioscaphoid arthritis-necessitated wrist fusion. <b>Conclusion</b>  The mid-term results of this technique may be satisfactory due to low incidence of degenerative arthritis in the radioscaphoid joint. However, longer follow-up with recruiting larger number of patients is needed.</p>","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"12 1","pages":"67-72"},"PeriodicalIF":0.7,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9836775/pdf/10-1055-s-0041-1731328.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9100339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Biomechanical Comparison of Fixation Techniques in Metacarpal Shaft Fractures.","authors":"Kevin M Albanese,&nbsp;Michael J Schreck,&nbsp;Frederick W Werner,&nbsp;Garrett W Esper,&nbsp;Nathaniel R Ordway","doi":"10.1055/s-0042-1751077","DOIUrl":"https://doi.org/10.1055/s-0042-1751077","url":null,"abstract":"<p><p><b>Background</b>  Typically, metacarpal shaft fractures are treated with closed reduction percutaneous pinning, intramedullary nails, or plate fixation. Recently some surgeons have begun using intramedullary headless compression screws. <b>Questions/Purposes</b>  The purpose of this study was to compare intramedullary screw fixation to K-wire fixation, which is the standard of care in a transverse metacarpal midshaft fracture, using a cadaveric model. Our hypothesis was that intramedullary screw fixation would have a biomechanical advantage (higher stiffness and peak load to failure) when compared with dual Kirschner wire fixation of transverse metacarpal shaft fractures. <b>Methods</b>  Four-point bend testing was performed to compare stiffness and failure load values of seven paired 2nd and 3rd metacarpals instrumented with headless intramedullary compression screw fixation or Kirschner wire fixation. Similar testing was performed on 14 unpaired 4th metacarpals. <b>Results</b>  There was no significant difference in peak load ( <i>p</i>  = 0.60) or stiffness ( <i>p</i>  = 0.85) between fixation groups for the 2nd and 3rd instrumented metacarpals. For the instrumented 4th metacarpals, there was no significant difference in peak load ( <i>p</i>  = 0.14), but the stiffness was significantly greater ( <i>p</i>  = 0.01) for the compression screw group compared with the Kirschner wire fixation. <b>Conclusions/Clinical Relevance</b>  In this study, the load to failure was not different between the two fixation methods and likely both techniques can sustain physiologic loads needed for rehabilitation. The greater stiffness in the 4th metacarpal compression screw group may be related to the smaller canal morphology than in the 2nd and 3rd metacarpals. Larger diameter screws may be needed to obtain a better fit particularly in the 2nd and 3rd metacarpals.</p>","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"12 1","pages":"46-51"},"PeriodicalIF":0.7,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9836774/pdf/10-1055-s-0042-1751077.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9777107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynadesis for Treatment of Dynamic Scaphoid Instability with 20-Year Results.","authors":"Houshang Seradge,&nbsp;Winfred Parker,&nbsp;Carrie Seradge,&nbsp;Cyrus Steppe,&nbsp;Ashley McKenzie","doi":"10.1055/s-0041-1735304","DOIUrl":"https://doi.org/10.1055/s-0041-1735304","url":null,"abstract":"<p><p><b>Background</b>  Even though the scapholunate interosseous ligament is the most common wrist ligament injury, its treatment remains a challenge for hand surgeons. We report on a surgical treatment (Dynadesis) for dynamic scaphoid instability (DSI) with a 20-year follow-up period. <b>Description of Technique</b>  Dynadesis utilizes antagonist forearm muscles in order to synergistically provide dynamic stabilization to the scaphoid when the wrist is loaded. It is a tendon-to-tendon transfer with the following two components: 1) Dorsal-The extensor carpi radialis longus (ECRL) is passed through a hole in the reduced, distal scaphoid, providing the scaphoid with an independent extension force. 2) Volar-A dynamic checkrein is created by tension-locking the ECRL tendon around the flexor carpi radialis (FCR) tendon. The portion of the FCR distal to the scaphoid tethers and tightens with contracture of the ECRL and FCR muscles. <b>Patients and Methods</b>  Twenty patients (21 wrists) were treated with Dynadesis and reevaluated 20 years later (range: 20-27 years). <b>Results</b>  Average grip strength improved by 8 kg. The average wrist flexion-extension arc decreased by 3 <b>°</b> . Wrist X-rays showed no radiocarpal arthritis. On the Mayo wrist score, 81% reported excellent to good results (average: 89). Pain levels improved by 90%, with 76% of patients reporting no pain. All patients (100%) were satisfied with their results and would recommend the procedure. <b>Conclusions</b>  Dynadesis is specifically designed for the treatment of DSI. It avoids the eventual complication of osteoarthritis and does not sacrifice wrist motion. A predictable and satisfactory long-term result is obtainable with correct patient selection based on clinical staging and arthroscopic findings.</p>","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"12 1","pages":"73-80"},"PeriodicalIF":0.7,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a8/06/10-1055-s-0041-1735304.PMC9836778.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9085620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeted Partial Arthroscopic Trapeziectomy and Temporary K-Wire Distraction for Basal Joint Arthritis in Young Patients: A Retrospective Study of 39 Thumbs.","authors":"Jean-Baptiste de Villeneuve Bargemon,&nbsp;Mathias Rouveyrol,&nbsp;Valentin Massin,&nbsp;Charlotte Jaloux,&nbsp;M Levadoux","doi":"10.1055/s-0041-1742204","DOIUrl":"https://doi.org/10.1055/s-0041-1742204","url":null,"abstract":"<p><p><b>Purpose</b>  There is a real need to find less invasive therapeutic options for young patients suffering from osteoarthritis of the first carpometacarpal joint. We wanted to assess the effectiveness of targeted partial arthroscopic trapeziectomy with distraction of the trapeziometacarpal (TM) joint with Kirschner wires (K-wires) in 39 thumbs impacted by TM osteoarthritis. <b>Methods</b>  We conducted a retrospective study in which preoperative and postoperative data on pinch strength, grip strength, and pain on a visual analogue scale were collected. Subgroup analysis was performed based on two different K-wire distraction techniques. Only patients suffering from primary osteoarthritis and younger than 70 years were included. Second, we compared the frequency of complications relative to the position of the pins. <b>Results</b>  We found a significant improvement in pain ( <i>p</i>  = 0.005) and grip strength ( <i>p</i>  = 0.0021) as well as an improvement in pinch strength ( <i>p</i>  = 0.5704). There was reduction in pain for all Badia levels, which was significant for stages 2 ( <i>p</i>  = 0.002) and 3 ( <i>p</i>  = 0.032) as well as an overall improvement in grip strength and pinch strength for all Badia levels. <b>Conclusion</b>  Partial trapeziectomy with K-wire distraction in young patients suffering from TM osteoarthritis is a simple technique that requires minimal equipment and yields satisfactory outcomes. Conversion to another surgical treatment is still possible if this less invasive technique is unsuccessful. <b>Level of Evidence</b>  This is a Level IV study.</p>","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"12 1","pages":"9-17"},"PeriodicalIF":0.7,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9836781/pdf/10-1055-s-0041-1742204.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10617766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scaphoid Malunion: Incidence, Predictors, and Outcomes.","authors":"Jill Putnam,&nbsp;Kayla Pfaff,&nbsp;Jeffrey Yao","doi":"10.1055/s-0042-1751016","DOIUrl":"https://doi.org/10.1055/s-0042-1751016","url":null,"abstract":"<p><p><b>Background</b>  Scaphoid malunion is rarely reported. Previous literature has attributed loss of carpal height and degenerative changes to scaphoid malunion, but the percentage of asymptomatic malunions remains unknown. <b>Purpose</b>  The authors of this study aim to define predictors of malunion and outcomes associated with scaphoid malunion. <b>Methods</b>  Institutional board review was obtained prior to evaluating medical records of patients 18 years and older who were treated for scaphoid fractures and/or nonunion between 2000 and 2020. The following data were collected for each patient: age, gender, fracture location, surgical technique, time to union, and whether malunion resulted. Malunion was defined using a lateral intrascaphoid angle (LISA) >45 degrees and height-to-length ratio (HLR) >60. Pain scores, range of motion (ROM), and secondary surgery were also evaluated. <b>Results</b>  Overall, 355 scaphoid injuries, including 196 acute fractures and 159 nonunions, were evaluated in this analysis. Of these, 55 scaphoids (15%) met the definition of malunion. Of these patients, 23% were female. The mean age at the time of injury was 29 years. Nonunion cases were more likely than acute cases to be associated with malunion. Proximal pole fractures were more likely to associated with malunion than waist fractures. When controlling for nonunion and fracture location, malunited scaphoids were not associated with any significant difference in pain score, ROM, or secondary surgery, compared with nonmalunion cases. A total of 10 patients (3.3%) without malunion and 2 patients (3.6%) with malunion went on to a secondary surgery. Final extension/flexion was 67/67 degrees and 56/59 degrees in nonmalunion and malunion groups, respectively, but these differences were not significant. <b>Conclusion</b>  Compared with scaphoid injuries that do not result in malunion, scaphoid injuries that heal into malunion have similar outcomes. While scaphoid malunion in a single case or series may be associated with poor outcomes, this study suggests that scaphoid malunions do not have worse functional outcomes. <b>Level of Evidence</b>  This is a Level IV study.</p>","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"12 1","pages":"40-45"},"PeriodicalIF":0.7,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9836771/pdf/10-1055-s-0042-1751016.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9758414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Allinside Anatomic Arthroscopic (3A) Reconstruction of Irreparable TFCC Tear.","authors":"Andrea Atzei,&nbsp;Fabio Andrés Tandioy-Delgado,&nbsp;Lucian Lior Marcovici,&nbsp;Thomas W Aust,&nbsp;Riccardo Luchetti","doi":"10.1055/s-0041-1735981","DOIUrl":"https://doi.org/10.1055/s-0041-1735981","url":null,"abstract":"<p><p><b>Background</b>  In recent years, new arthroscopic techniques have been introduced to address the irreparable tears of the triangular fibrocartilage complex (TFCC) (Palmer type 1B, Atzei class 4) by replicating the standard Adams-Berger procedure. These techniques, however, show the same limitations of the open procedure in relation to the anatomically defective location of the radial origins of the radioulnar ligaments (RUL) and the risk of neurovascular and/or tendon injury. Aiming to improve the quality of reconstruction and reduce surgical morbidity, a novel arthroscopic technique was developed, with the advantages of reproducing the anatomical origins of the RUL ligaments and providing all-inside tendon graft (TG) deployment and fixation. <b>Description of Technique</b>  The Allinside anatomic arthroscopic (3A) technique is indicated for TG reconstruction of irreparable TFCC tears in the absence of distal radioulnar joint (DRUJ) arthritis. Standard wrist arthroscopy portals are used. A small incision in the radial metaphyseal area and arthroscopic control are required to set a Wrist Drill Guide and create two converging tunnels, whose openings are at the radial anatomical origins of the RUL. An ulnar tunnel is drilled at the fovea from inside-out via the 6U portal. A 3-mm tendon strip, from the palmaris longus or extensor carpi radialis brevis, is woven through the tunnels and then secured into the ulnar tunnel with an interference screw. Postoperative immobilization with restricted forearm rotation is discontinued at 5 weeks, and then postoperative rehabilitation is started. <b>Patients and Methods</b>  The 3A technique was applied on 5 patients (2 females and 3 males), with an average age 42 years. DRUJ stability, range of motion (ROM), pain (0-10 visual analogue scale [VAS]), grip strength, modified Mayo wrist score (MMWS), and patient satisfaction were used for evaluation before surgery and at follow-up. <b>Results</b>  No intraoperative or early complications were registered. At a mean follow-up of 26 months, DRUJ was stable in all patients, which recovered 99% ROM. Pain VAS decreased from 7 to 0.6. Grip strength increased from 38 to 48.8 Kgs. There were 4 excellent results and 1 good result on MMWS. All patient showed high satisfaction. <b>Conclusions</b>  Although the 3A technique requires dedicated instrumentation and arthroscopic expertise, it takes advantage of improved intra-articular vision and minimized surgical trauma to reduce the risk of complications and obtain promising functional results.</p>","PeriodicalId":46757,"journal":{"name":"Journal of Wrist Surgery","volume":"12 1","pages":"2-8"},"PeriodicalIF":0.7,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9836779/pdf/10-1055-s-0041-1735981.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10536397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}