Session 10: Hand and Wrist
Torsdag d. 26. oktober
13:00-14:30
Lokale: Stockholm/Copenhagen
Chairmen: Maiken Stilling og Camilla Ryge
Allan Ibsen Sørensen, Peter Axelsson , Jonny Andersson
Clinic of Hand Surgery, Sahlgrenska University Hospital; Clinic of Hand Surgery, Sahlgrenska University Hospital; Clinic of Hand Surgery, Sahlgrenska University Hospital
Background: Only one pilot study have been presented in 2006 of a Scaphoid Trapezium Pyrocarbon Implant (STPI) in the scaphoid-trapezium- trapezoid (STT) joint.
Purpose / Aim of Study: In a prospective study to present our short- term results of a STPI implant in the STT joint in patients with osteoarthritis.
Materials and Methods: Postoperatively a cast was used for four weeks followed by rehabilitation. All patients were evaluated preoperatively six, 12 and 26 weeks postop. and then yearly with ROM, grip strength, pinch, key-pinch, VAS scores for pain, Quick-DASH, PRWE and patients satisfaction. X-Ray performed preop., 3 months postop. and thereafter yearly. Twenty-eight patients were operated on, 11 men and 17 women. Mean age was 63 years (51-78).
Findings / Results: Mean follow-up was 24 months (range 3- 48). Extension/flexion of the wrist was preop. 54/60 degrees and at follow-up 54/60 and radial/ulnar flexion preop. 19/41 and at follow-up 14/42. Radial abduction/palmar abduction of the CM1 joint was preop. 42/43 degrees and at follow-up 41/45. Opposition of thumb preoperatively 0.6 cm and postop. 0.1 cm. Grip strength not affected by the procedure, 24 Kg respectively 24 kg. Pinch/key-pinch (Kg) preop.: 4.6/5.0 and at follow-up: 5.4/6.0, (NS/NS). VAS pain (mm of 100) was preop. at rest/activity 47/72 and at follow-up 22/36 (p<0.01). Radiographic optimal position of the implant seen in 22 patients and dislocation in two. Quick DASH improved from 49 preop. to 32 p<0.01) at latest follow-up. PRWE changed from 63 preop. to 27 (p<0.01) at follow-up. Satisfaction (mm of 100) was preoperatively 20 and at follow- up 63 (p<0.01). No infections encountered but seven implants (25%) revised.
Conclusions: Short-term results with this STPI pyrocarbon implant in the STT joint are promising concerning pain, PROM, but revision rate was alarmingly high.
Clinic of Hand Surgery, Sahlgrenska University Hospital; Clinic of Hand Surgery, Sahlgrenska University Hospital; Clinic of Hand Surgery, Sahlgrenska University Hospital
Background: Only one pilot study have been presented in 2006 of a Scaphoid Trapezium Pyrocarbon Implant (STPI) in the scaphoid-trapezium- trapezoid (STT) joint.
Purpose / Aim of Study: In a prospective study to present our short- term results of a STPI implant in the STT joint in patients with osteoarthritis.
Materials and Methods: Postoperatively a cast was used for four weeks followed by rehabilitation. All patients were evaluated preoperatively six, 12 and 26 weeks postop. and then yearly with ROM, grip strength, pinch, key-pinch, VAS scores for pain, Quick-DASH, PRWE and patients satisfaction. X-Ray performed preop., 3 months postop. and thereafter yearly. Twenty-eight patients were operated on, 11 men and 17 women. Mean age was 63 years (51-78).
Findings / Results: Mean follow-up was 24 months (range 3- 48). Extension/flexion of the wrist was preop. 54/60 degrees and at follow-up 54/60 and radial/ulnar flexion preop. 19/41 and at follow-up 14/42. Radial abduction/palmar abduction of the CM1 joint was preop. 42/43 degrees and at follow-up 41/45. Opposition of thumb preoperatively 0.6 cm and postop. 0.1 cm. Grip strength not affected by the procedure, 24 Kg respectively 24 kg. Pinch/key-pinch (Kg) preop.: 4.6/5.0 and at follow-up: 5.4/6.0, (NS/NS). VAS pain (mm of 100) was preop. at rest/activity 47/72 and at follow-up 22/36 (p<0.01). Radiographic optimal position of the implant seen in 22 patients and dislocation in two. Quick DASH improved from 49 preop. to 32 p<0.01) at latest follow-up. PRWE changed from 63 preop. to 27 (p<0.01) at follow-up. Satisfaction (mm of 100) was preoperatively 20 and at follow- up 63 (p<0.01). No infections encountered but seven implants (25%) revised.
Conclusions: Short-term results with this STPI pyrocarbon implant in the STT joint are promising concerning pain, PROM, but revision rate was alarmingly high.
Maiken Stilling, Lene Dremstrup, Lone Kirkeby, Torben Bæk Hansen
Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Holstebro; Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Holstebro; Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Holstebro; Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Holstebro
Background: Dual-mobility (DM) articulation provides good stability in trapeziometacarpal (TMC) arthroplasty but the thin polyethylene (PE) liner raises concern about possible wear issues.
Purpose / Aim of Study: To evaluate cup fixation and PE wear of a press-fit conical DM cup.
Materials and Methods: A case-study of the first 111 consecutive patients (111 hands, 89 females) with Eaton stage 2-4 osteoarthritis (June 2013-May 2015). Moovis Elektra 9mm conical press-fit cup with UHMWPE DM liner and 5mm CoCr metacarpal head was used. Model-based radiostereometry (RSA) was used to measure cup fixation and PE wear. Cup subsidence was evaluated in the length axis of the cup. Polyethylene wear was measured as head/neck migration with respect to cup model feature points. Double RSA examinations were obtained for precision (95% agreement limits). RSA and PROMs were evaluated at baseline, 3 months, 1 and 2 years.
Findings / Results: Patients were mean 58 years (range 42-76). Precision was 0.15 mm. Cup subsidence was 0.02 mm (SD 0.35) at 2 years. Total cup translation (TT) at 2 years was mean 0.46 (SD 0.48) mm, and increased from 3 months to 2 years (p=0.01). At 2 years 13 cups (15%) had migrated more than 1mm TT (p=0.00), but no cups were revised. 3 trapeziums fractured intra-operatively and 2 patients had intraprosthetic dislocation of the dual-mobility liner. Clinical function improved (p=0.000) by VAS_rest 3 (SD 3), VAS_activity 5 (SD3), and qDASH 31 (SD 20). Bedding-in of the PE liner was 0.15mm (SD 0.16) until 3 months (p=0.001). PE wear was 0.06mm (0.17mm) from 3 months until 2 years (p=0.002), and 0.003mm (SD 0.13) between 1 and 2 years.
Conclusions: At 2 years followup Moovis Elektra cup fixation was acceptable for most implants (85%) and clinical improvements significant. There was bedding-in of the PE liner until 3 months, but after 1 year PE wear was small.
Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Holstebro; Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Holstebro; Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Holstebro; Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Holstebro
Background: Dual-mobility (DM) articulation provides good stability in trapeziometacarpal (TMC) arthroplasty but the thin polyethylene (PE) liner raises concern about possible wear issues.
Purpose / Aim of Study: To evaluate cup fixation and PE wear of a press-fit conical DM cup.
Materials and Methods: A case-study of the first 111 consecutive patients (111 hands, 89 females) with Eaton stage 2-4 osteoarthritis (June 2013-May 2015). Moovis Elektra 9mm conical press-fit cup with UHMWPE DM liner and 5mm CoCr metacarpal head was used. Model-based radiostereometry (RSA) was used to measure cup fixation and PE wear. Cup subsidence was evaluated in the length axis of the cup. Polyethylene wear was measured as head/neck migration with respect to cup model feature points. Double RSA examinations were obtained for precision (95% agreement limits). RSA and PROMs were evaluated at baseline, 3 months, 1 and 2 years.
Findings / Results: Patients were mean 58 years (range 42-76). Precision was 0.15 mm. Cup subsidence was 0.02 mm (SD 0.35) at 2 years. Total cup translation (TT) at 2 years was mean 0.46 (SD 0.48) mm, and increased from 3 months to 2 years (p=0.01). At 2 years 13 cups (15%) had migrated more than 1mm TT (p=0.00), but no cups were revised. 3 trapeziums fractured intra-operatively and 2 patients had intraprosthetic dislocation of the dual-mobility liner. Clinical function improved (p=0.000) by VAS_rest 3 (SD 3), VAS_activity 5 (SD3), and qDASH 31 (SD 20). Bedding-in of the PE liner was 0.15mm (SD 0.16) until 3 months (p=0.001). PE wear was 0.06mm (0.17mm) from 3 months until 2 years (p=0.002), and 0.003mm (SD 0.13) between 1 and 2 years.
Conclusions: At 2 years followup Moovis Elektra cup fixation was acceptable for most implants (85%) and clinical improvements significant. There was bedding-in of the PE liner until 3 months, but after 1 year PE wear was small.
Jesper Sonntag, Jesper Hern, Linn Woythal, Ulrik Branner, Kai H. W. Lange, Stig Brorson
Department of Orthopaedic Surgery, Nordsjællands Hospital; Department of Radiology, Nordsjællands Hospital; Department of Orthopaedic Surgery, Nordsjællands Hospital; Department of Orthopaedic Surgery, Nordsjællands Hospital; Department of Anaesthesia and Intensive Care, Nordsjællands Hospital; Department of Orthopaedic Surgery, Herlev Hospital
Background: After volar plating of distal radius fractures (DRF) repair of the Pronator Quadratus (PQ) muscle with sutures has been reported durable. It is not clear how the muscle reacts if not repaired. Furthermore, it is uncertain if a retracted muscle correlates to worse functional outcome or complications.
Purpose / Aim of Study: To investigate with ultrasound the anatomy of the PQ muscle after volar plating with PQ repair or non-repair and to correlate the ultrasound findings to patient reported outcome.
Materials and Methods: The participants were recruited from a clinical trial where they were randomly allocated to repair or non-repair of the PQ muscle after volar plating of DRF. The participants and radiologist were blinded to group allocation. Ultrasounds of both fractured and contralateral wrists were performed three months after surgery. Ultrasound measurements included difference in length of PQ muscles between the injured and un-injured side, retraction of PQ muscles and tendon complications. The length and retraction measurements were correlated to complications and Patient Related Wrist Evaluation (PRWE).
Findings / Results: The mean difference in length between the injured and the un-injured side in the non- repair group was 4.39mm and in the repair group 2.68mm with a mean difference between the two groups of 1.71mm (CI-95% = [0.09; 3.33]; p = 0.04). However, there were no clinically or statistically differences in complications or PRWE between the two groups. Retraction of the PQ muscle was only found in the non-repair group. We found no difference in complications or PRWE between the retracted and non- retracted groups.
Conclusions: PQ length was significantly shorter and retraction significantly larger without repair of the PQ muscle. However, neither length nor retraction correlated significantly with complications or PRWE.
Department of Orthopaedic Surgery, Nordsjællands Hospital; Department of Radiology, Nordsjællands Hospital; Department of Orthopaedic Surgery, Nordsjællands Hospital; Department of Orthopaedic Surgery, Nordsjællands Hospital; Department of Anaesthesia and Intensive Care, Nordsjællands Hospital; Department of Orthopaedic Surgery, Herlev Hospital
Background: After volar plating of distal radius fractures (DRF) repair of the Pronator Quadratus (PQ) muscle with sutures has been reported durable. It is not clear how the muscle reacts if not repaired. Furthermore, it is uncertain if a retracted muscle correlates to worse functional outcome or complications.
Purpose / Aim of Study: To investigate with ultrasound the anatomy of the PQ muscle after volar plating with PQ repair or non-repair and to correlate the ultrasound findings to patient reported outcome.
Materials and Methods: The participants were recruited from a clinical trial where they were randomly allocated to repair or non-repair of the PQ muscle after volar plating of DRF. The participants and radiologist were blinded to group allocation. Ultrasounds of both fractured and contralateral wrists were performed three months after surgery. Ultrasound measurements included difference in length of PQ muscles between the injured and un-injured side, retraction of PQ muscles and tendon complications. The length and retraction measurements were correlated to complications and Patient Related Wrist Evaluation (PRWE).
Findings / Results: The mean difference in length between the injured and the un-injured side in the non- repair group was 4.39mm and in the repair group 2.68mm with a mean difference between the two groups of 1.71mm (CI-95% = [0.09; 3.33]; p = 0.04). However, there were no clinically or statistically differences in complications or PRWE between the two groups. Retraction of the PQ muscle was only found in the non-repair group. We found no difference in complications or PRWE between the retracted and non- retracted groups.
Conclusions: PQ length was significantly shorter and retraction significantly larger without repair of the PQ muscle. However, neither length nor retraction correlated significantly with complications or PRWE.
Lene Dremstrup, Sebastian Breddam Mosegaard, Torben Bæk Hansen, Maiken Stilling
Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, , Holstebro; Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Holstebro; Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Holstebro; Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Holstebro
Background: Cup loosening in trapeziometacarpal (TMC) joint arthroplasty is a problem, and therefore new cup designs have been introduced. We have formerly validated a pig bone model for evaluation of TMC cup fixation by use of radiostereometric analysis (RSA).
Purpose / Aim of Study: to compare bone fixation of a spherical and a conical TMC cup.
Materials and Methods: 9 conical Moovis (Stryker) and 10 spherical “Type T” (Besnoska) cups were inserted into the trapezium equivalent pig bone using original instruments and surgical technique. Periprosthetic 1mm beads were inserted, and the bones were fixed with cement in a 20° angle. Static RSA was performed at baseline, after a low- pressure cyclic test (300 cycles, 150N), and after push-in loading until visual failure (up to 1100N). Cup subsidence was evaluated in the length axis of the cup, and double RSA examinations were obtained for assessment of precision by 95% agreement limits.
Findings / Results: Precision of cup subsidence was 0.1mm, and at 600N push-in load 9 Type T cups and 3 Moovis cups migrated above the precision limit (p=0.18). Up to 750N push-in load both cup types migrated (p<0.04), but similarly between groups (p=0.06), with subsidence of 0.16mm (sd 0.2) for the T type cup and 0.53mm (sd 0.52) for the Moovis cup. In all, 7 Type T cups and 4 Moovis cups failed by visual judgement (p=0.18), which coincided with 1mm cup subsidence. The failure pattern was subsidence of 1mm or more associated with a cup tilt of 8° -18° for the Type T cup, while the Moovis cup only subsided.
Conclusions: Cup subsidence was similar with press- fit fixation of spherical and conical cup designs. Both cup types sustained failure loads resembling a forceful pinch (750N). Bone quality is poorer in patients and stresses the importance of osseointegration prior to loaded hand activities.
Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, , Holstebro; Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Holstebro; Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Holstebro; Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Holstebro
Background: Cup loosening in trapeziometacarpal (TMC) joint arthroplasty is a problem, and therefore new cup designs have been introduced. We have formerly validated a pig bone model for evaluation of TMC cup fixation by use of radiostereometric analysis (RSA).
Purpose / Aim of Study: to compare bone fixation of a spherical and a conical TMC cup.
Materials and Methods: 9 conical Moovis (Stryker) and 10 spherical “Type T” (Besnoska) cups were inserted into the trapezium equivalent pig bone using original instruments and surgical technique. Periprosthetic 1mm beads were inserted, and the bones were fixed with cement in a 20° angle. Static RSA was performed at baseline, after a low- pressure cyclic test (300 cycles, 150N), and after push-in loading until visual failure (up to 1100N). Cup subsidence was evaluated in the length axis of the cup, and double RSA examinations were obtained for assessment of precision by 95% agreement limits.
Findings / Results: Precision of cup subsidence was 0.1mm, and at 600N push-in load 9 Type T cups and 3 Moovis cups migrated above the precision limit (p=0.18). Up to 750N push-in load both cup types migrated (p<0.04), but similarly between groups (p=0.06), with subsidence of 0.16mm (sd 0.2) for the T type cup and 0.53mm (sd 0.52) for the Moovis cup. In all, 7 Type T cups and 4 Moovis cups failed by visual judgement (p=0.18), which coincided with 1mm cup subsidence. The failure pattern was subsidence of 1mm or more associated with a cup tilt of 8° -18° for the Type T cup, while the Moovis cup only subsided.
Conclusions: Cup subsidence was similar with press- fit fixation of spherical and conical cup designs. Both cup types sustained failure loads resembling a forceful pinch (750N). Bone quality is poorer in patients and stresses the importance of osseointegration prior to loaded hand activities.
Allan Ibsen Sørensen
Clinic of Hand Surgery, Sahlgrenska University Hospital
Background: Different prostheses have been used for several decades in the TCM joint with a high revision rate for some prostheses.
Purpose / Aim of Study: To present short-term results of a Pyrocarbon implant (Pyrocardan) in the trapezometacarpal joint (TMC).
Materials and Methods: A pyro disc used as a spacer between first metacarpal bone and trapezium bone. A cast used for 4 weeks followed by rehabilitation. All patients were evaluated preoperatively, 6, 12 and 26 weeks postoperatively and then yearly with ROM, grip strength, pinch, key-pinch, VAS scores for pain, Quick- DASH and patients satisfaction. X-Ray performed preoperatively, 3 months postoperatively and thereafter yearly. Twenty-six patients operated 13 men and 13 woman. Mean age 60 years (45-79). Six additional operations performed on other thumb, finger and wrist joints. One patient operated later with arthrodesis in MP1 joint in same thumb.
Findings / Results: Follow-up was 23 months (range 3-46). Radial abduction/palmar abduction was preoperatively 38/38 degrees and at follow- up 41/41. Opposition of thumb was 0 cm (0-3.5) versus 0.5 (0-5.5) postoperatively. Grip strength in KgF preoperatively was 23 (range 6-50) and at follow-up 27 (7-48), p<0.05. Pinch/key-pinch (Kg) preoperatively 4.5/3.7 and at follow-up 5.0/5.6, (NS/NS). VAS pain (mm) was preop. at rest/activity: 48/80 and at follow- up: 11/49, p<0.05. Radiographic migration of one implant. Quick DASH preop.: 48 (16-86) and at follow-up; 28 (0-75) (p<0.01). Satisfaction (mm of 100) preop.: 20 (0-94) and at follow-up: 79 (5-100) (p<0.01). No infection. One implant revised (3.8%).
Conclusions: Short-term results with a pyrocarbon implant in the TMC joint concerning pain, grip strength, Quick-DASH and patient satisfaction are favorable. Longer follow-up and a larger series of patients operated on with this new technique is needed.
Clinic of Hand Surgery, Sahlgrenska University Hospital
Background: Different prostheses have been used for several decades in the TCM joint with a high revision rate for some prostheses.
Purpose / Aim of Study: To present short-term results of a Pyrocarbon implant (Pyrocardan) in the trapezometacarpal joint (TMC).
Materials and Methods: A pyro disc used as a spacer between first metacarpal bone and trapezium bone. A cast used for 4 weeks followed by rehabilitation. All patients were evaluated preoperatively, 6, 12 and 26 weeks postoperatively and then yearly with ROM, grip strength, pinch, key-pinch, VAS scores for pain, Quick- DASH and patients satisfaction. X-Ray performed preoperatively, 3 months postoperatively and thereafter yearly. Twenty-six patients operated 13 men and 13 woman. Mean age 60 years (45-79). Six additional operations performed on other thumb, finger and wrist joints. One patient operated later with arthrodesis in MP1 joint in same thumb.
Findings / Results: Follow-up was 23 months (range 3-46). Radial abduction/palmar abduction was preoperatively 38/38 degrees and at follow- up 41/41. Opposition of thumb was 0 cm (0-3.5) versus 0.5 (0-5.5) postoperatively. Grip strength in KgF preoperatively was 23 (range 6-50) and at follow-up 27 (7-48), p<0.05. Pinch/key-pinch (Kg) preoperatively 4.5/3.7 and at follow-up 5.0/5.6, (NS/NS). VAS pain (mm) was preop. at rest/activity: 48/80 and at follow- up: 11/49, p<0.05. Radiographic migration of one implant. Quick DASH preop.: 48 (16-86) and at follow-up; 28 (0-75) (p<0.01). Satisfaction (mm of 100) preop.: 20 (0-94) and at follow-up: 79 (5-100) (p<0.01). No infection. One implant revised (3.8%).
Conclusions: Short-term results with a pyrocarbon implant in the TMC joint concerning pain, grip strength, Quick-DASH and patient satisfaction are favorable. Longer follow-up and a larger series of patients operated on with this new technique is needed.
Sebastian Breddam Mosegaard, Maiken Stilling, Torben Bæk Hansen, Eva Glassou
University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Holstebro Regional Hospital, Denmark; University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Holstebro Regional Hospital, Denmark; University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Holstebro Regional Hospital, Denmark; University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Holstebro Regional Hospital, Denmark
Background: The potential effect from a hand operation as well as the potential risk is wide-ranging. An unsuccessful result after hand surgery will not only affect the patient but could also lead to increased expenses for the community (sick days) along with the potential loss of working capacity.
Purpose / Aim of Study: To identify potential predictors of low effect of operation for osteoarthritis in the trapeziometacarpal joint using total joint arthroplasty (TMTJA).
Materials and Methods: The study includes 287 patients with a mean age of 58.8 years (range 41-80) treated with TMTJA. In bilateral patients only data from the hand first treated was used. The patients were followed prospectively with hand function (DASH), pain score at rest and activity (VAS) and grip strength preoperatively and after 12 months. A positive outcome was defined as: DASH improvement >19 point, VAS improvement >3, grip strength improvement >15%. A combined positive outcome was defined as: a combination of at least 2 positive outcomes. Logistic regression was used to test for predictors of a negative outcome.
Findings / Results: There was no effect of age or sex. The probability of a positive outcome depended on the preoperative scores in DASH, VAS and grip strength. This means that if scores were already “good” prior to surgery a positive outcome was difficult to achieve. Preoperative grip strength was the only outcome measure with significant effect on the combined positive outcome (p<0.001). 55% had improvements in grip strength, 65% in DASH, 70% in VAS and 70% in combined positive outcome.
Conclusions: There was no isolated predictor for effect of operation with TMTJA. The probability of a positive effect was better with a preoperative high VAS, high DASH and low grip strength.
University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Holstebro Regional Hospital, Denmark; University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Holstebro Regional Hospital, Denmark; University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Holstebro Regional Hospital, Denmark; University Clinic for Hand, Hip and Knee Surgery, Department of Orthopaedics, Holstebro Regional Hospital, Denmark
Background: The potential effect from a hand operation as well as the potential risk is wide-ranging. An unsuccessful result after hand surgery will not only affect the patient but could also lead to increased expenses for the community (sick days) along with the potential loss of working capacity.
Purpose / Aim of Study: To identify potential predictors of low effect of operation for osteoarthritis in the trapeziometacarpal joint using total joint arthroplasty (TMTJA).
Materials and Methods: The study includes 287 patients with a mean age of 58.8 years (range 41-80) treated with TMTJA. In bilateral patients only data from the hand first treated was used. The patients were followed prospectively with hand function (DASH), pain score at rest and activity (VAS) and grip strength preoperatively and after 12 months. A positive outcome was defined as: DASH improvement >19 point, VAS improvement >3, grip strength improvement >15%. A combined positive outcome was defined as: a combination of at least 2 positive outcomes. Logistic regression was used to test for predictors of a negative outcome.
Findings / Results: There was no effect of age or sex. The probability of a positive outcome depended on the preoperative scores in DASH, VAS and grip strength. This means that if scores were already “good” prior to surgery a positive outcome was difficult to achieve. Preoperative grip strength was the only outcome measure with significant effect on the combined positive outcome (p<0.001). 55% had improvements in grip strength, 65% in DASH, 70% in VAS and 70% in combined positive outcome.
Conclusions: There was no isolated predictor for effect of operation with TMTJA. The probability of a positive effect was better with a preoperative high VAS, high DASH and low grip strength.
Janni Kjærgaard Thillemann, Sepp De Raedt, Peter Bo Jørgensen, Bart Kaptein, Lone Rømer, Torben Bæk Hansen , Maiken Stilling
Department of Orthopaedics, University Clinic of Hand, Hip and Knee Surgery, Hospital Unit West, DK ; Nordic Roentgen Technique, Aarhus, DK, ; Department of Clinical Medicine, Aarhus University, DK; Leiden University Medical Center, Leiden, NL, ; Department of Radiology, Aarhus University Hospital, DK; Department of Orthopaedics, University Clinic of Hand, Hip and Knee Surgery, Hospital Unit West, DK ; Department of Clinical Medicine, Aarhus University, DK
Background: Injury of the Triangular Fibrocartilage Complex(TFCC) can lead to distal radioulnar joint(DRUJ) instability. Wrist arthroscopy is the gold standard diagnosing TFCC injuries since current imaging examinations are insufficient.
Purpose / Aim of Study: To evaluate DRUJ kinematics without and with TFCC lesions using radiostereometry(RSA).
Materials and Methods: DRUJ stability of 10 human donor arms were evaluated with static RSA during Piano Key test and with dynamic RSA(dRSA) during radial-ulnar wrist motion. Recordings were obtained before and after cutting first the distal component(dc-TFCC) at the ulnar styloid, and next the proximal component(pc- TFCC) from the ulna fovea. Lesions were checked with wrist arthroscopy. CT based bone models were used for kinematic analysis with non-commercial AutoRSA software. Ulnar variance, DRUJ gapping and DRUJ translation was calculated. Anatomical coordinate system was used.
Findings / Results: Static RSA: The Piano Key test had a mean 1.80mm(CI95 0.64-2.95) DRUJ translation with intact TFCC, increasing to mean 2.66mm(CI95 1.80- 3.52) with dc-TFCC/pc-TFCC lesion(p=0.02). dRSA: DRUJ gapping and ulnar variance was reduced in ulnar wrist deviation compared to radial wrist deviation with both intact and cut dc-TFCC and pc-TFCC(p<0.01). The change in gapping and ulnar variance was similar before and after lesion of the TFCC(p>0.07). DRUJ translation was mean 0.83mm(CI95 0.57- 1.09) with intact TFCC. After dc-TFCC lesion DRUJ translation was similar(p=0.13), while a combined dc-TFCC/pc-TFCC lesion increased(p=0.02) DRUJ translation to mean 1.36mm(CI95 0.95-1.77).
Conclusions: Successive lesion of the dc-TFCC and pc-TFCC resulted in increasing DRUJ instability. dRSA is a novel non-invasive, low-dose radiological method. dRSA options in vivo quantification of DRUJ stability in patients during symptom provoking wrist motions.
Department of Orthopaedics, University Clinic of Hand, Hip and Knee Surgery, Hospital Unit West, DK ; Nordic Roentgen Technique, Aarhus, DK, ; Department of Clinical Medicine, Aarhus University, DK; Leiden University Medical Center, Leiden, NL, ; Department of Radiology, Aarhus University Hospital, DK; Department of Orthopaedics, University Clinic of Hand, Hip and Knee Surgery, Hospital Unit West, DK ; Department of Clinical Medicine, Aarhus University, DK
Background: Injury of the Triangular Fibrocartilage Complex(TFCC) can lead to distal radioulnar joint(DRUJ) instability. Wrist arthroscopy is the gold standard diagnosing TFCC injuries since current imaging examinations are insufficient.
Purpose / Aim of Study: To evaluate DRUJ kinematics without and with TFCC lesions using radiostereometry(RSA).
Materials and Methods: DRUJ stability of 10 human donor arms were evaluated with static RSA during Piano Key test and with dynamic RSA(dRSA) during radial-ulnar wrist motion. Recordings were obtained before and after cutting first the distal component(dc-TFCC) at the ulnar styloid, and next the proximal component(pc- TFCC) from the ulna fovea. Lesions were checked with wrist arthroscopy. CT based bone models were used for kinematic analysis with non-commercial AutoRSA software. Ulnar variance, DRUJ gapping and DRUJ translation was calculated. Anatomical coordinate system was used.
Findings / Results: Static RSA: The Piano Key test had a mean 1.80mm(CI95 0.64-2.95) DRUJ translation with intact TFCC, increasing to mean 2.66mm(CI95 1.80- 3.52) with dc-TFCC/pc-TFCC lesion(p=0.02). dRSA: DRUJ gapping and ulnar variance was reduced in ulnar wrist deviation compared to radial wrist deviation with both intact and cut dc-TFCC and pc-TFCC(p<0.01). The change in gapping and ulnar variance was similar before and after lesion of the TFCC(p>0.07). DRUJ translation was mean 0.83mm(CI95 0.57- 1.09) with intact TFCC. After dc-TFCC lesion DRUJ translation was similar(p=0.13), while a combined dc-TFCC/pc-TFCC lesion increased(p=0.02) DRUJ translation to mean 1.36mm(CI95 0.95-1.77).
Conclusions: Successive lesion of the dc-TFCC and pc-TFCC resulted in increasing DRUJ instability. dRSA is a novel non-invasive, low-dose radiological method. dRSA options in vivo quantification of DRUJ stability in patients during symptom provoking wrist motions.
Ellen Hamborg-Petersen, Trine Torfing, Bjarke Viberg
Department of Orthopaedic Surgery and Traumatology, Odense University Hospital; Department of Radiology, Odense University Hospital; Department of Clinical Research, University of Southern Denmark
Background: Ulnar collateral ligament (UCL) tear of the first fingers MCP joint is a common injury in the hand that often lead to surgery due to suspicion a Stener lesion. If the UCL is undisplaced, surgery might not be necessary but a reliable diagnostic imaging has not yet been evaluated.
Purpose / Aim of Study: To evaluate if MRI or UL is sufficient to distinguish between different types of UCL lesions in patients with clinical UCL ruptures of the thumb.
Materials and Methods: From 1/6 2014 to 31/5 2017 all patients with a clinical UCL rupture diagnosed in the Emergency Department at Odense University Hospital was referred for a preoperatively MRI and UL of the injured thumb. The MRI and UL was conducted by senior consultants with specialty in musculoskeletal radiology. The result of the MRI and UL was blinded to the hand surgeon who made an intraoperatively assessment of the UCL lesion which was deemed as the Gold Standard (GS). A sample size estimated 30 patients using 99 % sensitivity, 0.05 accuracy and 50 % Stener prevalence. After 15 patients, a new calculation was performed using the actual Stener prevalence yielding 46 patients.
Findings / Results: 50 patients were included. The mean age (standard deviation) was 41.4 (16) and there were 64 % males. 5 patients did not have a UCL lesion and the MRI had 80 % sensitivity (SN) and 100 % specificity (SP) while the UL did not find any normal UCL compared to GS. The undisplaced UCL lesion and no lesion was grouped and MRI had 67 % SN and 96 % SP while UL had 67 % SN and 61 % SP compared to GS. Grouping only Stener lesion, the MRI had 67 % SN and 82 % SP while UL had 42 % SN and 82 % SP compared to GS.
Conclusions: Neither MRI or UL could with 100 % sensitivity diagnose undisplaced or Stener UCL lesions of the thumb in patients with clinical UCL rupture.
Department of Orthopaedic Surgery and Traumatology, Odense University Hospital; Department of Radiology, Odense University Hospital; Department of Clinical Research, University of Southern Denmark
Background: Ulnar collateral ligament (UCL) tear of the first fingers MCP joint is a common injury in the hand that often lead to surgery due to suspicion a Stener lesion. If the UCL is undisplaced, surgery might not be necessary but a reliable diagnostic imaging has not yet been evaluated.
Purpose / Aim of Study: To evaluate if MRI or UL is sufficient to distinguish between different types of UCL lesions in patients with clinical UCL ruptures of the thumb.
Materials and Methods: From 1/6 2014 to 31/5 2017 all patients with a clinical UCL rupture diagnosed in the Emergency Department at Odense University Hospital was referred for a preoperatively MRI and UL of the injured thumb. The MRI and UL was conducted by senior consultants with specialty in musculoskeletal radiology. The result of the MRI and UL was blinded to the hand surgeon who made an intraoperatively assessment of the UCL lesion which was deemed as the Gold Standard (GS). A sample size estimated 30 patients using 99 % sensitivity, 0.05 accuracy and 50 % Stener prevalence. After 15 patients, a new calculation was performed using the actual Stener prevalence yielding 46 patients.
Findings / Results: 50 patients were included. The mean age (standard deviation) was 41.4 (16) and there were 64 % males. 5 patients did not have a UCL lesion and the MRI had 80 % sensitivity (SN) and 100 % specificity (SP) while the UL did not find any normal UCL compared to GS. The undisplaced UCL lesion and no lesion was grouped and MRI had 67 % SN and 96 % SP while UL had 67 % SN and 61 % SP compared to GS. Grouping only Stener lesion, the MRI had 67 % SN and 82 % SP while UL had 42 % SN and 82 % SP compared to GS.
Conclusions: Neither MRI or UL could with 100 % sensitivity diagnose undisplaced or Stener UCL lesions of the thumb in patients with clinical UCL rupture.
Robert Gvozdenovic
Ortopaedic Surgery Department, Hand Surgery Unit, Herlev/Gentofte Hospital
Background: Today, the most common cause of prolonged pain and disability after distal radius fracture is ulnar-sided wrist pain. Triangular fibrocartilage complex (TFCC) injury is present in up to 80 % of patients with displaced DRF.
Purpose / Aim of Study: We report first experiences with our preferred method of foveal repair in TFCC reconstruction.
Materials and Methods: Between April 2013 and June 2016, 10 patients have been operated arthroscopically, by modified ulnar tunnel technique for foveal re-attachment of TFCC injury. All patients had ulnar sided wrist pain and MR verified foveal TFCC injury. All patients had some grade of instability of the Distal Radioulnar Joint (DRUJ) and a positive hook test. Average time from the injury to the reconstruction was 23 months (3–96 m). There were 4 men and 6 women with a mean age of 24 years (16 – 40y). All patients were immobilized for 3 weeks. Mean follow-up was 24 months (12–48m). Retrospective evaluation included assessment of pain (VAS score), satisfaction, DRUJ instability, range of motion (ROM), grip strength and Disabilities of the Arm, Shoulder and Hand (quick- DASH) Score.
Findings / Results: No complication during the operative procedures or the post-op period was seen. All patients but one achieved full stability and showed improvement at the evaluation as well as full satisfaction. Both grip strength, pain and q-DASH values improved significantly (p<0.05). Mean grip strength of the operated hands showed a 23 % increase after the operative treatment (95 % of strength of the contralateral side). ROM improved, especially in pronation and supination. In one case, we observed recurrent pain and instability of the DRUJ.
Conclusions: Preliminary results of foveal repair of the TFCC injury provided satisfactory results with a few observed complications. The presented knotless technique simplifies the procedure.
Ortopaedic Surgery Department, Hand Surgery Unit, Herlev/Gentofte Hospital
Background: Today, the most common cause of prolonged pain and disability after distal radius fracture is ulnar-sided wrist pain. Triangular fibrocartilage complex (TFCC) injury is present in up to 80 % of patients with displaced DRF.
Purpose / Aim of Study: We report first experiences with our preferred method of foveal repair in TFCC reconstruction.
Materials and Methods: Between April 2013 and June 2016, 10 patients have been operated arthroscopically, by modified ulnar tunnel technique for foveal re-attachment of TFCC injury. All patients had ulnar sided wrist pain and MR verified foveal TFCC injury. All patients had some grade of instability of the Distal Radioulnar Joint (DRUJ) and a positive hook test. Average time from the injury to the reconstruction was 23 months (3–96 m). There were 4 men and 6 women with a mean age of 24 years (16 – 40y). All patients were immobilized for 3 weeks. Mean follow-up was 24 months (12–48m). Retrospective evaluation included assessment of pain (VAS score), satisfaction, DRUJ instability, range of motion (ROM), grip strength and Disabilities of the Arm, Shoulder and Hand (quick- DASH) Score.
Findings / Results: No complication during the operative procedures or the post-op period was seen. All patients but one achieved full stability and showed improvement at the evaluation as well as full satisfaction. Both grip strength, pain and q-DASH values improved significantly (p<0.05). Mean grip strength of the operated hands showed a 23 % increase after the operative treatment (95 % of strength of the contralateral side). ROM improved, especially in pronation and supination. In one case, we observed recurrent pain and instability of the DRUJ.
Conclusions: Preliminary results of foveal repair of the TFCC injury provided satisfactory results with a few observed complications. The presented knotless technique simplifies the procedure.
Rasmus Wejnold Jørgensen, Jens-Christian Vedel, Claus Hjorth Jensen
Hand Clinic, Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen; Hand Clinic, Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen; Hand Clinic, Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen
Background: Arthrodesis of the proximal interphalangeal joint is indicated in patients with painful and incongruent joints. Many techniques have been proposed, but literature on the results is sparse.
Purpose / Aim of Study: The purpose of this study was to assess healing and complication rate after arthrodesis of the proximal interphalangeal joint using plate fixation (PLF) or Kirschner- wire fixation (KWF).
Materials and Methods: We retrospectively analyzed 33 charts with a minimum follow-up of 2 years. 15 patients were operated on with the Leibinger plate, 5 patients were operated with the Variax plate and 13 patients were operated on with KW fixation. Patients were evaluated radiographically and clinically at 6-8 weeks postoperatively. Fisher’s exact test was used for binary data and Mann-Whitney test for numerical data. P<0.05 was considered statistically significant.
Findings / Results: In 19 of 20 cases, healing was obtained within 8 weeks postoperatively in the PLF group. One patient was not seen until 12 weeks postoperatively, healing was obtained at this point. 8 of 13 cases healed within 8 weeks in the KWF group. 5 cases required more than 8 weeks to obtain healing (range 12-36 weeks) showing a lower fusion rate at this stage as compared to PLF (P=0.023). In the KWF group 4 cases had the K-wires removed in an outpatient setting and 4 patients in the OR, one Leibinger plate had to be removed in the OR. One patient had an amputation in the PIP joint after KWF because of continous pain for over 6 months. Mean number of outpatient visits to the clinic following PLF was 4.5 and for KWF 5.53 (P=0.19).
Conclusions: Proximal interphalangeal joint arthrodesis can be achieved with either plate fixation or K-wire fixation. Union was eventually obtained in all patients. Fusion time is significantly shorter using plate fixation when comparing to K-wire fixation.
Hand Clinic, Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen; Hand Clinic, Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen; Hand Clinic, Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen
Background: Arthrodesis of the proximal interphalangeal joint is indicated in patients with painful and incongruent joints. Many techniques have been proposed, but literature on the results is sparse.
Purpose / Aim of Study: The purpose of this study was to assess healing and complication rate after arthrodesis of the proximal interphalangeal joint using plate fixation (PLF) or Kirschner- wire fixation (KWF).
Materials and Methods: We retrospectively analyzed 33 charts with a minimum follow-up of 2 years. 15 patients were operated on with the Leibinger plate, 5 patients were operated with the Variax plate and 13 patients were operated on with KW fixation. Patients were evaluated radiographically and clinically at 6-8 weeks postoperatively. Fisher’s exact test was used for binary data and Mann-Whitney test for numerical data. P<0.05 was considered statistically significant.
Findings / Results: In 19 of 20 cases, healing was obtained within 8 weeks postoperatively in the PLF group. One patient was not seen until 12 weeks postoperatively, healing was obtained at this point. 8 of 13 cases healed within 8 weeks in the KWF group. 5 cases required more than 8 weeks to obtain healing (range 12-36 weeks) showing a lower fusion rate at this stage as compared to PLF (P=0.023). In the KWF group 4 cases had the K-wires removed in an outpatient setting and 4 patients in the OR, one Leibinger plate had to be removed in the OR. One patient had an amputation in the PIP joint after KWF because of continous pain for over 6 months. Mean number of outpatient visits to the clinic following PLF was 4.5 and for KWF 5.53 (P=0.19).
Conclusions: Proximal interphalangeal joint arthrodesis can be achieved with either plate fixation or K-wire fixation. Union was eventually obtained in all patients. Fusion time is significantly shorter using plate fixation when comparing to K-wire fixation.
Jens-Christian Vedel, Rasmus Wejnold Jørgensen, Claus Hjorth Jensen
Ortopædkirurgisk afdeling, Herlev & Gentofte; Ortopædkirurgisk afdeling, Herlev & Gentofte; Ortopædkirurgisk afdeling, Herlev & Gentofte
Background: Various methods for arthrodesis in the small joints of the hand are described and no single method has proven superior.
Purpose / Aim of Study: The purpose of this study was to assess healing and complication rate after arthrodesis of the distal interphalangeal joint or the thumb interphalangeal joint using the Acutrak 2 headless compression screw or Kirschner wires.
Materials and Methods: We retrospectively analyzed 147 consecutive primary fusions performed with the Acutrak 2 headless compression screw (n=107) or Kirschner wires (n=40) in 139 patients. Healing was assessed clinically and radiographically at 6 to 8 weeks postoperatively. Follow-up was 12 months.
Findings / Results: In 95 of 107 cases, healing occurred at 6 to 8 weeks postoperatively following arthrodesis using the Acutrak 2 headless compression screw. Seven cases healed after 8 weeks. Secondary surgery with screw removal was required in 11 cases. In five cases, the screw was removed due to prominence of the screw, in two cases due to infection, and in four cases because of nonunion. In 29 of 39 cases, fusion had occurred at 6 to 8 weeks postoperatively following arthrodesis using Kirschner wires showing a lower fusion rate at this stage as compared to the Acutrak 2 headless compression screw group (Chi-square = 9.5, p<0.01). Another eight joints in the K-wire group fused at some point after 8 weeks of follow-up yielding a total fusion rate of 93% which was no different than a total fusion rate of 96% in the Acutrak 2 headless compression screw group (Chi- square = 0.7, p = 0.4).
Conclusions: Arthrodesis in the small joints of the hand can be achieved with either the Acutrak 2 headless compression screw or Kirschners wires. A shorter time to fusion using the Acutrak 2 headless compression screw as compared to Kirschner wires should be considered when choosing between the two methods.
Ortopædkirurgisk afdeling, Herlev & Gentofte; Ortopædkirurgisk afdeling, Herlev & Gentofte; Ortopædkirurgisk afdeling, Herlev & Gentofte
Background: Various methods for arthrodesis in the small joints of the hand are described and no single method has proven superior.
Purpose / Aim of Study: The purpose of this study was to assess healing and complication rate after arthrodesis of the distal interphalangeal joint or the thumb interphalangeal joint using the Acutrak 2 headless compression screw or Kirschner wires.
Materials and Methods: We retrospectively analyzed 147 consecutive primary fusions performed with the Acutrak 2 headless compression screw (n=107) or Kirschner wires (n=40) in 139 patients. Healing was assessed clinically and radiographically at 6 to 8 weeks postoperatively. Follow-up was 12 months.
Findings / Results: In 95 of 107 cases, healing occurred at 6 to 8 weeks postoperatively following arthrodesis using the Acutrak 2 headless compression screw. Seven cases healed after 8 weeks. Secondary surgery with screw removal was required in 11 cases. In five cases, the screw was removed due to prominence of the screw, in two cases due to infection, and in four cases because of nonunion. In 29 of 39 cases, fusion had occurred at 6 to 8 weeks postoperatively following arthrodesis using Kirschner wires showing a lower fusion rate at this stage as compared to the Acutrak 2 headless compression screw group (Chi-square = 9.5, p<0.01). Another eight joints in the K-wire group fused at some point after 8 weeks of follow-up yielding a total fusion rate of 93% which was no different than a total fusion rate of 96% in the Acutrak 2 headless compression screw group (Chi- square = 0.7, p = 0.4).
Conclusions: Arthrodesis in the small joints of the hand can be achieved with either the Acutrak 2 headless compression screw or Kirschners wires. A shorter time to fusion using the Acutrak 2 headless compression screw as compared to Kirschner wires should be considered when choosing between the two methods.