Hand and Wrist
Robert Gvozdenovic, Lars Solgård
Herlev-Gentofte University Hospital of Copenhagen, Department of Orthopedics, Hand Surgery Unit, Herlev-Gentofte University Hospital of Copenhagen, Department of Orthopedics, Hand Surgery Unit; Herlev-Gentofte University Hospital of Copenhagen, Department of Orthopedics, Hand Surgery Unit, Herlev-Gentofte University Hospital of Copenhagen, Department of Orthopedics, Hand Surgery Unit
Background: Limited intercarpal bone fusion (1CF, 2CF) has been introduced as an alternative to classic Four Corner Fusion (4CF) for the treatment of scapholunate advanced collapse (SLAC) arthritis and scaphoid non- union advanced collapse (SNAC) as 4CF is found related to high non-union- and complication rates. The rationale behind the simplified method with a less invasive approach, needing less bone grafting was to improve the union and consequently the results of surgery
Purpose / Aim of Study: The goal of this study was to present the results of lunocapitate/hamatotrapezoid (two column) or lunocapitate fusion only (one column), using the bone graft from the removed scaphoid bone and the Acutrak headless compression screw system
Materials and Methods: From August 2014 to January 2020, 42 consecutive patients,13 women, with a 58,5 year of age (mean) (range 35-76,) have been treated for SLAC/SNAC wrist. In 33 cases the surgery was performed as 2CF, in 9 as 1CF, triquetrum has been removed in 5 cases. In 26 cases surgery was done on the right wrist, 16 on left. The union was determined by CT- or X-ray follow-up studies and clinically. The assessment of pain (VAS score 0-100), range of motion (ROM), grip strength and Disabilities of the Arm, Shoulder and Hand (quick-DASH) Score were included
Findings / Results: 35 patients were available for the minimum 6 months follow-up, mean 12 (range 6- 48). All patients but two achieved union at mean of 10,8 weeks (range 5 –25). Pain diminished from 62 (mean), preoperatively to 10 (mean), postoperatively (p<0,05). Grip strength decreased, expectedly, from 31 KgF (mean) to 26 KgF (mean), pre- and postoperatively, respectively. qDASH improved from 45 (mean) to 10 (mean), before and after the surgery (p<0,05), while ROM of 69/31 (degrees, mean) were recorded for dorsovolar/radioulnar flexions, respectively. One pt. united after re- operation, eventually, two developed radiocarpal arthritis with time and were converted to TWF. Tree patients experienced complications needing surgery
Conclusions: 1 & 2CF showed significant improvement in pain and the function with minimal impairment of the grip strength on the short-term follow-up. A High union rate and an acceptable complication rate were achieved without fusing all carpals
Herlev-Gentofte University Hospital of Copenhagen, Department of Orthopedics, Hand Surgery Unit, Herlev-Gentofte University Hospital of Copenhagen, Department of Orthopedics, Hand Surgery Unit; Herlev-Gentofte University Hospital of Copenhagen, Department of Orthopedics, Hand Surgery Unit, Herlev-Gentofte University Hospital of Copenhagen, Department of Orthopedics, Hand Surgery Unit
Background: Limited intercarpal bone fusion (1CF, 2CF) has been introduced as an alternative to classic Four Corner Fusion (4CF) for the treatment of scapholunate advanced collapse (SLAC) arthritis and scaphoid non- union advanced collapse (SNAC) as 4CF is found related to high non-union- and complication rates. The rationale behind the simplified method with a less invasive approach, needing less bone grafting was to improve the union and consequently the results of surgery
Purpose / Aim of Study: The goal of this study was to present the results of lunocapitate/hamatotrapezoid (two column) or lunocapitate fusion only (one column), using the bone graft from the removed scaphoid bone and the Acutrak headless compression screw system
Materials and Methods: From August 2014 to January 2020, 42 consecutive patients,13 women, with a 58,5 year of age (mean) (range 35-76,) have been treated for SLAC/SNAC wrist. In 33 cases the surgery was performed as 2CF, in 9 as 1CF, triquetrum has been removed in 5 cases. In 26 cases surgery was done on the right wrist, 16 on left. The union was determined by CT- or X-ray follow-up studies and clinically. The assessment of pain (VAS score 0-100), range of motion (ROM), grip strength and Disabilities of the Arm, Shoulder and Hand (quick-DASH) Score were included
Findings / Results: 35 patients were available for the minimum 6 months follow-up, mean 12 (range 6- 48). All patients but two achieved union at mean of 10,8 weeks (range 5 –25). Pain diminished from 62 (mean), preoperatively to 10 (mean), postoperatively (p<0,05). Grip strength decreased, expectedly, from 31 KgF (mean) to 26 KgF (mean), pre- and postoperatively, respectively. qDASH improved from 45 (mean) to 10 (mean), before and after the surgery (p<0,05), while ROM of 69/31 (degrees, mean) were recorded for dorsovolar/radioulnar flexions, respectively. One pt. united after re- operation, eventually, two developed radiocarpal arthritis with time and were converted to TWF. Tree patients experienced complications needing surgery
Conclusions: 1 & 2CF showed significant improvement in pain and the function with minimal impairment of the grip strength on the short-term follow-up. A High union rate and an acceptable complication rate were achieved without fusing all carpals
Maiken Stilling, Lene Dremstrup, Lone Kirkeby, Lotte Priess Larsen, Torben Bæk Hansen
Department of Orthopaedics, Aarhus University Hospital; Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West; Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West; Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West; Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West
Background: In 2015 our department introduced a new cementless TMC total joint arthroplasty (Type T) consisting of a hydroxyapatite coated hemispherical cup with 3 rim-fins, a hydroxyapatite coated anatomical stem, a fixed-bearing UHMWPE polyethylene liner, and an 5mm diameter cobalt- chrome head/neck segment.
Purpose / Aim of Study: To evaluate the two-year clinical and radiological results.
Materials and Methods: From December 2015 to April 2017 five hand surgeons operated 106 joints (49 right side) with TMC osteoarthritis using the cementless Type T cup/stem (Beznoska). Mean patient age was 59 years (range 43-76). 75% were women. 18 patients (17%) received bilateral Type T implants. Clinical outcome was assessed by Quick DASH (QDASH), grip strength, pain, satisfaction, and complications. Implant fixation was evaluated with radiostereometry.
Findings / Results: There were two intraoperative trapezium fractures treated with screw fixation, and two intraoperative metacarpal fractures treated with cerclage wire. Nine cups (8%) were revised to trapeziectomy (eight due to aseptic loosening, 1 due to dislocation) and further ten cups (9%) had radiological signs of cup loosening at two years. No stems were revised or radiologically loose. QDASH improved mean 18 points (sd 24) from preoperative to three months (p=0.00), and was mean 13 (sd 18) at two years. Grip strength improved mean 3.8kg (sd 8.7) at two years (p=0.002). Pain at rest improved from mean 4.1 (sd 2.5) to 1.4 (sd 2.1) at three months (p=0.00). Pain in activity improved mean 4.2 (sd 2.8) at three months. 93% of patients without cup revision were very satisfied (NRS 8-10) with the result at two years, and 92% of patients without cup revision were willing to repeat surgery (NRS 8-10). The cup total translation was 0.34mm (sd 0.35) at three months, 0.37mm (sd 0.40) at one year, and 0.39mm (sd 0.40) at two years. The stem total translation was 0.52mm (sd 0.91) at three months, 0.59mm (sd 0.63) at one year, and 0.72mm (sd 0.99) at two years. Cup subsidence was higher in revised cups and cups with radiological loosening (p<0.02).
Conclusions: The Type T total TMC joint arthroplasty had a high rate of cup failure with revision and radiological loosening at 2 years follow-up. Failed cups migrated more.
Department of Orthopaedics, Aarhus University Hospital; Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West; Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West; Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West; Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West
Background: In 2015 our department introduced a new cementless TMC total joint arthroplasty (Type T) consisting of a hydroxyapatite coated hemispherical cup with 3 rim-fins, a hydroxyapatite coated anatomical stem, a fixed-bearing UHMWPE polyethylene liner, and an 5mm diameter cobalt- chrome head/neck segment.
Purpose / Aim of Study: To evaluate the two-year clinical and radiological results.
Materials and Methods: From December 2015 to April 2017 five hand surgeons operated 106 joints (49 right side) with TMC osteoarthritis using the cementless Type T cup/stem (Beznoska). Mean patient age was 59 years (range 43-76). 75% were women. 18 patients (17%) received bilateral Type T implants. Clinical outcome was assessed by Quick DASH (QDASH), grip strength, pain, satisfaction, and complications. Implant fixation was evaluated with radiostereometry.
Findings / Results: There were two intraoperative trapezium fractures treated with screw fixation, and two intraoperative metacarpal fractures treated with cerclage wire. Nine cups (8%) were revised to trapeziectomy (eight due to aseptic loosening, 1 due to dislocation) and further ten cups (9%) had radiological signs of cup loosening at two years. No stems were revised or radiologically loose. QDASH improved mean 18 points (sd 24) from preoperative to three months (p=0.00), and was mean 13 (sd 18) at two years. Grip strength improved mean 3.8kg (sd 8.7) at two years (p=0.002). Pain at rest improved from mean 4.1 (sd 2.5) to 1.4 (sd 2.1) at three months (p=0.00). Pain in activity improved mean 4.2 (sd 2.8) at three months. 93% of patients without cup revision were very satisfied (NRS 8-10) with the result at two years, and 92% of patients without cup revision were willing to repeat surgery (NRS 8-10). The cup total translation was 0.34mm (sd 0.35) at three months, 0.37mm (sd 0.40) at one year, and 0.39mm (sd 0.40) at two years. The stem total translation was 0.52mm (sd 0.91) at three months, 0.59mm (sd 0.63) at one year, and 0.72mm (sd 0.99) at two years. Cup subsidence was higher in revised cups and cups with radiological loosening (p<0.02).
Conclusions: The Type T total TMC joint arthroplasty had a high rate of cup failure with revision and radiological loosening at 2 years follow-up. Failed cups migrated more.
Robert Gvozdenovic, Sabine Hessler Simonsen
Ortopaedic Surgery Department, Hand Surgery Unit, Herlev/Gentofte Univerity Hospital of Copenhagen; Ortopaedic Surgery Department, Hand Surgery Unit, Herlev/Gentofte Univerity Hospital of Copenhagen
Background: Methods for fixation of TFCC injuries vary depending on the type of injury. Different suturing techniques (outside-in, inside in, inside-out, all-inside) have been introduced for the capsular injuries (Atzei Class 1). Similarly, different techniques (anchors, trans-osseous sutures, ulnar tunnel) are used for the foveal injuries (Atzei class 3). Solutions for fixation of the combined lesions (Atzei Class 2) have been sparsely investigated.
Purpose / Aim of Study: The aim of the study was to evaluate the feasibility of the modified ulnar tunnel technique in treating combined TFCC lesions through same 3,2 mm bony canal in ulna, usually used for foveal injuries. Second purpose was the evaluation of the MRI without contrast as a diagnostic tool for the combined TFCC injury.
Materials and Methods: Between June 2018 and February 2020, 18 patients, underwent surgery in which both components of the injury were sutured, using the all-inside technique for the capsular injury and usual technique for the foveal fixation, through the same ulnar tunnel. All patients had ulnar-sided wrist pain and mild to moderate instability of the distal radioulnar joint (DRUJ). Diagnosis was finally established intraoperatively by the positive hook- and trampoline tests and by visualization of the capsular tear. Prospective tear. Prospective evaluation included assessment of pain (VAS score), grip strength, range of motion and q-DASH score. score.
Findings / Results: No complications related to surgery occurred. 8 out of 18 patients were eligible for the minimum 6 months follow-up, mean follow-up 5 months [3-14]. All patients achieved stability of the DRUJ. Mean preoperative VAS score (rest/activity) decreased from 32 and 67 to 6 and 32 postoperatively (p<0.05). Grip strength and range of motion did not change, while qDASH score improved from 52 preoperatively to 25 postoperatively (p<0.05). One patient sustained new wrist trauma and is planned for re-operation. MRI without contrast was only positive in half of the cases.
Conclusions: Arthroscopic TFCC fixation of combined, capsular and foveal tear by modified ulnar tunnel technique is feasible, showing promising results on the short follow-up. MRI without contrast is questionable in diagnosing the TFCC injury. Longer follow-up study is needed.
Ortopaedic Surgery Department, Hand Surgery Unit, Herlev/Gentofte Univerity Hospital of Copenhagen; Ortopaedic Surgery Department, Hand Surgery Unit, Herlev/Gentofte Univerity Hospital of Copenhagen
Background: Methods for fixation of TFCC injuries vary depending on the type of injury. Different suturing techniques (outside-in, inside in, inside-out, all-inside) have been introduced for the capsular injuries (Atzei Class 1). Similarly, different techniques (anchors, trans-osseous sutures, ulnar tunnel) are used for the foveal injuries (Atzei class 3). Solutions for fixation of the combined lesions (Atzei Class 2) have been sparsely investigated.
Purpose / Aim of Study: The aim of the study was to evaluate the feasibility of the modified ulnar tunnel technique in treating combined TFCC lesions through same 3,2 mm bony canal in ulna, usually used for foveal injuries. Second purpose was the evaluation of the MRI without contrast as a diagnostic tool for the combined TFCC injury.
Materials and Methods: Between June 2018 and February 2020, 18 patients, underwent surgery in which both components of the injury were sutured, using the all-inside technique for the capsular injury and usual technique for the foveal fixation, through the same ulnar tunnel. All patients had ulnar-sided wrist pain and mild to moderate instability of the distal radioulnar joint (DRUJ). Diagnosis was finally established intraoperatively by the positive hook- and trampoline tests and by visualization of the capsular tear. Prospective tear. Prospective evaluation included assessment of pain (VAS score), grip strength, range of motion and q-DASH score. score.
Findings / Results: No complications related to surgery occurred. 8 out of 18 patients were eligible for the minimum 6 months follow-up, mean follow-up 5 months [3-14]. All patients achieved stability of the DRUJ. Mean preoperative VAS score (rest/activity) decreased from 32 and 67 to 6 and 32 postoperatively (p<0.05). Grip strength and range of motion did not change, while qDASH score improved from 52 preoperatively to 25 postoperatively (p<0.05). One patient sustained new wrist trauma and is planned for re-operation. MRI without contrast was only positive in half of the cases.
Conclusions: Arthroscopic TFCC fixation of combined, capsular and foveal tear by modified ulnar tunnel technique is feasible, showing promising results on the short follow-up. MRI without contrast is questionable in diagnosing the TFCC injury. Longer follow-up study is needed.
Robert Gvozdenovic, Michel Boeckstyns , Søren Merser
Department of Orthopedic Surgery, Hand Surgery Unit, Herlev-Gentofte University Hospital of Copenhagen; Hand Surgery Section, Capio/Cfr Hospital,Hellerup; Department of Orthopedic Surgery, Rigshospitalet
Background: Various implants have been described for ulnar head replacement (UHR) or for total replacement of the distal radioulnar joint (DRUJ). Few reports on mid- or long-term results.
Purpose / Aim of Study: This study aimed to report on the midterm results after ulnar head- only and total DRUJ replacement using the uHead in the treatment of painful disorders of the DRUJ. The secondary aim was eventually, to assess the combination of UHR and total wrist arthroplasty (TWA).
Materials and Methods: uHead was performed in 20 consecutive patients (14 women) between 2005 and 2017. Mean age was 59 years (range 36 - 80 y). The mean follow-up time was 5 years (range 2 – 15 y). Data were recorded prospectively and at follow-up examinations. The patients were followed- up at 3 weeks, 6 w, 3, 6 and 12 months postoperatively, thereafter annually. In 5 cases the uHead was implanted simultaneously with a Remotion TWA. In 4 cases, a Remotion TWA had been implanted previously. Kaplan-Meier survival analysis was used to estimate the cumulative probability of remaining free of revision. A nonparametric Wilcoxon signed- rank test was used for comparing data not normally distributed (QDASH scores), and the paired parametric Student’s t-test was used for normally distributed data (pain and VAS scores, range of motion, grip strength).
Findings / Results: Pain, grip strength and the function improved significantly. Pain after surgery decreased with 50 points on the VAS score scale of 100, from 66 (mean), preoperatively (range 16 - 97) to 16 (mean) (range 0 - 51), postoperatively, while grip strength nearly doubled - from 12 KgF (mean) (range 4 - 22), before to 21 KgF (mean) (range 6 - 36), after the surgery. qDASH scores improved from 56 (mean) (range 36 - 75), preop to 19 (mean) (range 4 - 47), postop. While 3 UHRs were revised early, 17 had an uncomplicated postoperative course. Due to limited number, comparing combined cases with UHR-only cases was abandoned.
Conclusions: Ulnar Head Replacement (uHead) showed significant improvement in pain, grip strength and the function of the patients with a painful disability of the DRUJ, without impairment on mobility on the mid-term followup. The overall implant survival over the time and the complication rate was acceptable.
Department of Orthopedic Surgery, Hand Surgery Unit, Herlev-Gentofte University Hospital of Copenhagen; Hand Surgery Section, Capio/Cfr Hospital,Hellerup; Department of Orthopedic Surgery, Rigshospitalet
Background: Various implants have been described for ulnar head replacement (UHR) or for total replacement of the distal radioulnar joint (DRUJ). Few reports on mid- or long-term results.
Purpose / Aim of Study: This study aimed to report on the midterm results after ulnar head- only and total DRUJ replacement using the uHead in the treatment of painful disorders of the DRUJ. The secondary aim was eventually, to assess the combination of UHR and total wrist arthroplasty (TWA).
Materials and Methods: uHead was performed in 20 consecutive patients (14 women) between 2005 and 2017. Mean age was 59 years (range 36 - 80 y). The mean follow-up time was 5 years (range 2 – 15 y). Data were recorded prospectively and at follow-up examinations. The patients were followed- up at 3 weeks, 6 w, 3, 6 and 12 months postoperatively, thereafter annually. In 5 cases the uHead was implanted simultaneously with a Remotion TWA. In 4 cases, a Remotion TWA had been implanted previously. Kaplan-Meier survival analysis was used to estimate the cumulative probability of remaining free of revision. A nonparametric Wilcoxon signed- rank test was used for comparing data not normally distributed (QDASH scores), and the paired parametric Student’s t-test was used for normally distributed data (pain and VAS scores, range of motion, grip strength).
Findings / Results: Pain, grip strength and the function improved significantly. Pain after surgery decreased with 50 points on the VAS score scale of 100, from 66 (mean), preoperatively (range 16 - 97) to 16 (mean) (range 0 - 51), postoperatively, while grip strength nearly doubled - from 12 KgF (mean) (range 4 - 22), before to 21 KgF (mean) (range 6 - 36), after the surgery. qDASH scores improved from 56 (mean) (range 36 - 75), preop to 19 (mean) (range 4 - 47), postop. While 3 UHRs were revised early, 17 had an uncomplicated postoperative course. Due to limited number, comparing combined cases with UHR-only cases was abandoned.
Conclusions: Ulnar Head Replacement (uHead) showed significant improvement in pain, grip strength and the function of the patients with a painful disability of the DRUJ, without impairment on mobility on the mid-term followup. The overall implant survival over the time and the complication rate was acceptable.
Linnea Bøgeskov Schmidt, Sebastian Bjørck, Ilija Ban
Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark; Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark; Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
Background: Open reduction and internal fixation with volar locking plates (VLP) of distal radius fractures in adults is one of the most frequent surgeries in fracture management. The argument for surgery is improved functional outcome by achieving anatomical reduction of the fracture. However, the rate of postoperative complications is not negligible and some of these can be related to implant position and imperfection of the osteosynthesis.
Purpose / Aim of Study: To evaluate the radiological quality of open reduction and fixation of distal radius fractures with VLP.
Materials and Methods: Retrospectively we identified 354 adults treated with VLP for distal radius fracture at our facility in 2015 and 2016. Postoperative radiographs were reviewed for twelve predefined operative imperfections, chosen based on the literature and clinical experience: Incorrect screw length, intraarticular screws, missing screws in the distal row, <6 corticis proximal to the fracture, floating plate, incorrect plate size or position, ad latus displacement, dorsal angulation, insufficient radial inclination, positive ulnar variance and incongruent joint surface.
Findings / Results: Radiological imperfection was found in 332 cases (93,8%) with an average of 2,63 imperfections per osteosynthesis (IQR 2-4). The highest number of imperfections in a single case was eight out of twelve possible. More imperfections were identified in intraarticular fractures compared to extraarticular fractures (mean 2.87 vs 2.40, p-value=0,004). Suboptimal placement of the implants was most common (n=320 / 90,4% of all cases) with incorrect screw length (n=249 / 70.3%) and incorrect position of the plate (n=186 / 52.54%) as the main imperfections. Anatomical reduction was not achieved in 184 cases (52,0%), most commonly due to residual ulnar variance (n=64 / 18.1%) and dorsal angulation (n=61 / 17.2%).
Conclusions: Based on the finding of imperfections in almost all cases we conclude that osteosynthesis with VLP is not a simple procedure. Knowledge of proper implant positioning and normal anatomy is mandatory to achieve surgical perfection. However, it is uncertain whether perfecting the osteosynthesis will improve functional outcome.
Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark; Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark; Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
Background: Open reduction and internal fixation with volar locking plates (VLP) of distal radius fractures in adults is one of the most frequent surgeries in fracture management. The argument for surgery is improved functional outcome by achieving anatomical reduction of the fracture. However, the rate of postoperative complications is not negligible and some of these can be related to implant position and imperfection of the osteosynthesis.
Purpose / Aim of Study: To evaluate the radiological quality of open reduction and fixation of distal radius fractures with VLP.
Materials and Methods: Retrospectively we identified 354 adults treated with VLP for distal radius fracture at our facility in 2015 and 2016. Postoperative radiographs were reviewed for twelve predefined operative imperfections, chosen based on the literature and clinical experience: Incorrect screw length, intraarticular screws, missing screws in the distal row, <6 corticis proximal to the fracture, floating plate, incorrect plate size or position, ad latus displacement, dorsal angulation, insufficient radial inclination, positive ulnar variance and incongruent joint surface.
Findings / Results: Radiological imperfection was found in 332 cases (93,8%) with an average of 2,63 imperfections per osteosynthesis (IQR 2-4). The highest number of imperfections in a single case was eight out of twelve possible. More imperfections were identified in intraarticular fractures compared to extraarticular fractures (mean 2.87 vs 2.40, p-value=0,004). Suboptimal placement of the implants was most common (n=320 / 90,4% of all cases) with incorrect screw length (n=249 / 70.3%) and incorrect position of the plate (n=186 / 52.54%) as the main imperfections. Anatomical reduction was not achieved in 184 cases (52,0%), most commonly due to residual ulnar variance (n=64 / 18.1%) and dorsal angulation (n=61 / 17.2%).
Conclusions: Based on the finding of imperfections in almost all cases we conclude that osteosynthesis with VLP is not a simple procedure. Knowledge of proper implant positioning and normal anatomy is mandatory to achieve surgical perfection. However, it is uncertain whether perfecting the osteosynthesis will improve functional outcome.
Robert Gvozdenovic, Dejan Susic
Herlev-Gentofte University Hospital of Copenhagen, Department of Orthopedics, Hand Surgery Unit, Herlev-Gentofte University Hospital of Copenhagen, Department of Orthopedics, Hand Surgery Unit; Herlev-Gentofte University Hospital of Copenhagen, Department of Orthopedics, Hand Surgery Unit, Herlev-Gentofte University Hospital of Copenhagen, Department of Orthopedics, Hand Surgery Unit
Background: Arthroscopic treatment of the scaphoid nonunion is a minimally invasive technique, not interruptive to the patient´s blood supply and proprioception. Few studies enlightened the union rate and the exact heeling progress of the arthroscopic procedures in the scaphoid nonunion treatment, nor the feasibility of the method has been investigated in technically demanding cases.
Purpose / Aim of Study: The aim of our study is to present the results of the arthroscopically assisted, scaphoid nonunion treatment, using a local bone grafting from the distal radius and Mini Acutrak headless compression screw system, regardless the location of the nonunion, presence of cystic formations or humpback deformity.
Materials and Methods: From December 2015 to November 2019, 18 consecutive patients have been treated for the scaphoid nonunion, arthroscopically. All the patients but one was men, with the mean age of 24,2 years (range 14 –51). Ten patients injured their left hand, nine their dominant. Mean time from the injury to surgery has been 16 months (range 3 months – 15 years). 6 patients had nonunion of the proximal pole, 7 had humpback deformity of the scaphoid waist, thus having the risk of poorer outcome. 14 patients presented cystic formations. The union was determined by the CT- or X-ray follow-up studies and clinically. The assessment of pain (VAS score), range of motion (ROM), grip strength and Disabilities of the Arm, Shoulder and Hand (quick- DASH) Score were included. Surgery duration was recorded.
Findings / Results: 16 out of 18 patients were eligible for the minimum of 6 months follow-up, mean 8 months (range 6-12 m). No complication during the surgery or postoperative treatment were discovered. All patients but one heavy smoker achieved bony healing at the mean of 7,8 weeks (range 5 –18). All patients who united showed statistically significant, (p<0,05) improvement in pain, grip strength and the functional outcome as well as full satisfaction. ROM improved, not significantly. Duration of surgery diminished by time.
Conclusions: Arthroscopically assisted bone-grafting and compression screw fixation of established scaphoid nonunion yielded fast and high union rate, thus allowing fast functional recovery.
Herlev-Gentofte University Hospital of Copenhagen, Department of Orthopedics, Hand Surgery Unit, Herlev-Gentofte University Hospital of Copenhagen, Department of Orthopedics, Hand Surgery Unit; Herlev-Gentofte University Hospital of Copenhagen, Department of Orthopedics, Hand Surgery Unit, Herlev-Gentofte University Hospital of Copenhagen, Department of Orthopedics, Hand Surgery Unit
Background: Arthroscopic treatment of the scaphoid nonunion is a minimally invasive technique, not interruptive to the patient´s blood supply and proprioception. Few studies enlightened the union rate and the exact heeling progress of the arthroscopic procedures in the scaphoid nonunion treatment, nor the feasibility of the method has been investigated in technically demanding cases.
Purpose / Aim of Study: The aim of our study is to present the results of the arthroscopically assisted, scaphoid nonunion treatment, using a local bone grafting from the distal radius and Mini Acutrak headless compression screw system, regardless the location of the nonunion, presence of cystic formations or humpback deformity.
Materials and Methods: From December 2015 to November 2019, 18 consecutive patients have been treated for the scaphoid nonunion, arthroscopically. All the patients but one was men, with the mean age of 24,2 years (range 14 –51). Ten patients injured their left hand, nine their dominant. Mean time from the injury to surgery has been 16 months (range 3 months – 15 years). 6 patients had nonunion of the proximal pole, 7 had humpback deformity of the scaphoid waist, thus having the risk of poorer outcome. 14 patients presented cystic formations. The union was determined by the CT- or X-ray follow-up studies and clinically. The assessment of pain (VAS score), range of motion (ROM), grip strength and Disabilities of the Arm, Shoulder and Hand (quick- DASH) Score were included. Surgery duration was recorded.
Findings / Results: 16 out of 18 patients were eligible for the minimum of 6 months follow-up, mean 8 months (range 6-12 m). No complication during the surgery or postoperative treatment were discovered. All patients but one heavy smoker achieved bony healing at the mean of 7,8 weeks (range 5 –18). All patients who united showed statistically significant, (p<0,05) improvement in pain, grip strength and the functional outcome as well as full satisfaction. ROM improved, not significantly. Duration of surgery diminished by time.
Conclusions: Arthroscopically assisted bone-grafting and compression screw fixation of established scaphoid nonunion yielded fast and high union rate, thus allowing fast functional recovery.
Michelle Fog Andersen, Linnea Bøgeskov Schmidt, Marcus Landgren, Galal Hassani
Department of Orthopedic Surgery, Holbæk Hospital; Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre; Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre; Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre
Background: In displaced and non-reducible distal radius fractures (DRF), open reduction and internal fixation with volar locking plates (VLP) has become the gold standard. Despite good outcome, surgery is not without complications.
Purpose / Aim of Study: To evaluate the incidence of postoperative complications after surgical treatment of DRFs with the use of VLPs.
Materials and Methods: We retrospectively reviewed the medical records of all patients treated with VLP (2.4- mm LCP, Synthes) for a DRF between January 2016 and December 2018 at Hvidovre Hospital. All postoperative complications (defined as minor or major) were extracted and radiographically evaluated in regard to fracture type (AO/OTA classification), volar plate positioning (Soong grade) and dorsal screw prominence. Days from injury to surgery and surgeon’s experience were reviewed as well. Patients were followed for a mean of 2 (range 1 to 3) years after primary surgery.
Findings / Results: A total of 605 DRFs treated with VLP fixation in 599 patients (127 males, 472 females) were included and reviewed. The mean age was 61 years (range 19-93). Fractures were classified as AO 23-A (29.3%), 23-B (19.0%) and 23-C (51.7%). The overall complication rate was 12.6% (76 cases), with 8.8% major (n=53) and 3.8% minor (n=23) complications. The most common complications were those attributable to metal hardware leading to removal (3.6%), mainly due to intraarticular screw (1.5%) and pain/reduced ROM (1.5%). Carpal tunnel syndrome (1.8%), transient neurapraxia (1.7%), loss of reduction (1.7%) and tendon complications, i.e. tenosynovitis (0.5%)/ruptures (0.5%) were frequent complications as well. Secondary revision surgery was performed in 9.3% (56 procedures). An overall majority of complications were found in patients with Soong grade 1, but no association was found in regard to the surgeon’s experience or the fracture according to AO type.
Conclusions: The incidence of postoperative complications in DRFs is low after VLP fixation, suggesting surgical treatment is an efficient technique. However, secondary surgery does occur due to complications; some of them could have been avoided. Consequently, it is imperative that the surgeon is aware of the risks and difficulties related to the procedure.
Department of Orthopedic Surgery, Holbæk Hospital; Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre; Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre; Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre
Background: In displaced and non-reducible distal radius fractures (DRF), open reduction and internal fixation with volar locking plates (VLP) has become the gold standard. Despite good outcome, surgery is not without complications.
Purpose / Aim of Study: To evaluate the incidence of postoperative complications after surgical treatment of DRFs with the use of VLPs.
Materials and Methods: We retrospectively reviewed the medical records of all patients treated with VLP (2.4- mm LCP, Synthes) for a DRF between January 2016 and December 2018 at Hvidovre Hospital. All postoperative complications (defined as minor or major) were extracted and radiographically evaluated in regard to fracture type (AO/OTA classification), volar plate positioning (Soong grade) and dorsal screw prominence. Days from injury to surgery and surgeon’s experience were reviewed as well. Patients were followed for a mean of 2 (range 1 to 3) years after primary surgery.
Findings / Results: A total of 605 DRFs treated with VLP fixation in 599 patients (127 males, 472 females) were included and reviewed. The mean age was 61 years (range 19-93). Fractures were classified as AO 23-A (29.3%), 23-B (19.0%) and 23-C (51.7%). The overall complication rate was 12.6% (76 cases), with 8.8% major (n=53) and 3.8% minor (n=23) complications. The most common complications were those attributable to metal hardware leading to removal (3.6%), mainly due to intraarticular screw (1.5%) and pain/reduced ROM (1.5%). Carpal tunnel syndrome (1.8%), transient neurapraxia (1.7%), loss of reduction (1.7%) and tendon complications, i.e. tenosynovitis (0.5%)/ruptures (0.5%) were frequent complications as well. Secondary revision surgery was performed in 9.3% (56 procedures). An overall majority of complications were found in patients with Soong grade 1, but no association was found in regard to the surgeon’s experience or the fracture according to AO type.
Conclusions: The incidence of postoperative complications in DRFs is low after VLP fixation, suggesting surgical treatment is an efficient technique. However, secondary surgery does occur due to complications; some of them could have been avoided. Consequently, it is imperative that the surgeon is aware of the risks and difficulties related to the procedure.