The ligament ruptures and the metacarpal translation associated with these ruptures were measured mm. Cartilage thickness in the trapezium and metacarpal of specimens was assessed. We described the degree of degenerative changes using the stanging protocol to describe visual degeneration by Koff et al. We investigated the relationship between the ligament ruptures and the area of chondromalacia and OA.
Ligament lesions were found in all 25 specimens. Conclusion: These observations suggest a translation of metacarpal on trapezium in the production of arthritic lesions and support a hypothesis that pathologic joint instability could be a cause of CMC OA.
Purpose: Management of failed total wrist arthroplasty TWA can be challenging, and treatment options include salvage arthrodesis or revision arthroplasty. To our knowledge, there are no previously published series on this subject. The aim of the study was to report outcome after revision arthroplasty of the wrist operated at a Swedish referral center. Methods: A cohort of 18 consecutive revision TWAs was evaluated preoperatively, 1 and 5 years postoperatively.
Indication for revision arthroplasty was failed TWA. The operations were performed between and The primary endpoint was implant survivorship. Results: Of the 18 revision cases, 4 were revised after a mean of 4. Mean follow-up was 6. Synthetic bone graft was used in 9 cases, allogenous corticocancellous bone graft in 1 case, and cement in 6 cases. Of the revised cases, 1 TWA was removed because of infection and 3 cases underwent total wrist arthrodesis.
Range of motion and grip strength was preserved compared with preoperative results. VAS pain score at rest and in activity decreased considerably 1 year 0 at rest; 2. COPM performance and satisfaction were improved considerably 1 year 5. Conclusion: Revision arthroplasty of the wrist is a motion preserving option to wrist arthrodesis in the management of failed TWA.
Good functional outcome can be achieved in selected cases. To the best of our knowledge, there is no report in the literature concerning revision procedures in failed RSA. In the same period of time, we performed revision procedures due to persistent pain following an RSA. Twenty-one of these patients with a mean age of 59 years range, years demonstrated a proximalization and bony impingement.
In these cases, we performed a revision suspension using half of the ECRL tendon. After an average follow-up of 4 years, 15 patients 13 female, 2 male were available for a clinical and radiological follow-up examination, including range of motion Kapandji-Score , grip and pinch strength, as well as several clinical tests eg, grind test. Standard radiographs of the wrist and the thumb in two planes were obtained.
One of the 6 patients who could not be included in the follow up died, another refused follow-up due to total well-being and 4 patients moved and could not be located. Results: The time between RSA and revision averaged 2 years range, years. Clinical examination showed a positive grind test in 4 patients, and 11 patients remained free of pain. Eleven patients showed full opposition, and 4 patients showed mild restriction of opposition. The Kapandji score averaged 9. Postoperative pain on VAS was 3 at rest and 5 with activity, whereas it was 8 at rest and 9 with activity previous to revision.
Thirteen patients reported major improvement and 2 reported unchanged pain postoperatively. Fourteen patients were satisfied with the final result and would have the same procedure. Radiological evaluation showed a significant improvement in proximalization postoperatively. Twelve patients resumed the original employment, 10 of them performing heavy manual labor. The operation appears to be an effective revision procedure for patients with persistent pain due to proximalization of the first metacarpal bone and bony impingement following RSA.
Objective: Total joint arthroplasty of the trapeziometacarpal TMC joint is an option for the treatment of degenerative or posttraumatic osteoarthritis OA of the thumb. The purpose of this study is to analyze, retrospectively, results over 5 years for patients with OA of the TMC joint treated by arthroplasty with prosthesis.
Materials and Methods: Fourteen patients 13 female and 1 male with OA of the TMC were treated surgically by 1 surgeon from to The average age of the patients was 68 years; the youngest was 56 years. Indications for surgery were severe pain, loss of pinch strength, diminished thumb motion, and deformity Eaton and Littler stages III and IV. Contraindications were history of acute or chronic infection, pantrapezial arthritis, and scaphotrapezial arthritis.
The postoperative care included 3 weeks immobilization of the thumb followed by a rehabilitation program. The average follow-up time was 60 weeks. All patients were evaluated by objective and subjective parameters. Objective assessment included range of motion at the TMC joint flexion-extension, abduction-adduction, and opposition , grip and pinch strength tip pinch and key pinch , and loosening. Subjective assessment was pain related to activity of daily living and patient satisfaction after surgery.
The residual pain was assessed by visual analogue scale VAS. Radiographic follow-up included evaluation for migration and loosening of the stem and cup, and joint subluxation as defined by Wachtl. Power of oppositional pinch was average 4. Ten patients were free of pain, 3 patients reported mild pain after heavy work 2 of 10 of VAS.
Only 1 patient complained of prolonged pain 4 of 10 of VAS due to the development of trapezoid arthritis. He was successfully treated with a cortisone injection. Osteolysis developed around the 2 cups and the 3 stems of the implants. One patient had posttraumatic loosening of the stem which was revised and tightened. There were no radiological signs of subluxation or periprosthetic fractures.
The first 2 patients in this study were surgically treated 16 years ago, and they currently actively work with no complaints or complications. Conclusions: Data from our study with a minimum of 5 years of follow-up demonstrate that patients have excellent, pain-free range of motion, with no significant radiologic signs of implant loosening, periprosthetic osteolysis, or complications.
Total joint arthroplasty with prosthesis is a promising option for long-term restoration of the stability and mobility in a compromised TMC joint. Arthrodesis of the DIP joint is commonly performed for symptomatic arthritis that has not responded adequately to nonoperative treatment. Although a variety of techniques have been described for DIP joint arthrodesis, the end result is a motionless joint. DIP fusion also carries the risk of malunion, nonunion, and implant-related complications. We hypothesize that an alternative technique involving an open dorsal cheilectomy and DIP joint debridement would result in adequate pain relief and cosmesis, while preserving joint motion and avoiding the potential complications associated with DIP arthrodesis.
We present our experience with 78 patients with symptomatic osteoarthritis of the DIP joint who underwent an open dorsal cheilectomy and debridement of the DIP joint. Materials and Methods: There were 70 women and 8 men with a mean age of 64 years range, years at the time of the surgery.
The dominant hand was involved in 59 patients. The most common fingers were the middle 36 patients and index 33 patients. Preoperative radiographic assessment demonstrated Kellgren and Lawrence grade 3 osteoarthritis in 44 patients and grade 4 in 34 patients. At completion, the DIP joint was immobilized in an extension splint. At 4 weeks postoperatively, the splint was removed and physical therapy was initiated for active range of motion. At the final follow-up, pain level, satisfaction, and DIP joint range of motion were assessed.
Results: The mean final follow-up was 37 months range, months. All clinical parameters demonstrated statistically significant improvement at final follow-up. Mean patient pain visual analogue scale scores improved from 8. Patient satisfaction scores significantly improved by an average of 7 points. Mean flexion contracture of the DIP joint significantly improved from There were no postoperative infections or tendon rupture.
Six patients experienced mild extensor tendon weakness at the DIP joint. No patients required additional surgery. No other complications were encountered. Conclusions: Open dorsal cheilectomy and debridement of the DIP joint in patients with symptomatic DIP joint osteoarthritis is a safe and reliable alternative procedure. This surgical technique reduces pain while preserving DIP joint motion.
Methods: The 29 patients with monoarthritis of the wrist retrospectively reviewed in this study underwent preoperative MRI with or without a white blood cell WBC scan. Their diagnoses were confirmed histologically after open synovectomy. Receiver operating characteristic ROC curves were used to calculate the cutoff differentiating rheumatoid arthritis RA from other diseases.
The optimized cutoff point for each parameter was determined using Youden index. Results: The areas under the ROC curves for the synovitis, bone erosion, and bone edema scores were 0. The cutoff values of these scores to predict RA were 5, 48, and 19, respectively.
A multimodal diagnostic approach using MRI, WBC scan, and histologic evaluation is recommended if the diagnosis cannot be established based on clinical, biochemical, and radiographic evaluations. Interpreting the structure is complicated by the existence of multiple joints as well as variability in bone shapes and anatomical patterns in the wrist.
Previous studies have evaluated lunate and capitate shape in an attempt to understand functional anatomical patterns. The purpose of this study was to describe anatomical shapes and wrist patterns in normal wrist radiographs using bone shape and measurements of joint contact and position. We hypothesized that we will find significant relationships between measurements enabling us to identify one or more patterns of wrist anatomy.
Materials and Methods: Seventy plain posteroanterior and lateral wrist radiographs were evaluated. These radiographs were part of a previously established normal database, had all been read by a radiologist as normal, and had undergone further examination by 2 hand surgeons for quality. Measurements included lunate and capitate shape, ulnar variance, radial inclination and height, volar tilt, distance and angle between 2 lines of reference and percentage of the lunate and capitate radial to these lines as well as the percentage of capitate circumference on PA radiographs that articulate with the lunate, scaphoid, and trapezoid.
Type 1 wrists had a lunate with no contact on the PA radiograph with the hamate bone as described and a spherical distal capitate. Type 2 wrists had a lunate with a facet for the hamate bone and a flat distal capitate. Conclusions: We were able to identify significant relationships within the joints of the wrist, especially in midcarpal joint. Objective: Trapeziometacarpal TMC arthritis is the most frequent indication for articular reconstruction in the upper limb.
The surgical treatment is an option when conservative treatment fails, and TMC joint ligament reconstruction and tendon interposition arthroplasty has been used due to its predictable pain relief and low morbidity. However, there are complications related to this technique, such as donor site pain and tendon failure.
Thus, a technique combining trapeziectomy and first ray stabilization with suture has been increasingly used. In this study, we present our results with trapeziectomy and first ray stabilization with mini-tightrope at a minimum 4-month follow-up. Materials and Methods: Seventeen patients with TMC arthritis were treated surgically with trapeziectomy and first ray stabilization with percutaneous placement of mini-tightrope between and Four patients had had previous surgical treatment with Weilby or Burton-Pellegrini techniques that failed and in these patients trapeziectomy had already been done.
We selected patients who had not responded to physical therapy and who had no high force demand for daily activities. Patients had a minimum follow-up period of 4 months. In the postoperative period, we collected data related to pain using the visual analogue scale VAS , joint mobility, grip and pinch strength and we also evaluated patients with the Quick Disability of the Arm, Shoulder and Hand QuickDASH score.
Patient satisfaction with the procedure was also evaluated. Results: We treated 17 patients, 15 women and 2 men, with a mean age of 57 years. Postoperative mobility was good with total opponens, extension, and flexion of the first finger in all patients and mobility without limitation in their daily activities. The average postoperative grip strength was 20 vs Pinch strength was also decreased with an average postoperative terminolateral pinch strength of 3.
The majority of patients referred a high level of satisfaction with the procedure at 2 months postoperative, with return to their previous activities. We report necessity of removal of the mini-tightrope in 2 cases, one due to pain related to the metal implant of the mini-tightrope, without pain referred to the TMC joint, and another due to conflict between the base of the first and second metacarpal bones. We report 1 case of failure, which was later, revised with good preliminary results. Conclusions: The surgical treatment for TMC arthritis has many valid options.
First ray stabilization with a mini-tightrope appears to achieve good results, with pain relief, high patient satisfaction, and a quicker return to work compared with conventional suspension techniques. Few complications were reported in our sample. It appears to be a valuable solution, in order to maintain good mobility in patients with low strength requirements on their daily lives. Objective: Trapeziometacarpal osteoarthritis has a high prevalence. In the failure of conservative treatment, there are several surgical procedures, not having been proved to date the superiority of any of them.
The PyroDisk interposition implant was introduced in , and the few existing studies have short follow-ups. The objective of this study is to evaluate the clinical and radiological results of interposition arthroplasty with PyroDisk, after a minimum follow-up of 5 years. Materials and Methods: We conducted a retrospective, cross-sectional analytical study with a sample of patients undergoing arthroplasty with interposition PyroDisk between January and April , with a minimum follow-up of 5 years.
They were evaluated in individual interviews and through the clinical process: degree of satisfaction with the surgery, pain through visual analogue scale , degree of capacity for the tasks of daily living Disabilities of the Arm, Shoulder and Hand [DASH] score , palmar pinch and digital forces through dynamometers , mobility Kapandji score , and complications.
We proceeded to assess the progression of osteolysis by analyzing postoperative radiographs and using Herren scale peri-implant radiolucency adapted to the trapeziometacarpal joint. The statistical data analysis was done through SPSS v We evaluated 26 patients corresponding to 29 arthroplasties 3 bilateral , 24 females and 2 males, average age The dominant etiology was primary osteoarthritis The average follow-up was Results: We found a high degree of satisfaction The average Kapandji score at follow-up was 8.
The mean grip strength was We registered three complications The implant survival at 5 years was Conclusions: Although the presence of peri-implant osteolysis has been universal in our study, we have not seen any relationship between the degree of osteolysis and implant failure, patient satisfaction, or clinical outcome. Our study confirms the good 5-year clinical results of interposition arthroplasty with PyroDisk.
The observed lysis did not compromise the results. More research and greater follow-up are needed to study the effects of this long-term implant. Introduction: Pyrocarbon is a high-strength, low-friction carbon material. It is isoelastic to bone and therefore considered ideal for a hemiarthroplasty.
Pyrocarbon interposition arthroplasty is an alternative to the traditional tendon interposition arthroplasty in the trapeziometacarpal joint, but follow-up series are rare. Objectives: We aimed to evaluate the short-term results and safety of pyrocarbon prosthesis in a younger population. The mean age was 61 years range, years.
Four patients were males and 21 females. The mean follow-up time was 28 months range, months. Grip strength was recorded with a JAMAR dynamometer and the pinch grip strength as well as volar and radial thumb abduction noted. Results: Six prostheses were revised: 4 due to prostheses dislocation, 1 due to scapho-trapezium-trapezoid STT arthritis and persistent, and 1 due to persistent pain without any cause.
All 6 patients were converted into abductor pollicis longus APL tendon interposition arthroplasty. The average pinch grip strength was 5. The mean VAS pain at rest was 1. VAS pain at activity was 4. The average DASH score was 32 range, Conclusion: The use of PyroDisk arthroplasty gives good range of motion and pain relief at rest, and the pinch grip after mean 28 months was close to the nonaffected side but not completely normalized.
Objective: Four-corner fusion 4CF is an accepted and effective procedure for managing several degenerative disorders of the wrist. This procedure consists of the excision of the entire scaphoid in association with midcarpal fusion of the remaining carpal bones lunate, triquetrum, capitate, and hamate , and it is generally performed through an open approach. The combination of a minimal volar approach, for scaphoid excision, with arthroscopy preparation of midcarpal joint surfaces plus bone graft placing and percutaneous fixation techniques can, potentially, generate the best possible functional outcome by minimizing the effect of extra-articular adhesion related to open surgery.
The purpose of this retrospective study is to present the arthroscopically assisted 4CF performed in our practice and to evaluate the clinical and radiographic results. Materials and Methods: Eleven patients underwent scaphoidectomy and 4CF. In each case, the scaphoidectomy was performed through a minimal volar approach, and the midcarpal joint surfaces were denuded through dry arthroscopy. The regular midcarpal portals were used.
The bone graft was prepared from the excised scaphoid, and it was placed in midcarpal space using a 3. The fixation was achieved using headless cannulated compression screws. In the postoperative period, patients were put in a splint for 2 weeks. Range of motion exercises began 2 weeks after operation.
Functional outcomes were assessed by objective and subjective measures: range of motion, grip strength, Quick Disabilities of the Arm, Shoulder and Hand QuickDASH score, visual analogue scale VAS of pain, satisfaction, and return to work.
The x-rays were evaluated for union. The mean follow-up was of 20 months. Results: Mean surgery time was 2 hours. There was no need for conversion to the classic open procedure in any patient. Terminal to terminal pinch averaged 5. Mean VAS postoperative pain rating was 2, compared with 7 preoperatively. All the patients were satisfied and were able to return to their previous activities. Fusion was achieved in every patient, confirmed by x-rays taken at 10 months postoperative.
We had a surgery-related complication, a second-degree burn related with the use of the burr, which resolved with dressings, and there was a breakage of a screw in 1 patients, but in both cases fusion was achieved. Conclusion: Although technically demanding, in our opinion, the arthroscopically assisted 4CF seems a valid alternative to the classic 4CF procedure.
The preliminary results seem promising, but longer follow-up is needed to confirm the benefits of this technique. The ulnar head is today, however, considered to be essential for the wrist function and alternatives are being investigated. We present a 5-year clinical and radiological follow-up of a primary hemi-DRUJ resurfacing implant.
Materials and Methods: Between November and October , 12 female rheumatoid arthritis patients, mean age 59 years range, years , were operated with an uncemented metal hemiprosthesis First Choice, Ascension Orthopedics, Texas, USA. Ten patients had a concomitant partial or total wrist fusion. A follow-up protocol was designed before study start, and clinical and radiographic data were recorded prospectively at 1, 2, and 5 years.
Results: One patient was revised after 2 years due to a suspected low-grade infection, and 1 patient was reoperated due to reduced forearm rotation. All patients were subjectively and objectively stable at the 5-year follow-up.
Radiographically, a remodeling of the sigmoid notch was seen in half of the patients with a minor radial shift of the prosthesis into the radius in some patients. Bone resorption around the collar of the prosthesis was noted in all but one patient. In 3 of 11 patients, the resorption was within 2 to 4 mm from the collar and in 3 of 11 patients between 4 and 7 mm.
Only one patient showed a major resorption of 20 mm, and this was seen already at 2 years. This patient was the only one showing a subsidence of more than 2 mm. No radiolucent zone greater than 1 mm around the ulnar stem was observed. In 1 patient a thin zone, indicative of a loosening membrane was noted after 1 year, but no deterioration was seen over time.
Conclusions: The preliminary results of the prosthesis in rheumatoid patients are encouraging, and the patients report minimal discomfort, an acceptable range of forearm rotation, and a well-functioning stable wrist. The concept of using a hemiprosthesis thus seems to be appropriate also for the rheumatoid DRUJ, at least as seen in this medium-term study.
Longer follow-ups are of course necessary, especially evaluating the osseous reaction of the nonsubstituted subchondral bone on the radial side, as well as the long-term stability of the joint. Background: Degenerative thumb carpometacarpal CMC joint osteoarthritis is a common disease in middle-aged woman. Nevertheless, synovitis and initial cartilage damage starts earlier and then progressive degenerative arthritis develops, leading to joint narrowing with progressive exposure of subchondral bone, osteophyte formation, subluxation, and deformity involving also the surrounding joints.
The aim of this study is to evaluate the outcome of the patients treated with autologous chondrocyte transplantation at thumb CMC joint. Materials and Methods: Ten cases of thumb carpometacarpal thumb osteoarthritis, stages II and early III, were treated by arthroplasty with the implant of autologous chondrocyte transplantation by open or arthroscopic technique. Preoperatively all patients had persistent pain reluctant to different kinds of nonoperative treatments for at least 6 months.
Mean preoperative pinch was 3. All patients had a limitation of abduction and flexion at maximal degrees. Ethic committee approval of our institute had been obtained. Fragments of 3 to 4 mm of cartilage were harvested under arthroscopy or by open technique from the wrist or elbow joint. Cartilage cells were sent to laboratory to grow on a collagenous biphasic matrix Novocart.
After 3 weeks, it has been possible to implant the chondrocyte-augmented scaffold in thumb CMC joint using fibrin glue or freeze them to have the second operation later. Dominant hand was treated in 6 cases; 2 patients had bilateral operation. In 8 cases, the patients were operated by open technique, and dorsal ligaments reconstruction was associated to stabilize the CMC joint.
Patients were reviewed at a mean follow-up of 6. Results: Impairing pain disappeared in all patients, and full range of motion was obtained in all cases. Mean pinch increased to 6. No complications occurred postoperatively. Two patients had persistent mild pain, 1 resolved spontaneously after 7 months. One patient was lost at follow-up. Conclusions: The results obtained are encouraging and implanted cartilage has lasted in the majority of cases up to 5 to 9 years. Tissue reconstruction is developing and could be an optimal solution to restore normal cartilage in young patients in order to postpone more aggressive procedures to an older age.
In cases of instability, it is necessary to associate a ligament stabilization procedure to avoid subsequent damage to implanted cartilage. A longer follow-up and a greater number of cases are necessary to definitively establish the usefulness of this procedure that has the advantage of being completely biological but has high costs.
Background: Thumb base arthritis is a common condition. Arthroscopic or arthroscopic assisted procedures offer better visualisation, less invasiveness and faster recovery than traditional open procedures; it also helps to guide decision making if further treatment is necessary. Methods: A review of cases who received arthroscopic procedures from April to August was performed. First carpometacarpal joint arthroscopic debridement was done in 76 patients, and synovectomy was performed in 65 patients female 51, male 14 with an average age of All patients failed nonoperative care for 6 months.
The average follow-up duration was 59 months. The operation was done under local or regional anaesthesia. Synovectomy, debridement of frayed capsule and radio-frequency ablation were done in all, loose bodies were removed in 25, and thermal shrinkage was done in 30 cases. Post-thermal shrinkage immobilisation was given for weeks. Results: 69 cases experienced pain relief after the operation.
Mean grip strength of Kapandji index was 8. DASH score was Patient satisfaction was 77 of There was no complication encountered. Conclusion: Long-term results of arthroscopic debridement and synovectomy, the surgical techniques, and the examples of arthroscopic assisted procedures at the thumb base were demonstrated and discussed.
Arthroscopic surgery for thumb base arthritis is a safe and feasible procedure that can provide long-lasting symptom relief. Introduction: Volar oblique ligament VOL is known as a primary trapeziometacarpal joint stabilizer. Because ligament laxity is one of most important cause of thumb basal joint arthritis, Eaton and Littler introduced their technique reconstructing VOL as a treatment of that; however, they recommended using this treatment only for Eaton-Littler stages I and II through their study result.
Material and Methods: We analyzed 21 patients who had undergone surgery for thumb basal joint arthritis in our hospital from May to October and had a minimum 12 month follow-up. All patients were women and the mean age at diagnosis was The stability of basal joint and progression of arthritis were also evaluated. Wilcoxon rank sum test was used for statistical analysis.
The mean follow-up period was Two of 6 patients with stage III osteoarthritis showed poor result. At last follow-up, average grip power was The stability of VOL-reconstructed basal joint were restored and maintained in 15 of 21 joints. Conclusion: Our results suggested that VOL reconstruction is a reliable method for management of Eaton stage I and II osteoarthritis and can be applied even in early Eaton stage III osteoarthritis before performing salvage procedures. Introduction: Carpometacarpal CMC joint osteoarthritis critically impacts activities of daily living.
Pain is the main reason for a consultation to the hand therapy clinic as described in the literature, and conservative treatment, typically an orthosis, is the first intervention of choice. A thumb orthosis is a specific nonoperative palliative treatment for CMC joint osteoarthritis for improving function and comfort.
A variety of thumb orthoses are described in the literature, but there is no supporting evidence highlighting the use of a specific orthotic design for short-time effect on pain and function. Purpose of the Study: The study was conducted to compare the short-term effect of 2 different thumb CMC orthoses on pain reduction as a primary outcome and improved hand function as a secondary outcome. Methods: A total of 66 patients were included in the study.
Both orthotic designs were custom fabricated for each patient. Results: Differences in pain scores and functional scores were found in both groups after the one-week washout period compared with baseline, but did not differ significantly between the two groups.
With respect to pain intensity, the mean pain score decreased from 7. Conclusion: The present study adds to our therapeutic knowledge base regarding the benefits of 2 different thumb orthotic designs on pain reduction and functional improvement in the first week using orthoses as an exclusive conservative treatment.
Materials and Methods: On days 1, 3, and 6 after tendon injury and surgical repair, reverse transcription-quantitative PCR RT-qPCR was used to assess messenger RNA mRNA expression levels for genes encoding the mucinous glycoprotein PRG4 also called lubricin , and a subset of matrix proteins, cytokines, and growth factors involved in flexor tendon repair. RabPXL01 in HA was administrated locally around the repaired tendons, and the mRNA expression was compared with untreated repaired tendons and tendon sheaths using analysis of variance.
Conclusions: These findings suggest that rabPXL01 in HA increases lubricin production while diminishing inflammation, which correspondingly reduces the gliding resistance and inhibits adhesion formation after flexor tendon repair. The size of contact area and the amount of force applied to the objects were evaluated and compared in 4 different active process of grasping the sample object and functional process of using the object functionally grip patterns.
Materials and Methods: Study includes right-handed healthy 80 participants 43 female, 37 male between the ages of 18 and 65 years. The glove has 17 sensorial areas 14 in the fingers, 3 in palm on the palmar surface of hand. Different objects were used for measurements; the plastic bottle for standard grip, the screw for pinch grip, the key and the lock for lateral grip, g metal object for tripod grip. The location of maximum force and contact area between the object and hand were determined.
Functional grip elevated the force amount and the contact area size compared with active grip. The maximum force occurred in the pulp of the middle finger for both active and functional tripod grip. The biggest force amount was observed on the radial sides of hand during standard grip. Although the required active grip force for holding the g plastic bottle was 3 fold higher than the bottle weight, required functional grip force was 7 fold higher.
Different grip forces were seen for grasping the g metal object actively and functionally. Active force necessitated 2 fold of object weight, whereas the functional grip necessitated 3 fold of object weight. Conclusions: These results of our study showed that grasping analysis, which is important part of the hand assessment, should be evaluated not only actively but also functionally.
We believe that our study will bring a new perspective to the grip analysis. Our data could be beneficial in hand surgery, process of hand therapy, and also robotic and electronic hand prosthesis. Objective: Recent published experimental investigations have shown the relevance of the forearm muscles in providing dynamic stability to the scapholunate joint, in the wrists without osteoarthritis.
Some chronic scapholunate advanced collapse SLAC wrists remain long time asymptomatic; the reason is unknown. How do forearm muscles influence on SLAC wrists? The kinetic behavior of an experimentally acute sectioned ligament compared with a SLAC wrist has not been determined. The hypothesis of this experimental biomechanical study was that there are no differences in SLAC and recent scapholunate instability wrists kinetics.
Methods: The kinetic effects of isometric loading of 5 wrist motor tendons abductor pollicis longus [APL], extensor carpi radialis longus [ECRL], extensor carpi ulnaris [ECU], flexor carpi ulnaris [FCU], and flexor carpi radialis [FCR] on 12 fresh normal cadaver arms in which scapholunate ligament was sectioned and in 5 wrists with a SLAC pattern of carpal osteoarthritis were analyzed. A custom-designed testing apparatus was used to hold the forearm and wrist vertical in neutral position.
A 6 degree-of-freedom electromagnetic motion tracking device with sensors attached to the scaphoid, triquetrum, capitate, and radius was used to monitor spatial changes in carpal bones alignment. The rotation sustained by the scaphoid in both experimentally acute sectioned scapholunate ligament and chronic SLAC groups were measured and statistically compared. Results: When all tendons were simultaneously loaded, no statistical differences were observed between the 2 groups: The proximal carpal row, as opposed to the normal wrist, tended to pronate in both situations.
Under individual muscle loading, the kinetic carpal behavior of both groups was also the same, with no statistical differences between them: The ECU is the only muscle that provokes scaphoid pronation; all other muscles induce its supination.
Isometric ECU contraction causes significant radioscaphoid subluxation, with the scaphoid rotating into substantial pronation average 4. None of the other muscles exhibited such an obvious destabilizing effect. The experimental kinetic behavior of the chronic SLAC wrist is similar to the one with a recent scapholunate dissociation without carpal collapse associated. In both groups 1 the direction of the scaphoid displacement is the same flexion, pronation and radial deviation , although the magnitude of the scaphoid displacement is greater in the SLAC wrists group, and 2 the ECU muscle load destabilizes the scapholunate joint, although SL joint destabilization is greater in the SLAC wrist group.
Conclusions: These findings suggest that, in SLAC wrists, the capsular distension associated to a chronic malfunction of the carpus plays a significant role in the magnitude of the carpal bones displacement under load, and that in patients with scapholunate instability, both with and without carpal collapse associated, ECU muscle contraction should always be avoided. Background: Insertion of the distal radioulnar ligaments onto the distal ulna is critical to provide translational stability and rotational guidance of the forearm.
However, the topographic anatomy of the footprints of these ligaments and their relationships with morphometry of the distal ulna remain unclear. Purpose: We provide a detailed description of the anatomy and the relationships described above in a cadaveric study.
Methods: Seventeen human distal ulnas attached by both the superficial and deep limbs of the distal radioulnar ligaments were scanned using micro-computed tomography and reconstructed 3 dimensionally. Results: The deep limbs have narrow marginal insertions just behind the pole of the distal ulna, but the width of the footprint was larger at the fovea than at the peripheral lesion.
The superficial limb footprints were the circular and condensed shape. The center of the deep limb was radially distant from the base of the ulnar styloid by a mean of 2. The mean distance between the center of the ulnar head and the center of the fovea was 2. Conclusions: The deep limb has a narrow marginal insertion just behind the pole of the distal ulna, suggesting its role as the capsular ligament.
The center of the fovea is located more radially from the ulnar styloid base. The data provide a better understanding of distal radioulnar ligament-related pathology to perform distal ulnar fixation or ligament repair to recover distal radioulnar joint stability. Yet they are rarely assessed in relation to wrist and forearm pathologies, or their treatments.
Absence of reliable methods that are easy to use might be one reason for this discrepancy. We designed 2 new procedures to quantify forearm torque and lifting strength in a clinical setting. The objective of this study was to determine the intra- and interrater reliability of these methods.
Materials and Methods: We used 2 commercially available dynamometers, the digital Baseline wrist dynamometer and the Kern hanging scale, to develop 2 procedures to measure forearm torque and lifting strength. Two assessors used the new techniques to test 15 healthy volunteers, 10 females and 5 males. Each assessor measured each participant on 3 occasions. Torque was tested for supination and pronation. Lifting strength was tested in 3 forearm positions, supinated, pronated, and neutral position.
As raters were fixed ICC model 3 was used with single measurements to determine consistency in agreement. Results: Torque: The intrarater reliability coefficients for test-retest observed for the Baseline dynamometer were for both raters between 0. Lifting strength: The intrarater ICCs for the different forearm positions were nearly the same for both investigators 0.
Conclusions: Both the Baseline and Kern dynamometers demonstrated excellent intra- and interrater repeatability. The quality of measurements performed with our new methods is sufficient for future studies of forearm torque and lifting strength. Simple, yet reliable methods to quantify torque and lifting strength in a clinical setting have the potential to improve evaluations of wrist and forearm disorders as well as their treatments.
Objective: There is increased clinical use of 3-dimensional 3D virtual planning and 3D printed patient-specific guides to correct malunited fractures. Previous studies have investigated the accuracy and possible improvements in outcome for this technology. The focus has foremost been on the benefits of the 3D printed guides while little research is done on the impact of the preceding 3D virtual planning.
The main purpose of this study was to examine if the 3D virtual planning process had affected the final choice for treatment. Materials and Methods: This retrospective study reviews a consecutive series of 23 cases of corrected malunited radius fractures, treated between and Bilateral, high-resolution forearm computed tomographic CT scans were acquired from each patient.
With use of Materialise Mimics software, 3D models that could be digitally manipulated were created. For all but 1 patient, the healthy forearm was mirrored and used as a template for correction. Three-dimensional virtual planning took place during web meetings between the surgeon and the clinical engineer. Different osteotomy locations and angles and different fragment positions and osteosynthesis plates were digitally evaluated.
This allowed the surgeon to choose his preferred treatment plan based on the virtual plate fit, fragment position, bone contact surface, natural ulnar variance seen on the contralateral side, and evaluation of the distal radioulnar joint congruency after virtual reduction.
Our review consisted of comparing the preliminary preoperative surgical plans before interaction with the surgeon and the clinical engineer, derived from 2D planning with either standard radiographs or CT images, with the final chosen 3D surgical plan after interaction. The 3D virtual planning was considered to be different from the preliminary 2D planning when it demonstrated the need for at least 1 of the following: A plate contouring, B bone removal for improved plate fit, C change in osteotomy levels or directions, D double level osteotomy, E change in ulnar variance from neutral, F over- or undercorrection compared with the parameters of the contralateral side, G not using the contralateral side as a template for correction, H avoiding corrective osteotomy.
Results: The preliminary 2D surgical plan before interaction between surgeon and clinical engineer was changed for 14 of the 23 patients. For the remaining 9 cases, the preliminary preoperative plan was chosen as final procedure. Conclusion: Limitations of this study include the retrospective design. As a consequence, details of the preoperative radiological planning were not comprehensively defined. Selection of a more ideal surgical method has the potential to improve outcomes of corrective osteotomies.
Objective: The treatment of segmental bone defects remains challenging as complications frequently occur with the currently available methods, including vascularized autograft, prosthetic replacement, bone transport, and cryopreserved bone allograft CBA.
Although the use of CBA is comparatively simple, it lacks donor site morbidity and provides immediate stability; however, the grafts remain largely necrotic, resulting in high failure rates due to nonunion, infection, and stress fractures. Revitalizing the CBA has the potential to solve these problems. Previous studies in small animal models have shown the use of surgical revascularization to induce neoangiogenesis and improve bone viability in the CBA. The purpose of this study is to investigate if surgical revascularization enhances bone circulation and bone remodeling in a tibial defect orthotopic reconstruction model, placing a cryopreserved allograft in a Yucatan mini pig.
Methods: Cryopreserved tibial bone allografts were transplanted in swine leukocyte antigen SLA -type-mismatched Yucatan mini pigs after creating a 3. The anterior tibial arteriovenous bundle AV-bundle was inserted into the intramedullary canal. Eight pigs received a patent AV-bundle revascularized group , 8 pigs received a proximally ligated AV-bundle control group , and the contralateral side was used as an untreated control.
The graft was fixated with a locking compression plate to provide a weightbearing construction. After 20 weeks, the pigs were killed and the tibia was removed and analyzed. Neoangiogenesis was evaluated by quantifying vascular volumes using the microcomputed tomography. Bone remodeling was measured by quantitative histomorphometry and micro-computed tomography.
Results: Seven AV-bundles in the revascularized group were patent and 1 bundle was thrombosed due to partial dislocation of the graft. All patent bundles showed neovascularization extending into the cortical bone. There was no statistical significant difference in outer cortical bone formation between the revascularized and the non-revascularized allografts. Conclusion: Surgical revascularization of porcine tibial CBAs by implantation of an AV-bundle creates an enhanced autogenous neoangiogenic circulation and accelerates active bone formation.
Objective: Hand strength is an important independent surrogate parameter to assess outcome and risk of morbidity and mortality. This study aimed to determine the influence of cofactors in the grip strength in a sample of the population of our country.
We carried in each individual, 5 measurements alternately in each hand, calculating the average value. Measurements were done in neutral position of arm, forearm, and wrist with Jamar Hydraulic Hand Dynamometer. We also note the active side, profession, height, weight, and size of the hand. The results were statistically analyzed using SPSS. The sample characterization was performed by frequency analysis. Analysis of variance was used to study the correlation between variables. Grip strength peaks at 40 to 49 years of age with an important difference between those with less then 50 years and with more then 50 years old.
Anthropometric variables such as hand size or sex showed a positive correlation with grip strength. Body mass index and type of work showed only a partial positive correlation or no correlation with grip strength. Conclusion: Easy-to-measure cofactors such as sex, age, and hand size have a high accurate prediction of normative pinch strength.
Body mass index and type of work did not demonstrate significant predictive value. We recommend side adjustment of measured values for intraindividual comparison and inclusion of information regarding anthropometric characteristics, as well as using gender and age-adjusted reference values. Objective: There is an increased need for evidence-based data in surgery. The scientific value of old-fashioned retrospective studies with a lot of inaccurate data nowadays is limited. A well-designed prospective trial needs a great amount of work and important financial support.
Our objective is to present and share this system with our colleagues. Methods: We have prepared the structure of a web-based system with well-designed questionnaires for different hand disorders. The questions are specific for the investigated problem. The number of questions is limited in order to make possible data collection and registration during the real-life patient care.
Filling a questionnaire should be less than 2 minutes at a time. Privacy regarding patient and uploader the only owner of the uploaded data has the priority during all the process. As the questionnaires are uniform, the system makes it possible to compare the outcome data of the different users or institutes but only based on their decision and agreement of collaboration.
Even small number of cases or rare conditions based on a multicenter upload of the system can provide statistically sufficient series in a relatively short period. Results: A pilot study using the aforementioned structure is already running for carpal tunnel syndrome, trigger finger, metacarpal fractures, and extensor tendon injuries, and there are several more condition protocols under construction. Only a few months of data collection for the carpal tunnel syndrome has demonstrated the unforeseen value of the system as in a few hours, 5 different hypotheses of this condition were able to be confirmed or denied.
The easily achievable large number of patients makes possible the construction of several evidence-based data and conclusions in a relatively short time. Conclusions: By using our register with a little effort on filling a questionnaire at every patient meeting, the benefit will be almost the same as of a prospective trial. This way, the cost-benefit ratio can be changed to your favor.
The information from the database could be used to evaluate your own results, compare them with other colleges, organize multicenter studies, and present them at live events or publishing them. This process is time limited, as the tissue has to be revascularized within 4 to 6 hours to minimize ischemia reperfusion IR injury. Normothermic perfusion was proposed as an alternative method of preservation in solid organ transplantation.
This method helps to avoid complications associated with cold preservation and maintains tissue viability without inducing IR injury. Using this method, previous investigators demonstrated its potential to prolong swine forelimb allograft survival up to 24 hours. In this study, we aimed to test this system on human forearm allografts.
Material and Methods: Five human forearms were procured from brain-dead adult donors under tourniquet control. Following elbow disarticulation, the brachial artery was cannulated. Muscle biopsies flexor carpi radialis were obtained at 0, 12, and 24 hours. Results: Average warm ischemia time was 76 minutes. Perfusate had an average pH of 7. Electrolytes sodium, potassium, chloride remained within a physiologic range. Lactate started to increase steadily throughout the experiment; however, neuromuscular electrical stimulation revealed ongoing contraction throughout the experiment.
Hematoxylin-eosin staining showed mild fatty infiltration on some myocytes at 24 hours. There was minimal change in fiber size, likely due to variation in age and gender between donors. Muscle architecture was preserved at the end of 24 hours perfusion. Conclusions: All limbs remained viable after 24 hours of near-normothermic ex situ perfusion as evidenced by ongoing neuromuscular stimulation.
While no assumptions can be drawn about the long-term function of the extremity, this approach could help extend VCA transplantation to a wider geographic area. It also has the potential to circumvent complications associated with cold preservation. Background: Macrodactyly is a congenital disease characterized by the aggressive overgrowth of adipose tissue in digits or limbs, with or without hyperostosis and nerve enlargement.
To reveal the pathological feature of this disease, the biological characteristics of adipose-derived stem cells ADSCs in macrodactyly Mac-ADSCs were systematically investigated in this study. Methods: Cell morphology was observed by microscopy; cell surface markers, cell cycle, and apoptosis were analyzed by flow cytometry, and cell proliferation was evaluated using MTT assay.
Adipogenic, osteogenetic, and chondrogenic differentiation potential were also tested. The osteogenic capability significantly increased and chondrogenic potential also enhanced, while the adipogenic potential was decreased. Conclusions: These biological characteristics were in accordance with the clinical manifestation of abnormal fat accumulation and bone hypertrophy in macrodactyly. Literature Updates. For Members. For Librarians. RSS Feeds. Chemistry World. Education in Chemistry.
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|Bet awards on bet||Six bone models from each group were tested for maximum bending force, maximum torsional force, and fatigue property. If remnant of the proximal phalanx was present, the toe phalanx was placed on the top of the remnant with 3 or 4 nonabsorbable sutures. Fusion was achieved in every patient, confirmed by x-rays taken at 10 months postoperative. The size of these branches at the proximal phalanx level was similar to that of the corresponding proper digital nerve at the level of the DIP joint. Fourteen patients were satisfied with the final result and would have the same procedure.|
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|Online baby betting pool||Pyrocarbon interposition arthroplasty is an alternative to the traditional tendon interposition arthroplasty in the trapeziometacarpal joint, but follow-up series are rare. Univariate analysis showed that only a few of the baseline variables correlated with postoperative outcome measurements at 12 months. According to the results of this research, a flap based on this CB may be raised to cover the volar wrist and palm in case of recalcitrant carpal tunnel and other deficits of coverage tissue. The average postoperative grip strength was 20 vs You have access to this article.|
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