Wrist arthrodesis using a Synthes wrist fusion plate

Thirty-nine patients were retrospectively reviewed after a wrist arthrodesis using a Synthes wrist fusion plate and iliac crest bone graft. Information was obtained from review of patient files, a questionnaire to assess pain, function and work status, and clinical assessment of grip strength, forearm rotation and fingers motion. All wrist fusions united except that the index carpometacarpal joint failed to unite in one patient. Thirty-seven patients were satisfied with the procedure, noting a reduction in wrist pain after fusion, but all reported some limitation of function. The wrist fusion plate was removed in six patients and a further four patients experienced minor symptoms over the dorsal aspect of the middle finger metacarpal.     

近排腕骨切除术治疗腕骨陈旧性骨折脱位

陈旧性腕骨骨折脱位临床上比较常见,多由于早期治疗不当所致,常有腕痛、腕关节活动受限及握力减弱,给患者带来工作和生活上的不便.作者自1986年5月至1999年6月共收治该类患者88例,对其中32例实行了近排腕骨切除腕关节成形术,经3月至10年随访,效果满意.     

Wrist arthrodesis with the AO titanium wrist fusion plate: a consecutive series of 42 cases

In a 4 year period (1996-1999), 42 total wrist fusions in 25 men and 17 women were performed using the AO/ASIF Titanium wrist fusion plate. The median age of the patients at the time of surgery was 41 (range, 19-72) years. The indication for fusion was post-traumatic arthritis in 29 wrists, Kienb?ck's disease in eight, rheumatoid arthritis in three, mono-arthritis in one and Volkmann's contracture in one. All patients were reviewed at a median follow-up of 23 (range, 6-50) months. The Buck-Gramcko and Lohmann score for functional evaluation was excellent in 35, good in 5 and satisfactory in 2 patients. We conclude that wrist arthrodesis with the AO/ASIF Titanium wrist fusion plate is an excellent option for treatment of various painful disorders of the wrist.     

Midcarpal arthrodesis with complete scaphoid excision and interposition bone graft in the treatment of advanced carpal collapse (SNAC/SLAC wrist): operative technique and outcome assessment

Thirty-six patients with stage II or III SNAC and SLAC wrists were treated by midcarpal arthrodesis and complete scaphoid excision. When assessed at a mean follow-up of 25 months, pain was significantly reduced both under resting and stress conditions. The active range of motion was 54% of the contralateral wrist and grip strength was 65% of the non-operated hand. The mean DASH score was 28 points, the Mayo wrist score was 63 points, and the Krimmer wrist score was 68. Correlation of the wrist scores with the DASH values demonstrated a significant correlation. Our data demonstrate that midcarpal fusion with complete excision of the scaphoid is a reliable procedure for treating advanced carpal collapse.     

Degenerative arthritis of the wrist: proximal row carpectomy versus scaphoid excision and four-corner arthrodesis

Two cohort populations of 19 patients from separate institutions performing exclusively either a scaphoid excision and 4-corner arthrodesis (lunate, capitate, hamate, and triquetrum) or proximal row carpectomy (PRC) for scapholunate advanced collapse arthritis were compared. There were no preoperative differences with respect to age, gender, dominance, stage of arthritis, or preoperative measures of pain and function. The length of the follow-up period averaged 28 months for the 4-corner arthrodesis group compared with 19 months for the PRC patients. At the follow-up examination wrist motion revealed no significant differences in the flexion-extension arc, averaging 81 degrees in the PRC patients and 80 degrees following 4-corner arthrodesis, which was 62% and 58%, respectively, of the opposite wrist. The 4-corner arthrodesis patients maintained greater radial deviation and total percent radial-ulnar deviation of the wrist. Grip strength averaged 71% for the PRC group compared with 79% for the 4-corner arthrodesis patients. Pain relief was similar using a variety of measures and patient satisfaction was equivalent. Function was similar except that the 4-corner arthrodesis patients scored significantly higher on the mental health component of the short form-36 health status survey. No differences were seen on the physical health component or an outcome scale specifically designed for the wrist. Both PRC and scaphoid excision and 4-corner arthrodesis are motion-preserving options for the treatment of scapholunate advanced collapse arthritis with minimal subjective or objective differences in short-term follow-up evaluations.     

腓骨近端移植治疗桡骨远端骨巨细胞瘤:关节融合与成形的比较

[目的]回顾性比较研究桡骨远端骨巨细胞瘤切除后采用腓骨近端移植行腕关节成形术和腕关节部分融合术的临床疗效。[方法]2006年2月~2012年5月,采用桡骨远端瘤段切除自体腓骨移植重建腕关节方法治疗16例桡骨远端Ⅱ、Ⅲ级(Campanacci分级)骨巨细胞瘤患者。男8例,女8例,年龄19~55岁,平均35.40岁。病程1个月~2年,主要症状为关节疼痛、肿胀及活动受限。9例行部分腕关节融合术,7例行腕关节成形术。[结果]术后切口均一期愈合。所有患者均获随访,随访时间4.00~10.20年,平均6.40年。1例融合病例出现腓骨-舟月骨界面不愈合,排除出该研究。随访期间所有病例肿瘤无复发。融合术病例:腕关节屈伸(55.63±6.78)°,前臂旋转(126.25±14.58)°,平均握力为对侧的(75.14±5.74)%,MSTS评分平均为(25.5±0.76)分。成形术病例:屈伸(72.86±15.24)°;前臂旋转(140±14.72)°,平均握力为对侧的(60.62±11.83)%,MSTS评分平均为(25.86±1.46)分。前臂旋转功能方面两组差异无统计学意义;腕关节屈伸活动成形组优于融合组,而手腕握力融合组优于成形组,差异有统计学意义;但两组MSTS评分差异无统计学意义。[结论]瘤段切除自体腓骨近段移植重建腕关节是治疗桡骨远端骨巨细胞瘤的良好方法,腕关节成形术和腕关节部分融合术都能保留一定的腕关节功能,都是安全、有效的重建方式。应根据患者的实际情况作出个性化选择。     

Comparison of open isolated subtalar arthrodesis with autogenous bone graft versus outpatient arthroscopic subtalar arthrodesis using injectable bone morphogenic protein-enhanced graft

Isolated subtalar joint arthrodesis is an established salvage procedure that can be performed in various ways for varying diagnoses. The purpose of this article is to report a new arthroscopic subtalar arthrodesis technique that has been developed. The results of this method versus an open technique were compared. Length of hospital stay, tourniquet time, morbidity, and fusion rate were studied in 17 fusion patients between 1990 and 1997. Twelve patients had open arthrodesis with bone graft and 5 patients had arthroscopic arthrodesis with supplemental, injectable, osteoinductive enhanced-graft gel. The length of stay decreased 1.7 days with the arthroscopic procedure. Tourniquet time was not significantly different. One open procedure required refusion, whereas none did in the arthroscopic group. One patient in each group required AO screw removal. In selected patients with subtalar arthrosis without significant hindfoot deformity, arthroscopic arthrodesis can be an effective. It is too early to determine if there are specific advantages in this procedure compared with a conventional open arthrodesis.     

Operative technique of distal radius resection and wrist fusion with iliac crest bone graft

Malignant lesions of distal radius and appropriately selected cases of benign aggressive lesions (giant cell tumor) of distal radius require resection for limb salvage. Post resection, reconstruction of that defect can be accomplished by either arthrodesis or arthroplasty both having their own pros and cons. In cases undergoing arthrodesis as modality of reconstruction, small defects (≤6 cm) can be reconstructed using autologous iliac crest bone graft which results in good cosmetic appearance and functional outcome. We have described in detail, the preoperative planning, surgical steps and rehabilitation of wrist fusion with iliac crest bone grafting post distal radius resection.     

Treatment of multilevel cervical spondylotic myeloradiculopathy with posterior decompression and fusion with lateral mass plate fixation and local bone graft

This is a retrospective review of 32 patients with multilevel cervical myelopathy treated by laminectomy and lateral mass plate fusion. The prognosis of surgically treated myelopathy is evaluated as well as prognostic factors for recovery of myelopathy. Diagnoses included cervical spondylosis or ossification of the posterior longitudinal ligament. Final follow-up was at 15.2 months (mean) postoperatively. Myelopathy was graded preoperatively and postoperatively by the system of Nurick. All patients had preoperative radiographs and magnetic resonance imaging (MRI). The presence of abnormal T2-weighted MRI signal (myelomalacia) was noted. Postoperative studies included flexion-extension radiographs to assess fusion and MRI to evaluate decompression of neural elements and resolution of myelomalacia. Severity of preoperative Nurick myelopathy, presence of myelomalacia, and age were evaluated as potential prognostic indicators for surgically treated myelopathy. Mean Nurick score improved from 2.6 (range 1-4) to 1.8 (range 0-3) postoperatively (p < 0.0001). Twenty-two patients (71%) had improvement in Nurick grade of at least one point, and nine showed no improvement. No patients had deterioration of Nurick grade. Preoperative myelomalacia was noted in 15 (47%) patients, and all 15 had residual myelomalacia postoperatively. Severe myelopathy, age, and myelomalacia had no prognostic value for improvement of myelopathy. Complications included pseudarthrosis (3%), wound infection (9%), and transient C5 palsy (6%). This study demonstrates excellent outcomes from laminectomy and fusion in multilevel cervical myelopathy. A high rate of improvement of myelopathy was observed, neurologic deterioration did not occur, and complication rates were low. Severe myelopathy and myelomalacia on preoperative MRI had no prognostic value.     

Comparative study of iliac bone graft and carbon cage with local bone graft in posterior lumbar interbody fusion

We performed a comparative study of iliac bone graft (the iliac bone group) and carbon cage with local bone graft (the cage group) in PLIF to evaluate the clinical results of both methods. We examined both groups about the operating time, the estimated blood loss, the operative results using the score rating system of Japanese Orthopaedic Association (JOA score), and the presence of bone union on radiography. The operating time and the estimated blood loss of the cage group were statistically less than those of the iliac bone group. There were no significant differences between both groups about the operative results. The radiographic evaluation on bone union showed that half of the iliac bone group had collapsed union, but all cases of the cage group revealed union without collapse.     

Resection of the first row of carpal bones: post-traumatic wrist and Kienbock's disease

This study reports the outcomes of 27 proximal row carpectomies for stage II (Watson) scapholunate--(10 Slac) and scaphoid non union--(8 Snac) advanced collapse and stage III (Lichtman) Kienb?ck's disease (9 cases) followed for an average of respectively 72 and 50 months. Following surgical treatment, more than 80% of patients in both groups were pain free. The total arc of motion averaged 67 degrees (unchanged), for the post-traumatic arthritis, and 59 degrees for Kienb?ck's, a decrease of 17%. Grip strength averaged a 17% increase in comparison to the opposite size for both groups. Proximal row carpectomy showed a high degree of patient satisfaction and is a motion-preserving and grip-preserving procedure used in stage II post-traumatic arthritis but Lichtman III stage in Kienb?ck's disease had a comparatively poor result. Proximal row carpectomy simplifies the structure of the radiocarpal joint. When the cartilage on the capitate head and the radial lunate facet are not worn, this procedure provides a good result with respect to pain, range of motion and strength which is stable with time.     

A comparison of plate and pin fixation for arthrodesis of the rheumatoid wrist

This retrospective study compared plate fixation versus pin fixation in 57 patients with rheumatoid arthritis who underwent wrist arthrodesis. Fixation was achieved by using plates in 32 patients and longitudinal pins in 25 patients. Clinical follow-up averaged 29 months (range: 12-57 months) and radiographic follow-up averaged 16 months (range 12-39 months). Union occurred in 97% of the wrists fixed with plates and in 96% of the wrists fixed with pins. There were 6 (19%) complications in the plate group and 7 (28%) complications in the pin group. Three (12%) wrists fixed with pins moved from the immediate postoperative position to a position of relative volar flexion, while radiographs showed no changes in wrist position in the plate group. With both methods, successful arthrodesis stabilized the wrist in a high percentage of patients. Plate fixation offers an excellent alternative method for arthrodesis of the rheumatoid wrist.