Wrist weight-bearing tolerance in healthy adults

Study DesignCross-sectional.IntroductionNo information is available in the literature regarding the amount of weight-bearing tolerance in a normal human wrist.Purpose of the StudyTo establish the normal limits of human wrist weight-bearing tolerance and to determine if gender, age and height are predictors of this weight-bearing tolerance.MethodsA sample (N = 465) of healthy adults ages 18-64 completed a questionnaire indicating their gender, age range and height. Subjects were instructed in performing a wrist weight-bearing tolerance test using a calibrated analog scale. The amount of pressure that the subject was able to apply to the scale in 3 independent trials was recorded and analyzed.ResultsA strong positive correlation was found between average weight- bearing values achieved through the right and left hands for the subjects of this study, r(463)= .97, P < .001. A 2-way analysis of covariance revealed main effects for both gender (20.9, 95% CI [15.7, 26.0] pounds, P < .001) and age (F(4, 454) = 6.143, P < .001, partial η² = .051). The highest weight-bearing tolerance was observed in males and individuals 25-34 years of age. Multiple regression analysis affirmed that gender, height and age categories of 45-54 and 55 to 64 were all statistically significant predictors of wrist weight-bearing tolerance, P < .01.DiscussionThese results establish normal wrist weight-bearing tolerance values and demonstrate that gender, age and height are predictors of this weight-bearing tolerance.ConclusionThese results could allow identification of pathologies associated with wrist instability.     

Correlation between radiological parameters and patient-rated wrist dysfunction following fractures of the distal radius

The present study investigates the correlation between radiological parameters of wrist fractures and the clinical outcome expressed by objective clinical parameters and the level of patient-rated wrist dysfunction. Thirty consecutive cases of unstable distal radial fractures treated with closed reduction and percutaneous fixation were prospectively studied for a period of one year. The outcome parameters included objective clinical and radiological parameters and the previously described and validated patient-rated wrist evaluation (PRWE) score. Analysis showed that for unstable (AO classification types 23-A2, -A3, -C1 and -C2) fractures the fracture type affects the range of wrist palmarflexion (p = 0.04) and that the presence of postoperative articular ‘step-off’ affects the range of wrist dorsiflexion and the patient-rated wrist function at the final time of the study (p < 0.01 and p = 0.02, respectively). It is also shown that permanent radial shortening and loss of the palmar angle were associated with prolonged wrist pain (p < 0.01 and p = 0.03, respectively). Our finding that residual articular incongruity correlates with persisting loss of wrist dorsiflexion and wrist dysfunction contradicts the view that loss of articular congruity is associated with late development of articular degeneration but not with early wrist dysfunction. Additionally, this study failed to show any association between the fracture type and the functional outcome as rated by the patients.     

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.     

部分腕骨融合术治疗腕部疾患进展

目的 综述近年来国内外有关部分腕骨融合治疗腕部疾患及其实验研究进展。方法 广泛查阅相关文献,对部分腕骨融合的临床应用效果和实验研究进展分析和综合。结果 部分腕骨融合既能解除腕关节疼痛,又能稳定和保留一定范围活动度。结论 采用部分腕骨融合术治疗腕部疾患,只要适应证和手术方法选择合适,应当首选。     

创伤性三角纤维软骨复合体损伤的腕关节镜诊断及治疗

目的 评价腕关节镜对创伤性腕关节三角纤维软骨复合体(TFCC)损伤进行诊断及治疗的效果.方法 选有急慢性外伤史的16例腕关节三角纤维软骨复合体可疑损伤患者,年龄19～39岁,平均27.6岁.对经体格检查、关节造影或MRI检查有异常,疑为TFCC损伤者施行关节镜检查.按照Palmer分型:I A型6例,I B型9例,I D型1例.I A型、I D型在关节镜下行TFCC修整术,IB型行边缘部撕裂缝合修复术.结果 术后平均随访19个月.按Green-O'Brien功能评定法评定:优13例,良2例,可1例.结论 腕关节镜手术治疗TFCC是一种微创、有效、安全的治疗方式.     

一种新的腕关节正侧位平片投照法及其摄影装置

目的　介绍一种新的腕关节正、侧位平片投照方法及其摄影装置。方法　设计并制作一种用于腕关节正、侧位平片投照的摄影架 ,以其为外参照物 ,限定上肢各个部位的活动角度 ,行腕关节前后正、侧位平片摄影。选取 2 0名志愿者的 2 0个腕关节 ,先用摄影架作侧位摄影 ,后做 Epner- Palmar腕关节标准位摄影 ,以桡舟角和桡月角为观测对象 ;比较两种投照方法角度的差值及可重复性。结果　摄影架摄影的重复性优于 E- P腕关节标准摄影 (P<0 .0 1)。该摄影架的操作较 E- P方法及国外的现有摄影架简便 ,受检者的体位更舒适。结论　用该摄影架作腕关节正、侧位平片摄影检查 ,其投影变异小 ,重复性强 ,可常规用于对腕关节细小变异的观测     

Four-corner arthrodesis with a radiolucent locking dorsal circular plate: technique and outcomes

Background

Scaphoid excision and four-corner arthrodesis (FCA) is an acceptable motion sparing procedure used to treat wrist arthritis. Recently, a locking dorsal circular plate composed of polyether-ether-ketone has been introduced (Xpode®; TriMed Inc.). The purpose of this study is to assess the efficacy of this specific plate design with regard to FCA.

Methods

A retrospective chart review of all patients who underwent FCA with an Xpode® between January 1, 2008 and December 31, 2012 was conducted. Patients were contacted and asked to return to clinic for clinical and radiographic follow-up. Patient demographics, range of motion, grip strength, and complications were collected from medical records. Patients completed a patient-rated wrist evaluation (PRWE). A paired t test was used to compare means, and p values <0.05 were considered statistically significant.

Results

Twenty-six procedures (24 patients) were identified. One patient required full wrist fusion following the initial procedure. Of the 25 remaining wrists, arthrodesis was successfully achieved in 20 (80 %). Eleven patients (13 wrists, 52 %) returned to clinic for an average follow-up of 28 months. Mean wrist extension improved from 30 to 47°, and flexion decreased from 33 to 23°. Average grip strength was 77 % of the uninjured side. The mean PRWE scores for pain and function were 19.7 and 17.1, respectively. Five patients underwent additional operations (two hardware removals, two contracture releases, and one distal radial ulnar joint arthroplasty).

Conclusions

FCA with the Xpode® yielded reasonable results for pain and function and demonstrated a fusion rate of 80 %.     

Reconstructing the Rheumatoid Wrist: A Utility Analysis Comparing Total Wrist Fusion and Total Wrist Arthroplasty from the Perspectives of Rheumatologists and Hand Surgeons

Rheumatologists and hand surgeons have historically demonstrated strikingly divergent attitudes toward the benefits of surgical intervention, either total wrist fusion or total wrist arthroplasty, for the rheumatoid wrist. A utility analysis was conducted to compare a national random sample of hand surgeons and rheumatologists regarding their opinions about surgical management of severe rheumatoid wrist disease. A web-based trade-off utility survey was developed, and participants were presented with survey scenarios comparing well-controlled rheumatoid arthritis with operative and non-operative management. Utility values were calculated for each scenario, and a decision analytic model was constructed. Utility values for rheumatologists and hand surgeons did not differ significantly for any scenario. Total wrist arthroplasty was associated with the highest expected gain in quality-adjusted life-years for each subgroup. This decision analytic model demonstrates similar opinions between two subspecialties that have historically demonstrated divergent attitudes towards rheumatoid hand surgery.     

Basics of diagnostic wrist arthroscopy

Minimal access surgery has considerably progressed in recent years. This has also led to advancements in the area of wrist arthroscopy, which has gained widespread acceptance. The complex nature of the carpus poses particularly difficult diagnostic dilemmas in the management of chronic wrist conditions and injuries of the wrist joint. Arthroscopic procedures involve less surgical dissection, better visualization and classification of lesions, less post-operative pain and a shorter recovery time for the patient. This article focuses on the indications, pre-operative assessment, theatre protocol and complications of wrist arthroscopy.     

马德隆氏畸形一家三代4例报告

马德隆氏畸形多因桡骨远端骨骺内侧发育障碍所致的腕部畸形,常为先天家族性疾病。作者曾于2001年3月11日-3月20日偶遇一家三代4例,病史、体征和X线表现典型。现报道如下。 例1 女,44岁。半月前下雪滑倒,左肘挫伤。就诊时发现双腕畸形。自诉从小双腕无力,腕部宽粗,尺侧突出,前臂短小,向桡背侧弯曲。除前臂旋后受限外,腕、臂、肘活动正常。X线片显示双侧桡骨远端呈笔尖状,关节面向尺侧倾斜,角度>60°。腕骨以月骨为顶点呈倒锥形排列,下桡尺关节分离,尺骨茎突与桡骨茎突处同一水平。桡骨短粗向桡背侧弯曲,短缩约2cm。双侧桡骨头发育不良,变形。肱桡间距增大,肘外翻30°畸形。双侧桡骨上、下段骨质疏松,皮质菲薄,桡骨粗隆呈骨囊肿样改变(见图1a,1b)。     

Injury patterns and the role of tendons in protecting neurovascular structures in wrist injuries

PurposeThe purpose of this study was to evaluate the anatomical features of injured structures, investigate the protection provided by the specific tendon of each corresponding important neurovascular structure (radial artery, median nerve, and ulnar nerve/artery) and to compare the results among the three categories of wrist injuries.MethodsThis study included 114 patients who underwent primary repair for damaged wrist structures; 40 patients sustained accidental damage without intention (group 1), 40 had self-inflicted damage (group 2), and 34 patients had a stab or penetrating wound caused by a sharp instrument during a conflict or violent event involving another person (group 3). The basic demographic factors, distribution pattern, area, and depth of the injured structures were investigated and compared. The barrier roles of the flexor carpi radialis (FCR) for the radial artery, palmaris longus (PL) for the median nerve, and flexor carpi ulnaris (FCU) for the ulnar nerve were estimated.ResultsIn group 1, FCU injury was the most common single-structure injury. In group 2, PL ± median nerve injuries were the most common. Multiple-structure injuries involving more than five structures occurred more frequently in group 3 than in the other groups. FCU ± ulnar nerve injuries were more common in group 3 than in the other groups. Radial-side structures were injured most frequently in group 3, and central-side injuries occurred most frequently in groups 1 and 2. Superficial- and middle-layer injuries occurred at similar frequencies among the three groups. Particularly, deep-layer injuries were most weakly related to group 2 injuries. The barrier effects of the FCR, PL, and FCU were confirmed, respectively.ConclusionsWrist soft tissue injuries showed particular patterns of injured structures and depths according to the injury mechanism. These patterns included features such as single-structure injuries and the locations and depths of multiple-structure injuries with or without neurovascular injuries. In addition, the roles of FCR, PL, and FCU in protecting important wrist neurovascular structures were confirmed.Level of evidenceTherapeutic III     

腕关节镜下Outside-in褥式缝合治疗PalmerⅠB型三角纤维软骨复合体损伤

目的探讨腕关节镜下Outside-in褥式缝合治疗PalmerⅠB型三角纤维软骨复合体损伤的长期临床疗效。方法对2018年5月-2019年8月收治的PalmerⅠB型三角纤维软骨复合体损伤患者37例给予腕关节镜下Outside-in褥式缝合。随访观察并比较术前术后患者腕关节的活动度、患肢握力、影像学MRI、腕关节VAS疼痛评分、腕关节的功能评分(改良Mayo评分)。结果所有患者术后随访6~18个月,平均(12.60±3.10)个月。末次随访时37例患者腕关节疼痛较术前均有改善,患肢握力基本与健侧一致,能满足生活工作要求;术后复查腕关节MRI,见三角纤维软骨复合体信号强度及形态均提示其连续性恢复;腕关节尺侧疼痛较术前明显缓解(P<0.05);术后腕关节的功能评分(改良Mayo评分)较术前明显提高(P<0.05)。结论腕关节镜下采用Outside-in褥式缝合方式治疗PalmerⅠB型三角纤维软骨复合体损伤是一种微创、安全、有效的方式,末次随访结果满意,可作为治疗PalmerⅠB型三角纤维软骨复合体损伤的可选方式。     

The Mannerfelt wrist arthrodesis – A study of patient-reported outcomes in a rheumatoid population

BackgroundWrist arthrodesis has been established as a mainstay form of surgical intervention in the rheumatoid wrist. Despite this however, there is a distinct lack of patient-reported outcome measure (PROM) studies justifying the efficacy of this procedure in rheumatoid disease. The aim of this study was to report any change in function or pain following the tunnel Mannerfelt wrist arthrodesis in a single surgeon series of rheumatoid patients over a 6 year period.Methods14 consecutive patients (15 wrists) who had undergone the Mannerfelt wrist arthrodesis were followed prospectively with a mean follow up period of 45 months. No patients were lost to follow up. The primary outcome measures included the validated Patient Rated Wrist Evaluation (PRWE) questionnaire and a satisfaction questionnaire.ResultsThe mean total pain score improved from 41 points preoperatively to 14.2 points postoperatively correlating with a 65.4% improvement in overall pain outcomes. The mean total functional score improved from 83.7 points preoperatively to 45.5 points postoperatively demonstrating a 45.6% improvement in overall function at the time of follow up.ConclusionsAll patients reported an overall improvement in pain and functional capacity. The satisfaction results were excellent. All patients reported that they would elect to have the procedure again with the vast majority being ‘very pleased’ with the outcome of their surgery (93.7% very pleased and 6.3% fairly pleased). The procedure enjoyed favourable mid-term results and we recommend the tunnel Mannerfelt wrist arthrodesis for improving both pain and level of function in this group of patients.     

经舟骨月骨周围腕背侧脱位12例的治疗

经舟骨月骨周围腕骨背侧脱位是临床较为少见的损伤,自1989年以来共收治12例,现总结报告如下。1临床资料本组12例均为男性,年龄28~54岁。右侧9例,左侧3例。伤因:高处翻下伤3例,平地滑倒伤5例,均为腕背伸位着地而致;直接外力打击伤3例;重物挤压伤1例;伴前臂严重软组织损伤尺骨喙突骨折。新鲜损伤9例,陈旧损伤3例。闭合损伤为10例,开放损伤2例。其腕舟骨骨折均为腰部骨折。2治疗方法新鲜损伤及受伤时间较短的陈旧性骨折,在臂丛麻醉下或局麻下复位,一助手握住患侧前臂,术者先行牵引,然后用一手渐将腕关节屈曲;另一手从腕背向掌侧推挤脱位的腕骨…     

马德隆畸形的X线分型和治疗方法的探讨

研究马德隆畸形的Ｘ线分型及治疗方法的探讨。分析了自１９７７～１９９５年以来诊断为马德隆畸形４７例７３侧的临床资料，根据患者分型不同分别采取手法矫正、尺骨远端骨骺阻滞桡骨远端骨骺刺激、尺骨小头切除或尺骨短缩桡骨远端楔形截骨、尺骨短缩桡骨远端楔形截骨翻转加管形石膏外固定术。平均随访９年。疗效评定标准：根据术后症状、体征的改善程度分优、良、可、差４级。２１例术后疗效优良，占８４％。提出马德隆畸形的Ｘ线分型，依据此分型分别采取不同的治疗方法，术后效果较好