Comparison between 7 Tesla and 3 Tesla MRI for characterizing orbital lesions

PurposeCharacterizing orbital lesions remains challenging with imaging. The purpose of this study was to compare 3 Tesla (T) to 7 T magnetic resonance imaging (MRI) for characterizing orbital lesions.Materials and methodsThis prospective single-center study enrolled participants presenting with orbital lesions from May to October 2019, who underwent both 7 T and 3 T MRI examinations. Two neuroradiologists, blinded to all data, read both datasets independently and randomly. They assessed general characteristics of each orbital lesion as well as image quality and presence of artifacts. Comparison between both datasets was made using Fisher exact test.ResultsSeven patients (4 women, 3 men) with a median age of 52 years were enrolled. Orbital lesion conspicuity was better scored at 7 T compared to 3 T MRI, with 3/7 lesions (43%) scored as very conspicuous at 7 T compared to 0/7 lesion (0%) at 3 T, although the difference was not significant (P = 0.16). Delineation of lesion margins was better scored at 7 T compared to 3 T with 3/7 lesions (43%) scored as very well delineated on 7 T compared to 0/7 lesions (0%) at 3 T, although the difference was not significant (P = 0.34). Details of internal structure were better assessed at 7 T compared to 3 T, with 4/7 lesions (57%) displaying numerous internal details compared to 0/7 lesions (0%) at 3 T (P = 0.10). Internal microvessels were visible in 3/7 lesions (43%) at 7 T compared to 0/7 lesions (0%) at 3 T (P = 0.19).ConclusionAlthough no significant differences were found between 7 T and 3 T MRI, assumably due to a limited number of patients, our study suggests that 7 Tesla MRI might help improve the characterization of orbital lesions. However, further studies with more patients are needed.     

腕关节融合钢板内固定术的临床疗效

目的评价腕关节融合钢板内固定术的临床疗效。方法2000年7月-2004年12月，采用腕关节融合钢板内固定术治疗创伤性腕关节炎21例。随访内容包括腕关节疼痛程度、手指关节活动度、握力和x线片。根据Buck—Gramcko／Lohrnanrm评分表评价腕关节总体功能，DASH调查表评价腕关节融合术对患者日常活动及生活质量的影响。结果术后21例获得随访，平均随访时间为20个月。术后患侧腕部疼痛值平均为1．5（术前4．5），12例掌指关节和lO例拇指指间关节出现轻微背伸功能障碍，腕部握力为30kg（健侧为38kg）。x线片示腕关节全部骨性融合。Buck—Gramcko／Lohmanrm评分值为8．7，其中优5例、良10例，中6例。DASH值为32，DASH调查表结果表明腕关节融合术后部分日常活动受限。结论腕关节融合钢板内固定成功率高，腕关节疼痛明显减轻，但术后腕关节部分功能丧失。     

Difficult wrist fractures. Perilunate fracture-dislocations of the wrist

Perilunate dislocations of the wrist have a common pathway of disruption that occurs from extensive dorsiflexion injuries. Open reduction and internal fixation of these injuries is required to provide accurate alignment and the option for ligament repair. Both dorsal and palmar surgical incisions may be indicated. Associated injuries to the median nerve must be recognized. Treatment includes scaphoid and radial styloid stabilization with multiple K-wires or internal compression screw (Herbert or Association for the Study of Internal Fixation [ASIF] screws). In these injuries, the lunate must be reduced first and stabilized. The scaphoid proximal segment follows the lunate unless the scapholunate (SL) ligament is torn. The distal scaphoid fragment, capitate, and triquetrum are reduced and aligned with the lunate and need to be held with K-wires. Ligament repair and augmentation may be necessary at both scapholunate and lunotriquetal areas if there has been serious ligament injury. Palmar ligament repair is often required, and we recommend a palmar exploration in most patients along with release of the median nerve. Surgical treatment results of perilunate fracture-dislocations of the wrist appear better than conservative treatment methods, but complications following both indicate the need for improved internal fixation and fracture-dislocation realignment. These fractures are a real challenge to the treating surgeon who must use patience, precise surgical techniques, and careful roentgenographic study (including tomograms and traction views) to assure the best result.     

The instability of wrist joint and total wrist replacement

Total wrist arthroplasty are not used as widely as total knee and hip replacement. The functional hands are requiring surgeons to design a durable and functional satisfying prosthesis. This article will list the main reasons that cause the failure of the prosthesis. Some remarkable and representative prostheses are listed to show the devolvement of total wrist prosthesis and their individual special innovations to fix the problems. And the second part we will discuss the part that biomechanical elements act in the total wrist replacement (TWA). Summarize and find out what the real problem is and how we can find a way to fix it.     

Chronic wrist pain: indications for wrist arthroscopy

Although arthroscopy represents a new and dynamic diagnostic technique for evaluating the wrist, specific indications for arthroscopic intervention in the wrist are not defined. To place this technique in perspective, we review our experience with 54 consecutive arthroscopies of the radiocarpal and midcarpal joints in 53 patients with chronic wrist pain. On the basis of this review, we believe arthroscopy is indicated for the diagnosis of wrist pain of longer than 3 months' duration. Defects of the triangular fibrocartilage and lesions of the articular cartilage, including loose bodies, are detectable and easily treated with wrist arthroscopy.     

Gymnast's wrist

The wrist is a frequent site of symptoms and injury in the gymnast, both acute and chronic. The chronic injuries are due to repetitive loading of the musculoskeletal system, and their incidence rises as participation and level of competition rises. More attention needs to be directed toward prevention, but many of these injuries seem to be inherent to the sport as it transforms the upper extremities into weight-bearing limbs. Evaluation and recognition of wrist injuries in the gymnast will allow appropriate management for these patients; however, the compulsive and intense nature of many gymnasts can lead to recurrent or new injury and continued wrist symptoms. Much more sophisticated and detailed examination of the gymnast's wrist should be done before onset of training, before increase of intensity of training, before competition, and with the onset of any symptoms, including observed guarding. In addition, pretraining and annual follow-up wrist radiographs should be considered for the skeletally immature gymnast. Follow-up evaluation after skeletal maturity and retirement from active participation is needed to elucidate the long-term effect of gymnastics on the wrist.     

Trigger wrist

Trigger wrist is a relatively rare phenomenon. The pathological entities to which the term trigger wrist is applied are not well defined in the literature. We present three cases of trigger wrist as a result of flexor tendon pathology, review the literature and discuss the use of the term "trigger wrist".     

Functional and patient-reported outcome of partial wrist denervation versus the Mannerfelt wrist arthrodesis in the rheumatoid wrist

Introduction

Wrist arthrodesis offers high success rates in patients with rheumatoid arthritis; however, loss of residual mobility may cause unnecessary disability. This makes wrist denervation an appealing alternative. However, there is a distinct lack of patient-reported outcome measure studies comparing these two procedures. The aim of this study was to report any change in function, pain and satisfaction following wrist arthrodesis compared to denervation in a single surgeon series of rheumatoid patients.

Patients and methods

The results of 16 wrist arthrodesis in 15 patients and 14 partial (PIN) wrist denervations in 13 patients were compared with a mean follow-up period of 39 and 22 months, respectively. The primary outcome measures were the same for both groups and included the validated patient-rated wrist evaluation questionnaire and a satisfaction questionnaire.

Results

Wrist arthrodesis significantly improved the mean total pain and functional outcome scores by 54 and 36 %, respectively, at the time of follow-up. Wrist denervation patients also reported significant improvements of 44 and 42 % in total pain and functional outcomes, respectively; 87 % reported being very satisfied with their wrist arthrodesis procedure compared to 78 % in the denervation group. No statistically significant difference in response between the groups was observed in this series of patients.

Conclusions

Both procedures enjoyed favourable results amongst patients with excellent satisfaction outcomes. PIN denervation is a simple procedure with low complication rates and we therefore consider it a valid alternative to more difficult treatment options, such as partial or total wrist arthrodesis.     

Comparison of MRI and wrist arthroscopy for assessment of wrist cartilage

In order to perform motion-preserving procedures for wrist arthritis rather than total joint fusion, it is important to determine the integrity of specific areas of wrist cartilage. This is generally performed using a wrist arthroscope and by directly visualising the cartilage. Twenty patients with wrist pain were investigated over a 1-year period with both MRI and wrist arthroscopy. Kappa analysis was used to compare the two methods of cartilage assessment. There is only a fair correlation (K = 0.38) between the two methods. With only a fair correlation between arthroscopy and MRI, it cannot be concluded that the two methods are equivalent for assessing wrist cartilage and, as such, wrist arthroscopy still has an important role to play in the assessment of a painful degenerative wrist.     

Osteoarthritis of the wrist

Osteoarthritis of the wrist is one of the most common conditions encountered by hand surgeons. It may result from a nonunited or malunited fracture of the scaphoid or distal radius; disruption of the intercarpal, radiocarpal, radioulnar, or ulnocarpal ligaments; avascular necrosis of the carpus; or a developmental abnormality. Whatever the cause, subsequent abnormal joint loading produces a spectrum of symptoms, from mild swelling to considerable pain and limitations of motion as the involved joints degenerate. A meticulous clinical and radiographic evaluation is required so that the pain-generating articulation(s) can be identified and eliminated. This article reviews common causes of wrist osteoarthritis and their surgical treatment alternatives.     

月骨周围进行性不稳定的腕运动力学研究

目的探索腕月骨周围进行性不稳定的运动力学变化。方法对１４具新鲜冷冻尸体腕关节，用计算机辅助测量了正常腕和各阶段月骨周围不稳定时腕动力肌腱在腕屈伸、尺桡偏时滑动幅度，根据肌腱滑动幅度和关节运动范围计算动力肌腱力臂。结果月骨周围进行性不稳定时屈腕肌腱力臂明显增大，屈指肌腱力臂减小；桡侧腕动力肌腱力臂以增大为主，尺侧肌腱力臂以减小为主。桡侧腕屈肌腱在腕屈伸或尺桡偏时均显著增大。结论腕运动力学变化对月骨周围不稳定的形成、运动力学变化、腕部塌陷起重要起动作用。