Wrist Arthritis Research Articles

Retrospective study of 54 cases of wrist denervation.

Most patients with post-traumatic and/or degenerative wrist arthritis present with pain and limitation of activities of daily living. Wrist denervation using a two-incision technique is an alternative to proximal row carpectomy and partial or total wrist arthrodesis. The purpose of this study was to evaluate whether two-incision denervation is a valid procedure for reducing pain in wrist arthritis of different etiologies. A retrospective study of fifty-four patients, mean age 56 years, operated on by one senior surgeon at a single center was designed. Inclusion criteria were chronic wrist pain of various etiologies, patients with previous wrist surgery were excluded. Preoperative pain was reported on a visual analog scale, and at least twelve months postoperatively, patient-rated wrist/hand assessment, pain, and range of motion were assessed. RESULTS: 54.8% of the population presented with post-traumatic osteoarthritis of the wrist (scaphoid non-union advanced collapse or scapholunate advanced collapse). 71.5% of the population underwent surgery on the dominant extremity. After clinical evaluation, the mean PRWHE was 15.76 (±14.53), with total joint motion of 68 ° (±14.44), flexion 64.5 ° (±13.36), extension 76 ° (±7.71), pronation 72.4 ° (±6.20), and supination 74.8 ° (±9.21). The overall mean pain reduction was 60% and there were no re-operations. Two-incision total wrist denervation is a valid technique for the treatment of wrist pain of various etiologies, leaving a good range of motion and acceptable autonomy in activities of daily living. If this technique fails, more invasive techniques such as proximal row carpectomy, partial or total wrist arthrodesis, and wrist arthroplasty can be used.

Short and Medium-Term Clinical and Radiographic Outcomes Following Arthroscopic Partial Wrist Arthrodeses - A Systematic Review.

Background: Partial wrist arthrodesis (PWA) is a salvage procedure used in advanced wrist arthritis and has traditionally been performed via an open dorsal approach. In recent years, surgeons have moved towards arthroscopic fusions to minimise soft tissue damage and preserve vascular supply, increase union rates and hasten recovery. The purpose of this study is to synthesise the current literature on the outcomes of arthroscopic PWA. Methods: A systematic review was performed to survey the literature regarding outcomes of PWA. English language studies that reported original data and commented on at least one postoperative measure of function were eligible for inclusion. Data collected included patient demographics, operation time and technique, complications and postoperative patient outcomes in the form of patient-rated surveys, grip strength, range of motion and the pain visual analogue scale (VAS). Results: Twelve studies were eligible for inclusion, with a total of 191 patients. 94% of patients achieved union, with a mean time to fusion of 12.5 weeks. VAS, Disabilities of the Arm, Shoulder and Hand (DASH) and Mayo Wrist scores were significantly improved after the procedure, and complication rates were comparable to open procedures. Range of motion varied greatly across studies, due to heterogeneity in carpal intervals fused. Conclusions: Arthroscopic PWA is a safe and effective procedure in the treatment of advanced arthritis of the wrist. Further comparative studies would be useful in assessing benefits of arthroscopic arthrodesis over an open approach. Level of Evidence: Level III (Therapeutic).

Is there a correlation between the scaphoid's morphology, the development of arthritis and the long-term functional outcomes in patients treated for nonunion with a bone graft?

The main complication following scaphoid fracture is nonunion, which requires a surgical intervention to prevent the development of Scaphoid Nonunion Advanced Collapse (SNAC) wrist arthritis. In some cases, the bone eventually heals in malunion. There is a lack of published data on the clinical and radiological consequences of these malunions. The aim of our study was to determine if there was a correlation between the scaphoid's shape after bone graft treatment of a nonunion and the development of arthritis and to determine the strength of the correlation between the shape and clinical outcomes. There is no correlation between the scaphoid's shape and the development of radiocarpal arthritis nor the clinical and functional outcomes in the long-term after nonunion treatment. Fifty patients having a mean age of 27.5 ± 10.3 years (19-68) were included and followed for a mean of 92.2 ± 58.6 months (18-244). The scaphoid's shape was determined using CT data (LISA: lateral intrascaphoid angle, H/L: height/length ratio) and using radiographs (RLA: radiolunate angle). The clinical data (age, sex, dominant hand, smoking habits, occupation, work status at final follow-up), the operative data, potential complications and functional outcomes (DASH, MWS, PRWE) were collected during the final follow-up visit. The mean RLA was 7.4 ± 11.1 ° (min -21; max +46), the mean LISA was 30.5 ± 5.8 (min 22 max 47) and the mean H/L was 0.6 ± 0.2 (min 0.5 max 0.8). The mean DASH was 17.7 ± 18.9 (min 0 max 63.6). PRWE was 26.3 ± 26.3 (min 0, max 127) and MWS was 82.7 ± 19 (min 25 max 100). There was no statistically significant correlation between the scaphoid's shape and the development of arthritis (p = 0.38 for RLA, p = 0.24 for LISA, p = 0.38 for H/L), nor between the scaphoid's shape and the clinical or functional outcomes at a mean follow-up of 7.7 years. In this study, the development of arthritis and the clinical outcomes were not correlated with the scaphoid's shape after nonunion treatment by bone graft, whether vascularized or not. IV; retrospective study.

Features Associated With Different Inflammatory Phenotypes of Calcium Pyrophosphate Deposition Disease: A Study Using Data From the International American College of Rheumatology/EULAR Calcium Pyrophosphate Deposition Classification Criteria Cohort.

The study objective was to examine the disease, demographic, and imaging features associated with different inflammatory phenotypes of calcium pyrophosphate deposition (CPPD) disease, ie, recurrent acute calcium pyrophosphate (CPP) crystal arthritis, chronic CPP crystal inflammatory arthritis, and crowned dens syndrome (CDS). Data from an international cohort (assembled from 25 sites in 7 countries for the development and validation of the 2023 CPPD classification criteria from the American College of Rheumatology/EULAR) that met the criteria were included. Three cross-sectional studies were conducted to determine the phenotypic characteristics of recurrent acute CPP crystal arthritis, chronic CPP crystal inflammatory arthritis, and CDS. Multivariable logistic regression analysis was used to calculate adjusted odds ratio (aOR) and 95% confidence interval (CI) to examine the association between potential risk factors and the inflammatory phenotype. Among the 618 people included (56% female; mean age [standard deviation] 74.0 [11.9] years), 602 (97.4%) had experienced acute CPP crystal arthritis, 332 (53.7%) had recurrent acute arthritis, 158 (25.6%) had persistent inflammatory arthritis, and 45 (7.3%) had had CDS. Recurrent acute CPP crystal arthritis associated with longer disease duration (aOR 2.88 [95% CI 2.00-4.14]). Chronic CPP crystal inflammatory arthritis was associated with acute wrist arthritis (aOR 2.92 [95% CI 1.81-4.73]), metacarpophalangeal joint osteoarthritis (aOR 1.87 [95% CI 1.17-2.97]), and scapho-trapezo-trapezoid (STT) joint osteoarthritis (aOR 1.83 [95% CI 1.15-2.91]), and it was negatively associated with either metabolic or familial risk for CPPD (aOR 0.60 [95% CI 0.37-0.96]). CDS was associated with male sex (aOR 2.35 [95% CI 1.21-4.59]), STT joint osteoarthritis (aOR 2.71 [95% CI 1.22-6.05]), and more joints affected with chondrocalcinosis (aOR 1.46 [95% CI 1.15-1.85]). CPPD disease encompasses acute and chronic inflammatory phenotypes, each with specific clinical and imaging features that need to be considered in the diagnostic workup.

Outcomes of Proximal Row Carpectomy With Interposition Arthroplasty for Advanced Wrist Arthritis.

This study aimed to evaluate and compare the outcomes of proximal row carpectomy (PRC) with interposition arthroplasty using dorsal wrist capsule interposition, lateral meniscus allograft, or dermal allograft in patients with lunate facet/capitate degeneration. Patients who underwent PRC with interposition arthroplasty between 2010 and 2022 at a single institution were identified. Preoperative and postoperative visual analog scale (VAS) pain, functional outcomes, and complications were recorded. Twenty-one patients (11 dorsal capsule, 6 meniscus, 4 dermal matrix) were identified with a mean follow-up of 65.8 months. Postoperative pain and functional outcome scores significantly improved. The mean postoperative Quick Disabilities of the Arm, Shoulder, and Hand score was 20.3. In total, 89.5% of patients returned to work, including 75% of manual laborers. No significant differences were found between dorsal capsular flap versus allograft groups. Proximal row carpectomy with interposition arthroplasty is an effective motion-sparing procedure for patients with proximal capitate and/or lunate fossa arthritis, improving pain and function.

PRC with Double Interposition Arthroplasty for Failed Partial Wrist Arthrodesis

Abstract Background In patients with lunate fossa and proximal capitate degeneration, or failed scaphoid excision and partial wrist arthrodesis, double allograft interposition arthroplasty may allow patients to maintain wrist motion and improve pain. Description of Technique Following dorsal exposure of the carpus, a completion proximal row carpectomy is performed. Suture anchors are placed evenly along the perimeter of the distal radius and used to secure a precut sheet of allograft. Additional suture anchors are placed at the proximal aspect of the distal carpal row, securing a second piece of allograft to the proximal capitate and hamate. Patients, Methods, and Results We present the case of a female with osteogenesis imperfecta who failed prior partial wrist fusion for treatment of scapholunate advanced collapse. She declined wrist arthrodesis and was not a candidate for total wrist arthroplasty. Proximal row carpectomy with double interposition arthroplasty provided resolution of her pain and preserved her wrist range of motion. Conclusions Double interposition arthroplasty may provide reliable pain relief and wrist range of motion for patients with advanced wrist arthritis in whom traditional salvage procedures are contraindicated or have failed. Use of this technique offers benefits that may minimize complications and improve longevity compared with previously described allograft interposition techniques.

Our Experience with Surgical Treatment of Scaphoid Fractures with Headless Compression Screw

BACKGROUND: Fractures of the scaphoid bone are quite common, and they come with their own set of challenges due to the specific shape of the fractures and the delicate blood supply to the scaphoid bone. Failing to diagnose and treat acute scaphoid fractures promptly can result in failure of the bone to heal and subsequent development of wrist arthritis. Advances in diagnosis, surgery, and implant materials have led to a growing inclination towards early surgical fixation, even for non-displaced scaphoid fractures that could potentially be treated without surgery. AIM: The study's goal was to assess the effectiveness of headless compression screws for treating acute scaphoid fractures and, in two cases, nonunion following previous conservative therapy. METHODS: Between January 2022 and March 2024 ten patients with scaphoid fractures were surgically treated at the University Clinic of Traumatology Skopje, within twelve months follow-up. All of them were male with mean age of 27,3 years. All were diagnosed with X-rays and CT scans. Six of the fractures were on the right hand and four on the left. RESULTS: All the patients were surgically treated with open reduction and internal fixation with headless compression screw. Volar approach was used in 9 cases and dorsal approach in only one of them. Six of the patients were surgically treated within 4-14 days after injury and four of them were surgically treated due to non union after previous conservative treatment, two of them after three and two of them after seven months of injury. All fractures united after a mean time of 9,5 weeks, without secondary displacement. Throughout the follow-up period, there were no incidences of developing osteoarthritis of the wrist. CONCLUSIONS: It is crucial to understand that achieving a positive result is not guaranteed for every patient and relies on selecting the right patients and fractures. However, our study shows favorable results in sooner surgical treatment with the headless compression screw, rather than delayed treatment of scaphoid fractures. Surgical treatment with headless compression screw showed both functional and radiographic results. While it is beneficial for the screw to be positioned in the subchondral area, it is important to be cautious to avoid cortical penetration, as this will require the screw to be removed later.

Complications following total wrist replacement: A single-center retrospective review

Background/Purpose: Total wrist replacement (TWR) is an alternative to wrist fusion in advance wrist arthritis with the advantage of preserving the wrist motion. TWR is, however, infrequently performed in Asia-Pacific region. This study aimed to describe our institution's experience in managing complications following TWR. Methods: This study represents a single-center retrospective review of all patients who underwent TWR at the Department of Orthopedics and Traumatology, Prince of Wales Hospital in Hong Kong. The study period spans from 1 January 2004 to 1 March 2023. Recorded demographic parameters include gender, age upon surgery, pathology, types of implants, and follow-up period. Outcomes focused particularly on postoperative complications and need for revision surgery. Results: Twelve TWR from 10 Chinese-Asian patients were reviewed with a mean follow-up duration of 97.4 months. The incidence of complications in our study was as follows: loosening (16.67%), metallosis (8.3%), infection (8.3%), and stiffness (8.3%). One patient required conversion to total wrist arthrodesis due to metallosis and stiffness. Conclusion: TWR offers promising solutions for managing painful arthritic wrists. However, it's crucial to recognize that complications can arise, necessitating further surgical intervention. Surgeons must thoroughly comprehend these risks to provide informed counseling to patients and explore alternative treatment approaches.

Study of Musculoskeletal Involvement and Inflammatory Arthritis of the Hand and Wrist in Egyptian Systemic Sclerosis Patients

Abstract Background Systemic sclerosis (SSc) is a complex autoimmune connective tissue disease characterized by widespread tissue and internal organ fibrosis, immune system activation, and vasculopathy. Articular symptoms are common and are associated with increased morbidity and mortality, ranging from arthralgia, tendon friction rubs to frank arthritis and contractures. Aim of the Work Is to study the musculoskeletal involvement and hand and wrist arthritis among Systemic Sclerosis patients. Patients and Methods This is a cross-sectional study with 30 SSc patients were selected from Rheumatology outpatient clinic and inpatient department Ain Shams University hospital. All the patients were diagnosed according to the 2013 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) SSc classification criteria. Informed consent was taken from all participating subjects. Results The mean age of all patients was (40 ± 9.9) years and the mean disease duration was 5.4 ± 4.1 years. Most patients were females, and some had positive family history of autoimmune disease. The majority of patients were receiving steroids, and some were receiving other medications. Regarding clinical manifestations, various symptoms were reported, including dysphagia, Raynaud’s phenomenon, digital ulcers, pitting scars, and telangiectasia. Joint space narrowing, erosions, osteophytes, and calcinosis were also observed in some patients. Conclusion In conclusion, this study sheds light on the musculoskeletal involvement and inflammatory arthritis of hand and wrist in SSc. However, further studies are needed to confirm these findings and explore other aspects of this disease.

Churg-Strauss Syndrome Presenting with Pericarditis

Background Churg-Strauss syndrome (CSS) is a rare systemic vasculitis, that affects medium-sized vessels, involves multiple organs and in the majority of cases is related to asthma and eosinophilia. We report the case of a young woman with acute pericarditis. Case History A 22-year-old woman with a history of allergic rhinitis, asthma and nasal polyposis was admitted at our emergency department for chest pain and bilateral lower extremity weakness with paresthesia. Laboratory tests showed eosinophilia, elevated C-reactive protein (112 mg/dl) and elevated biochemical markers of myocardial injury (troponin 0.46 ng/ml). The electrocardiogram was negative. Transthoracic echocardiography revealed a small pericardial effusion with no other abnormalities. Hearth magnetic resonance imaging was permormed and confirmed a diagnosis of pericarditis. Immunologic study showed ANA and ANCA positive, in particular ANA 1:100, p-ANCA 134 U/l, and elevated IgE. Electromyography revealed sensory-motor symmetric axonal neuropathy. She had also arthritis of the right wrist. This presentation led to a diagnosis of CSS and appropriate therapy with corticosteroid, colchicine and mepolizumab resulted in a remission of disease activity. Discussion Physicians should thus be alert to the possibility of CSS as a differential diagnosis in patients presenting with pericarditis, whenever the clinical setting is appropriate.

Churg-Strauss Syndrome Presenting with Pericarditis

Churg-Strauss syndrome (CSS) is a rare systemic vasculitis, that affects medium-sized vessels, involves multiple organs and in the majority of cases is related to asthma and eosinophilia. We report the case of a young woman with acute pericarditis. Case History A 22-year-old woman with a history of allergic rhinitis, asthma and nasal polyposis was admitted at our emergency department for chest pain and bilateral lower extremity weakness with paresthesia. Laboratory tests showed eosinophilia, elevated C-reactive protein (112 mg/dl) and elevated biochemical markers of myocardial injury (troponin 0.46 ng/ml). The electrocardiogram was negative. Transthoracic echocardiography revealed a small pericardial effusion with no other abnormalities. Hearth magnetic resonance imaging was permormed and confirmed a diagnosis of pericarditis. Immunologic study showed ANA and ANCA positive, in particular ANA 1:100, p-ANCA 134 U/l, and elevated IgE. Electromyography revealed sensory-motor symmetric axonal neuropathy. She had also arthritis of the right wrist. This presentation led to a diagnosis of CSS and appropriate therapy with corticosteroid, colchicine and mepolizumab resulted in a remission of disease activity. Discussion Physicians should thus be alert to the possibility of CSS as a differential diagnosis in patients presenting with pericarditis, whenever the clinical setting is appropriate.

Tarans-Scaphoid Lunate Fracture Dislocation: A Case Report of a Rare Injury

Trans-scaphoid lunate dislocation is an uncommon injury but can be devastating, causing loss of wrist joint movement and function, and compromising grip strength. In this report, we present a case of a 48-year-old man with a history of psychiatric disorder who attempted suicide by jumping from the second floor. He sustained a volar lunate dislocation and scaphoid fracture, with migration of the proximal part of the scaphoid to the volar aspect of the forearm. Open surgical reduction was planned through a dorsal approach: first, the lunate was reduced, then the proximal part of the scaphoid was retrieved from the volar aspect of the forearm and anatomically fixed with a 2.5 mm headless screw. The scapholunate relationship was reduced and fixed with two wires through the scapholunate and scaphocapitate joints. The wound was closed in layers, and the wrist joint was immobilized with a dorsal splint for six weeks. Six weeks postoperatively, the K wires were removed, and the patient started physiotherapy. At three months postoperative follow-up, the wrist joint function was good, with good grip strength and a good range of motion. The gold standard treatment option is open reduction and fixation of the fractured bone and stabilization of the carpal bones in anatomical alignment to reduce possible complications such as median nerve compression, chronic carpal instability, chronic wrist pain, loss of grip strength, wrist arthritis, and carpal collapse.

Clinical and laboratory features of juvenile idiopathic arthritis with wrist involvement: Results of a retrospective cohort study.

Previous studies in the pre-biological era showed an association of wrist inflammation in juvenile idiopathic arthritis (JIA) with progressive disease course, polyarticular involvement and failure of methotrexate treatment. To describe features of JIA, associated with wrist arthritis. Data from about 753 JIA patients were included in this retrospective cohort study. The clinical and laboratory features of patients with and without wrist involvement were analyzed. Wrist involvement was found in oligoarthritis (5.8%), RF(-)/RF(+) polyarthritis (44.9%/15.0%), enthesitis-related arthritis (17.7%), and systemic (58.6%) JIA categories. Unilateral wrist involvement was typical for oligoarthritis patients, bilateral involvement was either equal to that of unilateral involvement or was more frequent in other categories. Wrist arthritis was found to be associated with female sex, a low incidence of uveitis, and more indications of systemic inflammation, including elevated levels of C-reactive protein, erythrocyte sedimentation rate, and platelets, as well as involvement of the cervical spine, temporomandibular, shoulder, elbow, metacarpophalangeal, proximal interphalangeal, distal interphalangeal, hip, ankle, and tarsus arthritis. The number of patients with hip osteoarthritis and hip replacement was also higher. Wrist arthritis was associated with a lower probability of achieving remission [hazard ratio (HR) = 1.3 (95%CI: 1.0-1.7), P = 0.055], and a higher probability of being treated with biologics [HR = 1.7 (95%CI: 1.3-2.10, P = 0.00009)]. Wrist arthritis in JIA patients is a marker of a severe disease course, characterized by more intensive inflammation, unfavorable outcomes, and. requiring more intensive treatment with early administration of biologics. Close monitoring of wrist inflammation with ultrasound and MR assessment with early biological treatment might improve the outcomes.

Infectious wrist arthritis complicating acute carpal tunnel syndrome in a child: A CARE-compliant case report.

The objective of this case report is to provide clinical evidence that acute infectious wrist arthritis in children can lead to the rare condition of acute carpal tunnel syndrome (ACTS). This article discusses in detail the characteristics of infectious wrist arthritis complicating ACTS in children in terms of etiology, pathogenic bacteria, treatment modalities, and sequelae to improve the understanding of this disease. A 10-year-old male child presented with a 15-day history of swelling and pain in the left forearm, wrist, and hand. Left-sided infected wrist arthritis complicating ACTS. The child received emergency surgery and anti-infective treatment combined with regular rehabilitation. During the treatment period, the child's wrist pain and swelling gradually improved, and wrist movement was restored compared with the preoperative period. At 6-month follow-up, the activities of the metacarpophalangeal joints of the left hand were close to normal, and the flexion of the left wrist joint was slightly limited. In infectious wrist arthritis in children, ACTS is a serious complication that requires aggressive surgical carpal tunnel release to avoid median nerve injury in addition to anti-infective therapy.

Handwriting speed in juvenile idiopathic arthritis using the detailed assessment of speed of handwriting

BackgroundHandwriting is a commonly reported functional limitation for children with juvenile idiopathic arthritis (JIA). The aim of this study was to evaluate handwriting in children with JIA.FindingsTwelve children (mean age 13.0 years, SD = 1.9; range 9.1 to 15.6 years) with JIA completed the Detailed Assessment of Speed of Handwriting (DASH). The presence of hand and wrist arthritis, grip strength, disability, pain, and quality of life (QOL) was also assessed. The mean DASH score was 34.5th percentile (SD = 22.5). Eight (75%) scored below the 50th centile. DASH scores were negatively associated with grip strength (r = -0.31).ConclusionsHandwriting difficulties are common in children with JIA. Handwriting assessment may be helpful to direct treatments, and advocate for support and accommodations in school.

Outcomes of Patients Receiving Proximal Row Carpectomy and Meniscus Interposition Allografts for the Treatment of End-Stage Wrist Arthritis: A Comparative Study.

Proximal row carpectomy (PRC) is a mainstay of wrist arthritis treatment; however, it is traditionally contraindicated in patients with an affected capitate. The use of soft tissue interposition grafts to resurface the radiocapitate articulation has been previously described to allow for PRC in these patients. In the current study, we reviewed our outcomes using knee meniscus allograft interposition to resurface the radiocapitate articulation in patients who would have otherwise been contraindicated for PRC. A retrospective study of patients who underwent PRC with or without meniscus interposition arthroplasty was performed from 2011 to 2022. Patient demographics (age, sex, occupation, hand dominance, etc) were collected. Improvement in pain was the primary outcome. Wrist range of motion and reconstructive failure requiring fusion were the secondary outcomes. We identified a total of 83 patients and 43 met the inclusion criteria. Fifteen patients (35%) underwent PRC with meniscus interposition arthroplasty, and 28 patients (65%) underwent PRC alone. Patients with and without meniscus interposition arthroplasty had documented improvement in pain postoperatively (93% vs 95%, P > .05) at a median follow-up time of 11 (range, 3-38 months) and 9 months (range, 3-64 months), respectively. Postoperative wrist range of motion (flexion: +9 vs -4, P > .05, extension: +12 vs -4, P = .10) trended toward increase in patients undergoing meniscus interposition arthroplasty compared with PRC alone. Our short- to mid-term outcomes in patients with end-stage wrist arthritis affecting the capitate who undergo PRC and meniscus interposition arthroplasty are comparable with those receiving PRC alone.

Caution Regarding ChatGPT's Appropriateness and Reliability Regarding Surgery for Wrist Arthritis.

Chat Generative Pre-Trained Transformer (ChatGPT), an artificial intelligence (AI) program, is widely used for information compilation. This study sought to analyze the quality and consistency of the information generated by ChatGPT regarding common procedures for wrist arthritis. 32 standardized questions regarding wrist osteoarthritis and related procedures (4-corner-fusion [4CF], proximal row carpectomy [PRC], resurfacing capitate pyrocarbon implant, wrist denervation, and total wrist arthrodesis and arthroplasty) were presented to the ChatGPT-3.5 interface 3 separate times, without feedback. ChatGPT's answers were evaluated for medical accuracy by 3 reviewers and rated as "appropriate," "appropriate but incomplete," or "inappropriate." Ratings were then converted to numerical values to calculate an intraclass correlation coefficient (ICC). A DISCERN score was used to assess quality, and Flesch-Kincade Grade Level and Flesch Reading Ease Score for readability. 75% of the responses were deemed "appropriate," with 23 questions receiving unanimous appropriate ratings across all responses. The ICC was 0.97 (95% CI [0.46, 0.98]), indicating excellent reliability. DISCERN score was 60 (good). The Flesch-Kincaid Grade Level was 14.6 ± 1.9, and the Flesch Reading Ease Score was 25.3 ± 6.7, implying a college reading level. The information that ChatGPT provided for PRC and total wrist arthrodesis and arthroplasty, appeared to be more reliable than for 4CF and denervation. ChatGPT's reliability and accuracy of information varied across procedures, possibly due to unknown and diverse sources. Furthermore, while some answers were factually correct, many provided generic information across differing questions, limiting usefulness. ChatGPT must be used cautiously and the limitations understood.

Progression of arthritis after four-corner fusion in patients with calcium pyrophosphate deposition disease: a case series of eleven patients

Aim: The purpose of this study is to evaluate outcomes and radiographic progression of wrist arthritis after four-corner fusion (4CF) in patients with evidence of calcium pyrophosphate deposition disease (CPPD). The insights derived from this study are expected to improve the understanding of 4CF outcomes in the presence of CPPD, guiding clinical decisions, and management strategies. Methods: 11 patients with prior 4CF and evidence of CPPD were available for prospective follow-up and imaging, with a mean follow-up time of 5 years. Range of motion measurements, radiographs, and outcome data were collected at the follow-up visit and prior data and imaging were reviewed retrospectively. The chronological progression of arthritis was evaluated on standard three-view wrist radiographs using the Larsen scale. Results: All participants (11/11) deemed their wrist fusion a success, with an average satisfaction score of 8.8 out of 10.73% (8/11) patients were able to return to their original occupation after the procedure. The mean flexion of the affected wrist preoperatively was 43 degrees (SD: ±12 degrees) and 41 degrees (SD: ±7 degrees) at the final follow-up. The mean extension of the affected wrist was 35 degrees (SD: ±8 degrees) preoperatively and 40 degrees (SD: ±12 degrees) at the final follow-up. Radiographic analysis showed that 82% (9/11) of patients displayed progression of arthritis as per the Larsen scale by the final follow-up. All patients that showed radiographic progression had involvement of the radiolunate (RL) articulation, which is classically persevered in non-inflammatory wrist arthritis. Conclusions: Scaphoid excision with 4CF is a promising surgical option for managing CPPD-related wrist arthritis, offering significant functional improvements, motion preservation, and high patient satisfaction. However, it does not halt radiographic progression of arthritis for the majority of patients at a mean prospective long-term follow-up of 5 years.

Evaluating inter- and intraobserver reliability in radiographic determination of wrist alignment following scaphoid excision and four-corner arthrodesis

BackgroundFour-corner arthrodesis is commonly performed for advanced collapse patterns of wrist arthritis. Reduction of the capitolunate (CL) angle during four-corner fusion is crucial to allow for the greatest radiocarpal joint arc of motion. Previous studies demonstrate variable inter- and intraobserver reliability of measuring the CL angle. However, in a four-corner fusion, hardware implementation and scaphoid excision can complicate carpal alignment measurements. The purpose of this study is to investigate inter- and intraobserver reliability of measuring carpal alignment parameters following scaphoid excision and four-corner arthrodesis. MethodsThree fellowship-trained orthopaedic hand surgeons evaluated 30 posteroanterior and lateral radiographs of wrists after scaphoid excision and four-corner fusion. Radiographic evaluation included analysis of the radiolunate angle (RL), CL angle, lunate posture, carpal height, carpal height ratio, hardware impingement, and arthrodesis technique. Intraclass correlation coefficients (ICCs) and kappa values were used to evaluate reliability of radiographic measurements. ResultsRL and CL angles demonstrated very good inter- (ICCs: 0.657 and 0.693, respectively) and intraobserver agreement (ICCs: 0.576 to 0.924 and 0.596 to 0.811, respectively). Hardware impingement metrics by dorsal prominence and radiocarpal prominence had excellent interobserver reliability of 0.821 and 0.803, respectively. ICC values for arthrodesis technique were equal to 1.00. The inter- and intraobserver ICC values for the number of screws/staples used were in excellent agreement ranging from 0.910 to 1.000. ConclusionsOur study demonstrated favorable intra- and interobserver reliability at assessing carpal alignment following scaphoid excision and four-corner arthrodesis and these metrics potentially could be used in future research to evaluate long-term surgical outcomes. Level of evidenceLevel III, retrospective cohort study.

Extensor Tendon Reconstruction in Vaughan–Jackson Syndrome: Surgical Technique and a Case Illustration

Background and Aims: Vaughan–Jackson syndrome, a complication of rheumatoid arthritis, presents with extensor tendon rupture, dorsal tenosynovitis, distal radioulnar synovitis, dorsal subluxation of the distal ulna, and wrist arthritis. This article aimed to present a surgical approach for Vaughan–Jackson syndrome, focusing on dorsal tenosynovectomy, distal ulnar resection and extensor tendon reconstruction. Case Description: A detailed case study is presented, highlighting the surgical technique employed for managing Vaughan–Jackson syndrome. Technical nuances and considerations are discussed. Results: The surgical technique described resulted in successful management of the patient’s Vaughan–Jackson syndrome, with restoration of hand and wrist function. Conclusion: Surgical intervention involving dorsal tenosynovectomy, distal ulnar resection, and extensor tendon reconstruction is a viable option for managing Vaughan–Jackson syndrome. This article provides insights into the surgical management of this complex condition, offering guidance for clinicians encountering similar cases.