Average Wrist Score Research Articles

Arthroscopic bone grafting with percutaneous fixation in treating scaphoid nonunion

Objective To analyze the clinical effects of arthroscopic autologous bone grafting and percutaneous fixation in treating scaphoid nonunion. Methods From May 2013 to August 2017, a total of 25 cases of patients including 20 males and 5 females with unilateral scaphoid fractures and nonunion were reviewed, with mean age of 35.80±2.41 years (18-65 years). The duration from injury to treatment was averaged 11.70±1.90 months (5-18 months). All of the cases sustained waist and proximal end fractures. X-ray and CT scan showed sclerosis and bone resorption without any callus at the fracture sites. However, there were no serious deformities and wrist arthritis. The patients suffered pain and weakness at the radial side of the wrist. The type of the fractures were Slade-Geissler's III-VI, including grade III 4 cases, grade IV 13 cases, grade V 7 cases and grade VI 1 case. The patients were treated with arthroscopic debridement of the sclerotic bone, autologous bone grafting, percutaneous screw (9 cases) or K-wires fixation (16 cases) and immobilization by plaster for 3 weeks after operation, followed by functional rehabilitation training. Bone union was assessed by serial plain radiographs and CT scan regularly. The functional effects were evaluated by comparing the modified Mayo wrist score with the visual analogue scale (VAS) for pain, range of motion (ROM) and the grip strength, which were measured before operation and at 18 months after operation. Results All cases were followed up. Bone union was achieved in all of 25 nonunion. The average radiological union duration was 10.24±2.10 weeks (6-20 weeks). The average VAS score decreased from 6.75±1.10 preoperatively to 1.33±0.21. The mean ROM of wrist was improved to 168.48°±12.41° (92.90% of that of the normal side), compared to that of 135.24°±17.47° preoperatively (79.80% of that of the normal side). The mean grip strength showed improvement from an average of 35.68±3.81 kg (80.46% of that of normal side) preoperatively to 48.75±4.42 kg (90.65% of that of normal side). The average modified Mayo wrist score improved from 61.52±6.32 preoperatively to 85.88±8.37. Conclusion Arthroscopic autologous bone grafting with percutaneous cannulated screw and K-wires fixation is an effective and minimally invasive treatment for scaphoid nonunion, which could protect the blood supply of the fracture sites, decrease the surgical complications, promote bone healing and lead to a faster recovery. Key words: Arthroscopy; Bone transplantation; Scaphoid bone; Fractures, ununited; Fracture fixation, internal

Primary Wrist Hemiarthroplasty for Irreparable Distal Radius Fractures in the Independent Elderly

Objective: Despite the improvement of open reduction and internal fixation (ORIF) of distal radius fractures (DRFs) provided by locked volar plating in elderly patients, there are still complex distal DRF not amenable to any satisfactory fixation. The purpose of this article is to define irreparable acute DRF in autonomous elderly patients and to review the preliminary results of a prospective series using wrist hemiarthroplasty at the acute stage. Methods: A total of 12 wrists in 10 women were prospectively included. The average age was 74 years (range, 65-87). All patients were autonomous at home. All were intra-articular Arbeitsgemeinschaft für Osteosynthe-sefragen (AO) “C” type fractures. Circumferential comminution was present in all cases. Impaction and cartilage defect were present in all cases. All patients sustained wrist hemiarthroplasty through a single dorsal approach. The proximal part of a total wrist arthroplasty was used in 10 cases and a modified implant with a longer stem was used in 2 cases. An ulnar head resection was associated in 10/12 cases whereas the ulnar head could be kept intact in 2 wrists. Postoperative immobilization was 3 weeks followed by a splint for 3 weeks. Follow-up consisted of clinical and radiographic evaluation at 6 weeks and 2, 6, and 12 months. The average clinical and radiological follow-up was 27 months (minimum 12, maximum 41). Results: There were no dislocation, loosening, or implant removal. One wrist was reoperated on for stiffness followed by a significant improvement. Complex pain regional syndrome (CPRS) was present in 3 patients. At follow-up, Visual Analog Scale (VAS) pain was 10/100. Average Quick Disability of the Arm, Shoulder and Hand (QuickDASH) was 32 points and Patient-Rated Wrist Evaluation (PRWE) was 24.7. Mean active motion values were as follows: pronation 74°, supination 77°, extension 34°, and flexion 26°. The average grip strength was 14 kg, 67% of the contralateral side. The average wrist score was 69%. Radiologically, periprosthetic bone healing was observed in all cases. We observed 1 radial and 3 ulnar inclination of the implant. This was not observed with the longer stem implant. Discussion: Implant surgery at the acute stage for complex fractures in the elderly is an old validated concept for hip, shoulder, and elbow. Indeed some DRFs in the autonomous elderly are beyond any ORIF possibilities due to the combination of comminution and a very distal fracture line. Our results suggest that primary wrist hemiarthroplasty is a viable method to treat these difficult wrist injuries in this specific population. Further controlled prospective studies are necessary to validate this concept.

Traitement prothétique des fractures du radius distal irréparables du sujet âgé autonome. Résultats préliminaires, étude prospective de 10 cas

Introduction The purpose of this paper was to define irreparable acute DRF in autonomous elderly patients and to review the current results of a prospective study using a resurfacing implant to treat these injuries. Methods A total of 10 wrists in 10 women were prospectively included. The average age was 75 years (range 64–87). General health status was normal in 3 patients and there were co-morbidities in seven. However, all patients were autonomous at home. Functional needs were high in 3, intermediate in 7. All but one DRF were articular “C” type. Displacement was volar in 4 patients and dorsal in 6 patients. Circumferential comminution was present in all cases. The average intra-articular displacement severity score (Intra-DSS) was 11.5/12. Impaction and cartilage defect were present in all cases. All patients sustained total wrist arthroplasty through a single dorsal approach. An ulnar head resection was combined in 8/10 cases. Post-operative immobilization was 3 weeks followed by a splint for 3 weeks. Follow-up consisted of clinical and radiographic evaluation at 6 weeks, 2, 6, 12 months. A wrist clinical score was used as well as the Quick-Dash and PRWE. Results Reflex sympathetic dystrophy was present in 2 patients. In the 5 patients with more than 3 months of follow-up and no RSD, the average VAS pain was 1.6. Average ranges of active motion were: pronation 65°, supination 66°, wrist extension 28°, and flexion 21°. The average grip strength was 38% of the contralateral side. The average wrist score was 57 pts. Discussion Implant surgery at the acute stage for complex fractures in the elderly is an old validated concept for hip, shoulder and elbow. This concept recently emerged for DRF as well. Indeed, some DRF in the elderly are beyond any osteosynthesis fixation. Autonomous elderly patients are good candidates to prosthetic surgery. Our preliminary results confirm that there may be a room for prosthetic replacement of the distal radius at the acute stage in selected elderly patients. Further controlled prospective studies are necessary to validate this concept.

Traitement prothétique des fractures du radius distal irréparables du sujet âgé autonome. Résultats préliminaires, étude prospective de 10 cas

The purpose of this paper was to define irreparable acute DRF in autonomous elderly patients and to review the current results of a prospective study using a resurfacing implant to treat these injuries. A total of 10 wrists in 10 women were prospectively included. The average age was 75 years (range 64–87). General health status was normal in 3 patients and there were co-morbidities in seven. However, all patients were autonomous at home. Functional needs were high in 3, intermediate in 7. All but one DRF were articular o C O type. Displacement was volar in 4 patients and dorsal in 6 patients. Circumferential comminution was present in all cases. The average intra-articular displacement severity score (Intra-DSS) was 11,5–12. Impaction and cartilage defect were present in all cases. All patients sustained total wrist arthroplasty through a single dorsal approach. An ulnar head resection was combined in 8–10 cases. Postoperative immobilization was 3 weeks followed by a splint for 3 weeks. Follow-up consisted of clinical and radiographic evaluation at 6 weeks, 2, 6, 12 months. A wrist clinical score was used as well as the Quick DASH and PRWE. Reflex sympathetic dystrophy was present in 2 patients. In the 5 patients with more than 3 months of follow-up and no RSD, the average VAS pain was 1,6. Average ranges of active motion were – pronation 65°, supination 66°, wrist extension 28°, flexion 21°. The average grip strength was 38% of the contralateral side. The average wrist score was 57 pts. Implant surgery at the acute stage for complex fractures in the elderly is an old validated concept for hip, shoulder and elbow. This concept recently emerged for DRF as well. Indeed some DRF in the elderly are beyond any osteosynthesis fixation. Autonomous elderly patients are good candidates to prosthetic surgery. Our preliminary results confirm that there may be a room for prosthetic replacement of the distal radius at the acute stage in selected elderly patients. Further controlled prospective studies are necessary to validate this concept.

Treatment of Ulnar Impaction Syndrome using Arthroscopy and Ulnar Shortening Osteotomy

Pur p ose: To retrospectively analyze the follow-up results of patients with ulnar impaction syndrome, who were treated with arthroscopic debridement, thermal shrinkage and a simultaneous ulnar shortening osteotomy. Mat e r ia ls and Met h ods: E leven wrists from ten patients with ulnar impaction syndrome, which were diagnosed by the clinical history, physical examination, radiological evaluation and arthroscopic findings, and were treated by arthroscopic debridement, thermal shrinkage and ulnar shortening osteotomy were enrolled in this study. The minimum duration of the follow-up was one year. The ulnar variance was measured using Kreder’s method, and the follow-up results were analyzed radiographically as well as clinically using the C hun and P almer wrist score. Resul ts : According to the wrist scoring system, seven wrists were fair and four poor preoperatively. However, after surgery, eight wrists were excellent and three good. The average wrist score increased from 62 preoperatively to 93 at the last follow-up. The mean ulnar variance decreased from +3.3 mm (+0.4-+6.4 mm) preoperatively to +0.1 mm ( －0.8-+1.3 mm) at the last follow-up. Radi ological union of the osteotomy site was achieved after an average of 12 weeks. There were no cases of nonunion or malunion.

Arthroscopic Treatment of Partial Scapholunate Ligament Tears in Children with Chronic Wrist Pain

Scapholunate ligament injury is rare in the adolescent and pediatric population, and the results of treatment have not been well described. The purpose of the present study was to review the outcomes of arthroscopic management of patients with persistent wrist pain and scapholunate ligament injury as documented on arthroscopic examination who had had a failure of at least six months of nonoperative management. The medical records of thirty-two pediatric and adolescent patients who underwent arthroscopic treatment of scapholunate ligament injuries were retrospectively reviewed to obtain preoperative and postoperative modified Mayo wrist scores, radiographic data, and intraoperative findings, including the classifications of interosseous ligament injury, chondral injury, and other abnormalities. Patients were contacted after a minimum of two years of follow-up for reevaluation of the Mayo wrist scores. Arthroscopic evaluation revealed thirty Geissler type-II tears and two Geissler type-III tears. In addition to these scapholunate ligament injuries, seven of the thirty-two patients had partial tears of the short radiolunate ligament that appeared to be at the site of impaction from carpal subluxation, twelve had a triangular fibrocartilage complex injury, and twenty-seven had a chondral injury. The modified Mayo wrist scores showed improvement following arthroscopic débridement of partial-thickness tears and associated chondral injuries. The average wrist score was 66.3 preoperatively and 91.6 at an average of forty-three months of follow-up. Eight patients required subsequent surgery because of deterioration in their clinical status. After a mean duration of follow-up of 30.8 months, the average wrist score was 87.1. The majority of pediatric and adolescent patients with wrist pain who have a failure of nonoperative management and who have a Geissler type-II scapholunate ligament tear on arthroscopic examination can have substantial long-term improvement following arthroscopic débridement of the tear combined with treatment of other associated injuries.

ARTHROSCOPIC TREATMENT OF PARTIAL SCAPHOLUNATE LIGAMENT TEARS IN CHILDREN WITH CHRONIC WRIST PAIN

Background: Scapholunate ligament injury is rare in the adolescent and pediatric population, and the results of treatment have not been well described. The purpose of the present study was to review the outcomes of arthroscopic management of patients with persistent wrist pain and scapholunate ligament injury as documented on arthroscopic examination who had had a failure of at least six months of nonoperative management. Methods: The medical records of thirty-two pediatric and adolescent patients who underwent arthroscopic treatment of scapholunate ligament injuries were retrospectively reviewed to obtain preoperative and postoperative modified Mayo wrist scores, radiographic data, and intraoperative findings, including the classifications of interosseous ligament injury, chondral injury, and other abnormalities. Patients were contacted after a minimum of two years of follow-up for reevaluation of the Mayo wrist scores. Results: Arthroscopic evaluation revealed thirty Geissler type-II tears and two Geissler type-III tears. In addition to these scapholunate ligament injuries, seven of the thirty-two patients had partial tears of the short radiolunate ligament that appeared to be at the site of impaction from carpal subluxation, twelve had a triangular fibrocartilage complex injury, and twenty-seven had a chondral injury. The modified Mayo wrist scores showed improvement following arthroscopic débridement of partial-thickness tears and associated chondral injuries. The average wrist score was 66.3 preoperatively and 91.6 at an average of forty-three months of follow-up. Eight patients required subsequent surgery because of deterioration in their clinical status. After a mean duration of follow-up of 30.8 months, the average wrist score was 87.1. Conclusions: The majority of pediatric and adolescent patients with wrist pain who have a failure of nonoperative management and who have a Geissler type-II scapholunate ligament tear on arthroscopic examination can have substantial long-term improvement following arthroscopic débridement of the tear combined with treatment of other associated injuries. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Diagnosis and treatment of Essex-Lopresti injury: report of five cases

To explore the pathogenetic mechanism, diagnostic criteria, and treatment of Essex-Lopresti injury. The clinical data of 5 patients with Essex-Lopresti injury that were treated by reconstruction of the length of radius, reduction and stabilization of the distal radio-ulnar joint and 3 of which were followed up were analyzed. In all the five patients there were no pain in elbow or wrist, instability in elbow joints, and limitation in the territory of the elbow joints. The patients had an average elbow score of 86.8 points (75.5 to 95.5 points), one with excellent result; 4 with good result, and one with fair result, according to the Morry's elbow joint scoring system. There was a little limitation for the wrist joints. The injuries did not affect their ordinary life. Only one of the 5 patients with open injury felt being unable to do as much as he would like to, and the others were capable to go back to work as usual. The average wrist score was 87 points (80 to 90 points), 3 with excellent result, and 2 with good result, according to the Green and O'Brien's wrist clinical scoring system. Early and accurate diagnosis is critical in order to obtain a satisfactory result in Essex-Lopresti injury. The primary goal is to reestablish the normal length of radius, relocation and stabilization of the distal radioulnar joint.

Preliminary results of total wrist arthroplasty in rheumatoid arthritis using the trispherical total wrist arthroplasty

Thirty-two patients underwent 38 arthroplasties for advanced rheumatoid arthritis and marked soft tissue losses. Seven wrists required repair or transfer of at least one tendon for rebalancing. All patients were improved by the implants. Thirty-four of the 38 patients were improved beyond the functional level of a painless wrist arthrodesis. Overall, there were 23 excellent, 10 good, 3 fair, and 2 poor results. The average wrist score was 90.3 points, and the average arc of motion was 38°. There were three cases of migration of the third metacarpal stem and nine cases of lucency about the stems, three of which were progressive or greater than 1 mm. There were no deep infections. There was one reoperation for persistent pain and one for component loosening. There were no cases of implant failure. These results indicate that this total wrist arthroplasty is a safe, reproducible procedure for radiographic class III and IV rheumatoid disease and should be considered a first line of therapy for that group.