Arthritis Grade Research Articles

Indications of Total Ankle Replacement for Ankle Arthritis: The Evaluation of Quality of Life and Radiographic Findings

Objectives: Little is known about the quality of life and clear cut radiographic grades of ankle arthritis in patients with indication for the total ankle replacement (TAR) comparing with patients without indication for TAR. This study was to compare the quality of life and radiographic grades of ankle arthritis in patients who had ankle arthritis with and without indication for TAR. Methods: From January 2010 to November 2013, the evaluation was conducted on 23 patients aged 18 or older who had ankle arthritis from several causes. The 23 patients were divided into two groups according to their indications of TAR: TAR group (n=7 patients) and non-TAR group (n=16 patients). The medical records of each patient were reviewed to collect for the pre-treatment visual analogue scale (VAS-pain score), visual analogue scale foot and ankle (VAS-FA) score, health-related quality of life score via short-form 36 (SF-36), baseline data including age, gender, side of ankle arthritis, cause of arthritis, radiographic findings, and treatment methods. Results: There were no significant differences in the mean VAS-pain, VAS-FA, and SF-36 scores between the TAR and non-TAR groups (p>0.05). Poorer radiographic grades as Takakura grades 3-4 or the author's grades 3-4 were significantly higher in TAR group (p<0.001). SF-36 scores were significantly lower in patients with poorer radiographic grades in both Takakura (p=0.023) or Angthong (p=0.042) classifications. Conclusion: Although quality of life in patients with indication for TAR was not significantly poorer than patients without indication for TAR, radiographic grades in patients with indication for TAR were significantly poorer than patients without indication for TAR. Radiographic grades of ankle arthritis as Takakura grades 3-4 or the author's grades 3-4 are the clear cut criteria in combination with other accepted criteria to be indications for TAR.

Volar Ligament Release and Distal Radial Dome Osteotomy for the Correction of Madelung Deformity: Long-Term Follow-up

Madelung deformity is a disorder of growth of the distal aspect of the radius that is usually recognized in late adolescence near skeletal maturity. It results in a characteristic wrist deformity, decreased wrist motion, and wrist pain. The purpose of this study was to evaluate long-term results in patients treated by volar ligament release and distal radial dome osteotomy for Madelung deformity. Patients who had undergone volar ligament release and dome osteotomy for Madelung deformity at our institution from 1990 to 2002 and who were the subjects of a previous report on this treatment were contacted for clinical and radiographic evaluation at mid-term to long-term follow-up. Forearm and wrist motion was evaluated. Posteroanterior and lateral radiographs of both forearms were assessed for radial inclination, lunate subsidence, and arthritis changes. A Disabilities of the Arm, Shoulder and Hand (DASH) survey was completed. Twenty-seven patients underwent volar ligament release and distal radial dome osteotomy. Eight patients were either lost to follow-up or were unable to return for follow-up. Nineteen patients with thirty-one operatively treated wrists were available for follow-up. After further review, eighteen patients and twenty-six wrists were included in the study. The average age at the time of follow-up was twenty-five years (range, nineteen to thirty-one years), with an average length of follow-up of eleven years (range, seven to fourteen years). There was no change in radial inclination or in wrist motion between the immediate postoperative and long-term follow-up evaluations. There was a positive correlation between the amount of deformity correction based on more severe preoperative parameters and an increased arthritic grade at the time of follow-up. There was positive correlation between an increased DASH score and arthritis grade as well as a correlation between whole bone deformity and increased arthritis grade and DASH score. Volar ligament release and distal radial dome osteotomy for Madelung deformity provides lasting correction of the deformity. Long-term follow-up shows maintenance of original radiographic correction with good to excellent functional outcome. Patients with radiographic evidence of more severe disease preoperatively and the whole bone variety of Madelung deformity have poorer radiographic outcomes and trend toward poorer functional outcomes.

Two-Year Follow-up of Hip Arthroscopies: A Matched Control Study Comparing Patients Over 50 Years to Patients Under 30 Years (SS-32)

Hip arthroscopy has been gaining popularity for the last ten years, with growing evidence for its use in the younger population. Few studies have addressed the issue of hip arthroscopy in the aging population, and none have compared it directly to a young cohort. The purpose of the current study was to compare the outcomes and patient characteristics of hip arthroscopy procedures in patients over 50 years with a matched control group of patients younger than 30 years, at a minimum post-operative follow-up of two years. Between September 2008 and March 2010, data was prospectively collected on all patients over 50 years of age, undergoing primary hip arthroscopy. Previous hip conditions (Fracture, Avascular Necrosis, LCPD, Dysplasia, PVNS, Ehlers-Danlos syndrome) were excluded. A total of 64 cases met our inclusion/exclusion criteria, of which 59 (92%) were available to follow-up. A gender-matched control group of patients younger than 30 years old was created. All patients were assessed pre- and post-operatively using four hip-specific questionnaires. Pain was estimated on the visual analog scale (VAS) and satisfaction was measured on a scale from 0-10. Pre-operative radiographic assessment was performed on all patients, intra-operative findings were recorded. The mean age of our study group was 55.66 (50-76) and the control group was 21 (14-30). The groups were gender-matched, consisting of 19 (32%) male and 30 (68%) females in each group. The pre-operative joint space, as measured on X-ray was 3.3mm (1-6.8) in the study group and 3.48mm (1.9-5.6) in the control group. Twenty cases (34%) of the study group had undergone joint replacement surgery at the time of the last follow-up. The mean time from arthroscopy to joint replacement was 17.7 months (range, 3.5 months to 38.5 months) with a two-year survivorship of 49 patients (83%). Survivorship was 8 of 16 (50%) for patients with Tonnis 2 arthritic grade, versus 32 of 43 (74%) for patients graded Tonnis 0 or 1. At the two year follow-up the modified Harris Hip Score (mHHS) improved from 54.9 (22-96) to 84.5 (28.6-100) in the study group, and from 64.4 (25.3-97) to 89.3 (45.1-100) in the control group. The Hip Outcome Score for activities of daily living (HOS-ADL) improved from 58.0 (16.7-96.4) to 82.6 (35.3-100) in the study group and from a 67.1 (23-96) to 89.9 (36.8-100) in the control group. The improvement in both scores was higher for the study group, but not statistically significant. The post-operative VAS was 3 for the study group and 2.4 for the control (p=0.6895) and satisfaction was 8.26 for the study group and 8.46 for the control (p=0.84). Patients over 50 years with Tonnis grades of 0 or 1 have a significantly higher survivorship than those with Tonnis grade 2. Overall, patients over 50 years of age experienced similar improvement to patients younger than 30 years after hip arthroscopy regarding pain and function. Therefore, we believe that hip arthroscopy should be considered a valid option when treating hip pain in patients over 50 years with arthritic grade Tonnis 0 or 1.

Comparison of tricalcium phosphate cement and cancellous autograft as bone void filler in acetabular fractures with marginal impaction

ObjectiveTo compare clinical and radiological outcome between acetabular fractures with marginal impaction that were treated with either cancellous bone graft (CBG) or tricalcium phosphate cement (TPC) as bone void filler. DesignRetrospective study. PatientsForty-three patients with acetabular fractures with marginal impaction. InterventionEighteen patients received cancellous bone graft and 25 patients received tricalcium phosphate cement as bone void filler. Main outcome measurementClinical outcome was assessed using the Merle d’Aubigne score and Short-form-36. Radiographs were evaluated for postoperative reduction, arthritis grade and development of heterotopic ossification. ResultsForty-three patients met the inclusion criteria. There was no significant difference in the demographics, laterality, fracture type, associated injuries, surgical approach and postoperative quality of reduction between the groups. At final follow-up, a significantly higher number of patients in the cancellous bone graft group exhibited signs of moderate to severe post-traumatic arthritis (CBG: 6 (33%) vs. TPC: 4 (20%), p=0.007) and required a total hip arthroplasty (CBG: 4 (22.2%) vs. TPC: 1 (5%), p=0.08). There was no significant difference between the two groups in the SF-36 score and the modified Merle d’Aubigne score. ConclusionPatients with acetabular fractures with marginal impaction treated with tricalcium phosphate cement exhibit a significantly lower incidence of post-traumatic arthritis when compared to patients treated with cancellous bone graft. Level of evidenceIII.

Surgical Correction of the Ball and Socket Ankle Joint in the Adult Associated With a Talonavicular Tarsal Coalition

Ball and socket ankle (BASA) deformity is a rare condition. Little is known about outcomes and treatments in the adult population. Retrospective comparative review was performed of 13 patients treated for BASA with a minimum follow-up of 2.5 years. Evaluation included clinical and radiographic review, outcome scores, a questionnaire, and a subjective satisfaction survey. Nine patients with correctable valgus deformity not associated with arthritis of the ankle joint underwent a supramalleolar osteotomy (SMO). Four patients underwent arthrodesis-2 a tibiotalocalcaneal (TTC) arthrodesis and 2 a pantalar arthrodesis. AOFAS scores improved from 30.1 to 77.6 (range, 16-82) (P < .05) in the SMO group. AOFAS scores improved from 24 to 60.5 (range, 16-66) (P < .05) in the arthrodesis group. Arthritis grade in the SMO patients was unchanged in 4 patients at final follow-up and worsened in 5 patients by only 1 grade. Nine patients reported good results (all 4 arthrodesis patients, 5 SMO patients) and 4 reported fair results (all SMO patients). BASA deformity and dysfunction can be improved with corrective surgery. Level III, prospective comparative study.

Joint Space Height Correlates with Arthroscopic Grading of Wrist Arthritis

Osteoarthritis of the radiocarpal joints is commonly encountered by hand surgeons. To date, there is no well-defined method of radiographically grading osteoarthritis of the wrist. Preoperative radiographs of 48 patients undergoing wrist arthroscopy were evaluated retrospectively. Images were graded subjectively by five surgeons based on overall severity of arthritis, osteophytes, subchondral cysts, and subchondral sclerosis. The joint space height (JSH) ratio was calculated by measuring the space of the mid-radioscaphoid and mid-radiolunate joints and dividing each by the height of the capitate. Arthroscopic grading of arthritis was obtained from operative records and compared to subjective and objective grades. ANOVA testing evaluated for statistical significance with p < 0.05. Inter-rater and intra-rater reliability was determined using Pearson's correlation analysis and Cohen's kappa coefficient. Objective measurement using the JSH ratio demonstrated a significant decrease as arthroscopic arthritis grade increased for both radioscaphoid and radiolunate joints. Subjective grading of radioscaphoid and radiolunate joints was able to detect moderate/severe, but not mild arthritis. Subjective grading underestimated the degree of arthritis, particularly in the radiolunate joint. Inter-rater reliability was better for objective compared to subjective grading. Subjective grading of wrist arthritis can detect moderate/severe radiocarpal arthritis but poorly evaluates early arthritis and underestimates severity. Objective grading using the JSH ratio accurately grades radioscaphoid arthritis and detects early radiolunate arthritis. The JSH ratio more accurately assesses radiocarpal arthritis compared with subjective grading. As there currently is no accepted method to radiographically grade wrist arthritis, the JSH ratio represents a promising option.

Pre-operative arthritis severity as a predictor for total knee arthroplasty patients’ satisfaction

Studies have shown that up to 25% of TKA patients are dissatisfied with the implanted knee, even if registry data shows ten-year revision rates below 5%. It has been the question of our study, if it would be possible to identify those patients at risk for dissatisfaction pre-operatively. The data of 1,121 consecutive TKA patients with a follow-up between one and six years have been analysed retrospectively. Demographic, radiologic and perioperative variables have been recorded and all patients were asked by questionnaire for satisfaction with the implanted knee. Logistic regression models have been used to identify significant risk factors. The data of 996 patients (89%) were complete, 849 (85.2%) reported satisfaction and 147 (14.8%) dissatisfaction. Patients' satisfaction was independent of the time after operation (p = 0.285). The only factor which influenced patients' satisfaction was the osteoarthritic severity. In comparison to severe arthritis Kellgren Lawrence IV°, the risk for dissatisfaction was 2.556-fold elevated for arthritis grade III° (p < 0.001) and 2.956-fold higher for grade II° (p = 0.001). Patients suffering from mild or moderate osteoarthritis are at risk for dissatisfaction after TKA. The TKA indication in those patients should therefore be critically proven. Furthermore, to adjust patients' expectations, the elevated dissatisfaction risk in case of mild or moderate osteoarthritis should be included into patients' pre-operative information.

The Management of the Displaced Medial Wall in Complex Acetabular Fractures Using Plates and Additional Cerclage

Reduction for displaced quadrilateral plates in complicated acetabular fractures is difficult and requires wide exposure. The purpose of this study is to assess the usefulness of the additional cable in this complicated fracture and to evaluate the potential danger of compressing the superior gluteal artery and nerve with cable application. We evaluated 31 hips (these included 25 hips with fractures of both columns, two posterior wall and column fractures, three anterior column and posterior hemitransverse fractures, and one high T-shaped fracture) with an average six-year follow-up. Clinical outcomes were evaluated using a modification of the Matta grading system and radiographic arthritic grades. We assessed the postoperative clinical outcomes in relation with other variables such as anatomical reduction, delayed operation, seagull sign, and femoral head injuries. We determined whether the superior gluteal artery and nerve were compressed by cerclage with the help of femoral angiography and EMG. Clinical outcomes were graded as very good to excellent for 18 patients, good for five, fair for three and poor for five. Preoperative femoral head injury (P = 0.011), a seagull sign (P = 0.001), poor reduction (P = 0.015), and delayed reduction (P = 0.05) were found to statistically influence clinical results. We found that there were no injuries to the superior gluteal artery and nerve in spite of using a cable. Cerclage methods can be useful for initial reduction of displaced medial plates in acetabular fractures. These methods reduce operation time and blood loss as compared with other methods.

Proximal Interphalangeal Joint Injection Through a Volar Approach: Anatomic Feasibility and Cadaveric Assessment of Success

The proximal interphalangeal (PIP) joint is a challenging joint to access reliably for corticosteroid injection. Literature has confirmed both a relatively high failure rate for injections performed with the traditional dorsal approach and an improved clinical response rate for confirmed intra-articular injections. We describe a technique for injecting the PIP joint through a volar approach, assess its reliability through cadaveric dissection, and determine its reproducibility by comparing success rates with the dorsal approach in a cadaver model. We dissected the PIP joint of 10 cadaveric digits to document necessary anatomic landmarks for this technique. We then used 20 matched pairs of cadaver hands for the remainder of our study. Four PIP joints on each hand (thumb excluded) were injected with a solution of saline and radio-opaque dye using the dorsal approach. We injected each joint on the contralateral matched hand through the volar approach. We obtained standardized fluoroscopic images of each joint immediately after injection, which were reviewed by an independent observer who was blinded to the technique and who rated outcomes as success, failure, or mixed. Success rates were evaluated based on approach used, digit injected, and degree of pre-existing arthritis. We found reproducible anatomic landmarks that justified our injection technique. The rates of absolute failure were similar in the 2 cohorts. The volar approach demonstrated a higher percentage of successful injections with a smaller percentage of mixed results, although results did not reach statistical significance. There was no statistically significant difference in success rates based on digit injected or grade of arthritis in either cohort. The volar approach to injecting the PIP joint demonstrated success similar to that of the traditional dorsal approach. Reproducible surface landmarks exist to guide practitioners using this technique. Further study is needed to determine the potential complications and clinical outcomes of the volar approach. Therapeutic IV.

Two Year Follow-up Of Hip Arthroscopies

Objectives:Few studies have addressed the issue of hip arthroscopy in the aging population, and none has compared it directly to a young cohort. The purpose of the study was to compare the outcomes and patient characteristics of hip arthroscopy procedures in patients 50 years and over with a matched control group of patients 30 years and younger, at a minimum post-operative follow-up of two years.Methods:Between September 2008 and March 2010, data was prospectively collected on all patients 50 years and over undergoing primary hip arthroscopy. Sixty-four cases met our inclusion/exclusion criteria, of which 57 (89%) were available for follow-up at a minimum of two years. A gender-matched control group of 57 patients 30 years and younger was created. All patients were assessed pre- and post-operatively, using four patient-reported outcome (PRO) measures: the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score Activity of Daily Living (HOS-ADL) and Sport-Specific Subscales (HOS-SSS). Pain was estimated on the visual analog scale (VAS) and satisfaction was measured on a scale from 0-10. Pre-operative radiographic assessment was performed on all patients, and intra-operative findings were recorded.Results:The mean age of our study group was 55.68 (50-76), and the control group was 21 (14-30). The groups were gender-matched, including 17 (30%) male and 40 (70%) females in each group, with an average follow-up of 32 months (range 24-54 months). The two-year survivorship for the study group was 82%. The mean time from arthroscopy to joint replacement was 18.4 months (range 3.5-38.5 months). At latest follow-up, survivorship was 6 of 12 (50%) for patients with Tonnis 2 arthritic grade, versus 32 of 45 (71%) for patients graded Tonnis 0 or 1. For patients 50 and over, the score improvement from preoperative to two-year follow-up was 64 to 89 for mHHS, 60 to 88 for NAHS, 67 to 90 for HOS-ADL, and 42 to 77 for HOS-SSS. For patients 30 and younger, the score improvement from preoperative to two-year follow-up was 55 to 84.5 for mHHS, 53 to 80 for NAHS, 58 to 83 for HOS-ADL, and 35 to 62 for HOS-SSS. All improvements in both groups were statistically significant (p<0.05). There were no significant differences seen between the groups in score improvements for mHHS, NAHS or HOS-ADL. However, the improvement in the HOS-SSS was greater in the control group (p=0.03). The post-operative VAS was similar between the groups: 3.1 for the 50 and over group and 2.5 for the 30 and younger group. Satisfaction was 8.27 for the 50 and over group and 8.41 for 30 and younger group, and was also similar between groups.Conclusion:Overall, survivors 50 and over years of age experienced similar improvement to patients 30 and younger after hip arthroscopy regarding pain, functional scores, and patient satisfaction. Patients 50 and over with Tonnis grade 0 or 1 have higher survivorship than those with Tonnis grade 2. While a certain subset of patients in the older group may progress to hip replacement, the two-year survivorship of patients 50 and over was high (82%). These results present favorable two-year clinical outcomes for the older group when compared to a matched control group of younger patients. Therefore, we believe that hip arthroscopy should be considered a valid option when treating hip pain in patients 50 years and over with arthritic grade Tonnis 0 or 1.

Risk Factors for Ligamentum Teres Tears

The purpose of this study was to examine the relationship between nontraumatic ligamentum teres (LT) tears and acetabular radiographic architecture. The inclusion criteria for this study were all patients who had anteroposterior pelvis radiographic views and had undergone arthroscopic examination of the LT. The exclusion criteria were Tonnis arthritic grade 3 and traumatic high-energy mechanisms of injury. Radiographic data were measured preoperatively on an anteroposterior pelvis view, including acetabular inclination (AI), lateral center edge (CE) angle, magnitude of cross-over sign, and ischial spine prominence. A Lateral Coverage Index (LCI) was defined as the center edge angle minus acetabular inclination. Hips were divided into 3 groups according to the LCI: (1) high: 34° and above; (2) medium: 19° to 33°; and (3) low: below 19°. Of the 463 hips (430 patients) included in the study, 226 (49%) had a partial- or full-thickness LT tear. Patients with tears were significantly older than patients without tears (P < .0001), with average ages of 38 and 33 years, respectively. Radiographically, patients with tears had less acetabular retroversion, as reflected by lower ischial spine prominence values and lesser cross-over signs (P = .01 and .0005, respectively). Using the LCI, 115 hips (25%) were classified as high, 236 (50%) as medium, and 114 (25%) as low. Hips with low LCI were 1.74 times more likely to have LT tears than high LCI hips. This study found that the presence of LT tears was associated with acetabular bony morphology and age. LT tears were less frequent with high LCI and acetabular retroversion and less frequent in patients younger than 30 years. Further study is needed to establish whether there is a causal relationship between acetabular undercoverage and LT tears and whether LT tears may be a sign of microinstability of the hip. Level IV, therapeutic case series.

Osteoplasty for Cam Type Impingement Is More Accurate When Performed Open than Arthroscopic (SS-41)

Osteoplasty for Cam Type Impingement Is More Accurate When Performed Open than Arthroscopic (SS-41)

Hypermobility of the first ray in patients with planovalgus feet and tarsometatarsal osteoarthritis

Hypermobility in the foot is a common observation but difficult to quantify. Primary tarsometatarsal arthritis is less common and its aetiology uncertain. This study introduces a novel means of clinical measurement for range of motion of the medial column and investigates the association between hypermobility, planovalgus foot shape and tarsometatarsal arthritis. 32 planovalgus feet with symptomatic tarsometatarsal arthritis were compared with 36 controls. Radiographic angular measurements and arthritic grade were recorded from standing radiographs. Medial column flexion and extension was measured clinically using a validated electronic goniometer. There was a significant difference in medial column range of motion between the patient and control groups (17±5° compared to 9±3° [P<0.001]). Patients with planovalgus feet and tarsometatarsal osteoarthritis have greater range of motion of the medial column than controls with normal feet when measured using this technique. Recognition of this association may lead to progress in prevention and treatment.

Wallis interspinous implantation to treat degenerative spinal disease: description of the method and case series

The Wallis interspinous implant is most commonly used in the treatment of intervertebral disc herniation and for tears in the outer layer of the disc. The dynamic vertebral fixation concept was first initiated in 1984 with the goal of imitating the physiologic spinal kinetic. A total of 15 years later, a second generation of implant has been developed, termed the ‘Wallis interspinous Implant’, which aims to preserve the mobility of the operated spinal segment. To underline our own experience, a retrospective review of 15 patients that were treated with ‘Wallis implantation’ at our institution between January 2006 and March 2008. Our main inclusion criterion for Wallis implantation was low back pain because of degenerative lumbar spinal stenosis associated with segmental instability along with Modic changes 0–1 and with UCLA arthritic grade <II, while the main exclusion criteria were previous lumbar surgery, severe osteoporosis or degeneration UCLA grade >II in the adjacent two segments cephalad to implantation. The outcome was analyzed according to clinical and radiological parameters. One (n = 9), two (n = 4) and three levels (n = 2) were operated on using Wallis implantation, ranging from L2–L3 to L5–S1. We used implants of 8–14 mm in size. There was a reduction in low back pain (73 vs 43%) and gait disturbances (73 vs 14%) at the 3-month follow-up compared with preoperative values. In line with these results, the modified Japan Orthopedic Assocation Score (mJAOS) was increased from 12 preoperatively to 18 at 3 months and 20 at 12 months postoperatively. A reduction in low back pain could only be demonstrated for implants that were 10 mm in size or greater at 3 months and 12–15 months postoperatively. An improvement was seen in Modic grades after the operations as compared with those observed at preoperative MRI. The outcome in our patients was rated as good or excellent according to Odom’s criteria in all cases, independent of the levels that were used. Wallis implantation is therefore a safe procedure with a good to excellent outcome in the short- and mid-term follow-up and can lead to disc rehydration, as confirmed by postoperative MRI. Principal postoperative (clinical) success is based on the correct implant size.

Medial Fracture Line Significance in Calcaneus Fracture

In Sanders’ classification of calcaneus fractures, the medial fracture line (subtype C) is close to the tarsal canal, which contains an artery for the talus and calcaneus. We hypothesized that because of this brittle vascular localization, patients with C line fracture patterns might describe radiologic subtalar arthritis more often and have more complaints. The purpose of the present study was to compare the results of C line fracture patterns with other types of calcaneus fractures. A total of 25 surgically treated feet were involved. Regarding Sanders’ classification, group 1 included fractures involving the C line (11 feet), and group 2 included fractures not involving the C line (14 feet). Patient age at admission, trauma date, and interval until surgery were obtained from the patients’ medical records. The Bohler angles were determined from the radiographs. At the last follow-up visit, the radiologist graded subtalar arthritis using computed tomography. For clinical follow-up, the American Orthopaedic Foot and Ankle Society and Maryland scores were assessed. No significant differences were found in mean age, follow-up period, delay to surgery, or postoperative Bohler angle between the 2 groups. The mean preoperative Bohler angle was significantly low for group 1. Although not significantly different, the mean American Orthopaedic Foot and Ankle Society and Maryland scores were lower for group 1 (81.9 and 84.3) than group 2 (87.8 and 92.0), and the median subtalar arthritis grade was greater for group 1 (score 2) than for group 2 (score 1.5). The worse results with C line fracture patterns despite satisfactory reduction might result from sinus tarsi artery damage. Angiographic investigations could clarify this theory in the future. Consequently, surgeons must inform and should hesitate to operate on patients with these highly comminuted C line calcaneus fractures.

The effects of a displaced dorsal rim fracture on outcomes after volar plate fixation of a distal radius fracture

Introduction The purpose of this study was to determine whether a displaced dorsal rim fracture has an adverse effect on wrist function after volar plate fixation of a dorsally displaced distal radius fracture (DRF). Materials and methods Two matched cohorts of 23 matched patients, one with a displaced dorsal rim fracture >2 mm (group 1), and the other without a dorsal rim fracture (group 2) were analysed in this study of volar locking plate fixation for dorsally unstable DRFs. The two cohorts were analysed for differences in wrist function and wrist pain, radiographic parameters and arthritic grades of radiocarpal joints. Displacement of dorsal rim fragments and diameters of the retained articular portions of dorsal rims in group 1 were measured. Results No significant difference was found between the two groups in overall wrist function or wrist pain. Mean displacement of dorsal rims in group 1 was 3.0 mm and the mean diameter of the retained articular portion of dorsal articular wall was 2.0 mm. No significant difference was found between the two groups in terms of any radiographic parameters or the arthritic grading of radiocarpal joints. Conclusion A displaced dorsal rim fracture does not appear to affect outcomes adversely after volar locking plate fixation of dorsally displaced DRFs.

Complications with the Use of Artelon in Thumb CMC Joint Arthritis

Complications with the use of the Artelon spacer in thumb carpometacarpal (CMC) joint arthritis include inflammation, osteolysis, and persistent pain. We evaluated our short-term results and complications. A retrospective review of 29 patients was performed. Pre- and postoperative radiographs, operative techniques, complications, and subsequent surgeries were analyzed. Pearson's and chi-squared testing was used to identify associations between complications and surgical technique or preoperative radiographic criteria. The average age was age 51 ± 7.7 (34-66), average follow-up was 8months (1-26). Twelve patients sustained complications. Nine patients displayed postoperative osteolysis. Four patients underwent conversion to CMC suspensionplasty due to persistent pain. The rate of revision surgery and radiographic postoperative osteolysis were not significantly associated with preoperative arthritis grade, metacarpal subluxation, or surgical techniques: fixation method, the bony surface(s) involved in the osteotomy, or spacer modifications. Our study found a significant short-term complication rate following Artelon spacer arthroplasty of the CMC joint. This is higher than previously described. We could not identify any factors that were significantly associated with the complications. It is possible that the inherent instability of the joint or the material of the spacer is involved in implant failure. Further study is necessary to better define the indications for use and specific techniques for the use of the implant.

Complex and Unstable Simple Elbow Dislocations: A Review and Quantitative Analysis of Individual Patient Data

Objective: The primary objective of this review of the literature with quantitative analysis of individual patient data was to identify the results of available treatments for complex elbow dislocations and unstable simple elbow dislocations. The secondary objective was to compare the results of patients with complex elbow dislocations and unstable elbow joints after repositioning of simple elbow dislocations, which were treated with an external fixator versus without an external fixator. Search Strategy: Electronic databases MEDLINE, EMBASE, LILACS, and the Cochrane Central Register of Controlled Trials. Selection Criteria: Studies were eligible for inclusion if they included individual patient data of patients with complex elbow dislocations and unstable simple elbow dislocations. Data Analysis: The different outcome measures (MEPI, Broberg and Morrey, ASES, DASH, ROM, arthritis grading) are presented with mean and confidence intervals. Main Results: The outcome measures show an acceptable range of motion with good functional scores of the different questionnaires and a low mean arthritis score. Thus, treatment of complex elbow dislocations with ORIF led to a moderate to good result. Treatment of unstable simple elbow dislocations with repair of the collateral ligaments with or without the combination of an external fixator is also a good option. The physician-rated (MEPI, Broberg and Morrey), patient-rated (DASH) and physician- and patient-rated (ASES) questionnaires showed good intercorrelations. Arthritis classification by x-ray is only fairly correlated with range of motion. Elbow dislocations are mainly on the non-dominant side.

광범위 회전근 개 파열에서 방사선학적 소견과 임상 소견 간의 관계

Purpose: The purpose of this study was to determine the correlation between the radiographic and clinical findings of massive rotator cuff tears. Materials and Methods: Forty-five diagnosed cases (35 patients) of massive rotator cuff tears were investigated in this study. Grade of arthritis in the massive rotator cuff tears was classified based on plain radiographs using the method of Hamada et al.. And we clinically evaluated cases using the UCLA scoring system. Results: No statistically significant correlation (r s =0.220, p=0.151) was found between arthritis grades in massive rotator cuff tears and clinical features. Dominant arm involvement appeared to be related to a higher rate of surgical treatment and a lower UCLA score. Conclusion: In massive rotator cuff tear patients, radiographic findings of arthritis may not always correspond to clinical features relevant in daily life. Therefore, we suggest that treatment strategies should be carefully considered when considering treatment modalities.

Comparison of angle stable plate fixation approaches for distal radius fractures

Introduction The aim of the study was to compare radiological and functional outcomes between volar and dorsal surgical fixation of distal radius fractures using low-profile, fixed-angle implants. Patients and methods A total of 305 distal radius fracture patients were treated with Synthes locking compression plate (LCP) 2.4- or 3.5-mm fixation using either a volar ( n = 266) or dorsal ( n = 39) approach. The patients were examined at 6 months, 1 and 2 years for radiological assessment of fracture healing, alignment, reduction and arthritis, as well as the determination of various functional outcome scores. Results Both groups were comparable with respect to baseline and injury characteristics. The complication rate was higher for the volar approach (15%). No significant differences were observed for Disabilities of the Arm, Shoulder and Hand (DASH) and Short Form (36) Health Survey (SF-36) scores, pain, arthritis grade, grip strength and radiological measurements. However, a significantly better functional outcome represented by a low mean Gartland and Werley score was observed for the volar approach after 6 and 12 months. Significantly higher percentages of dorsal extension, palmar flexion, ulnar deviation and supination angle (relative to the mean contralateral healthy wrist) were also reported for volar approach patients at the 6-month follow-up. Conclusions Volar internal fixation of distal radius fractures with LCP DR implants can result in earlier and better functional outcome compared with the dorsal approach, yet is associated with a higher incidence of complications. After 2 years, these differences are no longer observed between the two surgical methods.