Modified Mayo Wrist Score Research Articles

Evaluation of grip strength in hook of hamate fractures treated with osteosynthesis. Is this surgical treatment necessary?

ObjectiveThe aim of this study was to evaluate the outcomes of open reduction and internal fixation (ORIF) in hamate hook fractures and review the literature on this surgical procedure. MethodsWe report the outcomes of ORIF of hamate hook fractures in 13 consecutive patients (12 men and 1 woman; mean age: 32 years (range, 22–48 years)). In eight patients (61%) the fracture was associated with ulnar nerve neuritis in Guyon's canal. We assessed the following clinical data: age, sex, mechanism of injury, side of the injured hand and associated lesions, fracture classification, average time from injury to correct diagnosis, surgical technique, complications, and length of follow-up.All patients underwent radiological imaging, including standard radiographs in two planes (anteroposterior and lateral projections), and a CT study. Functional outcomes evaluated were pain, range of motion, grip strength, Disabilities of the arm, shoulder and hand (DASH) and Mayo wrist score. ResultsThe mean follow-up was 36 months (range, 12–144 months). All 13 cases were treated with ORIF of the hook of the hamate. Mean VAS pain score was 5 preoperatively (4–9) and 1 (0–2) postoperatively. All patients returned to pre-injury level and only one patient felt pain on activity. Preoperative modified Mayo wrist score was 51 and the postoperative value was 94. All outcomes scores improved significantly from preoperative values. The patients who participated in sports postoperatively were able to do so at or near pre-injury levels. Postoperative average range of wrist motion was 76° in extension, 71° in flexion, 14° in ulnar deviation, and 21° in radial deviation.Mean grip strength in the hand with the hook fracture was 58 kg compared with 53 Kg in the unaffected hand. All patients returned to their pre-injury level of functioning after 10–12 weeks and there were no complications. Analysis of grip strength revealed values comparable with the unaffected hand. ConclusionORIF of hamate hook fractures is a safe and effective technique to restore normal grip strength and return to pre-injury level. In cases of ulnar nerve neuritis, neurolysis of the deep palmar branch is mandatory. Level of evidenceLevel IV, Therapeutic study.

Outcomes Following Temporary Kapandji Pinning Technique and Distal Radial LCP Fixation for Intra-Articular Fractures of the Displaced Distal Radius.

In partially or completely displaced intra-articular fracture of the distal radius , achieving satisfactory reduction and maintenance of good reduction before applying the plate may be difficult. Especially to accomplish the anatomic volar tilt remains a problem. Typically, the Kapandji technique has been described to reduce and stabilize a large displaced and extra-articular fracture of the distal radius. We present the results of a prospective series using the temporary Kapandji technique for K-wire intrafocal fixation followed by rigid fixation with distal radial locking compression plate. The mean follow-up period totaled 12 months. A total of 57 patients were evaluated by radiographic and clinical review. The modified Mayo wrist score was used for postoperative patient evaluation. The clinical results on follow-up were good to excellent. Minimal joint stiffness and functional outcomes of the wrist and elbow were satisfactory. Statically significant differences were found between the preoperative and postoperative radiologic parameters. No skin infection due to K-wire insertion was noted, and the fracture healed completely in every case. This paper reports the results of 57 cases of intra-articular fractures of the distal radius treated by Kapandji wires as a reduction tool and definitive fixation by the application of a locked volar plate. It could be performed easily and reliably. K-wires were used to temporarily maintain reduction throughout the rigid fixation without further displacement in the follow-up clinic. The results proved appropriate, and the technique has merit, as it obviates the need for dorsal exposure in most cases.

Resection arthroplasty for treatment of nonunion and avascular necrosis of the distal scaphoid

Background Posttraumatic osteonecrosis of distal pole of scaphoid is extremely rare, with only few reported cases so far. The purpose of this study was to evaluate the clinical and radiographic results of treatment of distal scaphoid nonunion and avascular necrosis with resection arthroplasty in adult patients. Patients and methods From 2008 to 2013, seven patients presented to the authors for treatment of nonunion and avascular necrosis of the distal part of the scaphoid following distal pole fracture. Pain was evaluated by means of the visual analog scale. The time to return to previous activities and work status were documented. Wrist function was measured according to the Mayo Modified Wrist Score. Carpal height index (Nattrass modification) and radiolunate angle were recorded. Results Follow-up period ranged from 24 to 60 months. Three patients had an excellent result (43%), and four had a good result (57%). There is significant postoperative improvement of pain, range of wrist motion, and Mayo Modified Wrist Score. All patients returned to their previous occupations within 2 months. There were statistically significant increases in the radiolunate angle and no significant decrease in Nattrass carpal height. Conclusion Resection of the distal scaphoid appears to be a valid technique and to constitute an alternative to vascularized bone graft or limited intercarpal arthrodesis for the treatment of scaphoid nonunion with avascular necrosis of distal pole. Level of evidence: level IV, case series.

Primary cemented bipolar radial head prostheses for acute elbow injuries with comminuted radial head fractures: mid-term results of 37 patients.

Radial head arthroplasty represents a widely accepted treatment for elbow injuries with non-reconstructible radial head fractures. The aim of this retrospective multicenter study was to assess mid-term results of patients with clearly defined elbow injuries including type III fractures of the radial head according to Mason's classification type III after primary arthroplasty using a cemented bipolar design. In 45 cases a primary cemented bipolar arthroplasty of the radial head was implanted for elbow injuries combined with an acute Mason type III radial head fracture. In all patients associated fractures were detected with preoperative CT scans and ligamentous injuries were evaluated and both were addressed intraoperatively based on a standardized algorithm. Patients with associated injuries other than coronoid fractures and collateral ligament tears were excluded from this study to obtain a more homogenous sample. Clinical and radiological assessment was performed on thirty-seven patients at an average of 5.6years postoperatively. DASH Score, functional rating index of Broberg and Morrey, Mayo Elbow Performance Score, and Mayo Modified Wrist Score confirmed good-to-excellent results in most of the patients. Compared to the unaffected arm range of motion and grip strength were slightly reduced. No elbow instability or loosening of the prosthesis, and minor degenerative changes were detected in a few cases. Primary cemented bipolar arthroplasty for type III fractures according to Mason's classification in an elbow injury pattern only including associated coronoid fractures and/or ligamentous tears resulted in good-to-excellent mid-term results. These results suggest that primary bipolar radial head arthroplasty combined with distinct treatment of all associated injuries provides good functional outcomes concerning range of motion, elbow stability, and strength in this cohort. However, the associated injuries may influence clinical and radiological outcome and need to be detected, classified, and treated carefully.

Arthroscopic Transosseous Repair for both Proximal and Distal Components of Peripheral Triangular Fibrocartilage Complex Tear.

Background:Tears of the triangular fibrocartilage complex (TFCC) can result in instability of the distal radioulnar joint (DRUJ) and ulnar-sided wrist pain. This study evaluates clinical results of arthroscopic transosseous repair for both proximal and distal components of TFCC tear with DRUJ instability.Materials and Methods:Ten patients who underwent both proximal component and distal component of TFCC repair were retrospectively reviewed. The proximal component of TFCC was repaired through arthroscopic one-tunnel transosseous suture technique, and the combined distal component tear was repaired to the ulnar capsule using same transosseous tunnel in all cases. Visual analog scale (VAS) score for pain, wrist range of motion, grip strength, and postoperative complications were evaluated after a mean followup period of 23.5 months, and each patient was rated according to modified Mayo wrist score and quick disabilities of the arm, shoulder, and hand (DASH) questionnaire.Results:On arthroscopic findings, the hook test confirmed the proximal component of the TFCC tear and visible capsular detachment from TFCC confirmed combined distal component tear in all patients. At final followup, 7 patients had normal stability of DRUJ and 3 patients showed mild laxity compared with the contralateral side. The mean VAS for pain perception decreased from 4.1 to 0.7, and grip strength was increased significantly. The modified Mayo wrist score and Quick DASH score showed significant functional improvement. No surgery-related complications occurred.Conclusions:Arthroscopic one-tunnel transosseous TFCC foveal repair and simulatneous transosseous capsular repair of distal component can be a safe and effective strategy for repair of complete TFCC tear combined with DRUJ instability.

Vascularized Thumb Metacarpal Periosteal Flap for Scaphoid Nonunion in Adolescents: A Prospective Cohort Study of 12 Patients

To evaluate clinical and radiological outcomes after surgical treatment of scaphoid nonunion in adolescents with a vascularized thumb metacarpal periosteal pedicled flap (VTMPF). Twelve patients younger than 18 years with scaphoid nonunion, who underwent a VTMPF procedure without bone grafting, were included for this prospective cohort study, at a mean follow-up of 10.2 months. Patients were operated on by 3 different hand surgeons at 3 hand surgery institutions. All patients received a VTMPF, but with different scaphoid internal fixation modalities, in 10 cases using 1 or 2 retrograde 2-mm headless compression screws and in 2 cases without internal fixation. In 11 boys and 1 girl, the mean age was 15.6 years. There were 1 type D1 nonunions (Herbert classification), 6 type D2, 2 type D3, and 2 type D4. Six patients had previously undergone an unsuccessful surgical attempt to treat their nonunion. The mean anterior bone defect was 3.5 mm in length. The patients experienced no postoperative complications. Successful consolidation was achieved in all cases, with 79% cross-sectional trabecular bridging at 12 weeks. Pain subsided after surgery and patients experienced improvements in both their Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and Modified Mayo Wrist Score (MMWS) results. Overall, 34% and 40% gains in strength and wrist motion, relative to the contralateral normal side, were observed. In this study, the use of VTMPF for scaphoid nonunion in children and adolescents is associated with generally good outcomes. Therapeutic IV.

Treatment of Kienböck’s Disease With Neutral Ulnar Variance by Distal Capitate Shortening and Arthrodesis to the Base of the Third Metacarpal Bone

We evaluated whether a surgical technique combining distal capitate shortening and arthrodesis to the base of the third metacarpal bone for the treatment of the early stages (stages II and IIIA) of Kienböck's disease with neutral ulnar variance resulted in pain relief, improvement in wrist motion, or changes in the radiographic evaluation. This retrospective study reviewed 22 patients with early stages of Kienböck's disease with neutral ulnar variance, treated by distal capitate shortening and arthrodesis to the base of the third metacarpal bone. Patients were divided into 2 groups by disease stage: stage II (n= 12) and stage IIIA (n= 10). There were 8 women and 14 men, with an average age of 35.7 years. The following parameters were measured before and after surgery: visual analog scale (VAS) for pain evaluation, grip strength, range of motion (ROM), ulnar variance, carpal height index, lunate height index, and the scapholunate and scaphocapitate angles. The patients were evaluated in accordance with Modified Mayo Wrist Score (MMWS). The average follow-up period was 30.5 months (range, 26-36 months). The stage II group showed significant improvements in the mean VAS (58-5), ROM (57% to 73%), grip strength (54% to 75%), and MMWS (51-78). Patients in the stage IIIA group showed nonsignificant changes in mean VAS score (64-42.5), ROM (52.5% to 55.5%), grip strength (46.5% to 57.5%), and MMWS (36-50.5). Significant decreases in the carpal height index and scaphocapitate angle, and an increase in scapholunate angle in all stage IIIA patients were observed. Distal capitate shortening with capitometacarpal arthrodesis can alleviate pain and improve ROM and grip strength in patients with stage II Kienböck's disease, but not in those with stage IIIA. Moreover, it cannot prevent carpal collapse, especially in stage IIIA of the disease. We do not recommend this technique for treating stage IIIA patients. Therapeutic IV.

Arthroscopic Management of Triangular Fibrocartilage Complex (TFCC) Injuries

Background: Triangular fibrocartilage complex (TFCC) injury is major cause of ulnar side wrist pain. It can lead to distal radio ulnar joint instability. Aim of the work: was to examine the efficacy of arthroscopic management of the TFCC injuries, and assess the functional outcome of this procedure. Patients and Methods: Twenty patients with torn TFCC underwent arthroscopic management. Five patients had central TFCC tears to which arthroscopic debridement was done. Five patients had superficial peripheral TFCC tears to which arthroscopic reattachment to the capsule was done. Ten patients had deep foveal TFCC tears with DRUJ instability to which arthroscopic assisted foveal reattachment by suture anchor was done. All patients were assessed before and after surgery (at follow-up) by Visual Analogue Scale (VAS) for pain, the Disability of the Arm, Shoulder and Hand (DASH) score, the Modified Mayo Wrist Score (MMWS), and the incidence of complications. Results: Twenty patients were available for follow-up at a mean of 12.9 months. VAS improved from a mean of 6 to a mean of 1.3 (p<0.001). The DASH score improved from a mean of 28.2 to a mean of 5.8 (P < 0.001). MMWS improved from a mean of 66.3 to a mean of 88.5 (p<0.001). Conclusion: Arthroscopic management of TFCC tears has shown to reach good results according with different TFCC lesions and improvement in pain and function. However, the current study is limited by absence of conservative or open control group for comparison and the relatively short follow-up period.

Kienböck's disease with non-negative ulnar variance : Treatment with combined radial wedge and shortening osteotomy.

There are only few studies that focused on Kienböck's disease with non-negative ulnar variance, even though many surgical procedures have been introduced. Acombined radial wedge and shortening osteotomy was carried out for Kienböck's disease with non-negative ulnar variance. The purpose of this article is to report the results of this procedure by analyzing the clinical and radiological data. The data for patients with Kienböck's disease who were treated by combined radial wedge and shortening osteotomy between 2007 and 2016 were retrospectively reviewed. Atotal of 18 patients (8 males, 10 females), average age 37years, were included in this study and the mean follow-up period was 22.3months. Radiological analysis included Lichtman stage, ulnar variance, radial inclination, carpal height ratio, radioscaphoid angle and Stahl's index. Clinical analysis included range of motion (ROM), visual analog scale (VAS) score, grip power, modified Mayo wrist score (MMWS), and disabilities of arm, shoulder and hand (DASH) score. Preoperative radiological analysis showed 16cases of Lichtman stage IIIA and 2cases of stage IIIB. Preoperative ulnar variance was +0.51 mm, radial inclination was 27.7o, carpal height ratio was 0.49, radioscaphoid angle was 52.8o and Stahl's index was 0.42. All patients had solid union at the osteotomy site. At the final follow-up the average ulnar variance was +1.9 mm, radial inclination was 16.5o, carpal height ratio was 0.48, radioscaphoid angle was 58.2o and Stahl's index was 0.36. Clinical analysis showed that the average dorsiflexion of the wrist was increased by 8.4o and palmar flexion of the wrist was increased by 29.6o. Grip power was increased by an average of 9.9 kg. Average VAS at the final follow-up was 1.0, DASH score was 4.3, and modified Mayo wrist score was 78.1. Radial wedge and shortening osteotomy can be recommended as an option for Kienböck's disease with non-negative ulnar variance, based on acceptable results from this study.

Application of wrist arthroscopy in treating scaphoid nonunion advanced collapse

Objective To investigate the clinical effect of wrist arthroscopy in the treatment of scaphoid nonunion advanced collapse (SNAC). Methods A retrospective case series study was performed on the clinical data of 15 SNAC patients admitted from March 2011 to January 2016. There were 12 males and three females, with a mean age of 32 years (range, 26-43 years). There were nine cases of right wrist injury and six cases of left wrist injury. The injury duration was 14-72 months, with an average of 18 months. According to the evaluation of the extent of wrist joint inflammation involvement under wrist arthroscopy, there were nine cases at SNAC I stage, four at stage II, and two at stage III. Stage I patients underwent wrist arthroscopy assisted radius styloid process resection, scaphoid sclerosis bone removal, and iliac bone grafting and internal fixation. Stage II and III patients underwent wrist arthroscopy assisted removal of most of the scaphoid and fusion fixation of skull bone and lunate bone. Joint healing time in the first month of fracture and fusion, visual analogue score (VAS) before operation and at the last follow up, joint mobility, and grip strength were recorded. Wrist function was evaluated by modified Mayo wrist function score at the last follow up. Results The patients were followed up for 9-23 months, with an average of 14 months. All cases were seen primary bone healing. The mean time of fracture healing was 11.7 weeks in stage I SNAC patients and the mean healing time was 11 weeks in stage II and III patients in the first month of joint fusion. VAS decreased from (5.9±0.8)points to (1.6±0.9)points. Range of motion of the wrist including the flexion/extension arc and the radial/ulnar deviation arc increased respectively from preoperative (38.7±6.3)°, (28.6±11.2)°, (19.8±1.4)° and (22.7±5.7)° to postoperative (54.1±5.8)°, (43.3±9.3)°, (22.0±1.9)° and (30.3±4.3)°. Grip strength was improved from preoperative (10.7±2.4)kg to postoperative (15.0±1.9)kg (all P<0.05). The modified Mayo wrist score was increased from preoperative (57.9±7.3)points to postoperative (84.5±6.9)points (P<0.05). According to modified Mayo wrist scores, the result was excellent in one case, good in nine cases and fair in five. Conclusions For patients with SNAC, it is necessary to evaluate the staging under wrist arthroscopy. Arthroscopy assisted scaphoid bone grafting can be applied to stage I patients. For stage II and III patients, wrist arthroscopy-assisted removal of most of the scaphoid and fusion fixation of skull bone and lunate bone is helpful to facilitate bone healing, relieve pain, and improve function. Key words: Scaphoid bone; Fractures, ununited; Arthroscopy; Bone transplantation

Wrist arthroscopy-assisted percutaneous Kirschner wire fixation for fresh scaphoid fractures

Objective To compare the efficacy of percutaneous Kirschner wire fixation assisted by wrist arthroscopy and percutaneous hollow screw fixation under fluoroscopy in the treatment of scaphoid fresh fractures. Methods A retrospective case control study was conducted on the clinical data of 34 patients with scaphoid fresh fractures admitted from April 2009 to January 2016, including 23 males and 11 females, aged 21-44 years, with an average of 28.9 years. There were 21 cases on the right side and 13 cases on the left side. According to the classification of Herbert scaphoid fractures, there were 25 cases of type B2 and nine cases of type B3. The duration from injury to operation was 1-13 d, with an average of 3.2 d. According to the different surgical methods, the patients were divided into arthroscopic assisted percutaneous Kirschner wire fixation group (Group A, 16 cases) and percutaneous hollow screw fixation under fluoroscopy group (Group B, 18 cases). In Group A, four cases were treated with autogenous iliac bone graft, and three cases with scapholunate ligament injury were treated with fixation of scaphoid joint with stage I Kirschner wire. The operation time, hospitalization time, bone healing time, visual analogue scale (VAS), disabilities of arm, shoulder and hand score (DASH), modified Mayo wrist function score, and complications were compared between the two groups. Results The patients were followed up for 6-12 months, averaging 7.5 months. The operation time of Group A and Group B was (52.3±11.2)minutes and (42.5±9.7)minutes, respectively(P 0.05), bone healing time was (11.8 ±1.4)weeks and (13.2±2.4)weeks respectively (P 0.05), and modified Mayo wrist score was (92.1±6.6)points and (85.4±7.5)points respectively (P<0.05). One case of early Kirschner wire loosening occurred in Group A, and one case of nonunion and another of residual scapholunate instability were found in Group B. Conclusion For fresh scaphoid fractures with displacement, percutaneous Kirschner wire fixation assisted by wrist arthroscopy can shorten operation time, promote fracture healing, relieve pain, and improve wrist joint function compared with percutaneous hollow screw fixation under fluoroscopy. Key words: Wrist injuries; Scaphoid bone; Arthroscopy; Fracture fixation, internal

Dorsolateral Biplane Closing Radial Osteotomy and Lunate Fixation for Stage IIIC Kienböck Disease: A New Surgical Approach.

The treatment of advanced-stage Kienböck disease (KD) remains highly controversial. Particularly important is stage IIIC KD, which includes patients with a lunate coronal fracture. The purpose of this paper was to describe a new approach to KD in patients with Lichtman stage IIIC KD, and our results using it. The procedure combines a dorsolateral biplane closing radial osteotomy and lunate fixation. A total of 11 patients from January 2002 through December 2016 with documented KD who underwent this technique were included. The patients were assessed before surgery, then postoperatively at 1 and 10 days, 3 and 6 weeks, 3 and 6 months, and annually. Wrist range of motion, grip and pinch strength, the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, a Modified Mayo Wrist Score (MMWS), 10-point visual analog scale, radiologic measurements, and data related to consolidation were collected. All statistical analyses were performed using the statistical software package SPSS. Some degree of pain relief, improvements in the QuickDASH score, MMWS score, grip strength, and the degrees of flexion and extension were observed, the results being statistically significant (P<0.05). After surgery, the values for radial and sagittal tilt were statistically different than those measured before surgery. Carpal collapse was not evident either before or after surgery. In conclusion, combining a dorsolateral radial osteotomy and a lunate compression screw may expand the options for patients with Lichtman stage IIIC KD. Our experience indicates that it is a viable option in challenging clinical scenarios.

A Long-Term Study of Application of Joshi's External Stabilizing System in Displaced Intra-articular Distal End Radius Fractures

Background Fractures of the distal end radius are a common upper extremity fracture. Intra-articular distal end radius fractures are recognized as very complex injuries with a variable prognosis. The aim of the study was to assess the long-term functional outcome of patients treated with Joshi's external stabilizing system (JESS) for displaced intra-articular distal end radius fractures. Materials and Methods A total of 170 patients with intra-articular distal end radius fracture were treated with JESS from 2014 to 2017. The patients were followed up at 2, 6 weeks, 6 months, 1, and 2 years (final) after the surgery. The assessment of pain, range of motion, grip strength, and satisfaction were assessed at 6 months, 1, and 2 years (final) follow-up and scored according to modified Mayo wrist scoring system. Results The good and/or excellent results were found in 82.2% of cases. We observed that patients with age less than 50 years had greater prognosis as compared with patients with more than 50 years of age. Final outcome was also found better in males as compared with females at 6 months, 1, and 2 years postoperatively. Conclusion JESS is an effective treatment technique for intra-articular distal end radius fractures in our community. On long-term follow-up of the patients treated with JESS for intra-articular distal end radius fractures, the functional and radiological outcomes were good with low complication rate.

Ultrasound-guided percutaneous Herbert screw for the treatment of fresh nondisplaced carpal scaphoid fracture

To explore the effectiveness of ultrasound-guided percutaneous Herbert screw for the treatment of fresh nondisplaced carpal scaphoid fracture. Between May 2013 and August 2015, 15 patients with fresh nondisplaced carpal scaphoid fractures (Krimmer type A2) were treated with ultrasound-guided Herbert screw fixation. There were 12 males and 3 females with an average age of 33.4 years (range, 18-51 years). The causes of injury included 9 cases of falls, 3 cases of training injuries, and 3 cases of machine injuries. The interval from injury to surgery was 2-15 days (mean, 5 days). No other complication was found. The operation time, intraoperative blood loss, intraoperative fluoroscopy times, and the fracture healing time were recorded. The wrist function was assessed by the modified Mayo wrist score standard. The operation time was 28-53 minutes (mean, 33.9 minutes); the intraoperative blood loss was 5-30 mL (mean, 10.5 mL); the intraoperative fluoroscopy was 2-6 times (mean, 2.6 times). All 15 patients were followed up 6-18 months (mean, 10.5 months). One patient developed pain and soreness in the skin of the nail entrance, and gradually relieved after fumigation. No complication such as infection occurred. All fractures healed clinically, and the healing time was 8-16 weeks (mean, 11.6 weeks). At last follow-up, the modified Mayo wrist score was 76-99 (mean, 92.5). Among them, 12 cases were excellent, 2 cases were good, and 1 case was fair, and the excellent and good rate was 93.3%. Ultrasound-guided fixation with Herbert screw is a reliable treatment method for fresh nondisplaced carpal scaphoid fractures with small invasion, less bleeding, and small radiation damage.

The Effect of Osteoporosis on the Outcomes After Volar Locking Plate Fixation in Female Patients Older than 50 Years With Unstable Distal Radius Fractures.

The aim of this study was to investigate the effect of osteoporosis on radiological and clinical outcomes after volar locking plate (VLP) fixation in women older than 50 years with unstable distal radius fractures (DRFs). We retrospectively reviewed data of 79 women older than 50 years with DRFs treated by VLP fixation. We collected patients' baseline data, including age and bone mineral density. We also measured the cortical thickness of the distal radius on plain radiographs and computed tomography to assess local bone density. Radiological outcomes included late displacement at 1 year after surgery, which was defined as a change in radiological parameters (radial inclination, volar tilt, and ulnar variance). Clinical outcomes were assessed with the Disabilities of the Arm, Shoulder, and Hand (DASH) and modified Mayo wrist score at 1 year after surgery. We compared mean values between the nonosteoporotic (group 1, T score >-2.5) and the osteoporotic groups (group 2, T score ≤ -2.5). We conducted linear and logistic regression analysis to investigate factors associated with poor outcomes. There were 49 patients in group 1 and 30 patients in group 2. Radiological outcomes were similar in both groups. The mean DASH score was 14.9 (SD, 16.4) for group 1 and 12.5 (SD, 13.5) for group 2, and the mean modified Mayo wrist score was 87.6 (SD, 8.8) for group 1 and 88.2 (SD, 11.4) for group 2. There were no significant differences in clinical outcomes between groups. Simple and multivariable linear regression analysis showed only older age was associated with the change in volar tilt. Osteoporosis and cortical thickness were not associated with poor clinical outcomes on simple logistic regression analysis. Osteoporosis and cortical thickness of the distal radius did not affect clinical outcomes after VLP fixation in women older than 50 years with unstable DRFs. Prognostic II.

The Malunited Distal Radius Fracture - Extraarticular Correction without Bone Graft

In open wedge osteotomies of the distal radius, bone grafts increase initial stability and enhance bone formation but are frequently associated with complaints and complications at the donor site. Previous studies have suggested that bone grafting may probably be unnecessary. Between 2013 and 2016, 19 patients with symptomatic extra-articular fractures of the distal radius, malunited in extension, underwent corrective osteotomy using a palmar locking implant without an additional bone graft. 3 patients dropped out for implant related problems. One patient refused the follow-up investigation. 12 patients (7 male / 5 female) showed complete remodeling of the defect at 5.5 ± 3.5 (1.5-13) months. Palmar tilt improved significantly, from a mean of 17° to -1°, the DASH score from 41 ± 26 (7-94) points to 26 ± 25 (0-75). Radial inclination and ulnar variance and pain level showed only slight, non-significant improvement. Final range of motion and grip strength did not improve. In the modified Mayo wrist score, 5 excellent, 1 good, 3 fair and 3 unfavourable results were obtained. Three female patients showed no remodeling at 10 ± 3 (6-12) months. In the modified Mayo wrist score, 1 fair and two unfavourable results were obtained. One of these patients underwent reoperation with iliac crest bone grafting. Though remodeling of the distal radius only failed in female patients, no statistically significant dependence of bony healing on gender, age at the date surgery or size of the defect was found. In the healed group there was no statistical correlation between the interval from surgery to bony fusion and gender, age at the date of surgery or width of the osteotomy gap dorsally. A correlation was found between the widths of the osteotomy gap palmarly and the interval to bony fusion. After open wedge osteotomy of the distal radius, remodeling may occur without filling the defect by a bone graft. Since bony healing is not predictable and may require more than 12 months in single cases, we will continue bone grafting in our own practice.

Clinical and functional outcomes of vascularized bone graft in the treatment of scaphoid non-union.

IntroductionScaphoid non-union is a challenging and complex problem. Various methods have been proposed for the management of patients with scaphoid non-union and to reduce the risk of complications. In this study, our aim was to evaluate the clinical and functional outcomes of using a vascularized bone graft in the treatment of scaphoid non-union.MethodsPatients with scaphoid non-union who underwent 1,2 intercompartmental supraretinacular artery pedicled vascularized bone graft between January 2005 and January 2011 were enrolled. The parameters assessed included clinical and functional outcomes, radiological measures, and potential risk factors.ResultsForty-one patients were finally included. Thirty patients achieved union (73%) and 11 did not. Smoking was a significant risk factor for non-union after the surgery. In patients who achieved union, grip strength and radioulnar abduction were greater in comparison to that in patients who did not achieve union. Functional measures, including the Disabilities of Arm and Shoulder score and the Modified Mayo Wrist Score, improved in patients with scaphoid union. The scaphoid length also improved significantly postoperatively in these patients.ConclusionSurgical treatment of scaphoid non-union using vascularized bone graft led to a high union rate with good clinical and functional outcomes. Smoking is a risk factor for non-union, even with the use of a vascularized bone graft. Avascular necrosis was not associated with an increased risk for non-union.

Biologic plating of unstable distal radial fractures

BackgroundVolar locking plating through the flexor carpi radialis is a well-established technique for treating unstable distal radial fractures, with few reported complications. In certain circumstances, including metaphyseal comminuted fractures, bridge plating through a pronator quadratus (PQ)-sparing approach may be required to preserve the soft tissue envelope. This study describes our prospective experience with bridge plating through indirect reduction.MethodsThirty-three wrists (four 23A2, six 23A3, 15 23C1, and eight 23C2) underwent bridge plating through a PQ-sparing approach with indirect reduction from June 2006 to December 2010. Mean patient age was 56.8 years (range, 25–83 years), and the mean follow-up period was 47.5 months (range, 36–84 months). Changes in radiologic parameters (volar tilt, radial inclination, radial length, and ulnar variance) were analyzed, and functional results at final follow-up were evaluated by measuring the Modified Mayo Wrist Score (MMWS) and Modified Gartland-Werley Score (MGWS).ResultsAll wrists achieved bone healing without significant complications after a single operation. At final follow-up, radial length was restored from an average of 3.7 mm to 11.0 mm, as were radial inclination, from 16.4° to 22.5°, and volar tilt, from − 9.1° to 5.5°. However, radial length was overcorrected in three wrists, and two experienced residual dorsal tilt. Excellent and good results on the MGWS were achieved in 30 wrists (90.9%). The average MMWS outcome was 92.6 (range, 75–100).ConclusionOur experience with bridge plating was similar to that previously reported in the earlier publications. Compared with the conventional technique, bridge plating through a PQ-sparing approach may help in managing metaphyseal comminuted fractures of both cortices with a reduced radio-ulnar index.

Midterm Results after Open versus Arthroscopic Transosseous Repair for Foveal Tears of the Triangular Fibrocartilage Complex.

Purpose Various surgical procedures for foveal tears of the triangular fibrocartilage complex (TFCC) have been reported, and the procedures can be grossly divided into open and arthroscopic repair. The surgical results of both procedures were compared. Materials and Methods Twenty-nine patients underwent repair of a TFCC foveal tear. The 13 men and 16 women were in the age range of 14 to 72 years (average age, 30 years). Five patients had a history of distal radius fractures that healed uneventfully with nonoperative treatment. The mean duration of symptoms before surgery was 7.1 months. The procedure for repair consisted of 8 open repairs and 21 arthroscopic repairs. In both procedures, the TFCC was repaired transosseously to the ulna. The mean follow-up period was 34.4 (range, 24-70) months. The patients' pain, range of motion (ROM), grasping power, ulnar head instability, Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), and Mayo modified wrist score (MMWS) were evaluated. The operating time was also compared. Results There were no significant differences between the groups in pain, ROM, grasping power, ulnar head instability, and DASH. The MMWS was excellent in 8 patients in the open repair group, with 18 excellent and 3 good in the arthroscopic repair group. The mean operating time was significantly shorter for arthroscopic repair than for open repair. Conclusion Satisfactory outcomes were achieved for both open and arthroscopic repair techniques in the midterm. If a surgeon becomes familiar with the arthroscopic repair, the arthroscopic technique would be more feasible than the open repair in terms of technical facility and shortening of the operating time. Level of Evidence Level III, therapeutic study.

The clinical result of arthroscopic bone grafting and percutaneous K-wires fixation for management of scaphoid nonunions

The purpose of this study is to analyze the clinical results of patients with scaphoid nonunion treated with arthroscopic bone grafting and K (Kirschner)-wires fixation.We retrospectively reviewed the records of 27 patients with scaphoid nonunion who had been treated with arthroscopic bone grafting and K-wires fixation method from November 2008 to February 2014. The average patient age was 35 years. The time from injury to treatment averaged 45 months. The average follow-up period was 18 months. Bone union was assessed using serial plain radiographs. The functional outcome was evaluated by comparing the modified Mayo wrist score with the visual analog scale (VAS) for pain, which were measured at the time of preoperation and at final follow-up.Union was achieved in 26 of the 27 nonunions (96.29%). The average radiologic union time was 10 weeks. The average VAS score decreased from 6.38 (range, 3–10) preoperatively to 1.59 (range, 0–3) at the final follow-up. The average modified Mayo wrist score improved from 60.19 preoperatively to 83.46 at the final follow-up. According to this score, there were 12 excellent, 6 good, and 9 fair results at the final follow-up.Arthroscopic bone grafting and percutaneous K-wires fixation is an effective treatment method for a scaphoid nonunion and has the advantages of allowing thorough assessment, enabling a comprehensive management approach for scaphoid nonunion in a minimally invasive manner, and this method can also be used for the scaphoid nonunion with SNAC stage I.