Mayo Wrist Scoring System Research Articles

Functional Outcomes of Fixation of the Scaphoid Fracture with Herbert Screw: A Cross-Sectional Study

Objective: The present study aims at the assessment of the radiological union and clinical outcomes of scaphoid fracture followed by fixation by Herbert Screw. Study design: A cross-sectional study Place and Duration: This study was conducted Muhammad Medical College and Hospital Mirpurkhas from may 2021 to may 2022 Methodology: A total of 20 patients were included in the study and all of them had sustained a scaphoid fracture. All of them were treated with Herbert screw fixation. Overall 18 of them were male and 2 were female. Serial radiographs were obtained for the assessment of union and the Modified Mayo wrist scoring (MMWS) system was used for the assessment of functional outcomes. The patients were called after 6 months of surgery for a follow-up visit. A total of 9 (45%) patients were treated within the first week of the injury. Overall 5 (25%) were treated in two weeks and 6 (30%) were treated in 2 to 4 weeks Results: Out of 20 patients included in the study, 17 had fractured at the waist of the scaphoid and the remaining 3 had sustained fractures at the proximal pole of the scaphoid. The dorsal and volar approach of fixation by Herbert Screw was used for treating all the fractures. A good alignment was observed post-operatively. Out of all the 20 patients, 12 (60%) patients showed excellent outcomes with a full range motion of the wrist, 6 (30%) had shown good results, and 2 (10%) showed poor results. A final follow-up was arranged during the sixth month of treatment and 18 (90%) patients showed adequate radiological union. Conclusion: Fixation of scaphoid fracture with a Herbert Screw in a convenient and effective mode of treatment which has shown excellent functional outcomes and exceptionally reduced complications. Keywords: Herbert Screw, Fixation, Functional outcomes, Scaphoid fracture

Evaluation of functional outcome by modified mayo wrist score in intra- articular distal end radius fracture managed by plate osteosynthesis

<p class="abstract"><strong>Background:</strong> Fractures of distal end of radius continue to pose a therapeutic challenge. Intra articular and extra articular malalignment can lead to various complications like post traumatic osteoarthrosis, decreased grip strength and endurance, as well as limited motion and carpal instability.</p><p class="abstract"><strong>Methods:</strong> A prospective study of forty patients with intra-articular distal end radial fractures treated under the department of orthopaedics, PIMS, Udaipur, were included in this study. All patients managed by plate osteosynthesis were followed up to 9 months.<strong></strong></p><p class="abstract"><strong>Results:</strong> When outcome according to modified Mayo wrist scoring system was assessed, only one patient (2.50%) scored with poor grade. 11 (27.50%) were graded as excellent, 19 (22.50%) as grade good, 9 (22.50%) as grade fair. 32 (80%) patients had union within 2-3 months and 06 (15%) patients had union in 3-4 months. There were 2 (5%) case of delayed union.</p><p class="abstract"><strong>Conclusions:</strong> Assessment of functional outcome by modified mayo wrist score in intra-articular distal end radius fracture managed by plate osteosynthesis gives an excellent scoring system to assess outcome of communited intrarticular distal radius fractures with reference to function of the hand and wrist of the individual. Also, it will help to predict the likely functional outcome in relation to fracture pattern of distal radius.</p><p> </p>

Modified Graner's Technique with\without Vascularized Capitate Lengthening for Kienböck Disease Stage IIIb-A Pilot Study.

Background Intercarpal fusions are used to treat stage IIIb Kienböck disease. They increase force transfer across the radioscaphoid articulation with predisposition to arthritis. Description of Technique This technique is excision of lunate followed by proximal transfer of capitate, with scaphocapitate and triquetrocapitate fusion to increase area of load transfer mimicking wrist hemiarthroplasty. Our purpose is to evaluate mid-term results of this technique. Patients and Methods A prospective case series study was conducted on 11 patients with stage IIIb and IIIc. In seven cases, transfer of the capitate was performed by osteotomizing the capitate just distal to its waist, proximal migration to replace the excised lunate then bone grafting. In four cases, proximal transfer of vascularized pedicled capitate was done. Clinical outcome measures included pain (visual analog scale), grip strength, range of motion, and functional evaluation by modified Mayo wrist score and scoring system of Evans. Radiological outcome measures included healing of fusion mass, progression of the disease, and occurrence of avascular necrosis to the capitate. Results Follow-up period averaged 54 months. Scaphocapitate fusion healing averaged 11 weeks. Union of the lengthened capitate occurred in 10 patients only. There was postoperative improvement in pain scores, grip, Evans, and modified Mayo wrist score. There was postoperative decrease in wrist flexion and extension. One patient showed resorption of the capitate head with progressive radioscaphoid arthritis-necessitated wrist fusion. Conclusion The mid-term results of this technique may be satisfactory due to low incidence of degenerative arthritis in the radioscaphoid joint. However, longer follow-up with recruiting larger number of patients is needed.

Study of treatment for distal end radial fractures by open reduction and internal fixation with volar locking compression plates

Introduction: For dorsally displaced lower end radius fractures percutaneous pinning fixation and insome studies fragment specific fixation shows their advantages. For volarly displaced fracturesvolarly plate fixation traditionally showed good results. The volar locking plates with their inheritanceability to provide absolute stability are attractive for their advantages. Objective: To assess thefunctional outcome of treating the distal end radius fractures with the use of volar lockingcompression plates. Materials and methods: Study of a total of 30 patients was conducted in thedepartment of orthopedics at G K General Hospital, Bhuj, Gujarat. All 30 patients with closedfractures were included in the study. All patients were treated with open reduction and internalfixation with the use of a volar locking compression plate. The patients were followed up at one, two,three, and up to six months. Mayo wrist scoring system was used to assess final functional outcomesof treatment. Results: At the final functional assessment, as per mayo wrist scoring out of a total of30 patients, 17 of them achieved excellent, 7 achieved good outcomes, with 5 patients exhibitingfair results and one patient had the collapse of fixation at the 3-month review. No, any patient haddiminution of functional outcome. On radiological assessment, 70% of patients had callus formationand no clear fracture line was seen, 18% had callus formation but a visible fracture line was presentand 12% of patients had clear visible fracture line up to final follow up. Conclusion: Open reductionand internal fixation with volar locking compression plating is a safe and effective treatment forunstable especially volarly displaced fractures of distal end radius with satisfactory functionaloutcome.

Prognostic Factors Affecting Clinical Outcomes of Arthroscopic Assisted Reduction and Volar Plating through Preservation of Pronator Quadratus for Intra-Articular Distal Radius Fracture.

Background: This study aimed to evaluate the clinical and radiological outcomes following an arthroscopic-assisted reduction and volar plating (AR-VP) surgery through pronator quadratus (PQ) preservation for treating intra-articular distal radius fractures (IA-DRFs) and to assess prognostic factors that affect functional outcomes. Methods: Between March 2014 and February 2017, 54 patients who had intra-articular DRF and underwent AR-VP through the PQ preservation technique and completed 1-year follow-up were enrolled. Patients were divided into the satisfactory group (excellent and good results) and an unsatisfactory group (fair and poor results) based on the modified Mayo Wrist Scoring System (MMWS) scored at 1-year follow-up to determinate prognostic factors that affected clinical outcomes. Patients' demographics, clinical outcome measures (VAS, DASH, PRWE, etc.), and pre-and post-operative radiographic parameters were analyzed. Results: The outcomes according to MMWS were 10 excellent, 22 good, 14 fair, and 8 poor. A univariate analysis showed a significant difference between the groups (p < .05) for all radiographic parameters, sex, and the presence of an intra-articular comminution. In the multivariate analysis, female gender, presence of an intra-articular comminution, and difference of palmar articular tilt compared to uninjured wrist (> 20.1°) at trauma were considered as significant poor prognostic factors of functional outcome. Conclusions: AR-VP surgery through PQ preservation for intra-articular DRFs has reliable clinical and radiological outcomes. However, female gender, presence of an intra-articular comminution, and difference of palmar articular tilt compared to the uninjured wrist (> 20.1°) at initial injury were considered poor prognostic factors for AR-VP through PQ preservation for intra-articular DRF.

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.

A novel percutaneous achievement and maintenance of reduction and screw fixation for acute displaced scaphoid fractures: minimum two-year follow-up.

The purpose of this study was to introduce a novel method of percutaneous achievement and maintenance of reduction for acute displaced scaphoid fractures and evaluate the feasibility of this method in treating acute displaced scaphoid fractures as well as explore its indications. From February 2012 to March 2014, 15 patients with acute displaced scaphoid fractures were treated with our technique. Two Kirschner wires were used to achieve and maintain the reduction of the scaphoid fractures throughout the entire process of the traditional percutaneous screw fixation process. The following parameters including function scores according to modified Mayo wrist scoring system, range of motion (ROM) of the wrist, grip strength, pinch strength, healing time, time to return to work, and final outcomes were recorded. All patients were followed up with a mean period of 2.5years (range, 2-3.5years). All fractures healed with a mean of 9.3weeks (range, 7-11.5weeks). All patients returned to pre-injury level of activity within sixweeks. The functional scores averaged 90.3 (range, 80-100). ROM of the wrist was equal to that of the contralateral side at threemonths postoperatively. Grip strength and pinch strength compared with contralateral were 98% and 92%, respectively. All were satisfied with the final outcomes. Our technique is successfully performed in acute displaced scaphoid fractures resulting in shortened immobilization and prompt functional recovery. It broadens the indications of the percutaneous method, which means the advantages of the percutaneous method are maximally reserved whilst the drawbacks of open reduction were avoided.

Outcome of fracture distal radius treated with open reduction internal fixation with volar locking compression plate (A study of 50 cases)

Introduction: Fractures of the distal radius constitute one of the most common skeletal injuries treated by Orthopaedic surgeons. These injuries account for one sixth of all fractures and represent 17% of all the fractures evaluated in emergency room. The use of strong implant in the form of Fixed Angle Volar Locking Compression Plate theoretically achieves, maintain the reduction and stability in displaced intra-articular & extra-articular distal radius fractures in both the economically productive young age group as well as in the osteoporotic elderly population with less bone stock.Hence, we have decided to study the results of management of distal radius fractures with the open reduction and internal fixation with Volar locking compression plates. Aim: To study the results of operative management of distal radius fractures in terms of functional and radiological outcome, with open reduction and internal fixation with Volar locking compression plates. Materials and Methods: This was a prospective study, where Fifty adult patients with distal radial fractures, treated with a volar locking compression plate using a Modified volar Henry approach(i.e flexor carpi radialis FCR approach), were included in this study. The fracture fragments were analyzed and involvement of radiocarpal and distal radioulnar joints were assessed and classified according to the Frykman’s and AO classification. First follow up of patients was done between tenth to fifteenth post-operative days Subsequent follow ups were done for three months at monthly interval.At each follow up clinical and radiological assessment was done using different parameters.Final assessment of the outcome was done after three months, by MAYO WRIST scoring system. Results and Discussion: In our series, we had 90% excellent, 6% good, 2%, fair and 2% poor result. Patients, who obtained excellent results, had no residual deformities or pain. Range of motion was within the normal functional range. Two patients (4%) had arthritic changes but no other complications. They were operated within 6 days after injury. Radial length, volar tilt and articular step-off were within acceptable limits. They were co-operative to physiotherapy. The results obtained in our series are comparable to other studies undertaken similarly. Conclusion: Use of locked compression plates in distal radius fractures provided good to excellent results with correction and maintenance of distal radius anatomy. By using these plates, joint motions and daily functioning were recovered in a shorter time.

Minimally invasive plate osteosynthesis in frkyman’s type I to IV fractures of distal end radius: A study of 30 cases

Introduction: Encouraged by the distinct advantages of minimally invasive plate osteosynthesis technique for treatment of peri-articular fractures of long bones, we have extended the concept for treatment of distal radius fractures. The aim of our study was to evaluate the clinical and functional outcome of MIPO technique for distal radius fractures. Method: Thirty patients with isolated Frkyman’s type I to IV fractures of distal radius were treated using minimally invasive approach of proximal vertical and distal transverse incision and fixed with volar locking plate and followed till six months post operatively. Final assessment was done using Mayo wrist scoring system at the end of six months. Results: Based on Mayo wrist scoring system 73% had excellent results and 27% had good results. All patients could return to pre-injury work status by 8 weeks. There were no cases of neuro-vascular injury or joint stiffness and cosmetic acceptance of barely visible scar was very satisfactory. Conclusion: Fixation of extra-articular distal radius fractures and minimally displaced, stable intra-articular fractures by using minimally invasive approach appears to be encouraging, reliable and easily reproducible by all.

Volar percutaneous screw fixation for scaphoid nonunion.

Percutaneous screw fixation is widely used in acute fractures of the scaphoid. In this study, we aimed to present our results with volar percutaneous screw fixation in patients with scaphoid nonunions. A total of 12 patients with scaphoid nonunion (≥13 weeks) that underwent volar percutaneous screw fixation were evaluated retrospectively. Two of the patients were female, and 10 were male. Mean age was 27 years (range = 19-41). The mean time that elapsed between the fracture and surgical procedure was 7.5 months (range = 4-12). According to the anatomic location, 33.3% were proximal pole, and 67.7% were waist fractures. All of the patients underwent percutaneous fixation with a headless cannulated screw from volar part under fluoroscopic guidance. Clinical evaluation was performed according to the modified mayo wrist scoring system (MMWS). The absence of a radiolucent fracture line on the radiographs was considered "union" on radiological evaluation. The mean follow-up time was 18 weeks (range = 8-36). Union was achieved in all patients (91.6%), except one. The mean time to union was 15.5 weeks (range = 8-30). Based on MMWS system, 8 patients were interpreted as excellent, 3 patients as good. Percutaneous fixation in appropriate patients provides satisfactory results with high union and minimal complication rates in scaphoid nonunions.

Comparison of two kinds of bone flap transplantation for treatment of old scaphoid fracture

Objective To compare surgical procedure and clinical effects of bone flap transplantation vascularized by recurrent branch of the radial artery and by descending genicular artery in the treatment of old scaphoid fracture. Methods From June 2009 to June 2015, a total of 49 patients with old scaphoid fracture were retrospectively reviewed. 22 cases were treated by internal fixation with transplantation of radial styloid bone flap pedicled on the recurrent branch of the radial artery, while the other 27cases by internal fixation with free grafting of medial femoral condyle bone flap pedicled on the descending genicular artery. The operation time, fracture healing time and wrist function were compared between the two groups. Results The operation time of the descending genicular artery bone flap group (186.00±26.48) min was greater than that of the radial styloid bone flap group (107.00±25.18) min (t=10.617,P<0.001). However, the fracture healing time of the radial styloid bone flap group (16.90±3.58) weeks was longer than that of the descending genicular artery bone flap group (13.20±3.10) weeks (t=3.874,P<0.001). Modified Mayo wrist scoring system was used to evaluate the wrist function 6 months after the surgery. In the radial styloid bone flap group, the results were excellent in 12 cases, good in 9 cases, and fair in 1 case with the average score being 87. In the descending genicular artery bone flap group, the results were excellent in 12 cases, good in 13 cases, fair in 1 case, and poor in 1 case with the average score being 81. There was no significant difference between the two groups. Conclusion Both of the surgical procedures are effective methods for treating old scaphoid fracture. The free grafting of medial femoral condyle bone flap pedicled on the descending genicular artery is faster in fracture healing, but more time-consuming and demanding. Key words: Scaphoid bone; Fractures,ununited; Vascularized bone flap

Clinical outcomes following reduction and pinning of lesser arc injuries without repair of the scapholunate interosseous ligament

BACKGROUND: Purely ligamentous lesser arc, Mayfield grade 3 and 4, perilunate dislocations (PLDs) are uncommon. Current recommendations are for open reduction and repair of the interosseous ligaments to prevent the development of scapholunate dissociation and degeneration to a scapholunate advance collapse (SLAC) wrist. This study proposes a less invasive treatment method which includes closed reduction and pinning alone without repair of the scapholunate interosseous ligament. We propose that most patients will obtain good function and pain scores and the few that develop instability may still have a reconstruction performed through a naive surgical field METHODS: Dislocations were reduced anatomically and held with buried K-wires which were removed at 6 weeks with no specific rehabilitation protocol observed. Subjective assessment included Mayo wrist scoring system, wrist range of movement, instability and grip strength testing. Radiological measurements included scapholunate distance, scapholunate angle, radiolunate angle and osteoarthritis RESULTS: Ten male patients, median age of 35 years, were followed up for a median of 22 months. Seven patients underwent a closed reduction and anatomical pinning while three underwent open reduction due to unachievable reduction by closed means. All of these patients presented at a median of 14 days after the injury occurred. None of the patients had their scapholunate ligaments repaired or reconstructed. Mayo scores included three excellent scores, two good scores and five fair scores. Instability was found clinically in one asymptomatic patient who had a positive Watson shift test. Radiological scores include a median scapholunate distance of 2 mm, a scapholunate angle of 70° and a radiolunate angle of 15°. Osteoarthritis was found in two patients, all of whom were asymptomatic DISCUSSION: Current recommendations in the literature are that PLDs should be reduced via an open surgical technique with repair of the scapholunate interosseous ligament (SLIL) and percutaneous pinning. However, the results of this treatment strategy are not optimal and do not confer uniformly good results. We propose a closed anatomical reduction and percutaneous pinning of the PLD. Our study shows that most patients will demonstrate good function and pain scores when managed this way. A smaller number of these injured wrists will go on to develop instability. However, the advantage of our method over the current recommendations is that when this happens the reconstruction of the SLIL will be made easier through a naive surgical field CONCLUSION: We recommend the closed reduction and anatomical pinning of a purely ligamentous lesser arc injury. This treatment strategy yields good results at medium term follow-up and preserves the option for the reconstruction of the scapholunate interosseous ligament should instability develop

Unstable Distal Radius Fractures Treated by Volar Locking Anatomical Plates.

Fracture of the distal end of radius represents the most common fracture of the upper extremity accounting for 16-20% of all fractures. Plating is now emerging as the gold standard for management of distal radius fractures due to increased rate of complications such as malunion, subluxation/dislocation of distal radio-ulnar joint or late collapse of fracture. Procedures such as closed reduction and cast immobilization, ligamentotaxis with external fixator and percutaneous pin fixation are no longer acceptable. The purpose of the study was to evaluate the functional and radiological outcome of unstable distal radius fractures treated with the volar locking plate. We reviewed 53 patients from January 2011 to December 2015, treated for unstable distal radius fractures using a volar locking compression plate. Standard radiographic and clinical assessment after 12 months (range 12-16 months) were measured and final functional and radiological outcome were assessed using the Modified Mayo wrist scoring system and Sarmiento's modification of Lindstorm criteria respectively. There were 42 males and 11 females with an average age of 39.12±31.78 years (18-71 years). At the end of 12 months, 36 patients had an excellent radiological outcome and 10 patients had good radiological outcome as per Sarmiento's modification of Lindstorm criteria. Eleven patients had an excellent functional outcome and 26 patients had a good functional outcome as per modified Mayo wrist scoring system. There was one case of superficial wound infection which subsided with intravenous antibiotics. The volar locking plate fixation helps in early mobilization of the wrist, restores anatomy, allows early return to function, prevents secondary loss of reduction and hence is an effective treatment for unstable fractures of the distal radius.

Intramedullary nailing for correction of post-traumatic deformity in late-diagnosed distal radius fractures

BackgroundPost-traumatic deformity of the distal radius may lead to multiple sequelae and severe functional impairment. Intramedullary fixation is a novel technique for treatment of distal radius fractures. The present study aimed to evaluate the functional and radiographic outcomes of intramedullary nailing for correction of post-traumatic deformity in late-diagnosed fractures of the distal radius.Materials and methodsFrom July 2009 to February 2011, 16 patients with late-diagnosed displaced fractures of the distal radius were included. Eligible inclusion was extra-articular fracture for more than 4 weeks. Surgical correction and internal fixation with intramedullary nailing was performed for treatment of ten AO type A2 and six AO type A3 fractures. All patients were followed up radiographically and clinically for an average of 20.3 months.ResultsAll fractures achieved bone union without major complications. Functional status and radiographic alignment significantly improved postoperatively. There was no significantly secondary displacement comparing early postoperative and final radiographic parameters. The functional results according to the Mayo wrist scoring system were good or excellent in 94 % of patients. The mean score was 83.8.ConclusionSurgical correction and internal fixation with the intramedullary nail is a feasible and less invasive technique with few complications in the treatment of post-traumatic deformity of the distal radius.Level of evidenceIV.

The Outcomes of Arthroscopic Repair Versus Debridement for Chronic Unstable Triangular Fibrocartilage Complex Tears in Patients Undergoing Ulnar-Shortening Osteotomy

The aim of this study was to compare the results of arthroscopic peripheral repair (AR) and arthroscopic debridement (AD) for the treatment of chronic unstable triangular fibrocartilage complex (TFCC) tears in ulnar-positive patients undergoing ulnar-shortening osteotomy (USO). A total of 31 patients who underwent arthroscopic treatments combined with USO for unstable TFCC tears and were followed-up at a minimum of 24 months were included in this retrospective cohort study. Fifteen patients were treated with AR, and 16 patients were treated with AD while at the same time undergoing a USO. Outcome measures included wrist range of motion, grip strength, Disabilities of the Arm, Shoulder, and Hand (DASH) and Patient-Rated Wrist Evaluation (PRWE) scores, and overall outcomes according to the modified Mayo wrist scoring system. In addition, a stress test to assess distal radioulnar joint (DRUJ) stability was performed before and after surgery to compare the 2 cohorts. Both respective cohorts showed significant improvements in grip strength and subjective scores at the final follow-up. Grip strength, DASH, and PRWE scores were better in the AR group than in the AD group. The recovery rate from DRUJ instability observed during the preoperative examination was superior in the AR group. Both AD and AR of the TFCC combined with USO are reliable procedures with satisfactory clinical outcomes for unstable TFCC tears in ulnar-positive patients. However, AR of the TFCC is suggested if DRUJ stability is concomitantly compromised. Therapeutic IV.

Scaphoid fracture combined with triangular fibrocartilage injury and radial head fracture: a new type of forearm injury triad

Objective To introduce a new triad of forearm injury: scaphoid fracture, triangular fibrocartilage (TFC) injury and radial head fracture, and discuss the similarities and differences comparing to Essex-Lopresti injury. Methods Six male patients of closed forearm injuries treated from October 2011 to May 2013 were involved in this study. They all had scaphoid and radial head fractures on the same side. Wrist arthroscopic examination was carried out in 3 cases that revealed injury to the radial rim of the TFC. One case had olecranon fracture on the contralateral side, while 5 cases had no other accompanying fractures.Two cases were non-surgically treated, while 4 cases were surgically managed where the scaphoid fracture was treated with percutaneous compressive cannulated screw fixation, and the laceration or perforation at the radial rim of the TFC revealed under wrist arthroscopy in 3 cases was treated with arthroscopic debridement. The radial head fracture in 3 cases was categorized as Mason type Ⅰ and treated with splint immobilization. Open reduction and internal fixation was used in 1 case of Mason type Ⅱ radial head fracture. Results All 6 patients were follow-up for 12 to 24 months. The mean follow-up period was 17 months. Fracture union was achieved in all six patients. Clinical evaluations using modified Mayo wrist scoring system and modified Morrey elbow score revealed excellent wrist and elbow functional results in all the patients. Conclusion Comparing to the typical Essex-Lopresti injury, the reported new triad of forearm injury has subtler clinical manifestations due to the relatively low energy impact despite of the similar injury mechanisms. Consequently, misdiagnosis or missed diagnosis is more likely to happen. Successful outcomes rely on prompt diagnosis and proper treatment. Key words: Scaphoid bone; Radius; Fractures, bone; Triangular fibrocartilage

Dorsal ligament reconstruction for old dorsal dislocation of distal radioulnar joint

Objective To evaluate the efficacy and safety of dorsal ligament reconstruction in treatment of old dorsal dislocation of distal radioulnar joint. Methods Seven patients with old dorsal dislocation of distal radioulnar joint were treated with dorsal ligament reconstruction using the palmaris longus tendon from March 2005 to May 2012 in our institute, including 4 males and 3 females with a mean age of 37 years. All patients had a history of wrist injury for more than 3 months and were diagnosed as isolated dislocation of distal radioulnar joint without fractures. During the operation a bone tunnel was made at dorsal ulnar side of radius near the ulnar notch, which was parallelized to long axial of ulna, two holes were drilled from dorsal to palmarulnaris side through the extensor carpi ulnaris sulcus of the ulna. The palmaris longus tendon was harvested and the strip of the tendon was penetrated through the radial hole. After the tips being crossed, put them through the holes of ulna, reduct the distal radioulnar joint by supinating the forearm, the strip of the tendon was sutured after being tightened, the reversed back the free end of the tendon to reconstruct the sheath of extensor carpi ulnaris tendon. Postoperatively, the upper extremity were kept in a long arm plaster in the position of elbow flexion 90° and forearm supination for 3 weeks, then the below elbow cast was replaced for another 3 weeks. Results Patients were followed-up for 1 year and 8 months-4 years and 2 months with the average of 2 years and 9 months. The rotation of wrist was improved and the handgrip strength was increased significantly. A functional evaluation was performed using the modified Mayo wrist scoring system. All patients had better wrists scores postoperatively(mean, 93) compared to preoperatively(mean, 68). All patients satisfied with the final result. Conclusion Dorsal ligament reconstruction should be a promise surgical modality for the old dorsal dislocation of distal radioulnar joint. Key words: Carpal joints, ulnoradial; Dislocations, dorsal; Ligament reconstruction

Résultats cliniques des cals vicieux scaphoïdiens après traitement chirurgical des pseudarthroses du scaphoïde : une étude à un recul minimum de cinq ans

BackgroundAlthough malunion resulting from reconstruction for scaphoid fracture nonunion is a typical complication, there has been little consideration regarding its clinical outcomes. HypothesisThe quality of restoration of the scaphoid anatomy may have little effect on clinical outcomes. Materials and methodsTwenty-five patients with scaphoid fracture nonunion underwent curettage and internal fixation with bone grafting performed by a single surgeon, and they were followed up for a minimum of 5 years. Some of these patients comprised the malunion group if the height/length ratio (H/L ratio) in the most central longitudinal computed tomographic image was more than 0.6. We compared the clinical outcomes of the malunion group with a well-union group based on various clinical scores (patient evaluation measure, disabilities of the arm, shoulder and hand, modified Mayo wrist scoring system). ResultsThe average follow-up period was 81 (range, 65–110) months, and 15 cases among the 25 patients were included in the malunion group. There were no statistical differences in the clinical scores between malunions (15 cases) and well unions (10 cases), and there was no correlation between the H/L ratios and the clinical outcomes. ConclusionThe clinical outcomes of malunited scaphoids after reconstruction for scaphoid fractures nonunion did not differ significantly from well-united scaphoids at a minimum 5-year follow-up. Level of evidenceLevel IV, prognostic case series.

Clinical outcome of scaphoid malunion as a result of scaphoid fracture nonunion surgical treatment: A 5-year minimum follow-up study

BackgroundAlthough malunion resulting from reconstruction for scaphoid fracture nonunion is a typical complication, there has been little consideration regarding its clinical outcomes. HypothesisThe quality of restoration of the scaphoid anatomy may have little effect on clinical outcomes. Materials and MethodsTwenty-five patients with scaphoid fracture nonunion underwent curettage and internal fixation with bone grafting performed by a single surgeon, and they were followed up for a minimum of 5years. Some of these patients comprised the malunion group if the height/length ratio (H/L ratio) in the most central longitudinal computed tomographic image was more than 0.6. We compared the clinical outcomes of the malunion group with a well-union group based on various clinical scores (Patient Evaluation Measure, Disabilities of the Arm, Shoulder and Hand, modified Mayo wrist scoring system). ResultsThe average follow-up period was 81months (range: 65–110), and 15 cases among the 25 patients were included in the malunion group. There were no statistical differences in the clinical scores between malunions (15 cases) and well unions (10 cases), and there was no correlation between the H/L ratios and the clinical outcomes. ConclusionThe clinical outcomes of malunited scaphoids after reconstruction for scaphoid fractures nonunion did not differ significantly from well-united scaphoids at a minimum 5-year follow-up. Level of evidenceLevel IV, prognostic case series.

Treatment of the Communited Distal Radius Fracture Using Volar Locking Plate Fixation with Allogenic Cancellous Bone Graft in the Elderly

Purpose: We studied results of the communited distal radius fracture treated with allogenic cancellous bone graft and volar locking plate in the elderly. Materials and Methods: We studied 29 cases of communited distal radius fracture treated with allogenic cancellous bone graft and volar locking plate from April 2009 to April 2013. Fracture was classified according to AO/OTA classification. Postoperative clinical evaluation was performed with measurement of wrist range of motion (ROM) at last follow-up, modified Mayo wrist scoring system (MMWS), and visual analogue pain scale (VAS). Radiologic evaluation was performed with measurement of radial length on immediate postoperation and last follow-up, radial inclination, volar tilt and ulnar variance checked at the last follow-up using Sarmiento criteria. Results: Using the MMWS, 13 cases were classified as ‘good’, 10 ‘fair’, and 5 ‘normal’. The average wrist ROM was 88.5% for flexion, 92.2% for extension, 90.5% for adduction, and 94.0% for abduction. The average VAS was 1.7. On the last follow-up, average radius length, radial inclination and volar tilt did not show statistically significant improvement (p＞0.05) compared to immediate post operation measurements, and according to Sarmiento criteria, 5 cases were classified as ‘good’, 14 ‘fair’, and 7 ‘normal’. Conclusion: Treatment of severe communited distal radius fracture accompanied by bone defect with volar locking plate and allogenic cancellous bone graft is a satisfying and effective treatment method in the elderly.