A 40-Year Retrospective Evaluation of Vascularized Bone Grafting for Kienböck Disease.

Scapholunate advanced collapse (SLAC) and scaphoid non-union advanced collapse (SNAC) are well-recognised degenerative wrist conditions. Debate persists over optimal treatment, particularly since 4 corner fusion (4CF) emerged in the 1980s. Reviews have compared the outcomes of 4CF and PRC; however, none of these have looked at whether the initial diagnosis determines the final outcome. This systematic review hypothesises that the outcome of PRC and 4CF for the treatment of stage 2 and 3 SNAC and SLAC varies depending on the initial diagnosis. Searches of PubMed, Google Scholar and Cochrane database using the terms 'SNAC' and 'SLAC' were performed. Studies were excluded based on results recorded, study nature and whether results were separated according to the initial diagnosis. Studies were assimilated using weighted averages and further analysed using Microsoft Excel and GraphPad Prism software. A total of 3320 studies were identified; however, only 6 studies (8 study arms) were included. Of these, 7 study arms recorded pre- and post-operative range of movement data, 4 with pre- and post-operative disabilities of the arm, shoulder and hand (DASH) scores and 5 with pre- and post-operative Visual Analogue Score (VAS) pain scores. There was no statistical difference in these outcome measures with a mean follow-up of 62 months (38-120). This review found no significant difference in the outcomes of these procedures; however, there is a high level of uncertainty. Further studies should focus on reporting data by procedure as well as initial diagnosis with appropriate power calculations and should be designed as prospective randomised control trials.

Pyrocarbon capitate resurfacing implant combined with proximal row carpectomy for advanced wrist osteoarthritis.

Acutely performed proximal row carpectomy (PRC) is a viable alternative to open reduction internal fixation for perilunate and/or lunate dislocations, offering comparable outcomes with fewer postoperative complications. Studies report good motion, low complication, and reoperation rates. However, limited research exists on acute PRC for perilunate dislocations (PLDs), warranting further investigation into its functional outcomes. A retrospective chart review was conducted on adult patients who underwent acute PRC for PLDs and perilunate fracture-dislocations (PLFDs) at a single institution (2010-2022). Inclusion criteria encompassed patients aged above 18 years with perilunate or lunate dislocation/fracture-dislocation treated with PRC within 21 days post-injury, among other criteria. Fourteen patients met our inclusion criteria. Patient-reported outcomes (PROs) were collected through phone surveys and final clinic visits, using Patient-Rated Wrist Evaluations (PRWEs), Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), visual analog scale (VAS) pain scores, and return-to-work statuses. Surgical approaches, patient demographics, and injury characteristics were analyzed. In our cohort (average age 49.4 years), injuries were due to motor vehicle collisions (57%) and falls (43%). Proximal row carpectomy was performed within an average of 5.6 days post-injury, and patients were contacted an average of 68.0 months post-surgery. Return-to-work rates were favorable, with 35.7% returning without restrictions and 35.7% with restrictions. Patient-reported outcomes, encompassing VAS (1.31), QuickDASH (20.5), and PRWEs (24.5), demonstrated favorable results. This study provides novel insights into the outcomes of acute PRC for perilunate and lunate dislocations, expanding on limited existing literature. It highlights PRC as a viable intervention for PLDs and PLFDs, demonstrated by substantial return-to-work rates and positive PROs.

The optimal surgical approach for Preiser disease, a rare avascular necrosis of the scaphoid, remains unclear. Our institution employs a stage-based strategy: vascularized bone grafting (VBG) or closing radial wedge osteotomy (CRWO) for early disease (Herbert classification stages 1-2) and proximal row carpectomy (PRC) for advanced disease (stages 3-4). This study evaluates this stage-based surgical approach. We retrospectively analyzed 8 patients (mean age: 60.6 years) who underwent surgical treatment for Preiser disease between 2000 and 2019. Preoperative evaluation included Herbert and Kalainov classifications. Outcome measures included the range of motion (ROM), grip strength (GS), pain (numeric rating scale [NRS] score), Modified Mayo Wrist Score (MMWS), and radiological parameters. Mean follow-up was 50 months. Five patients had stage 2, 1 had stage 3, and 2 had stage 4 disease. Seven patients were treated according to our strategy; 1 stage 4 patient deviated. In those treated per protocol, the VBG/CRWO group (n = 5) and the PRC group (n = 2) showed improvements across all clinical outcomes. Despite clinical gains, radiographic disease progression occurred in 4 of the 5 patients in the VBG/CRWO group. The patient treated outside the standard approach experienced clinical deterioration and developed dorsal intercalated segment instability deformity. Our stage-based surgical strategy for Preiser disease yields favorable clinical outcomes. While radiographic progression may occur regardless of treatment, clinical improvements are generally maintained when procedures are appropriately selected based on disease stage.

Abstract Dorsal lunate dislocation (DLD) is an exceptionally rare injury, typically resulting from high-energy trauma. Due to the scarcity of reported cases, its exact mechanism of injury is not well understood. This study aimed to present three cases of DLD treated at our institution and to perform a systematic review of the literature to evaluate the mechanisms of injury and treatment approaches for pure DLD. A retrospective review was conducted of three patients with pure DLD treated at a single tertiary care center. Data were collected through medical record analysis and radiographic review. Additionally, a systematic literature review was performed to identify reported cases of DLD. Patient demographics, mechanisms of injury, treatment modalities, and clinical outcomes were analyzed. We identified three cases of DLD, while the systematic review uncovered 17 additional cases. Overall, men represented 95% of cases, with high-energy trauma accounting for 85% of injuries. Forced wrist flexion was the most commonly reported mechanism, occurring in 55% of cases. Radiographic analysis showed concomitant wrist fractures in 55% of cases. Treatment strategies included fixation in 65% of patients, ligament repair in 45%, and lunate resection or proximal row carpectomy in 15%. The median follow-up duration was 12 months, with half of the patients achieving favorable outcomes. Notably, two of the three low-energy injury cases were associated with preexisting arthritis. Pure DLD is an extremely rare clinical entity, possibly resulting from axial loading on a flexed wrist or forced hyperflexion. Characteristic radiographic findings include disruption of Gilula's lines and dorsal displacement of the lunate on lateral radiographs. Optimal management involves initial closed reduction followed by surgical fixation and ligamentous repair when indicated to enhance outcomes and restore wrist function.

Motion-preserving procedures in the treatment of scapholunate advanced collapse wrist: Proximal row carpectomy versus four-corner arthrodesis.

The Osteochondral Autologous Transfer System (OATS) is a surgical technique initially developed for knee procedures to address focal articular cartilage defects. Although widely applied in the knee, elbow, shoulder, and ankle, its application in hand surgery is limited but growing. This review aims to compile evidence-based insights into OATS for hand surgery, focusing on indications, technical nuances, outcomes, and donor-site morbidity. Additionally, a demonstrative case is presented showcasing the reconstruction of a capitate using OATS. The systematic review followed PRISMA 2020 guidelines and was registered on PROSPERO. Electronic databases (PubMed, Google Scholar, Cochrane Library) and ClinicalTrials.gov were searched for studies up to August 1, 2024, using the keywords: OATS, osteochondral autologous transplantation system, hand, and wrist. Eligible studies included clinical applications of OATS in hand surgery with follow-up data. Case reports, series, and cohort studies were appraised for quality and risk of bias. Additionally, a narrative review addressed practical questions for hand surgeons. A demonstrative case involving capitate resurfacing during proximal row carpectomy was also included. Thirteen studies met the inclusion criteria, encompassing case reports and small series involving up to 11 patients. Indications for OATS in hand surgery included reconstruction of the lunate fossa, carpal bones, metacarpal heads, and interphalangeal joints. Favorable outcomes were reported, with donor sites including the lateral femoral condyle, medial femoral trochlea, and hemihamate bone. Donor-site morbidity was rare but included exertional knee pain and radiological degenerative changes. The demonstrative case highlighted capitate resurfacing with satisfactory functional and radiological outcomes. OATS shows promise in addressing osteochondral defects in the hand, with favorable outcomes across various applications. Although evidence remains limited to small case series and reports, the technique demonstrates potential as a motion-preserving option. Future research should address donor-site morbidity in healthy knees and explore the feasibility of allograft use.

Surgical outcomes in chronic perilunate dislocations: A systematic review.

The study aimed to evaluate the timeliness and effectiveness of treatment of all patients who underwent surgery for septic arthritis of the wrist at our department between 2003 and 2023. The retrospective study included 38 patients (26 men and 12 women). The mean age of the patients was 68 years. All patients underwent surgery for culture-positive arthritis of the native wrist. Patients with periprosthetic and extraarticular infections were excluded from the study. Once the diagnosis was established based on the clinical examination and laboratory analysis of blood and synovial fluid, antibiotic treatment was administered and revision surgery was performed. Arthroscopic procedure was used in the unaffected wrist, whereas open surgery was opted for in case of any degenerative changes of the wrist joint and extra-articular spread of infection. A total of 50 surgeries were performed, of which 6 arthroscopies, 32 open arthrotomies, 2 open surgeries with proximal row carpectomy, 6 open surgeries with simultaneous resection arthrodesis, 2 revision surgeries with arthrodesis via internal fixation for prolonged healing, 2 revision surgeries for another postoperative complication. In our study cohort of patients with septic arthritis, the arthritis of the wrist represented 7%. The most common pathogen was Staphylococcus aureus (60.5%). In 35 patients (92%) at least one risk factor for septic arthritis was present. In all patients, signs of local inflammation were present. 17 patients showed signs of system-wide inflammation and in 32 patients laboratory markers of inflammation were reported. In 6 cases both sides were affected. In our cohort the lethality reached 8%. These were patients with severe immunodeficiency and multiple loci of infection. Full recovery was achieved in 35 patients (92%), i.e. in all surviving patients, in whom the wrist joint was stable upon treatment completion and the self-care was not limited. The prevailing part of the patients (92.10%) with septic arthritis of the wrist showed risk factors for the development of septic arthritis, i. e. poor overall health condition of the patient, immunosuppression, organ failure, diabetes, age over 65 years, rheumatoid arthritis, surgery or trauma, drug or alcohol abuse. In case of bacteremia or sepsis, the risk factors include also chronic degenerative or inflammatory changes in the wrist region, with synovitis constituting a predisposition for hematogenous spread of septic arthritis of the wrist. Our cohort clearly confirms that the system-wide signs and laboratory markers of inflammation are nonspecific markers which cannot conclusively confirm the diagnosis of septic arthritis of the wrist, but the development of their values over time demonstrates the effect of treatment used. The presence of degenerative changes of the wrist joint influences the choice of surgical procedure. Septic arthritis of the wrist ranks among the less common types of arthritis. Early diagnosis should promptly be followed by adequate surgical treatment. Correct early management increases the likelihood of full recovery, even in high-risk patients.

Dermal Allograft Augmentation With Proximal Row Carpectomy: A Biomechanical Study.

Total wrist arthrodesis epidemiology and prior surgeries survival.

INTRODUCTION: The treatment of neglected perilunate dislocations of the wrist remains a complex challenge for surgeons. To address this issue, hand surgeons have several options in their arsenal: open reduction, lunate excision, proximal row carpectomy, arthrodesis, and arthroplasty. Open reduction appears to be an attractive approach, as it allows restoring normal wrist anatomy with preserving the possibility of future procedures in case of failure. However, there is no consensus among contemporary surgeons regarding the acceptable time interval between injury and surgery. Likewise, opinions differ on the technique of reduction itself. CASE DESCRIPTION: The treatment of 8 patients aged 24 to 42 years with neglected perilunate dislocations was analyzed. The interval between injury and surgery ranged from 1.5 to 19 months. The first stage involved application of an Ilizarov external fixator for gradual preoperative distraction of the wrist joint. After 2–4 weeks, the Ilizarov external fixator was removed, and open reduction followed by fixation with wires was performed. At the second stage, in three cases, scaphoid osteosynthesis with a screw and free bone grafting were additionally performed. In all cases, gradual distraction enabled progressive soft tissue elongation without ischemic or neurological complications. At the second stage, all perilunate dislocations were successfully reduced via open approach. Functional outcomes were assessed 6 to 60 months after open reduction using the Mayo wrist score. Hand function improved in 6 patients (60–80 points) and was fully restored in 2 patients with a 1.5-month injury duration (100 points). In patients (3) with scaphoid pseudarthrosis, bone union was achieved. In the long-term follow-up, 3 patients developed radiological signs of post-traumatic wrist osteoarthritis, including partial resorption of the lunate, capitate, and hamate in 2 cases. CONCLUSION: Preliminary wrist joint distraction facilitated and simplified the performance of open reduction of neglected perilunate dislocations of the carpal bones. The functional outcome in our patients depended on the time elapsed since injury and the presence of associated carpal fractures. The question of a time limit after injury for which open reduction remains a justifiable option remains unresolved.

Abstract The treatment of neglected chronic lunate dislocations is controversial while open reduction of lunate was often not available in the situation. Lunate excision, partial wrist fusion, or proximal row carpectomy (PRC) were recommended in several studies, but long-term complications of capsular contracture, carpal collapse, and posttraumatic arthritis were still noted.We described a 25-year-old male suffering from motor vehicle accident 3 years ago with neglected chronic lunate dislocation. The modified technique of anatomic front and back (ANAFAB) combined with lunate excision was applied in the young and active male. After surgery, 8 weeks of immobilization was adequate and no additional Kirshner wires were needed.The modified ANAFAB technique revealed the ability of sustaining significant load on the carpus and radius without pain, and the technique not only maintained the carpal stability and good recovery of range of motion but also preserved the options of partial wrist fusion or PRC in the future.

In Kienböck disease with carpal collapse scaphocapitate fusion (SCF) and proximal row carpectomy (PRC), are mainstays of surgical treatment. This study analyzed objective and patient-reported outcomes after SCF or PRC in laborers versus nonlaborers. A retrospective cohort study of patients who underwent surgery for Kienböck disease within a single health system from 1976 to 2023 was conducted. Postoperative Disabilities of the Arm, Shoulder, and Hand (DASH) and Patient-Rated Wrist Evaluation (PRWE) scores were surveyed from the available population. Labor status, grip, ROM, and return to the operating room were collected and radiographs were analyzed. Sixty-four patients underwent PRC, and 78 underwent SCF. Patients with PRC were significantly older than patients with SCF. Mean follow-up was 29 months (SD, 53 months). There was no significant difference in postoperative ROM or relative grip strength between the cohort groups. Laborers who underwent SCF demonstrated the least disability on DASH scores. There was no significant difference in postoperative DASH scores in PRC when comparing laborers versus nonlaborers. In contrast, the DASH and PRWE scores of patients who underwent SCF postoperatively varied between laborers and nonlaborers (mean ± SD, 11.1 ± 13.9 versus 30.5 ± 24.8, P = 0.005; and 17.5 ± 19.4 versus 42.3 ± 31.4, P = 0.024). Patients who underwent SCF had a greater rate of revision surgery compared with the PRC group (22 of 78 versus 6 of 64; P = 0.026). Wrist fusion rates were 19% for SCF compared with 1.6% for PRC ( P = 0.0007). SCF and PRC demonstrated no difference in postoperative ROM and grip based on labor status. Laborers with SCF had the least postoperative disability on DASH; however, SCF was associated with the need for additional surgical intervention and conversion to total wrist arthrodesis. Therapeutc, III.

A 19-year-old man presented with symptomatic stage IIIB Kienböck disease. He underwent salvaging proximal row carpectomy for sclerotic lunate, carpal collapse, scaphoid volar tilting, and osteoarthritis. He had a resolution of pain and functional improvement. To our knowledge, salvaging procedure of late-stage Kienböck disease at this age is rare and this article can provide insight into the surgical management and prognosis of patients with similar diagnoses. This case highlights the importance of early clinical suspicion, prompt use of advanced imaging, and awareness of Kienböck disease to avoid delays in diagnosis and prevent progression to late-stage disease, where treatment options are limited.

This study aimed to compare the clinical results and determine functional superiority in patients treated with scaphocapitate fusion (SCF) versus proximal row carpectomy (PRC) for advanced-grade Kienböck disease. The patients were assessed in terms of demographic data, follow-up duration, disease stage, preoperative and final follow-up values of the disability of arm, shoulder, and hand (DASH) score, patient-rated wrist evaluation (PRWE) score, and visual analog scale (VAS) pain score, together with the key-pinch grip and palmar grip values. The preoperative and postoperative flexion and extension angles and radial and ulnar deviation angles were also recorded and compared. As there were no records of preoperative grip strength values, comparisons were made with the healthy contralateral hand. A total of 26 patients were evaluated, including 10 who underwent PRC surgery and 16 who underwent SCF. Preoperatively, the flexion range was 65.8% in the PRC group and 58.8% in the SCF group, the extension range was 65.8% and 56.7%, radial deviation was 35% and 40.6%, and ulnar deviation was 65% and 61.1%, respectively. Postoperatively, the mean values of these parameters were comparable between the 2 groups. When grip strength was compared with the non-operated hand, it was determined to be 58.8% of the healthy hand in the PRC group and 60.9% in the SCF group. Similarly, pinch strength was 45.5% of the healthy hand in the PRC group and 55.6% in the SCF group. In all patients, a statistically significant reduction was observed in postoperative DASH, PRWE, and VAS scores compared to preoperative values. Specifically, in the PRC group, the postoperative scores were DASH: 22.6, PRWE: 43.6, and VAS: 3.2, while in the SCF group, the corresponding values were DASH: 26.5, PRWE: 38.2, and VAS: 2.9. In advanced-grade Kienböck disease, PRC appears to be a more favorable option when preserving joint range of motion is a priority, whereas SCF may provide better outcomes in terms of grip strength. Both techniques seem to o!er comparable pain relief and functional results, suggesting that the choice of procedure should be tailored to the patient's individual needs and priorities. Level IV, Therapeutic Study.

Three-Dimensional In Vivo Kinematic Analysis of Kienböck Disease Treated with Arthroscopic Lunate Excision.

Introduction Scaphoid nonunion can result in progressive scaphoid nonunion advanced collapse (SNAC) and have an impact on the quality of life in younger patients. The social significance of the pathological condition induces original research and literature analysis.The objective was to identify methods for preventing scaphoid nonunion and improving treatment outcomes for SNAC patients based on the literature on etiology, diagnosis and treatment of the disease.Material and methods The original literature search was conducted on key resources including Scientific Electronic Library (www.elibrary.ru) and the National Library of Medicine (www.pubmed.org) and using the keywords: scaphoid nonunion, scaphoid, bone grafting, scaphoid nonunion, vascularized bone graft. The search yielded 355 results. Literature searches included both Russian and English studies published between 1984 and 2024. Inclusion criteria included original articles, systematic reviews, meta-analyses relevant to the search topic. Non-inclusion criteria included a case report, case/control, and articles available only on a fee-paying basis. There were 67 articles identified.Results and discussion The topography of the scaphoid is associated with a high incidence of avascular necrosis, delayed healing and fracture nonunion. Clinical testing and imaging are essential for diagnosis of scaphoid fractures in the acute period of injury, and fracture instability would be important for surgical indications. There is a classification of scaphoid nonunions that is practical for the choice of a surgical treatment (osteosynthesis with compression screws, debridement and bone grafts or “salvage” operations). Scaphoid nonunions treated with the Ilizarov method employing no open approaches or grafts was reported in a few publications. Treatment of SNAC patients is traditionally based on the stage of the disease: 1 — scaphoid reconstruction, resection of the styloid process of the radius; 2–3 — 4-corner arthrodesis or the proximal row carpectomy. Meta-analyses highlight the need for the research into the effectiveness of various treatments. Arthroscopic techniques are common in wrist surgery improving diagnostic capabilities and minimally invasive interventions.Conclusion Timely healing of a scaphoid fracture is essential for preventing carpal instability and SNAC. The choice of SNAC treatment is associated with the stage of the disease and functional needs of the patient.

Retrospective study of 54 cases of wrist denervation.