Radial Styloid Research Articles

Quantitative 3-D CT Demonstrates Distal Row Pronation and Translation and Radiolunate Arthritis in the SNAC Wrist.

In scaphoid nonunion advanced collapse (SNAC) wrist arthritis, we analyzed the 3-dimensional (3-D) deformity patterns of carpal alignment secondary to scaphoid nonunion and quantified subchondral arthritis by investigating alterations in bone density. We constructed 3-D models of the carpal bones and radius from 51 patients with scaphoid nonunion (nonunion group) and 50 healthy controls (control group). We quantified the differences in 3-D geometric position of the distal carpal row relative to the distal radius in SNAC wrists versus controls. In addition, we assessed the bone density of anatomic regions of interest in the radiocarpal and capitolunate joints relative to the pisiform bone density to characterize degenerative changes in SNAC wrists. The distal carpal row pronated by a difference of 14° (7.2° versus -6.7°; p < 0.001), deviated ulnarly by a difference of 19° (7.7° versus -11.2°; p < 0.001), shifted dorsally by a difference of 17% of the dorsovolar width of the distal radius (21.0% versus 4.4%; p < 0.001), shifted radially by a difference of 8% of the radioulnar width of the distal radius (13.2% versus 5.3%; p < 0.001), and migrated proximally by a difference of 12% of the lunate height (96.3% versus 108.8%; p < 0.001) in the nonunion group compared with the control group. Additionally, it was found that bone density was greater at the capitolunate joint (capitate head: 140.4% versus 123.7%; p < 0.001; distal lunate: 159.9% versus 146.3%; p < 0.001), the radial styloid (157.0% versus 136.3%; p < 0.001), and the radiolunate joint (proximal lunate: 134.8% versus 122.7%; p < 0.001; lunate fossa: 158.6% versus 148.1%; p = 0.005) in the nonunion group compared with the control group. Scaphoid nonunion exhibited a unique deformity pattern and alteration in bone-density distributions. The distal carpal row not only shifted dorsally and migrated proximally but also pronated, deviated ulnarly, and shifted radially. Bone density was greater at the capitolunate joint, the radial styloid, and surprisingly, the radiolunate joint. Our findings give insight into the natural history and progression of arthritis of the SNAC wrist. Additionally, future studies may give insight into whether successful treatment of scaphoid nonunion arrests the progression of arthritis. Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Clinical Considerations of First Extensor Wrist Compartment (FEWC) Variants and De Quervain's Disease: A Review Study.

The first extensor wrist compartment (FEWC) displays significant variants. This review highlights all possible variants that may be associated with the occurrence and pathophysiology of de Quervain's tenosynovitis. A thorough search of PubMed and MEDLINE databases, following the PRISMA guidelines, was conductedfrom 2002 to 2022 to evaluate all FEWC variants, including the following: 1) the presence of an inter-tendinous septum, 2) the number of tendinous slips of the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB) muscles, 3) their distal insertions and 4) the presence of a bony ridge within the FEWC.A total of 3878 wrists (1277 cadaveric and 1296 de Quervain patients) were included.Of the 1234 cadavers, a total of 701 (56.8%) were males and 533 (43.2%) were females. Regarding the 883 patients, 178 (20.2%) of them were males and 705 (79.8%) were females. An inter-tendinous septum was identified in 42.9% (47% of the patients' wrists compared to 39.3% of the cadaveric wrists, p<0.0001). Cadaveric wrists presented two or more slips for the APL in a significantly higher percentage (92.5%, p < 0.0001) compared to de Quervain patients' wrists (74.5%). Regarding the EPB muscle, de Quervain patients' wrists had a single slip in 93% (p=0.0007) and two or more slips in 3.6%, compared to cadaveric wrists (a single slip in 87%, and two or more slips in 11%, p< 0.0001). A bony ridge over the radial styloid process was recorded in 58.9% of the cadaveric wrists compared to 17.8% of the patients' wrists (p < 0.0001). Remarkable diversity concerning the structures within the FEWC was reported. The presence of an inter-tendinous septum dividing the FEWC and a single EPB muscle slip is more likely to be found in patients with de Quervain's disease.

Raktamokshana - A Customary Perspective to alleviate De Quervain’s Tenosynovitis w.s.r. to Vatarakta - A Rare Case Study

The discovery of De Quervain's Tenosynovitis was much acknowledged in classical books in terms of symptoms that could be associated to Vatarakta (Gout), but the disease's nomenclature was only identified in the later period of global modernization. This case study describes a young woman who was pre-diagnosed with De Quervain's condition and treated using the Vatarakta paradigm of treatment protocols, principally raktamokshana (Blood-letting). Raktamokshana with the advent of jalauka (leech) is taken into consideration in the study because Vata and Rakta (blood) are vitiated, which furthers the disease. Rakatamokshana is an excellent treatment option for De Quervain's Tenosynovitis due to its efficiency, simplicity of administration, and safe therapy regimen. With outstanding results for pain management and the restoration of the functioning of the wrist joint, this therapy modality can therefore be recommended for the condition. Need of study: To evaluate the new conceptual idea for treating De Quervain’s Tenosynovitis that is non-invasive and helps to restoring the normal function of corresponding hand and wrist movements. Methodology: Current case report presents a 34-year-old woman with a right-hand dominant job whose primary complaints were pain, morning stiffness, localized burning sensation and swelling at the radial styloid process on the right hand at the base of the thumb for the past two months, who was diagnosed as De Quervain’s Tenosynovitis and was treated with Raktamokshana with Jaluka with two sittings. Conclusion: After first sitting she had 80% relief from symptoms and was totally symptomless after second sitting of Raktamokshana, helping new therapeutic regimen to treat the disease.

Effects of Statin Treatment on the Development of Tendinopathy: A Nationwide Population-Based Cohort Study.

Previous longitudinal cohort studies have reported the conflicting results of the relationship between statin use and the development of tendinopathy disorder. It is unclear if there is a relationship between statin use, particularly the type or cumulative doses, and the development of tendinopathy disorder. To investigate an association between statin treatment and the development of tendinopathy. Cohort study; Level of evidence, 3. A total of 594,130 participants were enrolled in this study in 2002 and evaluated until 2015. There were 84,102 statin users and 168,204 nonusers (controls) selected at a ratio of 1:2 using propensity score matching analysis. The types of included tendinopathy were as follows: (1) trigger finger, (2) radial styloid tenosynovitis, (3) elbow epicondylitis, (4) rotator cuff tendinopathy, and (5) Achilles tendinitis. Cox proportional hazards models with time-varying covariates were constructed to identify the association between statin use and tendinopathy development. Statin treatments regardless of statin types were associated with a significantly greater risk of all types of tendinopathy development (hazard ratio, 1.435; 95% CI, 1.411-1.460) compared with no statin treatment. A trend toward risk reduction was observed according to cumulative statin doses, which was indicated by hazard ratios of 2.337 (95% CI, 2.269-2.406), 2.210 (95% CI, 2.132-2.290), and 1.1 (95% CI, 1.098-1.146) in patients with cumulative defined daily doses of 90, 91-180, and >180, respectively. This nationwide population-based cohort study suggests that statin use regardless of the statin type was associated with a greater risk of tendinopathy compared with that of nonusers. The risk of tendinopathy development was diluted with the increasing cumulative defined daily dose.

Volar spanning plate fixation for a distal radius fracture

A comminuted distal radial fracture is sometimes so fragmented that it is impossible to treat it with fixation using a plate and screws. In this case, we can perform a bridging fracture and joints with an external fixator or a dorsal spanning plate. Unfortunately, both methods completely immobilize the wrist until the implants are removed. In the article is presented an alternative method of bridge fixation. After fracture bridging with a volar spanning plate, the patient immediately has the possibility of dorsal and volar flexion of approximately 30 degrees in each direction. The study group consists of 6 patients treated surgically with a volar spanning plate after an unsuccessful attempt of stable fixation with a volar plate. 5 patients suffered from a distal radius fracture in the AO classification type C3, and one man with an inveterate dorsal dislocation of the wrist and fracture of the radial styloid process type B1. The volar spanning plate was fixed distally in the scaphoid and lunar, and proximally in the shaft of the radius. All patients achieved bone union. There was no destabilization or any damage of the implant. The average dorsal flexion was 48°, and the palmar flexion was 45°. All patients obtained a satisfactory result according to the Mayo scale, without pain. The volar spanning plate may be indicated when intraoperative fixation by a volar plate turns out to be too optimistic. Compared to the external fixator or the dorsal spanning plate, the volar spanning plate does not distract the midcarpal and carpometacarpal joints. What is more, immediately after the operation, the possibility of dorsal and palmar flexion are approximately 30 degrees in each direction, which improves the quality of life in the first weeks of treatment. After removing the implant, there is still a chance to improve the range of motion of the wrist.

Comparison of Clinical Outcome in Surgically Treated Radial Styloid Fracture: K-Wire Vs Screw Fixation

Background: Distal radius fracture (DSF) is a frequent clinical issue. The aim of this study was that to compare surgical treatment of screw and k-wire fixation with related to the reunion, functionally outcomes and improve patient’s life quality after radius broken or fracture. Study design: The randomized controlled study was carried out at the department of orthopedic surgery CMH hospital, Rawalpindi for six months from 13 December 2022 to 12 June 2023. Materials and Methods: The total participants were 110 included both gender male and female were age group (20-62) and treated with k-wire and screw fixation. The surgery was carried out while the patient was under external anesthesia, using a pneumatic tourniquet and image intensification. We analyzed data by SPSS 21 version. Results: The mean age of patients in K-wire group was 41.99 ± 5.34 years and in screw fixation group was 47.19 ± 15.82 years. The minimum and maximum age in K-wire and Screw fixation group was 20-62 years respectively. The total participants were (n=110) which included each group consists of 55 participants in screw and k-wire fixation treatment. To compare the overall reunion rate of radius bone in screw fixation treatment group show significant result (p&lt; 0.001) as compared to k-wire group treatment and radiological healing time was 8 to 10 weeks in both surgical treatment groups. Conclusion: In the distal radius fracture treated surgically by screw and k-fixation but in our study to analyzed significant reunion and functional outcome in screw fixation group then k-wire fixation in the participants. Screw fixation takes less time 2.5 months for recovery after bone broken as compare to k-wire. The disadvantage of k-wire after surgery to show highly significant irritation of soft bone tissue and requiring implant removal. Keywords: Distal Radius fracture (DSF); K-wire fixation; screw fixation;

Unstable distal radius fractures fixation with a 2.4 mm volar variable-angle locking plate: radiological and functional assessment

Background: The main objective of this observational study was to evaluate the functional and radiological outcome of variable angle volar plates in intra-articular distal end radius fractures. Methods: Patients with distal end radius fractures (AO type 3C) treated operatively between Jan 2020 and Dec 2020 and then followed up for at least 12 months. A total of 32 patients (11 men and 21 women) with a mean age of 51.9 years were included in the study. The functional outcome was assessed by using modified Mayo wrist score (MMWS), disabilities of the arm, shoulder, and hand (DASH) score, wrist range of motion (ROM) and grip strength relative to the uninjured side and radiological assessment of radial height, volar tilt, and radial inclination. Results: MMWS and DASH scores improved postoperatively over time. Signs of radiographic union started around 12 weeks after surgery. The most common complication observed was finger and wrist stiffness, which was resolved with active wrist and finger movements. Non-union or hardware-related complications/ late complications such as tendon irritation/attrition were not observed with variable angle volar locking plates. Conclusions: Distal end radius fracture fixation with variable angle plate gives favourable radiological and clinical outcomes. These results can be owed to features such as low profile, variable locking, anatomical design and implant biomechanics. The surgeon determined angulation of the distal row of screw fixation may decrease the incidence of joint penetration and improve fixation of radial styloid and lunate facet stability.

TO DETERMINE EFFECTIVENESS OF SURGICAL RELEASE IN MANAGEMENT OF DE QUERVAIN'S TENOSYNOVITIS

Introduction: De Quervain tenosynovitis is rst described by Fritz de Quervain, in 1895. It involves tendon entrapment of the rst dorsal compartment of the wrist and thickening of the tendon sheaths of rst dorsal compartment the abductor pollicis longus and extensor pollicis brevis, where the tendons pass through the bro-osseous tunnel located along the radial styloid at the distal wrist. Pain is exacerbated by thumb movement and radial or ulnar deviation of the wrist. The prevalence of de Quervain tenosynovitis is about 0.5% in men and 1.3% in women with peak prevalence in their fourth and fth decades of life respectively. The present Materials and Methods: study was a prospective study. This Study was conducted from December 2021 to December 2022 at Department of Rampurhat Government Medical College and Hospital, West Bengal, India. In the total of 20 patients Result: were included, out of which 16 patients are female and 4 patients are male. Surgical release has excellent outcome; splinti Conclusion: ng and local steroid injection can be an alternative treatment option for DQ disease especially in patients with low grade disease.

Outcome of treatment of intra-articular distal end radius fractures by volar locking plate versus bridging external fixator augmented by single K-wire through radial styloid

Background: Distal radius fractures are common injuries occurring more frequently than any other fracture, and remain one of the most frequent skeletal injuries treated by orthopaedic or trauma surgeons. They are considered the most common fracture of the upper extremity. The use of percutaneous pin fixation, external fixation devices that permit distraction and palmar translation, low-profile internal fixation plates and implants, arthroscopically assisted reduction, and grafting techniques including bone-graft substitutes all have contributed to improving fracture stability and outcome. Methods: This is a prospective study consisting of 30 patients, who were treated with volar locking plate or K-wire augmented external fixation for intra-articular commented distal radius fractures (AO type C) at Rajendra institute of medical sciences between November 2020 and January 2023. The 15 patients were treated with open reduction using the volar approach and locking plate were used while 15 patients were treated with closed reduction under fluoroscopy, distraction with the external fixator (Joshi type external fixator) along with K-wire fixation for additional stability used. Result: The ORIF with plating group showed better functional outcomes in Green and O'Brien compared to ex fix group. The radiographic results in the ORIF group were more favorable than in the EF group. Conclusions: We found that both ORIF with plating and external fixation represent treatment choices for distal radius fractures. ORIF had better functional and radiological outcomes according to Green and O'Brien and Sarmiento scoring systems when compared to external fixation. ORIF had less incidence of complications compared with external fixation.

Lacertus Syndrome: an Outcome Analysis After Lacertus Release

The lacertus fibrosus or bicipital aponeurosis is a sheet of ligamentous tissue just distal to the elbow joint and can be a compression point for the median nerve. Essentially, lacertus syndrome is a subset of pronator syndrome and an uncommon diagnosis by itself. Surgical release of the lacertus consists of a small 2-cm incision that can be performed under local anesthesia. This study aimed to evaluate the outcome of lacertus release in resolving median nerve symptoms. This retrospective study was performed at Prince Court Medical Centre, Kuala Lumpur, Malaysia, from January 2020 until June 2021. Ninety-three patients who presented with numbness of fingers, hand, or upper limb; forearm pain; and muscle weakness. They were diagnosed with lacertus syndrome on the basis of local tenderness at the lacertus fibrosus with either weakness of flexor pollicis longus and flexor digitorum profundus of the index finger or paresthesia over the thenar eminence. The patients underwent 3 months of hand therapy, and those with no symptom improvement were offered lacertus release performed by a single surgeon. The surgical technique consists of a surgical incision starting from a point 2 cm distally and 2 cm radially to the medial epicondyle. The incision projects 2 cm distally in an oblique fashion toward the radial styloid. A wide-awake local anesthesia no tourniquet (WALANT) technqiue was utilized and 20 mL of local anesthesic was injected subcutaneously around this region at least 20 minutes before the surgery. Careful dissection was made subcutaneously, and the lacertus fibrosus was identified as a thickened, shiny white structure and released. The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, grip strength, and pinch strength were tested before and after surgery. At 6 months after surgery, the QuickDASH score was again assessed with a WALANT satisfactory questionnaire. A total of 93 patients were included in the study. The mean age of the patients was 38.7 years, and most were women (77.4%). The mean operating time was 70 minutes. The mean preoperative QuickDASH score was 53, which significantly reduced immediately after surgery to 7.8 (P < .001) and remained low at 6 months after surgery (10.6). The mean grip strength showed a significant increase from a preoperative mean of 16 kg to a postoperative mean of 24 kg (P < .001). Pinch strength also significantly increased from a preoperative mean of 9 kg to 13 kg after surgery (P < .001). Lacertus syndrome remains an underdiagnosed disease that can be treated efficiently with a directed minimal surgical incision under wide-awake local anesthesia. Lacertus release appears to significantly reduce pain and numbness with markedly improved hand grip and pinch strength. The corresponding QuickDASH scores also improved significantly after surgery. This study is vital to our understanding of proximal median nerve entrapment and to accurately diagnose it. Therapeutic III.

Review of De Quervain's tendinopathy

The tendons of the long thumb abductor (APL) and short thumb extensor (EPB), which travel through a fibroosseous tunnel in the styloid process of the radius, are afflicted by De Quervain's tendinopathy. This condition causes the tendons and the tunnel (or sheath) through which they pass to thicken non-inflammatorily. Individuals with this illness report radial side wrist discomfort that gets worse when the wrist and thumb are moved. The radial side of the wrist often has some swelling and discomfort. The physical examination findings, such as sensitivity and enlargement of the radial styloid in the first dorsal compartment and radial styloid pain with active or passive stretching of the thumb tendons over the radial styloids at thumb flexion, are used to make the diagnosis of de Quervain's tendinopathy (Finkelstein manoeuvre or test). The differential diagnosis includes calcified arthritis or tenosynovitis, intersection syndrome, ganglia, radial sensory nerve entrapment in the forearm, and osteoarthritis of the trapeziometacarpal joint (TMC). De Quervain's tendinopathy typically responds well to self-limiting therapies that alleviate symptoms. The patient's unique values and preferences have a significant role in the therapeutic decision. Nonsteroidal anti-inflammatory medicines (NSAIDs) for pain management, a forearm-based thumb splint, glucocorticoid injections, and surgery are all possible treatments. A forearm-based thumb splint with a free interphalangeal joint and a simultaneous NSAID pain reduction test are advised for individuals with de Quervain's tendinopathy. Patients with chronic pain and edema despite non-surgical therapy with splints and NSAIDs are advised to have glucocorticoid injections. Those who continue to experience symptoms despite nonsurgical treatment and glucocorticoid injection are typically the only ones who need surgery. De Quervain's tendinopathy is benign and self-limiting, therefore most patients are aware of this.

Pedicled Pronator Quadratus Transposition for Functional Opponensplasty: A Cadaveric Anatomical Study for Feasibility.

Techniques on opponensplasty for chronic carpal tunnel syndrome have been described previously. A novel pronator quadratus (PQ) transposition for chronic carpal tunnel syndrome is described. In addition, the relationship of the distal perforating branch of the radial artery to the surrounding tissue is detailed to optimize further use of the PQ flap for clinical applications. Ten cadaver hands underwent PQ dissection, and the perforating branch of the radial artery was identified. Measurements were taken from the radiocarpal joint and the radial styloid to the distal perforating branch. Finally, a proposed surgical technique of PQ transposition with proximal radius periosteum to the first metacarpophalangeal joint and anterior interosseous nerve transfer was performed. The average distance of the perforating branch from the radiocarpal joint was 10 ± 1.05 mm, and the average distance from the radial styloid was 17.1 ± 1.6 mm. Pronator quadratus transposed with a layer of radius periosteum demonstrated anatomical feasibility. The distal perforating branch of the radial artery predictably perfuses the PQ muscle, which may be used in the future as a means of opponensplasty for chronic carpal tunnel syndrome.

SHOULD ALL ISOLATED RADIAL STYLOID FRACTURES BE ASSESSED ARTHROSCOPICALLY FOR CONCOMITANT SCAPHOLUNATE LIGAMENT INJURY?

Chauffeur fractures or isolated radial styloid fractures (IRSF) are known to be associated with scapholunate ligament (SL) injuries. Diagnosis without arthroscopic confirmation is difficult in acute fractures. Acute management of this injury with early repair may prevent the need for more complex reconstructive procedures for chronic injuries. We investigated if all IRSF should be assessed arthroscopically for concomitant SL injuries.We performed a prospective cohort study on patients above the age of 16, presenting to the Gold Coast University Hospital with an IRSF, over 2 years. Plain radiographs and computerized tomography (CT) scans were performed. All patients had a diagnostic wrist arthroscopy performed in addition to an internal fixation of the IRSF. Patients were followed up for at least 3 months post operatively. SL repair was performed for all Geissler Grade 3/4 injuries.10 consecutive patients were included in the study. There was no radiographic evidence of SL injuries in all patients. SL injuries were identified arthroscopically in 60% of patients and one third of these required surgical stabilisation. There were no post operative complications associated with wrist arthroscopy.We found that SL injuries occurred in 60% of IRSF and 20% of patients require surgical stabilisation. This finding is in line with the literature where SL injuries are reported in up to 40-80% of patients. Radiographic investigations were not reliable in predicting possible SL injuries in IRSF. However, no SL injuries were identified in undisplaced IRSF. In addition to identifying SL injuries, arthroscopy also aids in assisting and confirming the reduction of these intra-articular fractures.In conclusion, we should have a high index of suspicion of SL injury in IRSF. Arthroscopic assisted fixation should be considered in all displaced IRSF. This is a safe additional procedure which may prevent missed SL injuries and their potential sequelae.

How Are Radial Height and Radial Shortening Defined in the Treatment of Distal Radius Fractures? A Critical Review.

Radial height is a radiographic parameter used to guide the treatment of distal radius fractures. However, it is often used synonymously with other terms, and there are substantial discrepancies in its measurement/definition. These discrepancies can alter the measurement of radial height and affect treatment decisions. The purpose of this review is to identify the different definitions of radial height in the literature relevant to distal radius fractures. A literature review was conducted in the PubMed/MEDLINE database from inception to 2022. Full-length, English-language studies that pertained to distal radius fractures and reported radial height as a recorded measurement were included. The method of radial height measurement (definition) was extracted from included studies. Level of evidence was determined by the Oxford Centre for Evidence-based Medicine Levels of Evidence tool. A total of 385 studies were identified. Of these, 183 (47.5%) did not provide a definition for radial height. Of the studies that defined radial height, 50.9% (103/202) measured radial height from the radial styloid to the distal ulna, 10.9% (22/202) measured from the radial styloid to the distal radius, and 29.2% (59/202) were "other" definitions. There is substantial discrepancy in the way that radial height is measured and reported. We advocate for a standardized measurement of radial height (synonymous with radial length) from the radial styloid to the distal ulnar articular surface. Radial shortening is a different measurement and requires comparison with a reference value.

Anatomical Localisation and Morphometric Study of Lister’s Tubercle of Radius: A Cross-sectional Study

Introduction: Fractures of the distal radius are one of the most common injuries and it accounts for 8-15% of all fractures of the upper limb. Lister’s Tubercle (LT) is an important anatomical, surgical landmark during various orthopaedic and other surgical procedures on the distal radius. Aim: To determine the anatomical localisation of LT in relation to radial styloid process and ulnar notch and to measure the morphometric parameters of LT on dry radii. Materials and Methods: The present cross-sectional study was done on 180 radii, 90 right-sided and 90 left-sided obtained from the Department of Anatomy, Medical College Baroda, Vadodara, Gujarat, India, from December 2021 to August 2022. Localisation and length, width and height of the lister tubercle were measured with the help of a vernier calliper. Mean and range of each parameter was calculated. All measurements were made by two observers to avoid bias interpretation. The data were entered in Microsoft Excel window 10. Results: On right-side the LT was nearer to the styloid process in 04 radii (ratio was less than 1) while it was nearer to the ulnar notch in 86 radii (ratio was more than 1). Highest ratio of two distance was 1.768 (LT nearer to ulnar notch) while the lowest distance was 0.8706 (LT nearer to styloid process). On left-side LT was nearer to styloid process in 28 radii (ratio was less than 1) while it was nearer to ulnar notch in 62 radii (ratio was more than 1). Highest ratio of two distance was 1.42 (LT nearer to ulnar notch) while the lowest distance was 0.79 (LT nearer to styloid process). The mean length of LT on right-side was 12.30±1.46 mm, breadth 4.66±0.98 mm, while height was 2.87±0.57 mm and the mean length of LT on the left-side was 13.19±1.511 mm, width 4.89±1.17 mm, while the height was 2.96±0.692 mm. Conclusion: The present study shows that in majority of cases, LT was nearer to the ulnar notch and the distance between LT and radial styloid process was more. The anatomical localisation and morphometric data of LT will be is useful in various surgical procedures like screw fixation in volar plating and micro nail techniques.

De Quervain's Disease among Patients Visiting the Orthopaedic Outpatient Department of Tertiary Care Center: A Descriptive Cross- sectional Study.

de Quervain's disease is one of the common causes of wrist pain. It can cause serious disability and absence from work due to impaired functioning of the wrist and hand. The aim of this study is to find out the prevalence of de Quervain's disease among patients visiting the orthopaedic outpatient department of a tertiary care centre. This was a descriptive cross-sectional study conducted among patients visiting the orthopaedic outpatient department of a tertiary care centre after receiving ethical approval (IRC KAHS Reference: 078/079/56). This study was conducted from 1 January 2021 to 30 December 2021 from hospital medical records. A convenience sampling method was used. Patients with de Quervain's disease from 16 to 60 years were included in this study. Clinically diagnosis of de Quervain's disease was based on the tenderness of the radial styloid process, tenderness over the first extensor compartment on resisted thumb abduction or extension and positive Finkelstein test. Point estimate and 95% Confidence Interval were calculated. Out of 9600 orthopaedic outpatients, de Quervain's disease was seen in 128 (1.33%) (2.68-4.52, 95% Confidence Interval). The prevalence of de Quervain's disease was similar when compared to other studies conducted in similar settings. de Quervain's disease; surgery; tenosynovitis.

Computer-Aided Assessment of Three-Dimensional Standard Bone Morphology of the Distal Radius.

The present study attempted to define the three-dimensional (3D) locations of reference points and standard measures of the distal radius of a normal wrist joint. One hundred wrists from 50 males and 50 females who matched the age distribution (19-95 years old, mean: 56.0 years old) were evaluated. Computed tomography (CT) images of normal wrist joints acquired for comparison with the affected side were used. The absence of a previous history and complaints in the unaffected wrist was confirmed in an interview and with medical records. Three-dimensional images of the distal radius were reconstructed using the data obtained from CT scans. The site at which the major axis of the radial diaphysis contacted the distal radius joint surface was defined as the origin. The 3D coordinates of reference points for the radial styloid process (1), sigmoid notch volar edge (2), and sigmoid notch dorsal edge (3) as well as the barycenter for the joint surface and joint surface area were evaluated. A slope of the line connecting coordinates 1-2 in the coronal plane was evaluated as the 3D radial inclination (3DRI) and that connecting coordinates 2-3 in the sagittal plane as the 3D palmar tilt (3DPT). Each measurement value was compared between males and females. The positions of each reference point from the origin were as follows: (1) 14.2 ± 1.3/12.6 ± 1.1 mm for the distal-palmar-radial position; (2) 19.3 ± 1.3/16.9 ± 1.3 mm for the proximal-palmar-ulnar position; (3) 15.6 ± 1.4/14.1 ± 0.9 mm for the proximal-dorsal-ulnar position; and (barycenter) 4.1 ± 0.7/3.7 ± 0.7 mm for the proximal-volar-ulnar position for males and females, respectively. The areas of the radius articular surface were 429.0 ± 67.9/347.6 ± 44.6 mm2 for males and females, respectively. The 3DRI and 3DPT were 24.2 ± 4.0/25.7 ± 3.1° and 10.9 ± 5.1/13.2 ± 4.4° for males and females, respectively. Significant differences were observed in all measurement values between males and females (p &lt; 0.01). The reference points and measured values obtained in the present study will serve as criteria for identifying the dislocation direction and reduction conditions of distal radius fractures in 3D images.

A cadaveric study of first dorsal extensor compartment in Africans: Clinical implications

While several reports have been made regarding the anatomic variations in the first dorsal extensor compartment, very few have emanated from Africa. This study looked at this compartment with respect to variations in the superficial branch of the radial nerve and the enclosed tendons. The first dorsal extensor compartment of the hand was studied in 32 formalin preserved adult African cadavers. The superficial branch of the radial nerve emerged from underneath the brachioradialis 8.4cm(sd±2.2cm) proximal to the radial styloid and branched 6.2cm (sd ±1.5cm) proximal to it as well. This nerve along with the cephalic vein or its tributary transversed part of the compartment in all the hands. A double Extensor pollicis longus was found in one hand. Septations were observed in 31.3 %(n=10) of the hands. Abductor pollicis longus tendon was fused in three hands, and had more than one slip in 94% of the hands. A single extensor pollicis brevis tendon was found all dissected hands. Clinical implications of these findings are highlighted in this work.

Comparison of the effect of ketorolac versus triamcinolone acetonide injections for the treatment of de Quervain’s tenosynovitis: a double-blind randomized controlled trial

BackgroundDe Quervain’s disease is tenosynovitis of the first dorsal compartment causing severely painful radial-side wrist pain and impaired function. Steroids are effective in treating this condition due to their anti-inflammatory properties. However, this drug causes problems such as hypopigmentation, and is contradicted in diabetes mellitus patients. Non-steroidal anti-inflammatory drug (NSAID) which are efficacious in shoulder pathology and not contraindicated in diabetics and can be used to avoid the local effects of steroids could be beneficial for some patients. The present study was a randomized controlled trial to examine the differences in pain scores and functional response to local injections of a corticosteroid and the NSAID ketorolac.MethodsSixty-four patients with radial styloid tenosynovitis were randomized using a computer-generated random number table into two groups receiving either a ketorolac injection or a triamcinolone injection. We evaluated post-injection pain intensity using a verbal numerical rating scale (VNRS), functional outcomes using the Thai Disabilities of the Arm, Shoulder and Hand (DASH) scale, and evaluated grip and pinch strengths, recorded at baseline and 6 weeks after the injection.ResultsThirty-one participants in the ketorolac group and 29 participants in the triamcinolone group completed the study and were included in the analysis. There were no significant differences in the assessments at baseline. At the 6-week conclusion of the study, patients in the triamcinolone group had a statistically lower average pain score than in the ketorolac group (0.7 ± 2.0 vs 5.3 ± 3.2, P < 0.001), higher DASH functional score (4.4 ± 6.5 vs 34.1 ± 20.2, P < 0.001), higher right grip strength (60.8 ± 16.8 vs 49.2 ± 18.6, P < 0.015), and higher left grip strength (59.8 ± 18.1 vs 50.3 ± 18.0, P < 0.04). However, there was no difference in pinch strength.ConclusionsOur study found that ketorolac injections resulted in inferior pain reduction, functional score and grip improvement than triamcinolone injection in patients with radial styloid tenosynovitis. Future studies are required to examine the effects of ketorolac in larger group and with longer follow-up periods to further elucidate the findings of this study.Trial registrationThe study was registered at Clinicaltrials.in.th (TCTR20200909006).

Multidetector-Row Computed Tomographic Analysis of the Superficial Palmar Branch of Radial Artery Perforator Flaps.

Soft-tissue defects in the hand and digits can be effectively covered by using the free superficial palmar branch of the radial artery (SPBRA) flap, which is harvested from the radial volar wrist. Because previous anatomical studies on this flap are limited, multidetector-row computed tomographic angiography of the upper limbs was conducted to characterize the three-dimensional anatomical structure of the SPBRA and its perforators in living patients. This retrospective anatomical study was conducted from 2014 to 2019. All data from Digital Imaging and Communications in Medicine were analyzed by using their viewer. SPBRA diameter and the location where it bifurcated from the radial artery were recorded, as were the number, location, branching patterns, and diameters of its perforators and their lengths. In total, 30 patients met all eligibility criteria. All had the SPBRA. The vessel bifurcated from the radial artery on average 13.2 mm proximally from the radial styloid process. The 30 patients had 40 SPBRA perforators in total. Their average SPBRA-to-dermis length was 6.43 mm. All patients had at least one direct cutaneous perforator. Nine and one also had one musculocutaneous perforator and another direct perforator, respectively. All direct cutaneous perforators were located inside a 16.4-mm-diameter circle with an origin on the scaphoid tubercle. The mean diameters of the SPBRA and its perforators were 1.12 and 0.62 mm, respectively. All patients had at least one reliable SPBRA perforator in the radial volar wrist. The authors' results suggest that plastic surgeons can easily and safely plan the SPBRA flap design, potentially without preoperative perforator mapping.