Range Of Wrist Extension Research Articles

Functional outcome of mirror therapy versus task oriented training on hand function in children with unilateral cerebral palsy

Background. Unilateral cerebral palsy (UCP) is a kind of spastic cerebral palsy which is characterized by atypical posture of upper limb, poor eye-hand coordination, and reduced hand skills. These symptoms can restrict a child’s ability to engage in life activities. Purpose. To compare the effectiveness of mirror therapy as well as task-oriented training on hand functions improvement among UCP children. Methods. Sixty children suffering from UCP were randomly allocated into three equal groups. A schemed physical therapy protocol was utilized to the control, mirror therapy (MT), and task-oriented training (TOT) groups. The protocols of mirror therapy and task-oriented training were administered to MT and TOT groups respectively. Assessments of upper extremity skills, hand dexterity, wrist extension range of motion, along with overall grip strength were conducted at baseline and after intervention using the Quality of Upper Extremity Skills Test (QUEST), Box and Block Test (BBT), universal goniometer, as well as pneumatic squeeze handheld dynamometer respectively. Throughout a total of twelve consecutive weeks, the intervention session was held three days a week. Results. The change amount in all measured hand outcomes were significantly improved following the intervention in all three groups, with the TOT group showing a larger significant effect. Conclusion. Task-oriented training had superior impact than mirror therapy in enhancing hand functions among children having UCP.

Non-surgical vs. surgical treatment of distal radius fractures: a meta-analysis of randomized controlled trials

PurposeTo compare the clinical outcomes between nonsurgical and surgical treatment of distal radius fracture.MethodsWe performed a systematic literature search by using multiple databases, including Medline, PubMed, and Cochrane. All databases were searched from the earliest records through February 2023. The study compared nonsurgical versus surgical treatment of distal radius fractures and included only randomized controlled trials (RCTS).ResultsThere were seventeen randomized controlled trials retrieved. A total of 1730 patients were included: 862 in the nonsurgical group and 868 in the surgical group. The results showed a significant reduction in DASH score with surgical treatment (WMD 3.98, 95% CI (2.00, 5.95), P < 0.001). And in grip strength (%), the results showed a significant improvement in surgical treatment compared with non-surgical treatment (WMD − 6.60, 95% CI (-11.61, -1.60), P = 0.01). There was significant difference in radial inclination, radial length, volar title, range of wrist pronation, range of wrist supination. However, no difference in radial deviation, ulnar deviation, ulnar variance, range of wrist extension and range of wrist flexion was observed.ConclusionsThe results of this meta-analysis suggest that some patients with surgical treatment of distal radius fractures not only improved the grip strength (%), decreased the DASH score, but also improved the range of wrist pronation and the range of wrist supination compared with nonsurgical treatment. Based on the present meta-analysis, we suggest that some patients with surgical treatment might be more effective in patients with distal radius fracture.

Effect of Dual-task Training on the Upper Limb Functon, Muscle Tone, and Actvites of Daily Living in Women With Chronic Stroke

Background and Aims Stroke is the fifth leading cause of death in the world; which can cause disability. One of the main goals of rehabilitation in these patients is to improve their upper limb function. Dual-task training (DTT) is one of the rehabilitation methods in stroke patients, which include performing motor tasks along with mental exercises. This study aims to investigate the effect of DTT on upper limb function, elbow flexor muscle tone, wrist extension range of motion (ROM), and the ability to perform activities of daily living (ADL) in women with chronic stroke. Methods In this pilot study, 16 female patients suffering from chronic stroke for more than 6 months were selected and divided into two groups of 8 including training and control. In both groups, the routine treatment included electrical stimulation of quadriceps and dorsiflexors of the affected hand, 10 minutes of bicycling, and performing three movement tasks for the upper limb (sorting colored blocks, opening and closing the bottle cap with the affected hand, and moving the beans with a spoon towards a determined point). In the training group, DTT included performing these three movement tasks simultaneously with performing mental task (counting down from 100). The training was performed for 4 weeks at 12 sessions, three sessions per week. The upper limb function was measured by the box &amp; block test; elbow flexor muscle tone by the modified Ashworth scale; active ROM of wrist extension by a goniometer; and ADL by the Barthel index before and after the treatments. Results No significant difference was found in any variables between the two groups (P&gt;0.05). In both in groups, there was a significant improvement in the three variables of elbow flexor muscle tone, upper limb function, and the ability to perform ADL after interventions compared to baseline (P&lt;0.05). However, no significant difference was found in the active ROM of wrist extension in any groups (P&gt;0.05). Conclusion Training with and without DTT can lead to significant improvement in elbow flexor muscle tone, upper limb function, and the ability to perform ADL in women with chronic stroke. The DTT has no superior effect on these variables.

Partial Scapholunate Interosseous Ligament Injuries: A Systematic Review of Treatment Options.

Purpose This systematic review summarizes the existing evidence on treatment options and outcomes for partial scapholunate interosseous ligament (pSLIL) injuries. Methods A systematic electronic search of Medline, Embase, and CINAHL was performed from inception through to February 13, 2022. All primary research articles addressing the treatment of pSLIL tears were eligible for inclusion regardless of timing of surgery, surgical technique, or rehabilitation. The PRISMA Checklist guided the reporting and data abstraction. Descriptive statistics and forest plots are presented. Results A total of 14 studies with 342 patients were included for analysis. Treatments were categorized into four groups: electrothermal shrinkage (ES), arthroscopic capsuloplasty (AC), open capsulodesis (OC), and no treatment (NT). There were five studies in the ES group ( N = 69, mean age = 34.3 ± 3.3 years), three studies in the AC group ( N = 138, mean age = 32.2 ± 3.8 years), five studies in the OC group ( N = 123, mean age of 30.7 ± 7.8 years), and one study in the NT group ( N = 12, mean age = 43 years, range = 28-67 years). The average postintervention visual analog scale pain score for the ES group was 1.4 ± 0.5 (from 5.7 ± 1.8), for the AC group was 3.2 ± 1.3 (from 6.6 ± 0), for the OC group was 2.3 ± 2.1 (from 5.6 ± 1.6), and for the NT group was 3.2 (from 7.6). The wrist extension range of motion improved postoperatively for all intervention groups (ES = 66.3°-70.7°; AC = 67°-74.5°; and OC = 48.9°-63.5°), whereas it remained unchanged for the NT group (46°-45°). Grip strength also improved in all intervention groups (ES = 17.9-29.9 kg; AC = 24.0-32.2 kg; and OC = 15.8-26.6 kg), while the NT group remained unchanged (25-24 kg). The radiographic scapholunate gap improved postoperatively in all groups that reported pre- and postintervention (ES = 2.2-1.9 mm; OC = 2.5-1.8 mm) and slightly worsened in the NT group (2.5-2.7 mm). In the ES group, there were three complications (11.5%, no major complications), in the AC group there was one major complication (0.9%, complex regional pain syndrome [CRPS]), and in the OC group there were six complications (15.4%, four major complications-CRPS). Conclusion All interventional treatment options (ES, AC, and OC) provided significant improvements in patient-reported pain, range of motion, grip strength, and radiographic parameters, with low complication rates. In comparison, no improvement in range of motion or grip strength was noted in the NT group. Therefore, surgical management of pSLIL injuries is an effective and relatively safe treatment option. Further studies comparing the outcomes of specific surgical treatments are warranted to further elucidate the optimal management option for pSLIL tears. Level of Evidence Level III, systematic review of Level III-IV studies.

Laboratory-Based Examination of the Reliability and Validity of Kinematic Measures of Wrist and Finger Function Collected by a Telerehabilitation System in Persons with Chronic Stroke.

We have developed the New Jersey Institute of Technology-Home Virtual Rehabilitation System (NJIT-HoVRS) to facilitate intensive, hand-focused rehabilitation in the home. We developed testing simulations with the goal of providing richer information for clinicians performing remote assessments. This paper presents the results of reliability testing examining differences between in-person and remote testing as well as discriminatory and convergent validity testing of a battery of six kinematic measures collected with NJIT-HoVRS. Two different groups of persons with upper extremity impairments due to chronic stroke participated in two separate experiments. Data Collection: All data collection sessions included six kinematic tests collected with the Leap Motion Controller. Measurements collected include hand opening range, wrist extension range, pronation-supination range, hand opening accuracy, wrist extension accuracy, and pronation-supination accuracy. The system usability was evaluated by therapists performing the reliability study using the System Usability Scale. When comparing the in-laboratory collection and the first remote collection, the intra-class correlation coefficients (ICC) for three of the six measurements were above 0.900 and the other three were between 0.500 and 0.900. Two of the first remote collection/second remote collection ICCs were above 0.900, and the other four were between 0.600 and 0.900. The 95% confidence intervals for these ICC were broad, suggesting that these preliminary analyses need to be confirmed by studies with larger samples. The therapist's SUS scores ranged from 70 to 90. The mean was 83.1 (SD = 6.4), which is consistent with industry adoption. There were statistically significant differences in the kinematic scores when comparing unimpaired and impaired UE for all six measures. Five of six impaired hand kinematic scores and five of six impaired/unimpaired hand difference scores demonstrated correlations between 0.400 and 0.700 with UEFMA scores. Reliability for all measures was acceptable for clinical practice. Discriminant and convergent validity testing suggest that scores on these tests may be meaningful and valid. Further testing in a remote setting is necessary to validate this process.

Investigation into the Effects of SORxSOAP in the Job-Related Performance of Deli Meat Slicers over a One-Month Period

Instrument-assisted soft tissue mobilization is well researched and widely accepted to improve circulation, decrease pain, improve function, increase strength, and promote overall soft tissue health. However, the administration of this intervention, in most cases, is limited to the brief amounts of time we spend mobilizing our soft tissue. SORxSOAP offers a pragmatic strategy by which one may mobilize their soft tissue while simultaneously showering or washing a specific part of their body. The purpose of this study is to demonstrate the effects SORxSOAP has on functional measures of upper extremity activity in the slicing hands of employees at a corporate deli franchise over the course of a one-month period. 31 employees of a corporate deli franchise were asked to participate in a study involving the use of SORxSOAP. The subjects were assigned to experimental and control groups rough random sampling. Twenty-one subjects in the experimental group were given a one month’s supply of SORxSOAP to use on a regular basis while showering. Ten subjects in the control group were not exposed to any independent variable. The subjects from both groups completed a questionnaire that asked the subjects to rate the level of ease at which specific job-related activities were for them to perform. Hand-strength/grip and range of motion measurements were also taken utilizing a handheld dynamometer and goniometer respectively by one evaluator both before and after a one-month duration of the experimental group’s exposure to SORxSOAP. Independent t-tests were performed to test the difference between pre and post-test values for the control and experimental groups. It was found that SORxSOAP significantly improves wrist flexion range of motion, results in significantly greater improvements in hand-grip strength compared to control, and significantly improves wrist extension range of motion over a one-month period. Improvements in the ease of job-related activities also appear to be correlated to the use of SORxSOAP for items #1, 2, 3, 4, 5, 6, 7, and 9. Significant differences were also found between the slicing and non-slicing hands for pre-test wrist extension range of motion measurements, indicating the presence of possible over-use injury in occupations and activities placing excessive demand on certain body regions. This provides isolated evidence that supports the notion that SORxSOAP could be a viable option for preventing the steady decline of wrist extension range of motion and actually promoting and maintaining soft tissue and overall joint health, making it clear how further investigation into the effects of SORxSOAP can not only improve joint and soft tissue health, but prevent the emergence of joint and soft tissue impairment entirely. Clinical Bottom Line: The use of SORxSOAP has the potential to significantly improve muscle and soft tissue performance and function over a period of one month.

Combined real-time fMRI and real time fNIRS brain computer interface (BCI): Training of volitional wrist extension after stroke, a case series pilot study.

ObjectivePilot testing of real time functional magnetic resonance imaging (rt-fMRI) and real time functional near infrared spectroscopy (rt-fNIRS) as brain computer interface (BCI) neural feedback systems combined with motor learning for motor recovery in chronic severely impaired stroke survivors.ApproachWe enrolled a four-case series and administered three sequential rt-fMRI and ten rt-fNIRS neural feedback sessions interleaved with motor learning sessions. Measures were: Arm Motor Assessment Tool, functional domain (AMAT-F; 13 complex functional tasks), Fugl-Meyer arm coordination scale (FM); active wrist extension range of motion (ROM); volume of activation (fMRI); and fNIRS HbO concentration. Performance during neural feedback was assessed, in part, using percent successful brain modulations during rt-fNIRS.Main resultsPre-/post-treatment mean clinically significant improvement in AMAT-F (.49 ± 0.22) and FM (10.0 ± 3.3); active wrist ROM improvement ranged from 20° to 50°. Baseline to follow-up change in brain signal was as follows: fMRI volume of activation was reduced in almost all ROIs for three subjects, and for one subject there was an increase or no change; fNIRS HbO was within normal range, except for one subject who increased beyond normal at post-treatment. During rt-fNIRS neural feedback training, there was successful brain signal modulation (42%–78%).SignificanceSeverely impaired stroke survivors successfully engaged in spatially focused BCI systems, rt-fMRI and rt-fNIRS, to clinically significantly improve motor function. At the least, equivalency in motor recovery was demonstrated with prior long-duration motor learning studies (without neural feedback), indicating that no loss of motor improvement resulted from substituting neural feedback sessions for motor learning sessions. Given that the current neural feedback protocol did not prevent the motor improvements observed in other long duration studies, even in the presence of fewer sessions of motor learning in the current work, the results support further study of neural feedback and its potential for recovery of motor function in stroke survivors. In future work, expanding the sophistication of either or both rt-fMRI and rt-fNIRS could hold the potential for further reducing the number of hours of training needed and/or the degree of recovery.ClinicalTrials.gov ID: NCT02856035.

Combined vascularized bone graft and scaphocapitate fusion in the treatment of stage III(b) Kienböck’s disease: a cohort study involving 11 patients

Background: The purpose of this study was to evaluate the results of combined scaphocapitate fusion and revascularization of the lunate for patients with stage III(b) Kienböck’s disease. Methods: Eleven patients with stage III(b) (Lichtman classification) Kienböck’s disease were identified. The inclusion criteria were stage III(b) Kienböck’s disease according to the Lichtman classification, with no previous surgical interventions, no radiocarpal arthritis, and intact lunate articular surfaces proven by plain radiographs, MRI, and intraoperative wrist arthroscopy. All patients were scheduled for scaphocapitate fusion and lunate revascularization. Intraoperative wrist arthroscopy was mandatory for the plan of treatment. Results: In all patients there was radiographic evidence of union and bone consolidation at the carpal fusion site at a mean of 8 wk. MRI was obtained 1 yr after the procedure and showed revascularization of the lunate in all patients. Postoperative serial radiographs showed improvement and maintenance of the lunate height and diameter. Postoperatively, wrist extension range of motion showed a mean improvement of 11.3%, while wrist flexion range of motion showed a mean improvement of 24.32%. Mean improvement in grip strength was 106.33%. VIsual analog scale (VAS) for pain showed a mean improvement of 71.02%. Disability of the Arm, Shoulder, and Hand (DASH) score showed a mean improvement by 77.67%. Conclusions: Revascularization and restoration of lunate anatomy together with an unloading procedure gives better results in the treatment of stage III(b) Kienböck’s disease. This technique prevents further collapse of the lunate with satisfactory long term results. Intraoperative wrist arthroscopy is mandatory to prove the intact lunate articular surface. Level of Evidence: Level IV.

Functional outcome of joint mobilization added to task-oriented training on hand function in chronic stroke patients

BackgroundApproximately half of stroke patients show impaired upper limb and hand function. Task-oriented training focuses on functional tasks, while joint mobilization technique aims to restore the accessory movements of the joints.ObjectiveTo investigate the effect of adding joint mobilization to task-oriented training to help the patients in reaching a satisfactory level of recovery for their hand function.Patients and methodsThirty chronic stroke patients with paretic hand participated in the study; they were divided equally into study and control groups. The study group received joint mobilization followed by task-oriented training for the affected hand. Meanwhile, the control group received task-oriented training only. Both groups received their treatment in the form of 3 sessions per week for 6 successive weeks. The primary outcome measures were hand function that was assessed by Jebsen-Taylor hand function test (JTT) and active and passive wrist extension range of motion (ROM) that was measured by a standard goniometer. The secondary outcome measure was the grip strength of the hand that was assessed by a JAMAR adjustable hand dynamometer.ResultsThere was a significant improvement in all the outcome measurements in both groups that were more evident in the study group.ConclusionCombining joint mobilization with task-oriented training had a highly significant effect in improving the hand function in chronic stroke patients compared to task-oriented training alone.

Treatment of Upper Limb Paresis With Repetitive Peripheral Nerve Sensory Stimulation and Motor Training: Study Protocol for a Randomized Controlled Trial.

Background: Repetitive peripheral nerve sensory stimulation (RPSS) has emerged as a potential adjuvant strategy to motor training in stroke rehabilitation. The aim of this study is to test the hypothesis that 3 h sessions of active RPSS associated with functional electrical stimulation (FES) and task-specific training (TST) distributed three times a week, over 6 weeks, is more beneficial to improve upper limb motor function than sham RPSS in addition to FES and TST, in subjects with moderate to severe hand motor impairments in the chronic phase (>6 months) after stroke.Methods: In this single-center, randomized, placebo controlled, parallel-group, double-blind study we compare the effects of 18 sessions of active and sham RPSS as add-on interventions to FES and task-specific training of the paretic upper limb, in 40 subjects in the chronic phase after ischemic or hemorrhagic stroke, with Fugl-Meyer upper limb scores ranging from 7 to 50 and able to voluntarily activate any active range of wrist extension. The primary outcome measure is the Wolf Motor Function Test (WMFT) after 6 weeks of treatment. The secondary outcomes are the WMFT at 3, 10, and 18 weeks after beginning of treatment, as well as the following outcomes measured at 3, 6, 10, and 18 weeks: Motor Activity Log; active range of motion of wrist extension and flexion; grasp and pinch strength in the paretic and non-paretic sides (the order of testing is randomized within and across subjects); Modified Ashworth Scale; Fugl-Meyer Assessment-Upper Limb in the paretic arm; Barthel Index; Stroke Impact Scale.Discussion: This project represents a major step in developing a rehabilitation strategy with potential to have impact on the treatment of stroke patients with poor motor recovery in developing countries worldwide. The study preliminarily evaluates a straightforward, non-invasive, inexpensive intervention. If feasibility and preliminary efficacy are demonstrated, further investigations of the proposed intervention (underlying mechanisms/ effects in larger numbers of patients) should be performed.Trial Registration: NCT02658578.

Effects of a 3D-printed orthosis compared to a low-temperature thermoplastic plate orthosis on wrist flexor spasticity in chronic hemiparetic stroke patients: a randomized controlled trial

Objective: The aim of this study was to compare the effects of two kinds of wrist-hand orthosis on wrist flexor spasticity in chronic stroke patients. Design: This is a randomized controlled trial. Setting: The study was conducted in a rehabilitation center. Participants: A total of 40 chronic hemiparetic stroke patients with wrist flexor spasticity were involved in the study. Interventions: Patients were randomly assigned to either an experimental group (conventional rehabilitation therapy + 3D-printed orthosis, 20 patients) or a control group (conventional rehabilitation therapy + low-temperature thermoplastic plate orthosis, 20 patients). The time of wearing orthosis was about 4–8 hours per day for six weeks. Main measures: Primary outcome measure: Modified Ashworth Scale was assessed three times (at baseline, three weeks, and six weeks). Secondary outcome measures: passive range of motion, Fugl-Meyer Assessment score, visual analogue scale score, and the swelling score were assessed twice (at baseline and six weeks). The subjective feeling score was assessed at six weeks. Results: No significant difference was found between the two groups in the change of Modified Ashworth Scale scores at three weeks (15% versus 25%, P = 0.496). At six weeks, the Modified Ashworth Scale scores (65% versus 30%, P = 0.02), passive range of wrist extension (P < 0.001), ulnar deviation (P = 0.028), Fugl-Meyer Assessment scores (P < 0.001), and swelling scores (P < 0.001) showed significant changes between the experimental group and the control group. No significant difference was found between the two groups in the change of visual analogue scale scores (P = 0.637) and the subjective feeling scores (P = 0.243). Conclusion: 3D-printed orthosis showed greater changes than low-temperature thermoplastic plate orthosis in reducing spasticity and swelling, improving motor function of the wrist and passive range of wrist extension for stroke patients.

Combination Effects of Self-Volar Gliding Using a Strap and Wrist Distraction on Pain and Wrist Extension Range of Motion in Subjects with Dorsal Wrist Pain

Combination Effects of Self-Volar Gliding Using a Strap and Wrist Distraction on Pain and Wrist Extension Range of Motion in Subjects with Dorsal Wrist Pain

Additional early active repetitive motor training did not prevent contracture in adults receiving task-specific upper limb training after stroke: a randomised trial.

In adults undergoing rehabilitation after stroke, does 1 hour of additional active repetitive reaching per day prevent or reduce upper limb contracture? Multi-centre, randomised controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Fifty adults undergoing rehabilitation after stroke who were unable to actively extend the affected wrist past neutral or were unable to flex the affected shoulder to 90 deg. Three inpatient rehabilitation units in Australia. Both groups received usual upper limb therapy 5 days a week for 5 weeks. In addition, the experimental group received up to 1 hour a day of active, intensive, repetitive upper limb training using the SMART Arm device 5 days a week for 5 weeks. Measures were collected at baseline (Week 0), after intervention (Week 5) and at follow-up (Week 7). The primary outcomes were passive range of wrist extension, elbow extension, and shoulder flexion at Week 5. The secondary outcomes were: the three primary outcomes measured at Week 7; passive range of shoulder external rotation; arm function; and pain at rest, on movement and during sleep measured at Weeks 5 and7. Following an average of 2310 reaching repetitions, the mean effect at Week 5 on passive range of wrist extension was 1 deg (95% CI -6 to 8), elbow extension -6 deg (95% CI -12 to -1), and shoulder flexion 5 deg (95% CI -8 to 17). There were no statistically significant or clinically important effects of the intervention on any secondary outcomes. In adults who are already receiving task-specific motor training for upper limb rehabilitation following stroke, 5 weeks of up to 1 hour of additional daily active repetitive motor training using the SMART Arm device did not prevent or reduce contracture in upper limb muscles. ACTRN12614001162606.

Survival Rate on a 10-Year Follow-Up of Total Wrist Replacement Implants: A 23-Patient Case Series.

Background According to current literature, the estimated average survival rate for Remotion, the total wrist implants, is above 90% on an 8-year follow-up. We examined our series of Remotion to calculate its survival rate on a 10-year follow-up. Case Description A total of 23 cases of total wrist implants were reviewed. The case series included 22 patients, 18 females and 4 males, of an average age of 55 years. The case series included 19 inflammatory rheumatic diseases, 3 Kienböck disease, and 1 posttraumatic arthrosis. Conclusion The average survival rate of our case series was 95.7% on a 4-year follow-up, 91.3% on a 6-year follow-up, and 69% on a 10-year follow-up. On our review, the QuickDASH score, pain, wrist extension range of motion, and grip strength were improved postoperatively. No difference was shown between preoperative and postoperative values for wrist flexion, pronation, and supination. The case series included a septic case, treated by arthrodesis, and three total wrist implants displacements, two of which were treated by carpal implant, and the remaining one was treated by arthrodesis. Clinical Relevance The survival rate of the total wrist replacement implant Remotion was estimated to be 69%.

An objective functional evaluation of the flexor carpi ulnaris set of triple tendon transfer in radial nerve palsy.

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Comparison of muscle activity of wrist extensors and kinematics of wrist joint during wrist extension in automobile assembly line workers with and without lateral epicondylitis.

Overuse of the extensor carpi radialis (ECR) may play a role in the development of lateral epicondylitis (LE). However, no studies have investigated the muscle activity ratio between the ECR and extensor carpi ulnaris (ECU) associated with the kinematics during wrist extension in workers with LE. We compared the ratio (ECR/ECU) of muscle activity between the ECR and ECU and the kinematics of the wrist during wrist extension between workers with and without LE. Fifteen automobile assembly line workers with LE and 15 workers without LE participated in this study. The ratio of muscle activity was measured using surface electromyography, and wrist kinematics were measured by a three-dimensional motion analysis system while the workers extended their wrists actively to the maximum range to which they did not feel uncomfortable. Significantly greater ratios of muscle activity, ranges of radial deviation, and combined motion of radial deviation and extension (CMDE) were shown in workers with LE compared to those without LE. Also, the range of wrist extension was significantly lower in workers with LE than in those without LE. Quantifying the ratio of muscle activity with altered kinematics of wrist extension may help researchers to understand why overuse of ECR is occurring and explain LE development in automobile assembly line workers.

Percutaneous Fixation for Scaphoid Nonunion with Bone Grafting Through the Distal Insertion Hole of a Fully Threaded Headless Screw.

Percutaneous scaphoid screw fixation is a popular treatment for acute scaphoid fractures with no or minimal displacement. For treating scaphoid nonunions, however, open reduction and internal fixation with bone grafting is still the most popular treatment. Percutaneous fixation with bone grafting through the screw insertion hole has received little attention, although it minimizes damage to the surrounding tissues. We report excellent results of six scaphoid nonunions treated by retrograde percutaneous fixation with curettage and bone grafting through the distal insertion hole of a fully threaded headless screw. Six scaphoid nonunions with substantial bone loss were treated, including one revision case. All nonunions were located at the middle third of the scaphoid. The mean patient age at operation was 26 years, and the mean interval between fracture and surgery was 7 months. In the revision case, the interval between the primary and revision surgery was 6 months. In one case, curettage alone was performed before retrograde insertion of the headless screw. In the other cases including the revision, curettage and bone grafting with a bone biopsy needle was required through a distal insertion hole. The mean follow-up was 11.3 months. Radiologically, union was achieved at averaged 12 weeks postoperatively. At the final follow-up, there was significant improvement in the wrist extension range of movement (from 65.8° to 80.8°) and grip strength (from 69.5% to 93.0% of the unaffected side). Five patients were free of pain, and one experienced mild pain only during heavy manual labor. The mean VAS, DASH, and Cooney wrist scores were 0.3, 1 and 99, respectively. All patients returned to their work or athletic activities. Retrograde percutaneous fixation with bone grafting through the distal insertion hole of a fully threaded headless screw is a promising option for surgical treatment of scaphoid nonunions.

Percutaneous Fixation for Scaphoid Nonunion With Bone Grafting Through the Distal Insertion Hole of a Fully Threaded Headless Screw

Objective: Percutaneous scaphoid screw fixation is a popular treatment for acute scaphoid fractures with no or minimal displacement. For treating scaphoid nonunions, however, open reduction and internal fixation with bone grafting is still the most popular treatment. Percutaneous fixation with bone grafting through the screw insertion hole has received little attention, although it minimizes damage to the surrounding tissues. We report excellent results of 10 scaphoid nonunions treated by retrograde percutaneous fixation with curettage and bone grafting through the distal insertion hole of a fully threaded headless screw. Materials and Methods: Ten scaphoid nonunions with substantial bone loss were treated, including 1 revision case. All nonunions were located at the middle third of the scaphoid. The mean patient age at operation was 24.7 years, and the mean interval between fracture and surgery was 8.8 months. In the revision case, the interval between the primary and revision surgery was 6 months. Surgery was performed under general anesthesia or an axillary brachial plexus block with local anesthesia at the iliac crest donor site. A 1.1-mm guidewire was percutaneously inserted into the scaphoid tuberosity and advanced to the proximal pole of the scaphoid with the wrist in an extended and ulnar-deviated position. A 1.2-mm second derotation wire was also inserted radial or ulnar to the original guidewire. A 2.0-mm cannulated drill was passed over the guidewire, stopping at the distal end of the cystic lesion. The guidewire was then removed. The 1.2-mm second derotation wire maintained the reduction of the scaphoid. Curettage inside the cystic lesion was performed using a small curette inserted through the distal insertion hole. Bone graft was harvested percutaneously from the iliac crest with an 11-gauge bone biopsy needle and inserted into the cystic lesion through the drill hole of the distal scaphoid fragment. The removed guidewire was reinserted into the previously drilled hole followed by insertion of a selected fully threaded headless screw (Acutrak 2 mini; Acumed, Hillsboro, OR, USA). After the operation, the wrist was immobilized in a thumb spica cast for the initial 6 weeks, followed by splinting until bone union was confirmed. In one case, curettage alone was performed before retrograde insertion of the headless screw. In the other cases including the revision, curettage and bone grafting with a bone biopsy needle was required through a distal insertion hole. Results: The mean follow-up was 12.1 months. Radiologically, union was achieved at averaged 12 weeks postoperatively. At the final follow-up, there was significant improvement in the wrist extension range of movement (from 65.8° to 80.8°) and grip strength (from 65.5% to 87.8% of the unaffected side). Nine patients were free of pain, and 1 experienced mild pain only during heavy manual labor. The mean visual analogue scale (VAS), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Cooney wrist scores were 0.1, 1.75, and 98.5, respectively. All patients returned to their work or athletic activities. Conclusions: Retrograde percutaneous fixation with bone grafting through the distal insertion hole of a fully threaded headless screw is a promising option for surgical treatment of scaphoid nonunions.

Minimising impairment: Protocol for a multicentre randomised controlled trial of upper limb orthoses for children with cerebral palsy.

BackgroundUpper limb orthoses are frequently prescribed for children with cerebral palsy (CP) who have muscle overactivity predominantly due to spasticity, with little evidence of long-term effectiveness. Clinical consensus is that orthoses help to preserve range of movement: nevertheless, they can be complex to construct, expensive, uncomfortable and require commitment from parents and children to wear. This protocol paper describes a randomised controlled trial to evaluate whether long-term use of rigid wrist/hand orthoses (WHO) in children with CP, combined with usual multidisciplinary care, can prevent or reduce musculoskeletal impairments, including muscle stiffness/tone and loss of movement range, compared to usual multidisciplinary care alone.Methods/designThis pragmatic, multicentre, assessor-blinded randomised controlled trial with economic analysis will recruit 194 children with CP, aged 5–15 years, who present with flexor muscle stiffness of the wrist and/or fingers/thumb (Modified Ashworth Scale score ≥1). Children, recruited from treatment centres in Victoria, New South Wales and Western Australia, will be randomised to groups (1:1 allocation) using concealed procedures. All children will receive care typically provided by their treating organisation. The treatment group will receive a custom-made serially adjustable rigid WHO, prescribed for 6 h nightly (or daily) to wear for 3 years. An application developed for mobile devices will monitor WHO wearing time and adverse events. The control group will not receive a WHO, and will cease wearing one if previously prescribed. Outcomes will be measured 6 monthly over a period of 3 years. The primary outcome is passive range of wrist extension, measured with fingers extended using a goniometer at 3 years. Secondary outcomes include muscle stiffness, spasticity, pain, grip strength and hand deformity. Activity, participation, quality of life, cost and cost-effectiveness will also be assessed.DiscussionThis study will provide evidence to inform clinicians, services, funding agencies and parents/carers of children with CP whether the provision of a rigid WHO to reduce upper limb impairment, in combination with usual multidisciplinary care, is worth the effort and costs.Trial registrationANZ Clinical Trials Registry: U1111-1164-0572.

Four corner fusion for the management of scaphoid nonunion advanced collapse - A new technique

Background There are several techniques to achieve four corner fusion to provide pain relief in cases of scaphoid nonunion advanced collapse (SNAC) wrist while preserving a function, but can be complicated with malunion, nonunion, hardware impingement or incomplete correction of the lunate extension. We evaluate a new time preserving and simple technique to achieve four corner fusion for the management of nonunion scaphoid with painful arthritis of the wrist. Patients and methods A prospective study was conducted on 16 patients with SNAC of the wrist. Their mean age was 31 years, and the average duration of symptoms was 21 months (range 5-60 months). Through a dorsal approach using a tubular osteotome, the junction between the capitate, lunate, hamate and triquetrium was excised down to the volar capsule and replaced with a core of cancellous iliac bone graft extracted using the same tool. Results The preoperative mean range of wrist flexion was 53° (30°-80°), the mean range of wrist extension was 56° (30°-80°), the mean visual analogue score was 3.2 and the Mayo score was poor in five, fair in three and good in six patients. The postoperative mean range of wrist flexion was 44° (10°-60°), the mean range of wrist extension was 49° (20°-70°), the visual analogue score was 0.7 and the Mayo score was excellent in eight patients, good in seven and poor in one patient. Only one patient proceeded to nonunion. Conclusion This new simple technique can be performed to achieve four corner fusion in the management of SNAC.