Volar Approach Research Articles

Percutaneous Removal of a Foreign Body From the Distal Phalanx Using a 14 Gauge Needle and Fluoroscopy

Percutaneous Removal of a Foreign Body From the Distal Phalanx Using a 14 Gauge Needle and Fluoroscopy

A Low Virulence Infective Tenosynovitis Triggered by a Neisseria Species.

A persistent infective tenosynovitis, caused by a non-pathogenic Neisseria species and involving the little finger and the thumb of a middle-aged woman, forming a horseshoe-type infection is presented. An extensive volar approach was utilised for excision of the granulomatous synovium and drainage of turbid fluid. Neisseria spp was isolated by tissue microbiology and targeted antibiotic therapy for 6 weeks was required to eradicate infection. The presence of low virulence microorganisms which might act as true pathogens should always be considered as a causative factor leading to persistent infections that require open surgical debridement and washout. Level of Evidence: Level V (Therapeutic).

Flexor Carpi Radialis Tendon Insertion Onto the Trapezial Ridge: An Anatomic Description

The flexor carpi radialis (FCR) tendon is often involved in surgical procedures of the hand and wrist. The FCR tendon may be mobilized from the trapezium during distal radius fracture fixation, for tendon transfer, and during carpometacarpal joint procedures. There is a paucity of literature describing the anatomy of the FCR insertion onto the trapezial ridge. We analyzed the insertional characteristics of the FCR onto the trapezium. Forty-two fresh-frozen cadaveric wrists were dissected using the extended FCR approach through the FCR tendon sheath. The length of the fibrous portion of the FCR insertion onto the trapezial ridge was measured from proximal to distal using a digital caliper. FCR insertion onto the trapezium was present in all specimens. The mean length of the FCR insertion was 11.8 ± 4.14 mm. The character of the tissue quality varied across specimens. These results demonstrate the commonality of the FCR fibers that insert onto the trapezium. The length and tissue quality of this insertion varied across specimens. Understanding the complex anatomy of the hand and wrist facilitates surgical planning and intraoperative techniques. The FCR tendon insertion onto the trapezium is an important component of exposure for the volar approach to the distal radius and surgical management of thumb carpometacarpal joint arthritis.

Zone 1 and 2 flexor tendon repair via a longitudinal incision crossing the volar distal interphalangeal joint: functional and cosmetic outcomes.

The primary aim of this study was to present patient-reported functional outcomes after zone 1 and 2 flexor tendon repair using a novel longitudinal volar approach crossing the distal interphalangeal joint (DIPJ) perpendicularly. The secondary aims were to investigate the cosmetic outcomes, satisfaction and complication rates associated with this technique. Over a 6-year period, 75 patients underwent flexor tendon repair using this technique. The quick version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), five-level EQ-5D (EQ-5D-5L), Patient and Observer Scar Assessment Scale (POSAS) and satisfaction questionnaires were collected. QuickDASH scores were available for 59 patients (79%), and POSAS scores were available for 45 patients (60%) at a mean follow-up of 48 months. Concomitant nerve repairs were undertaken in 24 cases. The median QuickDASH score was 4.5 (interquartile range [IQR] 1.1-12.5) and median POSAS score was 12 (IQR 8-16). No significant difference was observed in median QuickDASH score between patients with and without a concomitant nerve repair (4.5 vs 6.8; p = 0.36). Fifty-six patients (94%) were satisfied. Two patients required open tenolysis, and a single case of early re-rupture occurred that required revision open repair. Utilising validated patient-reported functional outcomes, this study demonstrated that a direct longitudinal incision over the DIPJ for zone 1 and 2 flexor tendon repairs can result in excellent functional and cosmetic outcomes, with high rates of patient satisfaction and low rates of complications. This challenges previously held dogma that longitudinal incisions crossing flexion creases should be avoided.

InternalBrace for Intercarpal Ligament Reconstruction.

Intercarpal ligament injuries such as scapholunate and lunotriquetral tears are common causes of wrist pain. There is no shortage of surgical techniques to address these injuries, nor is there a lack of literature exploring this topic. However, research progress has not led to a consensus regarding the optimal management of subacute and chronic injuries without articular wear. The senior author (K.C.C.) has performed the spectrum of reconstructive techniques, including dorsal and volar approaches, tendon weaves, ligament tenodesis procedures, reduction and association procedures, and bone-ligament-bone techniques. In the absence of convincing, consistent outcomes, the authors began investigating a novel all-dorsal reconstructive technique using the Arthrex InternalBrace system. The complexity and unpredictable outcomes associated with traditional ligament tenodesis procedures led them to adopt the all-dorsal InternalBrace technique as their primary reconstructive approach. The authors have performed more than 20 procedures with this technique since 2019. In an average tourniquet time of under 60 minutes, they are able to achieve predictable carpal stabilization, pain relief, and restoration of motion. This is the preferred reconstructive approach of the senior author.

Ligament-Sparing Volar Radiocarpal Arthrotomy During Distal Radius Fracture Repair: Anatomical Description and Quantification of Articular Surface Area Visualized in a Cadaveric Model

Distal radius (DR) fracture repair using the volar locked plating technique typically involves indirect fracture reduction, assessed using fluoroscopy, without direct visualization of the articular surface. This method of fracture repair may be guided by the rationale that volar radiocarpal ligament disruption may cause radiocarpal instability, although direct articular visualization may facilitate improved fracture reduction. This study investigated anatomical feasibility and articular surface visualization using volar ligament-sparing radiocarpal arthrotomy pertinent to DR fracture repair. Ten fresh-frozen cadaveric specimens of the upper extremity underwent volar arthrotomy via the standard flexor carpi radialis approach with partial longitudinal sectioning of the long radiolunate and partial transverse sectioning of the short radiolunate ligaments to visualize the articular surface of the DR. Following arthrotomy, the visible surface of the DR was analyzed using digital photography. The wrist was disarticulated, and the fully exposed articular surface was photographed. The visible area of the articular surface was quantified using digital imaging software by calculating the ratio of the surface area visualized using the arthrotomy to the total articular surface area. The percentage of the articular surface area of the DR visualized using the volar arthrotomy was 76% ± 7.6% (range, 69%-90%), including both the scaphoid facet, lunate facet, and scapholunate ridge. Volar radiocarpal arthrotomy allows clinically relevant visualization of the articular surface of the DR, including the scaphoid and lunate facets. Radiocarpal arthrotomy may facilitate improved articular reduction during DR fracture repair via the volar approach.

Orta kolonu ilgilendiren distal radius kırıklarında artroskopik destekli fragman spesifik fiksasyon standart volar plak ile fiksasyona göre üstün müdür?

Purpose: In this study, the clinical and radiological results of volar plating and arthroscopic intervention-assisted fragment-specific fixation techniques used in patients operated for AO Type B-C distal radius fracture in which the medial colon is affected were compared.
 Materials and Methods: X-ray and clinical records of 98 patients who underwent surgical treatment for radius distal end (DER) fracture between April 2011 and January 2017. The patient groups treated with arthroscopy-assisted fragment-oriented fixation (Group A) and plate screw fixation with a volar approach without arthroscopic intervention (Group B) were compared in terms of joint range of motion, grip strength, and clinical scores. Flexion and extension, ulnar deviation, radial deviation, pronation, and supination angles measured with a standard goniometer were recorded in the joint range of motion measurement. Grip strength was measured with a Jamar dynamometer for power measurement. DASH score was used in clinical evaluation.
 Results: When the operated wrists of both patient groups were compared, there was no significant difference between the DASH score, grip strength, palmar flexion, and pronation angles of motion. A statistically significant difference was observed between the mean dorsiflexion angles of 55 degrees in group A and 44 degrees in group B, mean radial deviation angles of 25 and 19 degrees, and the mean supination angles of 87 and 80 degrees, respectively.
 Conclusion: Although arthroscopic-assisted fragment-specific fixation is technically a laborious procedure that requires a learning curve in patients with intra-articular distal radius fractures, it may be beneficial to provide better postoperative results, especially in young patients with high range of motion expectations.

Volar Plate Interposition Arthroplasty of the Proximal Interphalangeal Joint: A Novel, Modified Malerich’s Technique

Summary:The choice of prosthetic or autologous reconstruction for proximal interphalangeal (PIP) joint arthroplasty in degenerative osteoarthritis represents a challenge for hand surgeons, especially in consideration of complications and patient’s quality of life. We report the case of a 49-year-old woman who developed diffuse arthritis of the finger joints, especially at the PIP joint of the third right finger. Radiographs showed destruction of the PIP joint, large osteophytes, marked narrowing of joint space, severe sclerosis, and deformation of bone contour. Through a volar approach, we removed the osteophytes, reshaped the joint, and performed an arthroplasty with volar plate interposition. The patient had an improved range of motion at 3 months postoperatively. This case study gives a detailed description and discussion, together with literature revision, of volar plate interposition arthroplasty to treat PIP osteoarthritis, as an alternative to other methods.

107 A Rare Presentation of a Giant, Multi-Compartmental Lipoma of the Hand Causing Median Nerve Compression

Abstract Lipomas are the commonest benign tumour, made up exclusively of adipose tissue, and can arise anywhere in the body. However, giant lipomas of the hand, defined as greater than 5cm in diameter, are rare. They have the potential to invade and cause a multitude of symptoms due to the compression and proximity of underlying structures. We describe a case of a 64-year-old woman who presents with a swelling of the left thenar eminence, associated with numbness and tingling in all fingers. MRI and nerve conduction studies confirmed the diagnosis of a lipoma causing median nerve compression. The patient underwent elective surgical excision using a volar approach, with good postoperative recovery. The excised lesion, measuring 12x7x2.4cm, is the largest giant lipoma of the hand reported in literature, and the first to demonstrate invasion from the mid palmar space into both the dorsal sub-aponeurotic space and carpal tunnel. Space occupying lesions, such as giant lipomas of the hand, are a rare but important secondary cause of compression neuropathies of the upper extremity and must be suspected when these neuropathies present with atypical symptomatology. Any patient presenting with a soft-tissue lesion of the hand demonstrating rapid growth, pain or large size must be thoroughly investigated to rule out malignancy. MRI forms an essential part of the workup in such cases due to its high diagnostic accuracy. Malignant transformation of giant lipomas of the hand is extremely rare, and such lesions can be removed by en bloc marginal resection with excellent postoperative results.

Digital nerve blocks: A systematic review and meta-analysis.

Study objectiveDigital nerve blocks (DNBs) provide local anesthesia for minor procedures of the digits. Several DNB techniques have been described, but it is unclear which technique provides adequate anesthesia with the least pain. DNB techniques can be grouped into a dorsal approach, which requires 2 injections, versus 3 different types of volar approaches, which require a single injection. We performed a meta‐analysis to compare DNB techniques with respect to time to anesthesia (TTA), duration of anesthesia (DOA), and pain of injection. We also reviewed data on degree and distribution of anesthesia and discuss the techniques preferred by study participants and clinicians performing injections.Data SourcesWe searched MEDLINE, EMBASE, and CENTRAL databases with terms “digital block,” “digital nerve block,” “local anesthetic,” “local anesthesia,” “lidocaine,” and/or “bupivacaine.”Study SelectionRandomized controlled trials (RCTs) were prioritized, though high‐quality prospective cohort studies were also eligible. All included studies evaluated DNB techniques or anesthetics. There were 23 papers (21 RCTs, 2 prospective descriptive studies) included.Data ExtractionDNBs studied included dorsal ring block, traditional dorsal block, transthecal block, modified transthecal block, and volar subcutaneous digital blocks. Outcomes measured included TTA, DOA, pain of injection scores, and degree of anesthesia.ResultsOverall, mean TTA was 4.5 minutes (95% confidence interval [CI] 3.5, 5.6), mean DOA was 187 minutes (95% CI 104.3, 269.7), and mean pain score was 2.1 out of 10 (95% CI 1.3, 2.8) without significant differences between studies or techniques.ConclusionsThere were no significant differences in the outcomes of TTA, DOA, and pain of injection between different DNB techniques. Single‐injection volar approaches may be preferred by participants and clinicians over dorsal approaches that require 2 injections, particularly with respect to pain. However, 2‐injection dorsal approaches may have better coverage of the proximal dorsal surface based on degree and distribution of anesthesia.

Mid-term radiological results of intra-articular penetration of the screw used in scaphoid surgery.

Headless cannulated compression screw is often used in scaphoid fracture and nonunion surgery. In the volar and dorsal surgical approach, when adequate fluoroscopic imaging is not performed, the screw may protrude beyond the scaphoid bone and penetrate into the joint. When the length of the screw is too long, and it is noticed intraoperatively, it is replaced with a shorter screw. However, there is no clear consensus in the literature about the way to be followed when screw penetration is noticed in the postoperative period. The cases in which cannulated screw penetrated the radioscaphoid, scapholunate, and scaphotrapeziotrapezoid joint on postoperative radiographs were included in this study. Sixteen patients (13 men and 3 women) were included. The mean postoperative follow up time was 35.1 months. There was scaphotrapeziotrapezoid joint penetration in seven cases, scapholunate joint penetration in two cases, and radioscaphoid joint penetration in seven cases. Osteoarthritis developed in the scapholunate joint in two cases and in the radioscaphoid joint in two cases. Early revision surgery or waiting for the fracture to heal and removing the screw, or not performing secondary surgery are among the options. In this study, mid term radiological results of screws penetrating radioscaphoid, scapholunate, and scaphotrapeziotrapezoid joints were examined. It was observed that it may cause osteoarthritis development in radioscaphoid and scapholunate joints, but it did not cause osteoarthritis development in scaphotrapeziotrapezoid joint. In the early postoperative period, revision surgery is recommended to prevent the development of osteoarthritis of screws penetrating the radioscaphoid and scapholunate joint.

A Cadaveric Comparison of Approaches for Exposure of the Volar Distal Radius: Is There a Utilitarian Approach?

It remains unclear whether exposure for planned fixation of distal radius fractrues is superior with any given approach, and whether a single utilitarian approach exists that permits reliable complete exposure of the volar distal radius. A cadaveric study was performed using 10 matched specimens. Group 1 consisted of 3 radially based approaches (standard flexor carpi radialis [FCR], standard FCR with radial retraction of FCR and flexor pollicis longus [FPL] tendons, extended FCR). Group 2 consisted of 2 ulnarly based approaches (volar ulnar, extended carpal tunnel). The primary outcome was total width of exposed distal radius at the watershed line. Mann-Whitney U and Wilcoxon rank testing was used to identify differences. The standard FCR approach exposed 29 mm (90%), leaving on average 3 mm (10%) of the ulnar corner unexposed. Retracting the FCR and FPL tendons radially allows for an extra 1 mm of volar ulnar corner exposure. Finally, converting to an extended FCR approach provided 100% exposure in all specimens. The volar ulnar exposure however provided exposure to only 9 mm (37%), leaving 20 mm (62.5%) left unexposed radially. The extended carpal tunnel provided exposure to 21 mm (65%), leaving 11 mm (35%) radially unexposed. Differences between each group were statistically significant (P < .05). The extended FCR approach exposed 100% of the volar distal radius in our study and may serve as a utilitarian volar surgical approach for exposure and fixation of distal radius fractures. Additional knowledge of the limitations of alternative approaches can be helpful in surgical planning.

An Outcomes Study of Proximal Interphalangeal Joint Silicone Implant Arthroplasty Using the Volar Approach.

Arthroplasty is performed at the proximal interphalangeal joint for the management of disabling osteoarthritis. This prospective cohort study evaluated outcomes of the silicone implant for the proximal interphalangeal joint using the volar approach. The authors hypothesize that the volar approach without extensor mechanism disruption will provide improved motion and maintain joint extension. Consecutive candidates for proximal interphalangeal joint silicone implant arthroplasty using the volar approach were evaluated. The Michigan Hand Outcomes Questionnaire and functional measurements, including grip/pinch strength and arc of motion, were administered preoperatively and at 6 weeks and 3, 6, and 12 months postoperatively. Twenty-eight patients (35 joints) were included in the study. Eighteen patients (24 joints) were followed to 1 year postoperatively, with an entire cohort average of 10-month follow-up. Nineteen patients were white women, and the mean age was 64 years. The authors' hypothesis was supported by the results showing a mean gain in arc of motion of 7 degrees and a mean 5-degree extension lag improvement at 1 year. The mean postoperative arc of motion was 53 degrees with a 10-degree average extension lag. The median Michigan Hand Outcomes Questionnaire pain score improved from 70 (60 to 80) to 28 (5 to 45); scores also improved for each of the questionnaire domains. Median grip strength was unchanged. The volar approach to proximal interphalangeal joint arthroplasty is technically challenging but facilitates early aggressive rehabilitation. This is critical for providing improved flexion, especially in the ulnar digits without worsening extension lag. Therapeutic, IV.

WALANT Technique in Percutaneous Scaphoid Osteosynthesis.

Scaphoid fractures account for 50 to 70% of all carpal bone fractures. Percutaneous scaphoid osteosynthesis can use the dorsal or volar approach, both with good results, and is most commonly performed under general anesthesia or regional nerve block. The wide-awake local anesthesia no tourniquet (WALANT) technique is already considered a safe and cost-effective technique in hand surgery around the world. Local anesthesia with epinephrine causes vasoconstriction, which obviates the need for tourniquet and, consequently, the need to use patient sedation. Thus, the possibility of testing fixation stability under physiological forces is another great advantage of using local anesthesia. In the technique described in the present paper, active wrist and hand motion can be tested immediately after scaphoid fixation. Wide-awake local anesthesia no tourniquet has been increasingly used in soft-tissue hand surgery and in the fixation of metacarpal and phalangeal fractures. However, to date, there is no published literature addressing the use of this technique in percutaneous scaphoid osteosynthesis. The purpose of the present technical note is to describe the use of WALANT for both the dorsal and volar approaches in percutaneous scaphoid osteosynthesis.

Scaphoid Open Reduction and Internal Fixation Through Dorsal Approach

Scaphoid fractures are the most common carpal injury and have a high complication propensity. In particular, the unique blood supply of the scaphoid leads to an increased rate of avascular necrosis, while the geometry of the scaphoid causes relatively high rates of nonunion. Among operative approaches, percutaneous and open reduction internal fixation (ORIF) may both be considered, with ORIF being preferred for displaced, comminuted, proximal pole and nonunion/delayed healing fractures. With internal fixation, a dorsal or volar approach can be undertaken based on fracture alignment. Here, we discuss the case of a proximal pole scaphoid fracture repaired with ORIF via a dorsal approach. After dissection through the joint capsule and exposure of the base of the scaphoid, a headless compression screw is placed anterograde in line with the thumb in all planes. This procedure provides increased stability and improved rate of the union in correlation with the accuracy of intraoperative reduction, leading to improved outcomes for surgical candidates over more conservative approaches.

2nd Metacarpophalangeal joint fracture dislocation [Kaplan’s Lesion] operated by open reduction with dorsal approach: A case report

Kaplan’s injury is the dislocations of metacarpophalangeal (MCP) joint dorsally. It may be seen in all five fingers but usually index finger is more prone to such injury. In Kaplan dislocation the head of the metacarpal button-holed through the constraint soft tissue surroundings and the volar plate goes dorsal to the metacarpal head which makes it irreducible by closed method. Both dorsal & volar approaches have been described in many literature for open reduction for the dislocation. Though, the right approach to treat such lesions is still a debate, it is the volar approach which is widely used & described more in literature. Some prefer dorsal approach. Volar approach is very prone to iatrogenic neurovascular injure.Surgical Procedure: Dorsal approach was used. This volar plate was completely dorsally dislocated. Head of metacarpal found fractured. A longitudinal incision was made over the plate & the head of the metacarpal was gently elevated & allowed to relocate. K wire was inserted through fracture fragment into the metacarpal head.Result: As follow-up after 6 weeks, the patient’s active range of motion consisted of metacarpophalyngeal joint hyperextension to 10° and 75° of flexion, proximal interphalangeal joint extension to 0° and flexion to 70°, and distal interphalangeal joint extension to 0° and flexion to 60°. Neurovascular evaluation was within normal limits. X-rays confirmed maintenance of reduction.

Clinical applications of internal fixation via the volar approach with pronator quadratus preservation for distal radius fractures.

The purpose of this study is to investigate the success rate of volar plate treatment of distal radius fractures with preservation of the pronator anterior muscle; the incidence of complications, such as infection, vascular nerve injury, and tendon injury; fracture healing rate; and changes in muscle anatomy. The Henry approach was adopted to treat distal radius fractures with pronator quadratus (PQ) preservation on a trial basis. Between June 2015 and January 2017, 46 cases of distal radius fractures were considered according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification. The PQ was preserved, the distal margin was exposed, and a fracture reset was completed by pulling the muscles toward the near side. The K-wires were temporarily fixed, and the plate was placed by a plate channel. The mean operation duration was 52 min and the average blood loss was approximately 30 mL. There were no implant failures, adhesions requiring tenolysis, and tendon rupture. No patient developed carpal tunnel syndrome. All fractures healed without infection, radial artery injury, nerve damage, tendon rupture, and nonunion. A guider was applied to implant a screw under the muscle. In total, 46 patients with PQ preservation between ages 29 to 52 were performed distal radius fracture surgery. AO classification revealed that there were four cases of type A, seven cases of type B3, 10 cases of type C1, 13 cases of type C2, and 12 cases of type C3. For most fractures, such as Types A, B3, C1, C2, and C3, the fracture sites were located around the muscle distal margin. Thus, slight pulling of the muscles to the near side can reveal the fracture, and surgery with PQ preservation can be implemented. The postoperative muscle structures found during hardware removal procedures were similar to the muscle structures before the first operation. The radiographic outcome of fracture fixation was satisfactory. Surgery with PQ preservation is suitable for most distal radius fractures other than Types B1 and B2. For a small part of fractures involving the shaft of the radius, the PQ needed to be partially cut off to complete the operation. The postoperative muscle structures were close to normal.

Arthroscopically Assisted Treatment of Volar Rim Fractures.

Background Arthroscopically-assisted reduction and internal fixation (AARIF) for distal radius fractures (DRF) has been extensively described. Little information is available about AARIF in AO "B3" and "C" DRF with displaced lunate facet volar rim fragment (VRF) and volar carpal subluxation. However, lunate volar rim fragment (LVRF) may be very difficult to reduce and fix under arthroscopic control using the flexor carpi radialis (FCR) or FCR extended approaches while traction is applied. Purposes The aims were to describe our surgical technique of AARIF of partial or complete DRF with VRF and provide information about how often this technique may be necessary, based on a large DRF database. Methods The dual-window volar approach for complete articular AO C DRF with volar medial fragment was described in 2012 for performing open reduction internal fixation (ORIF). Since 2015, we have used the dual-window approach for AARIF of "B3" or "C" DRF with volar carpal subluxation. We analyzed our PAF database, searching for patients treated with AARIF in "B3" and "C" fractures. Results The dual-window volar approach is very useful when using AARIF for AO "B3" and "C" DRF with displaced VRF and volar carpal subluxation. The anteromedial part of the exposure allows a direct access to reduction and fixation of the LVRF under traction and arthroscopic control. Overall, 1% of all articular DRF in this series showed a displaced LVRF amenable to the dual-window volar approach. Conclusion It is almost impossible to access and properly fix a VRF using traction and arthroscopic control through the FCR or FCR extended FCR approach because of the stretched flexor tendon mass. The use of the dual-window approach during AARIF of AO "B3" or "C" DRF has not previously been reported. Displaced VRF are rare whether they were part of "B3" or "C" fractures. If AARIF is chosen, we strongly recommend the use of the dual-window volar approach for AO "B3" and "C" fractures with VRF. A single anteromedial approach can also be used for isolated "B3" anteromedial DRF.

Comparison of a ceiling-mounted 3D flat panel detector vs. conventional intraoperative 2D fluoroscopy in plate osteosynthesis of distal radius fractures with volar locking plate systems

ObjectivesTo compare intraoperative 3D fluoroscopy with a ceiling-mounted flat panel detector in plate osteosynthesis of distal radius fractures (AO/OTA 2R3C1.2) with volar locking plate systems to conventional 2D fluoroscopy for detection of insufficient fracture reduction, plate misplacement and protruding screws.MethodsUsing a common volar approach on 12 cadaver forearms, total intraarticular distal radius fractures were induced, manually reduced and internally fixated with a 2.4 distal radius locking compression plate. 2D (anterior-posterior and lateral) and 3D (rotational) fluoroscopic images were taken as well as computed tomographies. Fluoroscopic images, Cone Beam CT (CBCT), 360° rotating sequences (so called “Movies”) and CT scans were co-evaluated by a specialist orthopedic surgeon and a specialist radiologist regarding quality of fracture reduction, position of plate, position of the three distal locking screws and position of the three diaphyseal screws. In reference to gold standard CT, sensitivity and specifity were analyzed.Results“Movie” showed highest sensitivity for detection of insufficient fracture reduction (88%). Sensitivity for detection of incorrect position of plate was 100% for CBCT and 90% for “Movie.” For intraarticular position of screws, 2D fluoroscopy and CBCT showed highest sensitivity and specifity (100 and 91%, respectively). Regarding detection of only marginal intraarticular position of screws, sensitivity and specifity of 2D fluoroscopy reached 100% (CBCT: 100 and 83%). “Movie” showed highest sensitivity for detection of overlapping position of screws (100%). When it comes to specifity, CBCT achieved 100%. Regarding detection of only marginal overlapping position of screws, 2D fluoroscopy and “Movie” showed highest sensitivity (100%). CBCT achieved highest specifity (100%).ConclusionAs for assessment of quality of fracture reduction and detection of incorrect position of plate as well as overlapping position of the three diaphyseal screws CBCT and “Movie” are comparable to CT – especially when combined. Particularly sensitivity is high compared to standard 2D fluoroscopy.

Percutaneous Dorsal Approach for Fractures of the Hook of the Hamate: A Less Common but Effective Option

Abstract Introduction Hook of hamate fractures are rare. The best treatment option is a source of debate; it ranges from conservative to surgical techniques, including resection of the hook or a volar approach followed by internal fixation. These techniques are not exempt from risk. Minimal invasive fixation using a dorsal percutaneous approach and a headless, cannulated mini screw is another option, although not commonly considered. We present a case series of patients who underwent this surgical technique. Methods This is a retrospective review of four patients with nondisplaced hook of hamate fractures treated with dorsal percutaneous fixation. The evaluation included symptoms, physical examination, and radiological (radiographs, magnetic resonance imaging [MRI], and computed tomography [CT]) findings, as well as pre and postoperative strength (determined with a Jamar (JLW Instruments, Chicago, USA) hydraulic dynamometer) and quick disabilities of the arm, shoulder and hand (QuickDASH) scores. Results The union rate was 100% with no associated complications. All patients resumed their preinjury activities 3 months after the surgery and reported they would undergo surgery again if needed. Conclusion This retrospective study shows that safe treatment of nondisplaced hook of hamate fractures with percutaneous dorsal fixation is feasible, with excellent clinical outcomes. In any case, our sample is limited, and further studies are required.