Journal of Wrist Surgery

Introduction  Various wrist arthroscopy techniques can be used in the management of scapholunate ligament (SLL) partial tears but their success has not been proven. Arthroscopic techniques including thermal shrinkage are becoming more popular in the management of partial SLL injuries. We hypothesized that arthroscopic ligament-sparing capsular tightening yields reliable and satisfactory results for the management of partial SLL tears. Methods  A prospective cohort study was conducted on adult (age ≥18 years) patients with chronic partial SLL tears...

Background  Carpal tunnel release (CTR) may be concomitantly performed along with distal radius fracture open reduction internal fixation (DRF ORIF) to prevent carpal tunnel syndrome; however, there is little to no literature investigating the rate, risk factors, and complications associated with CTR. Questions/Purposes  The purpose was to determine (1) the rate of CTR performed at time of DRF ORIF, (2) factors associated with CTR, and (3) whether CTR was associated with any complications. Patients and Methods  In this case-control study, adult patients who underwent DRF ORIF from 2014 to 2018 were identified from a national surgical database...

Purpose  Recent literature on significance and treatment of ulnar styloid fractures suggest that the ulnar styloid is not the central problem but the radioulnar ligaments and their impact on joint stability. However, specifically displaced ulnar styloid process fractures that secondarily heal in an ectopic position remain a rare situation for which diagnostics and treatment options remain a topic of discussion. Methods  This case series presents four patients with limited supination due to a fixed dorsal subluxation of the distal radioulnar joint (DRUJ)...

Background  Treatment algorithm for disruption of the triangular fibrocartilage complex (TFCC) from the ulnar fovea includes direct TFCC repair, tendon reconstruction of the radioulnar ligaments, or a salvage procedure in cases with painful distal radioulnar joint (DRUJ) degeneration. Case Description  We describe our surgical technique for reconstruction of the distal oblique bundle (DOB), to attain DRUJ stability in a young man, after failed attempts of direct TFCC reinsertion and radioulnar ligament reconstruction with the Adams procedure...

Background  Scaphoid stress fractures are rare and typically present in young, elite male athletes. Due to the infrequency in which these injuries are encountered, the optimum management is not established. Case Description  We present the case of a 20-year-old male gymnast with bilateral stress fractures of the scaphoid waist. Following conservative treatment, clinical and radiological signs of union were seen bilaterally. Eight months after return to normal activities, a unilateral recurrence of the stress fracture occurred...

Background  Pneumatic tourniquets are widely used in hand surgery. Elevated pressures can be associated with complications, and thus, guidelines based on patient-specific tourniquet pressures have been recommended. The primary aim of this study was to determine whether lower tourniquet values based on systolic blood pressure (SBP) could be effectively applied in upper extremity surgery. Methods  A prospective case series of 107 consecutive patients undergoing upper extremity surgery with use of a pneumatic tourniquet was performed...

Objective  Treatment of palmar midcarpal instability (PMCI) remains controversial and children can develop PMCI from asymptomatic hypermobility. Recently, case series have been published regarding the use of arthroscopic thermal shrinkage of the capsule in adults. Reports of the use of the technique in children and adolescents are rare, and there are no published case series. Methods  In a tertiary hand center for children's hand and wrist conditions, 51 patients were treated with arthroscopy for PMCI between 2014 and 2021...

Background  Four-corner arthrodesis (4CA) can be performed with a variety of methods. To our knowledge, fewer than 125 cases of 4CA with a locking polyether ether ketone (PEEK) plate have been reported, necessitating further study. Purpose  The purpose of this study was to evaluate the radiographic union rate and clinical outcomes in a series of patients who received 4CA with a locking PEEK plate. Methods  We re-examined 39 wrists in 37 patients at a mean follow-up of 50 months (median: 52 months, range: 6-128)...

Background  Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) are common patterns of wrist arthritis, and surgical treatment options include partial and total wrist arthrodesis and wrist denervation, which maintains the current anatomy while relieving pain. Introduction  The purpose of this study is to elucidate current practices within the hand surgery community with respect to the use of anterior interosseous nerve/posterior interosseous nerve (AIN/PIN) denervation in the treatment of SLAC and SNAC wrists...

Background  Wrist arthroscopy has become increasingly popular for diagnosing and treating traumatic wrist injuries. How wrist arthroscopy has influenced the daily practice of wrist surgeons remains unclear. The objective of this study was to evaluate the role of wrist arthroscopy for the diagnosis and treatment of traumatic wrist injuries among members of the International Wrist Arthroscopy Society (IWAS). Methods  An online survey was conducted among IWAS members between August and November 2021 with questions regarding the diagnostic and therapeutic importance of wrist arthroscopy...

Purpose  The purpose of this study was to evaluate the clinical and functional results of 67 patients with distal radius fracture (DRF), treated with a modified surgical technique that allows three-column fixation through the same palmar approach. Patients and Methods  Between 2014 and 2019, we treated 67 patients using a particular surgical technique. All patients suffered DRF, classified using the universal classification system. Two different intervals were developed palmary: the first ulnarly to the flexor carpi radialis tendon for direct visualization of the distal radius and the second one radially to the radial artery for direct visualization of the styloid process...

Background  In predynamic or dynamic scapholunate (SL) instability, standard diagnostic imaging may not identify SL interosseous ligament (SLIL) injury, leading to delayed detection and intervention. This study describes the use of four-dimensional computed tomography (4DCT) in identifying early SLIL injury and following injured wrists to 1-year postoperatively. Description of Technique  4DCT acquires a series of three-dimensional volume data with high temporal resolution (66 ms). 4DCT-derived arthrokinematic data can be used as biomarkers of ligament integrity...

Background  Locking of the distal radioulnar joint (DRUJ) induces restriction of the active and passive motion of pronation or supination of the forearm. Diagnosis of DRUJ locking due to a triangular fibrocartilage complex (TFCC) tear is sometimes difficult. Case Description  A 15-year-old female suffered from restriction of forearm supination after cast immobilization for the treatment of an elbow injury. The active and passive range of motion (ROM) of supination was 30 degrees, while the active ROM of pronation was normal...

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Mycobacterium avium intracellulare (MAI) infections of the hand, wrist, and upper extremity are rare, but potentially devastating atypical mycobacterial infections that can affect tendon, bone, and other soft tissues of the musculoskeletal system. We present an immunocompromised patient presenting with acute swelling and pain in the dorsum of the hand and wrist that underwent a wrist extensor tenosynovectomy with intraoperative cultures revealing infection with MAI. The patient developed severe progression of the infection with osteomyelitis of the distal forearm and carpal bones, multiple subsequent extensor tendon ruptures, and dorsal skin necrosis...

Introduction  The literature is scarce regarding the management of combined tears of scapholunate (SL) and lunotriquetral (LT) ligaments. This study aimed to evaluate our preliminary results with the arthroscopic dorsal ligamentocapsulodesis in managing such cases. Materials and Methods  Forty-two patients (13 females, 29 males; mean age = 31; age range = 18-51 years) who underwent arthroscopic dorsal ligamentocapsulodesis due to the combined tears of SL and LT ligaments were retrospectively reviewed...

Objective  The aim of the study is to describe the modified all-arthroscopic technique for triangular fibrocartilage complex (TFCC) ligamentoplasty in chronic injuries of the TFCC with distal radioulnar joint (DRUJ) instability, and to present the results obtained. Methods  A prospective study was conducted including 11 consecutive patients with chronic TFCC injury with DRUJ instability who underwent an all-arthroscopic TFCC ligamentoplasty. During follow-up, the range of joint motion, grip strength, pain according to the visual analog scale (VAS), functional outcomes according to the Mayo Wrist Score (MWS), and the QuickDASH Score were measured, and any complications and necessary reinterventions were recorded Results  We analyzed 11 patients with distal radioulnar ligament injury treated using the all-arthroscopic ligamentoplasty technique...

Background  This pilot study explored the value of a dedicated extremity magnetic resonance imaging (MRI) scanner by focusing on the qualitative depiction of important wrist structures in common wrist pathologies, the overall image quality, artifacts, and participant experience in undergoing the examinations. Methods  Images of the right wrist of 10 healthy adult volunteers were acquired with a 0.31-Tesla (T) dedicated extremity MRI and a 3-T MRI system, using a dedicated wrist coil. Images were separately evaluated by three radiologists...

Background  In response to the coronavirus pandemic the British Orthopaedic Association Standards for Trauma and Orthopaedics (BOAST) guidelines advised treating distal radius fractures (DRFs) non-operatively where possible. Questions/Purpose  The aim of this study was to assess whether the coronavirus disease 2019 (COVID-19) pandemic lockdown within the United Kingdom did alter the management of DRFs and whether there was any subsequent change in patient outcome or complication rate. Patients and Methods  A retrospective cohort study was performed at a single orthopaedic center within the United Kingdom...

Background  Pediatric carpal injuries are a clinical challenge due to their non-specific clinical features and occult nature on plain radiography. We hypothesized that early magnetic resonance imaging (MRI) will allow prompt diagnosis and treatment stratification, and that distal pole fracture of the scaphoid requires a shorter duration of immobilization. This study aims to assess the injury pattern and clinical outcomes of under-16-year-olds treated with acute post-traumatic wrist injuries in accordance with the unit's protocol...