Journal of Wrist Surgery

Background  Severely destroyed wrists can be managed by combined radiocarpal and distal radioulnar joint (DRUJ) replacement that reduces pain while mobility is ought to be reserved. The combination of these arthroplasties is rarely reported in the literature. Purpose  This article describes the clinical outcomes of six consecutive patients with both total wrist and Aptis DRUJ arthroplasty with a median follow-up of 50 months (range: 18-108 months). Patients and Methods  Patients with a TWA combined with an Aptis DRUJ arthroplasty were retrospectively identified...

We present two unusual cases of radially displaced perilunate dislocations, one of which involved acute ulnar nerve compression requiring Guyon's canal release. The first case underwent closed reduction and cast immobilization but developed scapholunate instability, necessitating secondary ligament reconstruction. The second case, treated with open reduction and fixation, resulted in persistent volar intercalated segment instability of the proximal row and ulnar nerve paresthesia 1 year after surgery.

Background  Intramedullary screw fixation is a commonly used technique for the management of metacarpal fractures. However, compression across the fracture site can lead to unintentional shortening of the metacarpal. Questions/Purposes  Our aim was to evaluate the risk of overshortening with differing intramedullary device designs for fixation of metacarpals. Methods  The small finger metacarpal of nine fresh-frozen cadavers were included. A metacarpal neck fracture was simulated with a 5-mm osteotomy...

Background  Single- or bicolumn limited intercarpal fusion, also called one- or two-column fusion, has been introduced as an alternative to four-corner fusion. The rationale behind this is obtaining less need for bone grafting and consequently improving the chances of the union. Method  From August 2014 to October 2020, 45 consecutive patients (15 women), with a mean age of 58.4 years (range: 35-79), have been treated for scapholunate advanced collapse or scaphoid nonunion advanced collapse wrist...

Background  Wrist arthroscopy has become a commonly used tool for the management of adults with distal radius fractures (DRFs), although its implementation requires technical competence. This systematic review and meta-analysis appraised the available evidence concerning the contribution of wrist arthroscopy to the functional and radiological outcomes of patients with DRFs operated with arthroscopic assistance. Methods  Randomized control trials were identified through five principal electronic databases on May 31, 2022: Web of Science, Scopus, EBSCO, Embase, and PubMed...

Background  The results of Mathoulin's arthroscopic dorsal capsuloligamentous reconstruction (ADCLR) are excellent in many patients with scapholunate instability, though less consistently good in higher grade instabilities. The purpose of this article is to describe a novel technique of volar scaphotrapeziotrapezoid (STT) reconstruction which may be used to augment rotational control of the scaphoid, in conjunction with the ADCLR, for use in European Wrist Arthroscopy Society (EWAS) grade IV/V instabilities...

No abstract text is available yet for this article.

Background  The integrity of the foveal insertion of the triangular fibrocartilage complex (TFCC) is currently assessed by inference using the hook test. Using dry arthroscopic techniques, the primary author observed that many patients with painful distal radioulnar joint (DRUJ) instability and a positive hook test had an intact foveal insertion. This study was performed to determine whether a positive hook test is a reliable index of a tear of the foveal insertion. Technique  The hook test is performed using a probe to elevate the TFCC off the ulna head toward the articular surface of the lunate...

Background  Vascularized bone grafting with screw fixation is currently considered the treatment of choice for scaphoid nonunions with avascular necrosis (AVN) of the proximal pole. A viable alternative to using vascularized bone grafts for scaphoid nonunions with AVN is nonvascularized bone grafting with screw fixation. Question  What are the functional outcomes of patients with scaphoid nonunions and associated proximal pole AVN who are treated with nonvascularized distal radius bone grafting and screw fixation? Patients and Methods  Eight scaphoid nonunions with AVN, which received nonvascularized distal radius bone graft and screw fixation, underwent a retrospective review...

We report the case of a 61-year-old woman with right-sided flexor pollicis longus (FPL) tendon ruptured a month after volar locking plate fixation. Five months after the initial operation, hardware removal and reconstruction of the FPL tendon with the ipsilateral palmaris longus were performed. The proximal stump of the ruptured FPL tendon was found in the space between the distal radius and plate.

Background  Understanding wrist biomechanics is important to appreciate and treat the wrist joint. Numerical methods, specifically, finite element method (FEM), have been used to overcome experimental methods' limitations. Due to the complexity of the wrist and difficulty in modeling, there is heterogeneity and lack of consistent methodology in the published studies, challenging our ability to incorporate information gleaned from the various studies. Questions/Purposes  This study summarizes the use of FEM to study the wrist in the last decade...

Introduction  Injury to the scapholunate interosseous ligament (SLIL) is a common cause of carpal instability, yet surgical management of chronic SLIL disruption remains challenging with no optimal technique identified. Purpose  The purpose of this meta-analysis was to comparatively review the available evidence of clinical, radiographic, and patient-reported outcome measures among popular techniques of SLIL reconstruction (capsulodesis, tenodesis, and bone-tissue-bone graft) to better guide management of SLIL injuries...

Background  The purpose of this case series is to show our experiences with the Masquelet procedure in a variety of infected defects of the wrist. Case Description  All consecutive patients that were treated between 2015 and 2021 were included in this case series. Five patients were included with an infected defect of the wrist, involving the radiocarpal and/or the distal radioulnar joints (DRUJ). All patients underwent thorough debridement of the defect and the created void was filled with a gentamicin/vancomycin cement spacer...

Background  Treatment of intra-articular distal radius fractures (DRFs) rests on anatomic internal fixation. Fragment-specific fixation (FSF) is applied when fracture pattern is too complex for standard volar plating (SVP), oftentimes with potential increased risk of complications. We hypothesized that patients undergoing FSF would achieve less wrist range of motion (ROM) with higher risk of complications compared with SVP. Methods  We conducted a retrospective review of 159 consecutive patients undergoing DRF fixation from 2017 to 2020...

No abstract text is available yet for this article.

Background  Volar locking plate fixation (VLP) is commonly used to treat distal radius fractures (DRF). Risk of dorsal compartment injury with distal screw hole fixation has been studied; however, the risk with proximal screw hole fixation is not well studied. Purpose  The goal of this study was to investigate the risk of dorsal structure injury from the screw holes proximal to the two distal rows. Methods  Nine cadaveric forearms were used. After volar distal radius exposure, a long VLP was applied...

Background  This paper's purpose was to analyze clinical results obtained with trapeziometacarpal arthrodesis and complications comparing different osteosynthesis systems. Methods  Thirty-seven trapeziometacarpal arthrodesis were performed in our center in a 7-year period, with a mean age of 52 years and 34 months of follow-up. The implants were distributed homogenously into three groups, using bone grafts in 12.5% of them. Results  A 75% achieved complete consolidation with a mean postsurgical Visual Analog Scale (VAS) of 2...

Purpose  Treatment of proximal scaphoid fractures remains a challenge with a risk of nonunions and avascular necrosis due to its retrograde blood supply. The ipsilateral proximal hamate has been described as a viable autograft option for osteochondral reconstruction of the proximal scaphoid. Our study evaluated the changes in the contact area and pressure of the radioscaphoid joint after proximal hamate autograft reconstruction. Methods  Thin sensors (Tekscan Inc., Boston, MA) were placed in the radiocarpal joints of six fresh-frozen cadaveric forearms...

Background  Surgical procedure selection for carpal arthritis depends on which articular surfaces are affected, but there is no consensus on how to preoperatively evaluate cartilage surfaces. Despite advances in cross-sectional imaging, the utility of advanced imaging for preoperative decision-making has not been well established. Objectives  Our objective was to assess if there is an added value to presurgical advanced imaging or diagnostic procedures in planning for carpal arthrodesis or carpectomy and to determine what imaging or diagnostic procedures influence surgical treatment options...

Purpose  Scapholunate advanced collapse (SLAC) wrist results from an untreated scapholunate dissociation and is the most common type of degenerative arthritis of the wrist. The most common surgical treatments for SLAC wrist are proximal row carpectomy and four-corner fusion with scaphoid excision. Arthroscopic surgical treatment for SLAC wrist has been reported; however, only limited data on functional outcomes are available. The purpose of this study is to report our 5-year follow-up clinical outcomes for arthroscopic treatment for SLAC wrist...