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Hand (New York, N.Y.) Jun 2024Total wrist arthrodesis is a well-established surgical technique that provides reliable pain relief in patients with advanced wrist disease. Key limitations of existing...
BACKGROUND
Total wrist arthrodesis is a well-established surgical technique that provides reliable pain relief in patients with advanced wrist disease. Key limitations of existing plating systems include hardware pull-out, hardware failure, and nonunion. There is limited literature on the newer style carpometacarpal joint (CMCJ) sparing plating system, produced by Medartis. The objective of this study was to determine the long-term clinical and radiological outcomes of wrist arthrodesis with a CMCJ sparing wrist plate.
METHODS
This study retrospectively identified 23 wrist arthrodeses using the Medartis CMCJ sparing plate for review. This study assessed the outcomes of 18 unilateral wrist fusions and 1 bilateral wrist fusion. The study group consisted of 12 men and 5 women with an average age of 56 years (range: 29-82 years) with a mean follow-up period of 17 months.
RESULTS
At the time of follow-up, all patients' wrists had fused without postsurgical complication. The final grip strength in the operative hand was 28.2 kg/cm, which was 87% of the contralateral side. The mean Quick Disabilities of the Arm, Shoulder, and Hand score at follow-up was 23.9, with all patients returning to daily living activities and work. Patients reported minimal pain (1.3/10), with almost all (17/18) satisfied with the outcome of the surgery and describing that they would recommend this procedure.
CONCLUSION
Our case series highlights that the Medartis wrist arthrodesis plate is a newer design that is a well-tolerated option for wrist arthrodesis based on clinical assessment, functional hand assessment, and patient satisfaction, when compared with the existing literature on traditional plating systems.
Topics: Humans; Arthrodesis; Male; Bone Plates; Female; Middle Aged; Aged; Adult; Retrospective Studies; Aged, 80 and over; Carpometacarpal Joints; Wrist Joint; Hand Strength; Range of Motion, Articular; Treatment Outcome; Follow-Up Studies; Disability Evaluation; Patient Satisfaction
PubMed: 36541766
DOI: 10.1177/15589447221141474 -
Hand Surgery & Rehabilitation Oct 2019Arthrodesis of the proximal interphalangeal joint is a proven technique for treating of a range of pathological conditions, including osteoarthritis. There are multiple...
Arthrodesis of the proximal interphalangeal joint is a proven technique for treating of a range of pathological conditions, including osteoarthritis. There are multiple surgical procedures. A biomechanical study was conducted to compare the stability of a compression wire to intraosseous wiring for the arthrodesis. Seventeen formalin-fixed human fingers were randomly assigned into two groups and the bone mineral density was determined. Arthrodesis in 20° flexion was performed using an oblique compression wire (n=8) or intraosseous wiring (n=9). The stability of the arthrodesis was tested by applying a tensile bending force until failure. The mean force needed to fail the compression wire arthrodesis and intraosseous wire arthrodesis was not significantly different (76.2N, SD 31N and 63.0N, SD 28N). There was no correlation between bone density and force to failure. The compression wire was within the approximate range achieved by intraosseous wiring in withstanding substantial force before failure. From a biomechanical point of view, a compression wire is feasible for PIP arthrodesis.
Topics: Arthrodesis; Bone Wires; Finger Joint; Humans; Random Allocation; Stress, Mechanical; Tensile Strength
PubMed: 31382028
DOI: 10.1016/j.hansur.2019.07.002 -
Hand Surgery & Rehabilitation Feb 2022In spastic patients, shortening wrist arthrodesis (SWA) is indicated in cases of severe fixed flexion contracture. At present, the most commonly used technique is dorsal...
In spastic patients, shortening wrist arthrodesis (SWA) is indicated in cases of severe fixed flexion contracture. At present, the most commonly used technique is dorsal plate osteosynthesis. Ideally, fixation with smaller hardware volume farther from the tendons would limit postoperative tendon irritation and reoperation rates for hardware removal. The objective of our study was to evaluate the efficacy of Rush pin SWA in adults. A retrospective study included all patients with a central neurological impairment, undergoing SWA using a Rush pin inserted through the head of the third metacarpal, and with at least 6 months' follow-up. Attainment of preoperative objectives was evaluated by Global Assessment of Response to Treatment (GART, ranging from -4 to +4) and, for functional objectives, the House score and the Frenchay Arm Test. Consolidation and any degenerative changes in the third metacarpophalangeal joint were assessed on X-ray. Fifteen patients were included, with a mean follow-up of 13 months (range, 6-29). In general, the preoperative objectives were attained: mean GART score was 2.7 (range, 1-4). Functional objectives were attained in 3 of the 11 patients followed up (27%). In all cases, the arthrodesis had healed at a mean 74 days (range, 39-102). Three had hardware removed after consolidation; 1 experienced discomfort at the head of the third metacarpal. Rush pin arthrodesis is an interesting alternative to plate arthrodesis in the management of severe wrist flexion contracture in spastic patients. It gives satisfactory results with regard to preoperative objectives and is not associated with complications. LEVEL OF EVIDENCE: IV, retrospective study without control group.
Topics: Adult; Arthrodesis; Humans; Muscle Spasticity; Retrospective Studies; Wrist; Wrist Joint
PubMed: 34752970
DOI: 10.1016/j.hansur.2021.09.011 -
Revue de Chirurgie Orthopedique Et... 1991Twenty-three shoulder arthrodeses after brachial plexus injuries have been performed. Average time between injury and arthrodesis was 3.4 years. 18 patients had... (Review)
Review
Twenty-three shoulder arthrodeses after brachial plexus injuries have been performed. Average time between injury and arthrodesis was 3.4 years. 18 patients had palliative procedures or direct approach of the brachial plexus to improve shoulder and hand function. Average follow-up was 5 years and 11 months. An analysis based on pain, function, and fusion occurrence gave 15 good, 2 fair and 4 poor results. The authors conclude that the shoulder arthrodesis is indicated when elbow and hand functions are sufficient and deafferentation pain has not occurred.
Topics: Adult; Arthrodesis; Bone Screws; Brachial Plexus; Female; Follow-Up Studies; Humans; Male; Middle Aged; Paralysis; Radiography; Restraint, Physical; Shoulder Joint
PubMed: 1837162
DOI: No ID Found -
Zeitschrift Fur Orthopadie Und Ihre... 1992Partial arthrodesis of the carpus has again become a topical method. The technique has been improved and the range of indications has been extended. Fusion of certain... (Review)
Review
Partial arthrodesis of the carpus has again become a topical method. The technique has been improved and the range of indications has been extended. Fusion of certain areas has indeed been propagated as first-line therapy, for example in lunatum necrosis or as an important additional operation in substitution plastic surgery. Partial arthrodesis of the carpus is intended to eliminate mechanisms which has become pathological whilst preserving the best possible mobility. Partial arthrodesis alters the movement pattern of the individual ossae carpi. Moreover, the pressure in the adjacent joints also rises. The risk of a new pathological process is considerable. Recent publications report on a rapid development of impingement and symptoms. The most frequent partial arthrodeses are discussed. The indications and the direct consequences are critically analysed and explained with reference to examples. Technical details and potential dangers are described. An STT-arthrodesis is indicated for osteoarthritis of these bones. The radio-lunar arthrodesis is recommended for ulnar drifting of the carpus in cases of rheumatoid arthritis. Reconstruction of the central axis with arthrodesis of the capitate-lunate is indicated for pseudarthrosis of the scaphoid with carpal collapse. Other combinations are possible, they cause however greater functional deficits. We recommend a critical analysis of the function of the entire carpus before the operation. Caution is called for when an incipient arthrosis is present in the adjacent joint. Partial arthrodesis of the carpus is rather a temporary solution, since it enables time to be gained. Total arthrodesis is the ultimate resort.
Topics: Arthrodesis; Carpal Bones; Humans; Range of Motion, Articular; Wrist Joint
PubMed: 1642031
DOI: 10.1055/s-2008-1040135 -
Hand Surgery & Rehabilitation Oct 2023The aim of this study was to analyze clinical and radiological results for 1-stage radiolunate arthrodesis and scaphoidectomy associated to the Sauvé-Kapandji...
OBJECTIVE
The aim of this study was to analyze clinical and radiological results for 1-stage radiolunate arthrodesis and scaphoidectomy associated to the Sauvé-Kapandji procedure, to alleviate pain and conserve wrist motion.
METHODS
Seven patients (8 wrists) with symptomatic osteoarthritis of the radiolunate and distal radioulnar joints were treated from 1999 to 2016. Mean age at surgery was 49 years and M/F sex ratio was 6/1. Etiologies were distal radial intra-articular malunion for 6 patients and bilateral gouty arthritis for 1. The procedure was performed by a dorsal approach in a single step. Pain was assessed on visual analogue scale (VAS). Pre- and post-operative active flexion-extension and pronation-supination were compared. The secondary endpoint was onset of postoperative complications.
RESULTS
At a mean 71 months' follow-up (range, 30-168 months), there was significant reduction in pain (VAS, 0.5/10; p < 0.0001). Motion results were satisfactory, with 32° flexion, 39° extension, for a non-significant decrease of 11° and 5° respectively; pronation and supination were significantly increased, by a mean 23° and 30° respectively. Three wrists (37.5%) required a second surgery. There were no cases of surgical site infection or non-union.
CONCLUSION
Radiolunate arthrodesis and scaphoidectomy combined to Sauvé-Kapandji procedure was an effective solution for the treatment of symptomatic radiolunate and distal radioulnar osteoarthritis.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Wrist; Osteoarthritis; Arthrodesis; Radiography; Pain
PubMed: 37490952
DOI: 10.1016/j.hansur.2023.07.011 -
The Journal of Bone and Joint Surgery.... Aug 2016Arthrodesis is considered a salvage procedure after failure of a knee arthroplasty. Data on the use of this procedure are limited. The purpose of this study was to...
BACKGROUND
Arthrodesis is considered a salvage procedure after failure of a knee arthroplasty. Data on the use of this procedure are limited. The purpose of this study was to identify the incidence, causes, surgical techniques, and outcomes of arthrodesis after failed knee arthroplasty in a nationwide population.
METHODS
Data were extracted from the Danish Civil Registration System, the Danish National Patient Register, and the Danish Knee Arthroplasty Register. A total of 92,785 primary knee arthroplasties performed in Denmark from 1997 to 2013 were identified by linking the data using the unique personal identification number assigned to each patient. Of these arthroplasties, 165 were followed by arthrodesis. Hospital records of all identified cases of arthrodesis were reviewed. A competing risk model was used to estimate the cumulative incidence of arthrodesis in the study period. Differences in cumulative incidence were compared with the Gray test.
RESULTS
A total of 164 of the 165 arthrodeses were performed for causes related to failed knee arthroplasty. The 15-year cumulative incidence of arthrodesis was 0.26% (95% confidence interval, 0.21% to 0.31%). The 5-year cumulative incidence decreased significantly (p < 0.0001) from 0.32% for arthroplasties performed from 1997 to 2002 to 0.09% for arthroplasties performed from 2008 to 2013. The most common causes of arthrodesis were periprosthetic infection in 152 patients (93%), extensor mechanism disruption in 46 (28%), soft-tissue deficiency in 25 (15%), and severe bone loss in 11 (7%). In 79 patients (48%), there were 2 or more indications for arthrodesis. Solid fusion was achieved in 65% of the patients. The fusion rate was significantly higher after intramedullary nail fixation compared with external fixation (p = 0.01). A total of 34 patients (21%) underwent repeat arthrodesis, and 23 patients (14%) eventually underwent transfemoral amputation.
CONCLUSIONS
The cumulative incidence of arthrodesis within 15 years after primary knee arthroplasty was 0.26%. There was a significant decrease in the 5-year cumulative incidence during the study period, suggesting an overall improvement in prevention of this adverse outcome of knee arthroplasty.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Topics: Adult; Aged; Aged, 80 and over; Arthritis; Arthrodesis; Arthroplasty, Replacement, Knee; Denmark; Female; Humans; Knee Joint; Knee Prosthesis; Male; Middle Aged; Prosthesis-Related Infections; Reoperation; Treatment Outcome; Young Adult
PubMed: 27535439
DOI: 10.2106/JBJS.15.01363 -
Tierarztliche Praxis. Ausgabe G,... Feb 2020This study compares the mechanical stability and surgical usability of 2 locking plate systems (Kyon ALPS-20 and Synthes PIP-LCP system) for arthrodesis of the equine...
OBJECTIVE
This study compares the mechanical stability and surgical usability of 2 locking plate systems (Kyon ALPS-20 and Synthes PIP-LCP system) for arthrodesis of the equine proximal interphalangeal joint (PIJ).
MATERIAL AND METHODS
The experimental ex vivo study included 6 pairs of cadaver distal limbs (n = 12). All specimens were derived from Warmblood horses of various ages that were euthanized for non-orthopedic reasons. Of the 12 limbs collected, 3 left and 3 right distal limb specimens were randomly assigned to each system for implantation. Two abaxial 4.5-mm cortical screws were inserted transarticularly in all cases. Both systems were implanted according to the manufacturer's instructions with the plates placed centrally between the 2 transarticular screws. The ALPS-20 systems were implanted using Kyon B-6.4-mm monocortical locking screws in all positions. The LCP systems were implanted axially using 2 Synthes 5-mm locking screws in the proximal and distal positions, with a standard 4.5-mm cortical screw inserted in the middle position. All constructs underwent CT-scans after implantation and biomechanical testing to detect implant deformation. Uniaxial mechanical loading was applied via a servo-hydraulic test system at a test speed of 50 mm/s, up to a maximum displacement of 80 mm. The resulting load-displacement curves were used to calculate yield point, stiffness, and maximum force for each construct. The measured values were evaluated for statistical significance (p < 0.05) between the 2 plate systems via one-factor ANOVA (Tukey test). The statistical power was verified for yield force, stiffness, and maximum load.
RESULTS
No statistically significant differences between the 2 preparation groups were calculated across all of the measured parameters (p > 0.05). The ALPS system implants showed no signs of deformation, either in the plates or the screws. In contrast, the LCP demonstrated visible deformation, which had already occurred at the time of implantation from the tightening of the middle screw, as well as during the subsequent testing of the implants. After biomechanical testing, deformations ranging between 3.1° and 7.0° were measured in 4 LCPs. A total implant failure was observed for 2 LCPs.
CONCLUSION AND CLINICAL RELEVANCE
Both systems demonstrated comparable mechanical properties in the present study's ex vivo test model for equine PIJ arthrodesis. As such, the Kyon ALPS-20 may be a good alternative to the Synthes LCP for equine PIJ arthrodesis.
Topics: Analysis of Variance; Animals; Arthrodesis; Biomechanical Phenomena; Bone Plates; Bone Screws; Cadaver; Horses; Joints; Normal Distribution; Tomography, X-Ray Computed
PubMed: 32059234
DOI: 10.1055/a-1067-3819 -
Der Orthopade Apr 2006The subtalar joint is part of what may be called the "lower ankle joint" and can be considered as the weight-bearing part of it. In the case of articular problems such... (Review)
Review
The subtalar joint is part of what may be called the "lower ankle joint" and can be considered as the weight-bearing part of it. In the case of articular problems such as post-traumatic malunions or congenital abnormalities, a joint fusion limited to the subtalar joint can be indicated. Resection of the joint surfaces for accommodating the bones to achieve sound union results in a loss of height which must be considered and avoided. Fractures of the os calcis also often cause a loss of height of the hindfoot, together with a maloriented heel which is incompatible with functional and stable gait. The technique of fusion in those cases implements full liberation of the calcaneus from the talus for complete tridimensional reorientation which most often results in an equivalent empty space. It is then necessary to stabilize the reorientation achieved, most efficiently by an autologous tricortical bone block taken from the posterior iliac crest at the sacroiliac joint level. The optimal surgical approach is from posterolateral as described by Gallie.
Topics: Ankle Injuries; Arthrodesis; Foot Deformities; Humans; Practice Guidelines as Topic; Practice Patterns, Physicians'; Plastic Surgery Procedures; Subtalar Joint
PubMed: 16231163
DOI: 10.1007/s00132-005-0881-y -
Chirurgie; Memoires de L'Academie de... 1996There is no ideal surgical indication for rhizoarthrosis of the trapezoid-metacarpal joint. Fusion using two screws or a screw and a pin allow solidification after...
There is no ideal surgical indication for rhizoarthrosis of the trapezoid-metacarpal joint. Fusion using two screws or a screw and a pin allow solidification after minimal immobilization for 45 days with the thumb placed in front of the index. A 1 to 21 year follow-up (mean 68 months) of 30 hands showed 23 cases of arthrosis and 7 cases of polyarthritis. Overall results were good in 17 cases, acceptable in 8 and poor in 5. Pain relief was obtained or improved in 90% of the cases. Radiographically, pseudarthrosis was seen in 10%. No reoperations were required. Fusion is an alternative to other surgical approaches allowing pain relief and solid grip without the major problems related to prostheses.
Topics: Arthrodesis; Female; Finger Joint; Humans; Male; Middle Aged; Thumb; Treatment Outcome; Wrist Joint
PubMed: 8978146
DOI: No ID Found