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Acta Orthopaedica Belgica Dec 2021Scaphoidectomy and 4-corner arthrodesis is a common salvage surgery for degenerative wrist pathology. The purpose of this study was to evaluate the results of this...
Scaphoidectomy and 4-corner arthrodesis is a common salvage surgery for degenerative wrist pathology. The purpose of this study was to evaluate the results of this procedure performed with headless compression screws, with a special focus on postoperative complications and their treatment. We assessed 36 wrists in 31 patients that were treated between 2009 and 2017. Mean follow-up was 5.2 years (range 2.9- 9.4). Pain was expressed on a Visual Analog Scale. The Quick Disabilities of the Arm, Shoulder and hand (qDASH) questionnaire and Michigan Hand Outcome Questionnaire (MHOQ) were used to assess patient functionality and satisfaction. Range of motion and grip strength of both wrists were measured. Radiographs of the operated wrist were evaluated. Mean pain score was 1.5 ± 2.3 with 19% of patients being completely free of pain also during activity. Mean qDASH was 44 ± 20 and mean MHOQ was 10 ± 5. Mean flexion-extension arc of the operated wrist was 69° and 61% of the contralateral wrist. Mean grip strength was 35kg and 89% of the opposite wrist. Non-union was observed in two patients. Two patients required hardware removal and in three patients a pisiformectomy was performed. Conversion to total wrist arthrodesis was needed in one patient. We observed postoperative complications in 28% of our patients. Most complications can successfully be treated with additional surgery. The presence of pisotriquetral arthritis should be assessed before surgery and treated with pisiform excision.
Topics: Arthrodesis; Bone Screws; Hand Strength; Humans; Range of Motion, Articular; Retrospective Studies; Scaphoid Bone; Wrist Joint
PubMed: 35172447
DOI: 10.52628/87.4.25 -
Annals of Medicine and Surgery (2012) Feb 2022Several studies have been conducted on the variations and branching pattern of the ulnar nerve in the hand. There are few studies conducted on defining the distance of...
OBJECTIVES
Several studies have been conducted on the variations and branching pattern of the ulnar nerve in the hand. There are few studies conducted on defining the distance of ulnar nerve from bony landmarks in the palm. Ulnar nerve is closely related to the pisiform and hook of hamate which act as important landmarks.
METHODS
The study was conducted on 30 formalin fixed adult hand specimens in the department of Anatomy. Various measurements related to the ulnar nerve in the palm were taken using a divider and Vernier Calipers and the values were tabulated after obtaining the mean and standard deviation.
RESULTS
The average distance seen in the hand specimens [n = 30] from pisiform to the division of ulnar nerve into superficial and deep branch was 0.89 ± 0.25cm and the distance between pisiform bone up to the division of superficial branch of ulnar nerve into proper and common digital branches was 1.36 ± 0.59 cm. The average distance from the origin of proper digital branch of ulnar nerve to the head of fifth metacarpal bone was 5.25 ± 0.59 cm. The length of common digital branch of ulnar nerve from its origin to division into 2 sensory branches was 4.31 ± 1.09 cm.
CONCLUSION
This study provides the metric parameters of the ulnar nerve in the hand from its significant bony landmarks which should be kept in mind during surgical procedures to minimize the incidence of injury to its branches. It would assist the orthopedic surgeon in the treatment of ulnar nerve compression in the Guyon's canal.
PubMed: 35145657
DOI: 10.1016/j.amsu.2022.103259 -
Skeletal Radiology Aug 2022To describe our techniques for ultrasound-guided injection of the pisotriquetral joint (PTJ), and to report our experience in a case series.
PURPOSE
To describe our techniques for ultrasound-guided injection of the pisotriquetral joint (PTJ), and to report our experience in a case series.
METHODS
Between 7/1/14 and 11/30/20, we performed 42 injections in 33 patients with ulnar-sided wrist pain, referred by clinicians who suspected the PTJ as the pain generator. There were 16 males and 17 females, average age 46.7 years. The patients were positioned in one of five ways: sitting with the hand maximally supinated; sitting with the hand maximally pronated; supine with the elbow flexed across the chest and the ulnar aspect of the wrist facing upward; supine with the elbow flexed, the arm externally rotated, and the ulnar aspect of the wrist facing upward; prone with the symptomatic hand at their side and the ulnar aspect of the wrist facing upward.
RESULTS
The procedures were performed by any of twelve fellowship-trained musculoskeletal radiologists. Fifteen patients reported immediate relief of symptoms, including 6 patients whose pisotriquetral joints were normal sonographically. Four patients underwent subsequent surgical excision of their pisiforms and the fifth underwent arthroscopic debridement of the pisotriquetral joint.
CONCLUSION
Ultrasound is a facile imaging modality for guiding pisotriquetral injections, which may be accomplished with a variety of patient positions and injection techniques.
Topics: Arthralgia; Carpal Joints; Female; Humans; Male; Middle Aged; Pisiform Bone; Ultrasonography, Interventional; Wrist Joint
PubMed: 35079865
DOI: 10.1007/s00256-022-03992-z -
The Journal of Hand Surgery... Dec 2021Aneurysmal bone cyst (ABC) is a benign expansile bone tumor without metastasis capability. Only 3-4% of ABCs occur in the hand and they mainly take place in metaphysis'... (Review)
Review
Aneurysmal bone cyst (ABC) is a benign expansile bone tumor without metastasis capability. Only 3-4% of ABCs occur in the hand and they mainly take place in metaphysis' of long bones like metacarpals or phalanges. Carpal ABCs have been reported as individual case reports in the literature due to rarity. A patient presented with pain in her right wrist. Magnetic resonance imaging revealed a well circumscribed one cm sized mass in the pisiform bone that resembled an aneurysmal bone cyst. Total pisiformectomy was performed. Treatment options are total excision or curettaging in ABCs. But rarity of these lesions may delay the diagnosis process for the inexperienced surgeon.
Topics: Bone Cysts, Aneurysmal; Bone Neoplasms; Female; Finger Phalanges; Humans; Magnetic Resonance Imaging; Pisiform Bone
PubMed: 34789109
DOI: 10.1142/S2424835521720231 -
The Journal of Hand Surgery Oct 2022Impaction fracture subluxation of the pisotriquetral joint producing arthrosis and ulnar triquetral osteochondral nonunion is a cause for ulnar wrist pain in batting...
Impaction fracture subluxation of the pisotriquetral joint producing arthrosis and ulnar triquetral osteochondral nonunion is a cause for ulnar wrist pain in batting athletes. Two cases of adolescent female softball players managed successfully with pisiform and triquetral fragment excision are reported.
Topics: Adolescent; Baseball; Carpal Joints; Female; Humans; Joint Dislocations; Osteoarthritis; Pisiform Bone; Triquetrum Bone; Wrist Joint
PubMed: 34538669
DOI: 10.1016/j.jhsa.2021.07.032 -
Journal of Medical Imaging and... Feb 2022
Topics: Humans; Pisiform Bone
PubMed: 33969624
DOI: 10.1111/1754-9485.13189 -
Hand Surgery & Rehabilitation Sep 2021Scaphoid fracture can evolve into scaphoid nonunion leading to wrist arthritis. Vascularized bone flaps used to treat scaphoid nonunion are supplied by delicate, small,...
Scaphoid fracture can evolve into scaphoid nonunion leading to wrist arthritis. Vascularized bone flaps used to treat scaphoid nonunion are supplied by delicate, small, or short arteries that are not always reliable. The pisiform bone has never been considered as a possible treatment of scaphoid nonunion since the traditionally harvested pedicle is too short. This study aimed to characterize the vascularization of the pisiform with the goal of developing a method of harvesting it with a longer pedicle that can be used as a graft to treat scaphoid nonunion. A cadaver study on 30 upper limbs was done in two parts: firstly, we dissected 20 cadaver specimens and documented the pisiform's vascularization (size, length, and articular surface) as well as anatomical characteristics of the dorsal ulnar artery; secondly, we used 10 cadaver specimens to study an experimental surgical procedure in which a vascularized pisiform graft is used to treat an artificially created nonunion and confirm its feasibility. The pisiform artery originated from the dorsal ulnar artery in all 20 dissections. Its average length of 4.036cm could be increased by 11% by ligating the upstream collateral branches from the dorsal ulnar artery. The pedicled vascularized pisiform flap was grafted to the scaphoid in 10 experimental procedures performed on fresh cadavers. The vascularized pisiform graft consists of a reliable vascular pedicle and well vascularized multi-cortical bone with a cartilaginous surface. However, more studies are needed to confirm the feasibility of this flap as an alternative for treating unstable scaphoid nonunion.
Topics: Fractures, Bone; Fractures, Ununited; Humans; Pisiform Bone; Scaphoid Bone; Upper Extremity
PubMed: 33798753
DOI: 10.1016/j.hansur.2021.02.003 -
Techniques in Hand & Upper Extremity... Mar 2021Pisotriquetral (PT) joint arthritis is a common cause of ulnar-sided wrist pain. Open pisiform excision is a well-established procedure and is indicated when the...
Pisotriquetral (PT) joint arthritis is a common cause of ulnar-sided wrist pain. Open pisiform excision is a well-established procedure and is indicated when the conservative treatment fails. Although arthroscopic visualization of the PT joint is part of the routine examination in a patient with ulnar-sided wrist pain, therapeutic arthroscopy of the PT joint is limited to one case in the literature through the standard dorsal portals. Arthroscopic pisiform excision is a novel technique described by the authors. The first aim of this procedure is pain relief maintaining wrist stability and strength. With this minimally invasive approach we believe that preserving the flexor carpi ulnaris and the PT ligament complex we maintain their biomechanical function, while at the same time, reducing scar tenderness and postoperative discomfort with better esthetic results and less recovery time. In addition to standard dorsal portals, a direct PT portal was used to have access to the PT space and as a working portal to complete the pisiform excision.
Topics: Arthralgia; Arthroscopy; Carpal Joints; Humans; Osteoarthritis; Pisiform Bone; Wrist Joint
PubMed: 33782357
DOI: 10.1097/BTH.0000000000000345 -
Journal of Orthopaedic Case Reports Sep 2020Chondroblastoma is a rare primary benign tumor of bone with male predominance and is typically seen in an epiphyseal location. The pisiform is a carpal bone and...
INTRODUCTION
Chondroblastoma is a rare primary benign tumor of bone with male predominance and is typically seen in an epiphyseal location. The pisiform is a carpal bone and chondroblastoma of the pisiform has not been reported in the literature to the best of our knowledge.
CASE PRESENTATION
An 18-year-old male presented with painful swelling over his right wrist with restriction of ulnar deviation. Based on magnetic resonance imaging findings, two diagnostic possibilities were entertained, namely, giant cell tumor of bone and chondroblastoma. Wide local excision was performed, and histopathology confirmed the diagnosis of chondroblastoma of the pisiform. After 2 years of follow-up, the patient has gained pain-free wrist movements post excision, and there are no signs of recurrence. The Modified Mayo Wrist Score of 75 (fair) improved to 100 (excellent).
CONCLUSION
Surgeon should always keep in mind the possibility of the tumor at the rare site and accurately diagnose the tumor with the help of imaging modalities and biopsy.
PubMed: 33489960
DOI: 10.13107/jocr.2020.v10.i06.1854 -
BMJ Case Reports Jan 2021A pisiform dislocation is an uncommon injury which can lead to significant morbidity if missed. The literature regarding pisiform dislocation is limited and largely from...
A pisiform dislocation is an uncommon injury which can lead to significant morbidity if missed. The literature regarding pisiform dislocation is limited and largely from case reports. In this case, we present a 51-year-old right-hand dominant male who sustained the injury after a fall. He attended the emergency department on the same day and a closed reduction was able to be performed under a haematoma block. On review in follow-up clinic the patient's symptoms had completely resolved.
Topics: Accidental Falls; Casts, Surgical; Closed Fracture Reduction; Humans; Joint Dislocations; Male; Middle Aged; Pisiform Bone; Treatment Outcome; Wrist Injuries
PubMed: 33408102
DOI: 10.1136/bcr-2020-237482