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Journal of Clinical Medicine Feb 2024: Metacarpal non-unions are complex hand defects that can lead to severe hand impairment. Treatment may require the use of artificial or autologous bone grafts. This... (Review)
Review
: Metacarpal non-unions are complex hand defects that can lead to severe hand impairment. Treatment may require the use of artificial or autologous bone grafts. This systematic review aims to describe the outcomes of bone grafting following metacarpal non-union in an attempt to establish an optimal therapeutic protocol for this complication. : A systematic review was conducted in adherence with PRISMA guidelines. Data collection and analysis were performed in duplicate and confirmed by a third investigator. Our primary outcomes focused on radiological time to bone fusion and rates of non-union. Additionally, functional outcomes and complications were analyzed as means of central tendency. : Eighteen studies were included in the systematic review, accounting for a total of 47 patients. The average follow-up time was 12.4 months. Fourteen studies analyzed radiological outcomes, with atrophic non-union representing the most common type. The time to bone fusion, assessed radiologically, following bone graft was an average of 6.9 months (n = 14), with a 100% rate of union in 42 patients. Regarding patient-reported pain improvement, 76% of patients experienced pain relief. Moreover, all patients reported a complete subjective return to baseline hand function. Adverse events, limited to hematoma and seroma, were seen in three patients, representing a complication rate of 11.8% in the examined population. : Metacarpal non-union can be treated successfully via vascularized and non-vascularized bone grafting. Based on the available evidence, bone grafts demonstrate favorable union rates, post-operative pain reduction, hand function recovery, earlier bone fusion times, and minimal complications in the context of metacarpal non-union management.
PubMed: 38398461
DOI: 10.3390/jcm13041148 -
Animals : An Open Access Journal From... Feb 2024This case report describes a novel procedure using the Isolock Intrauma implant system for treating medial instability of the carpometacarpal and tarsometatarsal joints,...
This case report describes a novel procedure using the Isolock Intrauma implant system for treating medial instability of the carpometacarpal and tarsometatarsal joints, as demonstrated in in two dogs. A 9-year-old spayed female Spanish greyhound presented with a non-weight-bearing right hindlimb following a trauma. The clinical and radiological findings confirmed medial tarsometatarsal instability consistent with valgus deviation of the tarsus and the opening of the joint line on the medial aspect from the first to the third tarsometatarsal joints. A 4-year-old female Drahthaar presented with a non-weight-bearing left forelimb, swelling of the carpus and valgus instability. Radiological examination revealed a widening of the spaces between the intermedioradial carpal bone, second carpal bone and metacarpal bone II, confirming the medial carpometacarpal instability. In both cases, the Isolock system, an implant including ultra-high-molecular-weight polyethylene suture (UHMWPE), was used to reinforce the medial joint structures. Minor short-term complications were observed, such as swelling of the tarsal surgical site and hyperextension of the carpus, but these resolved spontaneously. No lameness or major complications were reported five months postoperatively. Carpometacarpal and tarsometatarsal instabilities are rare diseases in dogs as compared to subluxations of the other joints of the carpus and tarsus. There are no previous reports regarding the use of a UHMPWE implant for the treatment of these rare joint injuries, though the present case report suggests the validity and efficacy of the Isolock Intrauma implant for restoring carpal and tarsal stability and preserving joint mobility.
PubMed: 38396544
DOI: 10.3390/ani14040577 -
Case Reports in Plastic Surgery & Hand... 2024Dieterich's disease or avascular osteonecrosis of the metacarpal head is rare and not often described in the literature. It affects typically the middle of metacarpal...
Dieterich's disease or avascular osteonecrosis of the metacarpal head is rare and not often described in the literature. It affects typically the middle of metacarpal bones and can occur at all age groups. A case of a teenager with chronic pain of the third and fourth metacarpal head is presented.
PubMed: 38380433
DOI: 10.1080/23320885.2024.2316026 -
Veterinary Medicine and Science Mar 2024A 15-year-old Cocker Spaniel was referred to for the evaluation of left forelimb lameness. Radiographic and computed tomography examinations revealed osteolysis of the...
A 15-year-old Cocker Spaniel was referred to for the evaluation of left forelimb lameness. Radiographic and computed tomography examinations revealed osteolysis of the proximal left third, fourth and fifth metacarpal bones and pathological fractures of the proximal left fourth metacarpal bone. Histopathological examination via bone biopsy did not provide a definitive diagnosis, and the owner elected limb-sparing surgery. The fourth metacarpal bone and digits were amputated. Subsequently, autologous bone grafts were performed on the lytic area of the third and fifth metacarpal bones. The dog showed improvement in gait 7 weeks after reconstructive surgery. Chronic non-bacterial osteomyelitis (CNO) was diagnosed by exclusion. To the best of our knowledge, CNO has not been previously reported in dogs.
Topics: Dogs; Animals; Surgery, Plastic; Tomography, X-Ray Computed; Osteomyelitis; Dog Diseases
PubMed: 38379264
DOI: 10.1002/vms3.1383 -
BMC Musculoskeletal Disorders Feb 2024Low bone mineral density affects 53% of women over age 65 in the US, yet many are unaware and remain untreated. Underdiagnosis of forearm osteoporosis and related...
BACKGROUND
Low bone mineral density affects 53% of women over age 65 in the US, yet many are unaware and remain untreated. Underdiagnosis of forearm osteoporosis and related fragility fractures represent missed warning signs of more deadly, future fractures. This study aimed to determine if hand radiographs could serve as early, simple screening tools for predicting low forearm bone mineral density (BMD).
METHODS
We evaluated posterior-anterior (PA) hand radiographs (x-rays) and Dual-energy X-ray absorptiometry (DXA) scans of 43 participants. The ratio of the intramedullary cavity to total cortical diameter of the second metacarpal (second metacarpal cortical percentage (2MCP)) was used as a potential diagnostic marker. Mixed-effects linear regression was performed to determine correlation of 2MCP with BMD from various anatomic regions. Repeated measures ANOVAs were used to compare BMD across sites. An optimal 2MCP cutoff for predicting forearm osteopenia and osteoporosis was found using Receiver Operating Curves.
RESULTS
2MCP is directly correlated with BMD in the forearm. The optimal 2MCP of 48.3% had 80% sensitivity for detecting osteoporosis of the 1/3 distal forearm. An 2MCP cutoff of 50.8% had 84% sensitivity to detect osteoporosis of the most distal forearm. Both 2MCP cutoffs were more sensitive at predicting forearm osteoporosis than femoral neck T-scores.
CONCLUSIONS
These findings support the expansion of osteoporosis screening to include low-cost hand x-rays, aiming to increase diagnosis and treatment of low forearm BMD and fractures. Proposed next steps include confirming the optimal 2MCP cutoff at scale and integrating automatic 2MCP measurements into PAC systems.
Topics: Humans; Female; Aged; Bone Density; Forearm; Retrospective Studies; Prospective Studies; Bone Diseases, Metabolic; Osteoporosis; Absorptiometry, Photon; Fractures, Bone
PubMed: 38378510
DOI: 10.1186/s12891-023-07127-w -
European Journal of Orthopaedic Surgery... Apr 2024The photodynamic bone stabilization system (PBSS) was was developed in 2010, and in 2018 gained FDA approval in the United States. Given its relative novelty, our... (Review)
Review
INTRODUCTION
The photodynamic bone stabilization system (PBSS) was was developed in 2010, and in 2018 gained FDA approval in the United States. Given its relative novelty, our analysis sought to analyze the available literature exploring the indications, outcomes, and complications of the PBSS.
METHODS
We performed a systematic review (PROSPERO registration of study protocol: CRD42022363065, October 8th, 2022). PubMed, EBSCOHost, and Google Scholar electronic databases were queried to identify articles evaluating PBSS in the treatment of pathologic or traumatic fractures between January 1 2010 and 15 October 2022. The quality of the included studies was assessed using the Methodological Index for Nonrandomized Studies tool.
RESULTS
Our initial search yielded 326 publications, which were then screened for appropriate studies that aligned with the purpose of our review. A total of thirteen studies, comprising seven case series, four case reports, and two cohort studies. The total sample size of the included studies consisted of 345 patients, with 242 females (70%) and 103 males (30%). The implants were most commonly utilized in the humerus (41%), radius (12%), and metacarpal (12%). The most common complications were related to broken implants (5%) and dislocation (1%). Most studies reported complete fracture healing and return of full strength and range of motion.
CONCLUSION
Despite being a relatively novel technology, PBSS appears to be a viable option for fracture stabilization. Most studies included in our analysis reported complete fracture healing and return of function with minimal complications.
Topics: Male; Female; Humans; Fractures, Spontaneous; Fractures, Bone; Fracture Healing; Joint Dislocations; Patient Reported Outcome Measures
PubMed: 38376586
DOI: 10.1007/s00590-024-03833-w -
JBJS Essential Surgical Techniques 2023The all-dorsal scapholunate reconstruction technique is indicated for the treatment of scapholunate injuries in cases in which the carpus is reducible and there is no...
BACKGROUND
The all-dorsal scapholunate reconstruction technique is indicated for the treatment of scapholunate injuries in cases in which the carpus is reducible and there is no arthrosis present. The goal of this procedure is to reconstruct the torn dorsal portion of the scapholunate ligament in order to stabilize the scaphoid and lunate.
DESCRIPTION
A standard dorsal approach to the wrist, extending from the third metacarpal distally to the distal radioulnar joint, is utilized. The extensor pollicis longus is transposed and retracted radially, and the second and fourth extensor compartments are retracted ulnarly. A Berger ligament-sparing capsulotomy is utilized to visualize the carpus. Volarly, an extended open carpal tunnel release is also utilized to relieve any median nerve compression and to aid in reduction. The contents of the carpal tunnel can be retracted radially, allowing for visualization of the carpal bones. Joystick pins are placed in order to reduce the scaphoid and lunate. Reduction is held provisionally by clamping the pins until 4 pins can be placed across the carpal bones. For scapholunate reconstruction, 3 holes are made: in the lunate, proximal scaphoid, and distal scaphoid. Suture tape is then utilized to hold the scaphoid and lunate in their proper position. The dorsal wrist capsule and extensor retinaculum are repaired during closure. The pins are cut near the skin and are removed in 8 to 12 weeks.
ALTERNATIVES
Several other methods of scapholunate reconstruction have been described, including capsulodesis, tenodesis, and bone-tissue-bone repairs. Additionally, in patients who are poor candidates for scapholunate reconstruction, wrist-salvage procedures can be utilized as the primary treatment.
RATIONALE
Scapholunate reconstruction has the advantage of preserving the native physiologic motion of the wrist, in contrast to the many different wrist-salvage procedures that include arthrodesis or arthroplasty. Avoiding arthrodesis is specifically advantageous in patients who have not yet developed arthrosis of the wrist bones.
EXPECTED OUTCOMES
Outcomes of scapholunate reconstruction vary widely; however, there is a nearly universal decrease in range of motion and strength of the wrist. Wrist range of motion is typically 55% to 75% of the contralateral side, and grip strength is typically approximately 65% of the contralateral side. In a prior study, 50% to 60% of patients whose work involved physical labor were able to return to their same level of full-time work. Disabilities of the Arm, Shoulder and Hand scores average between 24 and 30. Specific patients at risk for inferior outcomes are those with delayed surgical treatment, poor carpal alignment following reduction, or open injuries.
IMPORTANT TIPS
Patients are counseled preoperatively regarding the likelihood of permanent wrist stiffness and the possibility of scapholunate diastasis even in the setting of technically successful repair.Traction and dorsally directed pressure on the lunate through an extended carpal tunnel incision can aid in reduction of the lunate.The joystick pin position in the dorsal scaphoid is angulated from distal to proximal and that in the lunate is angulated from proximal to distal in order to help correct flexion of the scaphoid and extension of the lunate by clamping together the Kirschner wires. Modifying the distance of the clamp from the carpus can allow precision in the degree of scapholunate angle fixation.Intercarpal Kirschner wire fixation of the scapholunate, lunotriquetral, and midcarpal joints (scaphocapitate and triquetrohamate) is best performed with 0.062-in (1.6-mm) Kirschner wires. The insertion angle is best visualized when the Kirschner wire is introduced from inside the incision through the skin, "inside out," in order to best envision the trajectory on the dorsal carpus and define the starting point on the bone. The Kirschner wire is then advanced through the carpus from outside-in at a slightly more volarly translated (but not angulated) position. The Kirschner wires are then cut beneath the skin at a depth that will allow them to be retrieved but will not cause them to become exposed once swelling decreases.The wrist is generally immobilized until the pins are removed at 3 months postoperatively.
ACRONYMS AND ABBREVIATIONS
ROM = range of motionK-wire = Kirschner wireDASH = Disabilities of the Arm, Shoulder and HandDISI = dorsal intercarpal ligament instability.
PubMed: 38357468
DOI: 10.2106/JBJS.ST.23.00031 -
Ideggyogyaszati Szemle Jan 2024
Body mass index (BMI) is positively correlated with the frequency of carpal tunnel syndrome (CTS). However, there are different types of obesity, and the localization...
BACKGROUND AND PURPOSE
Body mass index (BMI) is positively correlated with the frequency of carpal tunnel syndrome (CTS). However, there are different types of obesity, and the localization of adipose tissue differs between the genders. In this study, we purposed to investigate whether there was an association between the amount of local adipose tissue thickness and anthropometry in upper extremity with the presence and/or electrophysiological severity of CTS on both genders.
.METHODS
Our study included 150 patients who were diagnosed with CTS clinically and electrophysiologically and 165 healthy controls. The biceps and triceps skinfold thickness, the diameters of the wrist and metacarpal joints, and the upper arm circumferences over the belly of the biceps muscle were measured by using skinfold caliper and measuring cylinder. All data were analyzed by using the Statistics Open For All package (SofaStats) programme. To detect the role of anthropometric indexes, we used multivariable multinomial logistic regression models.
.RESULTS
We revealed that BMI, biceps and triceps adipose tissue thicknesses were higher in females and also in patients with CTS. There was a positive correlation between electrophysiological grades of CTS and BMI with logistic regression analyzes. The mean Wrist circumference/Metacarpopharengeal Circumference ratio and biceps circumference were higher in moderate CTS groups. Metacarpofarengeal circumference was smaller in mild and moderate CTS cases compared to healthy ones.
.CONCLUSION
We suggest that the differences between the anatomical bone structure and local adiposity between the genders may play an important role in the occurrence of CTS. Moreover, the structures of proximal muscle groups and distal metacarpal joints may contribute both to the development and severity of CTS.
.Topics: Humans; Female; Male; Carpal Tunnel Syndrome; Anthropometry; Wrist; Body Mass Index; Obesity; Adipose Tissue
PubMed: 38321859
DOI: 10.18071/isz.77.0005 -
Journal of Hand Surgery Global Online Jan 2024The purpose of this study is to generate validated prediction rules for metacarpal lengths that can be applied without the need for computation tools to assist with...
PURPOSE
The purpose of this study is to generate validated prediction rules for metacarpal lengths that can be applied without the need for computation tools to assist with restoration of anatomic length after fracture and utilizes only ipsilateral metacarpals.
METHODS
The anatomic lengths of all hand bones in 50 hands (25 men, 25 women) were used along with linear regression subset analysis to determine which metacarpals are the most predictive of each other. The most predictive metacarpals were then used to generate simple addition and subtraction prediction rules via simplifying the linear equation generated with linear regression analysis. Those rules were then applied to subsequent test cases, and percent accuracy within various cutoffs were analyzed and compared to the accuracy when using the contralateral side.
RESULTS
The prediction rules were generated and were found to be identical for both men and women. When applied to the test cases, the estimated metacarpal lengths were within 3 mm of the actual value in 97.5% of the cases for women and 90% of the cases for men compared to 95% when using the contralateral side.
CONCLUSION
The simple additional and subtraction rules generated in this analysis were as good as or superior to using the contralateral side in all cases for women and were as good as or superior to using the contralateral side in for metacarpals 3-5 for men.
CLINICAL RELEVANCE
Using these simple estimating rules may be superior to using the contralateral side in most cases and provides a secondary method for determining anatomic lengths when contralateral radiographs are not available or when contralateral radiographs were obtained in different enough conditions such that the lengths may not be representative of the hand of interest.
PubMed: 38313627
DOI: 10.1016/j.jhsg.2023.09.006