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The Journal of Hand Surgery, European... Sep 2023Carpal dislocations result from sequential disruption of the complex relationship between the bones and ligaments of the wrist. Injuries to the carpus occur via... (Review)
Review
Carpal dislocations result from sequential disruption of the complex relationship between the bones and ligaments of the wrist. Injuries to the carpus occur via predictable mechanisms, an understanding of which is critical to identify and treat these frequently missed patterns of injury and to avoid the sequela of chronic instability. Lunate dislocations are by far the most common, but isolated dislocation of other carpal bones can also occur. Open reduction and internal fixation still remains the gold standard for treatment regardless of the debate around the specific approaches. These high-energy injuries are associated with significant long-term morbidity even when identified promptly and appropriately treated. This review will focus on the evaluation and management of common forms of carpal dislocations.
Topics: Humans; Joint Dislocations; Wrist; Carpal Bones; Disease Progression; Fracture Fixation, Internal
PubMed: 37704022
DOI: 10.1177/17531934231183260 -
RoFo : Fortschritte Auf Dem Gebiete Der... Feb 2021The term "carpal instability" describes different debilitating wrist conditions, in which the carpus is unable to maintain its physiological range of motion and load... (Review)
Review
BACKGROUND
The term "carpal instability" describes different debilitating wrist conditions, in which the carpus is unable to maintain its physiological range of motion and load transfer. Depending on the cause and location of the dysfunction, four groups can be defined: dissociative, non-dissociative, complex, and adaptive carpal instability. As the most common form by far, dissociative carpal instability can further be categorized as dorsal or palmar intercalated segment instability, contingent on the afflicted interosseous ligament.
METHOD
This review article outlines the different entities of carpal instability, their pathophysiology, and their clinical presentation. It further discusses the diagnostic significance of different imaging methods as well as the established treatment options for each form of instability in context with the current literature.
RESULTS AND CONCLUSION
Early detection and treatment of carpal instability are essential for preventing carpal osteoarthritis. Traumatic lesions of the scapholunate interosseous ligament are the most frequent cause of instability. They can occur in an isolated fashion or in context with other carpal injuries. While stress imaging and fluoroscopy facilitate the differentiation between dynamic and static forms of carpal instability, only MRI and CT/MR arthrography can directly reveal the extent of ligament discontinuity.
KEY POINTS
· Carpal instability can manifest only in motion (dynamic) or at rest (static).. · Dissociative forms must be distinguished from non-dissociative, adaptive, or complex entities.. · Most instabilities are related to traumatic injuries or CPPD arthropathy.. · Fluoroscopy, stress imaging, and MR and CT arthrography are helpful for diagnosis..
CITATION FORMAT
· Grunz JP, Gietzen CH, Grunz K et al. Imaging of Carpal Instabilities. Fortschr Röntgenstr 2021; 193: 139 - 150.
Topics: Arthrography; Carpal Bones; Early Diagnosis; Fluoroscopy; Humans; Joint Instability; Ligaments; Magnetic Resonance Imaging; Osteoarthritis; Range of Motion, Articular; Tomography, X-Ray Computed; Wrist Injuries
PubMed: 32882727
DOI: 10.1055/a-1219-8158 -
Orthopaedics & Traumatology, Surgery &... Feb 2015Painful wrist osteoarthritis can result in major functional impairment. Most cases are related to posttraumatic sequel, metabolic arthropathies, or inflammatory joint... (Review)
Review
Painful wrist osteoarthritis can result in major functional impairment. Most cases are related to posttraumatic sequel, metabolic arthropathies, or inflammatory joint disease, although wrist osteoarthritis occurs as an idiopathic condition in a small minority of cases. Surgery is indicated only when conservative treatment fails. The main objective is to ensure pain relief while restoring strength. Motion-preserving procedures are usually preferred, although residual wrist mobility is not crucial to good function. The vast array of available surgical techniques includes excisional arthroplasty, limited and total fusion, total wrist denervation, partial and total arthroplasty, and rib-cartilage graft implantation. Surgical decisions rest on the cause and extent of the degenerative wrist lesions, degree of residual mobility, and patient's wishes and functional demand. Proximal row carpectomy and four-corner fusion with scaphoid bone excision are the most widely used surgical procedures for stage II wrist osteoarthritis secondary to scapho-lunate advanced collapse (SLAC) or scaphoid non-union advanced collapse (SNAC) wrist. Proximal row carpectomy is not indicated in patients with stage III disease. Total wrist denervation is a satisfactory treatment option in patients of any age who have good range of motion and low functional demands; furthermore, the low morbidity associated with this procedure makes it a good option for elderly patients regardless of their range of motion. Total wrist fusion can be used not only as a revision procedure, but also as the primary surgical treatment in heavy manual labourers with wrist stiffness or generalised wrist-joint involvement. The role for pyrocarbon implants, rib-cartilage graft implantation, and total wrist arthroplasty remains to be determined, given the short follow-ups in available studies.
Topics: Arthrodesis; Arthroplasty; Biomechanical Phenomena; Bone Transplantation; Carpal Bones; Decision Trees; Denervation; Humans; Osteoarthritis; Prostheses and Implants; Radiography; Range of Motion, Articular; Wrist Joint
PubMed: 25596986
DOI: 10.1016/j.otsr.2014.06.025 -
Hand (New York, N.Y.) Sep 2016Carpal coalition and metacarpal synostosis are uncommon congenital anomalies of the carpus and hand. A comprehensive review of the literature was performed to help... (Review)
Review
Carpal coalition and metacarpal synostosis are uncommon congenital anomalies of the carpus and hand. A comprehensive review of the literature was performed to help guide surgical and non-surgical treatment of carpal coalition and metacarpal synostosis. The embryology, epidemiology, medical and surgical management, and associated outcomes are detailed. Most patients with these disorders will likely benefit from conservative measures. Surgery should be considered in patients with pain and limitations in wrist and hand function.
Topics: Carpal Bones; Humans; Metacarpal Bones; Radiography; Synostosis; Wrist Joint
PubMed: 27698627
DOI: 10.1177/1558944715614860 -
Hand Clinics Aug 2015Carpal instability is a complex array of maladaptive and posttraumatic conditions that lead to the inability of the wrist to maintain anatomic relationships under normal... (Review)
Review
Carpal instability is a complex array of maladaptive and posttraumatic conditions that lead to the inability of the wrist to maintain anatomic relationships under normal loads. Many different classification schemes have evolved to explain the mechanistic evolution and pathophysiology of carpal instability, including 2 of the most common malalignment patterns: volar intercalated segment instability and the more common dorsal intercalated segment instability. Recent classifications emphasize the relationships within and between the rows of carpal bones. Future research is likely to unify the disparate paradigms used to describe wrist instability.
Topics: Biomechanical Phenomena; Bone Malalignment; Carpal Bones; Carpal Joints; Humans; Joint Instability; Ligaments, Articular
PubMed: 26205700
DOI: 10.1016/j.hcl.2015.04.011 -
Orthopaedics & Traumatology, Surgery &... Feb 2014The complexity of the carpus explains the difficulty treating carpal injuries. Lesions are dominated by perilunate dislocation, scapholunate dislocation, and scaphoid... (Review)
Review
The complexity of the carpus explains the difficulty treating carpal injuries. Lesions are dominated by perilunate dislocation, scapholunate dislocation, and scaphoid fractures. The other injuries are trivial. Symptoms include pain and loss of wrist strength, reversible for an acute and well-treated lesion. Too often, these ligament injuries are diagnosed late. For delays longer than 6 weeks, ligament repair is ineffective. These old, complex lesions are potentially highly arthritic in the radiocarpal and mediocarpal joints. Improvements in wrist surgery have mitigated these chronic lesions. Various surgical techniques can preserve a functional wrist; wrist arthrodesis is no longer the only solution for these arthritic wrists. Over the past decade, arthroscopy has contributed to better understanding the injuries of the carpus as well as to better healing them. For acute or chronic ligament injuries without degenerative osteoarthritis, arthroscopy is the treatment of the future. This technique involves a long learning curve and the various arthroscopic techniques must be validated.
Topics: Adult; Arthrodesis; Arthroscopy; Bone Nails; Carpal Bones; Carpal Joints; Fracture Fixation, Internal; Fractures, Bone; Humans; Joint Dislocations; Joint Instability; Joint Prosthesis; Learning Curve; Ligaments, Articular; Osteoarthritis; Osteonecrosis; Postoperative Complications; Reoperation; Sprains and Strains; Wrist Joint
PubMed: 24461233
DOI: 10.1016/j.otsr.2013.06.015 -
Medicinski Glasnik : Official... Feb 2021Aim To illustrate the surgical treatment of bilateral post-traumatic scaphoid fracture. Methods We came across a young student, who sustained bilateral, undisplaced...
Aim To illustrate the surgical treatment of bilateral post-traumatic scaphoid fracture. Methods We came across a young student, who sustained bilateral, undisplaced scaphoid waist fractures following a fall during a football match. Despite careful clinical and radiographic evaluation by four views at the Accident and Emergency (A&E) Department, we initially performed only the diagnosis of the left scaphoid fracture treating it with a percutaneous Acutrack headless screw. Eight months later this patient returned to the A&E department due to a new trauma to his right wrist with the onset of painful symptoms: cystic scaphoid non-union. No pain had been reported on the wrist in those months. Results We performed osteosynthesis with Herbert headless screw through an extended volar approach placing a non-vascularized cortico-spongious bone grafts taken from radius. Periodic follow up by clinical examination, X-ray and CT scan with evidence of bone healing was performed. Conclusion Bilateral scaphoid fractures are rarely encountered, mostly as stress fractures in athletes and manual workers. If left untreated, arthritis, deformity, and instability can lead to significant disability. Comprehensive imaging should be done in case of suspected scaphoid fractures, especially after a trauma, even in the presence of modest symptoms, as failure to do so may lead to missed fracture. Considering what was exposed, the radiographic check on the right wrist repeated about two weeks after the trauma would have avoided a missed diagnosis, even in the absence of reported clinical symptoms. We therefore recommend to repeat the radiographic examination in all situations like these.
Topics: Bone Screws; Fracture Fixation, Internal; Fractures, Bone; Fractures, Ununited; Humans; Scaphoid Bone; Wrist Injuries
PubMed: 33480228
DOI: 10.17392/1332-21 -
Sultan Qaboos University Medical Journal May 2020Memorising human anatomy structures remains a challenge for nursing students. Educators endeavour to make human anatomy interesting and easy to memorise. Various...
Memorising human anatomy structures remains a challenge for nursing students. Educators endeavour to make human anatomy interesting and easy to memorise. Various instructional approaches can be used to help students enhance their memory. Mnemonics, for example, are well-established educational strategies that have proven useful in the encoding, retention and retrieval of anatomical terms. The carpal and tarsal bones are some of the anatomical structures that prove challenging to nursing students' study of anatomy. Although available online to students, most of the accessible mnemonics are in English and non-native English-speaking students (students who are native Arabic-speakers) might find them difficult to understand. Therefore, we have created two simple Arabic mnemonics that can simplify the memorisation of the carpal and tarsal bones. We believe that Arabic mnemonics effectively enhance memorisation by linking the new learning material to familiar information.
Topics: Carpal Bones; Education, Medical, Undergraduate; Human Body; Humans; Memory Consolidation; Tarsal Bones
PubMed: 32655916
DOI: 10.18295/squmj.2020.20.02.014 -
Anales Del Sistema Sanitario de Navarra Dec 2016Osteoblastoma is an infrequent primary osseous tumour. Its presentation in the upper extremities and more specifically in the carpal bones is unusual. We present a case...
Osteoblastoma is an infrequent primary osseous tumour. Its presentation in the upper extremities and more specifically in the carpal bones is unusual. We present a case of osteoblastoma localized in the hamate bone and review the treatment realized in this infrequent localization. A young male patient with pain and swelling in the back of his hand of one year’s evolution, resistant to medical treatment. Complementary tests showed lytic tumefaction in the hamate bone with non-aggressive characteristics. It was treated by curettage and filling the iliac crest with autologous graft. The pathological anatomical study diagnosed that it was a case of osteoblastoma. The result was satisfactory, with total disappearance of the pain and a radiological image of complete restitution of the osseous defect, with no signs of recurrence after 4 years. The treatment should be curettage plus autologous graft. Conversely, resection of the affected bone can be considered in cases with aggressive data.
Topics: Adult; Bone Neoplasms; Hamate Bone; Humans; Male; Osteoblastoma
PubMed: 28032879
DOI: 10.23938/ASSN.0246 -
IEEE Transactions on Bio-medical... Feb 2022The morphology of the carpal arch implicates the available space for the median nerve within the carpal tunnel. The purposes of this study were to 1) reconstruct the...
OBJECTIVE
The morphology of the carpal arch implicates the available space for the median nerve within the carpal tunnel. The purposes of this study were to 1) reconstruct the three-dimensional (3D) carpal arch by robot-assisted ultrasonography with a linear array transducer using cadaveric hands, and 2) investigate the 3D morphological properties of the carpal arch.
METHODS
An ultrasound probe with two-dimensional (2D) linear array was integrated on a robotic arm and maneuvered over the cadaveric carpal tunnels to scan the entire transverse carpal ligament and its osseous attachments to carpal bones. The acquired series of 2D ultrasound images together with robot positioning were utilized to reconstruct the 3D carpal arch for morphometric analyses.
RESULTS
Total carpal arch volume was 1099.4 ± 163.2 mm with the distal, middle, and proximal regions contributing 18.2 ± 1.5%, 32.7 ± 1.2%, and 49.1 ± 2.3%, respectively. The ligament surface area was 420.1 ± 63.9 mm. The carpal arch width, height, curvature, length, area, and palmar bowing index progressively increased from the distal to proximal locations within the tunnel (p < 0.01).
CONCLUSION
The incorporation of the robot technology with the ultrasound system advanced the applications of traditional 2D ultrasound imaging for a 3D carpal arch reconstruction, allowing for comprehensive morphological assessment of the carpal arch.
SIGNIFICANCE
The developed workflow can be used for the reconstruction and analysis of other anatomical features in vivo.
Topics: Carpal Bones; Hand; Humans; Robotics; Ultrasonography; Wrist Joint
PubMed: 34460363
DOI: 10.1109/TBME.2021.3108720