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Journal of Hand Surgery Global Online Mar 2020This study aimed to report the outcomes of patients with stage III Kienböck disease after treatment with a vascularized bone graft (VBG) to the lunate combined with...
Vascularized Bone Graft to the Lunate Combined with Shortening of the Capitate and Radius for Treatment of Advanced Kienböck Disease After a Follow-Up for More Than 10 Years.
PURPOSE
This study aimed to report the outcomes of patients with stage III Kienböck disease after treatment with a vascularized bone graft (VBG) to the lunate combined with capitate shortening osteotomy (CS) after a more than 10-year follow-up.
METHODS
A VBG to the lunate was combined with CS in 10 patients with stage III Kienböck disease (6 patients with stage IIIA and 4 with stage IIIB). We performed VBG, CS, and radial shortening osteotomy (RS) on 7 patients. Among them, 4 had undergone RS previously. The passive wrist extension angle and wrist flexion angle, grip strength (GS), carpal height ratio, Stahl index, visual analog scale of wrist pain, and Mayo modified wrist score were assessed before surgery and at the final follow-up.
RESULTS
The flexion angle decreased markedly after surgery, when GS increased in all 10 patients. Radiographic examinations revealed that the carpal height ratio decreased in 9 of 10 patients, whereas the Stahl index increased in 8 patients and remained unchanged in 2. The oldest 3 of 7 patients who underwent VBG, CS, and RS exhibited fusion of the proximal carpals except the pisiform. The mean visual analog scale decreased from 27.6 before surgery to 5.7 afterward. The Mayo modified wrist score improved in 9 patients after surgery and remained unchanged in one.
CONCLUSIONS
In stage III Kienböck disease, VBG to the lunate combined with CS relieved wrist pain and increased GS and lunate height but was followed by severely restricted wrist motion. Fusion of the proximal carpals developed in 3 of 7 patients who received VBG with CS and RS.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic Ⅳ.
PubMed: 35415486
DOI: 10.1016/j.jhsg.2019.09.012 -
Genes & Development Dec 1993Hox A11 is one of the expanded set of vertebrate homeo box (Hox) genes with similarities to the Drosophila homeotic gene, Abdominal-B (Abd-B). These Abd-B-type Hox genes...
Hox A11 is one of the expanded set of vertebrate homeo box (Hox) genes with similarities to the Drosophila homeotic gene, Abdominal-B (Abd-B). These Abd-B-type Hox genes have been shown to be expressed in the most caudal regions of the developing vertebrate embryo and in overlapping domains within the developing limbs, suggesting that these genes play important roles in pattern formation in both appendicular and axial regions of the body. In this report whole-mount in situ hybridization in mouse embryos gave a precise description of Hox A11 gene expression in the developing limbs and in the axial domain of the developing body. In addition, we generated a targeted mutation in Hox A11 and characterized the resulting phenotype to begin to dissect developmental functions of the Abd-B subfamily of Hox genes. Hox A11 mutant mice exhibited double homeotic transformations, with the thirteenth thoracic segment posteriorized to form an additional first lumbar vertebra and with the sacral region anteriorized, generating yet another lumbar segment. Furthermore, skeletal malformations were observed in both forelimbs and hindlimbs. In mutant forelimbs, the ulna and radius were misshapen, the pisiform and triangular carpal bones were fused, and abnormal sesamoid bone development occurred. In mutant hindlimbs the tibia and fibula were joined incorrectly and malformed at their distal ends. Also, an enlarged sesamoid developed ventral to the tibiale bone. Both heterozygous and homozygous mice displayed mutant phenotypes adding an additional level of complexity to the Hox code hypothesis.
Topics: Animals; Base Sequence; Embryonic and Fetal Development; Extremities; Gene Expression; Genes, Homeobox; Limb Deformities, Congenital; Mice; Mice, Inbred C57BL; Mice, Mutant Strains; Molecular Sequence Data; Mutation; Phenotype
PubMed: 7902826
DOI: 10.1101/gad.7.12a.2318 -
Acta Orthopaedica Et Traumatologica... Aug 2016Osteoid osteoma is an uncommon benign bone-forming tumor of the musculoskeletal system but it is the most common primary bone tumor of the carpal region. However, only...
BACKGROUND
Osteoid osteoma is an uncommon benign bone-forming tumor of the musculoskeletal system but it is the most common primary bone tumor of the carpal region. However, only seven cases of its pisiform involvement have been described.
CASE
We present a 19 year-old male patient with osteoid osteoma of the pisiform which initially could not be detected in any diagnostic study for long standing wrist pain. The patient was treated with excision and curettage. In 1 year of follow-up, the patient was asymptomatic without recurrence.
CONCLUSION
In cases with long standing ulnar wrist pain, one should consider osteoid osteoma of the pisiform in differential diagnosis. If an OO is suspected, thin slice CT scan in initial evaluation would be valuable in preventing the patient from misdiagnosis or delay in diagnosis.
Topics: Arthralgia; Bone Neoplasms; Humans; Magnetic Resonance Imaging; Male; Osteoma, Osteoid; Pisiform Bone; Tomography, X-Ray Computed; Wrist Joint; Young Adult
PubMed: 27555463
DOI: 10.1016/j.aott.2016.07.005 -
Plastic and Reconstructive Surgery.... Nov 2018Guyon's syndrome results from a lesion of the ulnar nerve at the wrist caused by several conditions. The most common causes are ganglion, lipomas, fractures of the...
Guyon's syndrome results from a lesion of the ulnar nerve at the wrist caused by several conditions. The most common causes are ganglion, lipomas, fractures of the radius or pisiform bone, occupational trauma, neuritis, musculotendinous arch, and diseases of the ulnar artery. The clinical presentation varies with the site of lesion, as described by Sean and McClain in 1969, and can involve combined sensory and motor deficits, motor deficit alone, or sensory deficit alone. We present a case of bilateral Guyon's canal syndrome caused by a lipoma with Pacinian corpuscles on both wrists. Patient presented with sensory deficit as it is described by Shea and McClain with a negative electroneuromyography for ulnar compression. Articles correlating clinical presentation, etiology, and electrophysiological findings relating to ulnar nerve compression on the wrist are still uncommon in the literature.
PubMed: 30881781
DOI: 10.1097/GOX.0000000000001946 -
Medicine Nov 2018No surgical procedure perfectly treats advanced Kienböck disease. Although vascularized os pisiform transferring (VOPT) is one of the main therapeutic approaches,...
No surgical procedure perfectly treats advanced Kienböck disease. Although vascularized os pisiform transferring (VOPT) is one of the main therapeutic approaches, reports on long-term follow-up and case series for this technique are scarce.We collected postoperative results in 11 patients with advanced Kienböck disease who underwent VOPT between 1986 and 2001 in our Hospital. Follow-up durations ranged from 15 to 26 years.At the last follow-up, excellent and good results were found in 81.8% according to the Modified Green and O'Brien score. Postoperative imaging revealed significantly reduced pisiform bone; carpal height ratio and Nattrass index were decreased, while the radioscaphoid angle was increscent, compared with preoperative and mid-term follow-up results.The favorable long-term results demonstrated that VOPT is a dependable and durable procedure for the treatment of advanced Kienböck disease, with pain relief and functional improvement despite some radiographic findings such as wrist osteoarthritis occurrence.
Topics: Adult; Female; Follow-Up Studies; Humans; Male; Middle Aged; Osteonecrosis; Pisiform Bone; Postoperative Complications; Retrospective Studies; Time Factors; Young Adult
PubMed: 30508905
DOI: 10.1097/MD.0000000000013229 -
Journal of Ultrasonography Sep 2015Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and a frequent cause of sick leaves because of work-related hand overload. That is why an early...
UNLABELLED
Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and a frequent cause of sick leaves because of work-related hand overload. That is why an early diagnosis and adequate treatment (conservative or surgical) are essential for optimal patient management.
AIM
The aim of the study is to assess the usefulness of high-frequency ultrasound in CTS for the assessment of patient eligibility for surgical treatment.
MATERIAL AND METHODS
The study involved 62 patients (50 women and 12 men, aged 28-70, mean age 55.2) with scheduled surgeries of CTS on the basis of clinical symptoms, physical examination performed by a neurosurgeon and a positive result of EMG testing. The ultrasound examinations of the wrist were performed in all these patients. On the basis of the collected data, the author has performed multiple analyses to confirm the usefulness of ultrasound imaging in assessing patient eligibility for surgical treatment of CTS.
RESULTS
US examinations showed evidence of median nerve compression at the level of the carpal tunnel in all of the examined patients. This was further confirmed during surgical procedures. The mean value of the cross-sectional area at the proximal part of the pisiform bone was 17.45 mm(2) (min. 12 mm(2), max. 31 mm(2)). Nerve hypoechogenicity proximal to the nerve compression site was visible in all 62 patients (100%). Increased nerve vascularity on the transverse section was present in 50 patients (80.65%).
CONCLUSIONS
Ultrasonography with the use of high-frequency transducers is a valuable diagnostic tool both for assessing patient eligibility for surgical treatment of CTS, and in postoperative assessment of the treatment efficacy.
PubMed: 26673415
DOI: 10.15557/JoU.2015.0025 -
Saudi Medical Journal Sep 2020To find reference data for the time of appearance of ossification centers in carpal bones and the lower ends of the radius and ulna in the Saudi population. In addition,...
OBJECTIVES
To find reference data for the time of appearance of ossification centers in carpal bones and the lower ends of the radius and ulna in the Saudi population. In addition, to check the sequence of appearance of carpal bones and the relation of this sequence to the appearance of distal epiphyses of the radius and ulna. Methods: A retrospective radiological study was carried out between 2012 to 2020 at King Fahad Hospital of the University, Al-Khobar, Saudi Arabia. A sample of 279 hand/wrist plain radiographs of Saudi children was analyzed.
RESULTS
The first bones at the wrist region to appear in Saudi children are the capitate, hamate, and distal epiphysis of the radius, and these appear during the first year of life. The other bones develop subsequently at yearly intervals, and the last one to appear is the pisiform, which arises at the end of the first decade of life.
CONCLUSION
The sequence of appearance of carpal bones in the Saudi population is similar to what is described in the literature. However, the time of appearance of some of these bones is earlier than that in other populations.
Topics: Adolescent; Bone Development; Carpal Bones; Child; Child, Preschool; Epiphyses; Female; Humans; Infant; Male; Osteogenesis; Radius; Retrospective Studies; Saudi Arabia; Sex Characteristics; Ulna
PubMed: 32893275
DOI: 10.15537/smj.2020.9.25348 -
Journal of Surgical Case Reports Jun 2019The pisiform is a sesamoid bone with in flexor carpi ulnaris tendon. Isolated dislocation of the pisiform bone is not common. It is usually missed and diagnosed as a...
The pisiform is a sesamoid bone with in flexor carpi ulnaris tendon. Isolated dislocation of the pisiform bone is not common. It is usually missed and diagnosed as a soft tissue injury or a sprain of the wrist by the emergency physicians. We present an unusual and unique case of a young man involved in a rugby tackle and who himself presented to the emergency department with a painful wrist. The diagnosis of a dislocated pisiform was initially missed; however it was later successfully treated with an open reduction leading to a satisfactory outcome.Early diagnosis and reduction is imperative to avoid prolonged morbidity and loss of earnings. A high index of suspicion is needed in young patients with wrist trauma displaying ulnar sided wrist pain.
PubMed: 31214321
DOI: 10.1093/jscr/rjz183 -
Journal of Wrist Surgery Aug 2016Carpal tunnel release (CTR) has been shown to change carpal arch morphology. However, the effect of CTR on the three-dimensional kinematics of the carpal bones has not...
BACKGROUND
Carpal tunnel release (CTR) has been shown to change carpal arch morphology. However, the effect of CTR on the three-dimensional kinematics of the carpal bones has not been demonstrated.
PURPOSE
This study examined whether release of the transverse carpal ligament (TCL) would alter the three-dimensional kinematics of the carpus, specifically the bony attachments of the TCL.
METHODS
The in vitro kinematics of the carpus was studied in five fresh-frozen cadaveric wrists before and after CTR using three-dimensional computed tomography. The specimens were evaluated in three positions: neutral, 60 degrees of flexion, and 60 degrees of extension.
RESULTS
The data indicate that carpal arch width increases significantly in all positions after CTR as measured between the trapezium and hamate. Second, the trapezium-hamate distance increases in both a translational and rotational component after CTR. Additionally, the pisiform rotates away from the triquetrum after CTR.
CONCLUSIONS
Carpal kinematics is significantly altered with a CTR, especially on the ulnar side of the wrist.
CLINICAL RELEVANCE
Although the kinematic changes are small, they may be clinically significant and potentially responsible for pillar pain or postoperative loss of grip strength.
PubMed: 27468373
DOI: 10.1055/s-0036-1578812 -
Archives of Rheumatology Dec 2019This study aims to investigate whether or not radial deviation developing after wrist involvement of rheumatoid arthritis (RA) is a cause of median nerve swelling.
OBJECTIVES
This study aims to investigate whether or not radial deviation developing after wrist involvement of rheumatoid arthritis (RA) is a cause of median nerve swelling.
PATIENTS AND METHODS
The study included 51 RA patients (12 males, 39 females; mean age 50.9±8.9 years; range, 18 to 65 years) without carpal tunnel syndrome (CTS) detected by electroneuromyography. Duruöz hand index, visual analog scale, and painDETECT questionnaire were performed in clinical assessment. Radiographic measurements including radial inclination (RI) angle were performed. Using ultrasonography, the median nerve cross-sectional areas (CSAs) were measured from the four levels of the distal one third of the forearm, radioulnar joint, pisiform bone, and hook of hamate, while the ulnar nerve CSAs were measured from the pisiform bone.
RESULTS
The study was completed with 102 hands of 51 patients. A negative correlation was found between the RI and the median CSAs measured from the radioulnar joint (R=-0.49; p=0.00), the pisiform bone (R= -0.45; p=0.00), and hook of hamate (R= -0.60, p=0.00). When the hands were divided into three groups according to the ranges of RI specified in the literature, the median nerve CSA was found to be significantly higher in the group with low RI at these levels (p<0.001).
CONCLUSION
In patients with RA without CTS, the increase in the median nerve CSAs may be associated with radiographic measures such as radial deviation.
PubMed: 32010886
DOI: 10.5606/ArchRheumatol.2019.7335