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Arthroscopy Techniques Dec 2015Our technique for acromioclavicular joint reconstruction provides a variation on coracoclavicular ligament reconstruction to also include acromioclavicular ligament...
Our technique for acromioclavicular joint reconstruction provides a variation on coracoclavicular ligament reconstruction to also include acromioclavicular ligament reconstruction. An oblique acromial tunnel is drilled, and the medial limb of the gracilis graft, after being crossed and passed beneath the coracoid and through the clavicle, is passed through this acromial tunnel and sutured to the trapezoid graft limb after appropriate tensioning. Tenodesis screws are not placed in the bone tunnels to avoid graft fraying, and initial forces on the graft are offloaded with braided absorbable sutures passed around the clavicle.
PubMed: 27284528
DOI: 10.1016/j.eats.2015.08.014 -
Hand (New York, N.Y.) May 2022The scaphoid-trapezoid-trapezium (STT) articulation stabilizes the scaphoid and links the proximal and distal carpal rows. The purpose of the study was to determine...
The scaphoid-trapezoid-trapezium (STT) articulation stabilizes the scaphoid and links the proximal and distal carpal rows. The purpose of the study was to determine whether trapezium excision in the treatment of trapeziometacarpal (TM) arthritis affects carpal stability. A retrospective chart and radiographic review was performed on all wrists that underwent trapeziectomy with suspensionplasty or ligament reconstruction, and tendon interposition for TM arthritis between 2004 and 2016. Radiographic outcome measures included the modified carpal height ratio (MCHR) and radioscaphoid (RS), radiolunate (RL), and scapholunate (SL) angles. Degenerative change at the TM and STT joints was classified according to the Eaton-Littler, and Knirk and Jupiter classification systems. Radiographic parameters were compared between preoperative and final follow-up time points. A total of 122 wrists were included in the study with a mean follow-up of 3.5 years (range: 1.0-13.0 years). The mean RL (range: -2.2° ± 11.8° to -10.7° ± 16.5°) and RS angles (range: 52.6° ± 13.8° to 44.4° ± 17.8°) decreased significantly (<.001) without significant change in SL angle, indicating progressive lunate and scaphoid extension after trapeziectomy. The mean MCHR decreased significantly (range: 1.6 ± 0.1 to 1.5 ± 0.1) following trapeziectomy, indicating progressive carpal collapse. Progressive scaphoid-trapezoid arthrosis was observed following trapeziectomy. No other preoperative radiographic factors investigated were associated with significant differences in preoperative and postoperative values for radiographic outcome measures. Trapeziectomy can lead to loss of carpal height, coordinated extension of both the lunate and scaphoid, and progressive scaphotrapezoid arthrosis. As such, in wrists with dynamic or static carpal instability, trapeziectomy should be performed with caution due to the risk of carpal collapse with a nondissociative pattern of dorsal intercalated segment instability.
Topics: Humans; Lunate Bone; Osteoarthritis; Retrospective Studies; Scaphoid Bone; Wrist Joint
PubMed: 32666846
DOI: 10.1177/1558944720939198 -
The American Journal of Case Reports Jun 2019BACKGROUND Trapezoid fractures are very uncommon, accounting for less than 1% of all wrist fractures. Isolated fractures of this bone are even more rare, with just a few... (Review)
Review
BACKGROUND Trapezoid fractures are very uncommon, accounting for less than 1% of all wrist fractures. Isolated fractures of this bone are even more rare, with just a few reports in the literature. The trapezoid bone has a very stable position within the wrist, forming a relatively immobile joint with the second metacarpal base distally. It is also connected by very strong ligaments to the trapezium, capitate and, scaphoid. Trapezoid fractures occur when a strong bending or axial force is applied to the second metacarpal base. CASE REPORT We present a clinical case of an isolated, non-displaced, trapezoid fracture in a young white male, which was treated with cast immobilization for 4 weeks and physical therapy. Complete functional recovery was achieved 3 months after the injury, without any pain or tenderness. CONCLUSIONS Fractures of the trapezoid bone usually have a good clinical outcome. Nonetheless, we need to be very suspicious about this diagnosis since radiography is apparently normal in almost all such cases and clinical examination results may not be entirely clear.
Topics: Adult; Athletic Injuries; Boxing; Casts, Surgical; Conservative Treatment; Fracture Healing; Fractures, Bone; Humans; Male; Prognosis; Radiography; Trapezoid Bone; Treatment Outcome
PubMed: 31164626
DOI: 10.12659/AJCR.915757 -
European Journal of Radiology Open 2021Scaphoid fractures are the most prevalent type of carpal bone fractures. High-spatial-resolution sonography detects direct signs of scaphoid fractures such as scaphoid... (Review)
Review
Scaphoid fractures are the most prevalent type of carpal bone fractures. High-spatial-resolution sonography detects direct signs of scaphoid fractures such as scaphoid cortical disruption; nevertheless, indirect signs such as radiocarpal effusion and scapho-trapezium-trapezoid effusion can also be visible. The diagnosis is performed when both direct and indirect signs of scaphoid fracture are presented. The presence of indirect signs alone is not enough to complete the diagnosis, for which more advanced imaging modalities are usually required. Here, we review the anatomy of the scaphoid, the clinical manifestations of scaphoid fractures, as well as ultrasonographic findings and differential diagnosis.
PubMed: 34095356
DOI: 10.1016/j.ejro.2021.100358 -
Ochsner Journal 2019The trapezoid is the least commonly fractured carpal bone, comprising 4% of all carpal fractures. To date, few articles have been published on isolated trapezoid...
The trapezoid is the least commonly fractured carpal bone, comprising 4% of all carpal fractures. To date, few articles have been published on isolated trapezoid fractures. Mechanisms of injury have typically been reported as an axial load, with or without forced wrist flexion/extension, that is transmitted from the second metacarpal indirectly to the trapezoid. Two patients presenting with symptoms of nonspecific wrist pain after acute trauma were initially worked up with plain film x-rays. Physical examinations identified nonspecific wrist pain in both patients. Mechanisms of injury involved direct trauma and an axial force transmitted through the scaphoid region of an extended wrist in each patient. Plain x-rays were negative for trapezoid fracture in both patients. Computed tomography and magnetic resonance imaging revealed the diagnoses. Conservative management consisted of splinting and immobilization, with full recovery reported at 2.5- and 3-month follow-up. Isolated fractures of the trapezoid require a high index of suspicion as they are rare, and localizing signs and symptoms are typically vague and may mimic those of scaphoid fractures. When athletes present with dorsal wrist pain, swelling, and snuffbox tenderness in the setting of negative plain x-rays, the most likely mechanisms of injury are associated with athletic activity. Treatment depends on the degree of displacement and other associated injuries and ranges from activity modification or immobilization to open reduction with internal fixation.
PubMed: 31528141
DOI: 10.31486/toj.18.0157 -
JSES International Jan 2023Fracture classifications of the distal clavicle are based on ligamentous integrity. The influence of osseous microarchitecture on fracture occurrence, morphology, and...
BACKGROUND
Fracture classifications of the distal clavicle are based on ligamentous integrity. The influence of osseous microarchitecture on fracture occurrence, morphology, and the lesion's stability has not yet been investigated. We aimed to characterize osseous microarchitecture according to common fracture classification systems based on ligamentous integrity and investigated the possible effects of age, gender, and osteoporosis in distal clavicle fractures.
METHODS
N = 20 human cadaveric distal clavicles were scanned using XtremeCT with an isometric voxel size of 82 μm. In the sagittal plane, each data set was evaluated in 11 sections of approximately 7 mm thickness. Three topographic regions were defined: the bone lateral to the trapezoid (LTR), intertubercular (ITR), and medial to the conoid (MCR) ligament. Cortical bone mineral density (BMD) [mgHA/cm] and cortical porosity (1- (BV/TV) [%]) were determined and evaluated relative to age and gender.
RESULTS
Along the mediolateral axis, there was an >20-fold increase in median cortical porosity ( ≤ .001). There were significant differences in cortical porosity between LTR and ITR ( ≤ .001) but not between ITR and MCR ( = .09). In ITR, cortical porosity was significantly greater in >60-year-old compared to younger donors ( = .01). For BMD, there was an >2-fold decrease toward the distal apex ( ≤ .001). BMD was significantly greater in ITR compared to LTR ( ≤ .001) and in MCR compared to ITR ( = .02). In ITR and MCR, clavicles of >60-year-old donors had significantly lower BMD values compared to younger donors ( < .01). Across all 3 regions, frequency distribution of low bone mass did not significantly differ between <60-year-olds and >60-year-olds ( > .6).
CONCLUSION
The distal clavicle features a characteristic bony microarchitecture. The present study revealed a significant difference in bone quality of lateral, intertubercular, and medial zones of the distal clavicle and could specify target areas and strategies for surgical treatment of unstable fractures. Age, gender, and osteoporosis have a limited effect on bone quality and fracture genesis. In contrast, ligamentous quality is supposed to exert a substantial influence on fracture characteristics, especially in ITR. Fracture morphology of the distal clavicle is determined by a bony-ligamentous conjunction, which remains to be characterized.
PubMed: 36820417
DOI: 10.1016/j.jseint.2022.09.015 -
European Journal of Trauma and... Apr 2022The primary treatment goals for advanced-stage thumb carpometacarpal (CMC) joint osteoarthritis are complete pain relief and restoration of thumb strength. The purpose...
PURPOSE
The primary treatment goals for advanced-stage thumb carpometacarpal (CMC) joint osteoarthritis are complete pain relief and restoration of thumb strength. The purpose of the present study was to introduce a variation of the abductor pollicis longus (APL) suspension arthroplasty using a single looping of a radial slip from the APL tendon around the flexor carpi radialis (FCR) tendon combined with RegJoint™ interposition and to determine its efficacy in the treatment of thumb CMC joint osteoarthritis.
METHODS
Between 2015 and 2017, 21 patients were included. The average age was 60.8 years (range 48-79). The mean follow-up was 27.7 months (range 8-50). Evaluation included pain, radial and palmar abduction, tip pinch and grip strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) score.
RESULTS
Pain averaged 0.3 (range 0-4) at rest and 1.4 (range 0-4) on exertion. The radial and palmar abduction were 97% and 99% compared to the contralateral side. The tip pinch and grip strength were 4.1 kg (range 3-6.5) and 22 kg (range 13.3-40), respectively. The DASH score accounted for 18.5 (range 0.8-41.7).
CONCLUSION
The modified APL suspension interposition arthroplasty was an efficient and simplified option for the treatment of thumb CMC joint osteoarthritis, with results comparable or better than other published procedures. The APL suspension technique was easy to perform avoiding difficult bone tunneling and incision of the FCR tendon. The RegJoint™ interposition as spacer prevented impingement of the first metacarpal base on the second metacarpal base or the trapezoid bone.
Topics: Aged; Arthroplasty; Carpometacarpal Joints; Humans; Middle Aged; Osteoarthritis; Pain; Tendon Transfer; Thumb
PubMed: 33367972
DOI: 10.1007/s00068-020-01577-w