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- Clementson, Martin, et al.
(författare)
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Union of Scaphoid Waist Fractures Assessed by CT Scan.
- 2015
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Ingår i: Journal of Wrist Surgery. - : Georg Thieme Verlag KG. - 2163-3916 .- 2163-3924. ; 4:1, s. 49-55
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Tidskriftsartikel (refereegranskat)abstract
- Background Union of a scaphoid fracture is difficult to assess on a standard series of radiographs. An unnecessary and prolonged immobilization is inconvenient and may impair functional outcome. Although operative treatment permits early mobilization, its influence on time to union is still uncertain. Purpose To assess union of scaphoid waist fractures based on computed tomography (CT) scan at 6 weeks, and to compare time to union between conservative treatment and arthroscopically assisted screw fixation. Patients and methods CT scan in the longitudinal axis of the scaphoid was used to provide fracture characteristics, and to assess bone union at 6 weeks in 65 consecutive patients with scaphoid waist fractures. In a randomized subgroup from this cohort with nondisplaced fractures, we compared time to union between conservative treatment (n = 23) and arthroscopically assisted screw fixation (n = 15). Results Overall, at 6 weeks we found a 90% union rate for non- or minimally displaced fracture treated conservatively, and 82% for those who underwent surgery. In the randomized subgroup of nondisplaced fractures, no significant difference in time to union was demonstrated between those treated conservatively and those who underwent surgery. The conservatively treated fractures from this subgroup with prolonged time to union (10 to 14 weeks) were comminuted, demonstrating a radial cortical or corticospongious fragment. Conclusion The majority of non- or minimally displaced scaphoid waist fractures are sufficiently treated with 6 weeks in a cast. Screw fixation does not reduce time to fracture union compared with conservative treatment. Level of Evidence level II, Therapeutic study.
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| 2. |
- Eriksson, Sara, et al.
(författare)
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Cone-Beam Computed Tomography Influences the Classification and Choice of Treatment for Distal Radius Fractures
- 2024
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Ingår i: Journal of wrist surgery. - : THIEME MEDICAL PUBL INC. - 2163-3916 .- 2163-3924.
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Tidskriftsartikel (refereegranskat)abstract
- Background and Purposes The objectives of this study were to investigate the inter- and intraobserver agreement in the classification of distal radius fractures (DRFs) according to the AO and the Buttazzoni classification system, for the two different radiology modalities: conventional radiography (CR) and cone-beam computed tomography (CBCT). Furthermore, we aimed to explore whether the radiological modality used influences the choice of treatment. Patients and Methods Fifty consecutive patients with DRFs were included. The fractures were visualized by both CR and CBCT. All images were independently reviewed by five observers (three orthopaedic surgeons and two radiologists) and the fractures were classified according to the AO and the Buttazzoni classification. Agreement on fracture classification between CR and CBCT, interobserver agreement for all observers, and intraobserver agreement for a repeated assessment after 8 weeks were calculated. Treatment was suggested by the orthopaedic surgeons. Results The Buttazzoni classification showed higher interobserver agreement than the AO classification, but the agreement for the AO classification was increased using CBCT. The agreement between classification of fractures by CR and CBCT for each observer varied from fair to moderate. CBCT was superior for classification of dorsally comminute fractures using both the AO and the Buttazzoni system. In 38% ( n = 57) of the observations, the suggested treatment was changed when CBCT was used, both from less advanced to more advanced and vice versa. Conclusion The choice of radiological modality affects both the classification and the choice of treatment for DRFs and CR tends to underestimate the complexity of DRFs. Level of Evidence Level 1.
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| 6. |
- Hooke, Alexander W., et al.
(författare)
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An anatomic and kinematic analysis of a new total wrist arthroplasty design
- 2015
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Ingår i: Journal of wrist surgery. - New York : Thieme Medical Publishers. - 2163-3916 .- 2163-3924. ; 4:2, s. 121-127
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Total wrist arthroplasty (TWA) is a viable surgical treatment for disabling wrist arthritis. While current designs are a notable improvement from prior generations, radiographic loosening and failures remain a concern.Purpose: The purpose of this investigation is to evaluate a new total wrist arthroplasty design kinematically. The kinematic function of a native, intact cadaveric wrist was compared with that of the same wrist following TWA.Method: Six, fresh-frozen wrist cadaveric specimens were utilized. Each wrist was fixed to an experimental table and its range of motion, axis of rotation, and muscle moment arms were calculated. The following tendons were attached to the apparatus to drive motion: extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), extensor carpi ulnaris (ECU), flexor carpi radialis (FCR), flexor carpi ulnaris (FCU), and abductor pollicis longus (APL). The wrist was then manually moved along a guide by an experimenter through a series of motions including flexion-extension, radial-ulnar deviation, and circumduction. The experiment was then performed on the specimen following implantation of the TWA.Results: Following the TWA procedure, there were statistically significant decreases in the ulnar deviation and the flexion/ulnar deviation component of dart throw ranges of motion. There were no statistically significant changes in flexion, extension, radial deviation, the extension/radial deviation component of the dart thrower motion, or the circumduction range of motion.Conclusions: Kinematic analysis of the new TWA suggests that a stable, functional wrist is achievable with this design.Clinical Relevance: While appreciating the limitations of a cadaveric study, this investigation indicates that the TWA design studied merits study in human populations.
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| 7. |
- Horvath, Alexandra, et al.
(författare)
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Treatment of Primary Dorsal Wrist Ganglion-A Systematic Review
- 2022
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Ingår i: JOURNAL OF WRIST SURGERY. - : Georg Thieme Verlag KG. - 2163-3916 .- 2163-3924. ; 12:2, s. 177-190
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The aim of this study was to compare the rates of recurrence and wound infection in patients with primary dorsal wrist ganglion treated with aspiration (with or without an injection of an additive), open excision, or arthroscopic resection. Methods This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and registered on PROSPERO. Systematic electronic searches in PubMed (MEDLINE), EMBASE, Web of Science, and the Cochrane Library of Controlled Trials were performed on May 5, 2020, and June 1, 2021, respectively. All clinical studies written in English determining the recurrence and wound infection rates after treatment of primary dorsal wrist ganglion with aspiration, open excision, or arthroscopic resection in patients over the age of 16 years were eligible for inclusion. Quality assessment was guided by the Cochrane Collaboration's tool for randomized controlled trials (RCTs) and the methodological index for nonrandomized studies (MINORS) tool for observational studies. Results The literature searches resulted in 1,691 studies. After screening, five RCTs, enrolling 233 patients, and six observational studies, enrolling 316 patients with primary dorsal wrist ganglions were included. Quality assessment of the included RCTs and observational studies determined the existing level of evidence pertaining to primary dorsal wrist ganglion treatment to be low. About 11 studies reported on recurrence rate, which ranged between 7 and 72% for patients initially treated with aspiration (with or without an injection of an additive). In comparison, the recurrence rate for the open excision and arthroscopic resection groups ranged between 6 to 41% and 0 to 16%, respectively. Four studies investigated wound-related complications, for which zero infections were reported, irrespective of treatment. Conclusion The evidence summarized in this systematic review demonstrates a considerable variability in recurrence rate following aspiration and open or arthroscopic resection of a primary dorsal wrist ganglion. The greatest variability in recurrence was displayed among studies on aspiration. The overall infection rate after treatment of dorsal wrist ganglions seems to be low regardless of the treatment type. However, the divergent results of individual studies highlight a pressing need for prospective controlled trials assessing outcomes following dorsal wrist ganglion treatment.
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| 9. |
- Nilsson, Klara, et al.
(författare)
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A Novel Technique to Assess Distal Radioulnar Joint Stability Using Increasing Torque
- 2019
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Ingår i: Journal of wrist surgery. - : Thieme Medical Publishers. - 2163-3916 .- 2163-3924. ; 8:4, s. 327-334
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Tidskriftsartikel (refereegranskat)abstract
- Background Previous studies on computed tomography (CT) in patients with a suspected triangular fibrocartilage complex (TFCC) injury have not been successful in assessing distal radioulnar joint (DRUJ) laxity. The aim of this study was to develop a novel servomotor-driven device for the assessment of DRUJ by applying increasing torque to the DRUJ in pronation and supination.Methods A custom-built device was designed to function during four-dimensional (4D) CT of the wrist. A torque meter, positioned between the incoming hand holder, and a direct current (DC) servomotor were used for angular positioning and for applying rotational force to the patient's arm. A total of 110 healthy participants were recruited to gather reference values for the range of motion (ROM), maximum torque in neutral and supinated/pronated position, and the ability to withstand an increasing, device-generated torque in these positions. The device was also used during 4D DRUJ CT in five patients with suspected TFCC injuries.Results A gender- and age-relevant reference chart for ROM and torque was created. Men showed a tendency (ns) toward having a larger ROM and increasing strength with increasing age, whereas women showed the opposite. Also, the dominant hand showed a tendency toward having a larger ROM and being stronger than the nondominant hand (ns). A smaller cohort of patients (n = 5) with suspected TFCC injuries showed a significantly decreased ability to withstand increasing torque in both supination (2.1 ± 0.3 vs. 3.1 ± 0.2 s; p < 0.005) and pronation (2.3 ± 0.5 vs. 3.1 ± 0.4 s; p < 0.0005) and also showed a clear laxity on real-time 4D CT image sequences. Decreased strength at all positions was also found (average 74% decrease compared to noninjured side).Conclusion Reference values for torque strength and ability to withstand increasing torque can be used clinically in the assessment of patients with symptoms that could represent ligamentous injuries to the TFCC. The ability to use the device during CT enables radiographic evaluation of instability during increasing torque.Level of Evidence This is a Level II study.
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| 10. |
- Rosvall, Felicia, et al.
(författare)
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Clinical and Socioeconomic Effects of Misdiagnosed Wrist Ligament Injuries
- 2024
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Ingår i: JOURNAL OF WRIST SURGERY. - 2163-3916 .- 2163-3924.
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Tidskriftsartikel (refereegranskat)abstract
- Purpose Misdiagnosed and maltreated wrist ligament injuries (scapholunate [SL], lunotriquetral, and triangular fibrocartilage complex [TFCC]) filed to the Swedish National Patient Insurance Company (LoF ["regionernas omsesidiga forsakringsbolag"]) 2011 to 2018 were analyzed in terms of complications and costs for society.Methods All filed claims are database registered. The database was assessed in June 2019 through injury International Classification of Diseases 10th Revision-SWE diagnoses. Demographics, reasons for avoidance, type of complication, and costs were assessed. Trend analysis was also used to compare the numbers of filed claims of wrist ligament injuries and total injuries.Results The mean age of the 231 extracted patients was 38 years. Females represented 57%. Ninety-eight (42%) of the claims were judged as avoidable, in accordance with the 40% approved patient injuries of all notified injuries during the same time period. Isolated injuries to the TFCC and SL ligament were the most common (n = 185, 80%). One to seven secondary surgical procedures/patient were needed to treat the condition. Sixty-nine (30%) of the 231 patients had medical invalidity due to the avoidable complication(s). Disability was more severe if more than one surgical procedure was needed. There was a significant trend toward decreasing numbers of filed claims for wrist ligament injuries ( p = 0.002) over time, in contrast to the total number of filed claims to LoF, which has increased by an average of 6% annually for a cumulative increase of 60% from 2011 to 2018.Interpretation The total cost for misdiagnosed and mistreated wrist ligament injuries in Sweden from 2011 to 2018 was euro2,203,467, and costly for both the patients and society at large.Level of Evidence Level III, therapeutic.
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