Three-dimensional finite element model construction and biomechanical analysis of customized titanium alloy lunate prosthesis / 中国修复重建外科杂志

OBJECTIVE@#To design customized titanium alloy lunate prosthesis, construct three-dimensional finite element model of wrist joint before and after replacement by finite element analysis, and observe the biomechanical changes of wrist joint after replacement, providing biomechanical basis for clinical application of prosthesis.@*METHODS@#One fresh frozen human forearm was collected, and the maximum range of motions in flexion, extension, ulnar deviation, and radialis deviation tested by cortex motion capture system were 48.42°, 38.04°, 35.68°, and 26.41°, respectively. The wrist joint data was obtained by CT scan and imported into Mimics21.0 software and Magics21.0 software to construct a wrist joint three-dimensional model and design customized titanium alloy lunate prosthesis. Then Geomagic Studio 2017 software and Solidworks 2017 software were used to construct the three-dimensional finite element models of a normal wrist joint (normal model) and a wrist joint with lunate prosthesis after replacement (replacement model). The stress distribution and deformation of the wrist joint before and after replacement were analyzed for flexion at and 15°, 30°, 48.42°, extension at 15°, 30°, and 38.04°, ulnar deviation at 10°, 20°, and 35.68°, and radial deviation at 5°, 15°, and 26.41° by the ANSYS 17.0 finite element analysis software. And the stress distribution of lunate bone and lunate prosthesis were also observed.@*RESULTS@#The three-dimensional finite element models of wrist joint before and after replacement were successfully constructed. At different range of motion of flexion, extension, ulnar deviation, and radial deviation, there were some differences in the number of nodes and units in the grid models. In the four directions of flexion, extension, ulnar deviation, and radial deviation, the maximum deformation of wrist joint in normal model and replacement model occurred in the radial side, and the values increased gradually with the increase of the range of motion. The maximum stress of the wrist joint increased gradually with the increase of the range of motion, and at maximum range of motion, the stress was concentrated on the proximal radius, showing an overall trend of moving from the radial wrist to the proximal radius. The maximum stress of normal lunate bone increased gradually with the increase of range of motion in different directions, and the stress position also changed. The maximum stress of lunate prosthesis was concentrated on the ulnar side of the prosthesis, which increased gradually with the increase of the range of motion in flexion, and decreased gradually with the increase of the range of motion in extension, ulnar deviation, and radialis deviation. The stress on prosthesis increased significantly when compared with that on normal lunate bone.@*CONCLUSION@#The customized titanium alloy lunate prosthesis does not change the wrist joint load transfer mode, which provided data support for the clinical application of the prosthesis.

Dorsal plate assisted fixation of dorsal lunate fossa fracture of distal radius / 中国骨伤

OBJECTIVE@#To explore clinical efficacy of dorsal plate assisted fixation of dorsal lunate fossa fracture block of distal radius.@*METHODS@#From January 2019 to January 2022, 30 patients were treated with dorsal plate assisted fixation of dorsal lunate fossa fracture of distal radius, including 13 males and 17 females, aged from 42 to 68 years old with an average of (48.7±5.6) years old;According to Doi fracture classification, 24 patients were type 3 blocks and 6 patients were type 4 blocks. The degree of palmar angle of anterior and posterior distal radius was fixed by dorsal steel plate during operation. Fracture healing and functional recovery of wrist were observed after operation. Functional evaluation was performed by Gartland and Werley scoring system at 12 months after operation.@*RESULTS@#All patients were followed up from 12 to 13 months with an average of (11.3±0.9) months. All fractures healed for 4 to 5 months with an average of(4.7±0.8) months. Median palpal inclination of anterior and posterior distal radius fixed by dorsal plate was 5.30°(4.85°, 6.03°), 12.45°(11.98°, 13.43°) respectively, and had statistical difference( P<0.01). Gartland and Werley scores was (1.1±0.4) at 12 months afteropertaion, and 27 patients got excellent result and 3 good.@*CONCLUSION@#Dorsal plate assisted fixation of dorsal lunate fossa fractures is beneficial to reduction and stabilization of displaced dorsal fractures and restoration of palmar inclination.

Artrodesis mediocarpiana: estudio de la evolución clínico-radiológica con tres años de seguimiento mínimo / Midcarpal fusion. Clinical and radiological study on outcomes with a minimum follow-up of three years

Determinar la evolución clínica y radiológica de los pacientes tratados con artrodesis mediocarpiana con un seguimiento mínimo de tres años. Materiales y Métodos: Se estudiaron los pacientes tratados en nuestro Servicio mediante artrodesis mediocarpiana desde mayo de 1998. Entre un total de 27, se incluyeron 11 muñecas que contaban con un seguimiento mínimo de tres años. Ocho pacientes eran hombres y tres, mujeres, con una media de edad de 47 años (rango 16-66) y un seguimiento promedio de 6.7 años (rango 3-15). La técnica utilizada fue artrodesis de 2 o 4 esquinas con resección del escafoides más injerto de radio distal. Se evaluaron el dolor con la Escala Analógica Visual, la movilidad y la fuerza de puño. Se aplicó el cuestionario QuickDASH y se tomaron radiografías de control. Resultados: El dolor mejoró de 5/10 en reposo y 8/10 en actividad antes del procedimiento a 0/10 y 2/10, respectivamente. La movilidad perdida con respecto al lado sano fue del 39% de flexo-extensión, 15% de desviación radial y 31% de desviación cubital. No hubo cambios en la pronosupinación y el QuickDASH posoperatorio fue de 10. La fuerza fue del 92% comparada con el lado contralateral. Radiológicamente cuatro pacientes no tuvieron cambios en la luz articular radiolunar; en los restantes, disminuyó. Dos fueron reoperados por seudoartrosis, con injerto óseo. Conclusiones: La artrodesis mediocarpiana mejora los síntomas y conserva el 61% de la flexo-extensión, el 85% de la desviación radial, el 31% de la cubital y el 92% de la fuerza. Nivel de Evidencia: IV...

To determine the clinical and radiological outcomes of patients treated with midcarpal arthrodesis with a minimum follow-up of three years. Methods: Patients treated in our Service through midcarpal arthrodesis since May 1998 were studied. From a total of 27 patients, 11 wrists with a minimum follow-up of 3 years were included. Eight patients were men and three were women, with a mean age of 47 years (range 16-66) and an average follow-up of 6.7 years (range 3-15). The technique was 2 or 4 corner fusion with scaphoid resection plus distal radius graft. Pain using Visual Analog Scale, mobility, and grip strength were evaluated. QuickDASH scoring and control X-rays were performed. Results: Pain improved from a preoperative value of 5/10 at rest and 8/10 at activity to 0/10 and 2/10 after surgery, respectively. The lost motion with respect to the healthy side was flexo-extension 39%, radial deviation 15%, and ulnar deviation 31%. There were no changes in pronosupination and the postoperative QuickDASH score was 10. Force was 92% compared to the opposite side. Radiologically four patients didn´t show changes in radiolunate joint space; in the remaining, it was narrower. Two patients were reoperated on for nonunion with bone graft. Conclusions: Midcarpal fusion improves symptoms, retaining 61% of flexo-extension, 85% of the radial deviation, 31% of the ulnar deviation and 92% of the force. Level of Evidence: IV...

Positive or Negative Ulnar Variance after Ulnar Shortening for Ulnar Impaction Syndrome: A Retrospective Study

BACKGROUND: The goal of this study was to compare simple radiographic findings and clinical results according to residual ulnar variance following ulnar shortening for ulnar impaction syndrome. METHODS: Forty-five cases of ulnar impaction syndrome, which were treated with ulnar shortening from 2005 to 2008, were studied retrospectively. Group I included 13 cases with positive residual variance after ulnar shortening and group II included 32 cases with negative variance after shortening. The presence of a lunate cystic lesion both preoperatively and at final follow-up and assessments of wrist function based on the modified Mayo wrist score, the disabilities of the arm, shoulder, and hand (DASH) score, as well as the Chun and Palmer score were evaluated. RESULTS: A cystic lesion of the lunate was present in 4 cases preoperatively and the size decreased in 2 cases at final follow-up in group I, and in 10 and 5 cases, respectively, in group II. No statistical difference was observed between the groups. The modified Mayo wrist score, DASH score, as well as the Chun and Palmer score improved significantly in both groups. No significant differences were observed between the two groups in terms of the proportion of positive cystic lesions at final follow-up or the functional scores. CONCLUSIONS: After ulnar shortening, the degree of radiological change in the cystic lunate lesions and clinical improvement did not differ significantly between the groups with unintended residual positive and negative variance after shortening.

Semilunar flotante: tratamiento artroscopico: reporte de un caso y revision de la bibliografia / Floating lunate: arthroscopic treatment: case report and bibliography review

La asistencia artroscópica ha beneficiado de manera significativa el diagnóstico y tratamiento de la inestabilidad carpiana. Presentamos un caso clínico en donde se combinan dos lesiones ligamentarias carpianas, la lesión del ligamento escafo-lunar y la del luno-piramidal. Ambas corresponden a lesiones pre-dinámicas y de grado III según la clasificación de Geissler. Describimos el tratamiento quirúrgico en donde se realizó en forma artroscópica termo contracción y fijación temporaria con clavijas. Pasados dos años de seguimiento no se han observado nuevos signos de inestabilidad ni dolor residual.

Penetrating type intraosseous ganglion cyst of the lunate bone / Ganglión intraóseo penetrante del semilunar

Intraosseous ganglion cysts of the carpal bones located in the lunate are one of the rarely seen pathologic conditions. Here we present a case of the penetrating type of intraosseous ganglion cyst located in the lunate as an uncommon cause of wrist pain. The patient was successfully treated by surgical intervention. Intraosseous ganglion cyst should be considered in the differential diagnosis of chronic dull wrist pain.

Los gangliones intraóseos de los huesos carpianos localizados en el semilunar, constituyen una de las condiciones patológicas más raras que puedan verse. Aquí presentamos un caso del tipo penetrante de ganglión intraóseo, localizado en el semilunar como causa poco común del dolor de muñeca. El paciente fue tratado exitosamente mediante una intervención quirúrgica. El quiste ganglionar intraóseo debe ser considerado en el diagnóstico diferencial de dolores de muñeca sordos que se han hecho sentir por mucho tiempo, y se han vuelto crónicos.

Penetrating type intraosseous ganglion cyst of the lunate bone / Ganglión intraóseo penetrante del semilunar

Intraosseous ganglion cysts of the carpal bones located in the lunate are one of the rarely seen pathologic conditions. Here we present a case of the penetrating type of intraosseous ganglion cyst located in the lunate as an uncommon cause of wrist pain. The patient was successfully treated by surgical intervention. Intraosseous ganglion cyst should be considered in the differential diagnosis of chronic dull wrist pain.

Los gangliones intraóseos de los huesos carpianos localizados en el semilunar, constituyen una de las condiciones patológicas más raras que puedan verse. Aquí presentamos un caso del tipo penetrante de ganglión intraóseo, localizado en el semilunar como causa poco común del dolor de muñeca. El paciente fue tratado exitosamente mediante una intervención quirúrgica. El quiste ganglionar intraóseo debe ser considerado en el diagnóstico diferencial de dolores de muñeca sordos que se han hecho sentir por mucho tiempo, y se han vuelto crónicos.

Tratamiento quirurgico de la enfermedad de Kienbock por escision del semilunar, elongacion del hueso grande y fijacion con tornillo de Herbert / Kienbockïs disease: surgical treatment by lunate excision, capitate lengthening and fixation with Herbert screw

Los autores analizan el resultado del tratamiento en 8 pacientes con necrosis aseptica del semilunar por escision de este hueso, elongacion del hueso grande y fijacion del tornillo de Herbert. La media del seguimiento fue de 33 meses (rango, de 3 a 63 meses). Luego de este periodo, se evaluo el grado de movilidad de la muñeca y se realizo un analisis radiologico y una evaluacion subjetiva del dolor y el retorno a las actividades laborales. Los resultados preliminares fueron buenos y solo un paciente necesito adaptarse a otra actividad profesional

Enfermedad de Kienböck bilateral / Bilateral Kienböck's disease

Se presenta un caso con enfermedad de Kienböck bilateral. El tratamiento empleado y la evolución de la paciente fueron favorables. Se señala esta forma rara de presentación y la no existencia de un reporte similar en nuestro país

treatment of kienbocics disease by lunate excision and scaphocapitate Fusion

Excision of the lunate combined with scaphocapitate [SC] fusion was performed for 14 patients with stage III Kienbock's disease. The average age was 21 years and the period of follow-up averaged 14.8 months. The operation was done through a dorsal approach with the use of autogenous bone graft and K wire fixation for the scaphocapitate articulation. Satisfactory fusion occurred in all cases after an average of 8.3 weeks. The procedure was successful in preventing further carpal collapse and scaphoid subluxation. Degenerative arthritis occurred in five patients and mild superficial infection in two patients. The range of motion averaged 29.6° of palmarflexion, 31.1° of dorsiflexion, 22.1° of ulnar deviation and 5.7° of radial deviation. The grip strength averaged 73.9% of the uninvolved side. Pain was markedly reduced in over 85% of the patients, and more than 70% of the patients were able to return to their former heavy manual jobs

Fractura-luxación del carpo / Fracture-luxation of carpus

Se realizó un estudio retrospectivo longitudinal en 25 pacientes con fracturas-luxaciones del carpo de 1971 a 1991, en el Hospital ABC y en el Instituto Nacional de Ortopedia tratados por el autor. De ellos, 7 fueron diagnosticados en las 3 primeras semanas después del accidente y 18 entre 4 y 8 meses. Veintidós correspondieron a fractura-luxación perilunar en sus diferentes variedades y fueron tratados quirúrgicamente con reducción abierta y síntesis ósea con clavos de Kirschner por abordaje dorsal y en 4 combinada con abordaje palmar. A 3 de los casos tardíos se les efectuó resección de la fila proximal del carpo. La valoración clínica se efectuó con la tabla de Green y O'Brien entre 6 y 18 meses después de la cirugía, obteniendo resultado bueno en 6(24 por ciento), regular en 8(32 por ciento) y malo en 11 (44 por ciento) de los pacientes. Ninguno obtuvo resultado excelente. Estas fracturas son un reto para el cirujano, que necesita paciencia, estudio cuidadoso de las radiografías y técnica quirúrgica precisa para obtener el mejor resultado

Necrose do semilunar (Kienbock): relato de um caso em uma criança / Necrosis of the semilunar bone (Kienbock): report of a case in a child

Após breve revisäo da literatura sobre a necrose do semilunar (NSL), os autores fazem o relato de um caso de NSL em um paciente de dez anos de idade. O diagnóstico foi feito baseado na história clínica, exame físico e exame radiológico. O paciente foi tratado cirurgicamente com osteotomia para encurtamento do rádio, tendo apresentado rápido restabelecimento clínico e radiológico. Os autores concluem tratar-se de caso raro pela idade em que se desenvolveu a doença.

Artrodese triescafóide do carpo / Triscaphe arthrodesis of the carpus

A artrodese triescafóide do carpo é hoje uma técnica de rotina em cirurgia de mäo. Quinze casos foram avaliados, entre os vinte operados no serviço usando os seguintes critérios: consolidaçäo da artrodese, alívio da dor, amplitude de movimentos, força de preensäo e retorno as atividades funcionais. os resultados foram graduados, dando-se um peso para cada critério, verificando-se cerca de 2/3 de bons resultados e 1/3 de regulares

Complicaçäo da artroplastia do semilunar: sinovite reacional / Complication of lunate arthroplasty: reactional synovitis

Sinovite reacional do tipo corpo estranho e com destruiçäo óssea focal desenvolveu-se em dois pacientes submetidos anteriormente a artroplastia do semilunar para tratamento da enfermidade de Kienböck. Os pacientes foram submetidos a biópsia e ao exame histopatológico, constatando-se processo inflamatório do tipo corpo estranho com presença de numerosas partículas de silicone. As próteses se encontravam deformadas, na superfície de contato com o rádio, e com coloraçäo amarelada opaca. Os dois casos apresentaram instabilidade rotacional do escafóide e foram submetidos à remoçäo da prótese e à artrodese triescafóide