Evaluating Accuracy of Plain Magnetic Resonance Imaging or Arthrogram versus Wrist Arthroscopy in the Diagnosis of Scapholunate Interosseous Ligament Injury.

Introduction Scapholunate interosseous ligament injury (SLIL) is the most common cause of wrist instability and a cause of morbidity in a proportion of patients with wrist injuries. Aim To evaluate the accuracy of plain magnetic resonance imaging (MRI) and MR arthrogram (MRA) in the diagnosis of SLIL injury against the existing gold standard-wrist arthroscopy. Materials and Methods We retrospectively reviewed 108 cases by comparing MRI/MRA reports and their wrist arthroscopy operation notes. Results Overall MRI sensitivity to SLIL injuries was 38.5% (91.0% specificity). When broken down into plain MRI and MRA the results were: plain MRI sensitivity = 19.2% (91.4% specificity) and MRA sensitivity = 57.7% (90.5% specificity). Conclusion Neither MRI nor MRA scanning is sensitive enough compared with the gold standard. Positive predictive value remains too low (62.5 and 88.2%, respectively) to consider bypassing diagnostic arthroscopy and treating surgically. The negative predictive value (60.4 and 63.6%, respectively) is inadequate to confirm exclusion of injury from MRI results alone.

Trapeziectomy with Ligament Reconstruction and Tendon Interposition versus Trapeziometacarpal Joint Replacement for Thumb Carpometacarpal Osteoarthritis: A Systematic Review and Meta-Analysis.

Background The trapeziometacarpal articulation in the thumb is a joint that is second-most commonly affected by osteoarthritis, and this can lead to considerable hand pain and disability. Currently, there is a multiplicity of surgical options available to address this problem, yet none has proven to be significantly superior to the others. Objective This study aims to compare the outcome of trapeziectomy with ligament reconstruction and tendon interposition versus trapeziometacarpal joint replacement for thumb carpometacarpal osteoarthritis. Materials and Methods A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards. The NICE Healthcare Databases Advanced Search (HDAS) tool was used to search articles. One randomized controlled trial (RCT), one prospective cohort study and two retrospective cohort studies were identified. Results Our results demonstrate a significant difference in the Quick Disabilities of the Arm Shoulder and Hand (QDASH) score between the trapeziectomy with ligament reconstruction and tendon interposition (LRTI) and Joint Replacement groups with the joint replacement group exhibiting better QDASH scores than the LRTI group. We also found that those who had a joint replacement had a significantly better thumb opposition than those in the LRTI group, as demonstrated by a superior Kapandji score. However, the complication rate of joint replacement appears to be higher. Conclusion Our study reveals that while both treatment options are valid, the limited body of evidence currently available shows that joint replacement carries more risks and thus should not replace the current standard treatment of trapeziectomy with LRTI. This study highlights the need for more trials to be performed to more accurately compare the two treatment modalities. For the time being, we advocate that joint replacement is only performed by surgeons who perform this procedure regularly to reduce the risk of complications.

MatOrtho Proximal Interphalangeal Joint Arthroplasty via Lateral Approach: Minimum 2-Year Follow-Up.

Background: The MatOrtho implant is a cementless, mobile-bearing surface arthroplasty with a cobalt-chromium metal-on polyethylene articulation designed to treat osteoarthritis of the PIP joint. Early results for the prosthesis inserted through a dorsal approach have demonstrated good pain relief but no significant improvement in range of motion. In an attempt to improve the range of motion the senior author has changed his surgical practice to inserting the MatOrtho implant via a lateral approach. The purpose of this study is to assess the outcome of this change of surgical technique. Methods: Consecutive patients with osteoarthritis who underwent PIPJ replacement surgery via the lateral approach at a single institution, with a minimum follow-up period of 2 years were identified. A visual analogue score was used to assess pain. Grip strength, range of motion and functional outcomes scores were collected. Results: A total of 46 PIP joint arthroplasties were performed in 29 patients. Ten patients were lost to follow-up resulting in 33 PIP joint arthroplasties reviewed in 19 patients. Six implants failed. The mean follow-up time at the final follow-up for the remaining 25 prosthesis was 34.2 months (range 24-52). Range of motion improved from a mean of 37.2 preoperatively to a mean of 57.9 postoperatively. This was statistically significant (p = 0.0007). There was also a significant improvement in pain and functional outcome scores but not for grip strength. Conclusions: The MatOrtho PIPJ replacement delivers significant improvements in pain relief and functional outcome scores, as well as increased range of motion when the surgical procedure is performed through a lateral approach. There are, however, limitations to the use of this implant. Currently we do not consider this implant when there is instability or deformity of the PIP joint preoperatively.

Wide-Awake Wrist and Small Joints Arthroscopy of the Hand.

The minimally invasive nature of wrist and small joint arthroscopy renders it particularly suitable for the application of the wide-awake local anesthesia no tourniquet (WALANT) technique. The application of WALANT wrist and small joint arthroscopy has given surgeons the ability to visualize both static and dynamic movements of a joint, to show the pathology and discuss with the patient, and to visualize a patient's repaired structures. This reinforces confidence in surgeons and encourages patients to comply with postoperative rehabilitation.

Effects of Ulnar Styloid Fractures on Unstable Distal Radius Fracture Outcomes: A Systematic Review of Comparative Studies.

Purpose In this literature review, functional outcomes such as Disability of Arm, Shoulder and Hand (DASH) score and the visual analog scale (VAS) of pain along with clinical outcomes such as range of movement and grip strength of treated distal radius fractures (DRF) accompanied with ulnar styloid fractures (USF) will be compared with those with isolated DRF. Materials and Methods We analyzed articles from MEDLINE, Embase, and CINAHL that met our predetermined inclusion and exclusion criteria as per the Preferred Reporting Items for Systematic Reviews and Meta-analysis statements. This resulted in the identification of 464 articles with 18 potentially eligible studies of which 6 were included at the full-text screening stage. The primary outcomes were wrist pain, range of motion, functional outcome and satisfaction, such as VAS, and the DASH questionnaire along with radiological assessment and incidence of complications. Results These studies involved 796 participants with DRF and 806 wrists with DRF; 444 (55%) of DRF had an associated USF. Three studies did not report any statistically significant difference in DASH scores between the DRF patients with or without USF. Two studies reported worse DASH scores in the group with associated USF. Wrist pain was reported to be statistically significantly worse in patients with associated USF in two studies. Grip strength did not exhibit a statistically significant difference in any groups in four studies. On assessing the range of motion of the wrist and forearm, only one study reported a statistically significant difference in flexion at 2 years follow-up, with less flexion in patients with USF. Conclusion This review suggests that there is no significant correlation between a USF and the functional and clinical outcomes of DRF treatment, albeit wrist pain and less flexion were reported in some studies to be associated with USF. There is a need for more robust evidence from large randomized controlled trials to specifically look at the effects of fixation versus nonfixation of USF on DRF, or large prospective cohort studies assessing DRF with and without USF, with a minimum of 12 months follow-up. Level of Evidence Level II-therapeutic.

The Outcome Of Surgical Management Of Chronic Pectoralis Major Ruptures In Weightlifters.

Pectoralis major repair is increasing in frequency due to the uptake of weight training. Chronic tendon injuries tend not to have as favourable outcomes. We report our outcome of chronic pectoralis major ruptures following surgical repair. Retrospective analysis of 8 patients who were weightlifters, treated for primary pectoralis major repair by one surgeon. Surgical repair was direct via suture anchors and one additionally required fascia lata graft due to tendon retraction. Outcome was assessed by comparing strength to the contralateral pectoralis muscle and the Oxford Shoulder Score. All patients were male with mean age of 36 years. Mean delay to surgery was 25.6 months. Mean followup was 19.6 months and mean Oxford Shoulder Score was 43.7. Six out of eight patients had full strength compared to the contralateral side. Complications included visible skin tethering not associated with weakness, stiffness associated with weakness and a seroma at fascia lata donor site. This is the largest documented study of Chronic Pectoralis Major repair showing excellent outcomes with repair, even if delayed.