Feasibility of ultrasound-based measurement of dorsal scaphoid displacement: A 3D-model study.

The present study aimed to develop a reliable dynamic measurement technique, which can be used directly in the outpatient setting, based on dorsal subluxation of the scaphoid on scaphoid shift test. This study was designed to evaluate feasibility and to quantify dorsal subluxation of the scaphoid in relation to the lunate. Based on a scaphoid shift test under ultrasonography, a standardized 3D test model was developed to measure subluxation. Sagittal subluxation ranged between 0 and 6 mm, as checked on the implemented scale. Four hand surgeons trained in ultrasonography (experience level II-V) performed blinded measurements (total of 52, n = 13 per investigator) with a standardized measurement protocol. Dorsal subluxation of the scaphoid was measured in relation to the lunate. Interobserver reliability on intraclass correlation coefficient (ICC) was excellent, at 0.97 (95% confidence interval, 0.930-0.992). Mean overall absolute measurement error was 0.27 mm ± 0.21. Dorsal subluxation of the scaphoid can thus be accurately measured on ultrasound with excellent interobserver reliability, quantifying and improving clinical assessment of scapholunate instability.

Long-term results after semiconstrained distal radioulnar joint arthroplasty: A focus on complications.

Arthroplasty of the distal radioulnar joint (DRUJ) using a semiconstrained DRUJ implant yields good outcomes according to the literature. The aim of this study was to investigate the subjective, clinical and radiographic outcomes with a special focus on complications in nine patients with a mean follow-up of 6years and to compare them with our previously published 3-year follow-up results. No subjective or objective changes were seen between the 3-year and the 6-year follow-up. In the previous study, one implant loosening and two irritations of the superficial branch of the radial nerve occurred. We saw three complications that needed surgery in addition to the three complications already found 3years after surgery. One patient with a large ulna had loosening of the cemented ulnar stem and therefore the prosthesis was explanted. One patient had an allergic reaction to the metal alloy of the prosthesis, which also led to removal. One patient had an ulnar impaction syndrome caused by too-distal placement of the implant that needed revision. Prior studies reported low complication rates. In our study, six complications occurred in four out of nine patients, requiring reoperation including two revisions and two implant removals. A precise surgical technique is mandatory to avoid the otherwise frequent complications and potential implant failures. LEVEL OF EVIDENCE: IV.

Midterm Results of Semiconstrained Distal Radioulnar Joint Arthroplasty and Analysis of Complications.

Range of motion and stability are important outcome parameters to assess function of the distal radioulnar joint (DRUJ), in particular pronation, supination, and weight-lifting capacity. The DRUJ semiconstrained implant developed by Scheker et al is intended to reproduce all the functions of the triangular fibrocartilage complex and the DRUJ. The aim of the study was to investigate the subjective, clinical, and radiographic results in 10 patients after primary implantation of the semiconstrained DRUJ arthroplasty following DRUJ derangement and painful instability, with an average follow-up of 3 years with a special focus on the complications. Standardized preoperative and postoperative evaluation included assessment of pain by a visual analog scale, radiographic examination, range of motion measurements, lifting capacity, and grip strength. The patient-perceived function was investigated using clinical score charts. Compared with the preoperative status, range of motion showed little change, while grip strength, lifting capacity, pain score, and patient-perceived functions improved significantly. One patient developed an ulna stem loosening, while two patients had to be reoperated because of an irritation of the extensor tendons and the superficial radial nerve at the first dorsal compartment of the wrist. In this study, arthroplasty of the DRUJ using the semiconstrained DRUJ arthroplasty was found to result in satisfactory outcome. Level of evidence: Level IV.

Comparison of clinical outcome with radiological findings after trapeziectomy with ligament reconstruction and tendon interposition.

UNLABELLED: The aim of our study was to investigate if pre- and postoperative radiographic thumb carpometacarpal position is correlated with clinical and subjective outcomes. Radiographs of 105 patients undergoing trapeziectomy with ligament reconstruction and tendon interposition were analysed before, as well as 1 year after, surgery for dorsal subluxation and proximal migration of the thumb metacarpal bone. Furthermore, key pinch strength was measured and patients completed the Michigan Hand Outcomes Questionnaire. Baseline dorsal subluxation and scaphometacarpal distances significantly decreased from 8.2 mm and 11.0 mm to 5.2 mm and 5.1 mm at 1 year, respectively. There was no correlation between the amount of subluxation or proximal migration and the Michigan Hand Outcomes Questionnaire score or key pinch strength. These results suggest that postoperative position of the metacarpal base of the thumb does not affect clinical or subjective outcomes after trapeziectomy with ligament reconstruction and tendon reposition of the thumb carpometacarpal joint. LEVEL OF EVIDENCE: Level 3.

Ten year follow-up of pyrocarbon implants for proximal interphalangeal joint replacement.

Results of anatomical resurfacing of the proximal interphalangeal joint using pyrocarbon implants showed reasonable clinical results with a high radiographic migration rate. The aim was to investigate the subjective, clinical, and radiographic results 10 years following surgery, and to compare them with our 2-year follow-up data. We re-evaluated 12 patients with 15 proximal interphalangeal implants on average 9.7 years after surgery. Pain significantly improved from 7.6 on a visual analogue scale pre-operatively to 1.4 at 2 years, and to 0.7 at the final follow-up. The mean total range of motion in all replaced joints was 36° pre-operatively and 39° at the 2-year follow-up, but had decreased significantly to 29° at 10 years. We saw one implant migration in addition to the eight migrated implants we already found 2 years after surgery. The moderate clinical results, combined with the high migration rate, mean that we no longer use this kind of implant.

[Clinical and radiological results after operative treatment of mallet fracture using Kirschner wire technique]. / Klinische und radiologische Ergebnisse nach operativ versorgten Frakturen dorsal an der Fingerendgliedbasismit Kirschnerdrähten.

BACKGROUND: In our clinic dorsal distal phalanx fractures involving more than 30% of the articulare line in the lateral view are treated operatively using the Kirschner wire technique. Recently conservative treatment of these fractures is more and more recommended. Therefore we investigated in a retrospective study our patients with special regards to complications. PURPOSE: The aim of this study was to evaluate the complications, as well as the clinical and radiological results of patients after operative treatment of dorsal distal phalanx fractures using the Kirschner wire technique. PATIENTS AND METHODS: 43 patients with dorsal intraarticular fractures of the distal phalanx involving at least one third of the articular surface of the distal interphalangeal (DIP) joint were treated between 02/05 and 08/09 using Kirschner wire technique. At a mean follow-up of 28 (8-60, median 24,5) months, 32 patients were evaluated clinically and radiologically as well as with ultrasound. RESULTS: 5 patients developed superficial wound infections and were treated with antibiotics. 2 of these patients needed an early removal of the Kirschner wires. 2 patients showed nail deformity and 2 had an ulnar deviation of the DIP joint. The mean extension lag was 10° (0-30°, median 10°), the mean flexion lag was 19° (0-60°, median 15°). 11 patients had a flexion lag of more than 20°. 4 patients had an extension lag of more than 20°. All of these patients showed tendon tears or large lesions by ultrasound. Degenerative changes were noted in radiographs of 15 patients. CONCLUSIONS: Because of unsatisfactory results in 63% (n=20), conservative treatment will be our treatment of choice in the future. Operative treatment will only be done in patients with subluxation of the distal phalanx.