Preliminary Outcomes of Scapholunate Ligament Augmentation with Internal Brace Technique.

Purpose: Injury to the scapholunate (SL) interosseous ligament (SLIL) is a common cause of carpal instability. Internal brace augmentation has been used in various ligament repair procedures; however, further investigation of its outcomes in hand surgery is needed. This study aimed to examine outcomes for patients who underwent SLIL repair with internal brace augmentation. Methods: Patients who underwent SLIL repair with the internal brace technique and had at least 1 year of follow-up were contacted. Available patients returned for an in-person evaluation with new radiographs and physical examination. If patients could not be contacted but had x-rays and physical examinations performed at greater than 1 year after surgery, these data were collected from their medical records. Participating patients completed the QuickDASH and Patient-Rated Wrist Evaluation surveys and rated their satisfaction with the surgery. Outcomes assessed included wrist range of motion, grip strength, scaphoid shift test, SL gap, SL angle, and radiographic evidence of radiocarpal arthritis. Results: We collected outcomes for 14 SLIL repairs among 13 patients (12 male). Mean length of the follow-up was 41 months (n = 14, 17-64). Mean QuickDASH and Patient-Rated Wrist Evaluation scores were 6.1 (0-43.2) and 9.6 (0-65), respectively. Radiographic measurements remained stable from immediate to latest follow-up, and no radiocarpal arthritic changes were noted. However, SL gap decreased from a mean of 5.33 mm (3.4-6.7) before surgery to 3.34 mm (2-4.6) at the latest follow-up, and SL angle decreased from a mean of 79.5° (67°-97°) before surgery to 67.3° (51°-85°) at the latest follow-up. All scaphoid shift tests were stable. Conclusions: Therefore, SL internal brace augmentation has favorable short-term results with improvements in pain, function, satisfaction, and carpal alignment at greater than 1 year postoperatively. This technique can be an effective option for the management of SL instability in the short term. Type of study/level of evidence: Therapeutic IV.

Analysis of Terminated Hand and Wrist-Related Clinical Trials.

Purpose: While clinical trials provide high-quality evidence guiding medical decision-making, early trial termination can result in both lost time and resources. Our purpose was to investigate the rate of and reasons for clinical trial termination for hand and wrist-related conditions and identify study characteristics associated with early trial termination. Methods: The ClinicalTrials.gov database was queried for all hand and wrist-related clinical trials. All terminated and completed trials were reviewed, with characteristics and reasons for termination recorded. Study characteristics included type, purpose, intervention assessed, enrollment, group allocation, blinding, trial phase, sponsor type, and geographic region. Chi-square test was used to identify associations between trial characteristics and terminated versus completed status. Results: A total of 793 hand and wrist-related clinical trials were identified, with 77 trials (10%) terminated prior to completion. The most common reason for termination was "recruitment/retention difficulty," reported in 37 (48%) terminated trials. In comparing competed versus terminated trials, primary purpose (nonobservational studies), enrollment (<50 patients), and geographic region (North America) were all significantly more likely to be terminated. Terminated trials were more likely to have an intervention type investigating a specific device or drug. Conclusions: Early trial termination for hand and wrist-related conditions is common (10%), with patient recruitment and retention identified as the leading cause of termination. Trials involving potential commercial incentives (those investigating a device or drug) were associated with an increased rate of trial termination. Clinical relevance: An emphasis on patient enrollment during study design may aid in mitigating the most common cause of early clinical trial termination.

Trends in the Utilization of Computed Tomography in Operative Treatment of Distal Radius Fractures.

Purpose: To identify patient, surgeon, and injury characteristics associated with preoperative computed tomography (CT) scan utilization for operative distal radius fractures (DRF). In addition, we aimed to determine if preoperative CT was associated with treatment methods other than isolated volar-locked plating (VLP). Methods: We retrospectively reviewed all operatively treated adult DRFs within our health care system from 2016 to 2020. Baseline demographics, injury, treatment characteristics, and the fellowship training of the 44 included surgeons were recorded. We compared cases with and without a preoperative CT, and an adjusted logistic regression model was generated to determine the odds of having a preoperative CT. Results: A total of 1,204 operatively treated DRFs performed by 44 surgeons were included. CT utilization increased during the study period. Intra-articular fractures accounted for 76% of cases, and preoperative CT scans were ordered in 243 of 1240 cases (20%). Overall, isolated VLP was used in 83% of cases. Cases with a preoperative CT were more likely to be treated with an alternative method of fixation (such as dorsal plating). The adjusted logistic regression model demonstrated that male sex (OR 1.62; 95% CI: 1.16, 2.26), intra-articular fractures (OR 3.11; 95% CI: 1.87, 5.81), and associated fractures (OR 2.69; 95% CI: 1.82, 3.98) had a significantly increased odds of having a preoperative CT. Fellowship training was not associated with increased CT utilization overall, but hand surgeons were more likely to use a CT in Orthopaedic Trauma Association-C3 fractures. Conclusions: Patient and injury characteristics are associated with CT utilization in operative DRFs. Preoperative CTs are associated with alternative fixation approaches, as cases with a CT were more likely to use fixation methods other than isolated VLP. The costs and benefits of CT scans must be carefully weighed against whether this modality adds value or improves outcomes in treating DRFs. Level of evidence: Prognostic II.

Four-Corner Arthrodesis: Comparative Analysis of Open Technique Versus Percutaneous Technique with Arthroscopic Assistance.

Introduction Four-corner arthrodesis is a salvage technique for patients with carpal advanced osteoarthritis. Nowadays, percutaneous techniques with arthroscopic assistance have been described, achieving favorable results with minimally invasive techniques advantages over open surgery. Objective To compare functional and radiological results in patients with SLAC or SNAC wrists operated with open surgical technique versus percutaneous surgery with arthroscopic assistance. Materials and Methods Retrospective case-control study of clinical records and radiological images of patients with carpal advanced osteoarthritis operated with both surgical techniques. We studied demographic variables, pain with visual analog scale (VAS) score, function in ranges of mobility, time of consolidation, and correction of DISI deformity. Results A total of 22 male patients with an average age of 32.5 years were studied. Thirteen patients in the case group (percutaneous technique with arthroscopic assistance) and nine patients in the control group (open surgery). Pain score in VAS at discharge was 3 for cases and 5 in controls ( p = 0.008), and at 30 days postoperatively, it was 0 and 3 respectively ( p = 0.00). The extension and flexion ranges were 52.6°and 38.7° in the cases and 35.7° and 32.4° in the control group ( p = 0.119 and 0.0016, respectively). The capitolunate angle was 10°in the controls and 5°in the cases ( p = 0.0008). The time of consolidation was 8.8 weeks in cases and 12.5 weeks in controls ( p = 0.039). Conclusions The percutaneous technique with arthroscopic assistance for the 4-courner arthrodesis is a reproducible technique and is effective in achieving consolidation, pain reduction and preservation of wrist motion. In the present study, we demonstrate superiority of this technique over the open surgery. Level of Evidence This is a Level III, therapeutic study.

Artrodesis de cuatro esquinas: análisis comparativo de técnica abierta versus técnica percutánea con asistencia artroscópica / Four-corner arthrodesis: comparative analysis of open surgery versus percutaneous technique with arthroscopic assistance

INTRODUCCIÓN: La artrodesis de cuatro esquinas es una técnica de salvataje para los pacientes con artrosis avanzada del carpo. Los objetivos quirúrgicos son disminuir el dolor y mantener cierto movimiento de la muñeca. En el último tiempo, se han descrito técnicas percutáneas con asistencia artroscópica que han logrado resultados favorables, a pesar de que la técnica abierta sigue siendo el gold estándar para realizar esa técnica quirúrgica. OBJETIVO: Comparar resultados funcionales y radiológicos en pacientes con muñecas con colapso avanzado escafolunar (scapholunate advanced collapse, SLAC) o colapso avanzado en la pseudoartrosis del escafoides (scaphoid nonunion advanced collapse, SNAC) operados con técnica quirúrgica abierta versus técnica percutánea con asistencia artroscópica. MATERIALES Y MÉTODOS: Estudio retrospectivo tipo caso-control, de fichas clínicas e imagenología de pacientes con artrosis avanzada del carpo operados con técnica percutánea y asistencia artroscópica y cirugía abierta. Se estudian variables demográficas, dolor mediante la Escala Visual Analógica (EVA), función en rangos de movilidad, tiempo de consolidación, y corrección del ángulo capitolunar. Se describe la técnica quirúrgica de la cirugía abierta y la cirugía percutánea con asistencia artroscópica. RESULTADOS: Se estudiaron 22 pacientes del sexo masculino con edad promedio de 32,5 años. Había 13 pacientes en el grupo de casos (técnica percutánea con asistencia artroscópica) y 9 pacientes en el grupo de controles (técnica abierta). El dolor en la EVA al momento del egreso hospitalario fue de 3 para los casos y de 5 para los controles (p » 0,008), y a los 30 días del postoperatorio, fue de 0 y 3 respectivamente (p » 0,00). Los rangos de extensión y flexión fueron de 52,6° y 38,7° para los casos y de 35,7° y 32,4° para los controles (p » 0,1119 y 0,0016, respectivamente). El ángulo capitolunar fue de 10° para los controles y de 5° para los casos (p » 0,0008). El tiempo de consolidación fue de 8,8 semanas para los casos y de 12,5 semanas para los controles (p » 0,039). DISCUSIÓN: Tanto la técnica percutánea con asistencia artroscópica cuanto la cirugía abierta para realizar una artrodesis de cuatro esquinas son técnicas reproducibles y efectivas en lograr consolidación, disminución del dolor, y mantenimiento de rangos de movimiento en la muñeca. CONCLUSIÓN: En el presente trabajo se demuestran mejores promedios de los parámetros evaluados con la técnica percutánea que con la cirugía abierta; sin embargo, es necesario realizar estudios prospectivos para realizar una recomendación con respecto a la técnica quirúrgica de elección.

INTRODUCTION: Four-corner arthrodesis is a salvage technique for patients with advanced carpal osteoarthritis. This procedure aims to reduce pain and preserve wrist motion. Even though percutaneous techniques with arthroscopic assistance reportedly have favorable outcomes and the advantages of minimal invasiveness, open surgery remains the gold standard for four-corner arthrodesis. OBJECTIVE: The present study aims to compare the functional and radiological outcomes of patients with scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC) submitted to open surgery versus percutaneous surgery with arthroscopic assistance. MATERIALS AND METHODS: Retrospective case-control study of clinical records and radiological images of patients with advanced carpal osteoarthritis submitted to percutaneous surgery with arthroscopic assistance versus open surgery. Demographic variables, pain score using the visual analog scale (VAS), function ranges of motion, time until consolidation, and correction of the capitolunate angle were analyzed. Both techniques are described. RESULTS: In total, 22 male patients with an average age of 32.5 years were studied, including 13 patients from the case group (percutaneous surgery with arthroscopic assistance) and 9 patients from the control group (open surgery). The VAS score for pain at discharge was of 3 for the cases and of 5 for the controls (p » 0.008); 30 days postoperatively, it was of 0 and 3 respectively (p » 0.00). The ranges of extension and flexion were of 52.6° and 38.7° for the case group, and of 35.7° and 32.4° for the control group (p » 0.119 and 0.0016 respectively). The capitolunate angle was of 10° for the controls and of 5° for the cases (p » 0.0008). The time until consolidation was of 8.8 weeks for the cases and of 12.5 weeks for the controls (p » 0.039). DISCUSSION: Both four-corner arthrodesis techniques are reproducible and effective in achieving consolidation, pain reduction and preservation of wrist motion. CONCLUSION: The present study demonstrates the superiority of the percutaneous technique with arthroscopic assistance over open surgery. Further prospective studies are required for an adequate recommendation.

INDICATIONS FOR DISTAL RADIOULNAR ARTHROPLASTY: REPORT ON THREE CLINICAL CASES.

Distal radioulnar arthroplasty is an attractive solution for treating various pathological conditions of the distal radioulnar joint because it allows restoration of stability, load transmission and function. The main indications are: radioulnar impingement after partial or complete resection of the distal ulna; and degenerative, inflammatory or post-traumatic arthritis of the distal radioulnar joint. The authors present three clinical cases of distal radioulnar pathological conditions: two patients with post-traumatic sequelae and one case of distal radioulnar impingement after a Sauvé-Kapandji operation. The three cases were treated surgically with a metallic prosthesis to replace the distal ulna (First Choice - Ascension(®)). The first two were treated with a resurfacing prosthesis and the last one with a modular prosthesis. All of the patients had achieved pain relief and increased movement of the distal radioulnar joint after one year of postoperative follow-up.