Scaphoid osteotomy for malunion.
Explore the source record for details and available documents.
Journal Article↗
Biomedical subjects
R L Linscheid
Publications and source records attributed to R L Linscheid.
Normal kinematics of carpal bones: a three-dimensional analysis of carpal bone motion relative to the radius.
Normal carpal kinematics were studied in 22 cadaver specimens using a biplanar radiography method. The kinematics of the trapezium, capitate, hamate, scaphoid, lunate, and triquetrum were determined during wrist motion in sagittal and coronal planes. The results were expressed using the concept of the screw displacement axis and converted to describe the magnitude of rotation about and translation along three axes (X-axis: pronation-supination axis, Y-axis: flexion-extension axis, and Z-axis: radial-ulnar deviation axis) commonly used for the wrist. The orientation of these axes is expressed relative to the radius. Within the proximal carpal row, considerable differences of carpal behavior around the Y-axis were observed during sagittal plane motion of the wrist. The scaphoid exhibited the greatest magnitude of rotation, and the lunate the least. The magnitude of rotation of the carpal bones around the X-axis during sagittal plane motion of the wrist was small. The proximal carpal bones exhibited some ulnar deviation in 60 degrees of wrist flexion. During coronal plane motion of the wrist, the magnitude of radial-ulnar deviation of the distal carpal bones was mutually similar and generally of a greater magnitude than that of the proximal carpal bones. The proximal carpal bones experienced some flexion during radial deviation of the wrist and extension during ulnar deviation of the wrist. Translation was generally minimal in all carpal bones throughout wrist motion. This study reports results from the largest cadaver wrist kinematics study completed to date. The accuracy of the current method was improved when compared to previous studies. A sufficient number of specimens to allow statistical comparison was used and minimal interspecimen variability was noted. This study enabled a precise description of quantitative analyses of normal carpal kinematics relative to the radius.
Adult↗
Corrective osteotomy for scaphoid malunion: technique and long-term follow-up evaluation.
Five patients with dorsal intercalated segment instability underwent corrective osteotomy for symptomatic scaphoid malunion. Follow-up examination at an average of nearly 9 years after the procedure (range, 1.5-19 years) revealed that all had improvement in range of motion (ROM). Total active ROM improved from a mean of 127 degrees (range, 95 degrees-165 degrees) to a mean of 156 degrees (range, 95 degrees-214 degrees). Grip strength increased from a mean of 16 kg (range, 14-35 kg) to a mean of 32 kg (range, 24-48 kg). The wrist score improved from an average of 19 to 75. The preoperative intrascaphoid and carpal malalignments were reduced, as demonstrated by trispiral tomography. Symptomatically, all patients reported improvement. All osteotomies healed within 5.5 months of the procedure. No case of avascular necrosis was noted. Mild radioscaphoid arthrosis is apparent in four patients and a preexisting midcarpal arthrosis persists in one patient. Corrective osteotomy for scaphoid malunion may have a role in the prevention or slowing of the onset of premature arthritis in young patients with high functional demands. A technique is described.
Adult↗
Radial recession osteotomy for Kienböck's disease.
Sixty-eight patients underwent radial recession osteotomy for avascular necrosis of the lunate were retrospectively evaluated after an average follow-up period of 52 months. Twenty-five patients had undergone 1 or more additional procedures concurrently for treatment of Kienböck's disease. Pain diminished in 93% of patients, grip strength improved, and wrist motion was preserved; 75% of patients continued in their original occupations, including heavy labor. Surgical complications were uncommon. Four patients subsequently underwent salvage procedures, including 2 total wrist arthrodeses. Three of these 4 patients were receiving workers' compensation. One third of patients demonstrated lunate healing after joint leveling. Preliminary results suggest that concomitant lunate revascularization or vascularized bone grafting may improve the radiographic result. With rare exceptions, radial recession osteotomy relieves pain and improves function in Kienböck's disease.
Adolescent↗
Trispiral tomographic staging of Kienböck's disease.
Trispiral tomography enhances the staging of Kienböck's disease and aids in surgical planning. The clinical records, plain x-rays, and trispiral tomograms of 105 patients with Kienböck's disease were reviewed. When tomograms were used, upward revision of the classification stage was indicated in 73% of patients with stage I or stage II disease and in 10% of those with stage III disease. On tomograms, 91% of patients had lunate fractures, compared with 55% on plain films. The most common lunate fracture seen on trispiral tomograms was a transverse shear fracture that represented lunate collapse; the next most common was a midcoronal fracture that may be displaced, causing fragment extrusion palmarly or dorsally. The most common instability pattern was nondissociative proximal row flexion, seen in stage III. Indices of carpal collapse and ulnar translation may be useful in following up patients, but values vary widely among patients.
Adolescent↗
Pisotriquetral loose bodies.
Eight patients--2 men and 6 women (mean age, 49 years)--who underwent excision of pisotriquetral (PT) loose bodies were identified from clinic records. The time interval from onset of symptoms to surgery averaged 18 months. Four patients reported a traumatic onset of symptoms, and 4 reported an insidious onset. For all patients, treatment by nonsteroidal anti-inflammatory drugs, splinting, and steroid injection had failed. Routine radiography revealed a loose body in only 4 patients. Trispiral tomography delineated all loose bodies. Three patients underwent loose-body excision only; 5 had PT joint degeneration and underwent additional pisiformectomy. Length of follow-up monitoring averaged 7.4 years. All patients had resolution of wrist pain and improvement in strength. There were no complications. Loose bodies, which may form in the PT joint or migrate from the radiocarpal joint, were identified best by tomography, with simple excision providing excellent relief of symptoms in the absence of PT joint degeneration.
Adult↗
Development of a surface replacement arthroplasty for proximal interphalangeal joints.
Sixty-six surface replacement proximal interphalangeal prostheses with a CrCo proximal and an ultrahigh-molecular-weight polyethylene distal component were used in the hands of 47 patients (mean age, 58 years) over a 14-year period. There were 37 fingers with degenerative arthrosis, 16 with traumatic arthrosis, and 13 with rheumatoid arthritis. The mean follow-up period was 4.5 years (range, 1-14 years). The results based on pain relief, motion, and deformity were good in 32 fingers, fair in 19, and poor in 15. Poor results occurred primarily in fingers with previous extensive injury or static deformity. Results with a dorsal approach were better than those with a lateral or palmar approach. Component loosening at the bone-cement junction beyond a minimal radiolucent line was seen in one late x-ray. Results in individuals changed little after the first year of follow-up care, but results overall improved during the course of the study, perhaps because of improvements in surgical technique and experience.
Adolescent↗
En bloc resection of tumors of the distal end of the ulna.
The operative treatment of malignant tumors and aggressive benign tumors involving the distal end of the ulna often necessitates en bloc resection. The oncological and functional results for eight patients in whom a neoplasm involving the distal end of the ulna had been treated with en bloc resection without reconstruction of the osseous defect were reviewed retrospectively at a mean of seventy-nine months (range, twenty-three to 271 months). Four patients had a giant-cell tumor; two, a low-grade osteogenic sarcoma; one, a hemangioendothelioma; and one, a soft-tissue epithelioid sarcoma with osseous involvement. The amount of bone that was removed from the distal end of the ulna ranged from 3.1 to 9.0 centimeters. In the four patients who had a malignant tumor, a minimum of 7.5 centimeters was removed in order to achieve an adequate wide margin proximally. In the patients who had a benign tumor, a maximum of 6.6 centimeters was resected. Extraperiosteal resection was performed in three of the patients who had a malignant tumor and in one of the patients who had an aggressive giant-cell tumor. Subperiosteal resection was performed in the three patients who had a benign tumor and in one patient who had a parosteal osteogenic sarcoma. None of the patients had local or systemic evidence of recurrence of the tumor. The functional result was excellent for six patients and good for two. Grip strength was reduced by a mean of 15 per cent compared with the strength on the contralateral side, and this reduction did not appear to be related directly to the amount of bone that had been resected. The findings of this study support the concept that routine reconstruction of the osseous defect is not necessary after en bloc resection of a neoplasm of the distal end of the ulna.
Adult↗
A short history of the wrist joint.
From the standpoint of descriptive anatomy and function, the wrist has been somewhat neglected when compared to other joints. This article tries to describe the major contributions to this subject, many of which were overlooked before the recent era of markedly increased interest.
Anatomy↗
Intercarpal kinematics during wrist motion.
Twenty-two fresh cadaver specimens were analyzed using a three-dimensional biplanar roentgenographic kinematic technique to quantitate intercarpal motion. The large number of specimens provided substantial power to dramatically optimize the statistical significance of the measurements. It was confirmed that the bones of the distal carpal row behave as a single, functional unit with little intercarpal motion and are directly linked to movement of the third metacarpal. The scaphoid, lunate, and triquetrum exhibit significant "out of plane" motion, noted mainly in relation to the distal row bones. Measurable differences in the kinematics of the proximal row bones, relative to each other, were repeatedly defined.
Adult↗
Rotational laxity and stiffness of the radiocarpal joint.
OBJECTIVE: To investigate the constraint and potential mechanism of torque transmission across the wrist joint. DESIGN: In vitro experiment using human cadaveric specimens. BACKGROUND: Transmission of torque from the forearm to the hand requires rotational stability at the wrist. Better appriciation of the constraints would have applicability to several clinical problems where the stability is compromised. METHODS: Thirteen fresh-frozen cadaveric specimens were used in this experiment to investigate the rotational laxity and stiffness of the radiocarpal joint in unloaded and axially loaded (100 N) conditions, and three forearm orientations in a neutral, pronation (60 degrees ), or supination (60 degrees ) position. RESULTS: In pronation or supination, there was no difference between loaded and unloaded conditions in primary or total laxity at a maximum torque of 2.3 Nm. Unloaded specimens showed a mean total rotational laxity of 42.1 degrees. Supination or pronation of the forearm caused a decrease in laxity with respect to neutral forearm rotation (35 degrees and 41.6 degrees versus 49.6 degrees respectively). The primary rotational laxity accounted for half of the total laxity. With axial compression, total rotational laxity did not change, but primary laxity dropped to 50% of its unloaded value. The primary stiffness was very low -- approximately 11% of the secondary stiffness. CONCLUSION: The ligamentous structures and the joint articulation restricted excessive axial rotation of the wrist. However, a laxity of approximately 20 degrees was identified for normal wrists. RELEVANCE: This study demonstrated that the primary axial rotational laxity of the radiocarpal joint was approximately 20 degrees. In the mathematical model and implant design, muscular balance of the joint within such laxity should be considered.
Journal Article↗
Ulnar lengthening and radial recession procedures for Kienböck's disease. Long-term clinical and radiographic follow-up.
Twenty patients with Kienböck's disease who had undergone a joint levelling procedure, were reviewed at a mean of 11 years following surgery. Clinical and radiological evaluation revealed good long-term results with all patients complaining of less pain than before surgery and with statistically significant increases in range of motion and grip strength. Radiologically a significant number of patients were found still to have lunate fractures and fragmentation. In addition, 13 patients have developed new bone formation in the lunate fossa, and 12 show osteoarthritic changes, particularly at the radioscaphoid interface. Radial shortening was felt to be superior to ulnar lengthening in that there were fewer problems with bone union.
Adult↗
Kinematics of the trapeziometacarpal joint: a biomechanical analysis comparing tendon interposition arthroplasty and total-joint arthroplasty.
The kinematics of the trapeziometacarpal joint were studied in 15 cadaver hands; normal joints were compared with simulated arthroplasties-either a total-joint arthroplasty of the ball-and-socket variety or a fibrous suspension arthroplasty of ligament reconstruction with tendon interposition. The motion of the thumb metacarpal was analyzed based on a trapezial coordinate system, using a magnetic tracking system. The pivot point (instantaneous center of rotation) for the thumb metacarpal changed during active and passive circumduction. Compared with normal trapeziometacarpal joint motion, the pivot point after ligament reconstruction with tendon interposition shifted significantly in palmar and ulnar directions in reference to the trapezial coordinate system, whereas after total-joint arthroplasty, the pivot point shifted slightly palmarly and radially. The axes of rotation were also compared for ligament reconstruction with tendon interposition and total-joint arthroplasty during thumb flexion-extension and abduction-adduction motions. After ligament reconstruction with tendon interposition, the center of flexion-extension shifted palmarly and the center of abduction-adduction shifted ulnarly. After total-joint arthroplasty, the center of rotation for flexion-extension shifted distally and palmarly and that for abduction-adduction shifted palmarly and proximally. In comparison with the normal joint, passive circumduction increased after tendon interposition arthroplasty but was less with total-joint arthroplasty. Changes in kinematics suggest a suspensory ligament function of ligament reconstruction with tendon interposition arthroplasty, whereas total-joint arthroplasty results in axes of rotation that reflect the joint replacement rather those of the normal joint.
Arthroplasty↗
Acute flexor tenosynovitis in association with Clostridium difficile infection: a case report.
Explore the source record for details and available documents.
Adult↗
Radial opening wedge osteotomy in Madelung's deformity.
Radiopalmar opening wedge osteotomy was used in 11 female patients (12 wrists) with Madelung's deformity who ranged in age from 9 to 31 years. Five patients met the radiographic criteria for generalized dyschondrosteosis. Clinically, there was dissatisfaction with the appearance of the wrist. The principal motion deficits were in radiocarpal extension and forearm pronosupination associated with varying degrees of discomfort with sustained activity. All had a decreased radioulnar angle, lunate subluxation shown radiographically, and various degrees of dorsal subluxation of the ulnar head. Indications for surgery were pain, limited motion, cosmetic appearance, and progressive deformity in two immature patients. Biplanar corrective opening wedge osteotomy of the radius was performed with iliac crest graft. Three patients had an added ulnar recession. Fixation was with a plate or Kirschner wire. Supplementary distracting external fixation was used in six cases. The follow-up period averaged 48 months. Pain relief in all patients was satisfactory. Range of motion and grip strength were not influenced. The radioulnar angle improved by 11 degrees, but lunate subluxation was minimally changed. Length of the forearm and bowed appearance of the forearm were improved. Reduction of the radioulnar joints was improved but remained incongruous.
Adolescent↗
Force and pressure transmission through the normal wrist. A theoretical two-dimensional study in the posteroanterior plane.
Force transmission through the wrist in the normal population was investigated using the rigid body spring modeling (RBSM) technique (assuming carpal bones are rigid bodies interposed by series of springs simulating articulating cartilage and constraining ligaments). One-hundred and twenty normal wrist posteroanterior X-rays of adults (evenly divided to represent both genders and two age groups) provided the anatomical data. Reaction forces between the carpal bones were modeled using a system of compression linear springs, representing cartilage and subchondral bone, and of tensile linear springs, representing ligaments. The spring constants were determined based on the material properties of wrist cartilage and ligaments. Assumed axial loads were applied along the metacarpals to simulate a grasp strength of 10 N with active stabilization of the wrist in neutral position. The force transmission ratio at the radio-ulno-carpal joint was 55% through the radio-scaphoid and 35% through the radio-lunate joints. The remaining 10% of the load was passing through the triangular fibrocartilage with minor differences between genders. Among the intercarpal joints, a large percentage of the load of the wrist was transmitted to the scaphoid. The peak pressure was highest at the proximal pole of the radio-scaphoid, with a radio-scaphoid versus radio-lunate peak pressure ratio of 1.6. The most important ligaments in terms of load transmission were those opposing ulnar translation of the carpus. The wrist morphology had little influence on the magnitude and pattern of load distribution. There was no effect of age on wrist force distribution.
Adult↗
Rotational stability of the carpus relative to the forearm.
To perform rotational tasks adequately, the rotational laxity between the radius and the carpus must be constrained within a certain limit. The contribution of nine individual capsuloligamentous structures to the rotational stability of the radiocarpal joint was studied using 14 fresh-frozen human cadaveric specimens. Torque-rotation curves, with sequential section of the soft-tissue structures, were used to calculate the percentage contribution of each individual structure. The primary pronation constraint was the palmar radioscaphocapitate ligament. The contributions to supination constraint were more complex; the dorsal radiotriquetral ligament was dominant, assisted by the palmar ulnolunate ligament. Structures originating from the ulna changed their major constraint contribution with forearm orientation, whereas those with a radial origin had a constant contribution independent of forearm rotation. Injury of these structures may lead to rotational instability at the radiocarpal level and should be considered when treating carpal instabilities.
Adult↗
Operative treatment of malunited fractures of the forearm.
We conducted a retrospective review of the results of twenty-seven consecutive osteotomies for malunited fractures of the forearm performed at the Mayo Clinic from 1976 to 1991. There were seventeen male patients and ten female patients who were an average of nineteen years old (range, nine to forty-one years old) at the time of the osteotomy. The corrective osteotomy was performed an average of seventy-three months (range, two to 324 months) after the fracture. The indication for the procedure was functional loss of motion (average arc of pronation-supination, 74 degrees; range, 20 to 120 degrees) in twenty patients, an unstable and painful distal radioulnar joint in six, and an unacceptable appearance of the forearm in one. Twenty patients had a corrective osteotomy of the radius; two, of the ulna; and five, of both bones. Of the twenty patients who had a corrective osteotomy for loss of motion of the forearm, nine were managed within twelve months after the initial injury and eleven were managed more than twelve months afterward. The patients who were managed early gained an average of 79 degrees (range, 20 to 160 degrees) of rotation after the osteotomy. Those who were managed late gained an average of only 30 degrees (range, -25 to 95 degrees). A pain-free, stable wrist was achieved in three of the six patients who were managed for an unstable and painful distal radio-ulnar joint. However, these six patients lost an average of 7 degrees (range, -25 to 25 degrees) of rotation of the forearm.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗