The Journal of hand surgery
-
Comparative Study
Clinical comparison of arthroscopic versus open repair of triangular fibrocartilage complex tears.
To determine whether traumatic triangular fibrocartilage complex (TFCC) tears treated by arthroscopic repair have improved functional outcome scores, range of motion, grip strength, and pain relief compared with those repaired using an open surgical technique. ⋯ There was no statistical difference in clinical outcomes after open versus arthroscopic TFCC repair. Although not statistically significant, there was an increased rate of postoperative superficial ulnar nerve pain in the open group (14 out of 39 patients) compared with the arthroscopic group (8 out of 36 patients). After TFCC repair, 13 out of 75 patients required reoperation for distal radioulnar joint instability in this sample. A statistically significant association was found between reoperation rate and female gender.
-
Distal radioulnar joint (DRUJ) instability can be tested using biomechanical cadaveric models, but inadequate isolation of the DRUJ during instability testing may introduce measurement error. The first goal of this investigation was to develop an effective model for isolating the DRUJ during biomechanical cadaveric testing. The second goal was to use this model to measure the effect of ulnar styloid fracture and subsequent repair on DRUJ kinematics in cadaveric specimens. ⋯ Increased work of rotation represents decreased joint laxity. Maximum supination torque and maximum pronation torque assess soft tissue restraints at joint end points. Method 3 showed the greatest values in these variables, indicating reduced elbow and carpal motion and better DRUJ isolation. Work of rotation and maximum supination torque in group 3 were increased from those of group 2 but not restored to group 1 values. Styloid fixation restores some soft tissue tension but laxity persists. Maximum pronation torque in group 3 was not increased significantly from that of group 2, perhaps from dorsal capsulotomy causing soft tissue injury and laxity not corrected with fixation. The influence of ulnar styloid fracture on dynamic DRUJ kinematics can be demonstrated in this model.
-
Comparative Study
Comparative biomechanic study of flexor tendon repair using FiberWire.
FiberWire, an increasingly popular suture material, allows for strong flexor tendon repair that may allow early mobilization. This study was designed to evaluate the mechanical characteristics of FiberWire for flexor tendon repair and to identify the most effective repair technique using this material. ⋯ The strength of the FiberWire repairs increased with locking repair and with increased number of strands but was not influenced by increased number of locking and grasping stitches. Four-strand locked cruciate and 2-strand double cross-locks provided the greatest strength and likely are appropriate for future clinical use in, respectively, 4-strand and 2-strand repairs. However, the poor knot-holding characteristics of FiberWire with the need of a greater number of knot throws may be of concern for surgeons using this product for flexor tendon repairs.
-
Four-corner arthrodesis with scaphoid excision has been shown to be an acceptable method for treating wrist degenerative changes. Some recent studies have identified higher complication rates when circular plates are used. This study examined a consecutive case series with defined technique for outcome and complications. ⋯ Despite recent reports indicating a high nonunion rate with plate fixation, standardized 4-corner arthrodesis using a recessed, dorsal circular plate and distal radius bone grafting produced excellent and reproducible results in this consecutive series. Notably, there was no development of secondary arthritic changes at the radiolunate joint, indicating a reasonable durability to the procedure. Optimal results require exacting technique with quality bone graft.
-
To prospectively determine the results of treatment of distal radius fractures with a volar locking plate system with no bone graft and early mobilization. ⋯ The volar locking plate fixation without bone grafting and early mobilization is a safe and effective treatment for dorsally displaced, unstable fractures of the distal radius.