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Ratliff Baker posted an update 3 weeks, 4 days ago
a median of 7 days after fixation. Clinical Relevance Our study demonstrates poor pain control regardless of intraoperative anesthesia or utilization of varying postoperative pain regimens.Background Percutaneous scaphoid osteosynthesis is an attractive and increasingly popular option, as a treatment for acute scaphoid fractures in selected cases, and as an alternative to conservative treatment. The purpose of this study is to assess the radiographic positioning of the screw in percutaneous scaphoid fixation, taking into consideration the surgeons’ experience, and the difference between volar and dorsal approaches. Methods We retrospectively assessed patients undergoing percutaneous scaphoid fixation from 2013 to 2019. Inclusion criteria are as follows (1) scaphoid waist fractures (Herbert’s B2), (2) a minimum of 18 years of age and a maximum of 55 years of age, (3) dominant hand, (4) manual work, (5) minimum follow-up time of 6 months, and (6) without associated lesions. Criteria for correct positioning are as follows (1) on the axis or parallel to the scaphoid axis with a maximum deviation of 1.5 mm volar/dorsal, (2) without proximal/dorsal prominence, (3) correct scaphoid alignment/reduction, and (4) absence of threads in the fracture site. Radiographs were evaluated separately by a hand surgeon, a general orthopaedic surgeon, and an orthopaedic resident. Results With a total of 39 patients, a dorsal approach was performed in 10 patients and a palmar approach in 29 patients. We verified a very good interobserver reliability. The hand surgeon’s team correctly positioned 15 (83.3%, 15/18), while the other team did 9 correctly (42.9%, 9/21). Comparing teams according to the approach used, the dorsal approach did not show a statistical difference, while the same was not true for the volar approach ( p less then 0.05). see more Conclusion This points to a positive impact on the team’s experience in the positioning of the screws, and therefore in the benefit of treatment by teams dedicated to the area, while daring to suggest that less-experienced surgeons should utilize the dorsal approach.Objective To determine the rate of salvage procedures and any other unplanned reoperations in patients with symptomatic Kienböck’s disease who were treated with radial shortening osteotomy. In addition, we studied patient-reported outcome in the long term using Patient-Reported Outcome Measure Information System (PROMIS) instruments. Patients and Methods We performed a retrospective review of all patients who underwent radial shortening osteotomy for stage 2 and 3A Kienböck’s disease. Patients who had concomitant revascularization were grouped separately. We collected demographic data, data regarding type of surgery and reoperations, and radiographic data. Patient-reported outcome measures were the PROMIS Upper Extremity Computer Adaptive Testing (CAT) and Pain Interference instruments, the abbreviated Disabilities of Arm, Shoulder, and Hand (QuickDASH), and the 0 to 10 numeric rating scale for pain and satisfaction. Results We included 48 patients who had radial shortening osteotomy alone, and 17 patientsk’s disease surgically. There appeared to be no benefit of direct revascularization in addition to radial shortening in terms of patient-reported outcome in the long term. Level of Evidence This is a Level IV, therapeutic study.Objective This study reports on the clinical outcomes of double screw fixation with autologous cancellous bone grafting and early active range of motion for delayed and nonunited scaphoid waist fractures with cavitary segmental bone loss. Patients and Methods Twenty-one consecutive patients underwent fixation using two 2.2 mm antegrade headless compression screws with autologous distal radius cancellous bone graft. Postoperatively, patients were allowed early active motion with a resting splint until union was achieved. Patients were reviewed radiologically and clinically to assess for fracture union, complications, residual pain, wrist function, and return to work and recreational activities. Results All but one patient was male, and the mean age was 23 years (range, 15-38 years). The average time from initial injury was 16 months (range, 3-144 months). Nineteen of 21 (90.5%) patients achieved union at a mean of 2.8 months (range, 1.4-9.2 months). Of the patients who failed, one underwent revision surgery with vascularized bone grafting at 10.6 months. The other patient refused further intervention as he was asymptomatic. Conclusion Double-screw fixation with bone grafting and early active range of motion is a safe and effective technique for management of delayed and nonunited unstable scaphoid fractures with cavitary bone loss. This potentially allows for earlier return to function, without compromise to union rates. Level of Evidence This is a Level IV, retrospective case series study.Background Injuries of the lunotrirquetral ligament (LT lig) could be part of an extensive carpal injury and are then often treated at the time of the injury. However, when an injury of the LT ligament occurs alone, the injury is often missed. Treatment of this injury has traditionally been by open surgery, such as reattachment of the LT ligament, ligament reconstruction, or arthrodesis of the LT joint. These procedures needed a large exposure to the carpus running the risk of damaging the external ligaments, the nerves important for proprioception, and the capsule with the potential of scarring and adhesions. Materials and Methods We describe a novel arthroscopic assisted technique for reconstruction of the LT ligament. Using this less invasive technique, there is a possible advantage of lesser scarring and faster mobilization. Results We have performed this technique in two patients with more than 30 months follow-up. They both have great improvement of the functional scores. Conclusion The novel arthroscopic assisted technique for LT lig reconstruction is a technically demanding procedure; however, this obtains good clinical results with more than 30 months follow-up due to less exposure of the carpus. Level of Evidence This is a Level IV, case series study.