Kompendium 2021 Forschung & Klinik

TOP-Studien
51
both wrist joints. The ballottement test was used to assess DRUJ instability
pre- and postoperatively. The severity of the instability was graded as either
dynamically unstable, statically unstable, or stable.
Patients and Results
A total of 30 patients were included in this study. Preoperatively, the median
MMWS was 60 (50 – 75), the DASH score was at a median of 48.3 (25.0 – 56.7),
and VAS scores ranged from 3 to 10 with a median of 7 (6.0 – 8.0). The first
evaluation took place at a median of 30 months postoperatively (2.5 years,
range 12 – 83 months). Stability assessment showed a stable DRUJ in 23
(76.7 %) patients and a dynamic instability in 5 (16.7 %) patients. All collected
scores demonstrated statistically significant improvements following
TFCC-repair (preoperative vs. 1st follow-up; MMWS: 60 vs. 100, p < 0.001;
DASH score: 48.3 vs. 2.5, p < 0.001; VAS: 7 vs. 1, p < 0.001).
At a median of 106 months (8.83 years, range 52 – 215 months), the second
clinical assessment was performed. Stability assessment showed a stable
DRUJ in 19 patients (63.3 %), while nine patients (30 %) had a dynamically
unstable DRUJ, and two patients (6.7 %) had a statically unstable DRUJ. At
the final follow-up, the PRWE was additionally performed with a median
score of 5 (0 – 18).
When compared to preoperative measures, evaluated scores demonstrated
persisting and significant improvement (preoperative vs. 2nd follow-up;
MMWS: 60 vs. 90, p < 0.001; DASH score: 48.3 vs. 2.5, p < 0.001; VAS: 7 vs. 1.8,
p < 0.001). Comparing patients with DRUJ instability to patients with stable
DRUJ at final follow-up, no significant differences in evaluated scores between
these two groups were found.
Dr. in Gerhild Thalhammer
Author:
Gerhild Thalhammer is a certified
hand surgeon and head
of the outpatient hand clinic
at the Department of Trauma
Surgery. She has been a
senior physician at the Clinical
Department of Traumatology
since 2013 and is specialist in
Trauma Surgery and Orthopaedics
and Traumatology.
Her research focuses on new
techniques in wrist arthroscopy
and the treatment of distal
radius fractures and scaphoid
fractures.
These results demonstrate that arthroscopically assisted reattachment
of the RUL provides reliable and satisfying long-term results. All study
partici pants achieved good to excellent clinical outcome, as indicated by
the MMWS at a median follow-up of 106 months. DASH-score and VAS also
showed a statistically significant improvement in all patients compared to
preoperative findings. Moderate deterioration of MMWS and VAS was observed
at the final examination compared to the mid-term results, whereas
the DASH score remained unchanged and the more wrist-specific PRWE
score showed an average of 5 points.
Regarding the stability of the DRUJ, we found no difference in clinical outcome
between patients with static or dynamic DRUJ instability preoperatively,
neither in mid-term follow-up examinations, nor in the long-term
follow-up. Comparing the mid-term and long-term results of our study population,
we found loss of DRUJ stability in some cases. This loss of stability of
the DRUJ did not correlate with any of the evaluated scores in our statistical
analysis. Despite this increase of instability, overall satisfying results in clinical
outcome and high rates of patient satisfaction were observed.
Conclusion
Arthroscopically assisted transosseous reattachment of the deep fibres
of RUL leads to excellent and good clinical results in mid- and long-term
follow-up. Loss of DRUJ stability during follow-up was not associated with
deterioration of clinical parameters or diminution of patient satisfaction.