Floor plan - 2013 Annual Meeting - American Association for Hand ...

AAHS Concurrent Scientific Paper Session A
Long Term Outcome Following Scaphoidectomy and Four-Corner Fusion
Institution where the work was prepared: Mayo Clinic, Rochester, MN, USA
David Dennison, MD; Coen Wijdicks; Justin Strickland; Steven Moran; Alexander Shin; Mayo Clinic
INTRODUCTION:
The long term outcome following scaphoidectomy and four-corner fusion (FCF) has received limited investigation and few studies have
included patient rated outcome measures. The purpose of this study was to examine the long-term outcome following FCF with respect
to patient rated outcome measures and to investigate the effect that the method of fixation, age, follow-up period, and radiographic
parameters, have upon outcome measures.
METHODS:
A retrospective review identified patients that underwent a scaphoidectomy and FCF between February 1976 and August 2003. The
Disabilities of the Arm, Shoulder and Hand (DASH), Patient Rated Wrist Evaluation (PRWE), and a pain survey were completed by 84 patients.
The mean outcome measure follow-up was 9.6 ± 5.7 years. Outcome measures were compared to method of fixation, age, follow-up period,
and postoperative capitolunate angle. The correlation between outcome scores was examined. Union rates were evaluated and compared
based upon fixation type. Statistical analysis was performed with significance set at alpha less than or equal to 0.05
RESULTS:
The mean DASH score was 23 (SD 19) and the mean PRWE score was 27 (SD 22). Eighty-four per cent of patients reported decreased
pain while 62% still had some degree of pain. There was a significantly higher PRWE score (more impairment) associated with dorsal
circular plate fixation compared to non-plate fixation. There was also a significant decrease in PRWE score with longer follow-up time.
The DASH and PRWE scores correlated well. There were no significant differences in nonunion rates with respect to type of fixation.
CONCLUSION:
Although higher PRWE scores were significantly associated with circular plate fixation, we were not able to detect a difference in union
rates between circular plate fixation and other methods of fixation. The PRWE was able to detect significant findings compared to the
DASH, and should be considered when evaluating patients with isolated wrist dysfunction.
Reconstruction of the TFCC Using ECU Half-Slip and Interference Screw
Institution where the work was prepared: Department of Orthopaedic Surgery, Keio University, Tokyo, Japan
Toshiyasu Nakamura, MD, PhD; Kazuki Sato; Noriaki Nakamichi; Yoshiaki Toyama; Hiroyasu Ikegami; Keio University
PURPOSE:
Since 1998, we treated 33 wrists of ulnar detachment of the TFCC by reconstruction technique using half-slip of the extensor carpi
ulnaris (ECU) tendon with the very small interference screw. We described the technique of the reconstruction and examined our clinical
results of the procedure.
TECHNIQUE:
This technique was indicated to the severe DRUJ instability cases with the avulsion of the TFCC from the ulnar fovea. The ECU half-slip
was harvested and was induced inside the TFCC from the dorsodistal artificial slit of the TFCC to the fovea area. The half-slip was tightly
sutured to the remnant TFCC, then pulled out through the bone tunnel that was made at the center of the fovea by 2.5 mm diameter
drill. The ECU half-slip was subsequently anchored to the ulnar fovea with the small interference screw (Figure). Two weeks long arm
cast was occurred, followed by three weeks of short arm cast.
PATIENTS AND METHODS:
There were 21 right, 10 left and 1 bilateral wrist with an average age of 35.8 years (range 13-68). All complained ulnar sided wrist pain
and severe distal radioulnar joint (DRUJ) instability. The neutral ulnar variance was indicated in 26 wrists and positive in 7. In the positive
variance wrists, the ulnar shortening equalized the abutment before the reconstruction. Periods from initial injury were 1 month to 48
years. Diagnosis of the TFCC avulsion was done by arthrogram and MRI. Radiocarpal arthroscopy could demonstrate loss of trampoline
effect in all wrists. DRUJ arthroscopy revealed detachment of the radioulnar ligament origin at the fovea in recent 13 cases. Clinical
results were evaluated by pain, range of rotation and DRUJ instability.
RESULTS:
At final follow-up (average 21.5months), 26 wrists indicated no pain and slight pain remained in 7 wrists. Complete re-stabilization of
the DRUJ was noted in 30 wrists, however there remained moderate DRUJ instability in 2 wrists. Severe DRUJ instability remained in 1
wrist. There were 21 excellent, 8 good, 2 fair and 2 poor results. CONCLUSION: This reconstruction technique represented real anatomical
reattachment of the TFCC to the ulnar fovea, which induced excellent DRUJ stability and clinical result. When the TFCC was
detached from the fovea completely and condition of the distal remnant TFCC was relatively secured, this technique is promising.
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