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

Post-Operative Complications Of Arthroscopic TFCC Repair
Institution where the work was prepared: University of Toledo, Toledo, OH, USA
Ian Rodway, MD; Martin C Skie; Despina E Ciocanel; University of Toledo
PURPOSE:
Wrist arthroscopy is frequently used in the diagnosis and treatment of traumatic injuries to the wrist, including repair of the triangular
fibrocartilage complex (TFCC) tears. Our purpose was to determine the incidence of complications after arthroscopic repair of Palmer
1B TFCC tears and to compare the results with data from the literature.
METHODS:
In order to determine the incidence of complications after arthroscopic repair for Palmer 1 B TFCC tears, we retrospectively reviewed
the records of 67 consecutive patients, 35 males and 32 females. All patients underwent arthroscopic repair using zone specific cannula
and the inside-out repair method. The mean patient age was 34 years, with a range of 14 to 59 years. The mean follow-up for these
67 patients was 17 months.
RESULTS:
The results of arthroscopic repair were compared and analyzed based on their complications. Transient paresthesis within the distribution
of the dorsal sensory branch of the ulnar nerve was the most frequent complication (49 %). Six patients (9%) were complicated with
ulnar nerve irritation (3 sensory paresthesia involving the ring and small fingers, 2 mild cubital tunnel syndromes and 1 ulnar motor neuropathy).
9 patients had residual instability of DRUJ ( distal radio-ulnar joint) and one patient had infection. 12 patients (18%) underwent
ulnar shortening following arthroscopic TFCC repair for treatment of continued pain, one of them having bilateral ulnar shortening.
CONCLUSION:
82% of our reported complications following TFCC tears arthroscopic repair were minor or transient. No previous study described transient
paresthesia as a complication of arthroscopic TFCC repairs. This complication was related to the suture knots near dorsal branches
of the sensory branch of ulnar nerve. Our results confirm similar findings (Hulsizer et al) that recommend an ulnar-shortening osteotomy
for unsuccessful arthroscopic debridement in eliminating ulnar-sided wrist pain. Overall the success rate of arthroscopic repair in our
study was similar with previous studies.
Scaphoid Excision and Limited Wrist Fusion: A Comparison of K-wire and Circular Plate Fixation
Institution where the work was prepared: Des Moines Orthopaedic Surgeons, West DesMoines, IA, USA
Jeff Rodgers, MD1; Gary Holt, MD2; Edward Finnerty, PhD3; Blake Miller, BS3; (1)Des Moines Orthopaedic Surgeons,
(2)Iowa Radiology, (3)Des Moines University
HYPOTHESIS:
Recent reports suggest that circular plate fixation for Scaphoid excision and limited wrist fusion is inferior to traditional methods. While
implicating the circular plate implant as the major cause of complications and failure, these studies failed to control for important variables
including the source of bone graft, surgical technique of multiple surgeons and patient factors that may have influenced the selection
of the implant.
The purpose of this study is to compare the clinical outcome, union rate and complications of Scaphoid excision and limited wrist
arthrodesis performed by a single surgeon using distal radius bone graft and k-wires or distal radius bone graft and circular plate fixation.
METHODS:
A sequential series of 12 wrists (eleven patients) that were stabilized with temporary k-wires were compared to 12 patients who were stabilized
with a circular plate. Minimum follow up was 1 year. One patient in the K-wire group was converted to a wrist fusion. 6 of the remaining
10 patients in the K-wire fixation group and 8 of the 12 patients in the Circular Plate fixation group returned for the following blinded
evaluations: Quick DASH, Analog Pain Scale, Range of Motion, Strength measurement, plain x-ray and Multi Detector CT evaluation.
RESULTS/STATISTICS:
Data was analyzed using SPSSÆ 14.0. The independent measures t-test was used for functional tests, two-factor ANOVA procedure for
ROM and Strength parameters and Pearson correlation was used to assess the CL-angle with ROM. Power and appropriate measures
of size effect were determined where indicated.
One non-union occurred in the K-wire group. There were no non-unions in the circular plate fixation group. There was no difference in
any of remaining measures or rate of complications.
Cost analysis assuming a return to the OR for k-wire removal reveals an overall cost of care savings of $1975 using circular plate fixation.
SUMMARY POINT:
Based on this Sequential Cohort with careful control of non-implant related variables, the use of a Circular Plate Device is equivalent in
efficacy and more cost effective than K-wires for Scaphoid excision and limited wrist fusion.
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