Modified Instruments for Wrist Fusion

A technique and new instruments for intramedullary fixation of the wrist arthrodesis is described, based on the technique of Clayton, popularised by Nalebuff and Millender. This allows early mobilisation, secure fixation and simplicity of the technique. It also allows other surgical procedures to be performed under the same anaesthetic and tourniquet due to the reduction in operative time.

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Minimally Invasive Pediatric Surgery: The Learning Curve

European Journal of Pediatric Surgery ◽

10.1055/s-0040-1703011 ◽

2020 ◽

Vol 30 (02) ◽

pp. 172-180

Author(s):

Marie Uecker ◽

Joachim F. Kuebler ◽

Benno M. Ure ◽

Nagoud Schukfeh

Keyword(s):

Postoperative Complications ◽

Minimally Invasive ◽

Learning Curve ◽

Clinical Outcomes ◽

Surgical Procedures ◽

Operative Time ◽

Learning Curves ◽

Current Evidence ◽

Stenosis Rate ◽

Mucosal Perforation

AbstractThe use of minimally invasive surgery (MIS) in pediatric patients has increased over the past decades. The process of mastering a new procedure is termed the learning curve, during which the ability to operate increases but poorer outcomes are produced. We aim to analyze the current evidence on learning curves in pediatric MIS and evaluate its impact on patient's clinical outcomes. A systematic literature search was performed for studies listed on PubMed that reported on the learning curve for MIS surgical procedures. Studies were included if they stated the number of procedures required to reach a consistency in outcomes or if they compared outcomes between early and late period of MIS experience regarding the endpoints operative time, conversions, and intra-/postoperative complications. A total of 22 articles reporting on 11 surgical procedures were included in the study. Most authors reported a significant decrease in operative time as well as peri- and postoperative complications with increasing experience of the surgeon. Complications ranged from minor to major, the latter being especially severe for patients receiving pyloromyotomy (5–7% higher risk of mucosal perforation), esophageal atresia repair (15% higher leakage rate and 19–77% higher stenosis rate), or Kasai portoenterostomy (26–35% more liver transplants in the first year after surgery) during the learning curve period. Pediatric MIS comes with a considerable learning curve that may have a significant impact on the patient's clinical outcomes. Efforts should be made to minimize the effect of the learning curve on the patients.

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A Prospective Outcomes Study of Four-Corner Wrist Arthrodesis Using a Circular Limited Wrist Fusion Plate for Stage II Scapholunate Advanced Collapse Wrist Deformity

Plastic & Reconstructive Surgery ◽

10.1097/01.prs.0000227737.90007.5d ◽

2006 ◽

Vol 118 (2) ◽

pp. 433-442 ◽

Cited By ~ 60

Author(s):

Kevin C. Chung ◽

Andrew J. Watt ◽

Sandra V. Kotsis

Keyword(s):

Stage Ii ◽

Wrist Arthrodesis ◽

Wrist Fusion ◽

Outcomes Study ◽

Limited Wrist Fusion

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Assessment of Wrist Function After Simulated Total Wrist Arthrodesis

Hand ◽

10.1177/1558944715626930 ◽

2016 ◽

Vol 11 (4) ◽

pp. 464-468 ◽

Cited By ~ 1

Author(s):

Richard M. Hinds ◽

Eitan Melamed ◽

April O’Connell ◽

Francoise Cherry ◽

Monica Seu ◽

...

Keyword(s):

Grip Strength ◽

Functional Limitation ◽

Test Duration ◽

Fusion Model ◽

Optimal Position ◽

Wrist Arthrodesis ◽

Ulnar Deviation ◽

Radial Deviation ◽

Wrist Fusion ◽

Wrist Function

Background: There is poor consensus in the literature regarding associated functional limitation and the preferred wrist position for total wrist arthrodesis. The purpose of the current investigation was twofold: (1) to assess the functional limitations of wrist arthrodesis and (2) to determine the optimal position for wrist arthrodesis using a simulated wrist fusion model. Methods: Twenty healthy volunteers underwent simulated wrist arthrodesis in 6 different positions using custom-molded wrist splints: 15° extension with 0° radio-ulnar deviation, 15° extension with 10° ulnar deviation, 15° extension with 10° radial deviation, 0° extension with 0° radio-ulnar deviation, 0° extension with 10° ulnar deviation, and 0° extension with 10° radial deviation. Each volunteer was independently assessed for wrist function using the Jebsen-Taylor hand function test, grip strength, and satisfaction in the simulated wrist fusion positions. Comparisons between all simulated fusion wrists and the baseline unsplinted wrist as well as among the 6 simulated fusion positions were performed. Results: Turning over a card (5.1 vs 4.3 seconds), picking up small objects (7.1 vs 5.8 seconds), and simulated feeding (8.3 vs 7.1 seconds) as well as total Jebsen-Taylor test duration (41.8 vs 37.9 seconds) was significantly longer in simulated fusion wrists. Both grip strength (55.9 vs 80.7 kg) and satisfaction scores (6.4 vs 9.6) were lower in simulated fusion wrists. Wrists in 0° extension also demonstrated significantly shorter durations in stacking checkers than wrists in 15° extension. Conclusion: Our findings suggest that wrist arthrodesis may only compromise select wrist functions. Among the tested wrist fusion positions, wrists fused in neutral may demonstrate better function than wrist fused in slight extension. However, grip strength and satisfaction seem to be unaffected by wrist fusion position.

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Wrist Arthrodesis in Rheumatoid Arthritis Using an LCP Metaphyseal Locking Plate versus an AO Wrist Fusion Plate

International Journal of Rheumatology ◽

10.1155/2018/4719634 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Toshitake Taii ◽

Takumi Matsumoto ◽

Sakae Tanaka ◽

Ichiro Nakamura ◽

Katsumi Ito ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Wound Dehiscence ◽

Extensor Tendon ◽

Plate Versus ◽

Original Position ◽

Wrist Arthrodesis ◽

Plate Group ◽

Wrist Fusion ◽

The Mean

Objectives. Although wrist arthrodesis using a plate is an established treatment with a well-documented successful union rate for severely destroyed wrists, plate-related complications are a matter of great concern. Methods. We retrospectively compared wrist arthrodesis using an AO wrist fusion plate in nine and a locking compression plate (LCP) metaphyseal plate in seven cases of rheumatoid arthritis. Results. The mean follow-up was 40.6 months in the AO wrist fusion plate group and 57.2 months in the LCP metaphyseal plate group. Bone union at the arthrodesis site was achieved in all cases in both groups. Comparison of the original position of the fusion on the immediate postoperative radiographs and the position on the most recent follow-up radiographs demonstrated good stability in both groups. Plate-related complications occurred in four cases in the AO wrist fusion plate group and no cases in the LCP metaphyseal plate group. Complications included pain over the plate, wound dehiscence and infection, extensor tendon adhesion, and fracture in one case each. Conclusion. Wrist arthrodesis using an LCP metaphyseal plate was favorable for rheumatoid arthritis patients with comparable stability to that of and a lower risk of plate-related complications than an AO wrist fusion plate.

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Pin Arthrodesis of the Wrist – A Modified Technique

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2005.05.001 ◽

2005 ◽

Vol 30 (5) ◽

pp. 461-463 ◽

Cited By ~ 7

Author(s):

K. KUMAR ◽

Q. G. N. COX

Keyword(s):

Rheumatoid Arthritis ◽

Operating Time ◽

Modified Technique ◽

Wrist Arthrodesis ◽

Distal Migration ◽

Wrist Fusion

An intramedullary pin is commonly used for wrist arthrodesis in patients with rheumatoid arthritis. However, pin migration is a recognized complication of this technique. We report the results of wrist fusion in 15 patients using a modified technique with a transverse blocking screw inserted into the metacarpal distal to the intramedullary pin to prevent distal migration and backing out of the intramedullary pin. The procedure is simple to perform, does not add significantly to the operating time and has not been associated with any complications.

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Reciprocating Bone Saw: Effect of Blade Speed on Cutting Rate

Volume 3: Design and Manufacturing ◽

10.1115/imece2011-62457 ◽

2011 ◽

Cited By ~ 2

Author(s):

Timothy B. Lannin ◽

Matthew P. Kelly ◽

Thomas P. James

Keyword(s):

Patient Outcome ◽

Cortical Bone ◽

Surgical Procedures ◽

Operative Time ◽

Thrust Force ◽

Stroke Length ◽

Cutting Rate ◽

Blade Cutting ◽

Linear Manner ◽

Improve Patient

Power reciprocating saws are used in surgical procedures to cut bone. Improved cutting rates are desirable in order to reduce operative time and improve patient outcome. A fixture was developed to test the effect of blade speed on cutting rate of bovine cortical bone. It was hypothesized that the volumetric cutting rate would increase in a linear manner for a fixed stroke length and a constant thrust force. A 7.0 N thrust force was applied. The reciprocating stroke length was held constant at 3.0 mm. Using an 18 TPI blade, cutting rate was determined to increase in a slightly non-linear manner, with disproportionately higher cutting rate at higher blade speeds. The data implies that a higher reciprocating frequency may invoke more efficient cutting.

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A Case of Implant Failure in Partial Wrist Fusion Applying Magnesium-Based Headless Bone Screws

Case Reports in Orthopedics ◽

10.1155/2016/7049130 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Alice Wichelhaus ◽

Judith Emmerich ◽

Thomas Mittlmeier

Keyword(s):

Revision Surgery ◽

Bone Screws ◽

Implant Failure ◽

Mechanical Instability ◽

Dual Use ◽

Wrist Arthrodesis ◽

Osseous Integration ◽

Wrist Fusion ◽

Screw Threads ◽

Partial Wrist Fusion

This article presents a case of implant failure resulting in mechanical instability of a scaphotrapezotrapezoideal arthrodesis using magnesium-based headless bone screws. During revision surgery osteolysis surrounding the screws was observed as well as degraded screw threads already in existence at 6 weeks after implantation. The supposed osseous integration attributed to magnesium-based screws could not be reproduced in this particular case. Thus, it can be reasoned that the use of magnesium-based screws for partial wrist arthrodesis cannot be encouraged, at least not in dual use.

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Joint Preservation of the Wrist Using Articulated Distraction Arthroplasty: A Case Report of a Novel Technique

Case Reports in Orthopedics ◽

10.1155/2015/812807 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Matt D. A. Fletcher

Keyword(s):

Functional Outcome ◽

Therapeutic Option ◽

Wrist Arthrodesis ◽

Distraction Arthroplasty ◽

Novel Technique ◽

Subjective Pain ◽

Wrist Fusion ◽

Functional Outcome Measures ◽

Orthopaedic Community ◽

Limited Wrist Fusion

Distraction arthroplasty of the ankle, elbow, and hip has become widely accepted and used within the orthopaedic community with excellent initial results which appear sustained. To date it has not been applied to the wrist in the same manner. A novel technique, drawn upon past success of articulated ankle distraction and static wrist distraction, was devised and evaluated by application of articulated wrist distraction performed over a 12-week period in a patient with poor functional outcome following limited wrist fusion. Posttreatment results showed improvement in range of motion (100-degree arc), subjective pain, and functional outcome measures (DASH 21.7, Mayo Wrist Score 80) comparable or better than either limited wrist fusion or proximal row carpectomy. Articulated wrist distraction initially appears to be a promising therapeutic option for the management of the stiff and painful wrist to maintain maximal function for which formal wrist arthrodesis may be the only alternative.

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