RESUMEN
Eighteen patients with symptomatic radioscaphoid arthritis had scaphoid excision and capitolunate arthrodesis. Eight patients also had a silicone scaphoid replacement. The follow-up period averaged 3 years. Fusion was solid in 12 cases at an average of 8 weeks, and pain was significantly less at follow-up evaluation. Six patients had a pseudarthrosis and five had persistent pain. Immobilization in the pseudarthrosis group averaged 6 weeks, which was significantly less than the group that fused. Two patients underwent successful repeat fusions. Wrist extension averaged 26 degrees, flexion 34 degrees, radial deviation 11 degrees, and ulnar deviation 24 degrees. Grip strength averaged 25 kg. Presence of an implant had no significant effect on motion or strength. Pin track infection and pseudarthrosis were the main complications. Pain relief, functional motion, good strength, and patient satisfaction can be expected after scaphoid excision and solid capitolunate arthrodesis. Kirschner wires should be buried subcutaneously to avoid infection. The addition of a scaphoid implant offered no advantage over simple scaphoid excision.
Asunto(s)
Artritis/cirugía , Artrodesis/métodos , Huesos del Carpo/cirugía , Articulación de la Muñeca/cirugía , Artritis/diagnóstico por imagen , Artritis/epidemiología , Hilos Ortopédicos , Femenino , Estudios de Seguimiento , Humanos , Hueso Semilunar/cirugía , Masculino , Persona de Mediana Edad , Prótesis e Implantes , Radiografía , Rango del Movimiento Articular/fisiología , Factores de Tiempo , Articulación de la Muñeca/diagnóstico por imagen , Articulación de la Muñeca/fisiopatologíaRESUMEN
Reconstruction of the proximal interphalangeal joint by arthroplasty using the Swanson implant is greatly simplified by the volar approach. The extensor tendon system is not violated, making an immediate motion program feasible. Combining this approach with local anesthesia allows for active and complete evaluation of the technique during the operative procedure.
Asunto(s)
Articulaciones de los Dedos/cirugía , Prótesis Articulares/métodos , Artritis/cirugía , Humanos , Prótesis Articulares/instrumentaciónRESUMEN
Although scapholunate diastasis with rotatory subluxation of the scaphoid (stage I perilunar instability determined by Mayfield's classification) has been studied by several investigators, the exact contribution of the supporting ligaments is still being defined. We designed and executed an experimental study using six fresh-frozen cadaver specimens to demonstrate the radiographic changes seen on standard and stress wrist radiographs that correlate with the sequential sectioning of the scapholunate stabilizing ligaments. The radioscapho-lunate ligament, the palmar scapholunate interosseous ligament, the dorsal scapholunate interosseous ligament, and the radiocapitate ligament were sectioned sequentially to simulate a progressive wrist injury caused by an extension, intercarpal supination and ulnar deviation force. The results showed significant ligamentous injury must occur before commonly used radiographic limits are exceeded. The lateral scapholunate angle most closely reflected the progressive nature of this injury.