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ABSTRACT: Fractures of the distal radius are among the most common fractures in adults. Recently, there has been a trend towards open reduction and internal fixation of these fractures through a volar approach. The purpose of this study was to assess the early complications of volar locking plate fixation of distal radius fractures with an emphasis on defining the relationship between surgeon experience and incidence of complications.
Following IRB approval, we conducted a retrospective chart review of the initial 96 distal radius fractures (92 patients) treated by open reduction and internal fixation of distal radius fracture using a volar locked plate. Our outcome measurements were incidence of postoperative complications and radiographic loss of reduction.
Twenty-two complications occurred in 21 patients. Of these, five complications (5%) required surgical treatment or hospitalization. Seventeen complications (18%) required no surgical intervention or hospitalization. Transient nerve dysfunction was the most common complication, accounting for 12 of 22 complications. The first 30 patients experienced significantly more complications than those treated later in the series (p = 0.03). There was a trend towards increased incidence of complications in cases where more than 10 days elapsed between injury and surgery or where supplementary Kirschner wire fixation was used. There was no correlation between patient age, sex, severity of fracture, or presence of ulnar styloid fracture and the development of complications or loss of reduction.
The incidence of complications decreased significantly with increased surgeon experience, suggesting that many of these early complications are avoidable.
Hand 06/2011; 6(2):185-9.
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ABSTRACT: Implant arthroplasty of the wrist offers pain relief with preservation of motion to patients with rheumatoid arthritis, although few studies have investigated the long-term results of this procedure. The purpose of the present study is to report the prospective results of total wrist arthroplasty with use of the Universal wrist prosthesis in a consecutive series of patients with rheumatoid arthritis who were managed by a single surgeon.
Twenty-four wrist arthroplasties in twenty patients with rheumatoid arthritis were followed prospectively. Nineteen wrists in fifteen patients were followed clinically and radiographically for a mean of 7.3 years (range, 5.0 to 10.8 years) after the index procedure. Outcome measures included the Disabilities of the Arm, Shoulder and Hand (DASH) score, wrist range of motion, and standard radiographic findings.
The average DASH score improved from 62 points preoperatively to 40 points at the time of the latest follow-up. The mean wrist flexion and extension at the time of the latest follow-up were 42° and 20°, respectively, for a mean improvement in the total flexion-extension arc of 14°. A total of nine wrists (45%) in eight patients underwent revision surgery because of a loose carpal component at the time of the latest follow-up. One patient underwent wrist arthrodesis because of recurrent wrist instability. Two additional wrists in two patients had radiographic evidence of carpal component subsidence at the time of the latest follow-up. The implant survival rates at five and seven years for the original prosthetic components were 75% and 60%, respectively.
The results for the Universal wrist prosthesis at a minimum of five years of follow-up include a high rate of failure, most often because of carpal component loosening, resulting in revision of ten (50%) of twenty wrists at the time of the latest follow-up (with the inclusion of one revision in a patient who died before five years). Patients with a stable prosthesis maintained a functional range of motion and had improvement in patient-reported outcome measures.
The Journal of Bone and Joint Surgery 05/2011; 93(10):914-9. · 3.27 Impact Factor
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ABSTRACT: Cavovarus foot deformity is common in patients with Charcot-Marie-Tooth disease. Multiple surgical reconstructive procedures have been described, but few authors have reported long-term results. The purpose of this study was to evaluate the long-term results of an algorithmic approach to reconstruction for the treatment of a cavovarus foot in these patients.
We evaluated twenty-five consecutive patients with Charcot-Marie-Tooth disease and cavovarus foot deformity (forty-one feet) who had undergone, between 1970 and 1994, a reconstruction consisting of dorsiflexion osteotomy of the first metatarsal, transfer of the peroneus longus to the peroneus brevis, plantar fascia release, transfer of the extensor hallucis longus to the neck of the first metatarsal, and in selected cases transfer of the tibialis anterior tendon to the lateral cuneiform. Each patient completed standardized outcome questionnaires (the Short Form-36 [SF-36] and Foot Function Index [FFI]). Radiographs were evaluated to assess alignment and degenerative arthritis, and gait analysis was performed. The mean age at the time of follow-up was 41.5 years, and the mean duration of follow-up was 26.1 years.
Correction of the cavus deformity was well maintained, although most patients had some recurrence of hindfoot varus as seen on radiographic examination. The patients had a lower mean SF-36 physical component score than age-matched norms, and the women had a lower mean SF-36 physical component score than the men, although this difference was not significant. Smokers had lower mean SF-36 scores and significantly higher mean FFI pain, disability, and activity limitation subscores (p < 0.0001). Seven patients (eight feet) underwent a total of eleven subsequent foot or ankle operations, but no patient required a triple arthrodesis. Moderate-to-severe osteoarthritis was observed in eleven feet. With the numbers studied, the age at surgery, age at the time of follow-up, and body mass index were not noted to have a significant correlation with the SF-36 or FFI scores.
Use of the described soft-tissue procedures and first metatarsal osteotomy to correct cavovarus foot deformity results in lower rates of degenerative changes and reoperations as compared with those reported at the time of long-term follow-up of patients treated with triple arthrodesis.
The Journal of Bone and Joint Surgery 01/2009; 90(12):2631-42. · 3.27 Impact Factor
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ABSTRACT: We describe a case of primary articular synovial chondromatosis in a metacarpophalangeal (MCP) joint of a 48-year-old male. The patient initially presented with MCP joint swelling and pain with normal plain radiographs. Following a fourteen month course of conservative management, surgical debridement of the joint revealed multiple loose bodies consistent with primary articular synovial chondromatosis. Though synovial chondromatosis rarely occurs in hand joints, the diagnosis should be considered in cases of metacarpophalangeal pain when common etiologies have been excluded.
The Iowa orthopaedic journal 02/2008; 28:91-3.
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ABSTRACT: A 46-year-old male developed spontaneous acute carpal tunnel syndrome of the right wrist without any antecedent trauma. Surgical exploration revealed hemorrhage secondary to diffuse giant cell tumor of tendon sheath as the underlying cause.
The Iowa orthopaedic journal 02/2007; 27:99-103.
