Limited wrist arthrodeses. I. The triscaphoid joint

From the Hartford Hospital, University of Connecticut and Yale University Medical Schools, and Newington Children's Hospital, Hartford, Conn.
The Journal Of Hand Surgery (Impact Factor: 1.67). 08/1980; 5(4):320-7. DOI: 10.1097/00006534-198110000-00081
Source: PubMed


Limited wrist arthrodesis is the surgical fusion of selected bones of the wrist. In each case the extent of the fusion is determined by the extent of the disease process. Limited wrist arthrodesis of the joints between the scaphoid, trapezium, and trapezoid is indicated in localized degenerative arthritis, radial hand dislocations, and certain instability patterns following ligament rupture (rotary subluxation of the scaphoid). Fusion is easily obtained utilizing a local bone graft donor site. Fusion of the three-bone unit leaves approximately 80% of flexion extension and 66% of radial and ulnar deviation in the wrist.

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    • "192 48 Nathan et al. [70] 118 81 Keith et al. [100] 97 16 Palmeret al. [21] 188 49 Carter et al. [71] 116 82 Duncan et al. [101] 97 17 Gelberman et al. [45] 184 50 Lieber et al. [72] 116 83 Watson and Hempton [102] 97 18 Chung et al. [46] 183 51 Eaton et al. [73] 116 84 Lister and Scheker [103] 96 19 Palmer et al. [22] 179 52 Cooney et al. [74] 114 85 Szabo and Chidgey [104] 95 20 Orbay and Fernandez [47] 176 53 Sheetz et al. [75] 113 86 Pellegrini and Burton [105] 95 21 Lieber et al. [48] 163 54 Armstronget al. [76] 112 87 SooHoo et al. [106] 94 22 Lundborg et al. [24] 163 55 Eaton and Glickel [77] 111 88 Aoki et al. [107] 93 23 Small et al. [30] 162 56 Viegas et al. [78] 110 89 Merrell et al. [108] 92 24 Dellon [49] 159 57 Friedman and Palmer [79] 109 90 Wilgis and Murphy [109] 92 25 Lundborg et al. [25] 153 58 Rozental and Blazar [17] 108 91 Lichtman et al. [110] 92 26 MacDermid et al. [50] 152 59 Klein et al. [80] 108 92 Hermansdorper and Kleinman [111] 90 27 Orbay and Fernandez [51] 151 60 Herzberg et al. [81] 106 93 Cooney et al. [112] 90 28 Zaidemberg et al. [31] 148 61 Sollerman and Ejeskar [33] 106 94 Winters et al. [113] 89 29 Ring et al. [52] 144 62 Pogue et al. [82] 105 95 Tomaino et al. [114] 89 30 Morrison et al. [53] 141 63 Cullen et al. [83] 104 96 Lavernia et al. [115] 89 31 Short et al. [54] 139 64 Lundborg et al. [26] 104 97 Zancolli and Angrigiani [116] 89 32 Gelberman and Menon [55] 139 65 Kambourglou and Axelrod [84] 103 98 Kopylov et al. [117] 88 33 Taleisnik and Watson [56] 136 66 Krakauer et al. [85] 102 99 Brandt and Mackinnon [118] 88 100 Pellegrini [16] 88 throughout those nine countries published the 100 most-cited papers. The Mayo Clinic (seven), Rochester and the State University of New York (six) were the most prolific (Table VI). "
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    ABSTRACT: Abstract The number of citations that a published article has received reflects the importance that paper has on that area of practice. In hand surgery, it is unknown which journal articles are cited most frequently. The purpose of this study was to identify and analyze the characteristics of the top 100 papers in the field of hand surgery. The 100 most cited papers were identified in the following journals; the Journal of Hand Surgery (American volume), the Journal of Hand Surgery (European volume), the Journal of Hand Surgery (British and European volume), The Scandinavian Journal of Plastic and Reconstructive and Hand Surgery, Hand Clinics, and the Journal of Plastic Surgery and Hand Surgery. The articles were ranked in order of the number of citations received. These classic 100 papers were analyzed for article type, their journal distribution, as well as geographic and institutional origin.
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    • "Whether this modification will alter the long-term results remains to be seen. Unlike STT fusions, which require from 8 to 12 weeks of wrist immobilization (Rogers and Watson, 1990; Srinivasan and Mathews, 1996; Watson and Hempton, 1980), our method requires only 2 to 3 weeks in a cast. This obviously allows a quicker return to full activities. "
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    ABSTRACT: Twenty-one patients with symptomatic scaphotrapeziotrapezoid osteoarthritis were treated with partial distal scaphoid excision. In 12 wrists the joint defect was filled with either capsular or tendinous tissue, while in nine no fibrous interposition was done. At an average follow-up time of 29 (range, 12-61) months, 13 wrists were painfree, while eight had occasional mild discomfort. Mean wrist flexion-extension was 119 degrees. Grip and pinch strength improved by an average of 26% and 40% respectively compared with their preoperative status. Fifteen patients returned to their original jobs, while six, who were unemployed, felt unrestricted for activities of daily living. Although patient satisfaction was comparable for both types of treatment, the wrists without fibrous interposition showed significantly greater wrist flexion-extension than patients with soft-tissue interposition. Removal of the distal scaphoid resulted in a DISI pattern of carpal malalignment in 12 wrists. At follow-up, none of these wrists showed further joint deterioration due to residual malalignment.
    Full-text · Article · Sep 1999 · The Journal of Hand Surgery British & European Volume
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    ABSTRACT: SUMMARY The authors report their experience in the treatment of isolated STT arthritis using an innovative technique and propose a four stage clinical classification based on radiological findings for this condition. The objective of the sur- gery is to stabilise the STT arthritic joint, rendered unstable due to the rupture of the capitotrapezium and volar scaphotrapezial ligaments, and thus, eliminate pain and tenosynovitis secondary to the STT instability. The aim of this study is to evaluate the effectiveness of this procedure. Material and methodos: The technique involves deepe- ning the trapezium into a gutter, excising the distal end of the scaphoid and anchoring the FCR in its fibro-osseous canal. The hand is immobilised in a plaster cast for 2-3 weeks depending on the FCR tendon condition noted du- ring surgery. This technique was utilised on 11 patients between 1995 and 2004 and follow-up was completed on all cases. Results: Complete and permanent relief of pain was obtained in all patients within an average period of 6 months, on a follow-up period ranging between 1 to 9 years. Flexion or extension range of motion did not decrea- se after surgery. In fact, wrist mobility either remained unchanged or improved. Post-operatively scapho-lunate an- gle remained unchanged on radiograph views, even in the two cases that showed pathological angles pre-operati- vely. Conclusions: The technique of FCR tenodesis and minimal bony resection of the distal end of the scaphoid is a simple and efficient method that offers the best long-term results in the treatment of STT arthritis, probably due to the fact that it acts on the isolated STT arthritic pathological process: stabilize the STT joint rendered unstable after the capitotrapezium and volar scaphotrapezial ligaments rupture. Riv Chir Mano 2005; 3: 152-161
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