- Email: [email protected]
Dynamic CT Imaging For Diagnosis of Scapholunate Joint Instability
8. Schuurman AH, Teunis T. A new total distal radioulnar joint prosthesis: functional outcome. J Hand Surg Am. Oct 2010;35(10):1614-1619. 9. Watts AC, Hayton MJ, Stanley JK. Salvage of failed distal radioulnar joint reconstruction. Hand Clin. Nov 2010;26(4):529-541.
PAPER 40 4BUVSEBZ 4FQUFNCFS to". $MJOJDBM1BQFS4FTTJPO%36+
Dynamic CT Imaging For Diagnosis of Scapholunate Joint Instability Not a clinical study
tSanjeev Kakar, MD, MRCS 4IVBJ-FOH 1I% $ZOUIJB.D$PMMPVHI 1I% t4UFWFO-.PSBO .% t3JDIBSE"#FSHFS .% ,SJTUJO%BJHMF;IBP ." HYPOTHESIS A novel dynamic imaging method comprised of 4-dimensional (4D; 3D + time) CT can accurately diagnose scapholunate (SL) joint instability.
METHODS Patients with a suspected diagnosis of SL instability, determined by clinical examination and standard x-ray imaging, underwent 4DCT scans during wrist movement. All patients presented complaining of pain and functional disability due to symptomatic instability of the wrist. A 4DCT technique was developed to acquire dynamic image data while patients move their wrists in radial-ulnar deviation, flexion-extension and dart thrower’s motion. A commercial dual source reconstruction algorithm was used to generate images with 75 ms temporal resolution and 4D movies. Two blinded fellowship trained hand surgeons reviewed movies of both wrists for each motion and scored the difference between the normal and injured wrist using a 5 point ordinal scale (1=no difference to 5=obvious difference).
RESULTS Four patients with a clinical suspicion of unilateral scapholunate wrist ligament injury were scanned in a dual source 128-slice CT scanner (Definition Flash, Siemens Healthcare, Forchheim, Germany). Motion of the scaphoid and lunate and the joint space between them were clearly visualized throughout the wrist motion cycle. For all patients, at least one motion was scored 4 or higher by both reviewers, indicating a substantial difference between the normal and injured wrists. The average scores from both reviewers over all 4 subjects were 4.0, 4.0 and 2.8 for radialulnar deviation, flexion extension and dart thrower’s motion.
SUMMARY POINTS ∙ ∙
∙
The 4DCT technique generated high spatial and high temporal resolution images of the moving wrist joint. Radial-ulnar deviation and flexion-extension motions qualitatively demonstrated a difference between the injured and uninjured wrist as compared to the dart thrower’s motion. 4DCT imaging may provide clinicians a useful tool for detecting scapholunate injury. Early detection and treatment may lead to more timely and efficacious treatment.
♦ Speaker has nothing of financial value to disclose
Figure 1. Volume rendered image from one frame of radial-ulnar deviation obtained using dynamic CT in a subject with scapholunate instability. t(SBOUSFDFJWFEGSPN/BUJPOBM*OTUJUVUFPG"SUISJUJTBOE.VTDVMPTLFMFUBMBOE4LJO Diseases – R21AR057902 (Kakar) t3PZBMUZ4VQQPSU4NBMM#POF*OOPWBUJPOT #FSHFS
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PAPER 41 4BUVSEBZ 4FQUFNCFS to". $MJOJDBM1BQFS4FTTJPO%36+
Failure of Proximal Row Carpectomy (PRC) and Fourcorner Fusion (4CF) in Patients Younger than 50 -FWFM&WJEFODF ♦ Matthew S. Zimmermann, MD t"SOPME1FUFS$8FJTT .% )FBUIFS(PUIB .%
HYPOTHESIS Many studies have identified advantages and disadvantages specific to both PRC and 4CF. PRC is a simple procedure but carries risk of subsequent osteoarthritis (OA). 4CF has a higher risk of complications but maintains the native radiolunate joint. It has been suggested that PRCs performed in young patients are especially prone to failure. We hypothesize that younger patients will have a higher likelihood of failure due to pain and/or secondary OA following PRC when compared to 4CF.
METHODS All patients who had a proximal row carpectomy or four-corner fusion by the lead author at less than 50 years of age were included in this study. Patients were excluded if they had a history of inflammatory arthritis. Patients were compared in regards to the development of complications including secondary OA development and the need for subsequent surgery.
RESULTS The average age at time of surgery was 38 in both groups. There was no difference between the groups in regards to workers compensation or gender. The average time of follow up was 34 months. Between 1995 and 2010 there were 34 patients under age 50 who underwent 4CF and 22 patients who underwent PRC. During the period of followup, six of the PRCs and 2 of the 4CF patients went on to total wrist fusion (p<0.05). Reasons for conversion included degenerative changes and unremitting pain. When comparing failure secondary to the development of degenerative changes at the radiocarpal joint, there were 3 failures in the PRC group and none in the 4CF group (p<0.05). Two additional patients in the PRC group underwent subsequent surgery, one for carpal tunnel release and one for neurolysis of superficial branch of the radial nerve.
31
PAPER 40 4BUVSEBZ 4FQUFNCFS to". $MJOJDBM1BQFS4FTTJPO%36+
Dynamic CT Imaging For Diagnosis of Scapholunate Joint Instability Not a clinical study
tSanjeev Kakar, MD, MRCS 4IVBJ-FOH 1I% $ZOUIJB.D$PMMPVHI 1I% t4UFWFO-.PSBO .% t3JDIBSE"#FSHFS .% ,SJTUJO%BJHMF;IBP ." HYPOTHESIS A novel dynamic imaging method comprised of 4-dimensional (4D; 3D + time) CT can accurately diagnose scapholunate (SL) joint instability.
METHODS Patients with a suspected diagnosis of SL instability, determined by clinical examination and standard x-ray imaging, underwent 4DCT scans during wrist movement. All patients presented complaining of pain and functional disability due to symptomatic instability of the wrist. A 4DCT technique was developed to acquire dynamic image data while patients move their wrists in radial-ulnar deviation, flexion-extension and dart thrower’s motion. A commercial dual source reconstruction algorithm was used to generate images with 75 ms temporal resolution and 4D movies. Two blinded fellowship trained hand surgeons reviewed movies of both wrists for each motion and scored the difference between the normal and injured wrist using a 5 point ordinal scale (1=no difference to 5=obvious difference).
RESULTS Four patients with a clinical suspicion of unilateral scapholunate wrist ligament injury were scanned in a dual source 128-slice CT scanner (Definition Flash, Siemens Healthcare, Forchheim, Germany). Motion of the scaphoid and lunate and the joint space between them were clearly visualized throughout the wrist motion cycle. For all patients, at least one motion was scored 4 or higher by both reviewers, indicating a substantial difference between the normal and injured wrists. The average scores from both reviewers over all 4 subjects were 4.0, 4.0 and 2.8 for radialulnar deviation, flexion extension and dart thrower’s motion.
SUMMARY POINTS ∙ ∙
∙
The 4DCT technique generated high spatial and high temporal resolution images of the moving wrist joint. Radial-ulnar deviation and flexion-extension motions qualitatively demonstrated a difference between the injured and uninjured wrist as compared to the dart thrower’s motion. 4DCT imaging may provide clinicians a useful tool for detecting scapholunate injury. Early detection and treatment may lead to more timely and efficacious treatment.
♦ Speaker has nothing of financial value to disclose
Figure 1. Volume rendered image from one frame of radial-ulnar deviation obtained using dynamic CT in a subject with scapholunate instability. t(SBOUSFDFJWFEGSPN/BUJPOBM*OTUJUVUFPG"SUISJUJTBOE.VTDVMPTLFMFUBMBOE4LJO Diseases – R21AR057902 (Kakar) t3PZBMUZ4VQQPSU4NBMM#POF*OOPWBUJPOT #FSHFS
"TDFOTJPO .PSBO
t0UIFS'JOBODJBM3FMBUJPOTIJQ"SUISFY *OD ,BLBS
t$POTVMUJOH'FFT"TDFOTJPO .PSBO
t*OUFMMFDUVBM1SPQFSUZ3JHIUT1BUFOU)PMEFS"TDFOTJPO .PSBO
PAPER 41 4BUVSEBZ 4FQUFNCFS to". $MJOJDBM1BQFS4FTTJPO%36+
Failure of Proximal Row Carpectomy (PRC) and Fourcorner Fusion (4CF) in Patients Younger than 50 -FWFM&WJEFODF ♦ Matthew S. Zimmermann, MD t"SOPME1FUFS$8FJTT .% )FBUIFS(PUIB .%
HYPOTHESIS Many studies have identified advantages and disadvantages specific to both PRC and 4CF. PRC is a simple procedure but carries risk of subsequent osteoarthritis (OA). 4CF has a higher risk of complications but maintains the native radiolunate joint. It has been suggested that PRCs performed in young patients are especially prone to failure. We hypothesize that younger patients will have a higher likelihood of failure due to pain and/or secondary OA following PRC when compared to 4CF.
METHODS All patients who had a proximal row carpectomy or four-corner fusion by the lead author at less than 50 years of age were included in this study. Patients were excluded if they had a history of inflammatory arthritis. Patients were compared in regards to the development of complications including secondary OA development and the need for subsequent surgery.
RESULTS The average age at time of surgery was 38 in both groups. There was no difference between the groups in regards to workers compensation or gender. The average time of follow up was 34 months. Between 1995 and 2010 there were 34 patients under age 50 who underwent 4CF and 22 patients who underwent PRC. During the period of followup, six of the PRCs and 2 of the 4CF patients went on to total wrist fusion (p<0.05). Reasons for conversion included degenerative changes and unremitting pain. When comparing failure secondary to the development of degenerative changes at the radiocarpal joint, there were 3 failures in the PRC group and none in the 4CF group (p<0.05). Two additional patients in the PRC group underwent subsequent surgery, one for carpal tunnel release and one for neurolysis of superficial branch of the radial nerve.
31