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Early results of a modified Brunelli procedure for scapholunate instability: a follow-up of 22 patients
T H E J O U R N A L O F H A N D SURGERY VOL. 22B SUPPLEMENT 1
Proximal row carpectomy: comparison between volar and dorsal approach R. Luchetti, O. Soragni, M. Ceruso, G. Checcucci, M. Poggi, T. Fairplay
Rep. San Marino, Firenze, Bologna, Italy Objectives Proximal row carpectomy by volar or dorsal approach was compared in order to verify the validity of the volar approach.
Methods Seventeen patients were divided into two groups depending on which approach was performed. The first group (volar approach) consisted of nine cases [7 men and 2 women, average age 34 years (range 20-61)] and the second of eight eases [6 men and 2 women, average age 41 years (range 30-57)]. All patients were right handed. Five patients of the first group and six patients of the second group were operated on their dominant hand. The postoperative evaluation of the patients was both clinical (pain, wrist movement, isometric and isokinetic grip and pinch strength) and by X-ray, including dynamic cineradiography or fluorography. Subjective results and return to work were also assessed.
Results With an average follow-up of 20 months and 32 months respectively, 78% of the patients were completely painfree in the first group and 50% in the second group. The postoperative average range of motion for flexion/extension of the wrist was 132° and 94 ° for the two groups, respectively. The ROM for wrist flexion was 79 ° for the volar and 51 ° for the dorsal approach, Extension was 52° for the votar and 43 ° for the dorsal approach. Mean radial/ulnar deviation of the wrist, detected only in the first group, was 59°. Isokinetic dynamic strength tests were always painless for the patients of the first group. Volar access showed the best results. Wrist flexion, functional hand grasp and pinch strength and endurance were significantly comparable with that of the non-involved hand but tended to be about 75% of the healthy hand for wrist extension. Dorsal approach tended to make the involved hand and wrist much weaker than the non-involved hand by an average of 66% overall in contrast to the volar approach which was 86% overall for all the static and dynamic tests performed. Cineradiographic studies demonstrated no sign of radiocarpal instability during the dynamic tests in the first group. The patients in the first group returned to their previous work earlier (average time of 66 days) than the patients in the second group (more than 120 days).
Conclusions On the basis of these results, the volar approach for PRC is considered a procedure which produces very functional results in the wrist and hand.
Early results of a modified Brunelli procedure for scapholunate instability: a follow-up of 22 patients K. L. S. Van Den Abbeele, Y. C. Loh, J. K. Stanley, I. A. Trail
Wigan, UK
Twenty-two patients with the diagnosis of scapholunate instability had a modified Brunelli procedure at the wrist. The diagnosis was made by screening and arthroscopy. The patient population consisted of eleven women and ten men. The mean follow-up time was 9 months (6-14 months). The mean age at the time of operation was 30 years (21--47). Twelve patients had their dominant wrist operated on, ten patients their nondominant wrist. Eighteen out of 22 patients remembered their injury. The majority of the patients had a longstanding problem for at least 1 year and sometimes even up to 15 years. The patients were assessed preoperatively and at the time of follow-up with a standard wrist form including the visual analogue scale for pain, evaluating function, range of motion, grip strength (Jamar Dynamometer), and specific wrist tests. Six shot series of the wrist were obtained to see if this operation altered the radiographic appearance. A subjective evaluation was performed by asking the patients if they would have the operation again considering the result of the operation at the time of follow-up. The complications of operation were recorded. Our results with the modified Brunelli procedure showed that about 70% of our patients had pain relief and obtained a good wrist function. Range of motion was slightly diminished in all patients. In only two patients was the grip strength equal to the non-affected wrist at the time of follow-up. Thirteen out of 20 patients with a preoperative positive Kirk Watson test had a negative test at follow-up. Four out of five patients with a radiographic scapholunate dissociation had no change in their post operative X-rays. 70% of the patients would have the same operation again if they had a similar injury to their opposite wrist. The commonest complication was scar tenderness over the volar incision (40%,), RSD was noted in two patients. One Acufex tag had to be removed from fixation in the lunate as it was believed to be the cause of considerable synovitis, Eight of the patients were involved in a worker's compensation claim or long term sickness benefit. This affected the objective and subjective results in a negative way.
Extensor carpi ulnaris tenodesis for chronic ulnar carpal instabilities: a 2 to 3 year follow-up of 15 wrists A. R. Tolat, J. K. Stanley, J. V. Mehta, J. Sinha.
Appley Bridge, UK Instability of the ulnar side of the carpus centres around the triquetrum, which is suspended by the ulnar triquetral ligaments and is supported proximally by the TFCC. Chronic ulnar carpal instabilities are difficult to treat and only a few case reports of ligament reconstruction exist in the English literature. Triquetro-lunate fusions have been reported, but with variable and often poor results (Sennwald, 1995). The authors present a new, previously unreported technique of extensor carpi ulnaris tenodesis for static ligamentous reconstruction of chronic, symptomatic ulnar carpal instabilities. 15 patients with a minimum follow-up of 2 years were assessed for improvement in pain, activity, range of motion, grip strength and ballotment tests (ulnocarpal). X-rays were further assessed pre- and postoperatively for lunotriquetral gap, VISI and ulnar variance. The arthroscopy findings in all the cases were analysed to suggest a new mechanism of staged injury to the ulnocarpal ligament complex (Stanley, 1995).
Proximal row carpectomy: comparison between volar and dorsal approach R. Luchetti, O. Soragni, M. Ceruso, G. Checcucci, M. Poggi, T. Fairplay
Rep. San Marino, Firenze, Bologna, Italy Objectives Proximal row carpectomy by volar or dorsal approach was compared in order to verify the validity of the volar approach.
Methods Seventeen patients were divided into two groups depending on which approach was performed. The first group (volar approach) consisted of nine cases [7 men and 2 women, average age 34 years (range 20-61)] and the second of eight eases [6 men and 2 women, average age 41 years (range 30-57)]. All patients were right handed. Five patients of the first group and six patients of the second group were operated on their dominant hand. The postoperative evaluation of the patients was both clinical (pain, wrist movement, isometric and isokinetic grip and pinch strength) and by X-ray, including dynamic cineradiography or fluorography. Subjective results and return to work were also assessed.
Results With an average follow-up of 20 months and 32 months respectively, 78% of the patients were completely painfree in the first group and 50% in the second group. The postoperative average range of motion for flexion/extension of the wrist was 132° and 94 ° for the two groups, respectively. The ROM for wrist flexion was 79 ° for the volar and 51 ° for the dorsal approach, Extension was 52° for the votar and 43 ° for the dorsal approach. Mean radial/ulnar deviation of the wrist, detected only in the first group, was 59°. Isokinetic dynamic strength tests were always painless for the patients of the first group. Volar access showed the best results. Wrist flexion, functional hand grasp and pinch strength and endurance were significantly comparable with that of the non-involved hand but tended to be about 75% of the healthy hand for wrist extension. Dorsal approach tended to make the involved hand and wrist much weaker than the non-involved hand by an average of 66% overall in contrast to the volar approach which was 86% overall for all the static and dynamic tests performed. Cineradiographic studies demonstrated no sign of radiocarpal instability during the dynamic tests in the first group. The patients in the first group returned to their previous work earlier (average time of 66 days) than the patients in the second group (more than 120 days).
Conclusions On the basis of these results, the volar approach for PRC is considered a procedure which produces very functional results in the wrist and hand.
Early results of a modified Brunelli procedure for scapholunate instability: a follow-up of 22 patients K. L. S. Van Den Abbeele, Y. C. Loh, J. K. Stanley, I. A. Trail
Wigan, UK
Twenty-two patients with the diagnosis of scapholunate instability had a modified Brunelli procedure at the wrist. The diagnosis was made by screening and arthroscopy. The patient population consisted of eleven women and ten men. The mean follow-up time was 9 months (6-14 months). The mean age at the time of operation was 30 years (21--47). Twelve patients had their dominant wrist operated on, ten patients their nondominant wrist. Eighteen out of 22 patients remembered their injury. The majority of the patients had a longstanding problem for at least 1 year and sometimes even up to 15 years. The patients were assessed preoperatively and at the time of follow-up with a standard wrist form including the visual analogue scale for pain, evaluating function, range of motion, grip strength (Jamar Dynamometer), and specific wrist tests. Six shot series of the wrist were obtained to see if this operation altered the radiographic appearance. A subjective evaluation was performed by asking the patients if they would have the operation again considering the result of the operation at the time of follow-up. The complications of operation were recorded. Our results with the modified Brunelli procedure showed that about 70% of our patients had pain relief and obtained a good wrist function. Range of motion was slightly diminished in all patients. In only two patients was the grip strength equal to the non-affected wrist at the time of follow-up. Thirteen out of 20 patients with a preoperative positive Kirk Watson test had a negative test at follow-up. Four out of five patients with a radiographic scapholunate dissociation had no change in their post operative X-rays. 70% of the patients would have the same operation again if they had a similar injury to their opposite wrist. The commonest complication was scar tenderness over the volar incision (40%,), RSD was noted in two patients. One Acufex tag had to be removed from fixation in the lunate as it was believed to be the cause of considerable synovitis, Eight of the patients were involved in a worker's compensation claim or long term sickness benefit. This affected the objective and subjective results in a negative way.
Extensor carpi ulnaris tenodesis for chronic ulnar carpal instabilities: a 2 to 3 year follow-up of 15 wrists A. R. Tolat, J. K. Stanley, J. V. Mehta, J. Sinha.
Appley Bridge, UK Instability of the ulnar side of the carpus centres around the triquetrum, which is suspended by the ulnar triquetral ligaments and is supported proximally by the TFCC. Chronic ulnar carpal instabilities are difficult to treat and only a few case reports of ligament reconstruction exist in the English literature. Triquetro-lunate fusions have been reported, but with variable and often poor results (Sennwald, 1995). The authors present a new, previously unreported technique of extensor carpi ulnaris tenodesis for static ligamentous reconstruction of chronic, symptomatic ulnar carpal instabilities. 15 patients with a minimum follow-up of 2 years were assessed for improvement in pain, activity, range of motion, grip strength and ballotment tests (ulnocarpal). X-rays were further assessed pre- and postoperatively for lunotriquetral gap, VISI and ulnar variance. The arthroscopy findings in all the cases were analysed to suggest a new mechanism of staged injury to the ulnocarpal ligament complex (Stanley, 1995).