113 results on '"Lunotriquetral ligament"'
Search Results
2. The Use of Cone-Beam Computed Tomography (CBCT) Arthrography for Wrist Ligamentous Injuries - A Diagnostic Test Accuracy Meta-analysis.
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Dhillon HK, Rojoa DM, Raheman Z, Monteoliva NC, Dhillon G, and Raheman FJ
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Background: Diagnosis of ligamentous wrist injuries can be challenging with the absence of dynamic instability on radiographs. Our aim was to evaluate the accuracy of cone-beam computed tomography (CBCT) arthrography in diagnosing scapholunate ligament (SLL), lunotriquetral ligament (LTL) and triangular fibrocartilage complex (TFCC) injuries. Methods: A systematic review and literature search were conducted in compliance with Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) and registered at the International Prospective Register of Systematic Reviews, PROSPERO (CRD42024517655). A mixed-effects logistic regression bivariate model was used to estimate summary sensitivity and specificity, and hierarchical summary receiver operating characteristic (HSROC) curves were constructed to determine diagnostic accuracy of CBCT arthrography. Results: We identified five studies assessing the accuracy of CBCT arthrography against wrist arthrography or intraoperative findings as reference standard. The pooled estimates for sensitivity and specificity of CBCT arthrography was 93% (95% CI 40-100) and 91% (95% CI 81-96) for SLL injuries, 83% (95% CI 37-98) and 64% (95% CI 42-81) for LTL injuries and 78% (95% CI 57-91) and 80% (95% CI 54-93) for TFCC injuries. The area under the curve was 0.91 (95% CI 0.89-0.94), showing an excellent diagnostic accuracy of CBCT arthrography in SLL injuries. CBCT arthrography had an estimated mean effective dose of 3.2 mSv (2.0-4.8). Conclusions: Our study confirms that CBCT arthrography has an excellent diagnostic accuracy for wrist ligamentous injuries with comparably high sensitivity to conventional arthrography and a better specificity. While further studies with more robust methodology are required to support its implementation in clinical practice, our analysis shows that it is a reliable option and has a promising future. Level of Evidence: Level III (Diagnostic).
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- 2024
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3. Wrist/Hand
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Hegazi, Tarek M., Wu, Jim S., Hegazi, Tarek M., and Wu, Jim S.
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- 2020
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4. How we decide when to immobilize the wrist after stable osteosynthesis of displaced distal radius fracture.
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Kilian M., Heger T., Simkovic P., Jacko P., Szaboova A., and Simko P.
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INTERNAL fixation in fractures , *FRACTURE fixation , *DISTAL radius fractures , *FLUOROSCOPY , *DIAGNOSIS of bone fractures - Abstract
PURPOSE OF THE STUDY: Fractures of the distal radius are frequently associated with injuries of the scapholunate (SL) and lunotriquetral (LT) ligaments. Our study is aimed at revealing their hidden lesions by employing a fast and accessible fluoroscopic identification. PATIENTS AND METHODS: We investigated 40 patients who were indicated for plate osteosynthesis of distal radius fracture. After completing the osteosynthesis, the procedure was concluded with a wrist arthrography. The patients with SL and LT interval lesions had their wrists immobilized by a plaster splint while patients with normal findings with an elastic bandage. The patients were followed up for 12 months after the surgery. The functional results were evaluated by Mayo wrist score. RESULTS: The intra-operative examination identified 62.5 % of patients with lesions of SL and/or LT interval, and 37.5 % of patients were lesion-free. The Mayo wrist scores after 3, 6 and 12 months in patients whose wrists were not immobilized were 72, 86.3, and 86.3, respectively. The latter scores in the group of patients with external immobilization were 54.4, 82, and 84.8, respectively. The difference between the groups was significant three months after the surgery. After six and twelve months, the difference became negligible. CONCLUSION: The exclusion of hidden lesions allows earlier rehabilitation, while in patients with signs of lesions, it is appropriate to immobilize the wrist (Tab. 1, Fig. 3, Ref. 31). Text in PDF www.elis.sk [ABSTRACT FROM AUTHOR]
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- 2021
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5. Level of evidence in wrist ligament repair and reconstruction research: a systematic review
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Jonny K. Andersson, Bo Rööser, and Jón Karlsson
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Scapholunate ligament ,Lunotriquetral ligament ,Triangular Fibrocartilage complex ,Repair ,Level of evidence ,Impact factor ,Orthopedic surgery ,RD701-811 - Abstract
Abstract There have been numerous studies on surgery of wrist ligament injuries, but a quick assessment reveals few with a high level of evidence (LoE). The primary aim of this study was to categorize the study type and LoE of studies on repair and reconstruction of the scapholunate ligament, the lunotriquetral ligament and the triangular fibrocartilage complex by applying the LoE rating system proposed by the Oxford Centre for Evidence-Based Medicine. The secondary aims were to evaluate the journal- and geographic- distribution of the included studies. An electronic literature search of articles published 1985–2016, in PubMed, Embase, and Cochrane Library was carried out in May 2016 and updated in April 2017. Therapeutic studies written in English were included. The PRISMA checklist guided the extraction and reporting of data. A total of 1889 studies were analyzed, of which 362 were included. Three journals represented 40% of the included studies and American authors dominated. Most studies (97%) had low LoE (IV-V). No studies of LoE I-II were found. There is insufficient evidence to recommend one technique over the other in terms of wrist ligament surgery in clinical practice. There is an immense lack of comparison studies with high level of evidence in the area of wrist ligament repair and reconstruction.
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- 2018
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6. Surgical Techniques for the Treatment of Acute Carpal Ligament Injuries in the Athlete.
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Gire, Jacob D. and Yao, Jeffrey
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The treatment of athletes with carpal ligament injuries provides many challenges. Our initial goals remain to make a timely and accurate diagnosis, provide treatment options, and create an environment for shared decision making. To optimize outcomes and facilitate return to play, early surgical intervention may be warranted. This article reviews common carpal ligament injury patterns in the athlete with a focus on both classic and newer surgical techniques. [ABSTRACT FROM AUTHOR]
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- 2020
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7. Wrist
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Julka, Abhishek, Maschke, Steven, Mauffrey, Cyril, editor, and Hak, David J., editor
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- 2015
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8. Ulnar-Sided Wrist Pain: A Diagnostic Evaluation Guide From 30-Plus Years of Experience.
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Mirza A, Mirza JB, Zappia LC, and Thomas TL
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Introduction: While multiple ulnar-sided wrist pain (USWP) diagnostic evaluation guides have been presented, none have included original clinical data or statistical analysis. The purpose of this study is to provide a diagnostic evaluation guide derived from original clinical data and analysis to help clinicians arrive at a differential diagnosis for USWP., Methods: Using a computer search of patients presenting with sprains, instability, and laxity of the wrist, 385 patient charts were identified. Patient demographics, mechanism of injury, subjective complaints, physical findings, and diagnostic test findings were reviewed. Statistical analysis was performed to determine sensitivity and specificity of diagnostic methods on their ability to identify lunotriquetral ligament tears, triangular fibrocartilage complex (TFCC) tears, and ulnar impaction syndrome. Diagnostic arthroscopy was used as the reference standard., Results: Ninety-three patients, comprising 101 cases of USWP, were included in the study. The onset of injury was traumatic in 83 out of 101 cases with motor vehicle accidents (N=46) being the most common, followed by overuse (N=18), and a fall onto an outstretched hand (N=16). The ulnocarpal tenderness test exhibited sensitivity/specificity of 72%/33%; lunotriquetral ligament laxity test of 42%/62%; bone scan of 80%/33%; radiocarpal arthrogram of 90%/98% for TFCC tears and 50%/91% for lunotriquetral ligament tears; midcarpal arthrogram of 82%/86% for lunotriquetral ligament tears. The mean ulnar variance on standard posteroanterior view radiograph was 0.95 mm, increasing to 2.67 mm on gripping posteroanterior view., Conclusion: Physicians should suspect a lunotriquetral ligament and/or TFCC tear with the acute onset of USWP following a loaded dorsiflexed mechanism of injury. Ulnocarpal tenderness tests and pre-operative ulnar variance measures are effective for increasing suspicion of USW pathology. Bone scans are helpful in diagnosing ulnar impaction syndrome in conjunction with radiographic findings. A combination of midcarpal arthrogram for lunotriquetral ligament tears and radiocarpal arthrogram for TFCC tears should be employed., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Mirza et al.)
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- 2024
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9. Comparison of magnetic resonance arthrography and wrist arthroscopy in the evaluation of chronic wrist pain in Indian population.
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Mehta, Nishank, Garg, Bhavuk, Ansari, Tahir, Srivastava, Deep, and Kotwal, Prakash
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ARTHROSCOPY , *CARTILAGE , *JOINT radiography , *MAGNETIC resonance imaging , *WRIST , *WRIST injuries , *ARTICULAR ligaments , *PREDICTIVE tests , *CARPAL joints - Abstract
Background: The purpose of our study was to compare magnetic resonance arthrography (MRA) as a diagnostic modality against the gold standard of wrist arthroscopy in the evaluation of chronic wrist pain. Materials and Methods: Thirty three patients with chronic wrist pain suspected to have ligament injuries of the wrist were prospectively recruited. They underwent MRA examinations followed by wrist arthroscopy. Arthroscopic findings were compared with radiological findings focusing on three important structures – triangular fibrocartilage complex (TFCC), scapholunate ligament (SLL), and lunotriquetral ligament (LTL). Results: For the 17 patients with TFCC tears/perforations on arthroscopy, MRA gave a sensitivity (SEN) = 88%, specificity (SPE) = 87.5%, positive predictive value (PPV) = 88%, and negative predictive value (NPV) = 87.5%. For the 13 patients with SLL tears on arthroscopy, MRA gave SEN = 77%, SPE = 100%, PPV = 100%, and NPV = 87%. For the 7 patients with LTL tears on arthroscopy, MRA gave SEN = 29%, SPE = 100%, PPV = 100%, and NPV = 84%. A composite correlation between findings on MRA and wrist arthroscopy revealed an overall SEN = 73%, SPE = 96%, PPV = 93%, and NPV = 85% for MRA, with overall accuracy = 88%. Conclusions: The presented diagnostic results of MRA are superior to those of magnetic resonance imaging quoted in literature. MRA is a potent tool for evaluating chronic wrist pain but tends to miss lesions of intrinsic carpal ligaments (SLL and LTL) more than TFCC. Wrist arthroscopy may be recommended when the clinical suspicion is strong. [ABSTRACT FROM AUTHOR]
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- 2019
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10. Three-dimensional kinematics of the lunate, hamate, capitate and triquetrum with type 1 or 2 lunate morphology.
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Shingo Abe, Hisao Moritomo, Kunihiro Oka, Kazuomi Sugamoto, Kenji Kasubuchi, Tsuyoshi Murase, and Hideki Yoshikawa
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The purpose of this study was to investigate the differences in three-dimensional carpal kinematics between type 1 and 2 lunates. We studied 15 instances of wrist flexion to extension (nine type 1, six type 2), 13 of radial to ulnar deviation (seven type 1, six type 2), and 12 of dart-throwing motion (six each of type 1 and 2) in 25 normal participants based on imaging with computerized tomography. Mean proximal translation of the distal articular midpoint of the triquetrum relative to type 2 lunates during wrist radioulnar deviation was 2.9mm (standard deviation (SD) 0.7), which was significantly greater than for type 1 lunates, 1.6mm (SD 0.6). The hamate contacted the lunate in ulnar deviation and ulnar flexion of wrists with type 2 lunates but not with type 1. We conclude that the four-corner kinematics of the wrist joint are different between type 1 and 2 lunates. [ABSTRACT FROM AUTHOR]
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- 2018
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11. Cost description of clinical examination and MRI in wrist ligament injuries.
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Andersson, Jonny K., Hansson-Olofsson, Elisabeth, Karlsson, Jón, and Fridén, Jan
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MEDICAL care costs , *WRIST injuries , *LIGAMENT injuries , *WRIST , *ARTHROSCOPY , *MAGNETIC resonance imaging , *THERAPEUTICS - Abstract
Objective:The total number and cost of wrist MRIs in the catchment area of the Västra Götaland Region in Sweden (population 1 723 000) during 1 year was analysed, together with the number and content of referrals. Methods:Six radiology departments reported the numbers and rate of all MRI investigations intended to diagnose wrist ligament injuries (n = 411) and other injuries to the wrist. Results:The additional cost of the difference between MRIs and a clinical examination by a hand surgeon, plus indirect costs for patients with suspected wrist ligament injuries, was calculated as 957 000 euros. Conclusions:It is recommended that MRI should only be used in patients in whom there are clinical difficulties in terms of diagnosing wrist ligament injuries. It is suggested that patients with suspected wrist ligament injuries should be referred directly to an experienced hand surgeon, capable of performing a standardised wrist examination and, when needed, diagnostic arthroscopy and final treatment. The proposed algorithm for the diagnosis and treatment of suspected wrist ligament injuries presented in the present study could save time for the patient and for the radiology departments, as well as reducing costs. The ability to implement the early and appropriate treatment of acute ligament injuries could be improved at the same time. [ABSTRACT FROM PUBLISHER]
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- 2018
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12. Kinematics and Pathophysiology of Carpal Instability
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Freeland, Alan E., Geissler, William B., and Geissler, William B., editor
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- 2005
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13. Evaluation of lesions of the internal ligaments of the wrist; conventional magnetic resonance imaging versus MR arthrography (MRA)
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Heba Ahmed Kamal, Manar Hussein Abdelsattar, and Nevien E. El-Liethy
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MRI ,MR arthrography ,Scapholunate ligament ,Lunotriquetral ligament ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Objective: The aim of this study is to assess the diagnostic value of direct MR arthrography compared to conventional MR imaging in the diagnosis of different pathologic entities affecting the internal ligaments of the wrist mainly the scapholunate and lunotriquetral ligaments. Subjects and methods: This study included 51 patients complaining of chronic wrist pain. Conventional MRI and MR arthrography (MRA) were done in all cases. Results: A comparison of the sensitivity of conventional MRI versus MRA was done by correlating the final diagnosis of each modality with the results of arthroscopy. Regarding complete SLL tears, MRI revealed a SEN, SPE and ACC of 61.54%, 96.77%, and 86.36%, while MRA showed a SEN, SPE and ACC of 92.31%, 100%, and 97.73% respectively, partial SLL tears, un-enhanced MRI revealed SEN, SPE and ACC of 10%, 94.12%, and 75%, while MRA showed 66.67%, 85.71%, and 81.82% respectively, complete LTL tears un-enhanced MRI revealed a SEN, SPE, and ACC of 25%, 100%, and 79.5% respectively, while MRA showed 91.67%, 100%, and 97.73% respectively. Conclusion: MR arthrography is a potent additional tool facilitating the diagnosis of different pathologic entities affecting the major internal ligaments of the wrist joint and helps to reduce arthroscopic interventions.
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- 2014
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14. Visualization of wrist ligaments with 3D and 2D magnetic resonance imaging at 3 Tesla
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Rana Ab-Fawaz, Ingvar Kristiansson, Isabella M. Björkman-Burtscher, Björn Lundin, Mats Geijer, Simon Götestrand, and Anders Björkman
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Adult ,Male ,Triangular Fibrocartilage ,Wrist Joint ,Wrist ,030218 nuclear medicine & medical imaging ,Young Adult ,03 medical and health sciences ,Imaging, Three-Dimensional ,0302 clinical medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,030222 orthopedics ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,General Medicine ,Anatomy ,Middle Aged ,Scapholunate ligament ,Lunotriquetral ligament ,Magnetic Resonance Imaging ,Visualization ,medicine.anatomical_structure ,Ligaments, Articular ,Female ,business ,Triangular Fibrocartilage Complex - Abstract
Background Wrist ligaments are challenging to visualize using magnetic resonance imaging (MRI). Injuries involving the scapholunate ligament (SLL), the lunotriquetral ligament (LTL), and the triangular fibrocartilage complex (TFCC) are common and difficult to diagnose, often requiring diagnostic arthroscopy. Purpose To compare the visualization of wrist ligaments on a three-dimensional (3D) sequence with two-dimensional (2D) sequences on 3-T MRI. Material and Methods Eighteen healthy volunteers were examined with a 3D SPACE (sampling perfection with application optimized contrasts using different flip angle evolution) sequence and 2D coronal, axial, and sagittal proton density-weighted (PD) sequences. Four musculoskeletal radiologists graded the anatomical visibility of the SLL, LTL, TFCC, and the image quality, using five grades in a visual grading characteristics (VGC) evaluation. After Bonferroni correction, a P value ≤0.005 was considered statistically significant. Results The 3D images were graded significantly better than the 2D images in the visualization of the dorsal and palmar parts of the SLL and the LTL. Regarding the TFCC, the 3D images were graded significantly better for visualization of the foveal attachment. 2D imaging was not found significantly superior to 3D imaging in any aspect. Conclusion The 3D SPACE sequence was scored as superior to the 2D sequences at 3 T in the assessment of the SLL, the LTL, and the foveal attachment of the TFCC. Thus, 3D SPACE can replace 2D PD sequences when these ligaments need to be assessed.
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- 2021
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15. Lunotriquetral Ligament Reconstruction Utilizing a Palmaris Longus Autograft.
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Harper, Carl M. and Iorio, Matthew L.
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LIGAMENT injuries , *RHEUMATOID arthritis , *WRIST diseases , *TENDON diseases , *LIGAMENT surgery - Abstract
Injury to the lunotriquetral ligament can result in midcarpal instability, with resultant alterations in normal wrist kinematics and subsequent arthrosis. We performed a previously undescribed technique of lunotriquetral ligament reconstruction in two patients utilizing a palmaris longus tendon autograft. Average age at presentation was 24 years old with a mean follow up of 10 months. Average range of motion was 62.5° of flexion and 57.5° of extension. Total arc of motion was 83% of the contralateral uninvolved extremity. Average grip strength was 31 kg which was 91% of the contralateral extremity. Average Quick Disability of Arm, Shoulder and Hand score was 12.5 and Modern Activity Subjective Survey of 2007 was 1.5. No complications were noted. [ABSTRACT FROM AUTHOR]
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- 2017
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16. Scapholunate and perilunate injuries in the athlete.
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Morrell, Nathan, Moyer, Amanda, Quinlan, Noah, and Shafritz, Adam
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Purpose of the review: Scapholunate and perilunate injuries can be difficult to diagnose and treat in the athlete. In this review article, we present the mechanism of injury, evaluation, management, and outcomes of treatment for these injuries. Recent findings: Acute repair of dynamic scapholunate ligament injuries remains the gold standard, but judicious use of a wrist splint can be considered for the elite athlete who is in season. The treatment of static scapholunate ligament injury remains controversial. Newer SL reconstructive techniques that aim to restore scapholunate function without compromising wrist mobility as much as tenodesis procedures show promise in athlete patients. Summary: Acute injuries to the scapholunate ligament are best treated aggressively in order to prevent the sequelae of wrist arthritis associated with long-standing ligamentous injury. Acute repair is favored. Reconstructive surgical procedures to manage chronic scapholunate injury remain inferior to acute repair. The treatment of lunotriquetral ligament injuries is not well defined. [ABSTRACT FROM AUTHOR]
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- 2017
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17. Transscaphoid lunate dislocation through the radiocarpal joint with intact palmar lunotriquetral ligament: a case report
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Lufei Dai and Ge Xiong
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Orthodontics ,business.industry ,Lunate dislocation ,Medicine ,Surgery ,business ,Lunotriquetral ligament ,Joint (geology) - Published
- 2021
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18. Scapholunate, lunotriquetral and TFCC ligament injuries associated with intraarticular distal radius fractures: Arthroscopic assessment and correlation with fracture types
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Philippe Bellemère, Steven Roulet, Ludovic Ardouin, and Marc Leroy
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Adult ,Male ,Triangular Fibrocartilage ,Adolescent ,Intra-Articular Fractures ,Radiography ,Computed tomography ,030230 surgery ,Arthroscopy ,Fracture Fixation, Internal ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,Fracture type ,Retrospective Studies ,030222 orthopedics ,Carpal Joints ,medicine.diagnostic_test ,business.industry ,Rehabilitation ,Middle Aged ,Scapholunate ligament ,medicine.disease ,Lunotriquetral ligament ,medicine.anatomical_structure ,Ligaments, Articular ,Soft tissue injury ,Ligament ,Female ,Surgery ,Radius Fractures ,business ,Nuclear medicine - Abstract
The aim of this study was to evaluate the prevalence of arthroscopic scapholunate (SL) and/or lunotriquetral (LQ) laxity and triangular fibrocartilaginous complex (TFCC) injuries in patients who have an intraarticular fracture of the distal radius and to correlate these lesions with fracture type. Fifty-seven intraarticular radius fractures, whether or not they were associated with an ulnar styloid fracture, were evaluated and treated by arthroscopy. Scapholunate and lunotriquetral ligament injuries were classified according to the EWAS classification. TFCC lesions were assessed according to Palmer's classification. Each injury was documented through preoperative X-rays and a CT scan. Fracture type and soft tissue injury were not significantly associated one to another. Arthroscopic examination revealed at least one soft tissue injury in 39 intraarticular fractures of the distal radius (68.4%). Twenty-five percent of arthroscopic SL laxities (including severe EWAS 3 injuries) were not detected on standard radiographs. Arthroscopic SL laxity was present in 8 of 11 cases (72.7%) of radial styloid fracture and in 15 of 25 cases (60%) of fractures with at least one radial styloid component. There was no association between LQ integrity and fracture type. Ulnar styloid fractures (base or tip) and TFCC lesions were significantly correlated (P0.0001). The prevalence of soft tissue lesions secondary to intraarticular fractures of the distal radius was 68.4%. However, there was no statistically significant relationship between the different types of radius fractures and soft tissue injuries. On the other hand, ulnar styloid fracture was predictive of TFCC injury.
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- 2020
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19. Reduction and Association of the Lunotriquetral Ligament for Reverse Perilunate Dislocation
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Hui-Kuang Huang, Jung-Pan Wang, and Tung-Yeh Tsai
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030222 orthopedics ,medicine.medical_specialty ,Motorcycle accident ,Percutaneous ,Perilunate dislocation ,business.industry ,030230 surgery ,Lunotriquetral ligament ,Surgery ,Lunate ,Compression screw ,03 medical and health sciences ,Fixation (surgical) ,0302 clinical medicine ,Triquetrum ,medicine ,Orthopedics and Sports Medicine ,business - Abstract
Background Reverse perilunate injuries are rare. Contrary to perilunate injuries, the violent force would start from the lunotriquetral ligament, go reversely toward the radial side, and cause the reverse or ulnar-sided perilunate dislocation. Case Description We describe a 31-year-old man with a reverse perilunate dislocation, who presented to our institution 3 weeks after a motorcycle accident. The patient was successfully treated with the reduction and association of the lunate and triquetrum (RALT) procedure by using closed maneuver and percutaneous headless compression screw fixation. The patient can obtain a good radiographic result and satisfactory function at the 30-month follow-up. Literature Review Many case series were reported concerning the perilunate injuries. However, few cases of reverse perilunate dislocation have been reported in the literature. No cases of reverse perilunate dislocation treated 3 weeks after the injury with the RALT procedure have been reported. Clinical Relevance In this case, we found that the dislocation could still be reduced with the closed maneuver. With the RALT procedure, the carpal alignment can be maintained and the stability can be regained. Also, the functional outcomes are good.
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- 2019
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20. Die Bandersatzplastik bei lunotriquetraler Instabilität mit einem distal gestielten Streifen der Extensor-carpi-ulnaris-Sehne.
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Pillukat, T., Fuhrmann, R., Windolf, J., and Schoonhoven, J.
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Copyright of Operative Orthopädie und Traumatologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2015
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21. Influence of associated lesions of the intrinsic ligaments on distal radius fractures outcome.
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Kasapinova, Katerina and Kamiloski, Viktor
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LIGAMENT injuries , *BONE fractures , *MANN Whitney U Test , *ARTHROSCOPY , *DISABILITIES - Abstract
Introduction: We aimed to evaluate the influence of associated scapholunate (SL) and/or lunotriquetral ligament (LT) injury on the outcome of distal radius fractures. Materials and methods: This prospective study included 40 patients with surgically treated distal radius fracture. Wrist arthroscopy was used to identify associated lesions of the scapholunate and lunotriquetral ligaments and classify them according to Geissler. Patients were divided in two groups by presence (injured group) or absence (intact group) of associated injury of the SL and/or LT ligament. The patient-rated wrist evaluation (PRWE) and the disabilities of the arm, shoulder and hand (DASH) questionnaires were used to evaluate disability 3 and 6 months after injury. Grip strength was also evaluated. Results: Wrist arthroscopy identified SL and/or LT injury in 15 patients (37.5 %). Mean total PRWE score for the intact group was 26.64 at 3 months and 16.22 at 6 months, and 50.47 (at 3 months) and 20.7 (at 6 months) for the group with ligament injury. Mean DASH scores were 26.03 and 13 at 3 and 6 months for the intact group, and 49.5 and 24.11 for the injured group. Mann-Whitney test results showed significant difference for the PRWE and DASH scores and the grip strength for the two examined groups. Conclusions: Patients with distal radius fracture with associated intrinsic ligament injury had worse outcomes than did patients without associated ligamentous injury. Associated injuries of the SL and LT ligament should be considered when treating distal radius fractures, and wrist arthroscopy should be incorporated into the operative protocol. [ABSTRACT FROM AUTHOR]
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- 2015
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22. Arthroscopic treatment for isolated traumatic lunotriquetral ligament injury without triangular fibrocartilage complex lesion
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Kim, B, Yun, K, Cho, W, Kim, B, Yun, K, and Cho, W
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- 2020
23. Arthroscopic dorsal capsulodesis for isolated lunotriquetral interosseous ligament injuries
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Ebubekir Eravsar, Ali Ozdemir, and Mehmet Ali Acar
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Dorsum ,Joint Instability ,Wrist Joint ,030222 orthopedics ,medicine.medical_specialty ,business.industry ,030230 surgery ,Lunotriquetral ligament ,Wrist Injuries ,Surgery ,body regions ,03 medical and health sciences ,Arthroscopy ,0302 clinical medicine ,medicine.anatomical_structure ,Treatment Outcome ,Ligaments, Articular ,Ligament ,medicine ,Wrist arthroscopy ,Humans ,business ,Retrospective Studies - Abstract
We assessed the outcomes of isolated lunotriquetral ligament injuries in ten patients who underwent arthroscopic dorsal capsulodesis. Data from patient records, radiologic images and arthroscopic video records were evaluated. The patients were evaluated for ulnar-sided wrist pain with history and physical examination. Preoperative radiographs and MRIs for pain aetiology were assessed. The patients underwent arthroscopic dorsal capsulodesis and were evaluated 29 months (range 19–45) after surgery. Nine patients returned to their original jobs. In one patient pain was aggravated with heavy activities. Mean scapholunate angle was 44°. There were significant improvements postoperatively in pinch and grip strength and MAYO wrist, patient-reported wrist evaluation and pain scores. The wrist flexion–extension and the radial ulnar deviation were significantly improved compared with the contralateral hand. We conclude that arthroscopic dorsal capsulodesis offers effective management for isolated lunotriquetral interosseous ligament injuries. Level of evidence: IV
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- 2021
24. Evaluation of lesions of the internal ligaments of the wrist; conventional magnetic resonance imaging versus MR arthrography (MRA).
- Author
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Kamal, Heba Ahmed, Abdelsattar, Manar Hussein, and El-Liethy, Nevien E.
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Objective The aim of this study is to assess the diagnostic value of direct MR arthrography compared to conventional MR imaging in the diagnosis of different pathologic entities affecting the internal ligaments of the wrist mainly the scapholunate and lunotriquetral ligaments. Subjects and methods This study included 51 patients complaining of chronic wrist pain. Conventional MRI and MR arthrography (MRA) were done in all cases. Results A comparison of the sensitivity of conventional MRI versus MRA was done by correlating the final diagnosis of each modality with the results of arthroscopy. Regarding complete SLL tears, MRI revealed a SEN, SPE and ACC of 61.54%, 96.77%, and 86.36%, while MRA showed a SEN, SPE and ACC of 92.31%, 100%, and 97.73% respectively, partial SLL tears, un-enhanced MRI revealed SEN, SPE and ACC of 10%, 94.12%, and 75%, while MRA showed 66.67%, 85.71%, and 81.82% respectively, complete LTL tears un-enhanced MRI revealed a SEN, SPE, and ACC of 25%, 100%, and 79.5% respectively, while MRA showed 91.67%, 100%, and 97.73% respectively. Conclusion MR arthrography is a potent additional tool facilitating the diagnosis of different pathologic entities affecting the major internal ligaments of the wrist joint and helps to reduce arthroscopic interventions. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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25. Ulnar Impaction Syndrome: Incidence of Lunotriquetral Ligament Degeneration and Outcome of Ulnar-Shortening Osteotomy.
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Iwatsuki, Katsuyuki, Tatebe, Masahiro, Yamamoto, Michiro, Shinohara, Takaaki, Nakamura, Ryogo, and Hirata, Hitoshi
- Abstract
Purpose: We hypothesized that most patients with ulnar impaction syndrome have degenerative changes of the proximal lunotriquetral (LT) membrane and that ulnar-shortening osteotomy is an effective procedure in these patients. Methods: We retrospectively reviewed 50 wrists of 49 patients with idiopathic ulnar impaction syndrome who underwent an arthroscopic evaluation at the time of ulnar-shortening osteotomy, and subsequently at plate removal. Based on the Geissler classification, patients were divided into group A, normal, and group B, grades I to IV. The degree of degeneration of the proximal LT membrane at first-look arthroscopy was compared with that at second-look arthroscopy. Results: After ulnar-shortening osteotomy, both groups improved significantly in wrist range of motion and grip strength. According to the Mayo wrist score, 29, 18, and 3 patients showed excellent, good, and fair results, respectively. Of the 50 wrists, 25 had degenerative changes (group B) in the proximal LT membrane at the time of first-look arthroscopy. Of the 25 wrists in group B, 11 wrists improved based on the Geissler grade, 9 wrists showed no changes, and 2 wrists became worse. Clinically, patients demonstrated improvement after ulnar-shortening osteotomy regardless of the degree of degenerative LT ligament changes. Conclusions: Degenerative LT membrane changes that were seen in about half of our patients were mostly of a mild nature, and the clinical outcomes of ulnar-shortening osteotomy were acceptable. Type of study/level of evidence: Therapeutic IV. [Copyright &y& Elsevier]
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- 2014
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26. Scapholunate and Lunotriquetral Injuries: Arthroscopic and Open Management.
- Author
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Slutsky, David J. and Trevare, Julien
- Subjects
- *
LIGAMENT injuries , *WRIST injuries , *ARTHROSCOPES , *BONE injuries , *SPORTS injuries , *SPORTS medicine - Abstract
It has become clear that the stability of the scapholunate joint is not dependent wholly upon the scapholunate interosseous ligament but rather upon both primary and secondary stabilizers, which form a scapholunate ligament complex. Each case of scapholunate instability is unique and therefore should be treated with tissue-specific repairs, which may partly explain why a single procedure cannot successfully restore joint stability in every case. Not all lunotriquetral ligament tears are traumatic. The optimal treatment of symptomatic tears is still uncertain. Wrist arthroscopy has a pivotal role in both the assessment and treatment of these derangements. [ABSTRACT FROM AUTHOR]
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- 2014
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27. Arthroscopic Assisted Reconstruction of LT-Ligament: A Description of a New Technique
- Author
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Jan Ragnar Haugstvedt and István Zoltán Rigó
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Open surgery ,Arthrodesis ,medicine.medical_treatment ,Arthroscopy ,Less invasive ,Level iv ,Lunotriquetral ligament ,Surgery ,medicine.anatomical_structure ,medicine ,Ligament ,Orthopedics and Sports Medicine ,business - Abstract
Background Injuries of the lunotrirquetral ligament (LT lig) could be part of an extensive carpal injury and are then often treated at the time of the injury. However, when an injury of the LT ligament occurs alone, the injury is often missed. Treatment of this injury has traditionally been by open surgery, such as reattachment of the LT ligament, ligament reconstruction, or arthrodesis of the LT joint. These procedures needed a large exposure to the carpus running the risk of damaging the external ligaments, the nerves important for proprioception, and the capsule with the potential of scarring and adhesions. Materials and Methods We describe a novel arthroscopic assisted technique for reconstruction of the LT ligament. Using this less invasive technique, there is a possible advantage of lesser scarring and faster mobilization. Results We have performed this technique in two patients with more than 30 months follow-up. They both have great improvement of the functional scores. Conclusion The novel arthroscopic assisted technique for LT lig reconstruction is a technically demanding procedure; however, this obtains good clinical results with more than 30 months follow-up due to less exposure of the carpus. Level of Evidence This is a Level IV, case series study.
- Published
- 2020
28. Arthroscopic treatment for isolated traumatic lunotriquetral ligament injury without triangular fibrocartilage complex lesion
- Author
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Kim, Byungsung, Yun, Keonhee, and Cho, WhiJe
- Subjects
triangular fibrocartilage complex ,ddc: 610 ,arthroscopic debridement ,thermal shrinkage ,610 Medical sciences ,Medicine ,lunotriquetral ligament - Abstract
Objectives/Interrogation: To evaluate the clinical results of patients treated by arthroscopic debridement and thermal shrinkage of the isolated traumatic lunotriquetral(LT) ligament tear without triangular fibrocartilage complex(TFCC) tear. Methods: We retrospectively reviewed the results[for full text, please go to the a.m. URL], 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)
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- 2020
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29. Co by měl fyzioterapeut vědět o karpálních nestabilitách?
- Author
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Dráč, P. and Maňák, P.
- Subjects
- *
PHYSICAL therapists , *CARPAL joints , *WRIST injuries , *SYMPTOMS , *MAGNETIC resonance imaging , *ARTHROSCOPY - Abstract
Carpal instability represents a heterogenic group of wrist injuries considering the extent of the injury, degree of damage and variability of symptomatology. They can be often unrecognited at the beginning - e.g. in the therapy of simultaneous fracture of distant end of radius. It is often the physiotherapist who primarily draws attention to complaints that become manifest in the course of the patient's rehabilitation after fracture of the distal radius, secaphoid, or treated for vague diagnosis of the wrist distortion which are caused by wrist instability. The establishment of diagnosis may be based on clinical tests, radiologic examination including stress images, magnetic resonance or wrist arthroscopy. An early and precise classification of the injury makes it possible to select a suitable therapeutic procedure and accordingly improve the chance for favorable clinical results. [ABSTRACT FROM AUTHOR]
- Published
- 2013
30. Ulnar-sided Wrist Pain: Evaluation and Treatment of Triangular Fibrocartilage Complex Tears, Ulnocarpal Impaction Syndrome, and Lunotriquetral Ligament Tears.
- Author
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Sachar, Kavi
- Subjects
WRIST diseases ,PAIN ,LIGAMENT injury treatment ,ETIOLOGY of diseases ,HEALTH outcome assessment ,DIFFERENTIAL diagnosis - Abstract
Ulnar-sided wrist pain is a common cause of upper extremity disability. Presentation can vary from acute traumatic injuries to chronic degenerative conditions. Because of its overlapping anatomy, complex differential diagnosis, and varied treatment outcomes, the ulnar side of the wrist has been referred to as the “black box” of the wrist, and its pathology has been compared with low back pain. Common causes of ulnar-sided wrist pain include triangular fibrocartilaginous complex injuries, lunotriquetrial ligament injuries, and ulnar impaction syndrome. [ABSTRACT FROM AUTHOR]
- Published
- 2012
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31. Ligamentous Injuries of the Wrist.
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Tanaka, Toshikazu, Ogino, Shuhei, and Yoshioka, Hiroshi
- Subjects
- *
WRIST , *WOUNDS & injuries , *LIGAMENTS , *OSTEOARTHRITIS , *MAGNETIC resonance imaging - Abstract
The purpose of this review is to summarize ligamentous injury of the wrist. Triangular fibrocartilage complex (TFCC), scapholunate ligament (SLL), and lunotriquetral ligament (LTL) are crucial to wrist stability. Damage to these ligaments causes changes in bone alignment and altered motion pattern. This may cause pain and eventually osteoarthritis. Imaging techniques of the wrist include conventional arthrography, computed tomography (CT) arthrography, conventional magnetic resonance imaging (Mm), and MR arthrography. Especially, MRI plays an important role in the assessment of TFCC, SLL, and LTL. Therefore, special attention is drawn to normal and abnormal MR imaging appearance of these ligaments in this review. Variety of treatment options dependent on classification of TFCC and ligamentous injury as well as role of imaging in the patient treatment are also discussed. [ABSTRACT FROM AUTHOR]
- Published
- 2008
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32. Ulnar-Sided Wrist Pain: Evaluation and Treatment of Triangular Fibrocartilage Complex Tears, Ulnocarpal Impaction Syndrome, and Lunotriquetral Ligament Tears.
- Author
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Sachar, Kavi
- Subjects
WRIST diseases ,ULNA injuries ,CARPAL tunnel syndrome ,HUMAN abnormalities ,OSTEOARTHRITIS ,HEALTH outcome assessment ,WRIST injuries ,PAIN - Abstract
Ulnar-sided wrist pain is a common cause of upper-extremity disability. Presentation can vary from acute traumatic injuries to chronic degenerative conditions. Because of its overlapping anatomy, complex differential diagnosis, and varied treatment outcomes, the ulnar side of the wrist has been referred to as the “black box” of the wrist, and its pathology has been compared with that of low back pain. Common causes of ulnar-sided wrist pain include triangular fibrocartilage complex injuries, lunotriquetral ligament injuries, and ulnar impaction syndrome. [Copyright &y& Elsevier]
- Published
- 2008
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33. Arthroscopic Evaluation of Associated Soft Tissue Injuries in Distal Radius Fractures
- Author
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Tommy Lindau
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Cartilage, Articular ,Joint Instability ,Triangular Fibrocartilage ,medicine.medical_specialty ,Soft Tissue Injuries ,030230 surgery ,Locking plate ,Arthroscopy ,03 medical and health sciences ,Fixation (surgical) ,0302 clinical medicine ,Humans ,Medicine ,Orthopedics and Sports Medicine ,030222 orthopedics ,medicine.diagnostic_test ,business.industry ,Soft tissue ,Scapholunate ligament ,Wrist Injuries ,Lunotriquetral ligament ,Surgery ,medicine.anatomical_structure ,Ligaments, Articular ,Ligament ,Radius Fractures ,business - Abstract
The best outcome in distal radius fractures is achieved if anatomy is restored, in particular the intra-articular congruity. This is achieved partly with improved fixation, such as using volar locking plates, and partly by using an arthroscopy-assisted reduction and fixation technique. In addition to improving the intra-articular congruity, associated ligament and chondral injuries can be detected and treated. This article outlines various associated injuries with suggested management in a stepwise fashion. It is hoped that overall outcomes will be improved once patient-related and treatment-related factors have been evaluated and previously undetected associated ligament injuries have been found and treated.
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- 2017
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34. Arthroscopically assisted osteosynthesis of distal intraarticular radius fractures.
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Peicha, Gerolf, Seibert, Franz, Grechenig, Wolfgang, Fellinger, Michael, and Clement, Hans
- Abstract
Closed reduction and internal fixation of intraarticular distal radial fractures under direct vision of the articular surfaces. Concomitant control of additional carpal injuries and, if necessary, minimally invasive treatment. Distal, intraarticular radial fractures, particularly of group B and C according to the AO fracture classification. Fractures of group A with marked displacement with probable suspected additional carpal injuries, such as of scapholunar and lunotriquetral ligaments, triangular fibrocartilaginous complex. Open fractures, polytrauma patients, comminuted intraarticular fractures. Closed reduction of fracture. Arthrography of the wrist. Exact reduction of the fragments under arthroscopic control. Stabilization of fragments with the help of percutaneously introduced Kirschner wires and/or cannulated screws. If required, temporary arthrodesis of the scapholunar joint, or resection or reattachment of the articular disc. Thirty patients were treated with the described method, 23 of them showed additional injuries. Twenty-three patients who had surgery at least a year before were followed up at an average of 32.5 months (12 to 48) and were assessed according to the point score of Cooney. An excellent or good result was seen in 16 patients, a satisfactory result in 4 and a poor result in 3 patients. A transient paresthesia was noted in 3 patients, in 1 patient we observed an irritation of the extensor pollicis longus. Two patients required revision surgery: 1 shortening of the ulna, 1 plate fixation of the radius. [ABSTRACT FROM AUTHOR]
- Published
- 2000
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35. Die arthroskopisch unterstützte Osteosynthese distaler intraartikulärer Radiusfrakturen.
- Author
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Peicha, Gerolf, Seibert, Franz Josef, Grechenig, Wolfgang, Fellinger, Michael, and Clement, Hans
- Abstract
Copyright of Operative Orthopädie und Traumatologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2000
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36. Comparison of Magnetic Resonance Arthrography and Wrist Arthroscopy in the Evaluation of Chronic Wrist Pain in Indian Population
- Author
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Nishank Mehta, Deep Narayan Srivastava, Bhavuk Garg, Prakash P. Kotwal, and Tahir Ansari
- Subjects
medicine.medical_specialty ,Lunotriquetral ligament ,Wrist ,Wrist pain ,03 medical and health sciences ,triangular fibrocartilage complex ,0302 clinical medicine ,lcsh:Orthopedic surgery ,wrist arthroscopy ,medicine ,Wrist arthroscopy ,Orthopedics and Sports Medicine ,wrist pain ,scapholunate ligament ,030222 orthopedics ,medicine.diagnostic_test ,business.industry ,Arthroscopy ,Magnetic resonance imaging ,030229 sport sciences ,Scapholunate ligament ,eye diseases ,body regions ,lcsh:RD701-811 ,medicine.anatomical_structure ,Orthopedic surgery ,Ligament ,Original Article ,medicine.symptom ,Nuclear medicine ,business - Abstract
Background: The purpose of our study was to compare magnetic resonance arthrography (MRA) as a diagnostic modality against the gold standard of wrist arthroscopy in the evaluation of chronic wrist pain. Materials and Methods: Thirty three patients with chronic wrist pain suspected to have ligament injuries of the wrist were prospectively recruited. They underwent MRA examinations followed by wrist arthroscopy. Arthroscopic findings were compared with radiological findings focusing on three important structures – triangular fibrocartilage complex (TFCC), scapholunate ligament (SLL), and lunotriquetral ligament (LTL). Results: For the 17 patients with TFCC tears/perforations on arthroscopy, MRA gave a sensitivity (SEN) = 88%, specificity (SPE) = 87.5%, positive predictive value (PPV) = 88%, and negative predictive value (NPV) = 87.5%. For the 13 patients with SLL tears on arthroscopy, MRA gave SEN = 77%, SPE = 100%, PPV = 100%, and NPV = 87%. For the 7 patients with LTL tears on arthroscopy, MRA gave SEN = 29%, SPE = 100%, PPV = 100%, and NPV = 84%. A composite correlation between findings on MRA and wrist arthroscopy revealed an overall SEN = 73%, SPE = 96%, PPV = 93%, and NPV = 85% for MRA, with overall accuracy = 88%. Conclusions: The presented diagnostic results of MRA are superior to those of magnetic resonance imaging quoted in literature. MRA is a potent tool for evaluating chronic wrist pain but tends to miss lesions of intrinsic carpal ligaments (SLL and LTL) more than TFCC. Wrist arthroscopy may be recommended when the clinical suspicion is strong.
- Published
- 2019
37. Perilunate instability: A rare variant
- Author
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Amanda Partap and Ian James Persad
- Subjects
Medicine (General) ,medicine.medical_specialty ,High energy ,business.industry ,Perilunate dislocation ,Fracture Dislocations ,Case Report ,General Medicine ,transscaphoid fracture dislocation ,030204 cardiovascular system & hematology ,Lunotriquetral ligament ,Surgery ,Lunate ,03 medical and health sciences ,R5-920 ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Medicine ,business - Abstract
Perilunate dislocations and perilunate fracture dislocations are rare injuries that occur as a result of high energy trauma. We describe a case of a volar fracture dislocation of the proximal pole of the scaphoid with an associated scapholunate and lunotriquetral ligament disruption as well as a lunate fossa fracture of the distal radius. These injuries are serious injuries that require a high degree of clinical acumen and radiographic scrutiny to allow for prompt treatment in order to avoid the sequelae of long-term complications that can arise. This case serves as a reminder of the complexity of these injuries and their associated mechanics.
- Published
- 2021
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38. Revisiting Lunotriquetral Arthrodesis in Chronic Lunotriquetral Ligamentous Injuries.
- Author
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Nickel KJ, Curran MWT, and Morhart M
- Abstract
Background Chronic lunotriquetral (LT) ligament tears are a source of ulnar-sided wrist pain. Left untreated, complete tears of the LT ligament may progress to a volar intercalated segment instability deformity and eventual carpal arthritis. Various treatments have been proposed, one of which is LT arthrodesis. LT arthrodesis has been criticized for high rates of nonunion frequently requiring reoperation, and therefore has largely fallen out of favor. However, our experience has been quite different from the literature. This study examines a single surgeon's experience with LT arthrodesis over a 15-year period. Methods A retrospective review of the senior author's practice over a 15-year period was performed. All adult cases of LT arthrodesis for chronic LT injuries were included. Headless compression screw and cancellous bone graft from the distal radius were used for primary arthrodesis in all cases. The primary outcome was rate of union, and secondary outcomes were time to union, secondary or salvage procedures, and range of motion. Nonparametric statistical analysis was used to calculate differences in outcomes. Results Twenty-eight patients met inclusion criteria. The median age was 45.5 (interquartile range [IQR] 35-50) years and 75% were male. The dominant hand was most commonly affected. Eighty-six percent of patients achieved union, one patient required redo arthrodesis, and one patient went on to wrist salvage. Three patients developed a pain-free pseudoarthrosis. Median time to radiographic union was 8.8 (IQR 5.9-11.9) weeks. Conclusion Despite multiple previous reports, this study demonstrates that LT arthrodesis for chronic LT injuries is a safe technique with high rates of successful union. Further comparative studies are warranted to determine the optimal treatment for chronic LT injuries., Competing Interests: Conflict of Interest None declared., (Thieme. All rights reserved.)
- Published
- 2022
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39. Radiocarpal Injuries: Cone Beam Computed Tomography Arthrography, Magnetic Resonance Arthrography, and Arthroscopic Correlation among 21 Patients
- Author
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Nina Lindfors, Nora Suojärvi, Ville Haapamäki, Seppo Koskinen, Clinicum, Department of Surgery, HUS Musculoskeletal and Plastic Surgery, Department of Diagnostics and Therapeutics, HUS Medical Imaging Center, and I kirurgian klinikka (Töölö)
- Subjects
Cartilage, Articular ,Male ,Cone beam computed tomography ,Wrist pain ,Multimodal Imaging ,030218 nuclear medicine & medical imaging ,Cohort Studies ,Arthroscopy ,Injury Severity Score ,0302 clinical medicine ,Wrist arthroscopy ,Range of Motion, Articular ,Arthrography ,CT ARTHROGRAPHY ,3-T MRI ,medicine.diagnostic_test ,MDCT ,Cone-Beam Computed Tomography ,Middle Aged ,Scapholunate ligament ,Wrist Injuries ,Lunotriquetral ligament ,Magnetic Resonance Imaging ,Treatment Outcome ,Cone beam computed tomography arthrography ,030220 oncology & carcinogenesis ,Ligaments, Articular ,Female ,MR ARTHROGRAPHY ,Radiology ,medicine.symptom ,Triangular Fibrocartilage Complex ,Adult ,medicine.medical_specialty ,ligament tear ,Risk Assessment ,chondral lesion ,03 medical and health sciences ,CARTILAGE ,wrist arthroscopy ,medicine ,Humans ,Retrospective Studies ,business.industry ,TEARS ,CBCT ,Magnetic resonance imaging ,TRIANGULAR FIBROCARTILAGE COMPLEX ,3126 Surgery, anesthesiology, intensive care, radiology ,magnetic resonance arthrography ,WRIST LIGAMENT ,Lunate ,Surgery ,business ,human activities ,Follow-Up Studies - Abstract
Background and Aims: Patients with acute or chronic wrist pain often undergo wrist arthroscopy for evaluation of chondral and ligamentous abnormalities. The purpose of this study was to compare findings of wrist arthroscopy with cone beam computed tomography arthrography and magnetic resonance arthrography. Materials and Methods: Altogether, 21 patients with wrist pain underwent cone beam computed tomography arthrography, magnetic resonance arthrography, and wrist arthroscopy. Chondral surfaces of the scaphoid, lunate, and radius facing the scaphoid and lunate were evaluated. The scapholunate ligament, the lunotriquetral ligament, and the triangular fibrocartilage complex were classified as either intact or torn. Sensitivity, specificity, positive and negative predictive values, and accuracy with 95% confidence intervals were assessed. Results: For chondral lesions (n = 10), cone beam computed tomography arthrograms showed slightly higher specificity than magnetic resonance arthrography. The sensitivity of cone beam computed tomography arthrography was also better for these lesions, except for those on the chondral surface of the lunate. For triangular fibrocartilage complex injuries (n = 9), cone beam computed tomography arthrography showed a better specificity and sensitivity than magnetic resonance arthrography. For ligamentous injuries (n = 6), cone beam computed tomography arthrograms were more sensitive, but less specific than magnetic resonance arthrography images. However, the number of lesions was very small and the 95% confidence intervals are overlapping. Conclusion: Cone beam computed tomography is an emerging imaging modality that offers several advantages over computed tomography and magnetic resonance imaging. Its usefulness particularly in ligamentous injuries should be further explored in a larger study. Cone beam computed tomography arthrography seems to offer similar sensitivity, specificity, and accuracy compared to magnetic resonance arthrography and therefore serves as a valuable option in evaluating patients with wrist pain.
- Published
- 2016
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40. Management of lunotriquetral instability: a review of the literature
- Author
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Marco J.P.F. Ritt, T. C. van de Grift, Medical psychology, Plastic, Reconstructive and Hand Surgery, and MOVE Research Institute
- Subjects
Joint Instability ,medicine.medical_specialty ,Arthrodesis ,medicine.medical_treatment ,Wrist pain ,Instability ,03 medical and health sciences ,Arthroscopy ,Triquetrum Bone ,0302 clinical medicine ,Soft tissue reconstruction ,medicine ,Humans ,Lunate Bone ,Range of Motion, Articular ,Minimally invasive procedures ,High rate ,030222 orthopedics ,Carpal Joints ,Hand Strength ,business.industry ,030229 sport sciences ,Lunotriquetral ligament ,Surgery ,medicine.anatomical_structure ,Patient Satisfaction ,Ligaments, Articular ,Ligament ,medicine.symptom ,business - Abstract
Lunotriquetral ligament injury is a relatively common cause of ulnar-sided wrist pain. Injury ranges from partial stable ligament tears to extensive perilunate instability. Clinical decision-making largely depends on the chronicity, instability and cause of the ligament injury. Conservative treatment is generally regarded as first choice of treatment of mild lunotriquetral instability; however, outcome studies on conservative treatment are lacking. Temporary arthroscopic pinning and/or debridement are minimally invasive procedures of preference. In the case of more dissociative injury, surgical interventions may be performed. The literature suggests that soft tissue reconstruction is an effective procedure in this group. Arthrodesis of the lunotriquetral joint is associated with high rates of non-union (up to 57%) and the indications for surgery should therefore be very clear. Methodological issues make it hard to draw firm conclusions from the data. Studies on the effectiveness of conservative management and prospective comparative studies will further improve clinical decision-making in lunotriquetral instability. Level of evidence: N/A
- Published
- 2016
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41. Level of evidence in wrist ligament repair and reconstruction research: a systematic review
- Author
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Andersson, Jonny K., Rööser, Bo, and Karlsson, Jón
- Published
- 2018
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42. Lunotriquetral Ligament Reconstruction Using Extensor Carpi Ulnaris Tendon
- Author
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Kevin C. Chung and Brett Michelotti
- Subjects
Extensor carpi ulnaris tendon ,business.industry ,Medicine ,Anatomy ,business ,Lunotriquetral ligament - Published
- 2018
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43. Wrist Imaging: The 'Top 5' Classic Diagnoses
- Author
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Robert D. Boutin
- Subjects
musculoskeletal diseases ,medicine.medical_specialty ,business.industry ,Scaphoid fracture ,Wrist ,Neurovascular bundle ,medicine.disease ,Lunotriquetral ligament ,Carpal instability ,body regions ,Lunate ,medicine.anatomical_structure ,medicine ,Tears ,Radiology ,Medical diagnosis ,business - Abstract
The wrist has intricate anatomy that can be “dissected” non-invasively with imaging. Imaging interpretations can be accomplished comprehensively and efficiently by using a systematic “checklist” approach to these anatomic structures (e.g., osteoarticular, ligamentous, musculotendinous, neurovascular). Diagnostic accuracy is maximized by mastering the problems certain to appear in patients with wrist maladies undergoing imaging. “The Top 5” classic wrist disorders are highlighted here, including fractures (e.g., scaphoid), AVN (e.g., lunate), carpal instability (e.g., scapholunate and lunotriquetral ligament tears), TFCC injuries, and common soft-tissue masses.
- Published
- 2017
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44. Posttraumatic ulnar carpal translocation type I accompanied with disruption of the lunotriquetral ligament caused by a severe radiocarpal fracture-dislocation injury type II accompanied with complete luxation of the distal radioulnar joint. What are the salvage options with its special features in indication when patients develop posttraumatic painful wrist joint osteoarthritis?
- Author
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Ingo Schmidt
- Subjects
medicine.medical_specialty ,medicine.anatomical_structure ,business.industry ,medicine ,Osteoarthritis ,Wrist ,Lunotriquetral ligament ,medicine.disease ,business ,Distal radioulnar joint ,Surgery - Published
- 2017
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45. Evaluation of lesions of the internal ligaments of the wrist; conventional magnetic resonance imaging versus MR arthrography (MRA)
- Author
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Manar Hussein Abdelsattar, Heba Ahmed Kamal, and Nevien Ezzat El-Liethy
- Subjects
lcsh:Medical physics. Medical radiology. Nuclear medicine ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,lcsh:R895-920 ,Arthroscopy ,Magnetic resonance imaging ,Lunotriquetral ligament ,Scapholunate ligament ,Wrist ,Wrist pain ,Mr imaging ,medicine.anatomical_structure ,Mr arthrography ,Radiology Nuclear Medicine and imaging ,medicine ,Tears ,MR arthrography ,Radiology, Nuclear Medicine and imaging ,Radiology ,medicine.symptom ,business ,MRI - Abstract
Objective The aim of this study is to assess the diagnostic value of direct MR arthrography compared to conventional MR imaging in the diagnosis of different pathologic entities affecting the internal ligaments of the wrist mainly the scapholunate and lunotriquetral ligaments. Subjects and methods This study included 51 patients complaining of chronic wrist pain. Conventional MRI and MR arthrography (MRA) were done in all cases. Results A comparison of the sensitivity of conventional MRI versus MRA was done by correlating the final diagnosis of each modality with the results of arthroscopy. Regarding complete SLL tears, MRI revealed a SEN, SPE and ACC of 61.54%, 96.77%, and 86.36%, while MRA showed a SEN, SPE and ACC of 92.31%, 100%, and 97.73% respectively, partial SLL tears, un-enhanced MRI revealed SEN, SPE and ACC of 10%, 94.12%, and 75%, while MRA showed 66.67%, 85.71%, and 81.82% respectively, complete LTL tears un-enhanced MRI revealed a SEN, SPE, and ACC of 25%, 100%, and 79.5% respectively, while MRA showed 91.67%, 100%, and 97.73% respectively. Conclusion MR arthrography is a potent additional tool facilitating the diagnosis of different pathologic entities affecting the major internal ligaments of the wrist joint and helps to reduce arthroscopic interventions.
- Published
- 2014
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46. Scapholunate and Lunotriquetral Injuries
- Author
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David J. Slutsky and Julien Trevare
- Subjects
Joint Instability ,Wrist Joint ,medicine.medical_specialty ,Ligaments ,business.industry ,Optimal treatment ,Joint stability ,Physical Therapy, Sports Therapy and Rehabilitation ,Scapholunate joint ,Scapholunate ligament ,Wrist Injuries ,Lunotriquetral ligament ,Biomechanical Phenomena ,Surgery ,Arthroscopy ,medicine.anatomical_structure ,Athletic Injuries ,Wrist arthroscopy ,Ligament ,medicine ,Humans ,Tears ,Orthopedics and Sports Medicine ,business - Abstract
It has become clear that the stability of the scapholunate joint is not dependent wholly upon the scapholunate interosseous ligament but rather upon both primary and secondary stabilizers, which form a scapholunate ligament complex. Each case of scapholunate instability is unique and therefore should be treated with tissue-specific repairs, which may partly explain why a single procedure cannot successfully restore joint stability in every case. Not all lunotriquetral ligament tears are traumatic. The optimal treatment of symptomatic tears is still uncertain. Wrist arthroscopy has a pivotal role in both the assessment and treatment of these derangements.
- Published
- 2014
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47. Arthroscopic Assisted Reconstruction of LT-Ligament: A Description of a New Technique.
- Author
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Haugstvedt JR and Rigó IZ
- Abstract
Background Injuries of the lunotrirquetral ligament (LT lig) could be part of an extensive carpal injury and are then often treated at the time of the injury. However, when an injury of the LT ligament occurs alone, the injury is often missed. Treatment of this injury has traditionally been by open surgery, such as reattachment of the LT ligament, ligament reconstruction, or arthrodesis of the LT joint. These procedures needed a large exposure to the carpus running the risk of damaging the external ligaments, the nerves important for proprioception, and the capsule with the potential of scarring and adhesions. Materials and Methods We describe a novel arthroscopic assisted technique for reconstruction of the LT ligament. Using this less invasive technique, there is a possible advantage of lesser scarring and faster mobilization. Results We have performed this technique in two patients with more than 30 months follow-up. They both have great improvement of the functional scores. Conclusion The novel arthroscopic assisted technique for LT lig reconstruction is a technically demanding procedure; however, this obtains good clinical results with more than 30 months follow-up due to less exposure of the carpus. Level of Evidence This is a Level IV, case series study., Competing Interests: Conflict of Interest J.R.H. reports personal fees from Arthrex, and others from AO, Medartis, and KLS Martin. I.Z.R. reports personal fees from Arthrex Inc., outside the submitted work., (Thieme. All rights reserved.)
- Published
- 2021
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48. Imaging Key Wrist Ligaments: What the Surgeon Needs the Radiologist to Know
- Author
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Hyojeong Mulcahy, Cyrus Bateni, Christopher H. Allan, Michael L. Richardson, and Roger J. Bartolotta
- Subjects
Adult ,Male ,musculoskeletal diseases ,Dorsum ,medicine.medical_specialty ,Wrist ,Young Adult ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Mri techniques ,business.industry ,General Medicine ,Middle Aged ,Scapholunate ligament ,Image Enhancement ,musculoskeletal system ,Lunotriquetral ligament ,Magnetic Resonance Imaging ,body regions ,medicine.anatomical_structure ,Ligaments, Articular ,Female ,Radiology ,business ,human activities ,Triangular Fibrocartilage Complex - Abstract
OBJECTIVE. Although much attention is paid to the scapholunate ligament, lunotriquetral ligament, and the triangular fibrocartilage complex, additional intrinsic and extrinsic ligaments in the wrist play an important part in carpal stability. With improved MRI techniques, the radiologist can increasingly visualize these ligaments. CONCLUSION. The anatomy, MRI appearance, and clinical significance of the scapholunate ligament, lunotriquetral ligament, triangular fibrocartilage complex, carpal metacarpal ligaments, and volar and dorsal extrinsic ligaments are reviewed.
- Published
- 2013
- Full Text
- View/download PDF
49. Clinical and arthroscopic assessment of wrist ligament injuries and instability
- Author
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Andersson, Jonny
- Subjects
triangular fibrocartilage complex ,instability ,children ,forearm rotation torque ,wrist ,wrist arthroscopy ,magnetic resonance imaging ,adolescents ,scapholunate ligament ,distal radio-ulnar joint ,carpal ligaments ,lunotriquetral ligament - Abstract
Wrist ligament injuries are common after trauma, especially when concomitant dislocated radius fractures are present. The diagnostics of scapholunate (SL), lunotriquetral (LT) and triangular fibrocartilage complex (TFCC) injuries are challenging and most often dependent on magnetic resonance imaging (MRI) examination or invasive arthroscopy. In some circumstances, missed ligament injuries can lead to devastating sequelae, in terms of pain, reduced grip strength, range of motion and subsequent degenerative arthritis. In certain cases and under certain conditions, the choice of treatment for wrist ligament injuries can sometimes be the subject of debate. An updated review of diagnostic accuracy, a higher awareness of the injuries among orthopaedic surgeons, a surgically adaptable classification of the injuries and objective and clinically easily adapted diagnostic tools are essential. This thesis demonstrates that a negative result from MRI cannot rule out the possibility of a clinically relevant injury to the SL ligament, the LT ligament or the TFCC. Clinical provocation wrist tests are of limited diagnostic value. The current gold standard, wrist arthroscopy, remains the preferred diagnostic technique with sufficient conclusive properties when it comes to wrist ligament injuries. Due to low accuracy and high costs, MRI can most often be abandoned, when it comes to wrist ligament injuries. The cost of wrist MRI is three times higher than that of a clinical examination at the Hand Surgery Department, Sahlgrenska University Hospital. The thesis emphasises the increased diligence required when dealing with wrist trauma in children and adolescents, as a substantial amount of delayed presentation of distal radio-ulnar joint (DRUJ) instability after wrist fractures or sprains in children and adolescents is found. The most striking finding is that several children and adolescents present with DRUJ instability with isolated TFCC tears. The long delay from injury to diagnosis and the severity of the injury in terms of solving the DRUJ instability problem among young people is also interesting and somewhat surprising. Four distinct SL injury types can be identified and classified. This classification can be used in both open and arthroscopic surgery and in acute, subacute and chronic injuries. An arthroscopically assisted SL capsuloplasty and suture may not be possible in all patients, particularly not when the ligament has been completely avulsed from the bone (in approximately 60% of patients; Andersson-Garcia-Elias Type 1 and 2), leaving no ligament remnant on one side. Most patients with an SL injury will require ligament re-attachment techniques using transosseous sutures, bone anchors, or ligament reconstruction. Distal radio-ulnar joint instability with an arthroscopically confirmed TFCC injury is associated with a 30% loss of pre-operative peak torque strength in pronation and supination – a measurement technique easily adapted in the clinical pre-operative setting.
- Published
- 2016
50. Wrist Surgery
- Author
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Alexander Y. Shin and Douglas M. Sammer
- Subjects
medicine.medical_specialty ,Wrist arthritis ,Carpal Joints ,business.industry ,Wrist surgery ,Plastic Surgery Procedures ,Wrist Injuries ,Lunotriquetral ligament ,Arthroscopy ,Current management ,Chronic Disease ,Ligaments, Articular ,Physical therapy ,Humans ,Medicine ,Surgery ,business - Abstract
LEARNING OBJECTIVES After reading this article, the participant should be able to: 1. Recognize the clinical features of chronic scapholunate and lunotriquetral ligament injuries and their long-term sequelae. 2. Describe the current management and latest techniques for treating chronic scapholunate and lunotriquetral ligament injuries and their long-term sequelae, such as wrist arthritis. SUMMARY This article provides an update on the diagnosis, current management, and latest techniques for the treatment of chronic scapholunate and lunotriquetral ligament injuries and their long-term sequelae, such as wrist arthritis.
- Published
- 2012
- Full Text
- View/download PDF
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