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Manuel F. Dasilva - One of the best experts on this subject based on the ideXlab platform.
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arthroscopic reduction and percutaneous pinning of a radiocarpal Dislocation a case report
Journal of Bone and Joint Surgery American Volume, 2011Co-Authors: Robin N. Kamal, Jason T. Bariteau, Bryan G. Beutel, Manuel F. DasilvaAbstract:Radiocarpal Dislocations are complex injuries characterized by high-energy shear and rotational forces to the Wrist, often combined with a fracture of the distal part of the radius or ulna1. They often present as open fractures and can be complicated by soft-tissue injuries such as intercarpal and radiocarpal ligament tears and nerve injuries1-3. Current management of radiocarpal Dislocations is based on treatment principles described by Ilyas and Mudgal, which include concentric reduction of the radiocarpal joint, identification and appropriate treatment of intercarpal ligament injuries, and stable repair of the osseous-ligamentous avulsions1. While these injuries were previously managed with the use of closed reduction and immobilization4-7, authors of recent reports have recognized the instability of these complex injuries and have described treatment algorithms using open reduction and internal fixation1. We report a case of ulnar radiocarpal Wrist Dislocation treated with Wrist arthroscopy and percutaneous pinning without repair of the extrinsic Wrist ligaments. A twenty-three-year-old right-hand-dominant male presented with pain in the left Wrist one week after a motorcycle accident. He had no neurological symptoms and no pain in other extremities. The patient's medical and surgical histories were noncontributory. The findings on the neurovascular examination of the left hand were normal, and the patient was able to actively flex and extend the Wrist approximately 20° with extreme pain. There was diffuse swelling about the Wrist and pain with passive Wrist motion. There was diffuse tenderness about the radiocarpal and midcarpal joints, and the patient was unable to tolerate any instability examinations secondary to severe pain. He had painless motion of the ipsilateral elbow and shoulder. Radiographs of the Wrist demonstrated an ulnar styloid fracture, triquetral avulsion fracture, and ulnar shift of the carpus that was approximately 3.3 mm more …
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Arthroscopic Treatment of Radiocarpal Dislocation (SS-48)
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2011Co-Authors: Robin N. Kamal, Jason T. Bariteau, Bryan G. Beutel, Manuel F. DasilvaAbstract:Introduction Radiocarpal Dislocations are complex injuries characterized by having a high-energy shear and rotational force to the Wrist. While these injuries were previously managed using closed reduction and immobilization, recent reports have recognized the instability of these complex injuries, and have described treatment algorithms using open reduction and internal fixation. Current management of radiocarpal Dislocations has been based on the following previously described principals: concentric reduction of the radiocarpal joint, identification and appropriate treatment of intercarpal ligament injuries, and stable repair of the osseous-ligamentous avulsions. Treatment with Wrist arthroscopy has never been described. We report a case of ulnar radiocarpal Wrist Dislocation successfully treated with Wrist arthroscopy and percutaneous pinning Methods A 23-year-old right-hand–dominant man presented after a motor vehicle accident with a right ulnar radiocarpal Wrist Dislocation, ulnar styloid fracture, and triquetrum avulsion fracture. The patient was taken to the operating room where a closed reduction was attempted. During stress exam under fluoroscopic imaging, it was apparent that a closed reduction was unobtainable, and we converted to Wrist arthroscopy. From the 3-4 portal, a portion of the radioscaphocapitate ligament was seen interposed within the radiocarpal joint preventing concentric reduction of the carpus. The ligament was reflected back into position and the carpus subsequently concentrically reduced. From the 4-5 portal the dorsal radiocarpal ligament was found to be ruptured and was debrided. Two K-wires were placed across the Wrist; one was placed proximal to the radial styloid through the scaphoid and capitate, and the second placed from proximal to the radial styloid through the radius, and across the lunate and triquetrum. The Wrist was immobilized for 3 months, and the pins were then removed. Results At the 4-month follow-up appointment, the patient had grip strength of 86 lbs, compared to 145 lbs in his contralateral hand (59%), with 40 degrees of flexion and 60 degrees of extension. At 10 months, the patient had full pronation and supination, grip strength of 130 lbs compared to 155 lbs in the contralateral hand (84%), and lacked only 20 degrees of Wrist flexion compared to the contralateral side. He returned to his pre-injury job as a manual laborer. Conclusion This is the first description of an ulnar radiocarpal Dislocation successfully treated with Wrist arthroscopy and percutaneous pinning. While the current applications for Wrist arthroscopy are extensive, its use in fracture and Dislocations of the carpus are limited. Advantages of Wrist arthroscopy are that it allows for direct visualization and treatment of intercarpal and midcarpal injuries. More importantly, treatment of these injuries can be completed with minimal disruption of the soft tissues. While our treatment algorithm followed the majority of the previously described treatment principles for the treatment of radiocarpal Dislocations, we did not address neurovascular structures and the extrinsic Wrist ligaments, which would require open decompression. Our results show that a successful clinical outcome and stable radiocarpal Wrist joint are obtainable by addressing intercarpal injuries arthroscopically, and stabilizing the radiocarpal joint.
Robin N. Kamal - One of the best experts on this subject based on the ideXlab platform.
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arthroscopic reduction and percutaneous pinning of a radiocarpal Dislocation a case report
Journal of Bone and Joint Surgery American Volume, 2011Co-Authors: Robin N. Kamal, Jason T. Bariteau, Bryan G. Beutel, Manuel F. DasilvaAbstract:Radiocarpal Dislocations are complex injuries characterized by high-energy shear and rotational forces to the Wrist, often combined with a fracture of the distal part of the radius or ulna1. They often present as open fractures and can be complicated by soft-tissue injuries such as intercarpal and radiocarpal ligament tears and nerve injuries1-3. Current management of radiocarpal Dislocations is based on treatment principles described by Ilyas and Mudgal, which include concentric reduction of the radiocarpal joint, identification and appropriate treatment of intercarpal ligament injuries, and stable repair of the osseous-ligamentous avulsions1. While these injuries were previously managed with the use of closed reduction and immobilization4-7, authors of recent reports have recognized the instability of these complex injuries and have described treatment algorithms using open reduction and internal fixation1. We report a case of ulnar radiocarpal Wrist Dislocation treated with Wrist arthroscopy and percutaneous pinning without repair of the extrinsic Wrist ligaments. A twenty-three-year-old right-hand-dominant male presented with pain in the left Wrist one week after a motorcycle accident. He had no neurological symptoms and no pain in other extremities. The patient's medical and surgical histories were noncontributory. The findings on the neurovascular examination of the left hand were normal, and the patient was able to actively flex and extend the Wrist approximately 20° with extreme pain. There was diffuse swelling about the Wrist and pain with passive Wrist motion. There was diffuse tenderness about the radiocarpal and midcarpal joints, and the patient was unable to tolerate any instability examinations secondary to severe pain. He had painless motion of the ipsilateral elbow and shoulder. Radiographs of the Wrist demonstrated an ulnar styloid fracture, triquetral avulsion fracture, and ulnar shift of the carpus that was approximately 3.3 mm more …
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Arthroscopic Treatment of Radiocarpal Dislocation (SS-48)
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2011Co-Authors: Robin N. Kamal, Jason T. Bariteau, Bryan G. Beutel, Manuel F. DasilvaAbstract:Introduction Radiocarpal Dislocations are complex injuries characterized by having a high-energy shear and rotational force to the Wrist. While these injuries were previously managed using closed reduction and immobilization, recent reports have recognized the instability of these complex injuries, and have described treatment algorithms using open reduction and internal fixation. Current management of radiocarpal Dislocations has been based on the following previously described principals: concentric reduction of the radiocarpal joint, identification and appropriate treatment of intercarpal ligament injuries, and stable repair of the osseous-ligamentous avulsions. Treatment with Wrist arthroscopy has never been described. We report a case of ulnar radiocarpal Wrist Dislocation successfully treated with Wrist arthroscopy and percutaneous pinning Methods A 23-year-old right-hand–dominant man presented after a motor vehicle accident with a right ulnar radiocarpal Wrist Dislocation, ulnar styloid fracture, and triquetrum avulsion fracture. The patient was taken to the operating room where a closed reduction was attempted. During stress exam under fluoroscopic imaging, it was apparent that a closed reduction was unobtainable, and we converted to Wrist arthroscopy. From the 3-4 portal, a portion of the radioscaphocapitate ligament was seen interposed within the radiocarpal joint preventing concentric reduction of the carpus. The ligament was reflected back into position and the carpus subsequently concentrically reduced. From the 4-5 portal the dorsal radiocarpal ligament was found to be ruptured and was debrided. Two K-wires were placed across the Wrist; one was placed proximal to the radial styloid through the scaphoid and capitate, and the second placed from proximal to the radial styloid through the radius, and across the lunate and triquetrum. The Wrist was immobilized for 3 months, and the pins were then removed. Results At the 4-month follow-up appointment, the patient had grip strength of 86 lbs, compared to 145 lbs in his contralateral hand (59%), with 40 degrees of flexion and 60 degrees of extension. At 10 months, the patient had full pronation and supination, grip strength of 130 lbs compared to 155 lbs in the contralateral hand (84%), and lacked only 20 degrees of Wrist flexion compared to the contralateral side. He returned to his pre-injury job as a manual laborer. Conclusion This is the first description of an ulnar radiocarpal Dislocation successfully treated with Wrist arthroscopy and percutaneous pinning. While the current applications for Wrist arthroscopy are extensive, its use in fracture and Dislocations of the carpus are limited. Advantages of Wrist arthroscopy are that it allows for direct visualization and treatment of intercarpal and midcarpal injuries. More importantly, treatment of these injuries can be completed with minimal disruption of the soft tissues. While our treatment algorithm followed the majority of the previously described treatment principles for the treatment of radiocarpal Dislocations, we did not address neurovascular structures and the extrinsic Wrist ligaments, which would require open decompression. Our results show that a successful clinical outcome and stable radiocarpal Wrist joint are obtainable by addressing intercarpal injuries arthroscopically, and stabilizing the radiocarpal joint.
Jason T. Bariteau - One of the best experts on this subject based on the ideXlab platform.
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arthroscopic reduction and percutaneous pinning of a radiocarpal Dislocation a case report
Journal of Bone and Joint Surgery American Volume, 2011Co-Authors: Robin N. Kamal, Jason T. Bariteau, Bryan G. Beutel, Manuel F. DasilvaAbstract:Radiocarpal Dislocations are complex injuries characterized by high-energy shear and rotational forces to the Wrist, often combined with a fracture of the distal part of the radius or ulna1. They often present as open fractures and can be complicated by soft-tissue injuries such as intercarpal and radiocarpal ligament tears and nerve injuries1-3. Current management of radiocarpal Dislocations is based on treatment principles described by Ilyas and Mudgal, which include concentric reduction of the radiocarpal joint, identification and appropriate treatment of intercarpal ligament injuries, and stable repair of the osseous-ligamentous avulsions1. While these injuries were previously managed with the use of closed reduction and immobilization4-7, authors of recent reports have recognized the instability of these complex injuries and have described treatment algorithms using open reduction and internal fixation1. We report a case of ulnar radiocarpal Wrist Dislocation treated with Wrist arthroscopy and percutaneous pinning without repair of the extrinsic Wrist ligaments. A twenty-three-year-old right-hand-dominant male presented with pain in the left Wrist one week after a motorcycle accident. He had no neurological symptoms and no pain in other extremities. The patient's medical and surgical histories were noncontributory. The findings on the neurovascular examination of the left hand were normal, and the patient was able to actively flex and extend the Wrist approximately 20° with extreme pain. There was diffuse swelling about the Wrist and pain with passive Wrist motion. There was diffuse tenderness about the radiocarpal and midcarpal joints, and the patient was unable to tolerate any instability examinations secondary to severe pain. He had painless motion of the ipsilateral elbow and shoulder. Radiographs of the Wrist demonstrated an ulnar styloid fracture, triquetral avulsion fracture, and ulnar shift of the carpus that was approximately 3.3 mm more …
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Arthroscopic Treatment of Radiocarpal Dislocation (SS-48)
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2011Co-Authors: Robin N. Kamal, Jason T. Bariteau, Bryan G. Beutel, Manuel F. DasilvaAbstract:Introduction Radiocarpal Dislocations are complex injuries characterized by having a high-energy shear and rotational force to the Wrist. While these injuries were previously managed using closed reduction and immobilization, recent reports have recognized the instability of these complex injuries, and have described treatment algorithms using open reduction and internal fixation. Current management of radiocarpal Dislocations has been based on the following previously described principals: concentric reduction of the radiocarpal joint, identification and appropriate treatment of intercarpal ligament injuries, and stable repair of the osseous-ligamentous avulsions. Treatment with Wrist arthroscopy has never been described. We report a case of ulnar radiocarpal Wrist Dislocation successfully treated with Wrist arthroscopy and percutaneous pinning Methods A 23-year-old right-hand–dominant man presented after a motor vehicle accident with a right ulnar radiocarpal Wrist Dislocation, ulnar styloid fracture, and triquetrum avulsion fracture. The patient was taken to the operating room where a closed reduction was attempted. During stress exam under fluoroscopic imaging, it was apparent that a closed reduction was unobtainable, and we converted to Wrist arthroscopy. From the 3-4 portal, a portion of the radioscaphocapitate ligament was seen interposed within the radiocarpal joint preventing concentric reduction of the carpus. The ligament was reflected back into position and the carpus subsequently concentrically reduced. From the 4-5 portal the dorsal radiocarpal ligament was found to be ruptured and was debrided. Two K-wires were placed across the Wrist; one was placed proximal to the radial styloid through the scaphoid and capitate, and the second placed from proximal to the radial styloid through the radius, and across the lunate and triquetrum. The Wrist was immobilized for 3 months, and the pins were then removed. Results At the 4-month follow-up appointment, the patient had grip strength of 86 lbs, compared to 145 lbs in his contralateral hand (59%), with 40 degrees of flexion and 60 degrees of extension. At 10 months, the patient had full pronation and supination, grip strength of 130 lbs compared to 155 lbs in the contralateral hand (84%), and lacked only 20 degrees of Wrist flexion compared to the contralateral side. He returned to his pre-injury job as a manual laborer. Conclusion This is the first description of an ulnar radiocarpal Dislocation successfully treated with Wrist arthroscopy and percutaneous pinning. While the current applications for Wrist arthroscopy are extensive, its use in fracture and Dislocations of the carpus are limited. Advantages of Wrist arthroscopy are that it allows for direct visualization and treatment of intercarpal and midcarpal injuries. More importantly, treatment of these injuries can be completed with minimal disruption of the soft tissues. While our treatment algorithm followed the majority of the previously described treatment principles for the treatment of radiocarpal Dislocations, we did not address neurovascular structures and the extrinsic Wrist ligaments, which would require open decompression. Our results show that a successful clinical outcome and stable radiocarpal Wrist joint are obtainable by addressing intercarpal injuries arthroscopically, and stabilizing the radiocarpal joint.
Bryan G. Beutel - One of the best experts on this subject based on the ideXlab platform.
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arthroscopic reduction and percutaneous pinning of a radiocarpal Dislocation a case report
Journal of Bone and Joint Surgery American Volume, 2011Co-Authors: Robin N. Kamal, Jason T. Bariteau, Bryan G. Beutel, Manuel F. DasilvaAbstract:Radiocarpal Dislocations are complex injuries characterized by high-energy shear and rotational forces to the Wrist, often combined with a fracture of the distal part of the radius or ulna1. They often present as open fractures and can be complicated by soft-tissue injuries such as intercarpal and radiocarpal ligament tears and nerve injuries1-3. Current management of radiocarpal Dislocations is based on treatment principles described by Ilyas and Mudgal, which include concentric reduction of the radiocarpal joint, identification and appropriate treatment of intercarpal ligament injuries, and stable repair of the osseous-ligamentous avulsions1. While these injuries were previously managed with the use of closed reduction and immobilization4-7, authors of recent reports have recognized the instability of these complex injuries and have described treatment algorithms using open reduction and internal fixation1. We report a case of ulnar radiocarpal Wrist Dislocation treated with Wrist arthroscopy and percutaneous pinning without repair of the extrinsic Wrist ligaments. A twenty-three-year-old right-hand-dominant male presented with pain in the left Wrist one week after a motorcycle accident. He had no neurological symptoms and no pain in other extremities. The patient's medical and surgical histories were noncontributory. The findings on the neurovascular examination of the left hand were normal, and the patient was able to actively flex and extend the Wrist approximately 20° with extreme pain. There was diffuse swelling about the Wrist and pain with passive Wrist motion. There was diffuse tenderness about the radiocarpal and midcarpal joints, and the patient was unable to tolerate any instability examinations secondary to severe pain. He had painless motion of the ipsilateral elbow and shoulder. Radiographs of the Wrist demonstrated an ulnar styloid fracture, triquetral avulsion fracture, and ulnar shift of the carpus that was approximately 3.3 mm more …
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Arthroscopic Treatment of Radiocarpal Dislocation (SS-48)
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2011Co-Authors: Robin N. Kamal, Jason T. Bariteau, Bryan G. Beutel, Manuel F. DasilvaAbstract:Introduction Radiocarpal Dislocations are complex injuries characterized by having a high-energy shear and rotational force to the Wrist. While these injuries were previously managed using closed reduction and immobilization, recent reports have recognized the instability of these complex injuries, and have described treatment algorithms using open reduction and internal fixation. Current management of radiocarpal Dislocations has been based on the following previously described principals: concentric reduction of the radiocarpal joint, identification and appropriate treatment of intercarpal ligament injuries, and stable repair of the osseous-ligamentous avulsions. Treatment with Wrist arthroscopy has never been described. We report a case of ulnar radiocarpal Wrist Dislocation successfully treated with Wrist arthroscopy and percutaneous pinning Methods A 23-year-old right-hand–dominant man presented after a motor vehicle accident with a right ulnar radiocarpal Wrist Dislocation, ulnar styloid fracture, and triquetrum avulsion fracture. The patient was taken to the operating room where a closed reduction was attempted. During stress exam under fluoroscopic imaging, it was apparent that a closed reduction was unobtainable, and we converted to Wrist arthroscopy. From the 3-4 portal, a portion of the radioscaphocapitate ligament was seen interposed within the radiocarpal joint preventing concentric reduction of the carpus. The ligament was reflected back into position and the carpus subsequently concentrically reduced. From the 4-5 portal the dorsal radiocarpal ligament was found to be ruptured and was debrided. Two K-wires were placed across the Wrist; one was placed proximal to the radial styloid through the scaphoid and capitate, and the second placed from proximal to the radial styloid through the radius, and across the lunate and triquetrum. The Wrist was immobilized for 3 months, and the pins were then removed. Results At the 4-month follow-up appointment, the patient had grip strength of 86 lbs, compared to 145 lbs in his contralateral hand (59%), with 40 degrees of flexion and 60 degrees of extension. At 10 months, the patient had full pronation and supination, grip strength of 130 lbs compared to 155 lbs in the contralateral hand (84%), and lacked only 20 degrees of Wrist flexion compared to the contralateral side. He returned to his pre-injury job as a manual laborer. Conclusion This is the first description of an ulnar radiocarpal Dislocation successfully treated with Wrist arthroscopy and percutaneous pinning. While the current applications for Wrist arthroscopy are extensive, its use in fracture and Dislocations of the carpus are limited. Advantages of Wrist arthroscopy are that it allows for direct visualization and treatment of intercarpal and midcarpal injuries. More importantly, treatment of these injuries can be completed with minimal disruption of the soft tissues. While our treatment algorithm followed the majority of the previously described treatment principles for the treatment of radiocarpal Dislocations, we did not address neurovascular structures and the extrinsic Wrist ligaments, which would require open decompression. Our results show that a successful clinical outcome and stable radiocarpal Wrist joint are obtainable by addressing intercarpal injuries arthroscopically, and stabilizing the radiocarpal joint.
P. H. M. Spauwen - One of the best experts on this subject based on the ideXlab platform.
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RADIOLOGICAL EVALUATION OF THE LONG-TERM EFFECTS OF RESECTION OF THE DISTAL ULNA IN RHEUMATOID ARTHRITIS
2016Co-Authors: A. M. L. Van Gemert, P. H. M. SpauwenAbstract:28 patients have been studied after distal ulnar resection on one side. The operated hand has been compared with the hand on which no operation has been performed, using X-rays which had been taken pre-operatively and 4 to 8 years post-operatively. Only patients with no difference or a difference of only one degree between the two Wrists, according to the Larsen classification, were admitted to the investigation. The mean ulnar translation was 5.3 mm in the operated Wrists, compared to 3.7 mm in unoperated Wrists. Radialization of the ulna following distal ulnar resection amounted to about 12 mm. Wrist Dislocation is more due to the rheumatoid process itself than to the distal ulnar resection. Journal of Hand Surgery (British and European Volume, 1994) 19B: 330-333 Distal ulnar resection is effective in providing pain reduction, increasing Wrist mobility, and improving activities of daily living in the rheumatoid han
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Radiological Evaluation of the Long-Term Effects of Resection of the Distal Ulna in Rheumatoid Arthritis
Journal of hand surgery (Edinburgh Scotland), 1994Co-Authors: A. M. L. Van Gemert, P. H. M. SpauwenAbstract:28 patients have been studied after distal ulnar resection on one side. The operated hand has been compared with the hand on which no operation has been performed, using X-rays which had been taken pre-operatively and 4 to 8 years post-operatively. Only patients with no difference or a difference of only one degree between the two Wrists, according to the Larsen classification, were admitted to the investigation. The mean ulnar translation was 5.3 mm in the operated Wrists, compared to 3.7 mm in unoperated Wrists. Radialization of the ulna following distal ulnar resection amounted to about 12 mm. Wrist Dislocation is more due to the rheumatoid process itself than to the distal ulnar resection.
