Angel Ferreres

Universal Total Wrist Arthroplasty: Midterm Follow-Up Study

PURPOSE We reviewed 21 consecutive patients who underwent a total wrist arthroplasty as a primary procedure between October 2001 and February 2007. The purposes of the present study were to communicate our midterm results and to compare them with previously published series. METHODS We evaluated all patients clinically and radiologically. We used the Patient-Related Wrist Evaluation a primary outcome measure. The mean follow-up was 5.5 years (range, 3-8 years). A total of 14 patients had rheumatoid arthritis, including 1 with juvenile arthritis, and 1 each had psoriatic arthritis, systemic lupus erythematosus, and undifferentiated spondyloarthropathy. Of the remaining 4 patients, 2 had grade IV Kienböck disease, 1 had degenerative arthrosis, and 1 had chondrocalcinosis. RESULTS Postoperative Patient-Related Wrist Evaluation scores averaged 24 points (SD, 21 pints) out of 100 (worst score). When the patients were specifically asked about pain and function of the arthroplasty, 20 claimed to be satisfied or very satisfied with the procedure. Two early and 3 late complications occurred. One patient had a wound hematoma and another had a superficial wound infection, both of which resolved with no further complications during the immediate postoperative period. In 2 patients, there was some osteolysis around the screw inserted into the medullary canal of the index metacarpal, but not in the trapezoid bone. One patient had a slight loosening of the distal component with subsidence on the ulnar side of the carpus. There have been no dislocations or surgical revisions of the components. CONCLUSIONS Based on our study, a total wrist arthroplasty should be considered as a good alternative to arthrodesis for patients who wish to preserve some degree of mobility of the wrist. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.

Wrist denervation: surgical considerations

We have analyzed the results of 22 total wrist denervations following Wilhelm’s technique and a series of 30 patients treated with denervation of the posterior interosseous nerve alone. Results of denervation have been classified depending on the pain (visual analogue scale) as other parameters (mobility and strength) have not been found to have any statistical significance. Results after partial denervation are worse than results achieved by total denervation.

Wrist denervation: Anatomical considerations

In 1966, Wilhelm published a technique of denervation of the wrist joint based on his own anatomical studies of 1958. Other authors have published their experience in wrist denervations with similar results, but there are some discrepancies in descriptions of the innervation of the wrist. We have studied the innervation of the wrist by dissection under magnification on 20 cadaver limbs and by histological examination of five human foetal wrists. Based in our anatomical findings, we have demonstrated that Wilhelms technique does not achieve total denervation of the wrist.

Nerve-Sparing Dorsal and Volar Approaches to the Radiocarpal Joint

Surgical approaches to the wrist joint have traditionally been focused on providing wide exposure to allow adequate access to the carpus. In light of recent investigations on the innervation and proprioception of the wrist joint, one should also take into consideration not to denervate the wrist capsule and ligaments. In this manuscript, we propose 2 surgical approaches to the dorsal and volar radiocarpal joint, intended to minimize damage to the innervation of the capsule while providing ample access to the wrist.

Transverse loaded pronosupination test

A new test to evaluate the ability of the distal radioulnar joint to sustain transverse loads while the forearm rotates from pronation to supination is described. Both arms were tested in 100 normal volunteers. The average weight-bearing capability of the normal unsupported forearm was 5.07 kg, equating to a force of 49.8 N. The test may be useful in the assessment of pathological conditions involving weakness of the forearm rotator muscles, with or without joint incongruity, as well as being an indirect way to assess the load-bearing capacity of radioulnar implants.

A Possible Mechanism of Direct Injury to the EPL Tendon at Lister’s Tubercle During Falls with the Wrist Fully Extended

We present three cases of pathology of the extensor pollicis longus tendon at the level of Lister’s tubercle after falls with the wrist fully extended. A small anatomical study demonstrates the possibility of the base of the third metacarpal impacting this area in hyperextension. This mechanism of injury to the tendon may explain the clinical findings.

Multislice Computed Tomography Angiography of the Fourth Dorsal Interosseous Space in Cadavers

PURPOSE To study computed tomography angiography (CTA) findings and compare anatomic correlation of the 4th dorsal metacarpal spaces and to determine the role of this technique for anatomic studies and flap design. METHODS Hands from 17 cadavers were injected with a radiopaque mixture. The specimens were imaged using 16-detector-row computed tomography. Each image was analyzed by a radiologist, a plastic surgeon, and an anatomist. The following data were recorded: the presence of the 4th dorsal metacarpal artery, proximal and distal communicating branches and distal recurrent branch, and the number of cutaneous perforators. Afterwards, a meticulous dissection was carried out. A correlation between the radiologic findings and the gross anatomy was established. RESULTS In all specimens, the 4th dorsal metacarpal artery and distal recurrent branch were identified. In 15 cases, at least 1 perforator was identified within the 4th space. In 2 cases, no perforator was identified. In all cases, the radiologic findings correlated with the anatomic findings in the dissection. CONCLUSIONS Multislice CTA provides good-quality information about the vascular anatomy of the dorsal aspect of the hand, including perforator vessels less than 0.5 mm in diameter. Multislice CTA allows for observation of the axis, trajectory, and branching pattern of the blood vessels and, most importantly, demonstrates the anatomic relationships among blood vessels, bones, and soft tissue.

Chronic Finger Injuries

Hand injuries in sports are usually traumatic in nature and may occur from falls, axial loading of digits, or rotational traumatic injuries with forced gripping.