Frederik Verstreken

What Does the Transverse Carpal Ligament Contribute to Carpal Stability

Background The transverse carpal ligament is well known for its involvement in carpal tunnel syndrome, and sectioning of this ligament remains the definite treatment for this pathology. Some authors believe that the transverse carpal ligament is an important stabilizer of the carpal arch, whereas others do not consider it to be significant. Several studies have been performed, both in vivo and in in vitro. Sectioning of the transverse carpal ligament does not seem to have any effect on the width of the carpal arch in the unloaded condition. However, patients will load the arch during their activities of daily living. Materials and Methods A cadaveric study was done with distraction of the carpal bones before and after sectioning the transverse carpal ligament. Results With the transverse carpal ligament intact, the carpal arch is mobile, with distraction leading up to 50% widening of the arch. Sectioning of the transverse carpal ligament resulted in a significant widening of the carpal arch by a further 30%. Conclusions Loading of the carpal arch after sectioning of the transeverse carapal ligament leads to a significant increase in intracarpal mobility. This will inevitably influence carpal kinematics in the patient and might be responsible for some complications after simple carpal tunnel releases, such as pillar pain, palmar tenderness, and loss of grip strength.

Percutaneous, Transtrapezial Fixation without Bone Graft Leads to Consolidation in Selected Cases of Delayed Union of the Scaphoid Waist

Purpose We evaluated clinical and radiographic outcome of percutaneous transtrapezial fixation of the scaphoid delayed union or nonunion using a headless bone screw without bone grafting. Methods Sixteen patients with delayed union or nonunion of the scaphoid were included in this retrospective study between 2006 and 2011. All patients had a delayed presentation of scaphoid fracture, and none of them was treated conservatively elsewhere. Patients with bone graft, sclerotic bone debridement, or displacement of the fragment at the nonunion site were excluded. A percutaneous transtrapezial fixation technique was used in all cases. Patients were reviewed until clinical and radiographic union was observed. At the final follow‐up, DASH (Disabilities of the Arm, Shoulder and Hand) and PRWHE (Patient‐Rated Wrist and Hand Evaluation) outcome scores were completed. Results Radiographic union was obtained in 15 out of 16 patients (94%) at an average follow‐up of 36 months (range: 12‐98 months). No complications from the percutaneous technique were noted. The average DASH score was 6 (range: 0‐39) and the average PRWHE score was 10 (range: 0‐56). No statistical significant difference in range of motion and grip strength was found between the operated side and the contralateral side. Conclusion Percutaneous transtrapezial screw fixation for delayed or nonunion of selected scaphoid fractures without bone grafting is promising. At a mean of 4 months, 94% union was obtained with good functional results when there was no sclerosis, minimal osteolysis, and no displacement at the scaphoid nonunion site. Type of Study Therapeutic study. Level of Evidence IV.

An Articulating Statistical Shape Model of the Human Hand

This paper presents a registration framework for the construction of a statistical shape model of the human hand in a standard pose. It brings a skeletonized reference model of an individual human hand into correspondence with optical 3D surface scans of hands by sequentially applying articulation-based registration and elastic surface registration. Registered surfaces are then fed into a statistical shape modelling algorithm based on principal component analysis. The model-building technique has been evaluated on a dataset of optical scans from 100 healthy individuals, acquired with a 3dMD scanning system. It is shown that our registration framework provides accurate geometric and anatomical alignment, and that the shape basis of the resulting statistical model provides a compact representation of the specific population. The model also provides insight into the anatomical variation of the lower arm and hand, which is useful information for the design of well-fitting products.

Corrective osteotomy of distal radius malunions using three-dimensional computer simulation and patient-specific guides to achieve anatomic reduction

Malunion is a common complication of distal radius fractures, especially those treated conservatively. In clinical studies, a significant correlation between anatomic reduction and wrist function has been shown. Corrective osteotomy is the preferred treatment for symptomatic cases, notwithstanding the technical challenges. The use of computer simulation improves pre-operative understanding of the three-dimensional deformity. Patient-specific surgical guides, based on precise pre-operative planning, lead to superior perioperative accuracy and reproducibility. The pre-operative planning and surgical technique of distal radius corrective surgery using three-dimensional computer technology are described in detail. The preliminary results demonstrate the excellent clinical and radiographic outcome of this technique.

Een 72-jarige fluitspeler met reeds jaren bestaande klachten van de rechterduim

Een veelvoorkomende locatie voor artrose in de hand is die van het basisgewricht van de duim, het CMC1-gewricht. In de meeste gevallen is conservatief beleid voldoende om de aandoening voor de patient draaglijk te houden. De patient uit deze casus is echter fluitist van beroep en zeer afhankelijk van een goede duimfunctie. Als na langdurig conservatief beleid onvoldoende resultaat wordt bereikt, overweegt de orthopeed een kunstgewricht te implanteren.

AO Distal Radius Fracture Classification: Global Perspective on Observer Agreement

Background The primary objective of this study was to test interobserver reliability when classifying fractures by consensus by AO types and groups among a large international group of surgeons. Secondarily, we assessed the difference in inter‐ and intraobserver agreement of the AO classification in relation to geographical location, level of training, and subspecialty. Methods A randomized set of radiographic and computed tomographic images from a consecutive series of 96 distal radius fractures (DRFs), treated between October 2010 and April 2013, was classified using an electronic web‐based portal by an invited group of participants on two occasions. Results Interobserver reliability was substantial when classifying AO type A fractures but fair and moderate for type B and C fractures, respectively. No difference was observed by location, except for an apparent difference between participants from India and Australia classifying type B fractures. No statistically significant associations were observed comparing interobserver agreement by level of training and no differences were shown comparing subspecialties. Intra‐rater reproducibility was “substantial” for fracture types and “fair” for fracture groups with no difference accounting for location, training level, or specialty. Conclusion Improved definition of reliability and reproducibility of this classification may be achieved using large international groups of raters, empowering decision making on which system to utilize. Level of Evidence Level III

Chronic Elbow and Forearm Instability

Elbow instability may be medial or lateral and presents as an acute or chronic problem. Traumatic or iatrogenic insufficiency of the lateral collateral ligament is reviewed, with emphasis on the clinical presentation, diagnostic exam, and appropriate imaging tests. Current trends on lateral elbow instability treatment are reviewed including both open and arthroscopic techniques. Medial instability is more prevalent among throwing athletes and may be associated with a valgus overload syndrome. Key aspects of the pathoanatomy, diagnosis, and treatment of this entity are reviewed.