Ilse Degreef

Missed radial head dislocations in children associated with ulnar deformation: treatment by open reduction and ulnar osteotomy.

Objective: To evaluate the results of open reduction and ulnar osteotomy on missed Monteggia fractures in children. Design: Retrospective review. Setting: Tertiary care center orthopaedic hospital in Pellenberg, Belgium. Patients/Participants: Six children between 2 and 6 years old who sustained a Monteggia fracture that was initially missed were treated at our institute. They presented in our hospital 5 to 59 weeks postinjury. Intervention: Open reduction of the radial head was performed, combined with a dorsal opening wedge osteotomy of the proximal ulna and fixation with plate and screws. Main Outcome Measurements: Mobility of the elbow was measured by an independent observer, evaluating flexion–extension and pronation–supination preoperatively and postoperatively. Results: All patients regained a normal range of motion, the radial head remained relocated, and the axis of the forearm remained normal. Conclusion: This operation—open reduction of the radial head and osteotomy of the ulna—results in an excellent outcome for a missed Monteggia fracture in children.

Effect of severity of Dupuytren contracture on disability.

The aim of this study was to investigate the correlation between the severity of Dupuytren contracture and disability. The American Medical Association (AMA) guidelines were used to assess the impairment for each involved hand. The disability of the arm, shoulder and hand (DASH) questionnaire was used for evaluating the disability. Eighty patients with 102 involved hands were enrolled. The mean total flexion contracture was 119°/hand or 65°/ray. The mean DASH score was 15 (range 0–69). There was no significant correlation between the DASH score on one hand and the total flexion contracture, the mean flexion contraction/finger, the mean flexion contracture of the proximal interphalangeal (PIP), the mean flexion contracture of the metacarpophalangeal (MCP), the number of involved hands, fingers or joints, and the AMA impairment rating on the other hand.

Ulnar shortening osteotomy for ulnar ideopathic impaction syndrome

Twenty-eight patients were treated by ulnar shortening osteotomy for static or dynamic ulnar impaction syndrome. Ulnar variance was measured on a true anteroposterior radiograph. There were 25 wrists that were too long, two neutral, and one that was short. Bones were shortened by a mean of 3.5 mm. Mean follow-up time was 29 months (range 7–60), all with confirmed consolidation. At final follow-up mean grip strength had improved from 67% to 75%, mean Disabilities of the Arm, Shoulder, and Hand (DASH) score from 40 (range 12–83) to 26 (range 0–61) and mean range of movement from 80% (range 40%–100%) to 88% (range 50%–100%). Smoking, age at operation, type of osteotomy (transverse or oblique), dominance of hand, and sex did not influence consolidation or functionality. Special attention was paid to the anatomy of the distal radioulnar joint and the inclination of the sigmoid notch of the radius. There was no correlation between the anatomy and the functional outcome scores. Mean consolidation time (10 months) (range 2–32) and return to work were longer than in similar studies. Our findings confirm the usefulness of ulnar shortening osteotomy in the relief of ulnocarpal impingement symptoms.

Outcome of proximal row carpectomy

Fifty-one patients who had had proximal row carpectomy between 1992 and 2002 with a minimum follow-up of one year were followed up clinically and radiologically retrospectively. Their diagnoses included Kienböck disease (n=21), avascular necrosis of the scaphoid (n=4), nonunion of the scaphoid with osteoarthritis (n=9), and scapholunate advanced collapse (n=17). The mean follow-up was 5 years, 8 months. The mean “disabilities of the arm, shoulder and hand” (DASH) score was 18. The mean patient-rated wrist evaluation (PRWE) score list was 25% of maximum disability for the function and pain score. Thirty-four patients (87%) were able to return to work a mean of six months after operation (range 3 weeks – 35 months). Nine patients (11%) required arthrodesis of the wrist and are considered as failures. Mean flexion of the wrist was 66%, extension 73%, radial deviation 74%, ulnar deviation 76%, and grip force 70% of the opposite side. Excision of the proximal row provided predictable and durable pain relief, restored functional movement and grip strength, and allowed returned to gainful employment in most of the patients.

Long term outcome of trapeziectomy with ligament reconstruction/tendon interposition versus thumb basal joint prosthesis

Several surgical techniques to treat thumb basal joint arthritis have been described. In this study we compared the results of a cemented thumb basal joint with trapeziectomy with a ligament reconstruction and tendon interposition. A questionnaire was sent to all 519 patients, 322 (with 382 procedures) responded. No significant differences were found when comparing impairment, pain, patient satisfaction and disability. Given the fact that the superiority of a prosthesis cannot be proven and the cost of the implant is greater, we recommend the trapeziectomy with ligament reconstruction and tendon interposition as opposed to arthroplasty as the first choice in the treatment of basal joint osteoarthritis of the thumb.

Immunohistochemical evidence for Zic1 coexpression with beta-catenin in the myofibroblast of Dupuytren disease.

The active cellular component in Dupuytren disease (DD) is the α-smooth muscle actin (α-SMA) containing myofibroblast. The underlying regulatory processes in activation of myofibroblasts resemble the pathophysiology of certain types of cancer. Accumulation of β-catenin has been shown in many fibroproliferative processes, including DD and, recent findings attributed a possible role to the Zic1 transcription factor. To assess Zic1 expression in DD and investigate its relation with the accumulation of β-catenin, neighbouring tissue samples in 20 patients with DD were stained immunohistochemically with monoclonal antibodies for β-catenin, α-SMA, and Zic1. Histological appearance was staged according to Luck. Cell-rich areas with accumulation of β-catenin in myofibroblasts that stained for α-SMA and showed apparent Zic1 coexpression were obvious. This coexpression seemed independent of proliferative or involutional histological staging. We found only Zic1 expression in residual stages. A different pattern of expression of protein in the residual stage may support earlier suggestions of a cellular heterogeneity with the existence of different cell (sub-)populations in nodules and cords. On the other hand coexpression of Zic1 and β-catenin may indicate a relation between Zic1 and the Wnt-pathway. Further studies are needed to elucidate cellular origin, potential heterogeneity and activity of the myofibroblasts in DD, and to define the exact role of Zic1 in fibroproliferative processes, wound healing, and cancer. The fibroblast in DD is an interesting model for future experiments.

In vitro biomechanical study to compare the double-loop technique with the Pulvertaft weave for tendon anastomosis

The tensile strength of a double-loop technique for tendon anastomosis was compared with those of two modified Kessler techniques and the traditional Pulvertaft weave technique. The experiments were made on specimens of fresh human extensor tendon. The double-loop technique was significantly stronger than the other suture techniques.

Proximal row carpectomy with or without postoperative immobilisation.

Previously published reports have shown good results after proximal row carpectomy in all cases that had a postoperative immobilisation period from 1 to 4 weeks. Immobilisation is thought to be necessary because of the risk of postoperative subluxation of the carpus and for pain relief. There is, however, no evidence of its value. The results in 13 patients who underwent proximal row carpectomy without postoperative immobilisation were compared with those in 25 patients who underwent proximal row carpectomy with postoperative immobilisation for 4 weeks. After a mean follow-up period of 27 months, no significant differences were found for pain, range of motion or return to work between the two groups. We conclude that postoperative immobilisation is not necessary after proximal row carpectomy.

Ulnar Impaction Syndrome: Ulnar Shortening vs. Arthroscopic Wafer Procedure

The outcome of ulnar shortenings was compared with that of arthroscopic wafer resections for ulnar impaction (or abutment) syndrome in patients with a positive ulnar variance. The outcome was measured by DASH score, visual analog scale for pain, and working incapacity. The mean DASH score in the ulnar shortening group was 26; in the wafer group it was 36. The VAS scores were respectively 4.4 and 4.6. The working incapacity was 7?months in the ulnar shortening group and 6.1 months in the wafer group. The differences between the two groups were not statistically significant.

Responsiveness of the Dutch Version of the Dash as an Outcome Measure for Carpal Tunnel Syndrome

A cohort of 119 patients with carpal tunnel syndrome completed the questionnaire of the Dutch version of the DASH score pre-operatively and one year postoperatively. The mean DASH score decreased from 38.2 to 22.0. There was a significant correlation with the Boston carpal tunnel outcome score (r =0.78). With an effect size of 0.87 and a standardized mean response of 0.69, the Dutch version of the DASH is highly responsive for the evaluation of the outcome of surgery for carpal tunnel syndrome.