PURPOSE OF THE STUDY This study aims to evaluate the results of patients treated by proximal row carpectomy at a follow-up of at least 5 years after the surgery. MATERIAL AND METHODS A total of 25 patients were treated by proximal row carpectomy for degenerative changes of the wrist as a consequence of the previous trauma or avascular necrosis of the lunate bone, of whom 21 patients underwent a follow-up examination at least 5 years postoperatively. Proximal row carpectomy was indicated in 15 patients for SLAC wrist, in 4 patients for avascular necrosis of the lunate bone, in 1 patient for SNAC wrist, and in 1 patient for inveterate dislocation of the wrist. The follow-up clinical and radiological examinations were performed at least 5 years after the surgery. The range of wrist motion, grip strength, presence of pain at rest or pain under loads, total clinical score according to the Green and O'Brien scoring system, patient satisfaction with the outcome of surgery were assessed. By fluoroscopy the range of wrist motion, degenerative changes of the radiocapitate joint, and translation of the capitate bone with respect to the distal radius were evaluated. RESULTS Postoperative improvements in the range of motion and grip strength were confirmed. Also, the pain relief at rest and under loads was achieved. Five years after the surgery, most of the patients (85.6%) reported an overall improvement. The total clinical score according to the Green and O'Brien scoring system improved from 35.8 preoperatively to 63.1 postoperatively. DISCUSSION The advantage of this procedure is a low percentage of complications, relative technical simplicity, maintenance of functional motion of the wrist, satisfactory grip strength, and pain relief. There are no complications related to the implant, no risk of a non-union. CONCLUSIONS As shown by our results obtained 5 years after the surgery as well as the published data, in the indicated cases the proximal row carpectomy is an appropriate surgical technique to treat the degenerative changes of the wrist. In most of the patients, favourable functional results and pain relief can be expected. Key words:proximal row carpectomy, SLAC wrist, SNAC wrist, avascular necrosis of the lunate bone, dislocation of the wrist.
- MeSH
- artralgie prevence a kontrola MeSH
- dislokace kloubu chirurgie MeSH
- kosti zápěstní diagnostické zobrazování zranění patologie chirurgie MeSH
- lidé MeSH
- následné studie MeSH
- nekróza MeSH
- ortopedické výkony škodlivé účinky metody MeSH
- poloměsíčitá kost patologie chirurgie MeSH
- pooperační komplikace MeSH
- rentgendiagnostika MeSH
- rozsah kloubních pohybů MeSH
- síla ruky MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY The most frequent valgus deformity of the big toe is often associated with a collapse of the traverse arc of the foot. The purpose of the present study was to assess the results of forefoot reconstruction by the Brandes-Keller resection arthroplasty of the first metatarsophalangeal joint and the Helal metatarsal osteotomy when this deformity was present. MATERIAL A retrospective study of 40 consecutive patients with severe forefoot deformities was performed. The patients were treated at our department in the period from 1997 to 2003. The average age at the time of surgery was 54.7 years. Twelve patients underwent bilateral surgery. The results of 52 operations were evaluated. RESULTS Each patient returned for a personal interview by an independent investigator and a clinical examination. A post-operative forefoot score was calculated according to the system of the American Orthopaedic Foot and Ankle Society (AOFAS). This 100-point scale includes items related to pain, level of activity, deformity and motion. The average AOFAS score was 85.5 points post-operatively No pain was reported in 38 (75 %) forefeet, mild pain in 12 (23 5 %) forefeet and moderate pain in 1 (2 %) forefoot. The complications included slow healing of the wound in two patients (3.8 %) and asymptomatic pseudoarthrosis after metatarsal osteotomy in two patients (3.8 %). Five patients (9.6 %) reported persisting swelling of the foot dorsum for a period longer than 3 months. DISCUSSION In agreement with the majority of the published data we are of the opinion that the Brandes-Keller resection arthroplasty is a surgical method suitable to treat valgus deformities of the big toe with concomitant arthritis of the first metatarsophalangeal joint (MTP) in elderly patients whose weight-bearing demands are low. This treatment permits early post-operative weight-bearing. In younger patients with valgus deformity of the big toe without arthritis it is preferred to use techniques preserving the joint. The use of total replacement of the first MTP joint is open to discussion. CONCLUSIONS The Brandes-Keller procedure with the Helal metatarsal osteotomy, if correctly performed in indicated cases, results in painless walking in patients with forefoot deformity.
Artróza zápěstí výrazně omezuje funkci ruky. Nejčastější příčinou rozvoje degenerativních změn v zápěstí jsou poúrazové stavy, po kterých dochází ke změně kinematiky karpu. Patří sem zejména poranění skafolunátního vazu a paklouby skafoidea. Artrotické změny jsou patrné již do několika let od úrazu. Pro správné zhodnocení stavu kloubních chrupavek a vazivového aparátu je vedle rentgenové dokumentace velmi přínosná i artroskopie zápěstí. Následně dle stupně degenerativního poškození zápěstí volíme vhodný operační výkon s cílem zachovat co největší nebolestivý rozsah pohybů. Při částečném postižení systému zápěstních kůstek volíme limitovanou dézu zápěstí nebo karpektomii proximální řady. Častým doplňkovým výkonem je selektivní denervace karpu, která přináší úlevu od bolesti a umožní oddálit totální artrodézu zápěstí. Při výrazném a celokloubním poškození zápěstí zvažujeme totální dézu zápěstí. Alternativou v indikovaných případech je totální náhrada zápěstí.
Osteoarthritis of the wrist dramatically limits the function of the hand. Post-traumatic conditions with changed kinematics of the wrist, especially scapholunate ligament injury and pseudoarthrosis of the scaphoid, result in symptomatic osteoarthritis of the wrist. Degenerative changes are notable as early as in few years after the injury. Wrist arthroscopy and X-ray procedure play a crucial role for the right evaluation of degenerative changes and ligament injuries of the wrist. An accurate diagnosis results in proper surgical management in order to maintain as much non-painful movement of the wrist as possible. Proximal row carpectomy and limited arthrodesis of the wrist are effective surgical procedures for the treatment of degenerative osteoarthritis that partly affects the wrist. Selective wrist denervation is a procedure that relieves pain and can delay total arthrodesis of the wrist. It is a common supplementary procedure. Total arthrodesis of the wrist is a procedure for the treatment of the most severe degenerative changes of the wrist. Total wrist replacement is a new alternative procedure with promising short term results.
- Klíčová slova
- totální náhrada zápěstí, proximální karpektomie, paklouby skafoidea, poranění skafolunátního vazu,
- MeSH
- artrodéza metody využití MeSH
- artroplastiky kloubů metody využití MeSH
- neuropatie nervus medianus chirurgie MeSH
- osteoartróza etiologie chirurgie radiografie MeSH
- poranění zápěstí komplikace MeSH
- zápěstní kloub chirurgie patofyziologie MeSH
- Publikační typ
- přehledy MeSH
