Randme posttraumaatiline artroos

Randmeliigese osteoartrootiliste muutuste peamiseks põhjuseks on trauma. Sagedasemad traumad, mille järel võib tekkida randmeliigese artroos, on lodiluu murru väärkokkukasve ja ebaliiges, randmeluude nihestused ning sidemete vigastused. Peamine põhjus, miks patsiendid traumajärgse osteoartroosiga abi otsivad, on valu, mis põhjustab käefunktsiooni häireid ning segab igapäevatööd. Lodiluu väärkokkukasve, ebaliigese ja randmeluude sidemete vigastuste korral tekivad randmeliigeses biomehaanika muutused, mis põhjustavad hälbe koormuse jaotumises ja viivad kõhre kulumiseni. Lodiluu ja kuuluu vahelise sideme katkemise järel kulgevat randmeliigese progresseeruvat artroosi nimetatakse lodiluu-kuuluu kollapsiks (scaphoid-lunate advanced collapse – SLAC) ja lodiluu ebaliigese järel tekkivate muutuste tagajärjel kujunevat artroosi nimetatakse lodiluu ebaliigese kollapsiks (scaphoid nonunion advanced collapse – SNAC). Esmaseks raviks on konservatiivne sümptomaatiline ravi, ja kui see on tulemuseta, siis on võimalik kirurgiline ravi. Randme proksimaalse rea luude eemaldamine ning randme osaline või täielik artrodees on enam kasutatud operatsioonid randme traumajärgsetest muutustest tingitud sümptomaatilise artroosi raviks. Ühtegi kirurgilist ravimeetodit ei saa pidada teistest absoluutselt paremaks ega halvemaks. Kirurgilise meetodi valikul tuleb arvestada radioloogilist leidu, patsiendi vanust, füüsilist aktiivsust, sh töö iseloomu ja ka patsiendi ootusi. Eesti Arst 2018; 97(5):247–252 &nbsp

Ligamentum semicirculare humeri kliiniline anatoomia

Ligamentum semicirculare humeri ehk rotaatorkaabel on hiljuti avastatud sidemelis-kapsulaarne struktuur õlaliigese kapsli ülemis-lateraalses osas. Esialgsed anatoomilised kirjeldused sellest sidemest on tehtud fi kseeritud preparaatidel. Meie uuringu eesmärgiks oli võrrelda kirjeldust fikseerimata preparaatidel eelnevate uuringute tulemustega ja visualiseerida see side artroskoopia käigus. Ligamentum semicirculare humeri esines kõigil uuritud preparaatidel. Side algas kahest kohast – tuberculum minus’e ülemiselt fassetilt ja tuberculum majus’e eesmis-ülemiselt fassetilt –, kulges kaarjalt m. supraspinatus’e ja m. infraspinatus’e kõõluste all ning kinnitus tuberculum majus’e tagumisele fassetile m. infraspintus’e ja m. teres minor’i kõõluste vahelisel alal. Histoloogiliselt koosnes see side paralleelsetest kollageenkiudude kimpudest. Ligamentum semicirculare humeri’st sõltub rotaatormanseti lihaste kõõluste ruptuuri kuju, kuna ta moodustab kahjustatud m. supraspinatus’e kõõluse defekti mediaalse serva. Eesti Arst 2009; 88(Lisa3):10−1

Hill-Sachs Remplissage Procedure Based on Posterosuperior Capsulomuscular Anatomy

The remplissage technique is a procedure designed to fill a posterosuperior humeral head defect with the infraspinatus tendon and posterior-superior capsule in patients with engaging Hill-Sachs lesions. We describe a remplissage technique using 2 posterior working portals that respects the anatomy of the posterior-superior area of the glenohumeral joint without compromising the vascularization

Surgery with locking plate or hemiarthroplasty versus nonoperative treatment of 3-4-part proximal humerus fractures in older patients (NITEP): An open-label randomized trial.

BackgroundProximal humerus fractures (PHFs) are common fractures, especially in older female patients. These fractures are commonly treated surgically, but the consensus on the best treatment is still lacking.Methods and findingsThe primary aim of this multicenter, randomized 3-arm superiority, open-label trial was to assess the results of nonoperative treatment and operative treatment either with locking plate (LP) or hemiarthroplasty (HA) of 3- and 4-part PHF with the primary outcome of Disabilities of the Arm, Shoulder, and Hand (DASH) at 2-year follow-up. Between February 2011 and December 2019, 160 patients 60 years and older with 3- and 4-part PHFs were randomly assigned in 1:1:1 fashion in block size of 10 to undergo nonoperative treatment (control) or operative intervention with LP or HA. In total, 54 patients were assigned to the nonoperative group, 52 to the LP group, and 54 to the HA group. Five patients assigned to the LP group were reassigned to the HA group perioperatively due to high comminution, and all of these patients had 4-part fractures. In the intention-to-treat analysis, there were 42 patients in the nonoperative group, 44 in the LP group, and 37 in the HA group. The outcome assessors were blinded to the study group. The mean DASH score at 2-year follow-up was 30.4 (standard error (SE) 3.25), 31.4 (SE 3.11), and 26.6 (SE 3.23) points for the nonoperative, LP, and HA groups, respectively. At 2 years, the between-group differences were 1.07 points (95% CI [-9.5,11.7]; p = 0.97) between nonoperative and LP, 3.78 points (95% CI [-7.0,14.6]; p = 0.69) between nonoperative and HA, and 4.84 points (95% CI [-5.7,15.4]; p = 0.53) between LP and HA. No significant differences in primary or secondary outcomes were seen in stratified age groups (60 to 70 years and 71 years and over). At 2 years, we found 30 complications (3/52, 5.8% in nonoperative; 22/49, 45% in LP; and 5/49, 10% in HA group, p = 0.0004) and 16 severe pain-related adverse events. There was a revision rate of 22% in the LP group. The limitation of the trial was that the recruitment period was longer than expected due to a high number of exclusions after the assessment of eligibility and a larger exclusion rate than anticipated toward the end of the trial. Therefore, the trial was ended prematurely.ConclusionsIn this study, no benefit was observed between operative treatment with LP or HA and nonoperative treatment in displaced 3- and 4-part PHFs in patients aged 60 years and older. Further, we observed a high rate of complications related to operative treatments.Trial registrationClinicalTrials.gov NCT01246167