Is arthrodesis still a good indication for non-inflammatory arthrosis of the wrist?

AbstractObjectiveThe aim of this study was to objectively and subjectively evaluate wrist function after total arthrodesis, among patients with sequelae of non-inflammatory arthritis who were treated with rigid internal fixation using a DCP plate.MethodsThirty-two patients with sequelae of non-inflammatory degenerative arthritis were treated using total arthrodesis of the wrist. Of these, two patients were treated with Kirschner wires and four discontinued the treatment, thus leaving 26 patients. The indication for arthrodesis of the wrist was the presence of intracarpal pathological conditions: eight wrists presented sequelae from fractures of the distal radius; 13 had sequelae from fractures of the scaphoid; and five had sequelae from Kienbock's disease. The cases were evaluated using the visual analogue scale (VAS), the muscle strength test, the Jebsen–Taylor functional test and the Buck-Gramcko test.ResultsIt was observed that there were no significant differences at the level of 5%, in the variables of grip strength, VAS, Jebsen–Taylor functional test or Buck-Gramcko/Lohmann test, between the pathological conditions.ConclusionTotal arthrodesis of the wrist using a plate in the dorsal region was shown to be a safe and efficient technique for patients with different types of pathological arthrosis of the wrist, since it did not cause any important functional incapacity and brought great pain relief

Clinical outcome of combined scaphocapitate fusion and posterior interosseous neurectomy for stage III Kienbock’s disease

Background: Treatment of Kienbock’s disease is still controversial. Several authors have described various surgical treatment options for Kienbock’s disease, all of whom reported successful treatment outcomes. The purpose of this study is to explore the clinical results of posterior interosseous neurectomy and scaphocapitate fusion as a treatment option for stage III Kienbock’s disease.Methods: This study evaluated the range of motion, grip and functional results after treatment of ten wrists of stage III Kienbock’s disease. Four males and six females with average age of 26.3 years, seven dominant and three non-dominant wrists were included. Two patients were smokers while six were housewives, three manual workers and a lawyer. The average follow up period was 14.2 months.Results: Four patients revealed excellent, three good and three fair results. The mean modified Mayo score was 81.5. Flexion-extension range was 105.5° representing 74.9% of the contralateral side range. The mean flexion and extension range of operated side was increased, while the flexion increase was nonsignificant. Regarding radial-ulnar deviation, the mean range was 33.5° representing 76.5% of the contralateral side. The mean ulnar and radial deviation was increased, while the radial increase was nonsignificant. The mean grip strength was significantly increased to 90 mmHg representing 93.2% of the contralateral side.Conclusions: Scaphocpitate fusion is a recommended solution for treatment of late stages of Kienbock’s disease with lunate collapse. Longer postoperative time has a positive impact on grip strength and flexion-extension range of motion

A Biomechanical Investigation of Load Sharing at the Distal Forearm

Loading at the distal forearm has been previously examined under static loads, however there remains no consensus on how loading is affected by active wrist and forearm motion. This work examines load magnitudes and load sharing at the distal radius and ulna during of active wrist and forearm motion. Two instrumented implants were designed to measure in vitro loading in cadaveric specimen. The implants were evaluated and found reliable for use in further biomechanical studies. An in vitro study investigated the effect of joint angle and direction of joint motion on loads in the distal radius and ulna during active flexion-extension, radioulnar deviation and dart throw motion. Loads through the distal radius and ulna were significantly greater in extension and reverse dart throw motion than in flexion and forward dart throw motion. A subsequent study examined the effect of radial length changes, joint angle and direction of motion on distal radius and ulna loading during active forearm rotation. Load magnitudes through the distal radius were greater in supination than in pronation. Radial lengthening found to increase radial loading and decrease ulnar loading and radial shortening decreased distal radius loading and increased distal ulna loading throughout forearm rotation, in a quasilinear fashion. This work improves the understanding of forearm bone loading and will assist clinicians in the development of rehabilitation techniques, surgical protocols and implant designs

Validation of Radiocarpal Joint Contact Models Based On Images from a Clinical MRI Scanner

Due to the severity and continuing escalation in occurrences of degenerative joint diseases, it is vital to establish a means of detection and prevention that could lead to an improvement in quality of life. One such means is MRI-based modeling for joint contact analysis of in vivo functional loading. The purpose of this study was to validate models generated from a clinical MR scanner for future in vivo joint contact analyses. Models were tested using 3 cadaver forearm specimens and compared with experimental data. It was found that models were validated based on contact area. Direct contact area measurements were observed to be very close to experimental data. Model force measurements were reasonable, but did not agree with experimental data as well as contact area. Peak pressure data from the models were less consistent in correspondence with experimental data. Also, radiocarpal mechanics were investigated to determine the effect of inserting a sensor into the joint space. Magnitudes of bone motions were found to be greater with film inserted than without film. Model results showed contact areas to be higher with film than without film

Interprofessional Education Enhancement: Inclusion of Occupational Therapy

The increase in interprofessional education (IPE) opportunities provides an excellent opportunity for occupational therapy (OT) educators to partner with other health professions to deepen the understanding of how the OT profession adds value to future healthcare teams. The purpose of this study was to describe the development and impact of a curricular unit about the OT profession that was integrated into an established IPE program for medical, advanced practice nursing, pharmacy and social work students. A Needs Assessment was conducted by embedding an OT consultant within interprofessional student teams working in clinical environments over six weeks to observe baseline understanding of how student primary care teams work with OT professionals. From these observations, a curricular unit was designed that included lecture, interactive work stations, and case studies. Students completed pre and post surveys in order to assess their learning. Quantitative and qualitative analysis of pre and post surveys indicated a significant increase in knowledge, application of information, and confidence to refer to and utilize OT in clinical practice. Interprofessional students learned about OT scope of practice, possible interventions, and examples of appropriate referrals. The curricular unit provided an excellent example of how OT professionals can partner with health professions schools to provide content about OT when OT students are not accessible. Future improvements include assessment of longitudinal impact of the curriculum on health professions behavior, including impact on patient referrals to OT by primary care teams

Stage III Kienböck's Disease Treated with Hyperbaric Oxygen: the Role of an Unusual Approach to a Rare Condition

Kienböck's disease is a rare condition characterised by avascular necrosis of the lunate bone. Its natural history and aetiopathogenesis have not yet been clarified, nor are its triggering factors identified. We present a case of a 17-year-old male gymnast, without relevant medical/family history, with stage IIIA Kienböck's disease diagnosed in 2016. Initially, submitted to conservative treatment that proved to be insufficient. Consequently, surgical treatment was proposed, but refused. The patient instead underwent experimental treatment with hyperbaric oxygen (120 sessions, 100% oxygen at 2.5 atm, for 70 min periods, once daily, five times per week). In April 2018, a favourable clinical and radiological evolution was observed, with an improvement in the patterns of pain, motion and strength and an almost complete involution of the process of aseptic necrosis of the semilunar. To the best of our knowledge, this is the first report of Kienböck's disease treated with hyperbaric oxygen.info:eu-repo/semantics/publishedVersio