Total wrist arthroplasty (TWA) can provide the motion, strength, and the stability needed to perform activities of daily living. 1-3 Clinical series reporting on total wrist arthroplasty, however, have been limited. Problems related to implant loosening and instability have limited the clinical application of TWA. [3][4][5][6][7] Wrist arthroplasty provides the potential of improving hand strength secondary to maximizing resting muscle tension as well as better positioning the hand for functional use in daily activities. Total wrist arthroplasty has traditionally required large bone resection from the carpus and distal radius, and the results have been fraught with difficulties including proximal and distal component prosthetic loosening and instability 4-11 New designs for TWA that are lower profile and more anatomic and utilize minimal bone resection and a resurfacing arthroplasty concept are now available. Comparative studies of older-generation
AbstractPurpose Total wrist arthroplasty (TWA) is an evolving procedure for the treatment of arthritis of the wrist joint. The purpose of this study is to compare outcomes of three different total wrist implants. Methods A retrospective review of the Biaxial, Universal 2, and Re-Motion total wrist arthroplasties was performed. Patients were evaluated for clinical outcome, radiographic analysis, review of complications (incidence and type), and conversion to wrist fusion. Patient function measures included: the Mayo wrist score, the Patient Related Wrist Evaluation, and Disabilities of Arm, Shoulder, and Hand (DASH) score. Results Forty-six wrist implants were performed in 39 patients. There were 36 rheumatoid and 10 posttraumatic cases. The average follow-up was 6 years (3.5 to 15). The total wrist inserted included 16 resectional arthroplasties (Biaxial) and 30 resurfacing designs (Universal 2 and Re-Motion). Nine implant failures were noted. Causes for arthroplasty failure included distal component implant loosening and wrist instability. Salvage procedures included revision TWA or wrist fusion. In successful cases, flexion and extension motion averaged 30 and 38 degrees, respectively, and grip strength improved by 3 kg. Mayo wrist scores, in successful cases, increased from 40 (preoperative) to 76 (postoperative). The Mayo wrist scores for posttraumatic conditions averaged 87 points versus 71 points for rheumatoid arthritis. The average DASH score for the two resurfacing designs were 20 and 37, and 48 for the resectional arthroplasty design. Discussion Total wrist replacement maintains itself and provides good pain relief and functional motion in over 80% of all cases and in 97% of resurfacing implants. Better results were correlated with improved distal component fixation and minimal resection of the distal radius.
Level of Evidence Level 3 Case Control
Bilateral gluteal compartment syndrome is a rare condition. Only 6 previous cases have been reported in the literature. Two previous cases involved positioning for urological procedures, while the other cited causes of bilateral gluteal compartment syndrome include exercise-induced, trauma, and prolonged immobilization from substance abuse. The 2 previously published reports of bilateral gluteal compartment syndrome associated with urologic positioning were treated conservatively due to late presentation and onset of rhabdomyolysis. This article presents a case of a 61-year-old man who developed bilateral gluteal compartment syndrome following prolonged urologic surgery in a dorsal lithotomy position. Orthopedic evaluation revealed physical examination findings and intracompartment pressures consistent with bilateral gluteal compartment syndrome. He underwent bilateral gluteal compartment fasciotomies. An expansile-type Kocher Langenbach incision was made, extending from lateral to the posterior superior iliac spine inferior to the level of the greater trochanter. The 3 compartments were decompressed bilaterally. At completion, the compartments showed definite objective softening. He was treated with delayed closure of his fasciotomy wounds. He was discharged home on sixth postoperative day 6. His wounds healed without difficulty and he regained normal strength and sensation in his lower extremities. Gluteal compartment syndrome following surgery is a preventable condition. Prevention should center on intraoperative padding and positioning, intraoperative repositioning, and restricting the length of the procedure. Once it is identified, early diagnosis and treatment can prevent long term complications.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.