We report three cases of intrasubstance failure of a LARS™ (Ligament Augmentation and Reconstruction System) artificial ligament used for acromioclavicular joint reconstruction. The LARS™ ligament failed within four months of the index procedure. All patients underwent a revision procedure following an unsuccessful trial of conservative management. A modified second loop technique was employed during the revision procedure for all cases using the LARS™ ligament. All three patients achieved full recovery to pre-injury level function.
Objective: Surgical management of Kienbock’s disease is debatable and there is no clear evidence of any procedure more efficacious over the other. Our aim was to evaluate the functional and radiological outcome of patients with Stage 2 and 3 Kienbock’s disease who underwent vascularised bone graft from 4, 5 extensor compartement artery to lunate. Methods: We retrospectively reviewed patients, who underwent vascularised bone grafts (VBG) using 4 and 5 th extensor compartment artery for Kienbock’s disease, between 2013 and 2019. We excluded those secondary to trauma, negative ulnar variances and advanced stage of disease. We used the Visual Analogue Score (VAS) for pain, qDASH for the functional outcome and radiological assessment at final follow up. Results: Ten patients underwent VBG for Kienbock’s disease stage 2 and 3a. They were all operated by a single specialist hand surgeon, using the same surgical technique where a bone graft was harvested from the distal dorsal radius with vascular pedicle from the 4 th and 5 th extensor compartment artery. The average age at surgery was 40.6 years. There were 7 males and 3 females. The mean follow-up is 30 months. At the final follow up the mean VAS is 2.6 out of 10 against 9.5 pre-operatively and mean qDASH is 25.4/100 against 70.7/100 pre-operatively. Radiographs at the final follow up showed no progression of disease. All patients reported improvement in range of movement following surgery. Conclusions: Our study has demonstrated that vascularised bone graft is a viable treatment option for Kienbock’s disease stage 2 and 3 on a carefully selected group of patients with improvement in pain and function.
Introduction: Carpo-metacarpal joint fracture-dislocations are rare injuries. They constitute less than 1% of all hand injuries [1]. They often go unnoticed [2]. Of these, dorsal fracture-dislocations on the ulnar side are more commonly seen [3] because of the greater stabilizing dorsal structures. Volar fracture-dislocations are very rare and difficult to diagnose for which, one should have a keen eye on.
Case Report: This is a case of a 51-year-old female with a closed injury to her wrist. With clinical suspicion and appropriate radiographs fracture-dislocation of the 4th and 5th carpometacarpal joints with volar displacement was diagnosed. She underwent closed reduction and percutaneous Kirschner wire fixation, followed by 6 weeks of immobilization. At the final follow-up in 4 months, the patient was noted to have a satisfactory outcome following intense physiotherapy.
Conclusion: Fourth and fifth carpometacarpal joint fracture-dislocations of the fingers are unique; their diagnosis can be challenging and often overlooked [4], which if missed can have very poor outcomes. The functional prognosis depends on the precocity of diagnosis and appropriate reduction and vigorous rehabilitation.
Keywords: Carpometacarpal joint, fracture-dislocation, volar displacement, wrist injury.
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