A-029419.6 'Dacic' (dorsal anchorage carpal instability control) a new technique for dtpd (dorsal transcaphoid perilunate dislocation)

Abstract

slightly slanted proximal-dorsal to distal-plantar and proximal-peroneal to distal-tibial. Nutrient foramina were found in every case in the dorsum and both sides of the proximal shaft. At least one nutrient vessel could be tracked back to the dorsalis pedis in every dissected specimen. Case reports: Three patients (33-56 years) have been operated to reconstruct major osteochondral defects on the distal surface of the radius after fractures, by a vascularised osteochondral graft taken form the base of the third metatarsal. In all cases a skin monitor was taken with the flap. No postoperative complications occurred. At a minimum follow-up of one year (1-2.5 years) all patients reported improvement in ROM (average 901) and decreased in pain (from nine preoperatives to average of 1.5 postoperatives in a VAS). No complaints from the donor site were referred. Conclusions: The procedure is indicated for irreparable chondral defects of the radius and it is a reasonable alternative to partial or total arthrodeses.Aim of the study: Clinical and radiological evaluation of the final outcome, of twenty five dorsal transcaphoid fracture dislocations of the wrist, treated by a new method. Material and method: Twenty-five dorsal transcaphoid perilunate dislocations were treated over the last five years (1999)(2000)(2001)(2002)(2003)(2004)(2005). The mechanism of injury was either a traffic accident (18 cases), or a fall from a height (seven cases). All patients were males with an average age of 26 years old (21-33 years). Under regional or general anesthesia a dorsal incision of 5 cm was performed over the third dorsal extensor compartment of the wrist slightly curved to the radial border of the second compartment. The wrist capsule was exposed and opened with a reverse ''T'' incision. The scaphoid fracture was reduced and fixed with an acutrac mini screw. After the dorsal scapholunate ligament was inspected for tears and the wrist was held in a neutral position with the help of 1 mm K-wire, a fluoroscopic control was performed. When proper alignment of the lunocapitate joint was achieved two mini Mitek anchors were introduced on the dorsal surface of the capitate and lunate bones. The right placement of the anchors was verified in order to respect the bone mass, direction and centre of rotation. The sutures then, were tied between lunate and capitate and K-wire was removed. The capsular ''T'' incision was finally closed using the same sutures in a retrograde mode imitating the binding of the shoe's ties. The wrist was held in a short arm cast in a neutral position for 6 weeks followed by physiotherapy and strengthening exercises for three months. Results: All patients were reviewed systematically every 6 months. Clinical and radiological findings were recorded. Clinical results were excellent in 21 cases (90-100), and fair in four cases (75-89) according to Mayo score. All wrists remained adequately reduced and all the scaphoid fractures united. No lunate necrosis with collapse was observed, but slight persistent radiological ...