Outcomes Assessment in Wrist Surgery

Slutsky, David J.

doi:10.1055/s-0033-1333892

Cited by 53 publications

(41 citation statements)

References 11 publications

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“…5,19,25,39 These upper extremity functionality scores integrate multiple facets of postoperative recovery including return to the previous level of activity, pain, and overall patient satisfaction. These patient-derived outcomes are critical in assessing postoperative recovery but are not as widely reported in the literature as objective physical exam and radiographic outcomes.…”

Section: Introductionmentioning

confidence: 99%

Vascularized Bone Grafting in Scaphoid Nonunion

Alluri

Yin

Iorio

et al. 2016

Hand (New York, N,Y.)

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Background: The radiographic and clinical outcomes following vascularized bone grafting (VBG) for scaphoid nonunion have previously been reported in the literature; however, few studies report on patient-derived outcomes. The purpose of this study was to determine the effect of VBG for scaphoid nonunion on patient-derived outcomes. Methods: The MEDLINE and PubMed databases were queried for the use of VBG in scaphoid nonunion. We included studies that reported on patient-derived outcomes. We excluded studies with less than 10 patients or less than 6 months of followup. The primary outcomes assessed included functionality, percent and time to return to preinjury activity, postoperative pain, and patient satisfaction. Results: Twenty-six articles described the outcomes of 520 patients with an average of 19.3 patients per study. Functionality was most commonly assessed by the Mayo Modified Wrist Score and Disabilities of the Arm, Shoulder and Hand scores, which improved by 53.1% and 81.7% postoperatively, respectively. Within 16 weeks, 90.3% of patients returned to their previous occupation or sporting activity. Pain was most commonly reported using a 0 to 10 visual analog scale and improved 4-fold postoperatively. Complete satisfaction was reported by 92% of patients. The most common complications were superficial infections (1.56%), neuropathic pain (1.56%), and complex regional pain syndrome (1.25%). Conclusions: VBG for scaphoid nonunion results in the improvement of patient-derived outcomes, and high rates of return to preinjury activity levels and patient satisfaction. Multiple metrics of patient-derived outcomes were utilized by the studies in our review without a clear consensus as to which metric is most responsive and accurate.

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Section: Introductionmentioning

confidence: 99%

Vascularized Bone Grafting in Scaphoid Nonunion

Alluri

Yin

Iorio

et al. 2016

Hand (New York, N,Y.)

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“…11,14,15,[26][27][28][29][30] Arthroscopic-assisted techniques have shown good results at follow-up ranging from 11 months to 4.8 years with pain reduction by VAS, grip strength returning to a mean of 71 to 95% of the contralateral hand, near full wrist and forearm motion, and improved outcome scores with mean DASH, PRWE, and MMW scores of 9 to 22, 33, and 71 to 91, respectively. 11,14,15,[26][27][28][29][31][32][33][34][35][36] All-arthroscopic techniques are performed solely through the arthroscopic portals and knots are placed intra-articularly. 30 Few studies have reported on outcomes following allarthroscopic repair of Palmer 1B peripheral TFCC tears.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes of All-Arthroscopic Pre-Tied Suture Device Triangular Fibrocartilage Complex Repair

2019

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Background A pre-tied suture device has been utilized for all-arthroscopic peripheral triangular fibrocartilage complex (TFCC) repairs with promising early clinical results. Purpose The purpose of this study was to evaluate long-term functional outcomes of these repairs. Patients and Methods A retrospective review of patients undergoing arthroscopic TFCC repair was performed. Inclusion criteria were the Palmer type 1B TFCC tears diagnosed on arthroscopy and repaired using the all-arthroscopic pre-tied suture device. Patients with any evidence of concomitant wrist injury at the time of surgery, history of prior wrist surgery, or nonrepairable and nonperipheral TFCC tears were excluded. Postoperative complications, range of motion, grip strength, and outcome assessments were recorded for each patient. Results Eleven patients (mean age, 36 years; range, 20–64 years) satisfied our inclusion criteria and comprised the study cohort. The mean follow-up period was 7.0 years (range, 4.3–10.9 years). Mean range of motion of the wrist revealed flexion of 76 ± 11 degrees and extension of 73 ± 12 degrees. Mean grip strength was 98 ± 15% of the nonsurgical extremity. QuickDASH, modified Mayo, and patient-rated wrist evaluation (PRWE) average scores were 9 ± 8, 80 ± 6, and 12 ± 12, respectively. No surgical complications were observed and no patient required any further surgical intervention. Conclusions Our cohort of patients following all-arthroscopic pre-tied suture device repair of isolated Palmer type 1B TFCC tears demonstrated excellent clinical function at a mean follow-up of 7 years. These findings indicate that the pre-tied suture device is a reliable, safe, effective, and most importantly, durable treatment option for repair of peripheral TFCC tears. Level of Evidence This is a Level IV, therapeutic study.

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“…1). 8 The angles between the scaphoid and the lunate and between the lunate and the radius were measured to rule out a dorsal or volar intercalated segment (DISI/VISI) deformity. The scapholunate angle is formed by the intersection of a line tangential to the palmar aspect of the scaphoid with the long axis of the lunate: angles > 60°indicate a DISI malalignment.…”

Section: Methodsmentioning

confidence: 99%

Treatment of Scaphoid Waist Nonunion Using Olecranon Bone Graft and Stryker Asnis Micro Cannulated Screw: A Retrospective Study—80 Case Studies and 6 Years of Follow-Up

et al. 2015

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Management of scaphoid nonunion continues to be a challenge for hand surgeons, and the optimal treatment remains controversial. Many factors contribute to the development of a nonunion, including the particular scaphoid vascularization, the degree of fracture displacement, the complex scaphoid anatomy, and delayed treatment. 1,2Nonunion rates of up to 12% have been reported. AbstractBackground Screw fixation and bone grafting are the gold standard for scaphoid waist nonunion without avascular necrosis. Question/Purpose Assesses the scaphoid waist nonunion healing rate with use of an uncommon cancellous bone graft (olecranon) and an unusual fixation system (Asnis Micro Cannulated Screw System; Stryker Inc., Kalamazoo, MI, USA).Material and Methods A series of 102 consecutive patients were treated for scaphoid waist nonunion (without deformity). Of these, 80 patients subjected to clinical (Modified Mayo Wrist Score (MMWS), Jamar hydraulic dynamometer) and radiographic examination before and after surgery were evaluated. Ipsilateral olecranon cancellous bone graft and the ASNIS Micro 3.0-mm diameter screw, were used. The average follow up was 6 years (min 3; max 10).Results Radiographic consolidation was achieved in 90% of patients; dorsal intercalated segment instability (DISI) deformities were corrected in 71.4% of cases. Ninety percent improved the range of motion of the wrist and grip strength. All patients showed a significant reduction of peak force in the operated hand. In 6.25% we observed clinical and radiographic screw head-trapezium impingement. Twenty-six patients developed a degenerative wrist sign. The MMWS yielded 68 optimal, 8 good, and 4 bad results. Conclusions To treat scaphoid waist nonunions without misalignment, low-profile headed screw and olecranon bone graft allowed a high consolidation rate with positive results to long-term follow-up. The Asnis Micro 3.0 mm diameter screw may be a suitable option for treating scaphoid waist nonunion. Level of Evidence IV.

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Outcomes Assessment in Wrist Surgery

Cited by 53 publications

References 11 publications

Vascularized Bone Grafting in Scaphoid Nonunion

Vascularized Bone Grafting in Scaphoid Nonunion

Long-Term Outcomes of All-Arthroscopic Pre-Tied Suture Device Triangular Fibrocartilage Complex Repair

Treatment of Scaphoid Waist Nonunion Using Olecranon Bone Graft and Stryker Asnis Micro Cannulated Screw: A Retrospective Study—80 Case Studies and 6 Years of Follow-Up

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