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Operative management of acromioclavicular joint injuries
Published in Andreas B. Imhoff, Jonathan B. Ticker, Augustus D. Mazzocca, Andreas Voss, Atlas of Advanced Shoulder Arthroscopy, 2017
Felix Dyrna, Brendan Comer, Augustus D. Mazzocca
It is important to secure the conoid (medial) limb of the graft first, as it allows proper tensioning of the graft across the coracoid, trapezoid tunnel, and AC joint. The graft is positioned so that the tail is left 2 cm proud from the superior aspect of the clavicle. The long tail of the graft exits the trapezoid tunnel laterally, and will later be used to recreate the superoposterior AC ligament. While ensuring reduction of the clavicle, a nonabsorbable radiolucent screw of the appropriate size and length (usually a 5.5 mm × 8 mm PEEK interference screw) is placed in the conoid tunnel. The screw is placed in the anterior aspect of the tunnel while tension on the graft is maintained. The lateral end of the graft exiting the trapezoid tunnel is then tensioned cyclically to remove slack, and, with tension held, a second PEEK screw is placed anterior to the tendon graft to secure the graft exiting the lateral trapezoid bone tunnel. With the graft now secure, the No. 2 Fiberwire ends are tied over the top of the clavicle to provide nonbiologic augmentation of the repair. The pointed reduction forceps can then be removed, and fluoroscopic images taken to confirm reduction of the AC joint (Figure 38.4).
Displaced isolated coronal shearing fracture of the trapezoid: a case report
Published in Case Reports in Plastic Surgery and Hand Surgery, 2021
Yuya Otake, Koji Sukegawa, Kenji Onuma, Shuhei Machida, Riyo Iida, Masashi Takaso
The last consultation was at one year postoperatively, and the patient denied any tenderness or pain. The grip strength was 35.1 kg, which corresponded to 90.6% of that of the right hand. The Disability of the Arm, Shoulder, and Hand score was 5, and the Modified Mayo Wrist Score was 90 points (excellent). Radiographs confirmed a complete trapezoid bone union and appropriate alignment of the proximal and distal carpal rows, with no arthritic changes of the second CM joint and no signs of avascular necrosis of the trapezoid (Figures 5 and 6). The patient returned to playing softball at the pre-injury level.
Two cases of pyrocarbon capitate resurfacing after comminuted fracture of the capitate bone
Published in Case Reports in Plastic Surgery and Hand Surgery, 2020
Aleid C. J. Ruijs, Joël Rezzouk
The second case (LG) is that of a 20-year-old male right-hand dominant student, who presented after a skiing accident with a traumatic injury of his right wrist. Standard X-rays and a CT scan showed a comminuted fracture of the capitate (Figure 3). During surgery, we noted that the capitate was severely comminuted, and there was extensive cartilage damage between the capitate and hamate, and capitate and trapezoid. The comminuted pieces of the capitate were removed and replaced by a corticocancellous bone graft harvested from the iliac crest. The volume needed was measured before harvesting the bone graft. It was a corticocancellous bone graft in one piece. The bone graft was prepared with a 75 degrees angle on the dorsal side, which corresponds to the 15-degree angle of the distal radius. A central tract was made in the graft with a large K-wire. Then the broach was inserted into the bone graft. The implant was placed into the graft, and the graft with implant was then fixed by several K-wires to the other carpal and metacarpal bones. Cancellous bone was added between the trapezoid bone, the bone graft and the hamate bone. K-wires were added for stability. There was good contact and mobility between the RCPI prosthesis and the scaphoid and lunate bones. A spanning external fixator was applied to provide distraction for protection of the cartilage during bone healing (Figure 4(A)). It was removed at 6 weeks post-operatively. At 29 months’ follow-up, his ROM was 55 degrees of flexion and 45 degrees of extension of the wrist, and a loss of both pronation and supination of 15°. Ulnar and radial deviation was functional at respectively 45 and 10 degrees compared to 50 and 30 degrees of the left wrist. Squeeze strength was 100%, Jamar grip strength was 65% and key pinch strength was 91% compared to the left side. At rest, he had no pain in his wrist, and after activity, his maximum pain level was 4 out of 10 (VAS-scale). The Quick Dash showed a score of 6%, and the PRWE a score of 13.5 out of 100. The RCPI prosthesis was in place and there were no signs of secondary degenerative changes between the prosthesis and the scaphoid or lunate bones (Figure 4(B)). He has had to give up his climbing activities but does still ride his motorcycle.