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Instruments and Implants in Hand Surgery
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Anil K Bhat, Ashwath M Acharya, Mithun Pai G
Yung–Cheng Chen was the first to describe wrist arthroscopy. He used a 1.7 mm arthroscope and carried out procedures through dorsal portals in cadavers and amputated arms [4]. Standard equipment includes a 2.4 mm, 30° angled arthroscope (1.9 and 2.7 mm scopes are also used), a 3 mm hook probe and overhead traction. Instruments that are used in the treatment of intra-articular pathology include a radiofrequency ablation probe and a mechanical shaver. The shaver may be necessary to clear the wrist of synovitis or degenerative soft tissue changes to perform a comprehensive diagnostic evaluation of the wrist (Figures 15.41 and 15.42).
Surgery of the Wrist
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Ramon Tahmassebi, Sirat Khan, Kalpesh R Vaghela
The ‘four-corner’ fusion (capitate–hamate–triquetrum–lunate fusion) is indicated in scapholunate advanced collapse (SLAC) wrist, scaphoid non-union advanced collapse (SNAC) wrist or mid-carpal instability. The procedure includes a scaphoidectomy and a fusion of the capitate, lunate, hamate and triquetrum. It is vital that the radiolunate joint remains in good condition and capable of function without pain. This should be carefully evaluated preoperatively either radiographically or using wrist arthroscopy. The landmarks, basic approach and structures at risk are similar to those of full wrist fusion.
Upper limb
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The triangular fibrocartilage is a complex consisting of the ulnocarpal ligaments, extensor carpi ulnaris tendon sheath and a meniscus-like structure between the distal ulna and the carpus. It is continuous with the dorsal and volar wrist capsules and stabilises the distal radioulnar joint. It can undergo traumatic or degenerative tears, presenting with ulna-sided wrist pain and distal radioulnar instability. An MR arthrogram or wrist arthroscopy aids diagnosis (Figure34.44). Peripheral tears of the TFCC can be repaired (open or arthroscopically), while central degenerative tears can be arthroscopically debrided.
A modified arthroscopic ulnar tunnel technique for foveal triangular fibrocartilage complex injury
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Robert Gvozdenovic, Sabine Hessler Simonsen
We treated 44 patients with the modified Iwasaki ulnar tunnel technique for foveal re-attachment of TFCC injury (Atzei Class 3) during April 2013 – September 2019. Overall, 77 patients referred to diagnostic wrist arthroscopy caused by chronic ulnar-sided wrist pain and mild instability of the DRUJ, were assessed clinically and radiographically. Thirty-three patients had to be excluded according to exclusion criteria, leaving 44 patients eligible for inclusion in this study. Mild instability was defined with a soft endpoint during the clinical assessment. The main inclusion criteria for this study was a positive fovea-sign according to Tay et al. [22], and a positive hook test during the arthroscopic evaluation of TFCC injury. The main exclusion criteria for this study were: age under 16 years, acute TFCC injuries (< 3 months), patients with degenerative cartilage changes of the DRUJ (irreparable TFCC), distal or complete (Atzei Class 1 and 2) TFCC injuries and patients with a gross DRUJ instability. All excluded patients’ injury patterns and treatment history are shown in Table 1.
Cost description of clinical examination and MRI in wrist ligament injuries
Published in Journal of Plastic Surgery and Hand Surgery, 2018
Jonny K. Andersson, Elisabeth Hansson-Olofsson, Jón Karlsson, Jan Fridén
The waiting time for a clinical examination at the Department of Hand Surgery, Sahlgrenska University Hospital, is currently 4 weeks for priority cases and 3–6 months for non-priority cases. The cost of a diagnostic wrist arthroscopy, necessary for a wrist ligament injury diagnosis, is currently 3588 euros. However, these last two processes are necessary for all patients, independently of whether or not they undergo an MRI investigation.
Experiences with Osteoligamentoplasty According to Weiss for the Treatment of Scapholunate Dissociation
Published in Journal of Investigative Surgery, 2018
W. Petersen, J. Rothenberger, H. E. Schaller, A. Rahmanian-Schwarz, M. Held
All patients underwent prior standard wrist arthroscopy and demonstrated a torn SL ligament without regenerative ligament stumps. The scaphoid could easily be pushed apart from the lunate with the endoscope so that a deep look into the gap between the two carpal bones was possible (Figure 2). Hence, a surgical reconstruction was indicated for all the patients suffering from the SL dissociation and distinct instability.