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CNAA / Theses / 2008 / June /

Surgical treatment of carpal injuries and their consequences


Author: Buzu Dumitru
Degree:doctor of medicine
Speciality: 14.00.22 - Orthopedics and Traumatology
Year:2008
Scientific adviser: Filip Gornea
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 25 June, 2008
Approved by NCAA on the 18 September, 2008

Abstract

Adobe PDF document0.46 Mb / in romanian

Keywords

carpal bone, wrist, perilunate dislocation, fracture-dislocation, midcarpal arthrodesis, scaphoid nonunion

Summary

Our study is based upon analyzing the experience of the surgical treatment of 162 patients with carpal injuries and their consequences, all treated in the Hand Surgery Department of Ortopedics, Traumatology and Field Surgery of the “Nicolae Testemitanu” Medical University between the years 2000 and 2006.The research included the findings of the clinical and paraclinical examinations of the patients, their anthropometric examination data denoting the grip strength and range of motion in the wrist joint, pain and functional status gradation, the X-ray results determining the capito-lunate index, the carpal height and the capito-lunate angle, as well as the analysis of the follow-up results according to Krimmer H. wrist score in 129 (79.65%) patients.

The patients in the study group have been performed: wires osteosynthesis - 11 cases, bone grafting and wire fixation - 75 cases, limited intercarpal arthrodesis - 33 cases, distal scaphoid resection arthroplasty - 3 cases, proximal row carpectomy - 1 cases, radial styloidectomy - 2 cases, one-step perilunate dislocation and fracture-dislocation reduction - 21cases and two-steps reduction - 17cases.

We has worked out a new method of estabinlishing the size of wrist distraction an external fixation device (Ilizarov) for old perilunate dislocations and fracture-dislocation reduction, the method being easy to use in practice and may be verified by X-rays at the end of distraction. Thus, we have determined that a grade I perilunate dislocation reduction needs a wrist distraction of 12,2±0,3 mm, a lunate bone dislocation - a distraction of 21,6±0,9 mm, a grade I fracture-dislocation needs a distraction of 15,0±0,9 mm and in grades II and III fracture-dislocations a distraction of 24,0±0,7 mm (P<0.001>) is necessary.

Midcarpal arthrodesis and complete scaphoid excision have been used in the treatment of grades II and III degenerative wrist arthritis secondary to scaphoid nonunion. To fix the bony structure we have designed a device and 2 techniques: a cross-plate and two parallel wires joined together in a tension band wiring. The method has the following advantages: a firm fixation of the bony structure, no need of a prolonged immobilization, the possibility of exercising more mints in the wrist joint at an early postoperative period.

The positive functional results obtained in 81,1% of cases are the chief reason in favour of correct indications and surgical techniques ,methods used and the external fixation devices employed in the treatment of severe carpal injuries and their consequences.