Postoperative immobilization using a short-arm cast in the semisupination position is appropriate after arthroscopic triangular fibrocartilage complex foveal repair

被引:7
作者
Jung, H-S. [1 ]
Park, J-G. [1 ]
Park, H-J. [1 ]
Lee, J. S. [1 ]
机构
[1] Chung Ang Univ Med, Hosp, Seoul, South Korea
关键词
DISTAL RADIOULNAR JOINT; CLINICALLY IMPORTANT DIFFERENCES; TRANSOSSEOUS REPAIR; ASSISTED REPAIR; LONG-ARM; RADIUS; FRACTURES; FOREARM; TFCC; MANAGEMENT;
D O I
10.1302/0301-620X.104B2.BJJ-2021-0592.R2
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Aims The aim of this study was to assess and compare active rotation of the forearm in normal subjects after the application of a short arm cast (SAC) in the semisupination position and a long arm cast (LAC) in the neutral position. A clinical study was also conducted to compare the functional outcomes of using a SAC in the semisupination position with those of using a LAC in the neutral position in patients who underwent arthroscopic triangular fibrocartilage complex (TFCC) foveal repair. Methods A total of 40 healthy right-handed volunteers were recruited. Active pronation and supination of the forearm were measured in each subject using a goniometer. In the retrospective clinical study, 40 patients who underwent arthroscopic foveal repair were included. The wrist was immobilized postoperatively using a SAC in the semisupination position (approximately 45 degrees) in 16 patients and a LAC in 24. Clinical outcomes were assessed using grip strength and patient reported outcomes. The degree of disability caused by cast immobilization was also evaluated when the cast was removed. Results Supination was significantly more restricted with LACs than with SACs in the semisupination position in male and female patients (p < 0.001 for both). However, pronation was significantly more restricted with SACs in the semisupination position than with LACs in female patients (p = 0.003) and was not significantly different in male patients (p = 0.090). In the clinical study, both groups showed improvement in all parameters with significant differences in grip strength, visual analogue scale scores for pain, modified Mayo Wrist Score, the Disability of the Arm, Shoulder, and Hand (DASH) score, and the Patient Rated Wrist Evaluation (PRWE) score. No significant postoperative differences were noted between LACs and SACs in the semisupination position. However, the disability caused by immobilization in a cast was significantly higher in patients who had a LAC on the dominant hand (p < 0.001). Conclusion We found that a SAC in the semisupination position is as effective as a LAC in restricting pronation of the forearm. In addition, postoperative immobilization with a SAC in the semisupination position resulted in comparable pain scores and functional outcomes to immobilization with a LAC after TFCC foveal repair, with less restriction of daily activities. Therefore, we recommend that surgeons consider using a SAC in the semisupination position for postoperative immobilization following TFCC foveal repair for dorsal instability of the distal radioulnar joint.
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收藏
页码:249 / 256
页数:8
相关论文
共 37 条
[1]   Midterm Results after Open versus Arthroscopic Transosseous Repair for Foveal Tears of the Triangular Fibrocartilage Complex [J].
Abe, Yukio ;
Fujii, Kenzo ;
Fujisawa, Takeyoshi .
JOURNAL OF WRIST SURGERY, 2018, 7 (04) :292-297
[2]   NEW TRENDS IN ARTHROSCOPIC MANAGEMENT OF TYPE 1-B TFCC INJURIES WITH DRUJ INSTABILITY [J].
Atzei, A. .
JOURNAL OF HAND SURGERY-EUROPEAN VOLUME, 2009, 34E (05) :582-591
[3]   Foveal TFCC Tear Classification and Treatment [J].
Atzei, Andrea ;
Luchetti, Riccardo .
HAND CLINICS, 2011, 27 (03) :263-+
[4]   A comparison of immediate postreduction splinting constructs for controlling initial displacement of fractures of the distal radius: A prospective randomized study of long-arm versus short-arm splinting [J].
Bong, Matthew R. ;
Egol, Kenneth A. ;
Leibman, Matthew ;
Koval, Kenneth J. .
JOURNAL OF HAND SURGERY-AMERICAN VOLUME, 2006, 31A (05) :766-770
[5]   Driving with an Arm Immobilized in a Splint: A Randomized Higher-Order Crossover Trial [J].
Chong, Paul Y. ;
Koehler, Elizabeth A. S. ;
Shyr, Yu ;
Watson, Jeffry T. ;
Weikert, Douglas R. ;
Rowland, Justin H. ;
Lee, Donald H. .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 2010, 92A (13) :2263-2269
[6]   Subluxation of the Distal Radioulnar Joint as a Predictor of Foveal Triangular Fibrocartilage Complex Tears [J].
Ehman, Eric C. ;
Hayes, Meredith L. ;
Berger, Richard A. ;
Felmlee, Joel P. ;
Amrami, Kimberly K. .
JOURNAL OF HAND SURGERY-AMERICAN VOLUME, 2011, 36A (11) :1780-1784
[7]   Arthroscopic Management of Triangular Fibrocartilage Complex Foveal Injury [J].
Fujio, Keiji .
HAND CLINICS, 2017, 33 (04) :619-+
[8]   How much can carpus rotate axially? An in vivo study [J].
Gupta, A ;
Moosawi, NA .
CLINICAL BIOMECHANICS, 2005, 20 (02) :172-176
[9]   Cast and splint immobilization: Complications [J].
Halanski, Matthew ;
Noonan, Kenneth J. .
JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS, 2008, 16 (01) :30-40
[10]   Distal radioulnar joint: functional anatomy, including pathomechanics [J].
Haugstvedt, J. R. ;
Langer, M. F. ;
Berger, R. A. .
JOURNAL OF HAND SURGERY-EUROPEAN VOLUME, 2017, 42 (04) :338-345