Session 3: Hand/wrist
Ondag den 22. oktober
09:00 – 10:30
Lokale: Helsinki/Oslo
Chairmen: Jesper O. Schønnemann / Pernille Leicht
25. Increased migration and more revisions of MOTEC compared with ELECTRA cups. A 2-year RSA study of trapeziometacarpal prostheses
Maiken Stilling, Torben Bæk-Hansen
Department of Orthopaedics, Regional Hospital Holstebro, Hospital Unit West
Background: Cup failure is a recognized problem in
total trapeziometacarpal (TM) joint
prosthesis. Several cup designs are
available but clinical documentation is
sparse. Cementless cups are inserted
pressfit and depend on a primary
mechanical and secondary osseous
stability, which may be evaluated with
radiostereometric analysis (RSA).
Purpose / Aim of Study: To compare cup stability with two
cementless screw cups and the
possible relation to cup revision.
Materials and Methods: 2 consecutive prospective patient
cohorts, Eaton type 2-4, were operated
with TM joint prostheses using two
differently designed trapezium screw
cups: the MOTEC cup with a collar
(n=22), and the ELECTRA bimetal cup
without a collar (n=22). Mean age was
60 (45-74) years. There were 31
female and 13 males. Model-based
RSA was used to measure cup
migration with respect to the
trapezium, which was marked with
1mm tantalum beads during surgery.
Stereoradiographs and DASH score
was measured at baseline, 3 and 6
months, and 1 and 2 years
postoperative.
Findings / Results: At 2 years total translation of mean
2.32 (sd 2.4) mm with MOTEC cups
(n=7) was higher (p=0.01) than mean
0.87 (sd 1.61) mm with ELECTRA
cups (n=16). At 3 months total
translation was higher in cups that
were revised later on (p=0.03). There
was a tendency for more subsidence
with MOTEC cups (1.03 vs 0.22 mm;
p=0.053). There was no significant cup
migration between 1 and 2 years
(p=0.62). However, at 2 years the
revision rate in the MOTEC group was
41% (9/22), versus 0% (0/22) in the
Elektra group (p= 0.02). There were no
significant differences in clinical results
between the two groups.
Conclusions: The MOTEC trapeziometacarpal cup
with a collar has higher implant
migration and more revisions
compared with the ELECTRA
collarless bimetal cup at 2 years
followup. Early migration was higher in
cups that were later revised.
26. High early revision rate in a new cemented polyethylene cup in trapeziometacarpal total joint arthroplasty
Jens Knak, Torben Bæk Hansen
Department of Orthopaedics and The Orthopaedic Research Unit, Hospital Unit West, Holstebro
Background: Trapeziometacarpal total joint
arthroplasty may be used in treatment
of trapeziometacarpal osteoarthritis
preserving the length of the thumb and
providing rapid rehabilitation and good
grip strength.
Unfortunately high revision rates have
been reported, and new implant
designs strive to reduce the revision
rates.
Purpose / Aim of Study: To evaluate the mid term results using
a new cemented cup design with the
Motec polyethylene trapezium cup in
ball and socket trapeziometacarpal
total joint arthroplasty.
Materials and Methods: We did a prospective study in 58
patients, 11 males and 39 females,
mean age 61 years (range 41-77)
operated with a Motec polyethylene
trapezium cup in the period december
2010 to November 2012.
All patients were followed with DASH
score, VAS and measurement of grip
strength as well as radiological follow-
up at 3, 12 and 24 months.
Findings / Results: After a mean follow-up of 33 months
(range 19-43) 8 patients had been
revised due to early aseptic loosening
or osteonecrosis, (14%), 2 patients
due to recidivant luxation, 1 patient
due to traumatic cup loosening and 1
patient due to deep infection.
5 of the 8 patients with aseptic
loosening/osteonecrosis were revised
during the first 12 months.
The clinical results in the remaining 47
patients were equivalent to other
published series.
Conclusions: The early revision rate due to aseptic
loosening or osteonecrosis has been
surprisingly high indicating a technical
failure during cementing.
We suspect heat induced bone
necrosis to be a possible cause, and
further studies are needed looking at
the cementation technique in
trapeziometacarpal total joint
arthroplasty.
27. Test-retest reliability of Antonovsky’s 13-item Sense of Coherence scale in patients with hand-related injures
Alice Ørts Hansen, Hanne Kaae Kristensen, Ragnhild Cederlund, Hans Tromborg
Department of Orthopedic , Odense University Hospital; Department of Rehabilitation, Odense University Hospital; Health Sciences, Lund University
Background: Patients with identical hand injuries,
who gets the same treatment and
rehabilitation, recover differently from
their injuries. It might be due to
personal factors. Antonovsky
developed a questionnaire measuring
Sense of Coherence (SOC13)
reflecting person’s ability coping in a
stressful situation. Studies have shown
that patients with strong Sense of
Coherence (SOC) get better functional
outcome and satisfaction in daily
activities after hand- and orthopaedic
injuries compared to patients with
weak SOC. Psychometric properties of
SOC 13 have not been tested on
patients with hand injuries. This is
necessary before using SOC13 to
predict outcome and plan rehabilitation.
Purpose / Aim of Study: To report on distribution, stability and
test-retest reliability of SOC13 in
patients with hand-related injuries and
explore associations between SOC13
and age, education level, gender and
type of injury.
Materials and Methods: The design was a survey with test-
retest using self-administered
questionnaire.
SOC13 and demographic data was
collected before occupational therapy
in an Outpatient Clinic from 170
patients with hand-related injuries
aged 18 and older. SOC13 was
completed after 14 days and 3 months.
Findings / Results: 170 patients completed SOC13 at
baseline (median score 71, range 30-
91). Intra-class correlation coefficient
(ICC) between baseline and 14 days
was 0.87 (n=151), 3 months 0.82
(n=113). Weak correlations was found
between SOC, age (r=0.17, p<0.03),
education(r= 0.02, p<0.02). No
correlation was found between SOC
and gender or type of injury.
Conclusions: SOC13 showed stability and reliability
for patients with hand injuries before
and 3 months after hand therapy. Age
and education had a weak relationship
with SOC without clinical relevance.
SOC13 has potential to be a powerful
tool measuring personal factors before
hand therapy.
28. Skin tear correlates to the degree of contracture when treated for Dupuytrens contracture with Xiapex
Christian Fagernæs, Susanne Mallet
Orthopaedics, Køge Hospital
Background: Xiapex is used in the treatment of
Dupuytren’s disease (DD). Xiapex is
injected into the cord which the next
day is manipulated to attempt rupture.
No trial has explored the number of skin
tear as an adverse effect (AE).
Purpose / Aim of Study: The aim was to explore the joint level
and the degree of contracture to the
risk of the AE of skin tear.
Materials and Methods: 105 cases (90 patients) with DD with DIP
and/or PIP contracture from august 1st
2012 till april 1st 2014 were enrolled
prospectively. Excisting skin defects
were cause for exclusion. DIP and PIP
contractures were treated with 0.25 mL
and 0.20 mL of Xiapex .The degree of
contracture was measured with a
goniometer and skin tears were
classified as yes/no.
Findings / Results: 77 (73%) had the contracted cord at the
level of the MCP joint and 28 (27%) at
the level of the PIP joint. 59 (56%) got
skin tear. The RR of skin tear is 1,5
for MCP level of >60 degrees compared to
MCP level at 20-59 degrees (p=0,17). The
RR of skin tear is 2,2 for PIP level of
>60 degrees compared to PIP level at
20-59 degrees (p=0,04). The relative
risk for skin tear is 1,1 (CI = (0.72;
1.58), p=0,74) for MCP level compared to
PIP level. By logistic regression it is
shown that the degree is the most
important factor concerning skin tear
with a higher risk in the >60
degree-group compared to the 20-59
degree-group with an odds ratio of 5.4
((95%CI (1.4; 20.6), p=0.01).
Conclusions: There is a higher risk of skin tear when
the contracture is >60 degree and
located at the level of the PIP joint.
Overall the factor most important for
higher risk of skin tear is the degree
of the contracture more that the level.
Focus on patients with contracture of
more than 60 degrees is needed. A type
of skin-softener could be helpful but
should be explored.
29. Long-term effect of surgery for thumb in palm in adolescent cerebral palsy patients.
Hans Tromborg, Alice Ørts
Hand Surgery, Dept of Ortopaedic Surgery, Odense University Hospital; Department of Rehabilitation (Hand), Odense University Hospital
Background: Cerebral palsy of the hand can be a
seriously debilitating illness, especially
hand activities demanding the use of
two hands can be affected. The ability
to open the hand to grip objects and
bringing the fist finger into contact with
the second finger (pinch key grip) are
cornerstones of hand function.
Purpose / Aim of Study: To evaluate the long-term effect of
thumb surgery for thumb in palm
spasticity in adolescent patients with
cerebral palsy.
Materials and Methods: Twenty six patients with cerebral palsy
was surgically reconstructed with flexor
carpi ulnaris (FCU) transferal to the
extensor carpi radialis brevis (ECRB)
and surgery to correct the thumb in
palm deformity. Age 15(6) years (AVG
(SD)).
Hand opening was measured as the
ability to grasp a wooden cylinder with
contact to the web space between the
first and the second finger. Two hand
activities (THAc) were measured by
awarding points for the use of two
hands in pre-defined and standardized
two hand activities (modified Sollerman
hand test). Maximum possible points
was 15.
After surgery, the patients were treated
with immobilization in a cast for eight
weeks. All patients initially received
highly specialized rehabilitation and
afterwards guided therapy.
Findings / Results: Patients increased hand opening from
4.6 (1.5) cm (AVG (SD)) preoperatively
to 5.5 (1.3) cm (p<0.05) after half a
year and increased points of THAc
from 9.2 (4.1) points preoperatively to
11.8 (4.0) points (p<0.001) after half a
year. Hand opening and THAc
increased a little from 6 months to 18
months and therefore remained
statistically significantly improved.
Conclusions: In carefully selected adolescent
children with cerebral palsy hand
opening and two hand function can be
improved by surgery and subsequent
hand therapy.
30. Short term results of the Maestro Total Wrist Arthroplasty for primary and revision arthroplasty
Allan Ibsen Søensen, Peter Axelsson
Clinic of Hand Surgery, University Hospital Sahlgrenska
Background: Wrist arthroplasties have been used for
dekades with better results for the newer
designs.
Purpose / Aim of Study: The aim of this study is was to review our
short-term results of the Maestro prosthesis
used for primary and revision wrist-
arthroplasty.
Materials and Methods: The Maestro implant is a modular total
wrist joint prosthesis. The indications for
it´s use in this study were rheumatoid
arthritis (RA), degenerative (OA) and
posttraumatic arthritis (POA) and revision
of former Wrist arthroplasty.
The procedure was performed in 14
patients, 3 men and 11 women. Median
age was 64 years (41-75). 10 RA, 3 OA
and 1 POA patients were operated.
Median follow-up was 13 month (range
12-25). Primary arthroplasty was
performed in 11 patients and revision
arthroplasty in 3 (2 KMI - and 1 Remotion
prosthesis were removed). Cement was
used in 4 cases. Additional Darrach
procedures were performed in 4 cases.
Findings / Results: Wrist extension and flexion was
preoperatively 35/30 degrees and at
follow-up 40/25. Radial/ulnar deviation
was 10/30 degrees versus 10/25
postoperatively. Grip strength, in KgF,
was preoperatively 8 (range 2-36) and at
follow-up 18 (7-30). VAS pain (0-100
mm) was preoperatively at rest/activity;
30/65 mm and at follow-up; 2/4 mm. Minor
radiographic osteolysis around one
screw was seen in 2 of 14 cases at the
last follow-up, but no signs of loosening
were detected. Quick DASH and PRWE
were preoperatively; 50 and 68 and at
follow-up; 28 and 12. VAS satisfaction at
latest follow-up was 98 mm (34-100).2
minor hematomas and 1 moderate
hematoma were observed. No infections,
dislocations or other early complications
were encountered and no reoperations
performed.
Conclusions: In this small selected case series the Maestro
Total Wrist Arthroplasty had a low
complication rate and showed promising
short-term results.
31. Trapezium resection vs. cemented cup revision in cup failures of the trapeziometacarpal total joint prostheses of the thumb
Jens Knak, Torben Bæk Hansen
Department of Orthopaedics and The Orthopaedic Research Unit, Hospital Unit West, Holstebro
Background: Total joint prostheses may be used as
treatment of trapeziometacarpal
osteoarthritis of the thumb, but
unfortunately a relatively high rate of
loosing of the trapezium component
has been observed.
Revision may be performed as a cup
revision or as a conversion into a
trapeziectomy, but so far no studies
have been made to compare these two
treatment options.
Purpose / Aim of Study: The primary aim of this study was to
compare the outcome in patients with
failure of the trapezium cup revised
into a cemented cup or into a
trapeziectomy.
Materials and Methods: We did a follow up-study in 44 patients
(with 49 operations) revised in the
period 2004 until 2014. 13 patients
were excluded because of a less than
12 months follow-up or declined to
participate, and it left us with 36
hands/operations in 31 patients,
respectively 23 trapezium resections
and 13 cup to cemented cup revisions.
Clinical measures were VAS-score,
DASH, strength and movement of the
thumb, and in all implants an AP and
lateral radiograph.
Findings / Results: We did not find any difference
regarding VAS-, DASH-score, grip
strength and movement of the thumb
comparing.
In the series of cup revision we found a
re-revision rate of 4 out of 18
operations (22%). These 4 patients
were revised into trapeziectomy.
Conclusions: Cup revision into trapeziectomy gives
a good functional result, and cup
revision into a cemented new cup
should be used in selected patients
only due to a high risk of re-revision.
32. Xiapex® (collagenase clostridium histolyticum) – treatment of patients with recurrence-Dupuytren’s contracture – 1 year follow-up
Søren Larsen , Karina Liv Hansen, Tune Ipsen, Jens Lauritsen
Unit for Hand Surgery, Department of Orthopaedic Surgery, Odense University Hospital
Background: Dupuytren’s contracture (DC) is a
disorder that affect the palmar fascia
where a pretendinous cord with time
causes the finger to flex resulting in
impaired hand function.
Purpose / Aim of Study: The aim of this study was to evaluate
the efficacy of Xiapex® treatment of
recurrence- DC at least 12 month after
Xiapex® injection.
Materials and Methods: The study was a prospective study on
consecutive series of patients with
recurrent DC and flexion deformities of
the metacarpophalangeal and/or
proximal interphalangeal joint of >200
and a palpable cord.
Our end points was reduction in
contracture, improving hand function
and patient satisfaction
Findings / Results: 144 treatments were enrolled, 124
men and 20 women, mean age 66
years [36-85].
91% of the treated fingers are the 4.
and 5. finger.
Treatment distribution MP/PIP joints
were 45/55%.
49% had a skin-rupture after
manipulation and 89% of these
patients had a need for additional visit
in our out-patient-clinic.
Mean follow-up was 15 month [12-23].
At follow-up a mean reduction in
contracture of 60/30% for MP/PIP-joint.
Mean DASH pre-injection was 15
[0-61] and at 3 months follow-up 8
[0-39].
In 6 cases (7%) there had been a need
for further treatment of Xiapex®
treated finger at 12 month
(=unacceptable recurrence).
At 12 months follow-up 44% of the
patients were satisfied or very satisfied.
Conclusions: Our results are acceptable and we find
Xiapex® a possible treatment option
for recurrence-DC-patients with a
palpable cord.
The treatment is not as effective, has a
higher recurrence-rate and lower
patient satisfaction compared to
Xiapex® treatment of primary DC.
33. Long - term results of total joint arthroplasties with Elektra prothesis in trapeziometacarpal osteoarhritis
Barbara Kulinski
Hand Unit, Southern Jutland Hospital
Background: The Elektra prothesis is a cementless
prothesis used in trapeziometacarpal
osteoarthritis.Early follow-up studies
showed fast recovery and good
functional results.Later studies with longer
follow-up indicated severe problems with
implant survival.
Purpose / Aim of Study: To report our long-term results with the
Elektra TMC prothesis
Materials and Methods: Between 2005 -2009 14 TMC joints in 13
patients (3 men,10 women) with a mean
age of 52(range 40-73) years were
operated using the Elektra prothesis.All
patients were diagnosed with symptomatic
and radiological TMC oeteoarthritis, Eaton-
Littler stage 2 and 3.One hand surgeon
performed all operations.Clinical and
radiological follow-up were performed at 3
weeks,12 weeks,52 weeks
postoperatively.In 2014 two hand surgeons
examined all implants still in place with
radiographs, grip/pinch strength and patient
perceived outcome. Blood samples were
analysed for serum cobalt and chrome.
Findings / Results: 4 implants(28%) had been revised
because of dislocation of the neck 34
months(range 3-70)postoperatively.The
necks were changed to longer
ones,however in two patients the
protheses later
had to be removed. One patient had the
prothesis removed after trauma. In two
patients revision with trapezectomy was
performed due to loose cup after 7 and 36
months.After mean follow-up of 93 months
(range 60-108) 8 patients with 9 retaining
implants (62%) were available for
follow-up.Radiographs showed no
loosening, mean quickDASH was12
(range 0-32 ),mean pinch strength was 6.5
(range 4-9)kg,mean grip strength was
30.6(range 20-42)kg.Mobility was excellent
in all patients.2 patients had elevated
serum cobalt and chrome values.
Conclusions: We found a high revision rate but excellent
functional result in the surviving protheses.
Due to high revison rate the Elektra
prothesis should be used in selected
patients.
34. Equally good methods for determination of bone quality of the trapezium
Kamille Breddam Mosegaard, Nadja Bouteldja, Maiken Stilling, Torben Bæk Hansen
Department of Orthopaedics , Regional Hospital Holstebro, Hospital Unit West, Denmark; Department of Radiology, Regional Hospital Holstebro, Hospital Unit West, Denmark; Department of Orthopaedics, Regional Hospital Holstebro, Hospital Unit West, Denmark
Background: High loosening rates of the trapezium
component in total joint arthroplasty of
the trapeziometacarpal joint may be
caused by multiple independent factors,
and one possible cause is poor bone
mineral quality of the trapezium.
However technical difficulties in
measuring the bone mineral density
(BMD) has been described due to the
irregular and sclerotic bone contours.
Purpose / Aim of Study: We wanted to compare the
measurements of bone quality of the
trapezium using DXA scan BMD with
bone quality measurements using
computed tomography (CT) and
Houndsfield units (HU).
Materials and Methods: We included 71 hands in 60 patients, 13
males and 47 females, mean age 59
years (43-77) diagnosed with Eaton–
Glickel stage II–IV osteoarthritis. In all
patients we measured the BMD of the
trapezium with two different methods:
DXA including the circumferential/cortical
part of the bone or in the center of the
trapezium alone. We also measured the
BMD of the distal radius. All BMD
measurements were compared to
measurements of the bone quality using
the HU.
Findings / Results: In the trapezium the CT measured HU in
the trapezium correlated with DXA
measured BMD (r=0.49, p=0.000) of the
trapezium (perimeter method) and with
DXA measured BMD (r=0.55, p=0.000) in
the trapezium (inner-circle method). DXA
measured BMD of the trapezium
(perimeter method) correlated (r=0.94,
p=0.000) with DXA measured BMD of
the trapezium (inner-circle method). In
the radius the average CT measured HU
in distal radius correlated with DXA
measured BMD (r=0.67, p=0.000).
Conclusions: The correlation between the two DXA
measurement methods was excellent,
and the easier inner-circle method may
be preferred. We found a good
correlation between measurements
made by CT with HU and DXA BMD in
both the distal radius and in the
trapezium using the inner circle method,
and both methods may be used.
35. Complication rates following volar plating of distal radius fractures in relation to fracture pattern and surgeon experience.
Andreas Qvist Christensen, Nina Madsen, Erik Valen, Casper Bindzus Foldager
Orthopedics, Randers Regional Hospital ; Radiology, Randers Regional Hospital
Background: Fractures of the distal radius are among the
most common injuries in orthopedics,
accounting for up to 15% of all extremity
fractures. Internal fixation using volar plating
has become increasingly popular. Reported
complication rates following volar plating
vary widely (9-60%), but are unknown in the
Danish population.
Purpose / Aim of Study: To examine complication rates following
volar plating of distal radius fractures in
relation to fracture pattern and surgeon
experience in patients operated at Randers
Regional Hospital in 2011-2012.
Materials and Methods: Patients with distal radius fractures
surgically treated with volar plating in 2011
and 2012 at Randers Regional Hospital were
enrolled in the study. Radiological
classification was performed using the AO
and Frykman. Clinical journals were
reviewed for complications. Surgeons were
categorized as resident, orthopedic surgeon
or hand surgeon. Correlation between
complications and surgeon experience or
fracture classification was investigated using
Spearman’s correlation.
Findings / Results: Seventy three patients were identified. Mean
age 64yrs (18-91) with 81% females. Most
common type was AO-27 A2.2 (25%) and
Frykman type was II (47%). Seventeen
different surgeons performed the
procedures (9 residents, 7 consultants, and
1 hand surgeon). The complication rate was
31.5%. Revision surgery rate was 16.4%
(12 pts). The most common complications
were wrist pain and implant-related
discomfort (61%). There was no correlation
between complication rate and surgeon
experience (P=0.49); fracture classification
(OA P=0.72; Frykman P=0.18).
Conclusions: We found a high complication rate of 31.5%
following volar plating, which was not related
to fracture classification or surgeon
experience in the present cohort.
36. Short term result of a stable modified Brunelli 360 degree technique for reconstruction of scapho-lunate ligament .
Allan Ibsen Sørensen, Jonny Andersson
Clinic of Hand Surgery, University Hospital Sahlgrenska
Background: Several techniques for reconstruction of the
scapho-lunate ligament have been used
during the years, but none of the techniques
have full stability of the ligament.
Purpose / Aim of Study: The aim of the study is to present short term
result of a stable modified Brunelli 360 degree
technique for reconstruction of scapho-
lunate ligament .
Materials and Methods: In the modified Brunelli technique a part
of FCR tendon or Plantaris tendon were
tunneled through scaphoideum as
Brunelli described. Then the tendon graft
is tunneled through lunate bone in AP
direction and then passed along the volar
capsule to tuberculum of the scaphoid
bone and fixed with either suture at
tuberculum or biocomposit screw in
scaphoideum. Furthermore the graft is
fixed in lunate bone with a biocomposit
screw. Fourteen patients were operated
and 2 patients twice, 13 men and 1
woman. Median age 39,8 years (19-52).
Median values are used.
Findings / Results: Median follow-up 15,6 month (2,8-36,5).
Preoperative SL distance 5,7mm and at
follow-up 2,7 mm. Dorsal/volar flexion
preoperatively 94 (35-185) of normal
wrist and at follow-up 77% (40-109),
radial/ulnar flexion 92% (35-193) versus
76% (35-133). Grip strength in KgF preop
40 (11-60) and at follow-up 42 (11-74).
VAS pain (mm) preop at rest/activity
19/67 and at FU 0/43. Watsons test
preop. positive in 10 of 11 cases and
post. op positive in 2 of 15. DISI in 8 of 13
cases preoperatively compared with one
positive of 13 post. op.. Quick DASH and
PRWE preop. 41 and 55 and at follow-up
23 and 27. There were one superficial
pin tract infection and one deep infection
in the two patients who were re-
operated due to instability.
Conclusions: In this small series modified Brunelli 360
degree technique for reconstruction of
scapho-lunate ligament seemed to have
promising short term results with a stable
fixation.