Surgical Treatment with External Fixator for Posttraumatic Carpal Instability

  • Kozo Shimada
  • Minoru Nishino
  • Tohru Kadowaki
  • Tomio Yamamoto
Chapter
Part of the NATO ASI Series book series (NSSA, volume 256)

Abstract

In case of posttraumatic carpal instability, especially a chronic case with malunion or nonunion after a fracture in the wrist region, we have reconstructed the bony structure at the originally injured site with a bone graft, repaired the ligaments and maintained it under the effect of ligamentotaxis by the external fixator “Orthofix Pennig Model” (Figure 1). The purpose of this paper is to describe our surgical procedure and clinical experience, and also clarify the effectiveness and problems of this procedure. We also present a cadaver study to demonstrate the effect of this procedure from a biomechanical point of view.

Keywords

Grip Strength Distal Radius Carpal Bone Wrist Pain Ulnar Variance 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    L. Böhler, Translated from the 13th German ed. by H. Tretter, H.B. Luchini, K. Kreuz, O.A. Russe, R.G.B. Bjornson, The treatment of fractures, Grune & Stratton, New York (1956).Google Scholar
  2. 2.
    W.P. Cooney, J.H. Dobyns, and R.L. Linscheid, Non-union of the scaphoid; analysis of the results from bone grafting, J. Hand Surg. 5:343 (1980).Google Scholar
  3. 3.
    D.L. Fernandez, A technique for anterior wedge-shaped grafts for scaphoid nonunions with carpal instability, J. Hand Surg. 9-A:733 (1984).Google Scholar
  4. 4.
    D.L. Fernandez, and R. Ghillani, External fixation of complex carpal dislocation: a clinical report, J. Hand Surg. 12-A:335 (1987).Google Scholar
  5. 5.
    G.R. Fisk, Carpal instability and the fractured scaphoid, Ann. R. Coll. Surg. Engl. 46:63 (1970).PubMedGoogle Scholar
  6. 6.
    G.R. Fisk, Overview of wrist injuries, Clin. Orthop. 149:137 (1980).PubMedGoogle Scholar
  7. 7.
    G.R. Fisk, Volar wedge grafting of the carpal scaphoid in non-union associated with dorsal instability patterns (discussion), J. Bone Joint Surg. 64-B:632 (1982).Google Scholar
  8. 8.
    J.M.G. Kauer, The mechanism of the carpal joint, Clin. Orthop. 202:16 (1986).PubMedGoogle Scholar
  9. 9.
    K.S. Leung, W.Y. Shen, P.C. Leung, A.W. Kinninmonth, J.C. Chang, and G.P. Chan, Ligamentotaxis and bone grafting for comminuted fractures of the distal radius, J. Bone Joint Surg. 71-B:838 (1989).Google Scholar
  10. 10.
    R.L. Linscheid, J.H. Dobyns, J.W. Beabout, and R.S. Bryan, Traumatic instability of the wrist; diagnosis, classification and pathomechanics, J. Bone Joint Surg. 54-A: 1612 (1972).Google Scholar
  11. 11.
    K. Shimada, K. Tada, T. Yoshida, and T. Shibata, Treatment for ulnar wrist disorders (in Japanese), J. Jpn Soc. Surg. Hand 7:626 (1990).Google Scholar
  12. 12.
    J. Vidal, Ch. Buscayret, M. Paran, and J. Melka, Ligamentotaxis, in: D.C. Mears ed. External skeletal fixation, Williams & Wilkins, Baltimore (1983).Google Scholar
  13. 13.
    E.R. Weber, Biomechanical implications of scaphoid waist fractures, Clin. Orthop. 149:83 (1980).PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1994

Authors and Affiliations

  • Kozo Shimada
    • 1
  • Minoru Nishino
    • 1
  • Tohru Kadowaki
    • 1
  • Tomio Yamamoto
    • 1
  1. 1.Department of Orthopaedic SurgeryOsaka Kosei-nenkin HospitalOsakaJapan

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