Document Type : Original Research
Authors
1 Joint and Bone Research Center, Shiraz University of Medical Sciences, Shiraz Iran
2 Department of Orthotics and Prosthetics, Rehabilitation Faculty of Shiraz University of Medical Sciences Shiraz Iran
3 Orthopedic and Rehabilitation Research Center, Shiraz University of Medical Sciences Shiraz Iran
Abstract
Background: Patients with Lunotriquetral Interosseous Ligament (LTIL) injuries often experience wrist pain and carpal instability, resulting in challenging treatment. The optimal surgical approach has to be determined for addressing this condition.
Objective: The current study aimed to assess the postoperative outcomes of orthopedic devices in lunotriquetral fixation using a 3D model.
Material and Methods: This computer simulation study aimed to develop a three-dimensional model of a normal wrist joint. The study then simulated LTIL tears and compared three surgical methods for fusing the lunate and triquetrum bones using a pin, a screw, and a combination of both.
Results: Based on normal mechanistic behavior in terms of anteroposterior and mediolateral displacement of the lunate bone, the results are presented. However, the use of pin-fixation is significantly superior to the other methods with a displacement of 1.65 and 1.47 mm in fixation versus 0.32 and 0.64 mm in normal anatomy. This approach also significantly decreased the stress on the lunate bone and showed the least stress on the orthopedic device compared to other surgical approaches. For the triquetrum bone, pin fixation proved superior in controlling anteroposterior and vertical motions. This method also imposed significantly less stress on the triquetrum compared to using a screw or double instrumentation.
Conclusion: Lunotriquetral fusion can be achieved using a pin, which provides better results than fusion with a screw or the combined use of a screw and pin.
Highlights
Hamid Namazi (Google Scholar)
Mohammad Taghi Karimi (Google Scholar)
Keywords
- Wilson MS. Diagnosis and Management of Lunotriquetral Ligament Injuries. Curr Rev Musculoskelet Med. 2023;16(2):55-59. doi: 10.1007/s12178-022-09819-7. PubMed PMID: 36689137. PubMed PMCID: PMC9889576.
- Berger RA. The anatomy of the ligaments of the wrist and distal radioulnar joints. Clin Orthop Relat Res. 2001;383:32-40. doi: 10.1097/00003086-200102000-00006. PubMed PMID: 11210966.
- Weiss LE, Taras JS, Sweet S, Osterman AL. Lunotriquetral injuries in the athlete. Hand Clin. 2000;16(3):433-8. PubMed PMID: 10955216.
- Mayfield JK, Johnson RP, Kilcoyne RK. Carpal dislocations: pathomechanics and progressive perilunar instability. J Hand Surg Am. 1980;5(3):226-41. doi: 10.1016/s0363-5023(80)80007-4. PubMed PMID: 7400560.
- Asaad AM, Andronic A, Newby MP, Harrison JWK. Diagnostic accuracy of single-compartment magnetic resonance arthrography in detecting common causes of chronic wrist pain. J Hand Surg Eur Vol. 2017;42(6):580-5. doi: 10.1177/1753193417695180. PubMed PMID: 28488454.
- Van De Grift TC, Ritt MJ. Management of lunotriquetral instability: a review of the literature. J Hand Surg Eur Vol. 2016;41(1):72-85. doi: 10.1177/1753193415595167. PubMed PMID: 26188693.
- Nicoson MC, Moran SL. Diagnosis and Treatment of Acute Lunotriquetral Ligament Injuries. Hand Clin. 2015;31(3):467-76. doi: 10.1016/j.hcl.2015.04.005. PubMed PMID: 26205708.
- Nelson DL, Manske PR, Pruitt DL, Gilula LA, Martin RA. Lunotriquetral arthrodesis. J Hand Surg Am. 1993;18(6):1113-20. doi: 10.1016/0363-5023(93)90412-V. PubMed PMID: 8294751.
- Anderson DD, Deshpande BR, Daniel TE, Baratz ME. A three-dimensional finite element model of the radiocarpal joint: distal radius fracture step-off and stress transfer. Iowa Orthop J. 2005;25:108-17. PubMed PMID: 16089082. PubMed PMCID: PMC1888764.
- Bajuri MN, Abdul Kadir MR, Murali MR, Kamarul T. Biomechanical analysis of the wrist arthroplasty in rheumatoid arthritis: a finite element analysis. Med Biol Eng Comput. 2013;51(1-2):175-86. doi: 10.1007/s11517-012-0982-9. PubMed PMID: 23124814.
- Ledoux P, Lamblin D, Wuilbaut A, Schuind F. A finite-element analysis of Kienbock’s disease. J Hand Surg Eur Vol. 2008;33(3):286-91. doi: 10.1177/1753193408090757. PubMed PMID: 18562358.
- Ramlee MH, Beng GK, Bajuri N, Abdul Kadir MR. Finite element analysis of the wrist in stroke patients: the effects of hand grip. Med Biol Eng Comput. 2018;56(7):1161-71. doi: 10.1007/s11517-017-1762-3. PubMed PMID: 29209961.
- Namazi H, Ghaedi E, Karimi MT. Comparison of Biomechanical Results about the Effect of Three Surgery Methods in Decompression of Lunate Bone. J Wrist Surg. 2021;10(4):296-302. doi: 10.1055/s-0041-1723976. PubMed PMID: 34381632. PubMed PMCID: PMC8328553.
- Sennwald GR, Fischer M, Mondi P. Lunotriquetral arthrodesis. A controversial procedure. J Hand Surg Br. 1995;20(6):755-60. doi: 10.1016/s0266-7681(95)80042-5. PubMed PMID: 8770736.
- Vandesande W, De Smet L, Van Ransbeeck H. Lunotriquetral arthrodesis, a procedure with a high failure rate. Acta Orthop Belg. 2001;67(4):361-7. PubMed PMID: 11725568.
- Guidera PM, Watson HK, Dwyer TA, Orlando G, Zeppieri J, Yasuda M. Lunotriquetral arthrodesis using cancellous bone graft. J Hand Surg Am. 2001;26(3):422-7. doi: 10.1053/jhsu.2001.24969. PubMed PMID: 11418902.
- Özçelik İB, Ayik Ö, Demirel M, Yildirim T, Uğurlar M. Arthroscopic Dorsal Ligamentocapsulodesis in the Treatment of Isolated Lunotriquetral Interosseous Ligamentous Injury: A Retrospective Case Series of 22 Patients. J Hand Surg Asian Pac Vol. 2022;27(3):480-90. doi: 10.1142/S2424835522500485. PubMed PMID: 35674261.
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