Silicone rubber implants for the replacement of the carpal scaphoid and lunate bones.
TL;DR: A new type of replacement arthroplasty of the scaphoid and lunate carpal bones with silicone rubber implants is presented in this article, where indications for their use and the technique for their insertion are discussed.
About: This article is published in Orthopedic Clinics of North America.The article was published on 1970-11-01. It has received 103 citations till now. The article focuses on the topics: Lunate & Carpal bones.
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TL;DR: Four thousand wrist x-ray films were reviewed to establish the pattern of sequential changes in degenerative arthritis of the wrist, and Flexion-extension and radial-ulnar deviation motions showed considerable improvement after the operation.
Abstract: Four thousand wrist x-ray films were reviewed to establish the pattern of sequential changes in degenerative arthritis of the wrist. After eliminating all other arthritides, we studied 210 cases of degenerative arthritis. The most common pattern (57%) was arthritis between the scaphoid, lunate, and radius; 27% of cases occurred between the scaphoid, trapezium, and trapezoid; a combination of these two patterns occurred in 15%. Twenty operations were performed on 19 patients with the scapholunate advanced collapse pattern. Eighteen of 19 patients had less pain postoperatively and none required pain medication. Flexion-extension and radial-ulnar deviation motions showed considerable improvement after the operation.
925 citations
TL;DR: A retrospective radiographic analysis of 64 patients with symptomatic scaphoid nonunions without previous surgical treatment showed a high frequency of degenerative changes occurring in a predictable sequence and Instability was progressive and associated with an earlier onset of arthritis.
Abstract: A retrospective radiographic analysis of 64 patients with symptomatic scaphoid nonunions without previous surgical treatment was accomplished. The results showed a high frequency of degenerative changes occurring in a predictable sequence. For nonunions of 4 years duration, 75 % of patients had radioscaphoid changes, and for those of 9 years duration 60 % of the patients had midcarpal changes. The pattern of arthritis in scaphoid nonunion is that of scapholunate advanced collapse (SLAC) wrist resulting from rotary subluxation of the distal scaphoid fragment. The radius-proximal scaphoid fragment joint and the radiolunate joint were consistently spared from degenerative changes, even with severe arthritis. Instability was progressive and associated with an earlier onset of arthritis. Patients with symptomatic scaphoid nonunions appear to have a significant likelihood of arthritis developing.
254 citations
TL;DR: Patients who have had silicone arthroplasties should be followed indefinitely, at regular intervals, by x-ray films and clinical examination.
Abstract: A number of patients with silicone rubber implants performed by us and other surgeons initially had excellent results; however, they returned with swelling and discomfort. We studied 18 patients ranging in age from 16 years to 57 years who presented 8 to 78 months (average, 31.7 months) after silicone arthroplasty (four scaphoid, six lunate, one scapholunate, four finger, two wrist, one trapezium, and one ulnar head for metacarpal hemiarthroplasty). Erosive osteolysis was seen on x-ray films, with progressive destruction evident in patients followed serially. None of the patients' conditions responded to conservative care. The severity of the proliferative, inflammatory synovitis and the foreign material in the multinucleated giant cells correlated with the interval since arthroplasty. Implant surface analysis by scanning electron microscope and x-ray spectrometer showed that silicone microparticles were the result of implant degeneration and erosion. All joint cultures were negative. Silicone particulate synovitis and destruction were arrested by the removal of the implant, a synovectomy, and curettage of the lytic lesions at salvage (resection arthroplasty or arthrodesis.) Patients who have had silicone arthroplasties should be followed indefinitely, at regular intervals, by x-ray films and clinical examination.
170 citations
TL;DR: It is believed that triscaphe arthrodesis with a silicone rubber lunate provides a means for load transference and heavy stress use capability of the hand.
Abstract: Sixteen patients with Kienbock's disease were treated with triscaphe arthrodesis (fusion of the scaphoid, trapezium, and trapezoid) with or without silicone rubber lunate arthroplasty. This approach removes compressive stress from the diseased lunate and treats the accompanying rotary subluxation of the scaphoid. Five patients were treated with triscaphe arthrodesis together with silicone rubber lunate arthroplasty. Three patients, who were symptomatic, after receiving silicone rubber lunate arthroplasty elsewhere, were treated with triscaphe arthrodesis. Eight patients were treated with triscaphe arthrodesis alone, without silicone rubber lunate arthroplasty. Two of these eight patients later required silicone rubber lunate arthroplasty. Radial styloidectomy and small lunate fragment excision were performed later on one patient. After an average follow-up of 20.5 months, relief of pain was satisfactory in all 16 patients. There was neither nonunion nor surgical infection. We believe that triscaphe arthrodesis with a silicone rubber lunate provides a means for load transference and heavy stress use capability of the hand. Triscaphe arthrodesis alone may suffice to bear the wrist load and can be used in an effort to preserve the diseased lunate. A silicone rubber lunate can easily be added at a later date if necessary.
162 citations
TL;DR: In a previous paper, early lunate silicone replacement arthroplasty for Kienbock's disease was advocated because of poor results obtained in stage III disease, and an additional 16 patients have been operated on, and 12 underwent successful SRA.
Abstract: In a previous paper, early lunate silicone replacement arthroplasty (SRA) for Kienbock's disease was advocated because of poor results obtained in stage III disease. Since then, an additional 16 patients have been operated on. Thirteen had stage III disease, and 12 underwent successful SRA. This result is attributed to the modification in anatomical configuration and the improvement in the physical characteristics of the new high-performance silicone lunate implant. Because SRA gives good results in a high percentage of patients in stage III disease, alternative modes of therapy may be considered in stage I or stage II disease without jeopardizing the ultimate result from SRA in stage III disease.
148 citations
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574 citations
TL;DR: In this article, Uber Anatomische Variationen der Handgelenkknochen is described and compared to the original handgelenknochens. But this time, the variations are different.
Abstract: (1928). Uber Anatomische Variationen der Handgelenkknochen. Acta Radiologica: Vol. 9, No. 2, pp. 155-168.
286 citations
276 citations
TL;DR: Excision of the proximal row of the carpus is a useful procedure, with a limited application in patients with ununited fractures of the scaphoid, Kienbock's disease, dislocation of the lunate bone, unreduced mid-carpal dislocations and similar injuries which do not respond to conservative management.
Abstract: 1. Excision of the proximal row of the carpus is a useful procedure, with a limited application in patients with ununited fractures of the scaphoid, Kienbock's disease, dislocation of the lunate bone, unreduced mid-carpal dislocations and similar injuries which do not respond to conservative management.
2. It is an acceptable alternative to arthrodesis, even when the wrist is likely to be subjected to heavy use.
3. In the event of failure arthrodesis can still be carried out.
4. Advanced degenerative changes are a contra-indication but mild to moderate changes do not appear to affect the results.
158 citations
TL;DR: Although some weakness of grasp and loss of motion occur after this procedure, these disabilities are not as severe as previously believed and did not seem to develop with time and prolonged use.
Abstract: Twenty-two cases of proximal-row carpectomy are presented. After follow-up periods of from three to seventeen years the results were excellent in fourteen, good in five, and fair in three.
Degenerative changes did not seem to develop with time and prolonged use. Changes of this type were observed in only one wrist ten years after operation.
Although some weakness of grasp and loss of motion occur after this procedure, these disabilities are not as severe as previously believed. All of the patients were pleased with their results.
126 citations