The ligaments of the wrist
The ligaments of the wrist were studied by dissecting ten fixed and seven fresh frozen wrists. In three other specimens multiple cross-sections were prepared. These studies show that the wrist ligaments can be classified into two groups: extrinsic and intrinsic. In the extrinsic group, the deep volar radiocarpal ligaments are three strong and very important structures connecting the radius to the capitate, the radius to the lunate, and, in a deeper layer, the radius to both the scaphoid and the lunate. A ligamentous deficiency was noted frequently between the capitate and the lunate. There also are very strong volar connections between the radius and the medial or ulnar carpus. These studies suggest that certain patients with a generalized ligamentous laxity and weakness will develop a pathological disruption of the volar ligaments with trauma. These torn volar ligaments should be repaired or reconstructed, for repair of only the dorsal ligaments seldom will provide good stability to such wrists.
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Cited by (331)
Scaphoid, lunate and capitate kinematics in the normal and ligament deficient wrist: A bi-plane X-ray fluoroscopy study
2023, Journal of BiomechanicsThe ligamentous structures of the wrist stabilise and constrain the interactions of the carpal bones during active wrist motion; however, the three-dimensional translations and rotations of the scaphoid, lunate and capitate in the normal and ligament deficient wrist during planar and oblique wrist motions remain poorly understood. This study employed a computer-controlled simulator to replicate physiological wrist motion by dynamic muscle force application, while carpal kinematics were simultaneously measured using bi-plane x-ray fluoroscopy. The aim was to quantify carpal kinematics in the native wrist and after sequential sectioning of the scapholunate interosseous ligament (SLIL) and secondary scapholunate ligament structures. Seven fresh-frozen cadaveric wrist specimens were harvested, and cycles of flexion–extension, radial-ulnar deviation and dart-thrower’s motion were simulated. The results showed significant rotational and translational changes to these carpal bones in all stages of disruptions to the supporting ligaments (p < 0.05). Specifically, following the disruption of the dorsal SLIL (Stage II), the scaphoid became significantly more flexed, ulnarly deviated, and pronated relative to the radius, whereas the lunate became more extended, supinated and volarly translated (p < 0.05). Sectioning of the dorsal intercarpal (DIC), dorsal radiocarpal (DRC), and scaphotrapeziotrapezoid (STT) ligaments (Stage IV) caused the scaphoid to collapse further into flexion, ulnar deviation, and pronation. These findings highlight the importance of all the ligamentous attachments that relate to the stability of the scapholunate joint, but more importantly, the dorsal SLIL in maintaining scapholunate stability, and the preservation of the attachments of the DIC and DRC ligaments during dorsal surgical approaches. The findings will be useful in diagnosing wrist pathology and in surgical planning.
Treatment of chronic scapholunate instability according to the functional demand of the wrist
2023, Hand Surgery and RehabilitationScapholunate instability is the most common form of carpal instability. Complete scapholunate ligamentous complex failure can lead to pain, reduced functional performance, and scapholunate advanced collapse if untreated. The goal of surgery for chronic scapholunate instability (diagnosed later than 6 weeks) before onset of osteoarthritis is to correct the scapholunate instability in order to reduce pain while limiting loss of motion and protecting against osteoarthritis-related collapse in the long-term. Because many ligament reconstruction techniques have been described and not every patient is a candidate for a demanding procedure, we addressed the question of what is the best adapted treatment for each stage of chronic scapholunate instability? This article reviews the anatomy and biomechanical properties of the scapholunate complex and the current diagnostic tools in scapholunate instability. A treatment algorithm based on instability stage and the patient’s functional demand is proposed.
III.
L’instabilité scapho-lunaire est la plus fréquente des instabilités du carpe. La déficience complète du complexe ligamentaire scapho-lunaire peut entrainer douleur, impotence fonctionnelle et arthrose par collapsus du carpe en l’absence de traitement. Le but d’une intervention pour instabilité scapho-lunaire chronique (vue à plus de 6 semaines) avant l’apparition d’arthrose est de corriger l’instabilité afin de diminuer la douleur sans perdre trop en mobilité et d’arrêter ainsi le processus dégénératif arthrosique à long terme. Parce que de nombreuses techniques de reconstruction du ligament scapho-lunaire ont été décrites et parce que chaque patient n’est pas forcément candidat à une chirurgie lourde, nous avons essayé de répondre à la question: quel est le traitement le plus adapté au patient à chaque stade de l’instabilité scapho-lunaire chronique? Ce travail passe en revue l’anatomie du complexe scapho-lunaire, ses propriétés biomécaniques et les moyens de diagnostic actuels de dépistage l’instabilité scapho-lunaire. Un algorithme de traitement, basé sur le degré d’instabilité et sur la demande fonctionnelle du patient, est proposé.
III.
Augmented reality-based surgical guidance for wrist arthroscopy with bone-shift compensation
2023, Computer Methods and Programs in BiomedicineIntraoperative joint condition is different from preoperative CT/MR due to the motion applied during surgery, inducing an inaccurate approach to surgical targets. This study aims to provide real-time augmented reality (AR)-based surgical guidance for wrist arthroscopy based on a bone-shift model through an in vivo computed tomography (CT) study.
To accurately visualize concealed wrist bones on the intra-articular arthroscopic image, we propose a surgical guidance system with a novel bone-shift compensation method using noninvasive fiducial markers. First, to measure the effect of traction during surgery, two noninvasive fiducial markers were attached before surgery. In addition, two virtual link models connecting the wrist bones were implemented. When wrist traction occurs during the operation, the movement of the fiducial marker is measured, and bone-shift compensation is applied to move the virtual links in the direction of the traction. The proposed bone-shift compensation method was verified with the in vivo CT data of 10 participants. Finally, to introduce AR, camera calibration for the arthroscope parameters was performed, and a patient-specific template was used for registration between the patient and the wrist bone model. As a result, a virtual bone model with three-dimensional information could be accurately projected on a two-dimensional arthroscopic image plane.
The proposed method was possible to estimate the position of wrist bone in the traction state with an accuracy of 1.4 mm margin. After bone-shift compensation was applied, the target point error was reduced by 33.6% in lunate, 63.3% in capitate, 55.0% in scaphoid, and 74.8% in trapezoid than those in preoperative wrist CT. In addition, a phantom experiment was introduced simulating the real surgical environment. AR display allowed to expand the field of view (FOV) of the arthroscope and helped in visualizing the anatomical structures around the bones.
This study demonstrated the successful handling of AR error caused by wrist traction using the proposed method. In addition, the method allowed accurate AR visualization of the concealed bones and expansion of the limited FOV of the arthroscope. The proposed bone-shift compensation can also be applied to other joints, such as the knees or shoulders, by representing their bone movements using corresponding virtual links. In addition, the movement of the joint skin during surgery can be measured using noninvasive fiducial markers in the same manner as that used for the wrist joint.
The morphologic and morphometric features of the triquetrum
2023, Hand Surgery and RehabilitationFractures of the triquetrum are the second most common form of isolated carpal bone fracture after the scaphoid. However, data on triquetrum morphology and morphometry are sparse. The aim of this study was to describe the morphology of triquetrum using anatomical landmarks, evaluate its morphometric features, and determine its vascular entry points. The morphological and morphometrical features of 87 adult dry triquetral bones (39 left, 48 right) were determined by measuring length, width and thickness. The number and locations of nutrient foramina wider than 0.5 mm were recorded. Mean length, width and thickness were 17.37 mm (range, 14.26–22.13), 12.65 mm (range, 10.37–15.85) and 11.41 mm (range, 8.98–18.23), respectively. The facet articulating with the pisiform was oval in 40 bones, round in 8 and amorphous (neither round nor oval) in 39. The mean length of the interarticular ridge was 7.09 ± 0.9 mm. The mean number of nutrient foramina was significantly greater on the dorsal than on the other aspects. The dorsal predominance of nutrient foramina makes the bone weaker in the dorsal region, which could explain why fractures are more common in this region. Also, the dorsal aspect is rich in blood supply, which could explain why avascular necrosis is less common in triquetral fractures. As most of the vascularization is on the dorsal side, there is need for caution when performing triquetrum surgery.
Level 2.
Les fractures du triquétrum sont les fractures isolées les plus courantes du carpe après celles du scaphoïde. Cependant, il existe peu de données sur la morphologie et la morphométrie du triquétrum dans la littérature. L’objectif de cette étude était de décrire la morphologie du triquétrum à l’aide de repères anatomiques, d’évaluer ses caractéristiques morphométriques et de déterminer ses points d’entrée vasculaires. Les caractéristiques morphologiques et morphométriques de 87 triquétrum secs adultes (39 gauches, 48 droits) ont été déterminées en mesurant la longueur, la largeur et l’épaisseur de l’os. Le nombre et l’emplacement des foramens nourriciers d’un diamètre supérieur à 0,5 mm ont été évalués. La longueur, la largeur et l’épaisseur moyennes du triquétrum étaient respectivement de 17,37 mm (min: 14,26, max: 22,13), 12,65 mm (min: 10,37, max: 15,85) et 11,41 mm (min: 8,98, max: 18,23). La face s’articulant avec l’os pisiforme était ovale sur 40 os, ronde sur 8 os et amorphe (ni ronde ni ovale) sur 39 os. La longueur moyenne de la crête interarticulaire était de 7,09 ± 0,9 mm. Le nombre moyen de foramens nourriciers sur la face dorsale était significativement plus élevé que sur les autres. La prédominance des foramens nourriciers sur la face dorsale rend l’os plus fragile dans sa région dorsale et pourrait expliquer que les fractures sont plus fréquentes dans cette région. De plus, la face dorsale est riche en apports sanguins et cela pourrait être la raison pour laquelle la nécrose avasculaire est moins fréquente dans les fractures du triquétrum. En outre, la majeure partie de la vascularisation se trouve sur la face dorsale, ce qui indique l’importance d’être prudent lors de la chirurgie du triquétrum.
Niveau 2.
Anatomical study of all carpal and adjoining bones of the wrist using 3D CT reconstruction –Finding the ultimate biomechanical theory
2022, Annals of AnatomyThe complex interplay of single wrist bones acting in combination with their ligamentous connections is still not fully understood. In this regard various theories exist, divisible in columnar and ring/row theories. The object of this study was to examine the mobility of the individual carpal bones as well as the ulna and metacarpals relative to each other in wrists of cadaveric hands using CT scans.
The regular wrist mobility of a total of 21 cadaveric hands was examined by CT imaging in neutral position, radial/ulnar abduction as well as wrist flexion and extension. The data were evaluated as 3D models by using a standardized global coordinate system and object coordinate systems. Rotation and translation of each carpal bone as well as radius/ulna and all metacarpal bones were evaluated.
The principal motion took place in the carpus between the radius and the proximal carpal row followed by the midcarpal joint and the carpometacarpal joints and not mainly between the individual bones of a row. The scaphoid moves out of its row aggregate mainly during flexion and adapts to the motion of the distal carpal row. The trapezium and first metacarpal bones play a specific role detached from the remaining bones.
With this study, a better understanding of the motion of the individual bones of the carpus, the metacarpals and the radius/ulna is shown. The study supports the row theory, where most motion takes place between the individual rows and not between the carpal bones, leaving the scaphoid and the first ray in a special role between the rows.