[Carpal instability].

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Abstract

[Indexed for MEDLINE] 2. J Hand Surg Am. 2021 Jul;46(7):622.e1-622.e12. doi: 10.1016/j.jhsa.2020.11.016. Epub 2021 Apr 10. Carpal Kinematics in Madelung Deformity. Peymani A(1), de Roo MGA(2), Dobbe JGG(3), Streekstra GJ(4), McCarroll HR(5), Strackee SD(6). Author information: (1)Department of Plastic, Reconstructive and Hand Surgery; Department of Biomedical Engineering and Physics. Electronic address: a.peymani@amsterdamumc.nl. (2)Department of Plastic, Reconstructive and Hand Surgery; Department of Biomedical Engineering and Physics. (3)Department of Biomedical Engineering and Physics. (4)Department of Biomedical Engineering and Physics; Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. (5)Department of Orthopaedic Surgery, California Pacific Medical Center, San Francisco, CA. (6)Department of Plastic, Reconstructive and Hand Surgery. PURPOSE: Various skeletal and soft tissue abnormalities have been identified in Madelung deformity and have been hypothesized to play a causal role in its progressive symptomatology; however, our pathological understanding of these changes remains limited. In this study, we biomechanically assessed the Madelung deformity wrist, using 4-dimensional computed tomography imaging. METHODS: Nine Madelung deformity wrists (5 patients; age, 24 ± 5 y) and 18 healthy wrists (9 volunteers; age, 28 ± 3 y) underwent 4-dimensional imaging during flexion-extension motion and radioulnar deviation. Carpal kinematics and radiocarpal joint parameters were quantified and compared. RESULTS: In Madelung deformity wrists, significantly decreased rotation was seen in the lunate (-4.6°) and the triquetrum (-4.8°) during flexion-extension motion. During radioulnar deviation, significant decreases were visible in lunate bone translation (-0.7 mm), triquetrum bone translation (-0.6 mm), and triquetrum bone rotation (-1.9°). Patients had significantly decreased articulating surface areas of the scaphoid (1.4 ± 0.2 cm2 versus 1.6 ± 0.2 cm2) and lunate (1.2 ± 0.4 cm2 versus 1.5 ± 0.3 cm2) fossa, and significantly increased radioscaphoid (1.3 ± 0.1 mm versus 1.2 ± 0.1 mm) and radiolunate (1.6 ± 0.2 mm versus 1.3 ± 0.3 mm) joint space thicknesses. CONCLUSIONS: There is a decreased mobility of the lunate and triquetrum bones in Madelung deformity. CLINICAL RELEVANCE: Four-dimensional imaging could be used in future studies that investigate the effect of surgical ligament release on carpal kinematics and subsequent wrist mobility. Copyright © 2021 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved. DOI: 10.1016/j.jhsa.2020.11.016