Congratulations to Drs. Delman, Saiz, Haffner, McNary, Szabo and Bayne for their collaboration on the paper: The Biomechanical Effects of Radioscapholunate Fusion with Distal Scaphoidectomy, Four-Corner Fusion with Complete Scaphoidectomy, and Proximal Row Carpectomy Compared to the Native Wrist.
Their paper received the 2020 Linscheid-Dobyns "Excellence in Wrist Research" Award. This award is given out annually to recognize the best wrist paper presented at the ASSH Annual Meeting. My name is Connor Delmon Hyman, orthopedic surgery resident at U. C. Davis Medical Center. I'll be presenting on the biomechanical effects of simulated radio Scapa Loony fusion with distal skateboard ectomy for corn infusion with complete skateboard ectomy and proximal row carp ectomy. Compared to the native wrist, my co authors and I have no conflicts of interest relevant to the content presented in this discussion. Starting off with the background, we know that scaffold Luna Advance collapse effects 55% of patients with risked osteoarthritis. The radiographic classifications includes Stage one disease, which involves the distal, scaphoid and radio style oId Stage two, which involves the entirety of the radio skateboard joint in Stage three, which involves the scaffold, capita and or capital loony Joint surgical treatment of slack typically involves a limited carp ectomy or limited carpal fusion for Stage two slack in particular, treatment options include a great escape Allouni fusion with distal skateboard ectomy, with or without a try creature may excision, a four corner fusion with complete skateboard ectomy and a proximal row carp ectomy. Data is lacking, comparing the biomechanical effects of each of these techniques. Therefore, this study aimed to determine the effect. A simulated radio skiffle unit fusion with the distal skate foot ectomy, four corner fusion and proximal row carp ectomy on wrist, range of motion, joint contact area joint contact pressure and joint contact Force at the principal risk articulation Compared to the native wrist, we have prophesized that compared to the intact native risk, there would be a decrease in range of motion after each procedure, with no difference between the three simulated techniques. That proximal Ralcorp ectomy would result in increased proximal capital pressures and that contact pressures at the Capitol. Skillful loony articulation following a raid escaping loony fusion with the distal skateboard ectomy and the radio loony articulation following a four corner fusion would be similar. Looking at our methods. 10 cattle Erica specimens were included in the study. They were all donated from institutions body donation program. There were seven female and three male specimens. A radiographic evaluation was performed to assess for radio carpal and metacarpal, or throw sis, or underlying skeletal abnormality, and this was confirmed via dorsal ligament sparing approach. Any specimens with underlying arthritis were excluded from the study. Each simulated procedure was performed sequentially. First, a radio skate foot loony fusion with distal skateboard Act Me was performed using 1.6 millimeter K wires has shown here on the right hand side of the screen. Next, the radio loony and radio skateboard wires were removed and the complete excision on the skateboard was performed. This allowed for a four corner fusion to be performed with retrograde placement of 1.6 millimeter Kjaer's between the distal and proximal row has shown here on the right side of your screen. Lastly, approximate Real Corp ectomy was performed following removable the K wires with complete excision of the loony and the trek reach room. Range of motion testing was performed after each procedure, using a specific Coney Ometer at 1.5 kg weight was applied to the third metacarpal head to measure flexion and extension has shown here on the right and the way it was applied to the second metacarpal head and fourth metacarpal head for radial and ulnar deviation, respectively. Bio mechanical testing was in performed sequentially. Mechanical loading system with the 445 new and load cell was used to apply a force to the third metacarpal in a direction co linear to the long axis of the radius and the ulna until a 35 new and reaction force was reached for 30 seconds. The contact area and contact pressure were then determined using a pressure sensitive film which was placed at the principal risk articulation of interest. Looking at our results, each simulated procedure resulted in a decrease in range of motion. Groups not connected by the same letter were determined to be significantly different. Looking at the wrist arc range of motion and degrees on the Y axis plotted by procedure type, you can see that there was a significant decrease in the range of motion arc for the radios capable in a fusion with distal skateboard ectomy group, as well as for the four corner Fusion Group. Compared to the intact native Risk specimen, there is also a decrease in range of motion in approximately carp ectomy group. Compared to the native specimen. However, approximately carp ectomy group had significantly more range of motion than the other procedure types. Each simulated procedure resulted in increased carpal pressures compared to the native wrist. Looking at carpal pressures plotted on the Y axis and make a Paschal's, you can see that the Radius Capel, Innit? Fusion Group did not reach statistically significant lower carpal pressures compared to the four corner fusion group, but did have significantly decreased carpal pressures compared to the Proximal Row Corp ectomy group, there was no significant difference in carpal pressures between the four corner fusion Approximate row crop ectomy simulated groups. No difference in contact area was demonstrated between the procedure types. When looking at the principal risked articulation. Lastly, each simulated procedure resulted in increased corporate forces. As you can see here, the main contact force plotted on the Y axis the great escape fill in a fusion treatment group had decreased mean contact forces compared to the proximate Ralcorp Ectomy group. But similar mean contact forces to the four corner Fusion Group in summary compared to the native wrist for corner fusion results in decrease range of motion in increased carpal pressures and contact forces approximately oh crap ectomy best maintained range of motion but increases carpal pressures and contact forces and radios capable. Any fusion with distal skateboard ectomy results in a mild reduction, a range of motion. But as the smallest increase in carpal pressures and contact forces, this study therefore supports considering a rate of skillful in a fusion with distal skateboard ectomy in the treatment of patients with stage to slack, given the overall favorable range of motion profile and decreased mid carpal forces. If the decreased range of motion profile of the raid escape Fellini Fusion and Distal Skateboard Ectomy Group is of concern to surgeons, they can consider the addition of a tree creature, um, excision at the time of the procedure. While our current study protocol prohibited the evaluation of this technique, it has been previously demonstrated that the addition of a try creature excision significantly increases range of motion. Furthermore, previous testing performed in our laboratory demonstrated that the addition of a truck protector me after simulated fusion does not significantly alter contact forces. My co authors and I would like to think the American Society for Surgery of the Hand for having us present our findings today. I can be reached at the email address shown here on the screen again, Thank you for your time attached are references for your review