PATIENT OUTCOMES FOLLOWING REDUCTION AND ASSOCIATION OF THE SCAPHOID AND LUNATE
Notice bibliographique
Résumé
Scapholunate lunate ligament (SLL) injury is the most common ligamentous injury of the wrist; however, the optimal surgical management remains unclear [1,2]. One promising technique for SLL reconstruction is the Reduction and Association of the Scaphoid and Lunate procedure (RASL), first described by Rosenwasser [3]. Despite promising preliminary outcomes by the creator [4], the outcomes of this procedure remain variable [5]. The objective of this retrospective analysis was to investigate factors affecting patient outcomes following the RASL procedure. Twenty-three patients who had a SLL tear treated with a RASL using a dual-incision approach as described by Rossenwasser [3] completed the data collection process. Participants completed a demographic survey and three standardized patient-reported outcome tools (DASH, PRWE and PROMIS questionnaires). Standard wrist radiographs were taken, and bilateral wrist range-of-motion and grip strength were measured. The scapholunate interval, scapholunate angle, radioscaphoid angle, radiolunate angle were measured preoperatively, intraoperatively, and at long-term follow up. The intraoperative images were used to assess screw placement. All measurements were taken by the primary author and independently verified by two board-certified hand surgeons. The average time since surgery was 6.3 years, with a minimum time since surgery of 2.2 years and a maximum of 11.1 years. The average age was 36.2 (SD 11) years at the time of injury. At the time of final follow-up, the average DASH score was 11.2 (SD 13). There was no correlation between DASH score and preoperative scapholunate angle (R² = 0.056), screw angle (R² = 0.061), or time from surgery (R² = 0.014). The average screw angle measured our intraoperative radiographs was 15.2° (SD 6.3°). At time of final follow-up, 4 participants had undergone a second surgery for screw removal and 1 participant was converted to a four-corner fusion for persistent pain. The average preoperative scapholunate gap was 5.0 mm in the group who had a second surgery (n =5) compared to 3.0 mm in the group with no revision surgery (n =18). The average screw angle measured our intraoperative radiographs falls below the target angle of 23°; however, we did not find a correlation between screw angle and patient-reported outcomes. Possible factors contributing to patient outcomes include severity of the injury as measured by pre-operative scapholunate gap. We conclude that patients can have exceptional outcomes following the RASL, but larger scale studies are required to identify patient and injury-related factors to select good candidates.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».