Daniel Calva1, Nicholas Calotta2, Joseph Lopez1, Adrienne Christopher3, Donna Magid4, Shadpour Demehri4, Scott D Lifchez1. 1. Department of Plastic and Reconstructive Surgery, The Johns Hopkins School of Medicine, University of Maryland Plastic Surgery Residency, 4940 Eastern Ave, Room A518, Baltimore, MD, 21224, USA. 2. Department of Plastic and Reconstructive Surgery, The Johns Hopkins School of Medicine, University of Maryland Plastic Surgery Residency, 4940 Eastern Ave, Room A518, Baltimore, MD, 21224, USA. calottan@jhmi.edu. 3. Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA. 4. Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
Abstract
PURPOSE: Post-traumatic arthritis is common in long-term follow-up of patients undergoing hemi-hamate arthroplasty (HHA). We hypothesize that anatomic mismatch could play a role in the development of arthritis. The purpose of this study is to establish a novel, computed tomography (CT)-based imaging technique for pre-operative assessment in HHA. With this technique, our group aims to identify digits with a high likelihood for anatomical mismatch between the donor graft and recipient interphalangeal joint. Using this technique to eliminate cases with high-likelihood of incongruent anatomy, we hypothesize the rates of arthritis could be reduced. METHODS: We conducted a retrospective review of upper extremity CT scans from 2007 to 2014 at our institution. Those studies meeting our inclusion criteria were exported to a clinical radiology software suite. Subsequently, angular and linear measurements of the hamate and potential recipient proximal interphalangeal joints were collected. Angular and linear comparisons were then made between the donor hamate graft and the individual recipient sites. Using pre-established cutoff values, matches were deemed to be inconsistent or consistent. RESULTS: The study included 31 CT scans. The rate of anatomical consistency was low; the small finger was most often consistent (38.7 %) and the index finger was least often consistent (12.9 %). Linear inconsistency was common in all joints besides the small finger; angular inconsistency was most prevalent in the index and long fingers. CONCLUSIONS: This novel use of CT scans as a tool for pre-operative HHA planning is a crucial first step in trying to reduce the observed rates of arthritis after HHA.
PURPOSE: Post-traumatic arthritis is common in long-term follow-up of patients undergoing hemi-hamate arthroplasty (HHA). We hypothesize that anatomic mismatch could play a role in the development of arthritis. The purpose of this study is to establish a novel, computed tomography (CT)-based imaging technique for pre-operative assessment in HHA. With this technique, our group aims to identify digits with a high likelihood for anatomical mismatch between the donor graft and recipient interphalangeal joint. Using this technique to eliminate cases with high-likelihood of incongruent anatomy, we hypothesize the rates of arthritis could be reduced. METHODS: We conducted a retrospective review of upper extremity CT scans from 2007 to 2014 at our institution. Those studies meeting our inclusion criteria were exported to a clinical radiology software suite. Subsequently, angular and linear measurements of the hamate and potential recipient proximal interphalangeal joints were collected. Angular and linear comparisons were then made between the donor hamate graft and the individual recipient sites. Using pre-established cutoff values, matches were deemed to be inconsistent or consistent. RESULTS: The study included 31 CT scans. The rate of anatomical consistency was low; the small finger was most often consistent (38.7 %) and the index finger was least often consistent (12.9 %). Linear inconsistency was common in all joints besides the small finger; angular inconsistency was most prevalent in the index and long fingers. CONCLUSIONS: This novel use of CT scans as a tool for pre-operative HHA planning is a crucial first step in trying to reduce the observed rates of arthritis after HHA.
Authors: Francisco Del Piñal; Francisco J García-Bernal; Julio Delgado; Marcos Sanmartín; Javier Regalado Journal: J Hand Surg Am Date: 2005-09 Impact factor: 2.230