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A-0482 Pisiform Excision; a solution for a long-term ulnar sided wrist pain. A retrospective analysis, comparing pre- and postoperative measurements
M.V. van Burink, S. Al Shaer, J. van Rossen, A. Fink, H. Slijper, T. M. Moojen, H. Rakhorst, G. van Couwelaar, R. Feitz, O.T. Zöphel, Xpert Clinic, The Netherlands
Friday, June 15, 2018 · 2:35 p.m. · 05m 44s
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production let some gentleman
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so we ask ourselves what with our patients when we uh excise the p. c. for about
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what is a what is the pain that is relieved at what our deepest
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party outcomes we offer these operations to patients with oversight wrist pain
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uh mostly due to p. t. osteoarthritis or ten you know like this the repartee
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or post traumatic pain and a lot of times we see a mix of diagnosis
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when non surgical treatment is insufficient we can excise the p. c.
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for bone and uh you know what to know about it
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if we look at the known literature we see all studies with a maximum of sixty six patients
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and all the studies reports high amounts of pain relief or two hundred percent
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but none of the studies they they see how much pain relief stories
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if they look at strengthen rest function they all say there's no difference prix operatives and post operative
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with great strength and function but none of the studies uses outcome measurements
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so we don't know what is really yams come after the separation
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so what we did we uh perform to multi centre and allies as
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of eleven different and surgical locations between two thousand eleven at fifteen
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and the data was collected you said using a prospective clinical
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registry so every patients which is operated in this
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um in this clinic is prospectively respectively
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measured prayer productive and post operative
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all the data is web based database so we can search this uh data for whatever we want
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and we use a pain as a primary outcome and range of
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motion grip strength wrist function a secondary complications of course
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so he got um our results we operated to hundreds
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of no one hundred seventy five patients most
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of them were female eighty percent and most of them seventy percent had b. d. osteoarthritis
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three different kinds of surgery were used and around eighty percent
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the basic form boneless excise trudy f. c. you we didn't see any differences
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in the three techniques but in the other two there are very few
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to complications occurred little bo tree that
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and when we look at the first measurements that we see that pretty operative that
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most patients had a fossil fife and there was improvements to advance of one until three months
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so that's the same as the other studies reports but after three months no um bettering is expected
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all the studies didn't report any uh differences in range of motion we yeah
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we get so see some difference in flexion and extension of the rest
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but was only thirteen percent real over deviation uh was not improved and
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also we looked at prosody nation but nothing to see there also
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we did see some improvement in the red strength that improved uh twenty percent
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uh in comparison with pretty operative measurements and almost
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tale a mean of twenty seven kilograms
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and the mean of the unaffected wrist was thirty kilograms so there's a
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big improvement thing grip strength after you excise the basic form button
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at last we looked at the wrist functioning your for we use the patients rated
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wrist and evaluation questionnaires it's a little bit the same as the dash course
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um in this core there's a maximal off a hundred
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points which indicates maximal and a can of the
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wrist and minimal of zero points and this indicates a non functional and a cup of the rest
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and after twelve bands um once we ask patients where they are
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and yeah they improve the two words the normal values
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so concluding we can say that basic form excision is a
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a safe procedure of course with very little complications but
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the best uh um a reductionist depending which reduces the pa score two one
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in three months with yeah we did see some improvement the worst
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function range of motion and the bridge trying to improve
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and the second we can say that if we um uh do prospective clinical registry of outcome
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measurements it that gives us all the tools we need to answer our patience questions
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thank you harder and questions
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from the audience
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so how do you do to diagnose it's it's it's only regular
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keep going clinical or to use that to some infiltration
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it's mainly at typical diagnosis but if we wished and most of the
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uh uh patients they'd have same radiology a or c. t. scan
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yeah but um yeah the the old techniques are radiology with the wrist a little bit
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and also flexion and you can uh this we see at the first picture
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there you can see the busy for only you can see osteoarthritis but
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a lot of surgeons they don't use radiology and they just operate
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that's yeah there were a lot of surgeons which performed operation but the new techniques r. c. t.
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