Session 14: Hand and wrist
17. November
09:00 - 10:00
Lokale: 102-105
Chair: Lone Kirkeby and Rasmus W Jørgensen
117. Five-year recurrence of Dupuytren’s contracture after needle fasciotomy or collagenase injection: a randomized controlled trial
Rasmus Wejnold Jørgensen1, Claus Hjorth Jensen1, Stig Jørring1
1. Hand Clinic, Department of Orthopedic Surgery, Herlev-Gentofte University
Hospital of Copenhagen, Denmark.
Background: In this randomized controlled trial, we compared
the recurrence of Dupuytren’s disease at 5-years
following needle fasciotomy or collagenase
injection treatment for isolated
metacarpophalangeal (MCP) joint contractures.
We have previously reported three year results in
favour of collagenase injections in the same
cohort.
Aim: To compare the recurrence of Dupuytren’s
disease at 5-years following needle fasciotomy or
collagenase injection treatment for isolated MCP
joint contractures. Further, to investigate if the
effect seen at 3 years was lasting at the 5-year
follow up.
Materials and Methods: The study was conducted between 2013 and
2015. The study design was a single centre
randomized controlled clinical trial with an
independent blinded observer. Patients were
randomized between collagenase clostridium
histolyticum injections (Xiapex®) and
percutaneous needle fasciotomy (CCH vs PNF).
A total of 36 patients were followed in the PNF
group and 32 in the CCH group. Two patients in
the PNF group died before the 5 year follow up.
Results: Patients who were treated with CCH had a
significantly lower recurrence rate than patients
treated with PNF during the period (p = 0.049).
Of the 34 patients who were followed in the PNF
group, 59% (n=20) had recurrence of extension
deficit or progression of the disease leading to
further treatment. Of the 32 patients who were
followed in the CCH group, 44% (n=14) had
recurrence or progression. No serious adverse
event was reported in any of the patients.
Interpretation / Conclusion: In this randomized controlled trial, we find less
recurrence and progression of Dupuytren’s
disease using collagenase injection as compared
to percutaneous needle fasciotomy five years
following treatment for isolated
metacarpophalangeal joint contractures.
118. Stable cup fixation at mid-term translates into good long-term survival of cemented and uncemented trapeziometacarpal arthroplasty: A prospective randomized radiostereometry study with 10 years follow-up.
Peter Godthaab Zeuner1, Torben Bæk Hansen1,2, Maiken Stilling2,3,4, Janni Kjærgaard Thillemann1,2,3
1. University Clinic for Hand, Hip and Knee Surgery, Gødstrup Hospital,
Herning, Denmark
2. Department of Clinical Medicine, Aarhus University, Denmark
3. AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University
Hospital, Denmark
4. Department of Orthopedics, Aarhus University Hospital, Denmark
Background: Aseptic loosening leading to revision has been a
substantial problem with both cemented and
uncemented cups in trapeziometacarpal (TMC)
arthroplasties used for treatment of TMC
arthritis. Radiostereometry (RSA) can measure
cup migration over time as a measure of implant
fixation, which predict the risk of aseptic
loosening.
Aim: To evaluate if mid-term cup migration predicts
long-term implant survival, and further, to
present 10-year clinical results, and patient
reported outcomes of cemented and
uncemented TMC cups.
Materials and Methods: In a patient-blinded prospective randomized
study 28 patients (5 men, 32 TMC joints) aged
mean 58 years (range 41–77) were randomized
to surgery with a cemented all-polyethylene cup
(DLC, n=16) or an uncemented HA-coated
Elektra screw cup with metal-on-metal
articulation (Elektra, n=16).The same
cementless HA-coated metacarpal stem was
used.
Clinical evaluation of grip strength, QDASH
score, and pain on NRS scale, were collected at
3 and 6 months, 1, 2, 5 and 10 years. Imaging
with RSA was performed until 5-years, with
baseline image taken the first postoperative day.
Implant survival was estimated at 10 years
follow-up.
Results: Migration (total translation) within the first 2
years was small for both groups (<0.26 mm).
From 2 to 5 years, total translation was 0.08 mm
(CI95% -0.06 – 0.21) in the DLC group and 0.05
mm (CI95% -0.04 – 0.14) in the Elektra group,
which was similar between groups (p=0.74).
Compared with preoperative, 10-year grip
strength, QDASH score, and pain at rest and in
activity improved (p<0.05) and with no
difference between groups throughout follow-up
(p>0.13). The 10-year survival was 80% (CI95%
50 – 93) for the DLC group and 67% (CI95% 38
– 85) for the Elektra group (p=0.40). All patients
with retained arthroplasties at the 10-year
follow-up reported excellent satisfaction and
willingness (100%) to repeat.
Interpretation / Conclusion: This first prospective randomized trial on DLC
and Elektra TMC arthroplasties found similar
and stable midterm cup-fixation, which
translated into good long-term implant survival.
Ten-year clinical outcomes and patient
satisfaction was excellent for both groups.
119. Distal radioulnar joint kinematics during active forearm rotation: a paired comparison of patients foveal TFCC injured and non-injured side
Janni Kjærgaard Thillemann1,2,3, Sepp De Raed3,4, Emil Toft Petersen1,2,3, Torben Bæk Hansen1,2, Maiken Stilling2,3,5
1. Department of Orthopaedics, University Clinic for Hand, Hip and Knee
Surgery, Gødstrup Hospital, Herning
2. Department of Clinical Medicine, Aarhus University
3. AutoRSA Research Group, Orthopaedic Research Unit, Aarhus
University Hospital
4. NRT X-RAY A/S, Hasselager
5. Department of Orthopaedic Surgery, Aarhus University, Denmark
Background: Foveal triangular fibrocartilage complex
(TFCC) injury may cause distal radioulnar
joint (DRUJ) instability. Dynamic
radiostereometry (dRSA) is a precise
imaging method valid for objective
measurement of DRUJ kinematics.
Aim: To use dRSA to study kinematics during
active forearm rotation in DRUJs with
arthroscopic confirmed foveal TFCC lesion
in comparison to non-injured DRUJs.
Materials and Methods: In a prospective cohort study 19 patients
(10 men) with a mean age of 34 years
(range 22-50) were included. All patients
presented with trauma based symptomatic
unilateral DRUJ instability evaluated
clinically by Ballottement test and had a
non-injured contralateral DRUJ for paired
comparison. A foveal TFCC lesion was
confirmed by arthroscopy post hoc. Bilateral
image recordings were made with dRSA
during forearm rotation, performed by the
patient. Kinematic analyses using CT bone
models and anatomical coordinate systems
were used to describe the position of the
ulnar head center in the sigmoid notch (SN)
(DRUJ position ratio) and the ulnar head
center distance to the SN (DRUJ distance).
Results: In general, the ulnar head moved in a volar
direction of the SN during supination and in
dorsal direction during pronation. However,
in full pronation the DRUJ position ratio was
up to 9% points (CI 1-17) more volar on the
TFCC injured DRUJs, and in full supination
up to 12% points (CI 3-21) more dorsal,
compared to the non-injured DRUJs. The
DRUJ distance did not differ in maximum
supination and pronation, but in the range
from 60o pronation to 10o supination, the
DRUJ distance was significantly wider in
TFCC injured DRUJs, with a increase of 1.3
mm (CI 0.3-2.3) in 0 degrees rotation.
Interpretation / Conclusion: The ulnar head position during active
rotation was more volar in pronation and
more dorsal in supination in DRUJs with a
foveal TFCC injury. Consequently, the ulnar
head moved towards the SN center when
the full trajectory of forearm rotation was
reached. Further, DRUJs with foveal TFCC
lesion had wider distance in neutral forearm
rotation, compared with non-injured DRUJs.
Evaluation of combined kinematics
(multidirectional) seems important when
evaluating DRUJ instability during active
patient performed exercises.
120. The interrater reliability of the diagnostic Hook -test in the arthroscopic definition of the foveal TFCC injury
Signe Juhl Dynesen1,2, Robert Gvozdenovic
1. University of Copenhagen, Faculty of Health and Medical Sciences,
Blegdamsvej 3B, 2200 København;
2. Department of Orthopeadic Surgery, Herlev/Gentofte University Hospital of
Copenhagen, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark ;
3. Department of Hand Surgery, Herlev/Gentofte University Hospital of
Copenhagen, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark;
4. University of Copenhagen, Faculty of Health and Medical Sciences, Institute of
Clinical Medicine, Blegdamsvej 3B, 2200 Copenhagen N, Denmark.
Background: The specificity and sensitivity of the Hook-test to
assess foveal TFCC injuries is well documented.
However, the inter-rater reliability of this test has
only been investigated through studies, where
surgeons evaluated the result of the hook-test
by looking at videos of the test being performed.
To our knowledge, a study that takes surgical
testing technique into account has not yet been
performed on the diagnostic Hook-test.
Aim: To evaluate the inter-rater reliability of the hook
test in vivo, using the technique during live
surgery.
Materials and Methods: From December 2022 to April 2023, 27
consecutive patients scheduled for
diagnostic wrist arthroscopy were included
after giving written consent for the study. The
patients included 13 women and 14 men,
ranging from 20 to 66 years of age. Four
different hand surgeons were used as
observers, three of surgeons’ expert level III,
and one of surgeons’ expert level IV,
according to Tang & Giddins. The diagnostic
wrist arthroscopy would proceed as normal
until the responsible operating surgeon
(Observer 1) had performed the hook test.
Afterward, one of the other participating
surgeons (Observer 2) would be permitted to
also perform the hook test during the same
surgical procedure. Both surgeons, unaware
of each other findings would independently
report their assessments and the surgery
would again proceed as normal. Afterward,
Cohen’s kappa was calculated and
evaluated according to the scale proposed
by Landis and Koch.
Results: Of the 27 wrists included, the surgeons were in
agreement on 21 of the findings and disagreed
on 6, (78%). Since some of the agreement could
be derived by the chance alone, we calculated a
Kappa value of 0,55, which corresponds to a
moderate agreement according to the scale
proposed by Landis & Koch.
Interpretation / Conclusion: Despite the reports of being highly accurate and
with high sensitivity and specificity, the
arthroscopic foveal TFCC hook test may not be
as reliable as previously thought when
evaluated in vivo. More research is needed on
the subject.
121. Arthroscopic versus open cancellous bone grafting for scaphoid delayed/nonunion in adults (SCOPE-OUT): study protocol for a randomized clinical trial
Morten Kjær1, Jeppe Vejlgaard Rasmusssen2, Robert Gvozdenoviz1,3
1. Department of Orthopedics, Hand Clinic, Herlev-Gentofte University Hospital of
Copenhagen, Denmark;
2. Department of Orthopedics, Shoulder and elbow clinic, Herlev-Gentofte
University Hospital of Copenhagen, Denmark;;
3. University of Copenhagen, Faculty of Health and Medical Sciences, Institute of
Clinical Medicine, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
Background: Scaphoid non-union results in pain and
decreased hand function. Untreated, almost
all cases develop degenerative changes.
Despite advances in surgical techniques, the
treatment is challenging and often results in a
long period with a supportive bandage until
the union is established. Open,
corticocancellous (CC) or cancellous (C) graft
reconstruction and internal fixation are often
preferred. Arthroscopic assisted
reconstruction with C chips and internal
fixation provides minimal trauma to the
ligament structures, joint capsule, and
extrinsic vascularization with similar union
rates. Correction of deformity after operative
treatment is debated with some studies
favouring CC, and others found no difference.
No studies have compared time to union and
functional outcomes in arthroscopic vs. open
C graft reconstruction.
Aim: We hypothesize that arthroscopic assisted C
chips graft reconstruction of scaphoid
delayed/non-union provides faster time to union,
by at least a mean 3 weeks difference.
Materials and Methods: Single site, prospective, observer-blinded
randomized controlled trial. Eighty-eight
patients aged 18–68 years with scaphoid
delayed/non-union will be randomized, 1:1, to
either open iliac crest C graft reconstruction
or arthroscopic assisted distal radius C chips
graft reconstruction. Patients are stratified for
smoking habits, proximal pole involvement
and displacement of > / < 2 mm. The primary
outcome is time to union, measured with
repeated CT scans at 2-week intervals from 6
to 16 weeks postoperatively. Secondary
outcomes are Quick Disabilities of the Arm,
Shoulder and Hand (Q-DASH), visual
analogue scale (VAS), donor site morbidity,
union rate, restoration of scaphoid deformity,
range of motion, key-pinch, grip strength,
EQ5D-5L, patient satisfaction, complications
and revision surgery.
Results: N/A
Interpretation / Conclusion: The results of this study will contribute to the
treatment algorithm of scaphoid delayed/non-
union and assist hand surgeons and patients in
making treatment decisions. Eventually,
improving time to union will benefit patients in
earlier return to normal daily activity and reduce
society costs by shortening sick leave.
Trial registration: ClinicalTrials.gov
NCT05574582.
122. Inter- and intraobserver agreement for the CT scan assessment of union after surgery for scaphoid fractures and nonunion
Morten Kjær1, Robert Gvozdenoviz1,3, Ivanov Dimitar2
1. Department of Orthopedics, Hand Clinic, Herlev-Gentofte University Hospital of
Copenhagen, Denmark;
2. Department of Radiology, Bispebjerg and Frederiksberg University Hospital of
Copenhagen, Denmark;
3. University of Copenhagen, Faculty of Health and Medical Sciences, Institute of
Clinical Medicine, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
Background: Assessment of scaphoid union using X-Ray is
often with some disagreement. Union is
defined as signs of consolidation in 3/4 views.
Inter- and intraobserver agreement are
reported to be fair/moderate of conservatively
treated scaphoid fractures. Overlining leads
to misinterpretation, and bone bridging cannot
be detected. CT-scans are increasingly used
to evaluate union, allowing a 3-dimensional
assessment of the trabecular architecture.
Studies for scaphoid fractures and non-union
after surgical intervention, where the metal
artifact is present are limited.
Aim: We hypothesized that inter- and intraobserver
reliability of the CT-scan assessment of union
after operative treatment for scaphoid fracture
and nonunion between observers are
moderate/substantial.
Materials and Methods: An institutional search identified 230 patients
with operative intervention. We randomly
selected 60 sets of CT scans (30 fractures
and 30 nonunions). Inclusion criteria were
age >18 years, operative intervention for
scaphoid fractures, and non-union with CT
scans 6-26 weeks postoperatively. Exclusion
criteria were concomitant injury to the hand
and earlier treatment for scaphoid non-union.
Three observers evaluated the anonymized
CT scans on two occasions 6 weeks apart in
random order. Observers were asked to
classify the scaphoids with >/< 50% bone
bridging, and with no healing/partial
healing/full healing.
Results: Cohens Kappa found overall moderate
interobserver agreement (no healing vs. partial
healing vs. full healing) (0.58), substantial (0.66)
for non-union cases, and moderate for fractures
(0.47). Overall interobserver agreement for
>/<50% healing was fair (0.35), fair for fractures
(0.23) and moderate for nonunion cases (0.46).
Results from intrarater agreement await.
Interpretation / Conclusion: Our results suggest CT scan between observers
are reliable in both scaphoid fractures and
nonunion (no healing/partial healing/full healing).
The agreement was better in nonunion cases
compared to fractures. Interater reliability for >/<
50 % healing was fair suggesting attention for
this evaluation. Subgroup analysis revealed
consistent substantial agreement between 2 of
the observers. The third observer varied between
slight to a moderate agreement.
123. Outcomes after Flexor Tendon Surgery in the Capital Region of Denmark
Benedicte Heegaard1, Rasmus Wejnold Jørgensen1
1. Hand Clinic, Department of Orthopedic surgery, Herlev-Gentofte University Hospital of
Copenhagen, Denmark
Background: The management of flexor tendon injuries in the
hand is a well-known challenge worldwide, however,
the exact outcomes and postoperative complications
in Denmark have not yet been reviewed.
Aim: To report outcomes and incidence of postoperative
complications in patients undergoing surgery after
traumatic flexor tendon injuries in the hand.
Secondly, to investigate if trauma in zone II of the
hand is associated with a poor outcome.
Materials and Methods: We retrospectively reviewed patients who had been
surgically treated for flexor tendon injuries of the
hand in two hospitals in Denmark in the period of
2010-2020. Demographic information, trauma type
and postoperative complications were recorded.
Major postoperative complications included re-
rupture, surgical tenolysis and admission due to
infection. Minor complications included infection
treated with oral antibiotics and decrease in mobility.
Results: In total, 281 patients (mean age 35 years, 64%
male) were reviewed. Ninety-five (34%) patients
had trauma in zone I, 137 (49%) had trauma in
zone II, and 49 (17%) had trauma in the other
zones of the hand. The median time from trauma
to surgery was 3 days. The median time from
surgery to the last visit at the hospital was 99
days with an average of 16 contacts to the
hospital after surgery. In total, 18% experienced
a major complication and 35% experienced a
minor complication. Twenty-three (8%) patients
experienced re-rupture, 15 (5%) underwent
surgical tenolysis due to adhesions, and 6
patients (2%) were admitted and revised due to
infection. At the final visit, 27% had a flexion
deficit of > 1 cm and/or extension deficit of >10
degrees and 19 patients (7%) were treated with
oral antibiotics due to infection. Traumas in zone
II of the hand were not associated with a higher
incidence of complications nor a worse outcome
as compared to traumas in zone I.
Interpretation / Conclusion: Following traumatic flexor tendon injuries, 18% of
patients experience a major postoperative
complication and 35% experience a minor
complication, including infection treated with oral
antibiotics or decreased mobility. Patients with zone
II traumas do not experience a poorer outcome as
compared to patients with zone I traumas.