An anatomical basis for the management of complex wrist injuries.
Date
2009
Authors
McLean, James M.
Editors
Advisors
Findlay, David Malcolm
Journal Title
Journal ISSN
Volume Title
Type:
Thesis
Citation
Statement of Responsibility
Conference Name
Abstract
The work described in this thesis was carried out by the author to address perceived
deficiencies in the knowledge of wrist anatomy, imaging and surgical management principles.
The thesis encompasses studies of normal anatomy, imaging of the normal and abnormal
wrist, the classification of complex carpal injuries, and the potential for further research.
At the commencement of this work, areas of deficiency were identified and were addressed.
These included (i) the morphology of the normal wrist, (ii) imaging techniques of
morphological variants, (iii) morphological association with midcarpal osteoarthritis, and (iv)
the clinical application of classification systems for the management of complex carpal
injuries.
To address these deficiencies, a combined radiographic and MRI study was undertaken to
determine the best method for identification of the various morphological variations of the
articular surfaces at the midcarpal joint, using non-invasive imaging techniques. In addition, a
clear standard for accurate recognition of these variants using different imaging techniques
was established. An inter-observer reliability study was undertaken to establish the
reproducibility of the techniques, and to compare the results with previously reported data. A
correlation analysis of the various carpal morphologies can now be undertaken. If a clear
pattern of wrist morphology exists, the differences in carpal kinematics and pathomechanics
related to wrist morphology can be more easily investigated. In addition, it is now possible to
use non-invasive methods of investigation to examine the relationship(s) between various
wrist morphologies and differences in ligament composition and distribution, different carpal
kinematics and pathomechanics, and different incidences and predispositions to various carpal
pathologies. Further research is needed to address these questions.
In summary, the work described in this thesis increases the knowledge of normal wrist
morphology and imaging. It further advances the knowledge of pathomechanics related to
wrist morphology and presents a new understanding in regard to the principles of the
management of complex carpal injuries.
School/Discipline
School of Medicine
Dissertation Note
Thesis (M.S.) - University of Adelaide, School of Medicine, 2009
Provenance
Copyright material removed from digital thesis. See print copy in University of Adelaide Library for full text.