The wrist: from anatomy to arthroscopy.
Date
2008
Authors
Bain, Gregory Ian
Editors
Advisors
Howie, Donald William
Findlay, David Malcolm
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 arthroscopy that limited the
surgical treatment of wrist disorders. The thesis encompasses studies of normal anatomy,
imaging of the abnormal wrist and the development of wrist arthroscopy.
At the commencement of this work problem areas identified, which were addressed, included (i) the morphology and kinematics of the normal wrist, (ii) imaging of scaphoid deformity and
the clinical application of fluoroscopy in the management of the wrist disorders, and (iii)
surgery of the wrist, which was usually performed as an open procedure, and the clinical
application of wrist arthroscopy, which was in its first decade of development.
To address these deficiencies, a radiological study was undertaken to determine how the
morphology of the lunate affected the kinematics of the scaphoid. Lunate morphology was
demonstrated to be associated with scaphoid kinematics. The result of this finding is that it is now possible to predict scaphoid kinematics because lunate type can be determined from
plain radiographs. An anatomical study of the triquetro-hamate joint was undertaken to
determine the morphology of this joint and whether it is related to the lunate morphology.
Two types of triquetro-hamate joint were identified but these were not associated with the
morphology of the lunate. One type had a helicoidal configuration and the other was
relatively flat. These morphological differences are likely to have implications for wrist
kinematics.
To image deformity of the scaphoid, a standardised method of longitudinal computed
tomography was developed. An inter-observer reliability study was undertaken to compare
the previously reported intra-scaphoid angle to newly developed methods of assessing the
humpback deformity. The height-to-length ratio and dorsal cortical angle were found to be
more reliable than the intra-scaphoid angle. The concepts of partial volume averaging for the
assessment of scaphoid fracture union and pre-operative templating of correction of scaphoid
deformity were described.
The role of arthroscopy was investigated in a number of clinical conditions. Patients withKienböck’s disease were assessed to determine whether characteristic patterns of articular
changes could be identified at arthroscopy. Based on the findings, a classification of these
arthroscopic findings was developed and used to direct future treatment. A study of
arthroscopically assisted reduction of distal radius fractures was undertaken, which included
development of new arthroscopically assisted and mini-open reduction and fixation
techniques. Post-operative articular deformity was found to be associated with an increased
incidence of pain. Arthroscopic debridement for scaphotrapezotrapezoidal joint arthritis was
demonstrated to be a safe and effective treatment, with a lower complication and re-operation
rate than with previously reported open procedures. New arthroscopic methods of capsular
release of the wrist, arthroscopically assisted drilling of intra-osseous ganglion of the lunate
and arthroscopic debridement of the ulnar styloid were developed. Fluoroscopy was valuable
in pre-operative assessment as well as the intra-operative management using these new
techniques.
In summary, the work described in this thesis increases the knowledge of the normal and
abnormal wrist morphology and advances the role of arthroscopy in the treatment of wrist
conditions.
School/Discipline
School of Medicine : Orthopaedics and Trauma
Dissertation Note
Thesis (Ph.D.) - University of Adelaide, School of Medicine, 2008
Provenance
Copyright material removed from digital thesis. See print copy in University of Adelaide Library for full text.