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. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1321390 / Thesis (Ph.D.) - University of Adelaide, School of Medicine, 2008
| Identifer | oai:union.ndltd.org:ADTP/264566 |
| Date | January 2008 |
| Creators | Bain, Gregory Ian |
| Source Sets | Australiasian Digital Theses Program |
| Detected Language | English |
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