Publications by authors named "Luc De Smet"

109 Publications

Functional outcome of ligament reconstruction with tendon interposition after failed first carpometacarpal joint prosthesis.

Acta Orthop Belg 2021 Mar;87(1):137-142

The purpose is to determine if ligament reconstruction with tendon interposition (LRTI) is a recommendable salvage option for failed total joint prosthesis of the first carpometacarpal joint. Twenty-two patients in our database met the in- clusion criteria for this retrospective study, with at least 6 months follow-up. Fourteen participated and were invited for a clinical examination and asked to fill out two questionnaires. They were evaluated for pain (VAS), impairment (NHS), disability (Quick DASH), opposition (Kapandji test) and grip strength (hydraulic dynamometer). Results of the questionnaires were compared to a cohort study of primary LRTI's. Kapandji test and grip strength were compared to the contralateral side. Compared to primary LRTI's, revision surgery showed mild deterioration of impairment and disability. The average VAS score was 2.9 out of 10. Twelve patients mentioned a sense of strength loss, which could be quantified with the dynamometer : a mean of 15.1 kg (operated thumb) versus 20.5 kg (contralateral). There was a relatively small decline of opposition with Kapandji 8.6 versus 9.9. The overall satisfaction was good for 8 patients, fair for 3 and poor for the remaining 3 (mainly based on strength loss). One patient needed a second revision. Failed first carpometacarpal joint replacement can be salvaged by ligament reconstruction with tendon interposition, providing an acceptable functional outcome in 79% of cases studied. However, compared to the functional outcome of primary LRTI's, mild aggravation of impairment and disability should be taken into account.
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March 2021

Trapeziectomy with ligament reconstruction and tendon interposition arthroplasty in a male cohort : a retrospective study.

Acta Orthop Belg 2020 Jun;86(2):227-232

Osteoarthritis of the carpometacarpal joint of the thumb is a common disease, mostly affecting middle aged women. This article presents the results of a trapeziectomy with a ligament recontruction/tendon interposition procedure. We evaluated 60 male patients with 76 operated thumbs. The mean follow- up was 62 months (ranging from 13 to 133 months, with SD of 33 months). The outcome was measured with the disabilities of the arm, shoulder and hand score, a Nelson Hospital score, a Visual analogue scale score and range of motion. The preoperative height of the trapezium was measured and compared with the height of the trapezial space postoperativaly. The disabilities of the arm, shoulder and hand score improved from 25.6 to 16.1. The Visual analogue scale score for pain, satisfaction, dexterity and funcion were correlated with each other. On x-ray, there was an average loss of 67% of trapezial height compared preoperativaly with postoperativaly, but no correlation was found with clinical outcome parameters.
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June 2020

Four-corner fusion versus proximal row carpectomy : a retrospective review with a minimal follow-up of 9 years.

Acta Orthop Belg 2020 Mar;86(1):146-150

A retrospective survey on the long-term outcomes of both proximal row carpectomy (PRC) and scaphoidectomy with 4-corner arthrodesis (4CA) was conducted. Seventeen PRC and nine 4CA wrists were retrieved with a minimal follow-up of 9 years. Pain, satisfaction and disability were not significantly different. There was a better flexion and ulnar deviation in the PRC wrists. Conclusion : at long term, the outcome for PRC remains stable despite some series recently reported worsening of the results due to progressive degenerative arthritis. PRC seems to yield comparable clinical results compared to 4CA but a slightly better range of motion than 4CA.
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March 2020

Short-term outcome trapeziectomy with ligament reconstruction and tendon interposition versus trapeziometacarpal prosthesis : a literature review.

Acta Orthop Belg 2020 Mar;86(1):122-130

Trapeziectomy with ligament reconstruction and tendon interposition and trapeziometacarpal prosthesis are two commonly used procedures for first carpometacarpal joint osteoarthritis. The purpose of this study is to compare the short-term outcome of trapeziectomy with ligament reconstruction and tendon interposition to trapeziometacarpal prosthesis. Pubmed, Cochrane library and science direct database were searched with adequate search terms. Used parameters were force, pain, mobility, functionality and complication. All papers describing short-term outcome of ligament reconstruction and tendon interposition or trapeziometacarpal prosthesis were included in this review. Trapeziometacarpal prostheses showed faster pain relief compared with trapeziectomy and ligament reconstruction and tendon interposition. Overall, there was a better strength in the trapeziometacarpal prosthesis group. A lack of information was found about the short- term functionality. The mobility recovers faster in the prosthesis group, although different scoring scales were used for measurement. We could confirm the faster pain relief in the prosthesis group and generally a faster recovery of strength and mobility. In the prosthesis group were more short-term complications. More studies are required to evaluate the short-term recovery of strength, the mobility, functionality and satisfaction.
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March 2020

Neurofibromatosis type 1-related pseudarthrosis: Beyond the pseudarthrosis site.

Hum Mutat 2019 10 18;40(10):1760-1767. Epub 2019 Jun 18.

Department of Human Genetics, KU Leuven-University of Leuven, Leuven, Belgium.

Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder affecting approximately 1 in 2,000 newborns. Up to 5% of NF1 patients suffer from pseudarthrosis of a long bone (NF1-PA). Current treatments are often unsatisfactory, potentially leading to amputation. To gain more insight into the pathogenesis we cultured cells from PA tissue and normal-appearing periosteum of the affected bone for NF1 mutation analysis. PA cells were available from 13 individuals with NF1. Biallelic NF1 inactivation was identified in all investigated PA cells obtained during the first surgery. Three of five cases sampled during a later intervention showed biallelic NF1 inactivation. Also, in three individuals, we examined periosteum-derived cells from normal-appearing periosteum proximal and distal to the PA. We identified the same biallelic NF1 inactivation in the periosteal cells outside the PA region. These results indicate that NF1 inactivation is required but not sufficient for the development of NF1-PA. We observed that late-onset NF1-PA occurs and is not always preceded by congenital bowing. Furthermore, the failure to identify biallelic inactivation in two of five later interventions and one reintervention with a known somatic mutation indicates that NF1-PA can persist after the removal of most NF1 negative cells.
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http://dx.doi.org/10.1002/humu.23783DOI Listing
October 2019

Secretan's syndrome: case report.

Acta Chir Belg 2019 Apr 14;119(2):123-124. Epub 2019 Feb 14.

a Leuven University Hospital Pellenberg , Pellenberg , Belgium.

Secretan's syndrome is a rare clinical condition with recurrent swelling of the forearm and dorsum of the hand, together with flexion contracture of the fingers and a thumb that is spared. The disease is associated with automutilation. We present a typical case of a 42-year old women with Secretan's syndrome.
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http://dx.doi.org/10.1080/00015458.2017.1399702DOI Listing
April 2019

Long-term follow-up of corrective ulnar osteotomy for missed Monteggia fractures in children.

J Shoulder Elbow Surg 2018 Nov 14;27(11):e337-e343. Epub 2018 Sep 14.

Department of Orthopedic Surgery, University Hospitals Leuven, Pellenberg, Belgium.

Background: Pediatric Monteggia fractures are relatively rare and are commonly missed. Radial head subluxation can persist with long-term consequences if these fractures are left untreated. We evaluated the long-term treatment outcomes after open reduction with ulnar osteotomy for missed Monteggia fractures during childhood.

Materials And Methods: Fourteen children were included. Our objective was to assess the clinical and radiographic postoperative outcomes. We evaluated satisfaction by questionnaire. Open reduction of the radial head was performed, combined with an opening-wedge ulnar osteotomy. The mean interval between trauma and surgery was 26.9 months (range, 1-145 months). The mean length of follow-up was 132 months (range, 67-206 months).

Results: Only patients with a delay of more than 6 months complained of elbow tenderness. Clinical improvement (except for pronation) was obtained postoperatively, with significance found in the flexion-extension arc (P = .011). In addition, pronation loss (P = .044) and the flexion-extension arc (P = .041) improved significantly in patients with a surgical delay under 6 months compared with patients with a surgical delay of more than 6 months. Radiographically, there were 9 good and 5 fair results. We found a negative association between radiographic outcomes and both age at surgery and delay to surgery (P = .036 and P = .039, respectively).

Conclusions: Good results can be obtained after open reduction with opening-wedge ulnar osteotomy. Lesser clinical and radiographic outcomes can be expected after a surgical delay of more than 6 months. Furthermore, the radiographic outcome seems better if the patient is younger than 6 years.
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http://dx.doi.org/10.1016/j.jse.2018.06.029DOI Listing
November 2018

Salvage of Failed Achilles Tendon Interposition Arthroplasty for DRUJ Instability After Ulnar Head Resection With Aptis Prosthesis.

Hand (N Y) 2017 09 28;12(5):476-483. Epub 2016 Oct 28.

4 University Hospitals Leuven, Belgium.

Background: Historically, failed conservative treatment for irreparably damaged distal radioulnar joints (DRUJs) is treated via distal ulnar resection or DRUJ fusion; complications include disabling painful convergence of the radius and ulnar stump during lifting Various treatments for radioulnar impingement include distal radioulnar Achilles tendon allograft interpositional arthroplasty. This technique does not adequately prevent radioulnar impingement and we explore an alternative treatment.

Methods: We report 7 adult patients who failed Achilles tendon interposition, subsequently treated with Aptis total DRUJ prostheses (mean follow-up, 26 months; range, 7-40).

Results: Revision to Aptis prosthesis produced clinically stable DRUJ, improved grip strength and painless lifting capabilities, high patient satisfaction, and no major complications. All returned to daily activities and even recreational sports.

Conclusions: Tendon lacks biomechanical features key to the shock-absorbing function of cartilage-features it cannot deliver when used to prevent radioulnar convergence. We report Aptis DRUJ prosthesis as an alternative to the tendon allograft technique.
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http://dx.doi.org/10.1177/1558944716676251DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5684928PMC
September 2017

Case Report: Oblique Fracture of the Ulnar Sesamoid Bone of the Metacarpophalangeal Joint, a Rare Pathology.

J Orthop Case Rep 2017 Mar-Apr;7(2):29-32

Department of Medicine, Catholic University of Leuven, KU Leuven, Belgium.

Introduction: Fractures of the sesamoid bones of the metacarpophalangeal joint (MCPJ) are a rare pathology in hand trauma. Only a few case reports and case series were found in literature. The diagnosis of an ulnar sesamoid bone fracture of the MCPJ is difficult and can pose a differential diagnostic problem with Stener lesions or ulnar collateral ligament (UCL) instability. This pathology is frequently missed with subsequent poor functional outcomes. Correct and early diagnosis is important as this will allow for correct treatment with full recovery of function without sequelae.

Case Presentation: We report a case of a 35-year-old male Caucasian patient after a thumb injury due to a fall with his mountain bike. X-ray showed a fracture of the ulnar sesamoid of the MCPJ of the pollex, which is rarely reported in this literature. Anamnesis, clinical examination, and X-ray evaluation contributed to our diagnosis. The ulnar sesamoid bone fracture of the MCPJ of the right pollex was initially treated conservatively with immobilization, rest and ice application. After 3-4 weeks, physiotherapy with thenar muscles exercises was started. 10 weeks after the injury, our patient reported a total recovery of function and pain-free thumb movement during daily activities.

Conclusion: Ulnar sesamoid fractures are rarely reported in current literature. This type of injury should be recognized as early as possible since it can be easily missed. Then a benign course can be expected after short immobilization of the MCPJ of the thumb during circa 2 weeks. UCL instability or a Stener lesion should be excluded at the emergency department by performing an ultrasound. With this case report, we underline the importance of early diagnosis and exclusion of an unstable Stener lesion.
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http://dx.doi.org/10.13107/jocr.2250-0685.736DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5553830PMC
August 2017

Fascial flap surgery for recurrent dorsal ganglion.

Acta Orthop Belg 2017 Jun;83(2):322-325

Recurrence after primary resection of a dorsal wrist ganglion may necessitate a reintervention. A technique was introduced in 2004 in which a flap of the extensor retinaculum is used to cover the defect left in the wrist capsule following repeat radical excision. This retrospective study presents the follow-up 4.6 years after this surgery in 20 patients. Recurrence, grip strength and possible flexion deficit are measured in 13 patients who attended clinic, as well as pain and satisfaction scores. Disability scores have been evaluated in 18 patients. One refractory patient was ascertained. A flexion deficit ≤ 10° was observed in 7 patients. Overall, mild pain, very mild disability, a flexion deficit of 14.2° and a loss of grip strength of 3.6 kg was observed. The retinaculum flap for recurrent dorsal wrist ganglion is a reliable procedure with limited risk for flexion deficit after surgery, high satisfaction rate and low recurrence risk.
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June 2017

A clinical trial of tension and compression orthoses for Dupuytren contractures.

J Hand Ther 2017 Jul - Sep;30(3):253-261. Epub 2017 Feb 21.

Orthopaedic Department, Hand Unit, University Hospitals Leuven, Pellenberg Campus, Pellenberg, Belgium.

Study Design: Randomized clinical trial on 2 patient groups with Dupuytren's disease.

Introduction: Despite an unpredictable outcome, surgery remains an important treatment for Dupuytren's disease. Orthotic devices are a controversial noninvasive treatment method to influence the myofibroblasts in the nodules.

Purpose Of The Study: To detect how much improvement 2 types of orthotic device (tension and compression) as only treatment intervention can provide on a Dupuytren's contracture. Is a compression orthosis better than a tension orthosis?

Methods: Thirty patients with measurable flexion contractures of the fingers were identified. Both primary and recurrence cases were included. Patients were randomized in 2 groups of 15 patients. One group had a standard tension orthosis (Levame), the other group a newly designed silicon compression orthotic device. Patients were instructed to wear the orthotic devices 20 hours a day during 3 months. Data were collected at first visit and after 3 months of orthotic treatment. Primary outcomes were active extension deficit of each joint and total active extension (TAE) of the digit. Secondary outcome was patient satisfaction. Visual Analog Scale (VAS) score of function and esthetics (0-10 points) were recorded at the start and after 3 months.

Results: Flexion contracture was reduced at least 5 degrees in all patients. After 3 months, TAE was significantly reduced in both groups (both P < .001).The mean change in TAE was 32.36° in the tension group and 46.47° in the compression group. Although reduction of TAE deficit was bigger in the compression group, this difference was not statistically significant (P = .39). VAS scale of esthetics and functionality was significantly increased in both treatment groups. The functional VAS scale after 3 months was 11% higher in the compression group than in the tension group (P = .03). A major complication of a tension orthotic is skin ulcers.

Discussion: Too much tension may cause myofibroblast stimulation and disease progression, whereas continuous limited tension can improve flexion contractures. The idea of a compression device is based on the treatment concept of hypertrophic burn scars.

Conclusion: Tension and compression orthotic devices can be used as a nonoperative treatment of Dupuytren's disease in both early proliferative untreated hands and aggressive postsurgery recurrence. Although there is no statistically significant difference, compression orthoses appear to be more effective and are better tolerated. Nevertheless, adjustment of orthotic design and research on long-term results are needed.

Level Of Evidence: I (Randomized controlled trial, Therapeutic study).
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http://dx.doi.org/10.1016/j.jht.2016.11.011DOI Listing
February 2017

MRI diagnosis of carpal boss and comparison with radiography.

Acta Radiol 2017 Oct 13;58(10):1245-1251. Epub 2017 Jan 13.

1 Department of Radiology, St.-Maarten General Hospital, Mechelen, Belgium.

Background A carpal boss is a potentially painful bony mass in the region of the second or third carpometacarpal joint. The combination of clinical examination and radiography is usually sufficient for the diagnosis. Purpose To determine whether magnetic resonance imaging (MRI) examination of the quadrangular joint can assist the diagnosis of persistent pain near a carpal boss. Material and Methods Fifty-seven patients with a carpal boss were retrospectively reviewed using MRI and conventional radiographs and compared to an asymptomatic control group. Results MRI demonstrated a variable morphology and a variety of bone and soft tissue abnormalities associated with carpal boss. Bone marrow edema around the quadrangular joint shows a significant correlation (Fisher's exact test: P < 0.001) and a positive correlation (Pearson's test r = 0.632, significant at the 0.01 level [two-tailed]) with a painful carpal boss. Conclusion MRI offers detailed examination of bone and soft tissue abnormalities associated with a carpal boss. Local bone marrow edema strongly correlates with a painful carpal boss.
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http://dx.doi.org/10.1177/0284185116685925DOI Listing
October 2017

Comparison of surgical treatments for mucous cysts of the distal interphalangeal joint.

Acta Orthop Belg 2015 Jun;81(2):213-7

Mucous cysts of the interphalangeal joints are common. Several surgical techniques have been described, but none has proven to be superior. We compared three techniques that entail complete removal of the cyst together with the concomitant osteophytes. In group A wound closure was obtained by full thickness skin graft, in group B by primary closure and in group C by a local skin graft. Sixty-four patients with 70 cysts were reviewed. An overall recurrence rate of 8.6% was observed. Forty-five of the studied patients received a full thickness skin graft (4 out of 45 recurred), 23 were closed primarily (2 out of 23 recurred) and 2 by a local skin graft (no recurrences). Full thickness skin graft showed no significant higher recurrence compared to primary closure. Full thickness skin graft showed no significant higher pain or satisfaction compared to primary closure. Patients with a recurrent cyst were less satisfied and had more pain than those without recurrences.
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June 2015

Avascular necrosis of the hamate: three cases and review of the literature.

J Wrist Surg 2014 Nov;3(4):269-74

Orthopaedic Department, Hand Unit, University Hospitals Leuven, Pellenberg Campus, Pellenberg, Belgium.

Background Avascular necrosis of the hamate (hamate-AVN) is a seldom reported disease of which little is known on etiology, best treatment modalities, and outcome. Hamate-AVN can occur in multiple locations within the hamate. Case Description Case one was an 8-year-old girl with painful AVN of the hamate hook. Surgical excision of the hook was performed, leading to excellent results (follow-up 8 years). Case two was a 44-year-old man with hamate-AVN of the proximal pole surgically treated with a vascularized bone graft from the radius based on the fifth extensor compartment artery, leading to excellent results (follow-up 7 years). Case three was a 36-year-old woman with hamate-AVN of the proximal pole surgically treated with débridement and cancellous bone grafting, leading to poor results (follow-up 1 year). Literature Review Nine other cases of avascular necrosis of the hamate were found in literature, all but one treated surgically. Etiology, treatment, and results of these cases, combined with our own cases, are reviewed. Clinical Relevance This article summarizes and synthesizes all presented cases of avascular necrosis of the hamate. We hope this will be helpful to physicians in decision making when confronted with this rare entity. Level of Evidence 4.
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http://dx.doi.org/10.1055/s-0034-1394135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4208962PMC
November 2014

Carpal malalignment in malunion of the distal radius and the effect of corrective osteotomy.

J Wrist Surg 2014 Aug;3(3):166-70

Department of Orthopaedic Surgery, University Hospitals, Leuven, Belgium.

Introduction Malunions of the distal radius often induce carpal malalignment. Two different types can be distinguished: an adaptive midcarpal malalignment (so-called CIA wrist: carpal instability, adaptive) and a radiocarpal malalignment (dorsal translation of the whole carpus). The effect of distal radial osteotomy on the carpal alignment has hardly been studied. Material and Methods 31 wrists in 31 patients (mean age 44 years) with malunion of the distal radius after a Colles fracture were treated with a corrective osteotomy. The patients were divided on basis of effective radio-lunate flexion (ERLF) in the two patterns of carpal malalignment. The radiographic changes were evaluated. Results There were 20 patients with midcarpal malalignment (ERLF ≤ 25°) and 11 with radiocarpal malalignment (ERLF > 25°). There was a correction of radial tilt and ulnar variance in both groups. There was a significant improvement of the carpal alignment in the midcarpal malalignment group, up to normal parameters. Neither age nor delay between fracture and osteotomy correlated. In the radiocarpal malalignment group a significant effect on the ERLF was observed. In the patients with dorsal plating 70% of the hardware had to be removed. Conclusion Distal radial osteotomy is a reliable technique for correction of the deformity at the distal end of the radius and carpal malalignment.
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http://dx.doi.org/10.1055/s-0034-1384823DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4117698PMC
August 2014

Proximal interphalangeal joint replacement: resurfacing pyrocarbon versus silicone arthroplasty.

Acta Orthop Belg 2014 Jun;80(2):190-5

Prosthetic replacement of the proximal interphalangeal joints is an operative treatment for osteoarhtritis, to preserve the range of motion and the function of the hand. The purpose of this study is to detect the differences regarding pain and function between a silicone implant using a volar approach and a resurfacing implant, placed through a dorsal approach. Patients were reviewed clinically and scored. We found no significant differences in outcome between the two types of implants. However, the complication rate in the resurfacing group was significantly higher. Also, the economic cost of both implants was significantly different. The resurfacing implants were more expensive than the silicone implants.
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June 2014

Ulnar Impaction Syndrome: Ulnar Shortening vs. Arthroscopic Wafer Procedure.

J Wrist Surg 2014 May;3(2):98-100

The Orthopaedic Department, University Hospitals, Leuven, Belgium.

The outcome of ulnar shortenings was compared with that of arthroscopic wafer resections for ulnar impaction (or abutment) syndrome in patients with a positive ulnar variance. The outcome was measured by DASH score, visual analog scale for pain, and working incapacity. The mean DASH score in the ulnar shortening group was 26; in the wafer group it was 36. The VAS scores were respectively 4.4 and 4.6. The working incapacity was 7?months in the ulnar shortening group and 6.1 months in the wafer group. The differences between the two groups were not statistically significant.
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http://dx.doi.org/10.1055/s-0034-1375966DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4078133PMC
May 2014

Arthroscopic debridement with and without distal ulnar resection in the treatment of triangular fibrocartilage complex tears.

Acta Orthop Belg 2014 Mar;80(1):112-5

A retrospective survey for debridement with or without wafer distal ulna resection was performed. Forty six patients responded to a questionnaire on pain, disability and time off work. The mean DASH score decreased from 42 to 28 on average. Thirty two patients were satisfied. The pain was considered severe in 12 patients. There were significant differences in the outcome between debridement only and debridement with wafer resection of the distal ulna.
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March 2014

High-dosage tamoxifen as neoadjuvant treatment in minimally invasive surgery for Dupuytren disease in patients with a strong predisposition toward fibrosis: a randomized controlled trial.

J Bone Joint Surg Am 2014 Apr;96(8):655-62

Hand Unit, Orthopaedic Department, Pellenberg Campus, University Hospitals Leuven, Weligerveld 1, 3212 Pellenberg, Belgium. E-mail address for I. Degreef: E-mail address for L. De Smet:

Background: Tamoxifen, a synthetic nonsteroidal anti-estrogen known to modulate the production of transforming growth factor-beta (TGF-β), has demonstrated effectiveness on fibroblast activity in vitro and in vivo. The main purpose of this study was to investigate the effect of tamoxifen on the outcome of surgery for Dupuytren contractures in patients with a strong predisposition toward fibrosis.

Methods: We used a prospective, randomized, double-blind study protocol (conforming to the CONSORT standards) to investigate the influence of tamoxifen compared with placebo on the total passive extension deficit in the finger and patient satisfaction after subtotal fasciectomy in thirty patients with a strong predisposition toward fibrosis (grade, >4 according to the Abe scale). High-dosage tamoxifen (80 mg/day) was administered from six weeks prior until twelve weeks after surgery, and patients were monitored for two years.

Results: Three months after surgery, patients in the tamoxifen group had a smaller total passive extension deficit and higher satisfaction compared with the placebo group. This positive effect was lost over the two years following cessation of the medication.

Conclusions: This study demonstrated that the short-term outcome of Dupuytren disease treatment could be influenced by use of tamoxifen as a neoadjuvant from six weeks prior to three months after subtotal fasciectomy in patients with a strong predisposition toward fibrosis. However, the beneficial effect disappeared within two years after surgery, with worsening of the contractures after the medication was discontinued. Thus, tamoxifen may have a short-term effect on the outcome of surgery for Dupuytren disease.
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http://dx.doi.org/10.2106/JBJS.L.01623DOI Listing
April 2014

Primary ulnar superficial slip resection in complicated trigger finger.

J Plast Surg Hand Surg 2014 Oct 31;48(5):340-3. Epub 2014 Mar 31.

Orthopaedic Department, Hand Unit, University Hospitals Leuven , Pellenberg , Belgium.

Long standing trigger finger, often present for 6 months to years before consulting, can result in a lack of extension, which is often painful and may persist after section of the A1 pulley. The ulnar superficial slip resection (USSR) was introduced by Le Viet to address this problem. It is hypothesised that primary section of the A1 pulley with USSR resolves both extension lack and pain in longstanding trigger fingers with a painful extension lack. This retrospective study reviewed the results of primary USSR for longstanding trigger fingers (6 months or more) with painful extension lack in 18 patients. Locking was resolved and full extension was acquired in all cases (100%). Satisfaction rate was high (89%) and disability returned to normal after surgery. In two patients, satisfaction was low due to residual loss of flexion as a result of osteoarthritis and cold intolerance in another. It is concluded that the USSR procedure is a valuable primary surgical option in complicated trigger finger with painful extension lack caused by flexor tendon tendinosis.
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http://dx.doi.org/10.3109/2000656X.2014.901971DOI Listing
October 2014

Outcome of simultaneous surgical treatment of hyperextension of metacarpophalangeal and basal joint osteoarthritis of the thumb.

Acta Orthop Belg 2013 Oct;79(5):514-6

Orthopaedic Department, University Hospitals Leuven, Belgium.

The effect of correction of metacarpophalangeal (MCP) joint hyperextension on the outcome of reconstructive surgery for basal joint osteoarthritis of the thumb was studied. Impairment, pain and satisfaction were similar after a combined surgical treatment of MCP hyperextension and basal thumb osteoarthritis in 33 patients, as in a series of 233 patients at the same institution after osteoarthritis surgery with a normal MCP joint.
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October 2013

Long-term outcome of elbow resurfacing.

J Shoulder Elbow Surg 2013 Nov 3;22(11):1455-60. Epub 2013 Sep 3.

Department of Orthopaedic Surgery, University of Leuven, Pellenberg, Belgium.

Background: The purpose of this study is to review the long term results the Kudo and instrumented Bone Preserving elbow prostheses. The instrumented Bone Preserving prosthesis is the successor of the Kudo prosthesis, and both of these are nonconstrained elbow resurfacing prostheses.

Methods: Fifty-five nonconstrained elbow prosthesis were implanted in 51 patients. Patients were evaluated with the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm Shoulder and Hand score. Revision or the necessity of revision was regarded as failure of the prosthesis.

Results: Twenty-one prostheses (of which 3 instrumented Bone Preserving prostheses) were revised or needed revision, yielding a revision rate of 15.1% after 5 years and 36.5% after 10. The major reasons for revision were loosening in 10 cases and instability in 5. Eleven of the nonrevised patients died of unrelated causes, having little or no subjective problems until the time of death. There was no statistical difference between Kudo and instrument Bone Preserving implant survival. Most nonrevised patients were satisfied, according to the Visual Analog Scale for satisfaction. The median MEPS indicated fair to good results.

Conclusion: When comparing our results to those of other elbow prosthesis we must conclude that our revision rate is high, however, the outcome of the nonrevised patients is good. This study shows that the results of the Kudo prosthesis, which have been reported twice before by our department, have clearly deteriorated after an average follow-up of 174 months (the last study had an average follow-up of 58 months).
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http://dx.doi.org/10.1016/j.jse.2013.06.013DOI Listing
November 2013

Does the "three-ligament tenodesis" procedure restore carpal architecture in static chronic scapholunate dissociation?

Acta Orthop Belg 2013 Jun;79(3):271-4

University Hospitals Leuven, Pellenberg, Belgium.

The effect of the three-ligament tenodesis on the scapholunate angle and scapholunate gap was studied. A comparison was made between these angles preoperatively and postoperatively in 12 patients. There was a significant decrease in the scapholunate angle from 77 to 68 degrees, and the scapholunate gap was reduced from 4.25 mm to 3.29 mm. We also studied the correlation between scapholunate angle and scapholunate gap postoperatively in a cohort of 25 patients and found a significant correlation. This suggests that the principle of the procedure is correct, but the aims are not fully achieved, and that the procedure has a similar effect on SL gap and SL angle.
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June 2013

Dupuytren disease: on our way to a cure?

Acta Orthop Belg 2013 Jun;79(3):243-9

Department of Orthopaedic Surgery, Upper Limb Surgery, University Hospitals of Leuven, Pellenberg Campus, Pellenberg, Belgium.

Despite its high prevalence, the clinical presentation and severity of Dupuytren disease is extremely variable. The disease features a broad spectrum of symptoms, from simple nodules without the slightest clinical impact towards an extremely disabling form requiring multiple surgical procedures, sometimes even partial hand amputations. Recurrence after surgery is considered a failure for both patient and surgeon, but its definition is vague. The term 'recontracture' was coined by a patient and reflects the disappointment of recurrent disease. Wether or not a treatment option will insure a definite result, may depend more on the severity of the disease, which is patient specific, than on the treatment method itself. If a patient presents with Dupuytren disease, one should not merely evaluate his hands. Different clinical and personal history features may uncover a severe fibrosis diathesis and both correct information to the patient and an individualized treatment plan are needed. In the near future, a simple genetic test may help to identify patients at risk. Similar to the evolving knowledge and treatment modalities seen in rheumatoid arthritis, treatment of Dupuytren disease is likely to advance in the direction of disease control with pharmacotherapy and single shot minimal invasive enzymatic fasciotomy with collagenase to correct established contractures.
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June 2013

Long-term outcome of trapeziectomy with ligament reconstruction and tendon interposition (LRTI) versus prosthesis arthroplasty for basal joint osteoarthritis of the thumb.

Acta Orthop Belg 2013 Apr;79(2):146-9

Department of Orthopaedics, Hand Unit, University Hospitals, Leuven, Belgium.

Several surgical techniques are available to treat thumb basal joint arthritis. In this study, we compare the long-term results of a thumb basal joint prosthesis (de la Caffinière or Roseland type prosthesis) with those of trapeziectomy with ligament reconstruction and tendon interposition (LRTI). We could not find any difference between both techniques with respect to impairment, pain reduction, patient satisfaction and disability.
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April 2013

The Scheker distal radioulnar joint arthroplasty to unravel a virtually unsolvable problem.

Acta Orthop Belg 2013 Apr;79(2):141-5

The University Hospital Pellenberg (K.U.L.), Lubbeek, Belgium.

Failure of the distal radioulnar joint leads to significant dysfunction of the upper limb. Numerous surgical procedures have been suggested to address this problem. In degenerative arthritis, joint instability and ulnar stump dislocation after salvage procedures such as Darrach distal resection or Sauvé-Kapandji distal fusion, an ideal solution may not be available. The ultimate option to restore distal ulna stability in these cases is to fuse the ulna and radius. Obviously, the morbidity of one bone forearm with complete loss of pronation - supination is very high and such a decision is never taken lightly. We present a challenging case series of gross radioulnar arthritis and instability with an acceptable medium-term outcome after semiconstrained Scheker arthroplasty of the distal radioulnar joint. We conclude that in selected cases with unsolvable distal radio-ulnar instability and loss of the DRUJ joint, the Scheker arthroplasty may offer a valuable solution.
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April 2013

Ulnar shortening or arthroscopic wafer resection for ulnar impaction syndrome.

Acta Orthop Belg 2012 Jun;78(3):323-6

Department of Orthopaedic Surgery, U.Z. Pellenberg, Lubbeek.

The outcome of ulnar shortenings was compared to the outcome after arthroscopic wafer resections for ulnar impaction (or abutment) syndrome in patients with a positive ulnar variance. Both surgical techniques are described. The outcome was measured by the DASH score, the visual analogue score for pain and the working incapacity. The mean DASH score in the ulnar shortening group was 26, in the wafer group it was 36. The VAS were respectively 4.4 and 4.6. The working incapacity was 7 months in the ulnar shortening group and 6.1 months in the wafer group. The differences between the two groups were not statistically significant.
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June 2012

Myositis ossificans of the hand in a child: case report.

J Pediatr Orthop B 2012 Nov;21(6):539-41

Department of Orthopaedics, U.Z. Pellenberg, Weligerveld, Pellenberg, Belgium.

Myositis ossificans of the hand is very rare. We report a case of an obviously post-traumatic case and discuss the value of trauma in the etiology.
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http://dx.doi.org/10.1097/BPB.0b013e3283524bfaDOI Listing
November 2012

Elbow arthrolysis for traumatic arthrofibrosis: a shift towards minimally invasive surgery.

Acta Orthop Belg 2011 Dec;77(6):758-64

Department of Orthopaedic Surgery, Upper limb Surgery, Leuven University Hospitals, Pellenberg, Belgium.

The elbow joint needs to be both mobile and stable to exercise its hinge function, which is the key to a normal upper limb. Loss of motion in the elbow joint leads to an exponential functional handicap. Elbow trauma is a common cause of elbow stiffness. Open elbow arthrolysis with release of the capsule has been demonstrated to be a very useful treatment. Arthroscopic elbow arthrolysis has now gained popularity, along with the rapid evolution in elbow arthroscopy. The authors present the preliminary results of this technique in 12 patients, with a mean follow-up of 19.4 months. The range of motion significantly increased from an extension lag of 39.2 degrees and a flexion limited to 115 degrees to an extension lag of 17.9 degrees and a flexion of 131.7 degrees. On average, a 38 degrees gain in range of motion was achieved. This result is comparable with a gain of 40 degrees after open arthrolysis, reported by the senior author in a previous study. The DASH score improved from 39 to 28, but not significantly, and the VAS for pain from 5.5 to 3.4 (significantly). All patients would undergo the procedure again and they experienced a mean subjective improvement of 63.6%. A literature review showed that open and arthroscopic arthrolysis yield a gain of about 44.10 degrees and 31.25 degrees, respectively. The conclusion is that there certainly is a place for arthroscopic elbow arthrolysis.
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December 2011

Failures of the three-ligament tenodesis for chronic static scapholunate dissociation are due to insufficient reduction.

Acta Orthop Belg 2011 Oct;77(5):595-7

Department of Orthopaedic Surgery, Upper Limb Surgery, University Hospitals of Leuven, Pellenberg Campus, Pellenberg, Belgium.

We retrospectively reviewed 13 patients who had successfully undergone three-ligament tenodesis for scapholunate instability, and compared the radiological outcome with 14 failed cases. The scapholunate angle in the failed group increased from 73 degrees to 81 degrees with a scapholunate gap of 532 mm, compared to a decrease in the successful group from 76 degrees to 66 degrees with a scapholunate gap of 2.94 mm. Postoperative radiographs may thus have a prognostic value and can also be used if confronted with a patient with persisting symptoms after operation. Salvage procedures may offer a better solution when tenodesis has failed and reduction is insufficient on radiographs, and we believe that redo operations are not indicated, when the initial reduction already failed.
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October 2011
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