Ten Tips to Simplify the Spaghetti Wrist.

Hand surgeons refer to deep lacerations of the volar distal forearm as "spaghetti wrists." Given that multiple tendons, vessels, and nerves often require repair, this injury may be intimidating. We review management of spaghetti wrists and summarize with 10 simplifying tips.

Use of a 5-Item Modified Frailty Index for Risk Stratification in Patients Undergoing Surgical Management of Distal Radius Fractures.

Purpose: Compared with cast treatment, surgery may expose patients with distal radius fractures to undue risk. Surgical intervention in this cohort may offer less benefit than previously thought and appropriate patient selection is imperative. The modified Frailty Index (mFI) predicts complications after other orthopedic surgeries.

Ulnar Artery Aneurysm in a 6-Month-Old: A Case Report.

Background: Pediatric ulnar aneurysms are rare and, unlike their adult counterparts, cannot be explained by repetitive trauma to the palm. A small number of case reports describe diagnostic difficulty with these lesions and different treatments.

Methods: We present the case of a 6-month-old with an ulnar artery aneurysm of unknown cause.

Viability of Hand and Wrist Photogoniometry.

Background: No goniometric technique is both maximally convenient and completely accurate, although photogoniometry (ie, picture taking to facilitate digital angle measurement) shows promise in this regard. Our purpose was to test the feasibility and reliability of a photogoniometric protocol designed to measure wrist and digit range of motion in general.

Methods: Two independent observers examined a sample of joints in both normal and abnormal hands according to a photogoniometric protocol.

Computed tomographic analysis of the internal structure of the metacarpals and its implications for hand use, pathology, and surgical intervention.

The variation of bone structure and biomechanics between the metacarpals is not well characterized. It was hypothesized that their structure would reflect their common patterns of use (i.e.

Suture-Button Reconstruction of the Interosseous Membrane.

Background: Reconstruction of the interosseous membrane (IOM) may play a role in the treatment of acute and chronic longitudinal forearm instability. Several reconstruction techniques have been proposed. Suture-button reconstruction is attractive because it obviates donor site morbidity and is relatively easy to perform.

Management of adult diaphyseal both-bone forearm fractures.

Simultaneous diaphyseal fractures of the radius and ulna, often referred to as both-bone forearm fractures, are frequently encountered by orthopaedic surgeons. Adults with this injury are typically treated with open reduction and internal fixation because of the propensity for malunion of the radius and ulna and the resulting loss of forearm rotation. Large case series support the use of plate and screw fixation for simple fractures.

The biomechanical stability of salvage procedures for distal radioulnar joint arthritis.

Purpose: To test distal forearm stability after 3 surgical procedures for distal radioulnar joint (DRUJ) arthritis.

Methods: We tested 11 cadaver limbs with the DRUJ intact, after distal ulna-matched hemiresection, after Darrach distal ulna resection, and after unlinked total DRUJ arthroplasty. We evaluated distal forearm stability in neutral rotation, full pronation, and full supination in unweighted and 1-kg-weighted conditions.

Tendon versus nerve transfers in elbow, wrist, and hand reconstruction: a literature review.

Upper extremity reconstruction forces the surgeon to chose between several available procedures, among them tendon and nerve transfer. Few guidelines exist to assist the surgeon in this regard, and the authors, therefore, undertook a retrospective review of case series describing tendon and nerve transfer. The authors discovered a scarcity of robust reporting, particularly in regard to tendon transfer, making an objective comparison between the two techniques difficult.

A history of surgery in the instrument tray: eponymous tools used in hand surgery.

Hand surgery emerged as a specialty after World War II, and early hand surgeons borrowed tools from established fields of the time. These tools remain in common use today, and many are identified by the names of the men who created them. Because these men did not specialize in surgery of the hand, their history remains obscure to modern surgeons who do.