Effects of radiofrequency probe application on irrigation fluid temperature in the wrist joint.

Purpose: Radiofrequency (RF) probes used in wrist arthroscopy may raise joint fluid temperature, increasing the risk of capsular and ligamentous damage. The purposes of the current study were to measure joint fluid temperature during wrist arthroscopy with the use of RF probes, and to determine whether using an outlet portal will reduce the maximum temperature.

Methods: We performed wrist arthroscopy on 8 cadaveric arms.

Unstable fracture-dislocations of the elbow.

Fracture-dislocations of the elbow are devastating injuries. The surgeon must maintain a high index of suspicion when evaluating an elbow dislocation to avoid missing critical associated injuries. Patterns of unstable fracture-dislocations include the "terrible triad" injury of the elbow (elbow dislocation, radial head fracture, and coronoid fracture), transolecranon fracture-dislocations, and the posterior Monteggia lesion.

Open surgical treatment of post-traumatic elbow contractures in adolescent patients.

The results of surgical treatment of post-traumatic elbow contractures in adolescence have been conflicting in the literature. Twelve adolescent patients (mean age 16.7 years, range 13-21) that had open release of post-traumatic elbow contractures were followed-up for a mean of 18.

Distal biceps tendon reconstruction in chronic ruptures.

The purpose of this retrospective study was to evaluate the results of anatomic reattachment with reconstruction of the distal biceps tendon using an Achilles tendon allograft in 7 male patients with chronic distal biceps ruptures. Through a 1-incision anterior approach, the tendon allograft was attached to the bicipital tuberosity by using suture anchors and then secured to the biceps remnant. Follow-up averaged 29 months.

A capsular-based vascularized distal radius graft for proximal pole scaphoid pseudarthrosis.

Purpose: To evaluate the clinical results of the application of a capsular-based dorsal distal radius vascularized bone graft in scaphoid proximal pole nonunions.

Methods: Thirteen patients with symptomatic nonunion at the proximal pole of the scaphoid (10 with avascular necrosis) were treated and reviewed retrospectively. The vascularized bone graft was harvested from the distal aspect of the dorsal radius and was attached to a wide distally based strip of the dorsal wrist capsule.

Arthroscopic debridement and closed pinning for chronic dynamic scapholunate instability.

Purpose: For chronic dynamic scapholunate (SL) instability (>3 months after injury) open procedures (capsulodesis, limited intercarpal fusions, tenodesis, SL ligament reconstruction) have become popular in recent years but their long-term results have been suboptimal. We evaluated retrospectively the results of aggressive arthroscopic debridement of the SL ligament to bleeding bone in an effort to induce scar formation and closed pinning of the SL joint in patients unwilling to have an open procedure.

Methods: Eleven patients (mean age, 37 y) presenting with persistent posttraumatic pain and weakness to the wrist were diagnosed with dynamic SL instability (positive Watson scaphoid shift test result, SL gapping on grip-view radiographs, arthroscopic findings of a Geissler grade III or IV SL tear) and treated.

Step-cut distal ulnar-shortening osteotomy.

Purpose: Several techniques for ulnar-shortening osteotomies have been described in recent years, reflecting the difficulties that sometimes are encountered in what seems to be a relatively simple procedure. We describe the use of a simple step-cut ulnar-shortening osteotomy stabilized with a lag screw and a palmarly placed 3.5-mm neutralization plate.

Partial scapholunate ligament injuries treated with arthroscopic debridement and thermal shrinkage.

Purpose: To present the early results of arthroscopic debridement and thermal shrinkage using radiofrequency probes for partial (Geissler grades I and II) scapholunate (SL) interosseous ligament injuries of the wrist.

Methods: Sixteen patients with a mean age of 34 years (range, 18-54 y) presenting with chronic dorsoradial wrist pain unresponsive to initial conservative treatment for a mean period of 12 weeks were included in this study. No patient showed radiologic signs of static dissociation (SL interval, <3.

Two-stage flexor tendon reconstruction in zone 2 of the hand in children.

Two-stage flexor tendon reconstruction (Hunter) is indicated in children with extensive adhesions in zone 2 of the hand, with some reservations concerning the patient's age and cooperation. Nine children (mean age 6.9 years) were treated with the modified Paneva-Holevich technique, which has advantages over the classic Hunter reconstructions.

Ipsilateral radial shaft, head, and medial epicondyle fractures.

A patient with a unique combination of ipsilateral midradial shaft (AO/OTA 22-A2), radial head (21-A2), and medial epicondyle (13-A1) fractures, without a recorded elbow dislocation or distal radioulnar joint disruption, is presented. The injury was treated surgically with a dorsal approach to the forearm and a lateral approach to the elbow through a single dorsolateral skin incision. The radial shaft fracture was stabilized using a 3.

Two-stage flexor tendon reconstruction in zone II using a silicone rod and a pedicled intrasynovial graft.

Purpose: To evaluate the results of a modified Paneva-Holevich technique for flexor tendon reconstruction in zone II.

Methods: Twenty patients (22 digits) with poor prognosis injuries (Boyes grade 2-5) were reconstructed. The technique included placing a silicone rod and creating a loop between the flexor digitorum profundus (FDP) and the flexor digitorum superficialis (FDS) in the first stage and reflecting the latter as a pedicled graft through the pseudosheath created around the silicone rod in the second stage.