Contested claims in carpal tunnel surgery: outcome study of worker's compensation factors.

Unlabelled: We retrospectively analyzed the importance of factors relating to worker's compensation for 273 wrists in 211 consecutive patients who underwent primary carpal tunnel release. Patients were divided into three groups: non-work related, worker's compensation-uncontested, and worker's compensation-contested. Contested claims were those in which the worker's compensation carrier denied authorization for surgery, and in which such authorization was given following intervention by a plaintiff's attorney.

Trispiral tomographic staging of Kienböck's disease.

Trispiral tomography enhances the staging of Kienböck's disease and aids in surgical planning. The clinical records, plain x-rays, and trispiral tomograms of 105 patients with Kienböck's disease were reviewed. When tomograms were used, upward revision of the classification stage was indicated in 73% of patients with stage I or stage II disease and in 10% of those with stage III disease.

Radial recession osteotomy for Kienböck's disease.

Sixty-eight patients underwent radial recession osteotomy for avascular necrosis of the lunate were retrospectively evaluated after an average follow-up period of 52 months. Twenty-five patients had undergone 1 or more additional procedures concurrently for treatment of Kienböck's disease. Pain diminished in 93% of patients, grip strength improved, and wrist motion was preserved; 75% of patients continued in their original occupations, including heavy labor.

Arthrodesis of the wrist for post-traumatic disorders.

We retrospectively reviewed the records of eighty-nine consecutive patients (ninety wrists) who had had a total arthrodesis of the wrist for the treatment of a post-traumatic disorder at one center. Fifty-six patients (fifty-seven wrists) had the arthrodesis with plate fixation, and thirty-three patients (thirty-three wrists) had the arthrodesis with a variety of other techniques. The average age of the patients at the time of the arthrodesis was forty-two years, and the dominant wrist was treated in forty-two patients.

Ulnar lengthening and radial recession procedures for Kienböck's disease. Long-term clinical and radiographic follow-up.

Twenty patients with Kienböck's disease who had undergone a joint levelling procedure, were reviewed at a mean of 11 years following surgery. Clinical and radiological evaluation revealed good long-term results with all patients complaining of less pain than before surgery and with statistically significant increases in range of motion and grip strength. Radiologically a significant number of patients were found still to have lunate fractures and fragmentation.

Upper extremity function after wrist arthrodesis.

Several studies have examined the normal range of wrist motion used to accomplish activities of daily living. Little information is present, however, on what functional limitations might be experienced by patients actually undergoing formal wrist arthrodesis. This study undertook comprehensive functional evaluation of 23 patients who underwent wrist arthrodesis for post-traumatic conditions.

Ulnar lengthening procedures.

Ulnar lengthening redistributes axial compressive forces partially relieving those on the lunate, slowing or halting further progressive collapse. Long-term results are satisfactory, although restitution of the carpal anatomy is not obtained.