Technique of ulnar shortening.

Ulnar shortening or recession is a common treatment for an expanding number of clinical indications. This procedure has become more reliably performed because of specialized equipment that permits the creation of 2 precise 45-degree osteotomy surfaces and a known amount of ulnar shortening. Further refinements in technique have facilitated compression of the osteotomy surfaces and application of an interfragmentary lag screw at a specified angle.

Ulnar shortening.

Ulnar shortening is a procedure that has steadily grown in popularity over the past decade. This technique was originally introduced to treat ulnar impaction following a displaced distal radial fracture. However, indications for ulnar shortening have increased over the years to include luno-triquetral tears and early degenerative arthritis at the distal radial-ulnar joint.

Precision oblique osteotomy for shortening of the ulna.

The obstacles of prolonged healing time and technically demanding osteotomy and plate fixation in the performance of ulnar shortening osteotomies have been overcome by a precision system that includes a 45 degrees osteotomy and 2.7 mm interfragmentary lag screw. In 23 transverse osteotomies healing time averaged 21 weeks with one nonunion.

The history and evolution of percutaneous pinning of displaced distal radius fractures.

This article discusses the history and evolution of percutaneous pinning of displaced distal radial articular fractures. Six distinct methods are examined from an historical viewpoint, focusing on problems associated with each technique. The evolution of the Kapandji technique to include arum nuts and the Rayhack technique to include an alignment jig and pin guide with locking set screws is presented also.

Closed elbow dislocation and brachial artery damage.

Damage to the brachial artery associated with closed elbow dislocation but without accompanying fracture is rare. Only 25 cases have been reported to date. We present a case that responded well to brachial artery vein grafting, and review the literature on this subject.

Computed analyses of the pathomechanics of scaphoid waist nonunions.

The computed tomography scans of both the injured and the normal wrists of nine patients with a scaphoid nonunion of 5 to 120 months' duration were used to create three-dimensional computer models. When the computer images of the normal and the contralateral fractured scaphoids were superimposed, it was possible to calculate the volume of bone that was lost as a result of the injury and its failure to heal, as well as the angular relationship of the fracture components to one another. The amount of the scaphoid bone that was lost varied from 6% to 15% of bone volume and did not show a linear correlation with the duration of the nonunion.

Management of auto-emasculation in the psychotic state.

We report 2 cases of self-inflicted penile amputations, which offered differing surgical options and contrasting surgical results due to varying time delays. In 1 case repair was done immediately, while repair in the other case was delayed by 3 days due to the psychotic state of the patient. The psychiatric backgrounds of such episodes are discussed, as well as the techniques of repair and reconstruction.

Digital subtraction arthrography of the wrist.

Digital subtraction arthrography of the wrist was used to identify abnormalities in eighty-six (60 per cent) of 139 patients during a fifteen-month period. Multiple abnormalities were noted in thirty-four (25 per cent) of the wrists. The clinical signs and symptoms in the eighty-six wrists did not always correlate with the defects that were seen on the arthrograms.

Polyarthritis associated with cutaneous T cell lymphoma.

This is the first reported synovial biopsy of a patient with concurrent onset of cutaneous T cell lymphoma and polyarthritis. The biopsy revealed a nonspecific chronic inflammatory process. Immunoperoxidase technique using monoclonal antibodies showed a mixture of helper T cells, suppressor T cells and B cells in the synovial infiltrate.

Advanced imaging of the wrist.

In an effort to improve the radiologist's contribution to the evaluation of the painful wrist, the authors have studied the usefulness of a variety of imaging techniques. Preliminary results of these studies, including: 173 conventional CT, 80 3-D CT, 119 postarthrography CT, 138 multiple compartment digital subtraction arthrography and 55 MRI examinations, are reported, and technical aspects of the examinations are described.

Work in progress: postarthrography computed tomography of the wrist: evaluation of the triangular fibrocartilage complex.

This report reviews a work in progress evaluating the use of postarthrography computed tomography (CT) of the wrist in assessing triangular fibrocartilage complex abnormalities. Twenty-two triangular fibrocartilage complex perforations in 119 patients were identified with both multiple compartment arthrography and postarthrography CT. To obtain a double contrast image of the triangular fibrocartilage complex, the postarthrography CT examinations were performed after multiple compartment arthrography and the injection of air into the radiocarpal compartment.

Transulnar percutaneous pinning of displaced distal radial fractures: a preliminary report.

Difficulty in maintaining the reduction of displaced radial fractures has prompted the use of numerous techniques to address this problem. The purpose of this study was to determine if four or five 0.045-in Kirschner pins when placed percutaneously through the ulna into the radius could maintain the reduction of this unstable fracture configuration.

CT of the wrist for the evaluation of traumatic injuries.

Computed tomography (CT) of the wrist can help evaluate many types of posttraumatic injuries, particularly bony trauma. Most wrist fractures can be diagnosed with routine radiography, but problematic cases and complicated healing fractures can be difficult to evaluate with conventional radiography. CT provides improved contrast resolution and multiplanar imaging.

Digital subtraction wrist arthrography: use of double contrast technique as a supplement to single contrast arthrography.

A new technique using double contrast after digital subtraction wrist arthrography is presented. Results of the double contrast wrist arthrograms were essential to the diagnosis, confirmed the diagnosis, or salvaged an otherwise poor or nondiagnostic examination. It was found that intra-articular injection of air augments the information obtained during postarthrogram active motion studies under fluoroscopy.

Posttraumatic ulnar translation of the carpus.

Ulnar translation of the carpus is a rare posttraumatic carpal instability pattern, in which the entire carpus is displaced ulnarward on the radioulnar surface. No previous formal reports of this problem have been located although it has been described in general discussions of wrist instability. Seven men and one woman were diagnosed with this condition although the diagnosis was delayed from 2 to 23 months, an average of 7.

Scaphoid orientation and location from computed, three-dimensional carpal models.

Subtle subluxations within the carpus are often difficult to diagnose. Carpal orientation and location can now be quantified by mathematical analysis of computed, three-dimensional models produced from serial CT scans. The technique and its application in the analysis of scaphoid subluxation are described.

A strain recording model: analysis of transverse osteotomy fixation in small bones.

Many current experimental testing procedures are cumbersome when applied to osteotomies of small bones and are complicated by the need for in-depth analyses of data derived from various specimens tested to failure. This strain recording model minimizes these factors. Various forms of internal fixation may be serially tested on the same specimen with this system because constructs are not tested to failure but rather within the elastic range of each specimen.

Treatment of unstable intertrochanteric fractures with anatomic reduction and compression hip screw fixation.

One hundred sixty-two cases of unstable intertrochanteric fractures treated by anatomic reduction and compression hip screw fixation were reviewed. One hundred twenty-four of these patients were followed up for an average of 19.2 months.

The erythrocyte sedimentation rate in orthopaedic patients.

The ESR, a sensitive measure of the inflammatory response, is elevated in 90% of patients who have serious orthopedic infections, e.g., discitis, septic arthritis, and hematogenous osteomyelitis.