Treatment of Madelung's deformity.

Treatment of Madelung's deformity is still controversial. We reviewed retrospectively 19 patients with Madelung's deformity (two bilateral, 21 cases) who underwent surgery to the radius and ulna to improve range of motion, decrease pain and improve appearance of the wrist. Nineteen patients underwent 21 distal radial osteotomy procedures using three different techniques: subtraction, addition or dome osteotomy.

Scaphocapitate arthrodesis for treatment of late stage Kienbock disease.

Symptomatic lunate collapse owing to Kienböck disease is difficult to treat. To define the potential role of scaphocapitate arthrodesis, we reviewed ten patients who underwent scaphocapitate arthrodesis for stage IIIB-IV Kienböck disease at a mean follow-up of 8.75 years (range 1.

Scaphocapitate arthrodesis for treatment of scapholunate instability in manual workers.

Purpose: To assess the long-term efficacy of scaphocapitate arthrodesis for treatment of chronic scapholunate instability in high-demand patients.

Methods: We retrospectively analyzed the clinical and radiographic results of 20 manual workers who underwent scaphocapitate arthrodesis for chronic scapholunate instability at a mean follow-up of 10 years (range, 1-23 y). We measured range of motion and grip strength; pain on a scale of 0 to 5; Quick Disabilities of the Arm, Shoulder, and Hand score; and ability to return to work.

[Vascularized pisiform transfer in place of lunatum for Kienböck's disease].

There is a specific vascularization of the pisiform bone depending on the cubito-dorsal artery, branch of the ulnar artery. The vascularized pisiform bone may be transferred in place of the excised lunatum. The aims are to decrease pain when keeping the mobility, to replace a dead bone, to maintain the distance between scaphoid and triquetrum and radius and capitatum, by preventing the carpal collapse.

[Scaphoid malunion].

Scaphoid fracture and healing are often difficult to diagnose. The scaphoid bone may heal in an abnormal position and this malunion is usually in flexion and shortening. Fractures of the mid or distal part of the bone are mainly concerned.

The pathology of the long ulna: anatomy and treatment.

A long ulna, as a result of congenital differential growth, such as Madelung's disease, or injury, commonly a consequence of a malunited distal radial fracture, may present clinically as pain, decreased motion, mainly of pronosupination, and weakness of grip. Secondary effects may include perforations and tears of the triangular fibrocartilage complex, cartilage wear of the proximal surface of lunate and triquetrum and tears of the lunotriquetral ligament. Positive ulnar variance may be evident on X-rays but a prominent ulnar head cannot always be excluded when there is neutral ulnar variance and further investigations, such as an arthroCTscan or arthroscopy, may be necessary.

Ulna oblique osteotomy for radius and ulna length inequality: technique and applications.

An ulna that is too long or too short may be responsible for symptoms around the wrist. Several techniques are available to shorten or lengthen the ulna. We have used, among other techniques, an oblique osteotomy which allows the length of the ulna to be modified by sliding the 2 fragments over each other, taking care to keep good contact between them.

[Distal radius malunions in flexion].

Aims: In this paper we will differentiate the clinical management of distal radial fractures with malunion in extension from those with malunion in flexion. Malunions in flexion are rare and radial shortening does not contribute significantly to the deformity. There is always a decrease in the range of motion, especially prono-supination.

Chondrocalcinosis of the wrist.

Calcium Pyrophosphate Dihydrate Deposition (CPDD) disease has characteristic radiographic features including soft tissue calcification, joint space narrowing, bone sclerosis, subchondral cyst formation without osteophyte formation, and large intraosseous geodes. Triangular fibrocartilage calcification is frequently found and isolated scapho-trapezio-trapezoid (STT) arthritis is specific for CPDD. Distal radio-ulnar (DRUJ), isolated midcarpal joint and piso-triquetral joint involvement also occur.

[Intraosseus synovial cysts of the lunate bone: diagnostic problems].

Intraosseous ganglia is one of the most frequent lytic defect at the wrist. Its location in the lunate may be discovered by chance on an X-ray performed for another reason, or because of wrist pain and very rarely for a lunate fracture. A.

[Piso-triquetral osteoarthritis. Thirteen case reports and review of the literature].

Piso-triquetral osteoarthritis (OA) is an infrequent cause of ulnar wrist compartment pain. Specific clinical manoeuvres may help for diagnosis. If this aetiology is suspected, a 30 degrees oblique wrist X-ray in supination and sometimes a CT scan with transverse cuts should be performed demonstrating a joint narrowing and osteophytes formation.

Anatomy and histology of the scapholunate ligament.

The scapholunate ligament links the scaphoid to the lunate. It runs transversally at its posterior aspect and obliquely at its anterior aspect, allowing significant relative motion between the two bones. From the neutral position to the full extension position, the lunate rotates by 28 degrees and the scaphoid by 30 degrees; from the neutral position to the full flexion position, the lunate rotates by 30 degrees, whereas the scaphoid rotation is 60 degrees because of the motion of the scaphoid around the capitate.

Radiocarpal dislocations: classification and proposal for treatment. A review of twenty-seven cases.

Background: The radiographic characteristics and treatment of radiocarpal dislocation are not well defined. There have been only two reported series of more than eight patients. Thus, there are many questions concerning treatment and functional results.

[Ligament repair and/or capsulodesis in scapholunate instability].

We have reviewed 37 patients with scapholunate instability, operated in Paris between 1979 and 1995 7 months after the injury. There were 12 partial and 18 complete ligament ruptures, but also 4 distensions. The repair was a secondary suture in 16 cases (7 direct, 1 transosseous, 1 combined, 5 anchor, 2 transosseous with anchor).

Soft tissue stabilization in the management of chronic scapholunate instability without osteoarthritis. A 15-year series.

Management of chronic scapholunate instability without osteoarthritis remains controversial. Some surgeons favor partial wrist arthrodesis; others, soft tissue stabilization. Many techniques for soft tissue repair have been described but with few or unpredictable results.

Resection of the distal scaphoid for scaphotrapeziotrapezoid osteoarthritis.

Twenty-one patients with symptomatic scaphotrapeziotrapezoid osteoarthritis were treated with partial distal scaphoid excision. In 12 wrists the joint defect was filled with either capsular or tendinous tissue, while in nine no fibrous interposition was done. At an average follow-up time of 29 (range, 12-61) months, 13 wrists were painfree, while eight had occasional mild discomfort.

[What's new in cosmetic surgery of the hand? Technical notes].

The author analyses the aesthetic aspects of the hand in three circumstances: trauma, rheumatism, and ageing. He describes the unsightly appearance of certain grafts and flaps and certain amputation stumps and malunions following trauma and emphasizes the cosmetic indication for finger transfer to an adjacent finger in four-finger hands. The main indications for rheumatic digital deformities concern distal deformities: DIP arthrodesis or arthroplasty depending on the finger.

Palmar perilunate fracture-dislocation of the carpus.

We report an uncommon palmar translunate, transhamate carpal fracture dislocation. CT-scans with three-dimensional reconstruction were most helpful for the assessment of the injury, which was treated operatively through a palmar approach. The lunate and hamate fractures were fixed using mini-screws and the radial styloid fracture and the scaphoid were reduced and stabilized with K-wires.

Radio-lunate arthrodesis for distal radial intraarticular malunion.

Eleven cases of symptomatic distal radial intraarticular malunion were treated by radio-lunate arthrodesis from 1983 to 1991. The mean age was 35.3 years.

[Dislocations of the carpal bones].

Thirty per cent of the carpal dislocations are missed although a significant injury was sustained by the wrist. The extent of the ligamentous tears is relative to the magnitude of the forces applied and the anterior lunate dislocation corresponds to the more severe lesions. When a scaphoid fracture is associated, its treatment is predominant.