Advanced Surgical Training Models for Wrist Surgery.

Globally, surgical exposure for the trainee has become challenging due to changes in shift patterns, increasing medicolegal issues and the recognition of burnout. Simulation models are a crucial adjunct for the development of arthroscopic skills and open procedures. Advanced anatomically precise 3D-printed wrist models are used in our workshops.

The Volar Cortical Hinge: An Independent Risk Factor for Distal Radius Fracture Displacement.

 Displaced distal radius fractures are prone to redisplacement after manipulation. This can result in the need for delayed surgery. Several criteria have been studied to predict the likelihood of redisplacement.

Lunate Fracture Morphology in Kienbock's Disease-A Computed Tomography Study.

 The pathogenesis of Kienbock's disease is poorly understood. The coronal fracture line is acknowledged as a poor prognostic marker in the disease. Other fracture types in the Kienbock's wrist have subsequently been identified.

An assessment of burnout in New Zealand orthopaedic resident medical officers.

Aims: Burnout and fatigue are common in the medical profession. The primary aim was to assess rates of burnout in trainee and non-trainee orthopaedic registrars in New Zealand. A secondary aim was to establish which specific factors are associated with burnout.

Preiser's Disease-Current Concepts of Etiology and Management.

The term Preiser's disease typically is used to describe idiopathic avascular necrosis of the scaphoid, but there have been a number of putative etiologies considered. It is rare and the natural history is not fully understood. Management of the condition should be based on patient factors as well as the stage of disease with regard to the scaphoid and the surrounding wrist.

The Pathoanatomy and Biomechanics of Kienböck Disease.

Kienböck disease (KD) involves osseous, vascular, and chondral aspects of the lunate and wrist. We present our theories on the etiology and pathogenesis of the condition based on basic science models, seminal literature, personal case experience, and kinematic observations of the Kienböck wrist. Three phenotypes of Kienböck disease occur, and each tends to have different morphology, rates of progression, and disease pattern.

Volar Marginal Rim Fractures of the Distal Radius Have a Higher Rate of Associated Carpal Injuries-A Comparative Cohort Study.

 Volar marginal rim distal radius fractures can be challenging due to volar instability of the carpus. The associated carpal injuries, however, have not previously been reported.  The aim of this study was to compare volar marginal rim fractures to other distal radius fractures to determine if there is any association with other carpal injuries.

Anatomic factors associated with partial distal biceps tendon tears: a comparative control study.

Background: There is minimal literature on the anatomic factors associated with partial distal biceps tendon (DBT) tears. It has been proposed that a larger radial tuberosity size-and, therefore, a smaller radioulnar space during pronation-may cause mechanical impingement of the DBT predisposing to tears. We sought to investigate the anatomic factors that may be associated with partial DBT tears by retrospectively reviewing the DBT anatomy using 3-T magnetic resonance imaging (MRI) scans of elbows with partial DBT tears and a comparison group of normal elbows.

Anatomy of the distal biceps tendon: an in vivo 3-T magnetic resonance imaging study.

Background: On the basis of the current literature, the optimal surgical technique for distal biceps tendon tears remains controversial. Cadaveric studies have investigated distal biceps anatomy but are limited by cohort size and tissue factors. We sought to investigate distal biceps anatomy in vivo by retrospectively reviewing magnetic resonance imaging (MRI) scans.

Kinematics of the wrist in Kienböck's disease: a four-dimensional computed tomography study.

We studied the kinematics of 20 wrists affected by Kienböck's disease using four-dimensional computed tomography (4-D-CT) scanning. Degenerative changes progressed from the lunate facet to the scaphoid fossa at the radiocarpal articulation, then involved the midcarpal joint. Lunate fracture types included coronal (14/20), sagittal (10/20) and ligament attachment-types (8/20).

Long-Term Outcome of Surgical Treatment for Kienböck Disease Using an Articular-Based Classification.

Purpose: The aim of this study was to report the outcomes of surgery using the Bain and Begg articular-based classification for the treatment of Kienböck disease.

Methods: We identified and followed patients who had surgery for Kienböck disease between 1995 and 2014. Assessment included functional scoring using a modification of the Gartland and Werley score, pain levels, and grip strength.

Defining the proximity of the axillary nerve from defined anatomic landmarks: an in vivo magnetic resonance imaging study.

Background: The location of the axillary nerve in the shoulder makes it vulnerable to traumatic or iatrogenic injury. Cadaveric studies have reported the location of the axillary nerve but are limited because of tissue compression, dehydration, and decay. Three-Tesla (T) magnetic resonance imaging (MRI) allows high anatomic resolution of neural structures.

Single-Cut Single-Screw Capitate-Shortening Osteotomy for Kienbock's Disease.

 Kienbock's disease, in spite of an uncertain natural history, is known to cause lunate compromise, leading to central column collapse, carpal instability, and degenerative arthritis of the wrist. Joint leveling procedures are performed in the early stages of Kienbock's disease to "unload" the lunate. Capitate shortening is the preferred procedure in Kienbock's patients with positive ulnar variance.

Application of dermal chlorhexidine antisepsis is ineffective at reducing colonization in shoulder surgery.

Background: Chlorhexidine as a skin surface antiseptic has been shown to be ineffective with respect to reducing colonization within the dermis. The purpose of the present study was to determine whether the application of aqueous chlorhexidine solution to the dermal layer decreased colonization during open shoulder surgery.

Methods: The present study enrolled 50 patients who were undergoing open shoulder surgery.

Association of scapholunate dissociation and two-part articular fractures of the distal radius.

Scapholunate dissociation may occur in association with distal radial fractures and is easily missed at initial presentation. The aim of this study was to examine variances in the scapholunate distance with respect to subtypes of two-part partial articular distal radial fractures. Axial computed tomography (CT) scans of acute two-part intra-articular radial fractures were assessed retrospectively from 80 patients and compared to 20 controls.

Erratum: Microstructure of the Distal Radius and Its Relevance to Distal Radius Fractures.

[This corrects the article DOI: 10.1055/s-0037-1602849.].

Microstructure of the Distal Radius and Its Relevance to Distal Radius Fractures.

 There is a paucity of information on the microstructure of the distal radius, and how this relates to its morphology and function.  This study aims to assess the microanatomical structure of the distal radius, and relate this to its morphology, function, and modes of failure.  Six dry adult skeletal distal radii were examined with microcomputed tomography scan and analyzed with specialist computer software.

The Role of Wrist Arthroscopy in Kienbock Disease.

Kienbock disease (KD) is a disease of uncertain etiology, leading to chondral and osseous change in the lunate and wrist. Traditionally, Lichtman's classification of KD, based on radiographic appearances, has been used to direct treatment. Diagnostic wrist arthroscopy allows direct assessment of the lunate and surrounding articulations.

Radioscapholunate fusion with triquetrum and distal pole of scaphoid excision: long-term follow-up.

Unlabelled: The purpose of this study was to assess the long-term outcomes of radioscapholunate fusion, with and without distal pole of scaphoid excision and excision of the triquetrum. These compromised three operative groups. Seventeen patients were identified with a minimum of 10 years follow-up, with a mean of 15 years (range 10-19).

Erratum: The Etiology and Pathogenesis of Kienböck Disease.

[This corrects the article DOI: 10.1055/s-0036-1583755.].

Kienböck Disease and Arthroscopy: Assessment, Classification, and Treatment.

The assessment and management of Kienböck Disease (KD) has always been a conundrum. The Lichtman classification has traditionally been used to guide treatment based on imaging. Arthroscopy provides a direct visualization of the articular surface, allows probing of the surfaces, and enables minimally invasive techniques to be performed.

The Etiology and Pathogenesis of Kienböck Disease.

Kienböck disease is a condition that typically occurs in the "at-risk" patient, in the "at-risk" aspect of the proximal condyle of the "at-risk" lunate. In the active male, repetitive loading causes the stress fracture that commences in the single layer proximal subchondral bone plate. The lunate fracture commences at the point the lunate cantilevers over the edge of the distal radius, and then takes on the shape of the radius.