Collagen and Vascular Changes in the Scapholunate Ligament Following Injury: An Immunohistochemical Study.

Purpose: The scapholunate ligament (SLL) is the most frequently injured wrist ligament. The aim of this study was to investigate cellular and extracellular changes within the SLL following injury.

Methods: Fifteen SLLs were harvested, ranging between 39 days to 20 years from time of injury.

Bioactive polymer composite scaffolds fabricated from 3D printed negative molds enable bone formation and vascularization.

Scaffolds for bone defect treatment should ideally support vascularization and promote bone formation, to facilitate the translation into biomedical device applications. This study presents a novel approach utilizing 3D-printed water-dissolvable polyvinyl alcohol (PVA) sacrificial molds to engineer polymerized High Internal Phase Emulsion (polyHIPE) scaffolds with microchannels and distinct multiscale porosity. Two sacrificial mold variants (250 µm and 500 µm) were generated using fused deposition modeling, filled with HIPE, and subsequently dissolved to create polyHIPE scaffolds containing microchannels.

Simplifying the Decision-Making Process in the Treatment of Kienböck's Disease.

 In recent years, the classification and treatment algorithm for adult Kienböck's disease (KD) has expanded. However, the priority of the investigations done in determining its management has not been discussed, as not every patient with KD requires magnetic resonance imaging (MRI) or wrist arthroscopy.  We discuss the role of these investigations and emphasize the importance of computed tomography (CT) imaging in evaluating the cortical integrity of the lunate and its role in the decision-making process and management of KD.

Medial Femoral Condyle Corticoperiosteal Flap for Failed Total Wrist Fusions.

 Recalcitrant nonunion following total wrist arthrodesis is a rare but challenging problem. Most commonly, in the setting of failed fusion after multiple attempts of refixation and cancellous bone grafting, the underlying cause for the failure is invariably multifactorial and is often associated with a range of host issues in addition to poor local soft-tissue and bony vascularity. The vascularized medial femoral condyle corticoperiosteal (MFC-CP) flap has been shown to be a viable option in a variety of similar settings, which provides vascularity and rich osteogenic progenitor cells to a nonunion site, with relatively low morbidity.

Double-Screw Osteosynthesis in an Unstable Scaphoid Fracture Model: A Biomechanical Comparison of Two Screw Configurations.

Purpose: Although there is evidence that a single headless compression screw is sufficient for fixation of most scaphoid fractures, double-screw osteosynthesis has been shown to result in higher failure strength and stiffness than a single screw. However, the biomechanical effect of different screw configurations has not been determined.

Methods: A standardized unstable fracture model was produced in 28 cadaveric scaphoids.

Functional Recovery Following Trapeziectomy and Ligament Reconstruction and Tendon Interposition: A Prospective Longitudinal Study.

Purpose: Patients undergoing surgery for trapeziometacarpal (TMC) joint arthritis require preoperative counseling on the expectations of surgery. This study aims to document the objective and functional recovery over the initial 12 months following trapeziectomy and ligament reconstruction with tendon interposition (LRTI).

Methods: We prospectively followed 55 patients with symptomatic TMC joint osteoarthritis after trapeziectomy and LRTI.

Biomechanical comparison of intramedullary screw fixation, dorsal plating and K-wire fixation for stable metacarpal shaft fractures.

We compared four methods of metacarpal shaft fixation: 2.2 mm intramedullary headless compression screw; 3.0 mm intramedullary headless compression screw; intramedullary K-wire fixation; and dorsal plate fixation.

Surgical Repair of Triangular Fibrocartilage Complex Tears: A Systematic Review.

 This study systematically reviews the outcomes of surgical repair of triangular fibrocartilage complex (TFCC) tears. Existing surgical techniques include capsular sutures, suture anchors, and transosseous sutures. However, there is still no consensus as to which is the most reliable method for ulnar-sided peripheral and foveal TFCC tears.

Reconstruction of the Proximal Scaphoid With a Medial Femoral Trochlea Osteochondral Graft: Minimum 2-Year Results.

Purpose: To report the clinical and radiological outcomes after medial femoral trochlear (MFT) osteochondral graft for the salvage of proximal scaphoid fractures with a minimum 2-year follow-up.

Methods: A retrospective review was performed of patients with comminuted fractures of the proximal scaphoid treated by excision of the proximal pole and replacement with free vascularized MFT osteochondral graft. Demographic data, objective and radiographic measurements, and patient-reported outcome measures of the upper limb and knee were collected.

The Twist X-Ray: A Novel Test for Dynamic Scapholunate Instability.

 Scapholunate instability (SLI) is the most common form of carpal instability. Early detection of SLI is imperative as early reconstructive procedures can potentially prevent the natural history of progressive degenerative arthritis. After wrist arthroscopy, magnetic resonance imaging (MRI) remains the next best noninvasive diagnostic option; however, access still remains costly and is often limited in many health care systems worldwide.

Quantitative analysis of in-vivo thumb carpometacarpal joint kinematics using four-dimensional computed tomography.

The purpose of this study was to define the normal thumb carpometacarpal joint kinematics in-vivo during opposition and abduction using four-dimensional computed-tomography in four volunteers. Movement of the metacarpal relative to the trapezium was quantified using both Euler and helical axis representations. Articular surface contact patterns were also analysed.

Scaphoid Fracture Fixation in a Nonunion Model: A Biomechanical Study Comparing 3 Types of Fixation.

Purpose: Union of a scaphoid fracture after fixation is influenced by various factors, one of which is fracture stability. This study aims to compare the biomechanical stability of 3 different types of scaphoid fracture fixation in a scaphoid nonunion model.

Methods: Thirty cadaveric scaphoid specimens were assigned to one of 3 different fixation groups: (1) single 3.

Radial Column Excision and Four-Corner Fusion for the Treatment of Basal Thumb Arthritis and Scapholunate Advanced Collapse Wrist or Midcarpal Arthritis.

 The combination of trapeziometacarpal arthritis and intercarpal pattern of degenerative wrist arthritis is uncommon.  To report on the clinical and radiologic results of patients who have undergone radial column excision (scaphoidectomy and trapeziectomy) (RCE) and four-corner fusion (4CF). We describe the patterns of disease that present with basal thumb and midcarpal arthritis and treatment outcomes of a single-surgeon series.

Cadaveric scapholunate reconstruction using the ligament augmentation and reconstruction system.

Background Untreated scapholunate ligament disruption may lead to progressive wrist arthritis. Current techniques used to treat the disruption may not prevent arthritis because of attenuation of a reconstructive ligament substitute or failure to re-establish normal wrist kinematics. Questions/Purposes This study evaluates a combined synthetic-autologous technique for the treatment of scapholunate dissociation.

Osteotomy for sigmoid notch obliquity and ulnar positive variance.

Background Several causes of ulnar wrist pain have been described. One uncommon cause is ulnar carpal abutment associated with a notable distally facing sigmoid notch (reverse obliquity). Such an abnormality cannot be treated with ulnar shortening alone because it will result in incongruity of the distal radioulnar joint (DRUJ).

Ligament reconstruction of the Trapezial-metacarpal joint for early arthritis: a preliminary report.

Purpose: To evaluate the results and determine the efficacy of an alternative ligament reconstruction technique in patients with a symptomatic trapezial-metacarpal joint associated with subluxation and early or limited chondral damage.

Methods: This retrospective, nonrandomized study was composed of 6 patients, all women with ages between 31-46 years, treated by arthroscopic evaluation and reconstruction of the intermetacarpal and reverse anterior oblique ligament of the trapezial-metacarpal joint, using a strip of flexor carpi radialis tendon. Evaluation at an average follow-up of 18 months (range,12-28 mo) consisted of interview, examination, and computed tomography.

Sigmoid notch osseous reconstruction.

The purpose of this article is to describe a technique of restoring stability or congruency to the distal radioulnar joint (DRUJ) by osteoplasty or osteotomy of the sigmoid notch, where abnormalities in the osseous anatomy have resulted in DRUJ instability. This technique addresses the osseous cause to DRUJ instability and avoids the need for complex soft tissue procedures to treat chronic volar instability or salvage procedures to treat dorsal instability of the DRUJ associated with an impacted fracture of the dorsal rim of the sigmoid notch.

Sigmoid notch osteotomy for posttraumatic dorsal dislocation of the distal radioulnar joint: A case report.

Instability of the distal radioulnar joint (DRUJ) is associated most commonly with injury to the soft-tissue restraints of that joint, particularly the triangular fibrocartilage complex. The dorsal rim of the sigmoid notch, however, also plays an important role as a bony restraint to dorsal subluxation. We report a case of posttraumatic dorsal dislocation of the DRUJ associated with a depressed fracture of the dorsal rim of the sigmoid notch.

Chondrocyte apoptosis in response to dislocation of the hip in the rat model.

Background: Joint dislocation is a traumatic event that can lead to osteoarthritis. The purpose of this paper is to study cartilage changes following prolonged joint dislocation for 1, 2 or 8 h.

Methods: Sprague-Dawley rats (n = 27) were used in this study.

Scaphotrapezial joint arthroscopy: a palmar portal.

Purpose: Arthroscopy of the scaphotrapezial trapezoid (STT) joint is performed traditionally through a dorsal radial midcarpal portal. This portal allows visualization of the dorsal rim of the STT joint but is difficult to approach owing to lack of surface landmarks and it passes close to the radial artery and nerve. The purpose of this study was to assess the safety, ease of access, and visualization of the STT joint through a palmar portal.