Outcomes of Surface Replacement Proximal Interphalangeal Joint Arthroplasty Through a Volar Approach: A Prospective Study.

Background: The dorsal approach to the proximal interphalangeal (PIP) joint provides the advantage of improved visualization of the articular surface, while the disadvantage of a dorsal approach is the disruption of the central slip and extensor mechanism requiring a delay in range of motion exercises. A volar approach keeps the central slip and extensor mechanism intact, allowing for early range of motion. The goal of this study was to evaluate patient outcomes of surface replacement (SR) PIP joint arthroplasty performed through a volar approach.

Distal radius malunion and forearm rotation: a cadaveric study.

Background Malunions following distal radius fractures are common, with shortening, translation, and rotation occurring. The patients frequently lose forearm rotation, but there is no data to indicate whether this is due to mechanical misalignment between the radius and the ulna or to contracture of the soft tissues. Material and Methods Seven fresh cadaveric specimens were used to determine the loss of forearm rotation with varying simulated distal radius fracture malalignment patterns.

Scaphoidectomy and Capsulodesis for SNAC or SLAC Stage II.

Two common types of wrist arthritis are scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC). In stage II SLAC or SNAC, there is arthritis between the scaphoid and the radius, sparing the cartilage between the capitate and the lunate and between the lunate and the radius. When nonsurgical treatment failed, scaphoidectomy plus capsulorrhaphy was used in 8 patients to provide pain relief without requiring an arthrodesis or compromising the radiolunate articulation.

Treatment of plastic deformation of the forearm in young adults with double-level osteotomies: case reports.

Plastic deformation of the forearm is a rare injury in young adults that occurs when a slow bending or rotational force is applied to the arm, most commonly in the setting of an industrial workplace accident. There are currently no guidelines for treatment of the residual forearm deformity that often results in limitations of forearm supination and pronation. We present 2 cases demonstrating that deformity correction with single cortex, double-level osteotomies combined with rigid plate fixation and early range of motion exercise that results in good functional outcomes.

Zone-II flexor tendon repair: a randomized prospective trial of active place-and-hold therapy compared with passive motion therapy.

Background: In order to improve digit motion after zone-II flexor tendon repair, rehabilitation programs have promoted either passive motion or active motion therapy. To our knowledge, no prospective randomized trial has compared the two techniques. Our objective was to compare the results of patients treated with an active therapy program and those treated with a passive motion protocol following zone-II flexor tendon repair.

Glatiramer acetate immune system augmentation for peripheral nerve regeneration in rat crushed sciatic nerve model.

Background: Protective antiself response to nervous system injury has been reported to be mediated by a T-cell subpopulation that can recognize self-antigens. Immune cells have been shown to play a role in the regulation of motor neuron survival after a peripheral nerve injury. The objective of the present study was to evaluate the effects of immune system augmentation with use of the antigen glatiramer acetate, which is known to affect T-cell immunity, on peripheral nerve regeneration.

Management of scaphoid nonunions.

Scaphoid nonunions can exist with or without avascular necrosis of the proximal pole, and waist fractures may have an associated humpback deformity. CT best shows the deformity and bone loss, whereas MRI will show avascular necrosis. Operative treatment should be directed at correcting the deformity with open reduction and internal fixation and bone grafting.

Lessons learned from a case of proximal humeral locked plating gone awry.

A 59-year-old woman underwent plate fixation of her 2-part anatomic neck proximal humerus fracture through an open anterolateral approach. The fixation subsequently failed, and the operation resulted in a dense axillary nerve palsy. Six weeks after her initial procedure, she was returned to the operating room.

Benign parosteal osteochondromatous proliferation of the hand originally diagnosed as osteochondroma: a report of two cases and review.

Bizarre parosteal osteochondromatous proliferation (BPOP) is a rare cartilaginous neoplasm that often presents in the long bones of the hands and feet. BPOP is a benign but locally aggressive fibro-osseous mass that has striking clinical, radiographic, and histologic similarities with osteochondroma. Differentiating between the two lesions is important as BPOP often requires more extensive surgical resection and has a higher recurrence rate compared to osteochondroma.

Work of flexion related to different suture materials after flexor digitorum profundus and flexor digitorum superficialis tendon repair in zone II: a biomechanical study.

Purpose: Repair of both flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS) tendons is commonly performed in zone II flexor tendon injuries; however, the bulk of the repair may impair tendon gliding. We evaluated whether repairing 1 slip of FDS tendon and resecting the other would significantly decrease work of flexion and whether suture material affected this interaction in an in vitro study.

Methods: The index, middle, and ring fingers from 10 fresh-frozen human cadaveric hands were disarticulated and their tendon sheaths opened.

Outcome after vascularized bone grafting of scaphoid nonunions with avascular necrosis.

Purpose: Vascularized bone grafting has been proposed as a treatment for scaphoid nonunions with avascular necrosis of the proximal pole. The purpose of this investigation is to report the results of vascularized bone graft and internal fixation for established scaphoid nonunions with proximal pole avascular necrosis as measured by validated outcome instruments.

Methods: From 1996 to 2004, 30 consecutive patients with established scaphoid nonunion, proximal pole avascular necrosis, and no prior surgery were treated with open reduction and internal fixation in addition to a vascularized bone graft based on 1,2 intercompartmental supraretinacular artery.

Distal tunnel placement improves scaphoid flexion with the Brunelli tenodesis procedure for scapholunate dissociation.

Purpose: Treatment of scapholunate dissociation remains difficult. The modified Brunelli procedure, a flexor carpi radialis tenodesis through the scaphoid and secured with dorsal wrist ligaments, has shown promising results. This study compares the biomechanical effects on scaphoid flexion and scapholunate gap between proximal and distal tunnel placement in the modified Brunelli procedure.

Comparison of ulnar-shortening osteotomy with a new Trimed dynamic compression system versus the Synthes dynamic compression system: clinical study.

Purpose: Ulnar-shortening osteotomy has become common in the treatment of symptomatic positive ulnar variance. Our goal was to evaluate prospectively a new dynamic compression plating system in comparison with a commonly used dynamic compression system. In contrast with other systems, the new system uses a slotted hole that enables fixation of the plate to the bone prior to performing the osteotomy, a fitted compression clamp, and a lag screw.

Repair of acute ulnar collateral ligament injuries of the thumb metacarpophalangeal joint: a retrospective comparison of pull-out sutures and bone anchor techniques.

Background: The use of intraosseous suture anchors in the treatment of ruptures of the ulnar collateral ligament of the thumb metacarpophalangeal joint has previously been described. However, no direct comparisons exist of ulnar collateral ligament repair with bone anchor versus repair with a pull-out button and immobilization.

Methods: Two cohorts of patients with complete rupture of the ulnar collateral ligament of the thumb metacarpophalangeal joint were compared.

Capitate shortening osteotomy with vascularized bone grafting for the treatment of Kienböck's disease in the ulnar positive wrist.

Purpose: Decompression surgery combined with revascularization surgery may provide better results than either alone in the treatment of Kienböck's disease. This study describes our experience with capitate shortening combined with vascularized bone grafting for the treatment of Kienböck's disease in ulnar neutral and ulnar positive variant patients.

Methods: Between 1996 and 2004, patients diagnosed with Lichtman stage II or stage IIIA Kienböck's disease with ulnar neutral or ulnar positive wrists were enrolled in this prospective study and had capitate shortening osteotomy with concurrent vascularized bone grafting.

Scapholunate interosseous ligament reconstruction: results with a modified Brunelli technique versus four-bone weave.

Purpose: To compare clinical and radiographic outcomes in patients with chronic scapholunate dissociation treated with a modified Brunelli technique versus a 4-bone tendon weave.

Methods: A retrospective cohort study was performed. Twenty-three patients presented with chronic scapholunate dissociation and were treated with the 4-bone tendon weave technique as described by Almquist and colleagues.

Basal joint arthritis of the thumb.

The carpometacarpal joint of the thumb is the second most common site of arthritis in the hand. Patients in whom conservative treatment fails benefit from surgical intervention, although no consensus exists as to the best method to provide maximum pain relief and functional outcomes. The pathophysiology of carpometacarpal arthritis is loss of the integrity of the palmar oblique ligament, which allows for dorsal subluxation of the metacarpal on the trapezium.

Comparative biomechanic study of flexor tendon repair using FiberWire.

Purpose: FiberWire, an increasingly popular suture material, allows for strong flexor tendon repair that may allow early mobilization. This study was designed to evaluate the mechanical characteristics of FiberWire for flexor tendon repair and to identify the most effective repair technique using this material.

Methods: Forty-nine human cadaver flexor tendons were randomized and tested biomechanically using one of the following techniques of flexor tendon repair performed with 3-0 FiberWire: (1) modified Kessler, (2) modified Pennington, (3) 2-strand multiple grasping, (4) 2-strand multiple locking, (5) 2-strand double cross-locks, (6) Massachusetts General Hospital, and (7) 4-strand locked cruciate.

Endoscopic revision of carpal tunnel release.

Background: Open revision has been the standard approach for treatment of recurrent carpal tunnel syndrome. The authors hypothesized that endoscopic revision would yield results comparable to those with open revision.

Methods: Forty-one patients with unilateral recurrence were analyzed prospectively before and after endoscopic revision for a period of 1 year.

Medial collateral ligament injury in the overhand-throwing athlete.

Medial collateral ligament injuries are rare and occur almost exclusively in overhand-throwing athletes. The late cocking phase of the overhand throw places a marked valgus moment across the medial elbow. This repetitive force reaches the tensile limits of the medial collateral ligament, subjecting it to microtraumatic injury and attenuation.

The detailed anatomy of the 1,2 intercompartmental supraretinacular artery for vascularized bone grafting of scaphoid nonunions.

Purpose: To describe the configuration of the 1,2 intercompartmental supraretinacular artery (1,2 ICSRA), including the location of the perforators, and to discuss the clinical use of the 1,2 ICSRA for vascularized bone grafting of scaphoid nonunions.

Methods: Thirteen fresh-frozen cadaveric forearms were used to evaluate the variations in the anatomy of the 1,2 ICSRA. After injection of red latex, the 1,2 ICSRA and its perforators were characterized and measured.

Diagnosis and anatomic reconstruction of extensor carpi ulnaris subluxation.

Purpose: To evaluate the efficacy of dynamic ultrasound to diagnose extensor carpi ulnaris (ECU) subluxation and assess the results of a new technique for anatomic ECU tendon sheath reconstruction.

Methods: Dynamic ultrasound was used to confirm the diagnosis of ECU tendon subluxation in patients presenting with painful snapping of the ulnar wrist during supination and pronation. Twenty-one patients with persistent subluxation had reconstruction of the ECU tendon sheath using a new technique.

A comparison of polyglycolic acid versus type 1 collagen bioabsorbable nerve conduits in a rat model: an alternative to autografting.

Purpose: Severe nerve injury with segmental loss requires nerve graft or conduit repair. We compared 2 synthetic, bioabsorbable nerve conduits with the gold standard of autogenous nerve grafting using histopathologic and neurophysiologic analyses.

Methods: A 10-mm segment of the sciatic nerve of 45 Sprague-Dawley rats was resected, leaving a gap defect.

Ulnar nerve laceration and repair.

Patient age, the site and extent of the injury, and the delay of treatment significantly influence the outcome after repair of ulnar nerve injuries. Ulnar nerve repairs in older patients, high-level injury, and delayed cases may result in a poor prognosis. High-level lesions and lesions that are close to the elbow can also benefit from nerve transposition.