Fragment-Specific Fixation for Fractures of the Distal Radius.

This article summarizes the management of distal fractures utilizing Acumed fragment-specific family of plates. No single plate option can address every fracture pattern of the distal radius. These fragment-specific plates are usually adjuncts to allow the surgeon to expand the armamentarium in the management of complex volar and dorsal comminuted distal radius fracture patterns.

Arthroscopic Knotless Peripheral Ulnar-Sided TFCC Repair.

This article describes the indications and technique for all-arthroscopic knotless repair of a peripheral tear to the triangular fibrocartilage complex (TFCC). The advantage of this technique is that it allows repair of the articular disk back to the fovea of the ulna without any suture knots to irritate the patient. The learning curve is steep, but once learned, this technique can be performed very quickly and is faster.

Ligamentous sports injuries of the hand and wrist.

Athletic injuries of the hand and wrist continue to increase as athletes get bigger, faster, and the weekend warrior continues to be active throughout his or her lifespan. The management of hand and wrist injuries in these athletes depends on the sport, position, timing during the season the injury occurs, and how many years the athlete has left to play in competition. In the past, these injuries were thought to be trivial; but if not ideally managed, complications can occur which may keep the skilled athlete or the weekend warrior out for a prolonged period of time.

Management distal radius and distal ulnar fractures with fragment specific plate.

This article describes the use of a new generation low profile dorsal rim plate for management of distal radius fractures from the dorsal approach. This plate was designed to maximize stability while minimizing complications from the extensor tendons. A volar ulnar plate designed to specifically stabilize fractures of the ulnar head and neck is also described.

Arthroscopic management of scapholunate instability.

Wrist arthroscopy plays a valuable role in the management of scapholunate instability. A spectrum of injuries can occur to the scapholunate interosseous ligament, which may be difficult to detect with imaging studies. Wrist arthroscopy enables detection and management of injury to the scapholunate ligament under bright light and magnified conditions, in both acute and chronic situations.

Results of ulnar shortening osteotomy with a new plate compression system.

Purpose: The gold standard for treatment of ulnar impaction has become ulnar shortening osteotomy. Previous reports in the literature have shown not only good results with relief of ulnar-sided wrist pain but also significant nonunion rates and painful hardware necessitating further surgery and potentially, metal removal. The purpose of this paper is to review the success rate of ulnar shortening osteotomy utilizing a low profile compression plate designed specifically for ulnar shortening osteotomy.

Scaphoid fractures: what's hot, what's not.

The scaphoid is the most commonly fractured carpal bone of the wrist. It is an unusual carpal bone in that it bridges both the proximal and the distal rows; this subjects it to continuous shearing and bending forces. Approximately 80% of the scaphoid is covered by cartilage, which limits its ligamentous attachment and vascular supply.

Arthroscopic knotless peripheral triangular fibrocartilage repair.

Peripheral tears to the articular disk of the triangular fibrocartilage complex are fairly common. Patients complain of ulnar-sided wrist pain with ulnar deviation and forearmrotation along the prestyloid recess. The peripheral tears of the articular disk are amenable to arthroscopic repair due to its blood supply.

Arthroscopic knotless peripheral ulnar-sided TFCC repair.

Peripheral ulnar-sided tears of the triangular fibrocartilage complex (TFCC) are common injuries and are amenable to arthroscopic repair. This article describes an all-arthroscopic knotless technique for TFCC repair. This technique has the advantage of being all arthroscopic using 3 portals, has the ability to repair both the superficial and deep layers of the articular disk, repairs the articular disk directly back to bone, and does not require any suture knots that may irritate the surrounding soft tissues.

Bracing and rehabilitation for wrist and hand injuries in collegiate athletes.

Athletic injuries of the hand and wrist are common. The key to management of these injuries is prevention. Certain sports require athletes to participate in positions that pose a higher risk of injury to the fingers and wrists.

Operative fixation of metacarpal and phalangeal fractures in athletes.

Metacarpal and phalangeal fractures are common athletic injuries that can significantly affect the athlete's career when they occur during the season and affect the athlete's training when they occur in the off season. This situation is particularly relevant if there are complications or if fixation is not stable enough to permit early range of motion and rehabilitation. This article discusses percutaneous and open reduction techniques of hand fractures as these injuries pertain to athletes.

Arthroscopic management of scaphoid fractures in athletes.

Fractures of the scaphoid are a common athletic injury. In this article the indications and treatment strategy for arthroscopic management of scaphoid fractures and nonunions in athletes are reviewed. Various arthroscopic assisted and percutaneous techniques for the fixation of fractures of the scaphoid are discussed, including the volar and dorsal percutaneous approaches, and arthroscopic reduction by the Geissler technique.

Complex elbow instability.

This article attempts to outline the most current relevant literature regarding diagnosis, pathoanatomy, and treatment options for complex elbow instability. Specific attention is directed toward unique injury patterns, important biomechanical principles, and recent clinical outcome studies. Directions for future research are suggested.

Bone graft substitutes in the upper extremity.

The development of effective bone graft substitutes is one of the most important innovations in musculoskeletal surgery. Bone graft substitutes provide an osteoconductive scaffolding similar to those of autogenous bone. They eliminate donor site morbidity,decrease operative time and complexity and treatment costs, and improve patient satisfaction.

Cannulated percutaneous fixation of intra-articular hand fractures.

Percutaneous fixation techniques minimize edema, scar formation, and stiffness from operative trauma when restoring position and stability of displaced and unstable hand fractures. Percutaneous Kirschner wires merely splint fractures and may migrate, disengage, or irritate soft tissues; may be associated with pin tract suppuration; and may require removal at 4 to 6 weeks after insertion. Percutaneous miniscrews may provide more secure fixation for larger articular and oblique diaphyseal fractures of the thumb and finger phalanges by means of bicortical fixation and compression, are less intrusive to adjacent tissues, retain the fracture throughout the healing process, and seldom require removal.

Midshaft clavicular fractures: the role of operative treatment.

Plate fixation remains a staple for open fractures, closed fractures requiring open management, and nonunions, especially if bone grafting is required.

Intra-articular distal radius fractures: the role of arthroscopy?

Arthroscopic assisted fixation of distal radius fractures offers several advantages. It allows for the evaluation of the articular reduction under a bright light and magnification. Particularly, rotation of the fracture fragments, which is difficult to judge under fluoroscopy, may be detected arthroscopically and corrected.

Current concepts in the treatment of distal radial fractures.

Surgical indications for the treatment of distal radial fractures are evolving. It is important to identify the various articular fragments and their significance to facilitate optimal surgical treatment of these fragments from the standpoint of both internal and external fixation. New techniques in the visualization and stabilization of the articular surface and the treatment of defects in the metaphysis, including the use of cement to buttress the articular surface, have been brought to the forefront.

Percutaneous internal fixation of selected scaphoid nonunions with an arthroscopically assisted dorsal approach.

Background: Preliminary reports have indicated that selected scaphoid nonunions-i.e., those that are well aligned and without extensive sclerosis or bone resorption at the nonunion site-can be treated effectively with internal fixation alone.

Percutaneous internal fixation of scaphoid fractures via an arthroscopically assisted dorsal approach.

Percutaneous internal fixation of scaphoid fractures allows for more predictable union and less morbidity than cast treatment or open internal fixation. A headless cannulated compression screw (standard Acutrak) is implanted by way of a dorsal percutaneous approach with the aid of fluoroscopy and arthroscopy to confirm screw position and fracture reduction. This technique is indicated in the correction of acute proximal pole fractures, acute waist fractures, and delayed unions that are not associated with avascular necrosis or collapse.