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.

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.

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.

Comparison of pullout button versus suture anchor for zone I flexor tendon repair.

Purpose: To evaluate the clinical outcome after repair of zone I flexor tendon injuries using either the pullout button technique or suture anchors placed in the distal phalanx.

Methods: Between 1998 and 2002 we treated 26 consecutive zone I flexor tendon injuries. Thirteen patients had repairs from 1998 to 2000 using a modified pullout button technique (group A) and 13 patients had repair using suture anchors placed in the distal phalanx (group B).

Open rotator cuff repair without acromioplasty.

Background: In most clinical reports on rotator cuff repair, acromioplasty was done as part of the procedure. In this prospective study, we evaluated the hypothesis that rotator cuff repair without acromioplasty would result in a substantial improvement in shoulder comfort and function.

Methods: Ninety-six consecutive primary repairs of full-thickness tears of the rotator cuff were performed through a deltoid-muscle-splitting incision that preserved the integrity of the coracoacromial arch and the deltoid insertion.

Overcoming peripheral nerve gap defects using an intact nerve bridge in a rabbit model.

This study investigated the intact nerve bridge technique for overcoming peripheral nerve gap defects in a rabbit model. To create the intact nerve bridge, a 1-cm segment of the peroneal nerve is resected leaving a gap defect. The proximal and distal peroneal nerve stumps are sutured 1 cm apart, in an end-to-side fashion, to the intact tibial nerve epineurium.

A cadaver model to evaluate the accuracy and reproducibility of plain radiograph step and gap measurements for intra-articular fracture of the distal radius.

Purpose: The purpose of this study was to determine the accuracy and reproducibility of intra-articular step-off and gap displacements measured on plain radiographs using a standard cadaver model.

Methods: Twenty-two physicians, in a blinded randomized fashion using a standard technique, examined the radiographs of 12 unique combinations of step and gap displacement created by a 3-part intra-articular osteotomy of the distal radius. Observer accuracy, inter- and intraobserver agreement, and tolerance limits were calculated.

Regeneration along intact nerves using nerve growth factor and ciliary neurotrophic factor.

The purpose of this investigation was to evaluate the ability of a specific growth factor combination, nerve growth factor (NGF) and ciliary neurotrophic factor (CNTF), to enhance peripheral nerve regeneration. Eight groups of eight Sprague-Dawley rats underwent repair of a nerve gap defect: Group A (immediate repair), Group B (intact nerve bridge), Group C (nerve autograft), Group D (gap in situ), Group E (NGF + CNTF), Group F (NGF), Group G (CNTF), and Group H (saline). Twelve weeks after surgery, analysis included the measurement of the isometric force of muscle contraction for the tibialis anterior muscle and tissue harvesting for both quantitative and qualitative analysis.

Central placement of the screw in simulated fractures of the scaphoid waist: a biomechanical study.

Background: Recent reports on internal fixation of acute fractures of the scaphoid waist have demonstrated higher rates of central placement of the screw when cannulated screws were used than when noncannulated screws were used. This cadaveric study was designed to determine whether central placement in the proximal fragment of the scaphoid offers a biomechanical advantage.

Methods: Eleven matched pairs of scaphoids were removed from fresh cadaveric wrists.