Post-traumatic contracture of the elbow. Operative release using a lateral collateral ligament sparing approach.

We performed a lateral approach for the release of post-traumatic stiffness of the elbow in 22 patients using a modified technique designed to spare the lateral ligaments. They were reviewed after a mean interval of 26 months. The total humeroulnar joint movement had increased from a mean of 74 degrees to 129 degrees and forearm rotation from a mean of 135 degrees to 159 degrees.

The distal radioulnar joint capsule: clinical anatomy and role in posttraumatic limitation of forearm rotation.

Posttraumatic limitation of forearm rotation can be the result of pathology at any location along the forearm axis. Scar contracture of the distal radioulnar joint (DRUJ) capsule, independent of the triangular fibrocartilage complex (TFCC), is one of the sources that may influence the pronosupination arc. We dissected the wrists of 8 fresh-frozen cadaver specimens to characterize the precise anatomy, relationships, and dynamic characteristics of the entire DRUJ capsule.

X-ray changes after expanded polytetrafluoroethylene (Gore-Tex) interpositional arthroplasty.

Thirty-one patients with degenerative osteoarthritis at the trapeziometacarpal joint underwent 34 expanded polytetrafluoroethylene interpositional arthroplasties. The average follow-up period for the group of patients was 41 months (range, 15-82 months). Subjective results and objective measurements for the patients at the time of review were favorable.

Rotatory instability of the elbow. The anatomy and role of the lateral stabilizers.

Posterolateral rotatory instability of the elbow has been attributed to disruption of the ulnar part of the lateral collateral ligament. Forty fresh cadavera were studied to define the ligamentous anatomy of the lateral aspect of the elbow specifically as it relates to rotatory instability. The dissections revealed a broad conjoined insertion of the lateral collateral and annular ligaments onto the proximal aspect of the ulna.

Arthrodesis of the wrist for post-traumatic disorders.

We retrospectively reviewed the records of eighty-nine consecutive patients (ninety wrists) who had had a total arthrodesis of the wrist for the treatment of a post-traumatic disorder at one center. Fifty-six patients (fifty-seven wrists) had the arthrodesis with plate fixation, and thirty-three patients (thirty-three wrists) had the arthrodesis with a variety of other techniques. The average age of the patients at the time of the arthrodesis was forty-two years, and the dominant wrist was treated in forty-two patients.

Salvage of the failed Darrach procedure.

Six patients (5 post-traumatic, 1 rheumatoid) underwent a three-component reconstruction for correction of dorsal instability and radioulnar impingement following failure of a Darrach resection of the entire distal end of the ulna. The technique was devised to prevent simultaneous coronal and sagittal instability. The procedure used longitudinal intramedullary tenodesis of the extensor carpi ulnaris tendon, dorsal transfer of the pronator quadratus through the interosseous space, and temporary percutaneous pinning to maintain corrected distal radioulnar relationship.

Philosophy of the treatment of athletes.

There is a proliferation of sports medicine physicians whose training is largely in the management of such athletically debilitating conditions as knee ligament and meniscus tears. Physicians with responsibility for the management of the full spectrum of sports-related conditions, including upper extremity injuries, may actually be a disservice to the athlete who may receive less than expert care for his or her injured wrist or hand.

Flexor tenolysis in children.

This study aimed to determine whether there is an age below which flexor tenolysis may not be beneficial and whether there is any detriment to waiting for a more appropriate age. In this study, patients in their first decade had minimal improvement in their active flexion after flexor tenolysis. Six patients were tenolysed more than 1 year after their original operation and none appeared to have been compromised by the prolonged interval between injury repair and tenolysis.

Flexor Tendon Injuries: II. Operative Technique.

The repair of flexor tendons (zones I and II) is a technique-intensive surgical undertaking. It requires a strong understanding of the anatomy of the tendon sheath and the normal relationship between the pulleys and the flexor digitorum superficialis and flexor digitorum profundus tendons in the digit. Meticulous exposure, careful tendon retrieval, and atraumatic repair are extremely important, and the repair should be of sufficient strength to resist gapping and permit the early postrepair application of motion forces.

Flexor Tendon Injuries: I. Foundations of Treatment.

During the past 20 years, the difficult process of reestablishing satisfactory function after primary repair of flexor tendons has evolved from scientifically unsupported trial-and-error efforts to protocols based on sound laboratory and clinical investigations. Enhanced appreciation of tendon structure, nutrition, and biomechanical properties and investigation of factors involved in tendon healing and adhesion formation have had significant clinical applications. In particular, it has been found that repaired tendons subjected to early motion stress will increase in strength more rapidly and develop fewer adhesions than immobilized repairs.

Percutaneous Kirschner wire fixation through the snuff box: an anatomic study.

We undertook this study to better define the anatomy of the radial aspect of the wrist and to establish a zone of safety for the placement of Kirschner wires, cannulated screws, and arthroscopes within the anatomic snuff box. Twenty fresh frozen cadaver upper extremities underwent placement of three percutaneous Kirschner wires under fluoroscopic guidance through the anatomic snuff box. In each extremity, one Kirschner wire was placed into the radial styloid, one across the scaphocapitate joint, and one across the scapholunate joint.

Treatment of traumatic radioulnar synostosis by excision and postoperative low-dose irradiation.

Post-traumatic radioulnar synostosis can have a profound effect on upper extremity function. Prior reports of excision, with and without interposition material, have demonstrated frequent recurrence and disappointing results. Based on a favorable experience with radiation prophylaxis of heterotopic ossification following total hip arthroplasty, this modality has been used in the management of post-traumatic forearm synostosis.

Flexor digitorum superficialis lasso tendon transfer in isolated ulnar nerve palsy: a functional evaluation.

Twelve patients (23 digits) with isolated ulnar nerve palsy underwent flexor digitorum superficialis lasso tendon transfers for correction of claw deformity, weakness, and asynchronous digital flexion. The average follow-up period from date of injury was 5 years (range, 2-11 years) and from surgery was 3 years (range, 15 months to 7 years). Transfers successfully corrected the claw deformity in 19 of the 23 digits.

Long-term follow-up of forearm bone diaphyseal plating.

A retrospective review of 175 patients treated with forearm bone plating for acute diaphyseal fractures, nonunions, and malunions was undertaken to identify problems related to plate removal as opposed to plate retention. One hundred thirteen patients retained their forearm plates, of which five patients experienced complications related to the plate, including infection, bone failure, plate failure, and loosening. Patients retaining forearm bone plates reported minimal discomfort or functional limitation.

Scapho-lunate diastasis in fractures of the distal radius. Pathomechanics and treatment options.

The concurrence of scapho-lunate diastasis and distal radial fractures is now well established. External fixation is considered to be one of the best methods of treating distal radial fractures, but in the presence of ligament injury, distraction fixation may lead to carpal instability and chronic wrist pain. We have reviewed existing English literature and analyzed possible mechanisms of injury, and offer some suggestions towards treatment of this combination of injuries.

Soft tissue reconstruction for rheumatoid swan-neck and boutonniere deformities: long-term results.

Ninety-two fingers with rheumatoid swan-neck deformity were treated with dorsal capsulotomy and lateral band mobilization. An initial increase of 55 degrees of motion into flexion was noted, but this proximal interphalangeal motion deteriorated over time. Of 15 fingers followed at 3 and 12 months, there was a mean loss of 17 degrees of the early postoperative flexion.

Preoperative factors and outcome after lunate decompression for Kienböck's disease.

Preoperative factors and outcome were studied after lunate decompression for Kienböck's disease. Twenty-three patients treated with radial shortening or scaphoid-trapezium-trapezoid fusion were evaluated. The mean follow-up was 59 months.

Indications and techniques of open reduction. Internal fixation of distal radius fractures.

Complex distal radius fractures present in a variety of patterns that differ by the area and degree of involvement of the articular and metaphyseal fracture components. No single method of treatment is appropriate for all fractures. This article discusses the types of fractures that either require or are best handled by formal open reduction and internal or external fixation.

[Arthrodesis of the wrist. Indication, technique and functional consequences for the hand and wrist].

Three studies conducted in our center demonstrated an improved technical success rate and elimination of preoperative pain in patients undergoing wrist fusions, with no significant difference in the ability to perform rapid movements requiring manual dexterity in the course of activities of daily living compared with patients who had undergone motion-preserving limited arthrodeses. The only absolute drawback of wrist fusion is that it obviously does not allow for any wrist motion at all. Limited intercarpal arthrodesis preserves some motion, but according to our results never leads to increased motion postoperatively.

Strength and functional recovery following repair of flexor digitorum superficialis in zone 2.

A two-pronged study was designed to evaluate the strength in vitro and functional recovery in vivo of FDS repairs in zone 2. In part I, horizontal mattress or Tajima grasping repairs were performed on fresh-frozen cadaveric digits, using 3/0 or 4/0 braided nylon suture material. The Tajima repair was significantly stronger than the mattress suture, using either 3/0 (P = 0.

The anatomy of the proximal radioulnar joint.

This study is an anatomic investigation to define the architecture of and the stabilizing structures for the proximal radioulnar joint. Ten fresh-frozen cadaver elbows were dissected. Measurements of the radial head, annular ligament, radial fossa of the ulna, and interosseous membrane were made and were correlated to clinical observations of elbow stability.

Radial nerve rupture after a traction injury: a case report.

A case in which a patient sustained a closed rupture of the radial nerve at the lateral intramuscular septum from a traction injury is presented. No humeral fracture occurred, and the patient regained substantial function after delayed primary repair.