Outcome of carpal tunnel release surgery in patients with and without Linburg-Comstock anomaly.

Anatomical variations may entail increased volume within the carpal tunnel and consequently the development of carpal tunnel syndrome (CTS) symptoms. The clinical importance of anomalous connection between the flexor pollicis longus (FPL) and flexor digitorum profundus (FDP) tendons was described by Linburg and Comstock. The objective of the present study was to compare postoperative outcomes of carpal tunnel release surgery in patients with and without Linburg-Comstock anomaly (LCA). Hands of CTS patients with and without LCA were evaluated for finger sensitivity, grip, tip, key and tripod pinch strength, pain intensity and Boston Carpal Tunnel Questionnaire score. Patients were evaluated preoperatively and 1, 3 and 6 months after surgery. Forty-six hands in 36 CTS patients with LCA and 50 hands in 38 patients without LCA were included. On all study parameters, no significant difference was found between CTS patients with versus without LCA. As outcomes are similar in both cases, LCA resection is not useful in patients with LCA and CTS. Preoperative diagnosis is unnecessary and screening for LCA is non-contributive for CTS evaluation.

Linburg-Comstock anomaly: A comparison of the prevalence in women with and without clinical carpal tunnel syndrome.

We aimed to compare the prevalence of the Linburg-Comstock anomaly in women with and without a clinical diagnosis of carpal tunnel syndrome. The prevalence of the Linburg-Comstock anomaly was evaluated in 400 hands from 200 women over 40 years of age who were diagnosed clinically with carpal tunnel syndrome (CTS), designated as the CTS group. The volunteer group consisted of 400 hands from 200 healthy women over 40 years of age. The women from both groups were asked to carry out the clinical flexion and pain tests described by Linburg and Comstock (1979) as a basis for the clinical diagnosis. CTS patient ages ranged from 40 to 90 (mean 55.8) years, while volunteer group ages ranged from 40 to 93 (mean 55) years. The flexion test was positive in 305 (76%) hands in the CTS group and 242 (60%) hands in the volunteer group. The pain test was positive in 261 (65%) hands in the CTS group and 108 (27%) hands in the volunteer group. Both tests were positive in 244 (61%) hands in the CTS group and 98 (24%) hands in the volunteer group. All these differences were statistically significant. Based on clinical examination using the flexion and pain tests, the prevalence of Linburg-Comstock anomaly was statistically higher in the group of women with carpal tunnel syndrome than in healthy volunteers.

Experiences with Bicontact ceramic-ceramic total hip arthroplasty.

AIM: Mid-term result documentation of ceramic-on-ceramic cementless total hip replacement. METHOD: From November 1998 to December 2005, 356 patients were submitted to 419 total hip arthroplasties of the hip with a cementless, ceramic-ceramic Bicontact/Plasmacup type of prosthesis. Patients were controlled in a consecutive prospective study. RESULTS: The average age of the patient group is 47.9 years, with an average follow-up of 48 months. There was no case with release of osteolysis of the acetabular or femoral components. There was one ceramic head fracture in an obese patient. Articular wear was negligible and could not be measured radiographically. CONCLUSION: The ceramic-ceramic Bicontact hip joint replacement presents a low complication rate in young patients, with very low wear.

Osteotomy of the radius and ulna for the Madelung deformity.

The Madelung deformity can result in pain and decreased function of the wrist and hand. None of the surgical techniques available has been shown consistently to improve grip strength, range of movement or relieve pain. In this prospective study we have treated 18 patients with the Madelung deformity (25 wrists) by wedge subtraction osteotomy of the radius and shortening of the ulna. Our results show statistically significant improvement in grip strength and range of movement of the wrist and forearm. Pain improved in 80% of the patients and 88% were satisfied with the appearance. One patient had a wound infection and another developed reflex sympathetic dystrophy. Two had some recurrence due to continued growth of the ulna and it is recommended that the procedure be delayed until skeletal maturity, or else combined with epiphysiodesis of the ulna.

Study of anatomical bases of a latero-dorsal flap of the forearm preserving the radial artery.

The authors studied the dorso-lateral cutaneous branches of the radial artery in 26 forearms of fresh cadavers following injection of latex. Three to eight branches were identified, with frequent anastomoses. Extensive venous drainage was also observed. One to three cutaneous branches arose within a 3-cm region close to the radial styloid precess. This provides a basis for an island flap supplied by these branches and thus, it is possible to maintain the radial artery intact.

Mallet finger: classification

Based on results of a prospective study of 200 patients with "mallet finger", the author establishes criteria to divide the injuries into recent and late. In view of the radiologic and anatomic findings as well as the extent of "falla" of the distal phalanx, a classification that allows prognosis and type of most adequate treatment for each case, is proposed.