Salvage of failed resection arthroplasties of the distal radioulnar joint using a new ulnar head prosthesis.

Twenty-three patients with painful instability following total or partial resection of the ulnar head were treated using a new ulnar head prosthesis combined with a simple soft tissue repair. Stability and marked symptomatic improvement were achieved in all patients. With a mean follow-up period of 27 months, this improvement has been maintained in all but 1 patient, whose prosthesis had to be removed because of a low-grade infection. These results suggest that the use of a prosthesis is a satisfactory way to restore stability and relieve secondary symptoms that may be associated with partial or total excision of the ulnar head.

Arthroscopy of the distal radioulnar joint.

Arthroscopy of the distal radioulnar joint is a natural extension of radiocarpal arthroscopy and can be a useful tool for certain conditions that affect this small joint. Arthroscopy provides a minimally invasive means of evaluating the distal radioulnar joint and enables visualization of the articular surfaces, synovium, and undersurface of the triangular fibrocartilage. In this article, indications, surgical techniques, and potential pitfalls of this technically demanding procedure are presented.

Arthroscopy of the distal radioulnar joint.

Arthroscopy of the distal radioulnar joint is challenging. Its indications are evolving. When the experienced hand surgeon believes that the procedure is justified, unusual discoveries may be made. Patients with distal radioulnar joint pain who remain a diagnostic challenge before arthroscopy may sometimes be helped by the results of arthroscopy of this small joint.

Closed traumatic rupture of finger flexor pulleys.

Nine patients are described with closed traumatic rupture of the digital flexor pulley system. All presented with significant flexion contractures of the proximal interphalangeal joint and bow-stringing of the flexor tendons. In seven patients, the pathology was verified at surgery and pulley reconstruction provided a good result. The diagnoses in the other patients, treated conservatively, were verified by tenogram and magnetic resonance imaging.

Anatomy of the proximal interphalangeal joint.

The proximal interphalangeal joints (PIPs) of the fingers are crucial for normal digital and hand function. Studies of their anatomy reveal subtle bony differences that dictate the precise planes of motion allowed in the constrained joint. Soft tissue restraints guide the cartilaginous surfaces through permissible ranges of motion. Understanding these restraints and the precise orientation of other joint structures assists treatment of conditions affecting the PIP joint.

Long-term outcome of Volz total wrist arthroplasties.

The authors determined the outcomes of 18 consecutive Volz total wrist arthroplasties that were followed for an average of 8.6 years. Nine of these wrists were followed for 10 or more years. Fourteen wrists were replaced for rheumatoid arthritis and four for post-traumatic degenerative joint disease. Forty-nine degrees of combined flexion and extension and 25 degrees of combined ulnar and radial deviation were maintained. The balance of wrist motion was dependent upon the design and location of the metacarpal prosthesis. A 24% loss in carpal height (subsidence) occurred during the study period. Four metacarpal components were loose (22%), three of which were placed in patients with degenerative joint disease. One radial component (6%) was loose. Fifteen of 18 wrists (83%) had little or no pain. The three wrists with moderate or severe pain were in patients with degenerative joint disease. There were five (28%) complications. One revision was performed and another was recommended. Overall, the long-term outcome of total wrist arthroplasty was favorable in patients with rheumatoid arthritis.

Distal radioulnar joint arthroplasty. Current concepts.

Arthroplasty techniques for the distal radioulnar joint can be grouped into several categories. These are resectional or excisional arthroplasty, hemiresection or partial resectional arthroplasty, ulnar shortening, or replacement arthroplasty. These techniques are used in varying conditions and situations. Once the function of the radioulnar joint is understood, the choice of arthroplasty technique is simplified. This article presents the theoretical basis for selecting a particular type of arthroplasty technique in any patient. The author's hemiresection interposition technique of arthroplasty developed in the mid 1970s. Sufficient results have now been published that an assessment of the efficacy of the procedure is available. The author's current concept is that detailed and increasing experience with the procedure has uncovered some problems and some modifications. The major indications for the hemiresections arthroplasty and its alternatives must be in the armamentarium of those dealing with this joint.

Instability of the distal radioulnar articulation.

This complex issue is addressed by a discussion of a classification of clinically observed instabilities. Experimental data and clinical observations are combined to provide a theoretical rationale for understanding the subject. Clinical usefulness is described.

Nerve suture and grafting.

Nerve anatomy, terminology, and techniques for nerve restoration are reviewed in sufficient detail to allow the reader to quickly update his or her knowledge in this area. Ideas for future directions of study are presented.

Sprains and joint injuries in the hand.

Several specific injuries are discussed in detail, including acute collateral ligament injury, ulnar collateral ligament injuries of the thumb MP joint, volar plate injuries, volar PIP joint dislocations, pseudoboutonniere deformity, and dorsal MP joint dislocations.

Chondromyxoid fibroma of the proximal phalanx. A tumour that may be confused with chondrosarcoma.

Chondromyxoid fibroma is a rare benign tumour of chondral origin. The diagnosis is difficult, but as Jaffe emphasized, "its recognition is of some importance in that pathologically it may be mistaken for sarcoma and, as such, treated more radically than is necessary" (Jaffe, 1948). Salzer (1965) found only 136 cases in the world literature since 1948 when Jaffe defined the criteria for their histological diagnosis. Only six cases of chondromyxoid fibroma have been reported involving the hand (Frank, Rockwood, 1969; Zatyepin, Klimova, Lipkin, Perety, 1979).

Congenital absence of the triquetrum: a case report.

A case of congenital absence of the triquetrum in a 47-year-old man is reported. The etiology could be related to deficient chondrification or ossification. Conservative treatment relieved his symptoms of pain and weak grasp.

Distal radioulnar joint arthroplasty: the hemiresection-interposition technique.

The hemiresection-interposition technique for distal radioulnar joint arthroplasty was developed from anatomic studies that indicated the importance of preserving the functional elements of the ulnocarpal ligament complex. The technique has been previously described. My experience with 38 patients who were followed for an average of 2 1/2 years shows that the procedure is most valuable for patients with rheumatoid arthritis (85% had stable, painless pronation averaging 84 degrees and supination of 77 degrees, while 15% had mild pain and pronation of 70 degrees and supination of 75 degrees). It is also valuable for patients with degenerative or trauma-induced arthritis (100% had painless rotation-pronation averaging 80 degrees and supination of 80 degrees). A modified procedure is useful for patients with ulnocarpal impingement syndrome where the Milch shortening osteotomy may not succeed because of radioulnar incongruity.

Capitate-radius arthrodesis: an alternative method of radiocarpal arthrodesis.

Arthrodesis of the wrist may be indicated for a variety of conditions and can be achieved by many techniques. We have had experience with radiocarpal arthrodesis by fusion of the capitate to the radius after a modified proximal row carpectomy . The common feature in our 10 patients was a flexion deformity of the wrist. In five of the patients it was the result of spastic posturing. Five of the patients had a variety of other conditions. Primary arthrodesis occurred in all patients and the cosmetic improvement was appreciated by all patients. Functional improvement seemed to be most related to the preoperative condition. The follow-up evaluation averaged 5.4 years with a range from 6 months to 11 years.

Management of small joint injuries in the hand.

The principles of management of small joint injuries of the fingers are discussed. Particular attention is paid to acute capsular injuries, fractures, and chronic capsular problems.

Ulnar variance--the effect of wrist positioning and roentgen filming technique.

Ulnar variance--the roentgenographic distance between contiguous articular surfaces of the distal radiocarpal and ulnocarpal joints--changes with wrist and forearm position. Supination increases the measurement of negative ulnar variance. Pronation decreases the measurement of negative ulnar variance. Wrist deviation and alterations of the x-ray beam in the longitudinal plane also influence the measurement. A standardized wrist roentgenogram has been developed to allow accurate and reproducible measurements of ulnar variance. Internal landmarks for recognizing the standard views are introduced. The use of standard wrist roentgenographic techniques for all wrist films is recommended.