ABSTRACT
We treated a 6-year-old child able to extend her wrist only to within 30 degrees of the neutral position secondary to posttraumatic palmar midcarpal instability with palmar and dorsal capsulodesis and pinning. More than 8 years after surgery, she has no complaints referable to her wrist and has 30 degrees of active wrist extension. Although unpredictable in adults, soft-tissue reconstruction is a treatment option in the pediatric patient with posttraumatic palmar midcarpal instability.
Subject(s)
Carpal Bones/surgery , Joint Dislocations/diagnosis , Joint Dislocations/surgery , Joint Instability/diagnosis , Joint Instability/surgery , Biomechanical Phenomena , Carpal Bones/injuries , Carpal Bones/physiopathology , Child , Female , Humans , Joint Dislocations/physiopathology , Joint Instability/physiopathology , Ligaments, Articular/injuries , Ligaments, Articular/physiopathology , Ligaments, Articular/surgery , Range of Motion, Articular/physiologyABSTRACT
The purpose of this study was to evaluate the results of a 1-incision posterolateral surgical approach with concomitant irradiation (700 rad) for early resection of synostosis after a 2-incision biceps repair. Between 1992 and 2000, 8 patients with radioulnar synostosis after a 2-incision biceps repair were evaluated and treated, with a mean age of 38 years (range, 29-47 years). The mean time between tendon repair and resection of the synostosis was 7 months (range, 4-14 months). The mean follow-up was 27 months (range, 13-36 months). All patients had 0 degrees of forearm rotation preoperatively. Postoperatively, all patients underwent postoperative radiotherapy in two divided doses for a total of 700 cGy. At a mean follow-up of 27 months, the rotation arc of the forearm improved to 155 degrees (range, 140 degrees -170 degrees ). The strength of supination was 80% (range, 70%-90%) of the contralateral limb. Seven of the eight patients had no pain after activities of daily living or work. One had mild pain after prolonged activity. No radiographic or clinical evidence of synostosis recurrence was seen at final follow-up. We believe that resection of most radioulnar synostoses after 2-incision biceps repair can be achieved safely and efficaciously through one posterolateral incision.
Subject(s)
Muscle, Skeletal/injuries , Muscle, Skeletal/surgery , Orthopedic Procedures/adverse effects , Orthopedic Procedures/methods , Radius/surgery , Synostosis/radiotherapy , Synostosis/surgery , Ulna/surgery , Adult , Female , Forearm , Humans , Male , Middle Aged , Pain , Radius/pathology , Range of Motion, Articular , Recurrence , Rupture/complications , Treatment Outcome , Ulna/pathologyABSTRACT
A patient suffering from recalcitrant carpal tunnel syndrome despite 4 surgical decompressions was treated successfully with revision carpal tunnel release, neurolysis, and autogenous saphenous vein wrapping of the median nerve. When he subsequently developed compression of the common digital nerve to the middle finger his carpal tunnel was re-explored and the previously applied vein graft underwent a biopsy examination. Histopathologic analysis of the biopsy specimen was remarkable for neovascularization of the vein graft and structural transformation of the vein endothelium, neither of which has been reported in vein wrapping of the upper extremity.
