ABSTRACT
BACKGROUND: Ulnar styloid triquetral impaction (USTI), one of many causes of ulnar sided wrist pain, is a pathological entity with clear clinical and radiographic features, distinct and different from the impaction of the ulnar head against the lunate or ulno-carpal impaction (UCI). Pain is ulnar and point-tenderness is present precisely over the ulnar styloid as opposed to the proximal lunate in UCI. The provocative maneouvre of dorsiflexion in pronation followed by supination is markedly different from the ulnar deviation grind test maneouvres used to diagnose UCI. Multiple anatomical and pathological features interplay to produce a situation in which the distance between the tip of the ulnar styloid and the triquetrum is reduced resulting in USTI. The concept of ulnar styloid variance is introduced and anatomical variations of ulnar styloid length are demonstrated. METHODS: The clinical and radiographic features of 56 patients diagnosed with USTI were analysed. One thousand standardised film-file wrist radiographs were measured to determine the average length of the ulnar styloid in the population as well as the average projection of the styloid above the radius (ulnar styloid variance). RESULTS: An aetiological classification system for USTI was developed based on the clinical and radiographic features of the aforementioned patients and radiographs. CONCLUSIONS: The causes of this syndrome are often complex and classification of the aetiological features is clinically useful. It is important for physicians and surgeons to recognise the clinical and radiographic features of this syndrome in order to properly manage the symptoms and prevent an iatrogenic production of USTI.
Subject(s)
Carpal Bones/diagnostic imaging , Joint Diseases/diagnosis , Radius/diagnostic imaging , Ulna/diagnostic imaging , Wrist Joint/diagnostic imaging , Adolescent , Adult , Aged , Carpal Bones/pathology , Female , Humans , Joint Diseases/classification , Joint Diseases/physiopathology , Magnetic Resonance Imaging , Male , Middle Aged , Pronation , Prospective Studies , Radiography , Radius/pathology , Range of Motion, Articular , Supination , Ulna/anatomy & histology , Ulna/pathology , Wrist Joint/pathology , Wrist Joint/physiopathologyABSTRACT
PURPOSE: This study was conducted to determine the appropriateness of using the articular cartilaginous surfaces of the proximal tibiofibular joint to resurface damaged distal radial articular surfaces and to assess the clinical results in the first 2 patients. METHOD: Cadaveric specimens of the facets of the proximal tibiofibular joints and distal radius were sized and compared. Two patients underwent transfer of a fibular facet. RESULTS: The surface area of each of the proximal tibiofibular facets were larger than either the scaphoid or lunate facets of the distal radius. The 2 patients had excellent clinical results with minimal donor morbidity. CONCLUSIONS: Use of the articular surfaces from the proximal tibiofibular joint to replace damaged distal radial facets is possible and can be accomplished with excellent results and minimal morbidity.
Subject(s)
Cartilage, Articular/transplantation , Radius Fractures/surgery , Adult , Analysis of Variance , Cadaver , Female , Fibula , Humans , Male , Middle Aged , Radius Fractures/diagnostic imaging , Tibia , Tomography, X-Ray Computed , Transplantation, AutologousSubject(s)
Joint Dislocations/diagnostic imaging , Wrist Joint/diagnostic imaging , Adult , Humans , Male , RadiographyABSTRACT
OBJECTIVES: To document the refracture rate after removal of internal fixation at the metaphyseal region of the distal radius and to compare this rate to that associated with diaphyseal plate removal reported in the literature. DESIGN: A chart review with telephone follow-up. SETTING: Three tertiary care hospitals (in Ottawa, Burlington, Vt., and London, Ont.). PATIENTS: Fifty-three patients (54 radii) underwent elective removal of internal fixation of the distal radius after distal metaphyseal procedures. The mean follow-up was 46.8 months. MAIN OUTCOME MEASURE: The refracture rate. RESULTS: No refractures were reported after plate removal, and the overall complication rate was minimal. CONCLUSIONS: The refracture rate at the metaphvsis of the radius after plate removal is lower than the rate after diaphyseal plate removal reported in the literature.
Subject(s)
Bone Plates , Radius Fractures/surgery , Adult , Female , Humans , Male , Middle Aged , RecurrenceABSTRACT
In brief Sprains of the ligament complex between the scaphoid and lunate bones may be more difficult to diagnose than other wrist injuries. However, patients will have characteristic localized pain and, in severe ruptures, diagnostic radiographic abnormalities. Minor scapholunate sprains usually heal with no sequelae, but severe sprains may lead to localized arthritis if the ligament complex is not repaired surgically.
