Limited wrist arthrodeses. I. The triscaphoid joint.

Limited wrist arthrodesis is the surgical fusion of selected bones of the wrist. In each case the extent of the fusion is determined by the extent of the disease process. Limited wrist arthrodesis of the joints between the scaphoid, trapezium, and trapezoid is indicated in localized degenerative arthritis, radial hand dislocations, and certain instability patterns following ligament rupture (rotary subluxation of the scaphoid). Fusion is easily obtained utilizing a local bone graft donor site. Fusion of the three-bone unit leaves approximately 80% of flexion extension and 66% of radial and ulnar deviation in the wrist.

Developmental humerus varus.

Humerus varus, the upper extremity analogue of coxa vara, may be found in association with, and probably as a consequence of hematologic, infectious metabolic, genetic and neurologic disorders. No matter what the etiology, there is a similar pattern of development and progression of the deformity. The medial region of the proximal humeral physis either develops slowly or failed to develop, while the lateral region develops more rapidly, causing varus rotation of the proximal humeral epiphysis and physis. In the more extreme cases, the lateral region of the growth plate is almost parallel to the longitudinal axis of the shaft. In many cases there is a medial lucency, adjacent bony epiphyseodesis, and significant shortening of the humerus. Although abduction is usually decreased, major functional impairment is unusual even in the dominant arm.