Symptoms and radiographic findings in the proximal and distal ulnar stumps after the Sauvé-Kapandji procedure for treatment of chronic derangement of the distal radioulnar joint.

PURPOSE: We analyzed correlations between symptoms and radiographic findings with respect to the proximal and distal ulnar stumps after the Sauvé-Kapandji procedure for treating chronic derangement of the distal radioulnar joint. METHODS: A total of 26 patients were studied (13 men, 13 women) with a mean age of 46 years at examination. Clinical assessment included elicitation of postoperative symptoms related to the proximal and distal ulnar stumps. In the radiographic study the radioulnar distance in the neutral wrist position and the presence or absence of scalloping at the radius were determined from posteroanterior (PA) views. The total mobility distance of the proximal ulnar stump was measured on the PA and lateral views while the wrist moved from radial to ulnar deviation or from extension to flexion. RESULTS: Eleven patients complained of tenderness over the distal ulnar stump and 5 patients felt discomfort around the proximal ulnar stump during forearm rotation. The postoperative radioulnar distance in patients with tenderness was significantly smaller than in the group without tenderness. Scalloping at the radius was shown in 9 patients but it was not related to the radioulnar distance. The total mobility distance of the proximal ulnar stump on the PA view was significantly greater in patients with tenderness than in those without, and it also was significantly greater in patients with scalloping than in those without. The total mobility distance on the lateral view was significantly greater in the group with discomfort than in the group without discomfort. CONCLUSIONS: The radioulnar distance was related to tenderness over the distal ulnar stump but not to the scalloping. Tenderness and scalloping each were related to radioulnar instability of the proximal ulnar stump. Discomfort around the proximal ulnar stump was related to dorsovolar instability of the stump. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic, Level IV.

Ulnocarpal impaction syndrome restricts even midcarpal range of motion.

Ulnocarpal impaction syndrome is believed to be caused by abutment between the ulna and the ulnar carpus. We measured radiocarpal and midcarpal ranges of motion in 40 patients with ulnocarpal impaction syndrome by radiographic motion studies. The results showed that the radiocarpal and midcarpal ranges of motion were equally restricted in the affected wrist compared with the unaffected wrist. Therefore, motion of the radiocarpal joint and midcarpal joint contributed equally to total wrist motion bilaterally. No correlation between ulnar variance and the contribution of radiocarpal motion to overall wrist motion was found. Restriction of wrist motion in ulnocarpal impaction syndrome is not caused directly by abutment between the ulna and ulnar carpus, but a satisfactory explanation for restricted motion is still lacking.

The hydrophilization of polystyrene substrates by 172-nm vacuum ultraviolet light.

This paper describes the photochemical surface modification of polystyrene (PS) substrates using vacuum ultraviolet (VUV) light 172 nm in wavelength. We have particularly focused on the effects of atmospheric pressure during VUV irradiation on the obtained surface's wettability and the stability of the wettability, in addition to its chemical structure, morphology, and photooxidation rate. Samples were photoirradiated with VUV light under pressures of 10, 10(3), or 10(5) Pa. Although, in each case, the originally hydrophobic PS surface became highly hydrophilic, the final water-contact angle and photooxidation rate depended on the atmospheric pressure. The samples treated at 10 Pa were less wettable than those prepared at 10(3) and 10(5) Pa due to the shortage of oxygen molecules in the atmosphere. The minimum water-contact angles of the samples treated at 10, 10(3), and 10(5) Pa were about 8 degrees, 0 degrees, and 0 degrees, respectively. With the samples prepared at 10 and 10(3) Pa, photooxidation reactions proceeded in the topmost region closest to the surface, while at 10(5) Pa photooxidation was found to be greatly enhanced in the deeper regions, as evidenced by angle-resolved X-ray photoelectron spectroscopy. Photoetching rates were determined through atomic force microscope observation of microstructured PS samples prepared by a simple mesh-contact method. As estimated from AFM images of the latticed microstructures obtained, the rates of samples prepared at 10(3) and 10(5) Pa were about 1.5 and 1.3 nm/min, respectively. However, no photoetched features were observable on the sample surface prepared at 10 Pa. Hydrophilic stability also varied greatly depending on atmospheric pressure. The hydrophilicity of samples treated at 10 and 10(3) Pa gradually decreased as they were exposed to air. On the other hand, the sample surface prepared at 10(5) Pa showed excellent hydrophilicity even after being left in air for 30 days.

Surgical outcome of radial osteotomy for Kienböck's disease-minimum 10 years of follow-up.

PURPOSE: Long-term results of radial osteotomy for Kienböck's disease seldom are seen in the literature. The purpose of this study was to report the minimum 10-year results and to compare them with the 5-year results to determine whether the favorable intermediate-term results were maintained. METHODS: Twenty-five patients who underwent radial osteotomy were followed-up for a mean period of 14.5 years. They were examined for pain, grip strength, and wrist range of motion (ROM). Through a review of clinical records, 5-year postoperative results were collected. The carpal height ratio and Ståhl's index were measured and the x-rays were inspected for osteoarthritic changes. We devised an original lunate grade to evaluate radiologic improvement of the ischemic lunate. Overall results were evaluated using Cooney's wrist function score and Nakamura's scoring system for Kienböck's disease. The long-term results were compared with both the preoperative status and the 5-year results. RESULTS: Pain, ROM, and grip strength were improved significantly after surgery, and the results were maintained for a long period. Carpal height ratio and Ståhl's index did not show significant improvements but ischemic lunate showed certain radiologic improvements with time by the lunate grade system. Osteoarthritic changes were observed in 54% of patients at 5 years and in 73% of patients at the final follow-up evaluation, but the arthrosis generally was mild and did not affect the clinical results. Cooney's wrist function score was excellent or good in 96% of the patients, and the results with Nakamura's scoring system for Kienböck's disease were excellent or good in 68% of the patients at the final follow-up evaluation. The percentages were the same 5 years after surgery. CONCLUSIONS: Radial osteotomy for Kienböck's disease is a reasonable treatment option and clinical improvement lasts for a long period of time. Although radiologic improvement was not drastic, the inner structure such as sclerotic change or bone cysts of the lunate improved with time, indicating healing of the ischemic lunate. Severe osteoarthritic change or proximal migration of the capitate can be avoided.