Flexor tendon grafting to the hand: an assessment of the intrasynovial donor tendon-A preliminary single-cohort study.

We report the results of a pilot study using intrasynovial donor tendons for flexor tendon reconstruction in 8 patients (10 digits) at a mean follow-up time of 3.8 years for neglected or failed primary repair of zone 2 lacerations and for neglected flexor digitorum profundus avulsions. The flexor digitorum longus to the second toe was used as the donor tendon graft. Four patients (4 digits) underwent single-stage reconstruction and 4 patients (6 digits) had multistage reconstruction. The overall patient satisfaction using a standardized visual analog reporting scale was excellent. There was 1 excellent, 1 good, 1 fair, and 1 poor result in the single-stage reconstruction group, including 1 repair site rupture and 1 digit requiring tenolysis. In the multistage reconstruction group there was 1 excellent, 3 good, 1 fair, and no poor results, including 1 digit requiring tenolysis. One patient was lost to follow-up. There was no donor site morbidity. The average active motion recovery was 64% and 56% for single-stage and multistage reconstructions, respectively, and was 73% overall for single digit reconstructions. The results of this pilot study suggest that intrasynovial tendon grafting may offer an improved alternative for tendon grafting to the synovial spaces of the digit.

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.

External fixation and cancellous bone grafting for Kienböck's disease: a preliminary report.

Between 1985 and 1990, 17 patients with histologically proven Kienböck's disease (Lichtman stages I, II, and III) underwent a combination of cancellous bone grafting to the lunate and external fixation across the wrist. All 17 patients were available for review with a minimum follow-up of 2 years (average, 47 years). Based on pain, functional status, range of motion, and grip strength (Mayo wrist score), there were 6 excellent, 6 good, 2 fair, and 3 poor results (2 of whom required further surgery). An overall success rate of 71% (12 of 17) was achieved. Ten patients underwent postoperative magnetic resonance scanning, and in 5, some improvement in signal intensity was demonstrated. The combination of cancellous bone grafting and external fixation is an alternative treatment for Kienböck's disease.

Hand and wrist disorders: how to manage pain and improve function.

Pain, swelling, or impaired function of the hand or wrist may be the result of one of several chronic or acute conditions, including tendinitis, arthritis, infection, or trauma. The first step in diagnosing a hand or wrist disorder is a detailed history. Include a review of the medical history, as many systemic disorders (eg, psoriasis, diabetes mellitus, rheumatoid arthritis, and scleroderma) may affect the hand and wrist. In the physical exam, assess motions of the cervical spine and those of all joints in the symptomatic extremity. A simple neurologic evaluation is required to assess function of the major nerves in the upper extremity. X-rays are indicated in any patient with hand or wrist pain.