Interposition Arthroplasty of the Elbow After Proximal Ulna Reconstruction With the Masquelet Technique: A Case Report.

INTRODUCTION: Periarticular bone loss in the upper extremity poses challenges for a functional reconstruction. CASE: A 32-year-old man sustained an open elbow fracture-dislocation from a high-velocity gunshot resulting in significant bone and soft-tissue loss about the proximal ulna. He underwent bony reconstruction with the Masquelet technique and delayed interposition arthroplasty in an attempt to preserve function. CONCLUSIONS: The Masquelet technique, coupled with interposition arthroplasty, may be used to address significant articular bony defects about the proximal ulna, allowing patients to maintain function and limit pain.

Ulnar-Sided Wrist Pain in the Athlete.

Ulnar-sided wrist pain can be a challenging entity for the hand surgeon and even more so in the athletic population. The authors present 8 causes of ulnar-sided wrist pain in an athlete (hook of hamate fracture, pisiform fracture, hypothenar hammer syndrome, triangular fibrocartilage complex injuries, ulnocarpal impaction syndrome, lunotriquetral ligament tears, extensor carpi ulnaris tendinitis, subluxation of extensor carpi ulnaris) and their associated imaging and treatment options.

Lateral compression injuries in the pediatric elbow: Panner's disease and osteochondritis dissecans of the capitellum.

Lateral compression injuries of the elbow typically occur in throwing athletes and gymnasts. In the preadolescent and adolescent patient, these injuries predominantly include Panner's disease and osteochondritis dissecans. Panner's disease, an osteochondrosis of the capitellum, is a rare disorder that usually affects the dominant extremity in individuals younger than age 10 years. Symptomatic management of Panner's disease consisting of reduction of stressful activities of the elbow is usually sufficient to allow resolution. Although a prolonged period is required for healing, most patients demonstrate excellent long-term results. Osteochondritis dissecans of the capitellum typically occurs in adolescents and is associated with loose body formation. Panner's disease and osteochondritis dissecans likely represent a continuum of disordered endochondral ossification with presentation and prognosis dependent primarily on age at onset.

Dorsal intercarpal augmentation ligamentoplasty for scapholunate dissociation.

Carpal instability secondary to scapholunate ligament tears can lead to significant disability of the wrist. Disruption of the ligamentous stabilizers of the scaphoid causes rotatory subluxation of the scaphoid and subsequent abnormal loads across the radioscaphoid joint. Arthritic changes involving the radioscaphoid and midcarpal joint will develop if the wrist is untreated. Treatment of scapholunate ligament tears has varied widely in the literature. Today, most surgeons perform either a soft tissue reconstruction using local tissue or a limited fusion. Motion of the wrist favors soft tissue reconstructions. Also, the relative intercarpal motion with a more flexible carpus may prevent abnormal load patterns that are associated with a rigid radial column and limited fusions. We have reconstructed flexible subacute (>3 weeks) and chronic (>2 months) scapholunate dissociations with a radial-based dorsal intercarpal ligament. Clinical results have demonstrated increased grip strength, decreased pain, and improved intercarpal alignment.