Arthroscopic treatment of triangular fibrocartilage tears.

The triangular fibrocartilage complex is an intricate anatomic structure located at the ulnar aspect of the wrist. The triangular fibrocartilage is important to the stability and biomedical function of the ulnar carpus and distal radioulnar joint. This article reviews the anatomy and biomedical function of the triangular fibrocartilage. Diagnosis and treatment of traumatic injuries to the triangular fibrocartilage are also discussed.

Workers compensation. Effect of state law on treatment cost and work status.

Workers compensation legislation is regulated at a state level resulting in different benefits based on the state of employment. The negative effect of workers compensation on the results of surgical treatment has been established previously. A comparison of the results of treatment of patients receiving workers compensation from different states has not been reported. This study prospectively evaluated the effect of the difference in state workers compensation laws on the number of postoperative visits, amount of postoperative therapy, time off from work, and return to work status. The study group consisted of 275 patients. The results indicated a significant increase in the number of postoperative visits, amount of therapy, time off from work, and number of patients who remained out of work in the compensation versus the noncompensation group. A significant increase in these parameters also was present in the Pennsylvania compensation group as compared with the New Jersey compensation group. This study shows that differences in workers compensation benefits have a significant effect on the results of medical treatment, return to work status, and the cost of medical care.

Arthroscopic repairs of triangular fibrocartilage complex tears.

Technical advancements in arthroscopic wrist procedures have improved our knowledge of normal and abnormal intraarticular wrist function. Triangular fibrocartilage complex (TFCC) tears from trauma injuries are a common source of ulnar-sided wrist pain. Fortunately, the TFCC is a structure that can be evaluated and treated arthroscopically with results that are comparable to open surgical procedures. Successful arthroscopic repairs of TFCC tears depend on a coordinated team effort between perioperative nurses, orthopedic surgeons, nurse practitioners, and occupational hand therapists, as well as cooperation from patients and family members. This article reviews the anatomy and physiology of the TFCC, the biomechanics of the wrist and mechanisms of injury, and arthroscopic repairs of TFCC tears.

The role of arthroscopy in the treatment of traumatic triangular fibrocartilage injuries.

The triangular fibrocartilage complex is a complex anatomic structure located at the ulnar aspect of the wrist and is important to the stability and biomechanical function of the ulnar carpus and distal radioulnar joint. This article will review the anatomy and biomechanical function of the TFCC and its relationship to the diagnosis and treatment of traumatic injuries to the TFCC.

Equipment malfunction in common hand surgical procedures. Complications associated with the pneumatic tourniquet and with the application of casts and splints.

Pneumatic tourniquets and plaster of Paris splints and casts are the hallmarks of hand surgery, firmly entrenched as an adjunct in the routine treatment of upper extremity disorders. Because they are usually employed with a comparative degree of safety and because they are relatively simple devices from a technologic perspective. Little is written about them in the scientific literature. In this paper we extensively review their historical developments, physiologic effects, and common complications, and we attempt to provide a rationale for their safe and effective use.

Dynamic computerized tomography of the occiput-atlas-axis complex in trauma patients with odontoid lateral mass asymmetry.

Over a 23-month period, 25 patients aged 11 to 74 years presented to our Level I trauma center with odontoid lateral mass asymmetry of 2 to 5 mm on properly centered AP open-mouth X-rays: 32% of patients were asymptomatic, 68% had cervical pain, and 32% had limited range of motion. Patients with cervical spine fractures or dislocations and those with fixed deformity were excluded. The clinical significance of asymmetry was determined utilizing dynamic axial CT scanning of the occiput (C0), atlas (C1) and axis (C2) with the head neutral and with 15 degrees to 30 degrees active rotation. Nineteen patients demonstrated greater than 5 degrees of relative motion of C1 on C2 bilaterally. Three patients had less than 5 degrees of relative motion bilaterally and three patients had less than 5 degrees relative motion with left rotation only. No patient had formal treatment and all had nearly normal cervical range of motion on clinical examination at the time of hospital discharge. The finding of an asymmetric odontoid-lateral mass interspace on properly centered open-mouth AP X-rays in the presence of otherwise normal cervical spine X-rays, in conscious patients without fixed deformity, appears to be incidental and requires no further evaluation or treatment.

Bipolar femoral endoprosthesis: a study correlating component movement with clinical outcome.

Fifty-five bipolar femoral hemiarthroplasties performed between January 1979 and February 1986 were reviewed to correlate component movement with clinical outcome. Fourteen of these patients were examined clinically using the Harris Hip Score and radiographically by the method of Drinker and Murray to determine the per cent of total motion in abduction present at the inner bearing surface. The average followup was 19.7 months. The data demonstrate that the clinical result is related to inner bearing motion. The inner bearing motion is significantly decreased by weight bearing and may be influenced by the size of the femoral component.

Prosthetic nerve grafts: a resorbable tube as an alternative to autogenous nerve grafting.

The use of a prosthetic nerve graft, composed of a resorbable polyorthoester tube, as an alternative to free autogenous nerve grafting for the treatment of a gap in a peripheral nerve was studied, with a cat sciatic nerve as the model. The results demonstrate that regeneration will occur through a resorbable tube spanning a 1.5 cm gap and reinnervate end organ muscle. In those muscles showing evidence of reinnervation, nerve regeneration through the tubes as assayed by electrophysiologic examination demonstrated no difference compared with autogenous nerve grafts, with the exception that the initial rate of regeneration was delayed by 4 to 6 weeks.

Peripheral nerve grafts: the relationship of axonal growth cone and biomechanical properties.

Cat sciatic nerves containing 2 and 4 cm nerve grafts were subjected to tensile testing with the finding that a significant decrease in force at failure occurs at the distal suture line at a time after surgery that is graft length dependent. Tritiated labeling of regenerating axons and qualitative electromyography demonstrated that this effect was unrelated to the leading edge of the axonal growth cone, but temporally related to the functional reinnervation of denervated muscle.