Arthroscopic-assisted reduction of distal radius fractures.

The outcomes of seven patients with severe comminuted intraarticular fractures of the distal radius treated by arthroscopic reduction and percutaneous external fixation (ARPEF) were retrospectively reviewed. All of the fractures were classified as C3 types using the AO classification scheme. Outcomes were evaluated using the Gartland and Werley functional criteria, an objective wrist examination, a radiographic analysis, and a self-assessment outcome form at an average follow-up of 27 months (range, 12 to 45 months). All patients were free of pain and had returned to their prior occupations. No patient had articular incongruency of greater than 1 mm, and there was no evidence of radiocarpal degenerative change. Active range of motion and maximal grip strength averaged 92% and 98%, respectively, of the uninjured wrist. The technique of arthroscope-assisted reduction and percutaneous external fixation yielded excellent results in a small group of patients, with minimal complications.

Scaphoid shift in the uninjured wrist.

To determine the prevalence of a positive scaphoid shift in an uninjured population, 100 patients presenting with symptoms unrelated to trauma or wrist instability underwent physical and radiographic evaluation. On physical examination, the scaphoid shift maneuver was performed bilaterally, and generalized ligamentous laxity was assessed using standard criteria. Standard x-ray films were inspected for carpal abnormalities, and the radiolunate and scapholunate angles were measured. The prevalence of a positive scaphoid shift was 32%; the shift was painless in all patients. Fourteen patients had a unilateral scaphoid shift. Patients with a positive scaphoid shift had increased generalized ligamentous laxity manifested by a decreased average thumb-to-forearm distance and an increased mean flexion-extension arc. A positive shift was not correlated with radiographic carpal malalignment.

Wrist arthroscopy: an overview.

An introductory overview of wrist arthroscopy is presented. The relevant anatomy and pathology of the wrist are reviewed, with special emphasis on the triangular fibrocartilage complex. Operative technique and equipment are described, and operative indications are presented. The role of diagnostic arthroscopy is discussed and comparison is made to arthrography in terms of diagnostic efficacy. Some future directions for wrist arthroscopy are presented.

The treatment of peripheral nerve injuries using irradiated allografts and temporary host immunosuppression (in a rat model).

Irradiation of allografts prior to transplantation and host immunosuppression with cyclosporin-A were studied separately and in combination as means of lessening the rejection of transplanted peripheral nerve tissue. Lewis and Brown Norway rats were used in the animal model, as they differ at both major and minor histocompatibility loci. Sciatic nerve grafts (2.5 cm) were used and the animals were followed for 16 weeks after nerve grafting. The outcome was studied by functional measurements (sensory testing, gait analysis, joint flexion contracture, and muscle weight), as well as by measurements of biochemical and histologic parameters (hydroxyproline concentration and axon counts, respectively). Sensory testing was not reliable because of crossover innervation by the saphenous nerve. Evaluation by standard gait-testing techniques was found to be unsatisfactory. However, the allografted animals receiving cyclosporin-A had significantly smaller flexion contractures, compared to the allografted animals without immunosuppression (17 degrees +/- 12 degrees vs. 44 degrees +/- 13 degrees and 51 degrees +/- 13 degrees, p less than 0.005). Allografted animals receiving short-term cyclosporin-A had contractures that were not significantly different from those seen in isografted control animals (17 degrees +/- 12 degrees vs. 22 degrees +/- 15 degrees, NS). Muscle hydroxyproline concentration analysis revealed a lower hydroxyproline concentration among the allografted groups that received irradiated allografts, compared to groups receiving nonirradiated allogeneic grafts. The studies of muscle hydroxyproline concentration and muscle weight both showed substantial reinnervation, even in allografted animals without pretreatment of the grafts or immunosuppression of the recipient animal.(ABSTRACT TRUNCATED AT 250 WORDS)

Ulnocarpal abutment after wrist arthrodesis.

We report three patients aged from 22 to 34 years, in whom ulnocarpal abutment developed after wrist arthrodesis. Two were treated by excision of the triquetrum and one by excision of the pisiform. The three patients were seen after wrist fusion because of ulnar wrist pain on forearm rotation, which was relieved by excision of a carpal bone. Two patients had had wrist arthrodesis because of wrist pain resulting from degenerative arthritis and silicone synovitis resulting from silicone rubber replacement of the lunate as treatment for Kienböck's disease. One patient had had a wrist arthrodesis to treat degenerative arthritis after an intra-articular distal radius fracture. The arthrodeses were all done with an A. O. plate and iliac crest bone graft. One patient gained forearm rotation after the excision of the carpal bone and none of the patients lost rotation. The average follow-up was 16 months.