Anatomic Variation in Volar Tilt of the Scaphoid and Lunate Facet of the Distal Radius.

PURPOSE: The aim of distal radial fracture treatment is to achieve optimal function through the restoration of normal anatomy, including volar tilt. The accuracy of assessing volar tilt on standard lateral radiographs compared with anatomic tilt lateral (ATL) radiographs is uncertain. This study aimed to investigate the anatomy of the articular surface of the distal radius, in particular measuring the angle between the dorsal and volar rims at several points from radial to ulnar, to ascertain whether volar tilt is uniform between the scaphoid and lunate facet and to explore consistency between standard lateral and ATL views. METHODS: We studied 38 dry cadaveric specimens of radii. The distal articular surface of each specimen was marked at 5 intervals and placed in a customized jig. A 1.5-mm stylus was placed at each marker to represent the articular surface angle, and was photographed in standard lateral and ATL projections. An on-screen protractor was used to measure each angle from the digital photographs. RESULTS: The volar tilt measurements at the lunate facet demonstrated a significantly shallower angle than those at the scaphoid facet. The measurements between the standard lateral and ATL were found to have no significant difference. CONCLUSIONS: Adjusting the projection angle between a simulated standard lateral and ATL view did not significantly change the volar tilt measurements in this anatomic study. The lunate facet was found to have a significantly shallower volar tilt than the scaphoid facet. Variance in radiographic volar tilt may relate to different anatomic sagittal planes, reflecting the anatomic variation between the scaphoid and lunate facets. CLINICAL RELEVANCE: A detailed understanding of distal radius anatomy is required by the surgeon for accurate radiologic interpretation and anatomic fracture reduction and fixation.

A case report of trigger wrist associated with carpal tunnel syndrome caused by an intramuscular lipoma.

Triggering at the wrist with finger movement is an uncommon presentation. We present the case of a 46 year old male with painful wrist triggering with associated carpal tunnel syndrome caused by an intramuscular lipoma of the lumbrical muscle. As far as we are aware this is only the second documented case of wrist triggering caused by an intramuscular limpoma. Surgical removal of the tumour led to a resolution of the patients symptoms. We review the literature and discuss other published cases of this rare presentation.

A method for internal fixation of unstable distal clavicle fractures: early observations using a new technique.

Unstable distal clavicle fractures often require open reduction and internal fixation. A variety of fixation methods have been used and are currently in use. None of the current fixation methods seem to be without problems. We present a new technique and early observations using a distal radius locking T-plate normally used for fixation of distal radius fractures.

Driving plastered: who does it, is it safe and what to tell patients.

BACKGROUND: The number and safety of patients who drive in an upper limb fracture cast has been largely untested. This study investigates the proportion of persons who drive in their casts and the capability of a casted persons driving is also assessed. The stance of government and insurance bodies is reviewed. The aim is to provide a guide for when a doctor should advise a patient not to drive while wearing an upper limb fracture cast. METHODS: Patients attending fracture clinic in upper limb casts were anonymously surveyed and asked (along with demographics) if they drove while in a cast and if they believed it illegal or covered by insurance to drive. Driving tests of the author wearing upper limb fracture casts were undertaken. The Queensland police traffic branch, the Queensland Department of Transport and the RACQ insurance company were contacted to review the legal and insurance issues involved. RESULTS: Two-thirds of male and one-third of female patients (half overall) were found to drive while in an upper limb cast. The author failed driving instructor tests in all casts and occupational therapist driving assessments while wearing long arm casts. The author passed occupational therapy driving assessments in left and right short arm casts. CONCLUSIONS: According to these results, a doctor's advice should be to patients not to drive in a long arm upper limb fracture cast and to consider concomitant patient factors when advising patients in short arm casts. Although we do not suggest that patients drive while wearing any cast, we have found a large proportion do. Our limited study has found that a young, fit and pain-free person may be able to drive well enough to pass a driving test while wearing a short arm cast.