Endoscopic carpal tunnel release using the subligamentous two-portal technique.

The surgical treatment for entrapment neuropathy of the median nerve in the carpal tunnel is varied. Recent publications have demonstrated a closed, endoscopic method for release of the carpal tunnel using a two-portal technique. In this report, a surgical technique for performing a subligamentous modification of this two-portal procedure is discussed, and the special tools used in this approach are demonstrated. In the early portion of this series of 75 symptomatic hands in 65 patients, 8% (6/75 hands) developed transient postoperative ulnar nerve neuropraxia. One patient experienced an iatrogenic laceration of the median nerve. Following the institution of the subligamentous approach, no postoperative nerve complications occurred. The majority of the patients experienced a significant decrease in their median nerve symptoms. This procedure has been found to be safe and is equally as effective as open surgical treatment of patients with carpal tunnel syndrome.

Changes in tibiotalar joint contact areas following experimentally induced tibial angular deformities.

Six cadaveric legs were stripped of all soft tissue excluding the interosseous membrane and the tissues about the ankle joint and foot. Angular deformities were simulated in all planes to a maximum of 15 degrees for proximal, middle, and distal third levels following tibial resection and same-level fibular osteotomy. Anterior ankle arthrotomies allowed exposure to the tibiotalar joint so that contact area could be measured with pressure-sensitive film inserted between the tibia and talus. An angular deformity of 15 degrees or less produced no significant alteration in the contact area of the ankle joint for proximal and middle third tibial levels. Distal tibial deformities showed a dramatic change in the contact area, with as much as a 42% decrease in contact area for anterior deformities. The contact shape for distal third angular deformities of 10 degrees and 15 degrees in all planes also tended to elongate, with a shift to more lateral contact noted. Although minor degrees of angular malalignment had little effect on ankle contact for proximal and middle third levels, it would appear that distal third deformities produce a greater change in ankle joint contact; thus, fractures at the distal level should be managed to minimize the possibility of tibial malalignment.

Synovectomy of the elbow in rheumatoid arthritis.

The combined procedure of synovectomy and resection of the radial head was performed in thirty-five patients (forty-two elbows) with Stage-III or IV rheumatoid arthritis. These patients were followed postoperatively for a minimum period of two years (average, seven years). The result was graded as excellent in four, good in fifteen, fair in fourteen, and poor in nine elbows. Pain was diminished from the preoperative level in all but six elbows, but motion was not much improved. Synovitis recurred postoperatively in thirteen elbows, but in only five did the destructive process progress to a degree requiring a second operation. We think that synovectomy for relief of pain in the elbow is not contraindicated in the presence of Stage-III or IV rheumatoid disease, but that little improvement of elbow motion can be expected.