The role of arthroscopy in the treatment of lunatotriquetral ligament injuries.

Disruption of the lunatotriquetral ligament is a common cause of ulnar-sided wrist pain. A review of the literature of the pathophysiology and treatment of LT ligament tears is presented. The authors report a series of 20 consecutive patients with arthroscopically confirmed LT ligament tears without a VISI collapse treated with arthroscopic reduction and pinning of the LT joint. At an average follow-up of 2 years 8 months, there was an 80% success rate. Success of the procedure correlated negatively with arthroscopic findings of chondromalacia and positively with decreased postoperative active wrist motion.

Brachial artery rupture associated with closed posterior elbow dislocation: a case report and review of the literature.

A case report of a closed posterior elbow dislocation with brachial artery rupture treated with a reversed saphenous vein graft, fasciotomy, and medical collateral ligament (anterior oblique component) repair is presented. A literature review of 21 other similar cases is discussed. Three patients were treated with direct arterial suturing, four with ligation, four closed reductions, nine vein grafts, and two were undescribed. Early postoperative complications included anastomosis failure in two patients (9%) and thrombosis in three patients (14%). At final follow-up, 12 patients (55%) had a motor and/or sensory deficit, and 11 patients (50%) had restriction of elbow extension. Seven of these 11 patients had a loss of elbow extension of 5 to 15 degrees; the other four patients had a loss of 20 to 35 degrees.

Surgical treatment of the duplicated thumb.

Fifteen patients with 18 duplicated thumbs were treated surgically at The Shriners Hospital for Crippled Children, Springfield Unit, between 1925 and 1990. We compared the outcome of patients treated by ablation of the extra thumb with that of patients treated by ablation and radial collateral ligament reconstruction. Three patients with four duplicated thumbs, all from the ablation-only group, required additional surgical treatment for the following reasons: joint instability, contracture, angulation of the digit, and bony prominence. No patient from the ablation-plus-ligament-reconstruction group has required further operative treatment.

Intratendinous ganglia of the hand.

We report a series of seven patients with 10 intratendinous ganglia that were treated operatively. One ganglion was in the abductor pollicis longus tendon. The rest were in tendons of the fourth extensor compartment, and all of them were associated with tenosynovitis. The average age of the patients at operation was 55 years. One patient was treated by resection of the tendon with tendon transfer. The other patients were treated by excision of the ganglion with repair of the tendon or tenosynovectomy. The mean length of postoperative follow-up time was 6 years. One patient experienced a recurrence. Three of the six patients with preoperative dorsal tenosynovitis had tenosynovitis postoperatively. We speculate that the ganglia arose secondary to tenosynovitis. When an intratendinous ganglion is diagnosed, tenosynovectomy is recommended, with resection of the intratendinous ganglion and longitudinal tendon repair when needed.

Treatment of isolated ulnar shaft fractures with functional bracing.

A prospective study was initiated using functional bracing to treat isolated ulnar shaft fractures. Forty-seven consecutive patients with 48 fractures were treated from July 1987 to January 1989. Twenty-eight patients with 29 fractures were available for follow up. Three of these fractures were subsequently excluded, as they had open reduction and internal fixation, leaving a group of 26 fractures. The mean time to union was 45 days (6.4 weeks). Fractures of the middle third of the ulnar diaphysis had the highest mean time to union, as did those with an oblique fracture pattern of 26% to 50% initial displacement. For union time, there was no significant difference for fracture location (P > .05 via t-test) or for fracture pattern (P > .05 via analysis of variance).

Hawkins type III fracture-dislocation of the talus and diastasis of the tibiofibular joint without concomitant fracture of the malleolei. A case report.

A 23-year-old man injured his foot in a motorcycle accident. Roentgenograms and computed tomography scans demonstrated a Hawkins Type III fracture-dislocation of the talus with a suspected disruption of the anterior tibiofibular ligament. Prompt anatomic reduction of the talus with rigid internal fixation was performed. Intraoperative stress roentgenograms confirmed the presence of a syndesmotic disruption. No cases of this injury have been reported in the literature. When no obvious fracture of the ankle mortise is present in a Hawkins Type III or IV talar fracture-dislocation, care must be taken to fully evaluate the osseous and ligamentous structures of the ankle to rule out an occult injury. Computed tomography scans, stress roentgenograms, intraoperative clinical examination, and direct visual inspection can all be used to aid in this evaluation.