The accuracy of posterior condylar angles measured by one MR image.

The posterior condylar axis is used to establish femoral rotational alignment during total knee arthroplasty. One magnetic resonance image or computed tomography image often is used to determine the posterior condylar angle. However, the bony landmarks for determining the posterior condylar angle are not always present or obvious. We hypothesized measuring the posterior condylar angle on one slice would be no different when compared with using superimposed images with bony landmarks accurately identified in one or more slices. We analyzed magnetic resonance images of 95 knees without any bone disorders. Only 20 knees had all four bony landmarks apparent on any single slice. We compared the posterior condylar angles measured from one slice in which the medial sulcus, lateral epicondyle, or both posterior condyles were accurately identified with the angle measured from superimposed images. The average posterior condylar angle in the remaining 75 knees measured from superimposed images was 4.27 degrees +/- 1.95 degrees, which was similar to the angle measured from one in which the lateral epicondyle was the most accurately identified (3.95 degrees +/- 1.93 degrees). However, the largest difference (-3.53 degrees and 4.29 degrees) between three-dimensional and two-dimensional posterior condylar angle measurements in the worse-case scenario was unacceptable in clinical practice. We could not confirm our hypothesis: using one two-dimensional image to measure the posterior condyle angle is not accurate enough to determine its three-dimensional angle.

Results of arthroscopic reduction and percutaneous fixation for acute displaced scaphoid fractures.

PURPOSE: This study used percutaneous techniques augmented by simultaneous wrist arthroscopy to visualize the fracture and thus confirm the fracture alignment and reduction and also to assesses the concurrent associated ligament injuries. TYPE OF STUDY: Retrospective study. METHODS: Arthroscopy was used to help to reduce scaphoid fractures and assess soft-tissue injuries in 15 acute cases (13 male and 2 female patients). The fractures were treated by reduction under arthroscopic control and percutaneous fixation with the cannulated interosseous compression screw. Soft-tissue lesions were also treated at the same time using debridement, suture repair, or K-wire transfixation. The average age of the patients was 29.2 years (range, 19 to 48 years). RESULTS: Two patients (13.3%) had scapholunate (SL) ligament injuries, and both exhibited partial tear of the SL ligament. Four patients (26.7%) suffered lunotriquetral (LT) ligament injuries and received ligament debridement, K-wire fixation of the LT joint, and splinting. Six patients (40%) had chondral fractures. Additionally, the triangular fibrocartilage complex (TFCC) was torn in 5 patients (33%). Finally, 5 patients (33%) suffered radioscaphocapitate ligament or long radiolunate ligament injuries. All fractures healed without malunion or nonunion and, at follow-up of 24 to 28 months, 11 patients had excellent results and 4 had good results based on Mayo Modified Wrist Scores. CONCLUSIONS: We believe that arthroscopic reduction may be considered for scaphoid fractures because this approach can use a single procedure to achieve acceptable restoration of fractures as well as assessment and management of soft-tissue lesions. LEVEL OF EVIDENCE: Level IV Therapeutic Study, case series with no, or historical, control group.

Evaluation of shoulder proprioception following muscle fatigue.

OBJECTIVE: To investigate the effect of shoulder muscle fatigue on glenohumeral proprioception. DESIGN: A repeated proprioception test was performed. BACKGROUND: The role of conditioning and fatigue in sport injuries remains controversial. It has been hypothesized that proprioceptive information plays an important role in joint stabilization and that muscle fatigue may alter proprioceptive ability. However, the effect of shoulder muscle fatigue on glenohumeral proprioception is still controversial. METHODS: Eleven normal subjects (mean age 27.3 years) participated in this study. Proprioception tests (on the dominant shoulder) were performed in which proprioception of the active reproduced and passive reproduced shoulder position was measured using an isokinetic dynamometer and a proprioception testing apparatus, respectively. The speed of active repositioning was at 2 deg/s and passive repositioning was at 0.5 deg/s. The mean value of maximum voluntary contraction and the number of repetitions for muscle fatigue were recorded. Post-fatigue proprioception test was started within 3 min after muscle fatigue. RESULTS: There was no significant difference of shoulder proprioception between pre- and post-fatigue determinations of passive repositioning in shoulder internal rotation, passive repositioning in external rotation and active repositioning in internal rotation. There was a significant difference between pre- and post-fatigue determination of active repositioning in external shoulder rotation (mean degrees: 2.57 (SD 1.02) vs. 4.96 (SD 1.73), P<0.05). CONCLUSION: Shoulder proprioception in active repositioning in external rotation was major affected by muscle mechanoreceptors in the presence of muscle fatigue. RELEVANCE: This study revealed that the shoulder proprioception after muscle fatigue in active repositioning in shoulder external rotation was affected more sensitively by the muscle mechanoreceptors than the joint mechanoreceptors. Increasing resistance of muscle fatigue would increase the shoulder proprioceptive ability.

Treatment of tibial pilon fractures using the Link May Anatomic Bone Plate.

BACKGROUND: The tibial pilon fracture is a relatively uncommon but a most difficult fracture to manage. Most orthopedic surgeons agree that the goal of treating such kind of fracture should be anatomic restoration of the articular surface, rigid and stable fixation, early restoration of joint motion, and finally, good functional recovery. We report our experience in managing the fracture and evaluate the operative results for patients who were treated with the Link May Anatomic Bone Plate. METHODS: A retrospective study was performed for tibial pilon fracture from January 1997 to February 2000. A total of thirty patients underwent surgical treatment using Link Distal Fibular Anatomic May Bone Plate, including twenty males and ten females with an average age of 42.6 years (range, 18 to 88 years). According to Rüedi-Allgöwer classification, the fracture patterns were type I in 30% (n = 9), type II in 53.3% (n = 16), and type III in 16.7% (n = 5). Twenty-two fractures (73.3%) were closed type; three (10%) were classified (Gustilo) as grade I open fracture; and five (16.7%) as grade II open fracture. Associated injuries included multiple fractures in five cases and head injury in four cases. All patients were evaluated clinically and radiologically after a mean time of 27.1 months (range, 17 to 39 months). RESULTS: Satisfactory results were obtained in 83.3% of cases. Complications were found in four patients (13.3%), with one nonunion, two superficial wound infections and one deep wound infection. CONCLUSIONS: We concluded that this plating system is one choice of treatment for tibial pilon fracture which provides relatively good outcome.

Dorsal capsulodesis and ligamentoplasty for chronic pre-dynamic and dynamic scapholunate dissociation.

Scapholunate (SL) instability is the most common cause of carpal instability. Pre-dynamic and dynamic type SL instability is difficult to diagnose and treat. This series reviews 17 soldiers with pre-dynamic or dynamic SL instability diagnosed by midcarpal arthroscopy and treated with dorsal capsulodesis and augmentation ligamentoplasty with partial dorsal radiocarpal (DRC) ligament procedure between 1997 and 2000. The sample included 14 males and three females. The dominant hand was involved in 15 patients. Moreover, the average patient age was 29.3 years (range 19-36 years). The diagnosis was based on clinical and arthroscopic criteria. Fifteen patients were followed up at our clinic regularly, with the follow-up period ranging from 12 to 39 months (mean 25.2 months). Fourteen patients had excellent or good results, and one patient had poor result based on Mayo Modified Wrist Score. Wrist motion in the flexion-extension plane loss averaged 18.4 degrees. Grip force increased significantly following treatment, with improvement totaling 15% of normal side. No complications were found in this series. Consequently, dorsal capsulodesis and ligamentoplasty with partial DRC ligament is considered a valuable therapeutic option for cases of pre-dynamic and dynamic SL instability.

Early isolated triangular fibrocartilage complex tears: management by arthroscopic repair.

BACKGROUND: Tears in the traumatic triangular fibrocartilage complex (TFCC) are generally caused by falling accidents with pronated, hyperextended wrists, or by distraction injuries that pull the ulnar side of the wrist out of place. Tears in the triangular fibrocartilage complex often appear in association with ulnar wrist pain and limited wrist function in work or sport. This study addressed the arthroscopic repair of peripheral tears in the TFCC, in a sample of 37 patients who were undergoing TFCC repair by wrist arthroscopy. METHODS: From September 1996 to February 1999, 37 patients underwent TFCC repair by wrist arthroscopy. The mean follow-up period was 25.6 months (range, 22-28 months), and the patients' average age was 21 years. The study included 30 men and 7 women. All patients had early peripheral TFCC tears and no wrist fractures. The inside-out method was used to repair the tears and the distal radioulnar joint was fixed for 6 weeks using a 2.0-mm Kirschner wire. After operation, patients were rehabilitated, reexamined, and followed up at the clinic. Complications were also recorded. RESULTS: The results were graded with a Mayo Modified Wrist Score. Ten of the 37 wrists were rated excellent, 24 were good, and 3 were fair. Overall, 34 of 37 patients (92%) rated satisfactorily and returned to sporting or work activities. Four patients experienced mild pain during work or exercise. Although motion remained normal for these patients, grip strength on the affected hand was at least 72% of that on the other hand. CONCLUSION: Arthroscopic repair of early peripheral tears of the triangular fibrocartilage complex is a satisfactory method of repair. The procedure can enhance patients' wrist function by relieving pain and increasing tolerance for work or sport.

Dorsal ganglion of the wrist: results of treatment by arthroscopic resection.

Between September 1997 and September 2000, 32 patients (20 males and 12 females; average age 23.7 years) received arthroscopic surgery for dorsal wrist ganglion. Five of the patients (15.6%) experienced recurrences after open surgery. All patients complained of pain or a cosmetic problem due to the lump. Before the operation, they were all sonographically examined using a high-resolution 7.5 MHz real-time probe. After operation, they were followed-up by telephone after 15 to 37 months (mean 26.8 months). No recurrences occurred in our series. Arthroscopic resection is safe and addresses the anatomic pathology. Recurrences have been fewer than in the reported results of the open surgery. The approach is reasonable for operatively treating the dorsal ganglion.

Chronic triangular fibrocartilage complex tears with distal radioulna joint instability: A new method of triangular fibrocartilage complex reconstruction.

From September 1996 to September 1997, 27 adult patients were diagnosed with chronic triangular fibrocartilage complex (TFCC) tears with distal radioulna joint (DRUJ) instability in our clinic. They all received the procedure of TFCC reconstruction with partial extensor carpi ulnaris (ECU) tendon combined with or without ulnar shortening. There were 26 males and one female in the study with a mean age of 22.4 years. The follow-up period ranged from 22 to 28 months with a mean of 26.2 months. 24 patients who had positive or zero ulnar variance received the procedure of ulnar shortening. Three patients who had minus ulnar variance only received TFCC reconstruction. After the operation, the DRUJ was fixed by a 2.0 mm K-wire for 4 weeks. All patients underwent a rehabilitation program and they were reexamined at our outpatient department (OPD). The results were graded according to the Mayo Modified Wrist Score. Five of the 27 patients rated their wrists 'excellent', 18 rated 'good', and 4 rated 'fair. Overall, a total of 23 patients (85%) rated satisfactorily and returned to work or sport activities. In the 4 patients rated 'fair', mild pain at work and/or exercise, and mildly limited supination were found; however their grip strength was improved at least by 65% compared to the opposite hand. Therefore, as suggested by this study, TFCC reconstruction with partial ECU tendon combined with the ulnar shortening procedure is an alternative method for chronic TFCC tears with DRUJ instability.