Long-term outcome after carpal tunnel decompression - a prospective randomised study of the Indiana Tome and a standard limited palmar incision.

This randomised trial compared the results of carpal tunnel decompression using the TM Indiana Tome (Biomet, Warsaw, Indiana, USA) and a standard limited palmar open incision. Two hundred patients were randomly selected to have a carpal tunnel decompression with either the Indiana Tome or a limited palmar technique. They were assessed clinically for 3 months and using the Levine-Katz self-assessment evaluation for 7 years. After 7 years, there were 62 returned questionnaires from the open group and 53 from the Tome group. There were no significant differences in functional scores, pain, scar tenderness, pinch and grip strength at 3 months. There were two complications in the open group and nine in the Tome group, including one median nerve injury. There was both a higher rate of immediate complications, and more recurrences and persisting symptoms at 7 years in the Indiana Tome group.

An unusual rugby injury.

We describe an unusual sports injury in a young man, a combination of obturator hip dislocation with an ipsilateral anterior cruciate ligament injury. Traumatic non-prosthetic hip dislocations, particularly obturator hip dislocations, are extremely rare sports injuries and have not previously been reported in conjunction with a knee ligament injury. The severe pain and obvious deformity from the hip injury can distract from other injuries, particularly to the ipsilateral knee. This case reinforces the need for a thorough assessment of the knee joint, before hip reduction if possible and certainly after reduction of the dislocation.

Functional benefit of Dupuytren's surgery.

The results of surgery for Dupuytren's disease were prospectively assessed to see if there is a correlation between hand function, the degree of deformity and the post-operative result. A total of 42 patients were followed-up for 6 months. The mean flexion deformity was 81 degrees pre-operatively and 32 degrees post-operatively. The mean Sollerman score improved from 71 (out of 80) pre-operatively to 77 post-operatively. There was a significant correlation between the degree of deformity and the Sollerman score, and also between the improvement in deformity after surgery, and the Sollerman score. We conclude that hand function is worsened by increasing deformity in Dupuytren's disease and improved by correction of the deformity.

Colour Doppler ultrasound in the diagnosis, management and follow-up of a digital flexor pulley injury.

We present the case of a rock climber with a rupture of the A3 flexor sheath pulley. The diagnosis was confirmed with Colour Doppler Imaging (CDI) and with B-mode ultrasound imaging, and the surgical repair was evaluated in the same way. Vertical displacement of the flexor tendon meant that using CDI measurements of the longitudinal movements was not possible. However, using computer analysis of digitized B-mode images from texture patterns identified in the tendons, the vertical and longitudinal components of movement during flexion were calculated. The repair of the pulley was shown to produce tendon movement ratios nearer those of the control digit of the opposite hand.

Bilateral anterior shoulder dislocations in bench pressing: an unusual cause.

A case of bilateral anterior glenohumeral dislocation in a young weight trainer is presented. The patient, an insurance clerk, had been using a free weight bar in the bench press position and had become tired when the weight on the bar forced his arms into hyperextension in the mid-abducted position. The humeral shaft gradually pivoted on the bench and the humeral heads were slowly dislocated anteriorly by the weight of the bar. Simple closed reduction under sedation was performed and there were no complications. After six weeks in bilateral broad arm slings, with pendulum exercises from two weeks, the patient began to mobilise his arms and he achieved a full range of movements. This unusual mechanism of injury has not previously been reported and we recommend that bench pressing should be performed with a weight that can be "locked" to prevent crushing of the user. Furthermore, the bench should be narrow enough to allow the shoulders to overhang, allowing greater extension in the abducted position without the arm pivoting on the edge of the bench.

Mechanical stability of the AO internal spinal fixation system compared with that of the Hartshill rectangle and sublaminar wiring in the management of unstable burst fractures of the thoracic and lumbar spine.

STUDY DESIGN: A radiographic comparison of the mechanical efficacy of the Hartshill rectangle and that of the AO internal spinal skeletal fixation systems in the management of unstable burst fractures of the thoracic and lumbar spine. OBJECTIVES: To study the restoration and maintenance of normal spinal anatomy after open reduction and internal fixation of unstable burst fractures of the thoracic and lumbar spine. SUMMARY OF BACKGROUND DATA: There are laboratory studies documenting the biomechanical advantages of the AO internal spinal skeletal fixation systems. There have been no previous comparisons of the internal spinal skeletal fixation system with the Hartshill rectangle and sublaminar wiring in matched patient groups. METHODS: Radiographs obtained before surgery, immediately after surgery, and at 2 years after surgery were used to assess the restoration and maintenance of normal spinal anatomy in 14 patients who had undergone stabilization with the Hartshill System and in 12 patients who had undergone internal fixation using the AO internal spinal skeletal fixation system. RESULTS: The initial restoration of normal spinal anatomy was good using both systems. However, on examination 2 years after surgery, it was found that the AO system provided significantly superior maintenance of both middle (P < 0.01) and anterior column anatomy (P < 0.001). CONCLUSION: The AO internal spinal skeletal fixation systems is associated with significantly superior maintenance of spinal anatomy 2 years after surgery.