Scaphoid Nonunions Treated with Nonvascularized Bone Grafting and Screw Fixation.

Background Vascularized bone grafting with screw fixation is currently considered the treatment of choice for scaphoid nonunions with avascular necrosis (AVN) of the proximal pole. A viable alternative to using vascularized bone grafts for scaphoid nonunions with AVN is nonvascularized bone grafting with screw fixation. Question What are the functional outcomes of patients with scaphoid nonunions and associated proximal pole AVN who are treated with nonvascularized distal radius bone grafting and screw fixation? Patients and Methods Eight scaphoid nonunions with AVN, which received nonvascularized distal radius bone graft and screw fixation, underwent a retrospective review. Range of motion, strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were obtained. Follow-up X-rays were compared with immediate postoperative X-rays. Results At a mean follow-up of 88.9 months, thumb palmar abduction and radial abduction were significantly higher on the operative side ( p = 0.28 and 0.49, respectively). Extension/flexion arc was significantly lower in the operative wrist ( p = 0.148). There was no significant difference between the operative and nonoperative sides with regard to strength. The median postoperative DASH score was 2.9 (interquartile range [IQR]: 8.3). There was no progression of osteoarthritis when immediate postoperative and follow-up X-rays were compared. Radiographic union was observed in six of the seven (85.7%) patients who were able to return to the office for follow-up radiographs. The mean scapholunate and radioscaphoid angles measured on X-rays were within normal anatomic range postoperatively. Conclusions Using nonvascularized distal radius bone graft and screw fixation in the treatment of scaphoid nonunions with associated AVN has favorable radiologic and functional outcomes and should be considered a viable treatment option for this difficult problem.

Electrodiagnostic Evidence of Berrettini Anastomosis.

PURPOSE: Cadaveric palmar dissections reveal an ulnar sensory crossover (Berrettini anastomosis) to the third common palmar nerve so frequently that this crossover is considered a normal part of the anatomy. No literature has documented electrophysiologic evidence of the Berrettini anastomosis (BA). Presentation of third digit ulnar sensory crossover waveforms. METHODS: Retrospective chart review case series. Clinical office. Nerve conduction waveforms and data. RESULTS: Ulnar stimulation sensory crossover waveforms to digit three consistent with BA are presented. CONCLUSIONS: Third digit BA is measurable in routine electrodiagnostic nerve conduction study in some patients. The observed BA latency is the same and the amplitude is smaller (25% to 33%) than the ulnar sensory response. The clinical significance of the BA sensory response is unclear. The presence of a BA in severe carpal tunnel syndrome may give a small amplitude normal latency sensory response that could be misinterpreted and lead to a false negative result.

Prevention of Tendon Subluxation in Dequervain's Tenosynovitis Release Using Retinacular Repair.

This study compared the incidence of tendon subluxation in patients of a single surgeon undergoing Dequervain's release with and without retinacular repair. The study reviewed 31 patients that underwent standard Dequervain's release without retinacular repair and 49 that underwent Dequervain's release with retinacular repair. Each subject's functional status was assessed using the Patient-Rated Wrist/Hand Evaluation. Subjects were compared against age, gender, handedness, tendon subluxation, return to work duration, and surgical laterality. Tendon subluxation is an infrequent complication affecting patients undergoing Dequervain's release. This complication has a higher incidence in younger females and demonstrates no predilection for hand dominance. The efficacy of retinacular repair is suggested by good Patient-Rated Wrist/Hand Evaluation outcome scores and should be considered as an adjunct to prevent tendon subluxation. This is a level 4 study.