Suprapatellar tibial nailing: intraoperative arthroscopic evaluation and results at a minimum of 12 months follow-up.

To arthroscopically evaluate the intra-articular structures before and after placement of an intramedullary tibial nail using the suprapatellar approach and to assess the 1-year results. All patients with a tibial fracture that underwent intramedullary tibial nailing using the suprapatellar approach with a minimal follow-up of 12 months were included. Diagnostic intraoperative knee arthroscopy was performed before and immediately after insertion of the IMN. A radiological and clinical evaluation and VAS score of the patients was collected postoperatively. In total, 36 patients were included. The mean follow-up period was 14.9 ± 4.9 months. The mean age of the patients was 45.5 ± 18.8 years. The mean visual analog scale (VAS) score at 12 months was 1.0 ± 1.5. The complication rate was 19.4% and the reoperation rate was 16.7%. Union of the fractures was achieved in 33 patients (91.6%) after primary surgery after a mean of 6.1 ± 1.8 months. A change in the patellofemoral cartilage after insertion of the nail was seen in 1 patient. The suprapatellar procedure for tibia fractures resulted in excellent VAS scores and union rates at 1-year follow up, with a complication of articular damage to the PF joint in 2.8%.

Dorsal wrist plating for the management of intra-articular distal radius fractures.

The aim of the study was to evaluate the results of Dorsal Wrist Plating in intra-articular distal radius fractures with a dorsal displacement. In this prospective study, a single surgeon treated 20 patients with a (partially) intra-articular distal radius fracture with a dorsal rim avulsion or a dorsal Barton's type fragment. They all underwent an open reduction and internal fixation by Dorsal Wrist Plating. A total of 17 patients had a follow-up period of at least 12 months (mean follow- up of 17 months) and these patients were included in the study. Both functional and radiological outcome parameters were measured. The total range of motion was 92 % of the contralateral side. The mean grip strength and key pinch were 24.6 kg and 6.9kg respectively compared to 29.5 kg and 7.4 kg on the non-operated side. The average Mayo Wrist Score was 89.7 (range 80-100) and the mean Disability of the Arm, Shoulder and Hand score was 4.5 (range 0-9.2). An articular step-off was only noted in 2 patients (1 and 2 mm respectively). Radial inclination was restored in all patients. Palmar tilt was anatomically restored in five patients. In all other patients, the palmar tilt was acceptably restored. There was no significant radial shortening in any of the patients. No infections, no tendon ruptures, no Complex Regional Pain Syndrome, or union problems were observed. Dorsal wrist plating seems to be a safe and reliable procedure in the treatment of intra-articular distal radius fractures with dorsal displacement.

Traumatic divergent dislocation of the extensor tendons over the metacarpophalangeal joint.

Dislocation of the extensor tendon over the metacarpophalangeal joint (MCP) is rare. Involvement of the fifth ray is even more exceptional. The authors of the present study describe such a case that occurred in a professional musician. We report a divergent dislocation of both extensor tendons over the metacarpophalangeal joint of the fifth finger.

Lunotriquetral arthrodesis, a procedure with a high failure rate.

The authors retrospectively reviewed 29 patients with chronic lunotriquetral ligament tears who were treated with lunotriquentral arthrodesis. Arthrography confirmed the diagnosis in 17 cases, arthroscopy in 18. Associated lesions included 13 TFCC tears and 8 scapholunate ligament tears. The fusion was carried out with staples in 5 cases, a Herbert screw in 17, a Kirschner wire in 6. Bone grafts were used in 24 cases. In 15 cases additional procedures were performed. As for the subjective outcome, 5 patients were fully satisfied, 10 had reservations and 14 were not satisfied; 17 patients would repeat the procedure. The average Pellenberg wrist score for pain and function was 59/80 (0 no symptoms, 80 maximal pain). Mean grip force was 69% of the contralateral side and lateral pinch force was 79%. Flexion loss averaged 24 degrees, and extension loss 21 degrees. Fusion was achieved in 16 cases; nonunion persisted in 13. Twelve important complications were noted. In 17 cases the wrist remained painful; in 19 patients an average of two additional surgical procedures were required. Fusion was obtained in two of seven revision cases; five remained painful. Three patients went on to complete wrist arthrodesis. In the light of these results the effectiveness of this procedure has to be reconsidered compared to other alternatives, such as ligamentoplasty and extended arthrodesis (4 corner).

Dieterich's disease: avascular necrosis of the metacarpal head: a case report.

The authors report a case of non-traumatic avascular necrosis of the third metacarpal head. This very rare condition is known as Dieterich's disease and has been associated with trauma, systemic lupus erythematosus and steroid use.