Unilateral lumbar interbody fusion (ULIF).

Results and clinical outcome of a prospective multicenter clinical study involving 100 patients under-going a lumbar interbody fusion procedure using an unilateral approach to the spine to introduce a new surgical technique as a viable and less invasive alternative to standard posterior (PLIF) or transforaminal (TLIF) lumbar interbody fusion techniques : For certain indications clinical data show that unilateral lumbar interbody fusion (ULIF) offers the surgeon a considerable time advantage compared to standard lumbar interbody fusion techniques.

Painless osteoid osteoma of the finger in a child. Case report.

The authors report the case of an 8-year-old child presenting with painless swelling of the middle phalanx of the ring finger. Radiology demonstrated simple hypertrophy of cortical bone with a clear zone. Bone biopsy showed the typical features of osteoid osteoma. Osteoid osteoma is rarely painless and generally corresponds to a superficial tumour (hand, foot, skull and thorax).

Proximal row carpectomy: an alternative to wrist fusion?

Problems with implant failure and silicone synovitis and a high complication rate in wrist arthrodesis have recently increased the interest in solutions that use residual biological articular surfaces. These include limited intercarpal fusions and proximal row carpectomy (PRC). PRC is a relatively easy procedure with few complications. We reviewed 27 personal cases. According to this study PRC offers a painless range of motion, with an average of 68 degrees flexion/extension range and an average grip strength of 60% of the contralateral side. The failure rate is 18.5%. However, failures can be successfully converted into wrist arthrodesis. Our follow-up period ranges from 6 to 36 months. Late deterioration has not been reported in the literature. On the contrary, improvement of mobility and grip strength several months after operation have been observed. We still favor PRC as a salvage procedure in order to offer the patient some motion, provided that there is no osteoarthritis over the capitate and the lunate facet preoperatively.

The value of wrist arthroscopy. An evaluation of 129 cases.

In order to evaluate diagnostic and therapeutic wrist arthroscopy we analyzed 129 arthroscopies with a follow-up of at least 6 months. Seventy-seven arthroscopies were performed for therapeutic purposes; 52 arthroscopies were diagnostic. There were diagnostic benefits in 55 arthroscopies (42.5%), therapeutic benefits in 29 arthroscopies (22.5%), combined diagnostic and therapeutic benefits in 39 (30%) and no benefits in six (5%). In 65 cases of the therapeutic group (with preoperative diagnosis) the authors found that the arthroscopy had been worthwhile. For the diagnostic group without a preoperative diagnosis, an arthroscopic diagnosis was made in 44 cases. Complications occurred in two patients: one tendon incision over a Kirschner wire in the therapeutic group and one superficial infection in the diagnostic group.

Arthroscopic treatment of triangular fibrocartilage complex lesions of the wrist.

The arthroscopic treatments (suture, debridement and "wafer" resection of the distal ulna) performed for TFCC lesions in 42 patients were retrospectively reviewed. Overall results were disappointing, with a better outcome for isolated lesions, for sutured TFCC's and degenerative lesions.

Radial osteotomy and Sauvé-Kapandji procedure for deformities of the distal radius.

We treated 12 patients with a posttraumatic or congenital deformity of the distal radius. A radial osteotomy and a Sauvé-Kapandji procedure were carried out. In 9 patients the deformity was caused by a malunited fracture; the other 3 patients were referred to us with a Madelung deformity. We performed 6 open wedge osteotomies and 6 closing wedge osteotomies. All but one patient rated the result of the operation as good or excellent. The reason for the only failure could be carpal instability.

Frayed ulno-triquetral and ulno-lunate ligaments as an arthroscopic sign of longstanding triquetro-lunate ligament rupture.

In patients with chronic wrist pain of more than 6 months duration, arthroscopy may reveal fraying of the ulno-triquetral and ulno-lunate ligaments. This can be a sign of longstanding triquetrolunate dissociation. We present a prospective study in which frayed ulno-triquetral (UT) and ulno-lunate (UL) ligaments were sought on wrist arthroscopy and correlated with longstanding triquetro-lunate (TL) rupture.

Monostotic localization of Paget disease in the hand.

Paget disease rarely affects the hand and when it does, there is usually a polyosteotic involvement. Only a few cases have been described in the literature on monostotic localization in the hand. This paper adds two cases with solitary involvement of a metacarpal.

The Sauvé-Kapandji procedure for nonrheumatic disorders of the distal radioulnar joint.

The Sauvé-Kapandji procedure has received little attention until recently. Follow-up survey was performed of 31 wrists with nonrheumatic disorders. The wrists were evaluated with the Cooney score. A satisfactory result with good pain relief was obtained in 87% of the patients. The most frequent complication, reossification of the gap that is created, can be avoided with correct operative technique.

An arthroplastic salvage procedure for combined radiocarpal and distal radioulnar pathology.

In a patient with silicone synovitis and degeneration of the distal radioulnar joint after 2 operative procedures for Kienböck's disease, and in a patient with long-standing scapholunate dissociation and distal radioulnar degenerative arthritis, a combined salvage arthroplasty was performed. A proximal row carpectomy with a Sauvé Kapandji procedure maintained reasonable function.

A snapping wrist due to a loose body. Arthroscopic diagnosis and treatment.

A cartilaginous loose body of the radiocarpal joint was removed arthroscopically in a 45-year-old woman who complained of locking and snapping of her wrist. The diagnosis was made at arthroscopy and immediate relief was obtained.

Arthroscopic suturing of TFCC lesions.

Different types of triangular fibrocartilage complex (TFCC) lesions have been described. We propose an arthroscopic repair of the peripheral tear, as it is a tear in the vascular portion of the TFCC. The technique is based on one used for meniscal repairs of the knee, and it is quite easy to perform.

Lesions of the triangular fibrocartilaginous complex.

The authors present a retrospective study of 14 triangular fibrocartilaginous lesions in 13 patients. Based on their radiographic and clinical observations a new classification is presented taking into account associated lesions in the wrist.

Flexor pollicis longus rupture with scaphoid nonunion. A case report and literature study.

A case of flexor pollicis longus rupture which resulted from a pseudarthrosis of the scaphoid in a non-rheumatoid patient is described. Treatment consisted of an interphalangeal joint arthrodesis.

The dynamic axial fixator in fractures of the tibia and femur. A retrospective study in 98 patients.

In a retrospective study involving 98 patients the results achieved with the dynamic axial fixator (Orthofix) in closed or open fractures of the tibia or femur treated in two district hospitals in the southwest of England during the period 1986-1988 were evaluated. Fifteen patients were vacationers and, as a result, were lost to followup. The operation and subsequent management was performed by more than 15 different members of the staff, of different levels of seniority and experience. The present survey in this group of surgeons has demonstrated that the dynamic axial fixator is a reliable means of treating open fractures of the tibia following an initial good reduction. It does, however, highlight the importance of the strict adherence to simple guidelines for application, pin care and dynamization if best results are to be obtained.