Mycobacterium tuberculosis infection of the wrist.

Reports of tuberculous infections of the wrist have been scarce, especially during the past 30 years. The diagnosis of tuberculosis may be difficult and requires a high index of suspicion, especially in patients with significant risk factors. Prompt diagnosis and treatment are crucial, as untreated wrist infections can have disastrous outcomes. This article describes the clinical presentation and management of an atypical case of tuberculosis of the wrist--a case of extensive carpal destruction without tenosynovial involvement. Quiescent tuberculosis seemed to reactivate after an episode of minor trauma.

Isolated fracture of the trapezoid.

We describe a case of an isolated trapezoid fracture that was managed nonoperatively with a favorable clinical outcome. To our knowledge and based on a literature review, this is the first report of a true isolated trapezoid fracture without accompanying dislocation and without associated metacarpal, carpal, or distal radial fractures. We present our findings in this case and review the clinical presentation, diagnostic workup, and treatment of trapezoid fractures in general.

A simple effective splinting technique for the mallet finger.

We describe an inexpensive, simple, and effective technique for the closed treatment of mallet fingers. This technique splints the mallet finger in 0 degrees of extension. It is simple, readily reproducible, and easy to use, requiring materials that are readily available to any physician. Thirty-seven patients, ages 21 to 65 years, presented with a closed mallet finger injury at day zero to 5 months after injury. Ten of these patients had a fracture. All were treated with this splinting technique. We report excellent results in 35 of 37 patients, who recovered either complete or near-complete active extension. Our results compare favorably with results from other techniques and splints.

Quadrilateral space syndrome: diagnosis, pathology, and treatment.

Quadrilateral space syndrome is an infrequent, recently established neurovascular compression syndrome affecting young active adults. With this syndrome, the neurovascular bundle, consisting of the posterior humeral circumflex artery (PHCA) and the axillary nerve, is compressed by fibrotic bands as it traverses the quadrilateral space. Symptoms result from compression of the axillary nerve, not from PHCA occlusion. Because of the vague, often nonspecific, clinical presentation of patients with quadrilateral space syndrome, diagnosis is challenging and requires a high index of suspicion from the orthopedist. Subclavian arteriography confirms the diagnosis. Treatment is usually conservative; operative management is reserved for selected patients. A posterior approach with detachment of the deltoid and teres minor muscles is recommended for surgical decompression and for lysis of fibrous tissue. We report two cases of persistent quadrilateral space syndrome in young adults, treated surgically, with 2-year follow-up. In the present report, diagnostic criteria, pathology, management, operative technique, and recent literature are also reviewed.

The wire interlock technique for harvesting a partial-width distally attached tendon graft.

A wire interlock technique useful for harvesting a partial-width tendon graft with an intact insertion for local reconstructive procedures is described. This technique is rapid and reliable for procuring attached tendon grafts with minimal exposure. The technique was used to harvest a flexor carpi radialis tendon graft for basal joint interposition arthroplasty in 12 patients. This method also may be readily applicable for other procedures requiring local ligament reconstruction with a partial-width tendon graft. (J Hand Surg 2000; 25A:176-182.

Hip arthrodesis in adolescents using external fixation.

Between 1994 and 1998, seven adolescents underwent hip arthrodesis with the use of an external fixator. Mean time of follow-up was 24.0 months after surgery. The duration of fixation and time to fusion were 6.6 months (range, 5-9.5 months) and 8.0 months (range, 5.2-15 months), respectively. At most recent follow-up, there was a significant improvement in the mean modified Harris hip score, in which the maximum score is 91 points after omitting 9 points for hip range of motion and deformity, from 25.7 before surgery to 66.7 after surgery (p < 0.01). The advantages of this procedure include (i) the ease and accuracy of obtaining the proper position for fusion, (ii) the ability to lengthen the affected leg at the same time, (iii) the diminished likelihood of compromising future hip operations, and (iv) the ability to ambulate and bear weight throughout the treatment course. We recommend this method of hip arthrodesis with external fixation for patients with intractable hip pain necessitating this procedure.

Midterm clinical and radiographic results with the genesis I total knee prosthesis.

The midterm results of primary posterior cruciate ligament-retaining, minimally conforming, cemented modular total knee arthroplasties using the Genesis I prosthesis in 110 knees in 72 patients were reviewed. Patients were evaluated at a mean follow-up of 7.3 years by Knee Society pain and functional scores, radiographic and survivorship analysis, and Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC) health status questionnaire. Range of motion increased from an average of 96.3 degrees to 112.5 degrees. Knee Society pain and functional scores increased from preoperative averages of 55 and 44 to 92 and 88, respectively. There were 91 excellent, 16 good, 1 fair, and 2 poor results. WOMAC scores were increased significantly in each subcategory examined (pain, stiffness, and physical function). Kaplan-Meier survivorship was 97% at 10 years. An increase in loosening as a result of eccentric stress concentration secondary to the nonconforming design of this prosthesis, theoretically a matter of some clinical concern, was not shown in this investigation.