Distal Oblique Bundle in the Distal Interosseous Membrane of the Forearm: Review of Current Knowledge.

The distal oblique bundle has been recognized as a distinct structure of the distal interosseous membrane of the forearm since 2009, when Noda et al. named it. Our minireview will attempt to summarize knowledge gathered and provide guidelines toward possible questions that arise when reading studies about this topic. It is our strong belief that the distal oblique bundle is worth investigating in full, since it seems to have an important role as a stabilizer of the distal radioulnar joint. Due to the efforts of a small number of surgeons and authors, the groundwork for understanding its purpose has been laid, but more research needs to be done.

Beware of the ulno-palmar distal radial fragment.

Five patients sustained isolated fractures of the ulnopalmar rim of the distal radius. In three cases the fragment was small and was classed as an avulsion fracture of the short radiolunate ligament. Palmar wrist subluxation occurred in all cases, four during treatment in a cast or splint. The ulnopalmar rim of the distal radius contributes to the stability of the radiocarpal joint and fractures in this region merit particular attention.

Does the term scaphocapitate syndrome need to be revised? A report of 6 cases.

This is a retrospective study of six patients with displaced fractures of the neck of the capitate. In four of the six patients the diagnosis was delayed by at least 1 week. After open reduction and internal fixation the results were assessed as excellent (three cases), fair (two cases) or poor (one case). In all cases there was a concomitant injury to the radial side of the wrist: in four cases this was a fracture of the waist of the scaphoid. In five of the six cases there was also an injury to the ulnar side of the wrist. As a scaphoid fracture does not always occur with the fracture of the neck of the capitate, we consider the term "scaphocapitate syndrome" inappropriate for this injury.

Simultaneous ipsilateral diaphyseal fractures of the femur and tibia: treatment and complications.

We present our experience of intramedullary nailing (IM) and external fixation in the treatment of 54 patients with ipsilateral diaphyseal fractures of the femur and tibia. Eight femoral and 24 tibial fractures were open. They were classified into three groups: IM nailing of both fractures (group A, 19 patients); IM nailing of the femoral and external fixation of the tibial fracture (group B, eight patients); and external fixation of both fractures (group C, 27 patients). In group C (which included all but one grade III open fracture), two patients died and four underwent amputation. Femoral fractures treated with external fixation had significantly more complications and reoperations than those treated with IM nailing. In tibial fractures this difference was also present but not statistically significant. We believe that IM nailing is the method of choice for femoral fractures and is preferable for tibial fractures, with the exception probably of grade III B and C open injuries.

Perilunate dislocations and fracture-dislocations. Closed and early open reduction compared in 28 cases.

27 patients (28 cases), were treated for perilunate dislocations in 20 and fracture-dislocations in 8. Capitate displacement was dorsal in 27 cases and palmar in 1 case, and in 16, the scaphoid was fractured. There was no substantial delay of treatment. In 8 patients treated with closed reduction, follow-up averaged 6 (1-15) years. 19 patients (20 cases) who underwent early open reduction with K-wire stabilization and ligamentous repair, had an average follow-up of 2 (0.5-7) years. The clinical outcome was evaluated using a scoring system based on pain, occupation, ROM and grip strength, while the radiographic outcome was assessed according to findings of carpal instability, nonunion of scaphoid, and/or arthrotic changes. In patients treated with closed reduction, results were fair in 3 and poor in 5, while patients treated with early open reduction had a better clinical score with 4 excellent, 9 good, 3 fair and 4 poor results. These findings suggest that perilunate fracture-dislocations are too unstable to be treated with closed reduction. In addition, a combined approach was found effective in the management of dorsal perilunate dislocations. Finally, open reduction presupposes reparation of the torn scapholunate ligament, to obtain normal carpal kinematics.

The unstable capitolunate and radiolunate joints as a source of wrist pain in young women.

A retrospective study of 12 young women (14 cases) complaining of chronic wrist pain, obscure numbness and reduction of grip strength is presented. The average duration of the complaints was 7.3 years. All wrists were in VISI alignment, with normal motion series and normal intrinsic interosseous ligaments demonstrated arthrographically. The dorsal-displacement stress test showed subluxation of the capitolunate (in nine cases) or both the capitolunate and the radiolunate joints accompanied by a marked feeling of apprehension. Surgical management consisted of ligamentous reefing of the whole palmar aspect of the midcarpal joint and the radiolunate joint when needed. Additionally, a neurectomy of the terminal branch of the anterior interosseous nerve was done in four cases. The result was excellent in eight cases, good in five cases and fair in 1 case. Young women with "delicate" wrists and obscure wrist pain may have isolated instabilities of the capitolunate and radiolunate joints. In cases that do not respond to conservative measures ligamentous reefing should be considered.

Late management of post-traumatic palmar carpal subluxation: a case report.

Only a few cases of palmar carpal subluxation associated with an ulnovolar fragment from the distal radius have been reported previously. We report a case which was treated operatively six months after the injury.