Pisiform impingement after total wrist arthroplasty.

We present a 64-year-old woman with rheumatoid arthritis who developed increasing pain 3 years after a total wrist arthroplasty. The pain was localized over the ulnar side of the wrist secondary to erosion of the pisiform. Pisiform excision resulted in a resolution of the symptoms. When placing a carpal component, which includes a base plate as part of its design, care should be taken to avoid any overhang of the implant edge into the pisotriquetral joint.

A biomechanical evaluation of an anatomical coracoclavicular ligament reconstruction.

BACKGROUND: Despite numerous surgical techniques described, there have been few studies evaluating the biomechanical performance of acromioclavicular joint reconstructions. PURPOSE: To compare a newly developed anatomical coracoclavicular ligament reconstruction with a modified Weaver-Dunn procedure and a recently described arthroscopic method using ultrastrong nonabsorbable suture material. STUDY DESIGN: Controlled laboratory study. METHODS: Forty-two fresh-frozen cadaveric shoulders (72.8 +/- 13.4 years) were randomly assigned to 3 groups: arthroscopic reconstruction, anatomical coracoclavicular reconstruction, and a modified Weaver-Dunn procedure. Bone mineral density was obtained on all specimens. Specimens were tested to 70 N in 3 directions, anterior, posterior, and superior, comparing the intact to the reconstructed states. Superior cyclic loading at 70 N for 3000 cycles was then performed at a rate of 1 Hz, followed by a load to failure test (120 mm/min) to simulate physiologic states at the acromioclavicular joint. RESULTS: In comparison to the intact state, the modified Weaver-Dunn procedure had significantly (P < .05) greater laxity than the anatomical coracoclavicular reconstruction or the arthroscopic reconstruction. There were no significant differences in bone mineral density (g/cm(2)), load to failure, superior migration over 3000 cycles, or superior displacement. The anatomical coracoclavicular reconstruction had significantly less (P < .05) anterior and posterior translation than the modified Weaver-Dunn procedure. The arthroscopic reconstruction yielded significantly less anterior displacement (P < .05) than the modified Weaver-Dunn procedure. CONCLUSION: The anatomical coracoclavicular reconstruction has less anterior and posterior translation and more closely approximates the intact state, restoring function of the acromioclavicular and coracoclavicular ligaments. CLINICAL RELEVANCE: A more anatomical reconstruction using a free tendon graft of both the trapezoid and conoid ligaments may provide a stronger, permanent biologic solution for dislocation of the acromioclavicular joint. This reconstruction may minimize recurrent subluxation and residual pain and permit earlier rehabilitation.