Arthritis predicting factors in distal intraarticular radius fractures.

INTRODUCTION: Intra-articular malunion with step off and gap formation is claimed to be crucial for radiocarpal degeneration. In addition to well-defined intraarticular malunion, the shape of the distal radius is important for unaffected wrist function. In typical intra-articular fracture patterns with a dorsoulnar and palmar ulnar fragment, alterations of the shape of the articular surface, in a kind of a cavity, without obvious step off can be observed. The aim of the present study is to determine the residual articular deformity following intra-articular radius fractures and to analyze their impact on the final clinical and radiological outcome. MATERIALS AND METHODS: Eighty one patients with dorsally displaced distal intraarticular radius fractures were followed up for a mean period of 9 years. Surgical treatment of all patients included open reduction, plate fixation and corticocancellous bone grafting. Radiological measurements included palmar tilt, radial inclination and radial shortening as defined by ulnar variance, intra-articular Stepps and the measurement of the anteroposterior distance of the radial joint surface. Clinical assessment included active range of motion (ARM) of the wrist, pain according to a visual analogue scale (VAS), grip power, working ability, Disability of Arm, Shoulder and Hand Score (DASH Score). RESULTS: Articular malunion in the form of a cavity in the sagittal plane measured 4.8 mm, 1.3 mm more than on the non-injured side. Anteroposterior distance measured 20.6 mm, 2.1 mm more than on the non-injured side. Articular step-off and gap was noticed in 11 patients. At the final follow-up examination, there was a significant difference in articular cavity depth and the anteroposterior distance between arthritis stage I and II. Arthritis stage was associated with the range of motion (ROM) in the sagittal plane, but had no significant influence on the DASH, pain level, grip strength and ROM in the frontal plane. CONCLUSION: ORIF leads to predictable results in the restoration of length and form of the distal radius. Increasing the articular cavity depth should be avoided to prevent degenerative arthritis at the radiocarpal joint at long-term follow-up visits.

[Limits of palmar locking-plate osteosynthesis of unstable distal radius fractures]. / Grenzen der palmaren winkelstabilen Plattenosteosynthese bei instabilen distalen Radiusfrakturen.

PURPOSE: The use of locking plate systems in the treatment of distal radius fractures has increased during the last years. In the presented study our experience and results after palmar plating of dorsal dislocated distal radius fractures are analysed and presented. Besides the functional and radiological results, the potential surgical risks and the observed complications are discussed. PATIENTS AND METHODS: Over a mean 15-month period, 112 consecutive patients (24 men, 88 women) with an average age of 57 years who were treated for an unstable dorsal dislocated distal radius fracture using the palmar locking-plate system could be assessed. The functional results were compared with the uninjured contralateral side. The subjective pain level was assessed using the visual analogue scale (VAS) and the subjective results were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) Score. Radiographic assessment included palmar tilt, radial inclination, and ulnar variance. The objective and subjective functional results were evaluated using the modified Mayo-Wrist Score. RESULTS: Functional results: extension slashed circle 53.1 degrees (84 % as compared with the uninjured side); flexion slashed circle 45.8 degrees (81 % as compared with the uninjured side); pronation slashed circle 78.7 degrees (95 % as compared with the uninjured side); supination 81.9 degrees (95 % as compared with the uninjured side); grip strength slashed circle 56 Kp (73 % as compared with the uninjured side). Radiological results: postoperative reduction/mean postoperative loss of reduction: radial inclination: slashed circle 20.4 degrees /slashed circle 0.2 degrees ; palmar tilt: slashed circle 0.2 degrees /slashed circle 3.1 degrees ; ulnar variance: 0.08 mm/slashed circle 0.42 mm. Pain values: slashed circle 2.7 points; DASH score: slashed circle 14.8 points; complications: breakage of plates 1 %, screw loosening 3 %, intraarticular screw position 2 %, delayed bone union 4 %, rupture M. extensor pollicis longus 2 %/M. flexor pollicis longus 3 %, peritendinitis extensor tendons 5 %, synovialitis flexor tendons 8 %, CTS 3 %, complex regional pain syndrome 6 %. CONCLUSION: Favourable indications for palmar locking plate osteosynthesis are A2, A3, C1 and C2 fractures with big distal fracture fragments. In these cases, additional bone grafting is not needed. In very distal fractures, multidirectional plate-systems are advantageous. Multifragmental C3 fractures show a high complication rate. Additional bone grafting for the metaphyseal defect should be considered.

[Acceptance of patient-related evaluation of wrist function following distal radius fracture (DRF)]. / Zur Akzeptanz der patientenbezogenen Bewertung der Handgelenkfunktion nach distaler Radiusfraktur (DRF).

INTRODUCTION: Outcome evaluation after distal radius fractures is mainly based on wrist function and radiological parameters, while measuring patient satisfaction seems to be more difficult. The purpose of this study was to assess different subjective features with regard to patient satisfaction for wrist healing, activity and participation. MATERIALS AND METHODS: A questionnaire combining items from the established PRWE (Patient related wrist evaluation), wrist-specific items from the DASH (Disability of Arm, Shoulder and Hand) as well as the ICF questionnaire (international classification of function, health and disease) was created, and then distributed to patients without wrist injuries (group 1) and patients following a distal radius fracture (group 2). Analysis of answered questions was performed with regard to response rate, valid content, mean differences between the two groups, correlation with radiology features in the patient group and age. RESULTS: Of 510 individuals with non-relevant wrist injuries, 96.7 % of the questions were answered, while of 133 distal radius fracture patients, 92.2 % of the questions were answered, rendering a total response rate of 95.5 %. Frequency of not responding to questions varied between 1.4 % to 14.4 %, and remained < 5 % for 17 questions. Internal consistency of the questionnaire with regard to wrist function was high in both groups (Cronbach alpha index for patients with non-relevant wrist injuries 0.9836, for distal radius fracture patients 0.9881). All questions were deemed specific for wrist function (discriminatory power > 0.7), and highly significant (p < 0.01) for ascertainment of subjective comfort after distal radius fracture in comparison with non-relevant wrist injuries. Fourteen of 25 questions (56 %) were correlated significantly (p < 0.05) with radiological features of malunion. For ages 30 to 49, and > 70 years, wrist function was deemed worse in the distal radius fracture patients vs. the non-injured wrist group. For ages 50 to 69, a significant difference was found only for 5 of 25 (20 %) questions. CONCLUSION: All questions were of a high validity and significance to determine subjective outcome after distal radius fractures. Patient acceptance was significantly different for questions, and subjective wrist comfort depended on age. For ages 50 to 69, additional questions in terms of employment situation and recreational function could be incorporated. Only about half of the questions correlated with radiological parameters of distal radius malunion. Eight questions showed both high acceptance and high correlation with radiology. Standardised measurements of range of motion and power, as well as radiology features and subjective questions of high acceptance and radiology relevance are essential for a wrist-specific questionnaire.

[Distal radius fractures--aetiology, treatment and outcome]. / Distale Radiusfrakturen--Atiologie, Behandlungsmethoden und Ergebnisse.

INTRODUCTION: Distal radius fractures were investigated in a retrospective open multicenter cohort study to assess aetiology, fracture pattern and treatment modalities and their influence on subjective and objective outcome. PATIENTS AND METHOD: Demographic data, fracture history, course of fracture healing, functional and radiological parameters and the DASH-questionnaire were collected from 18 Austrian hospitals and analysed statistically. PATIENTS: n = 707, 465 (65.8 %) female, 242 (34.2 %) male. Mean age: 52 (19 - 86) years; age group 1 (19 - 39 years) 26 %, age group 2 (40 - 59 years) 41 %, age group 3 (60 years and elder) 33 %. FOLLOW-UP: mean 5.8 (3.9 - 17) years; HISTORY: fall 65.1 %, sports 17.4 %, traffic accidents 8.9 %, fall from great height 7.5 %; others 1.1 %. Most frequent fracture patterns according to AO: A2 (26.6 %), C2 (22.2 %), A3 (16.1 %), C1 (12.7 %); according to PE: I-2 (44.8 %), I-1 (40.0 %), III-2 (4.4 %), II-2B (4 %). There was no significant correlation between fracture pattern and age groups for both fracture classifications. TREATMENT: 57.9 % surgical, 42.1 % conservative. Radiological results: Depending on treatment, there were significant differences between the radial tilt and the palmar radial inclination, the dorsal and palmar ulnar variance and the width of the DRU-joint. DASH-questionnaire: Median 6.03 (90 - 0). There was a significant, minor positive correlation of bad results in the elderly and a minor positive correlation of bad results correlated to the palmar radial inclination as well as a minor negative correlation to the palmar DRUJ-value and the ulnar variance. CONCLUSION: The incidence of distal radius fractures was increased in females and in patients with the age between 40 - 59 years. The most frequent cause to sustain a distal radius fracture was a simple fall. 85 % of the fractures were dislocated dorsally. The most frequent fracture type was the dorsal intraarticular. There was no specific fracture type observed to be typical for one of the age groups and surgical treatment was almost as frequent as conservative. Surgical treatment improved reconstruction of the radial tilt, palmar inclination and the DRU-joint. Subjective outcome was worse in elderly patients. The radiological changes in the DRU-joint correlated to minor DASH values.

[Long-term results following ORIF of dorsal dislocated distal intraarticular radius fractures]. / Langzeitergebnisse operativ versorgter distal intraartikulärer Speichenfrakturen.

PURPOSE: To evaluate the sequelae of distal intraarticular radius fracture with regard to the development of arthritis and clinical symptoms. PATIENTS AND METHOD: In a retrospective follow-up examination, 72 patients with a distal intraarticular radius fracture could be included for clinical and radiological investigation 9 years following the trauma. All fractures were treated by ORIF and cortico-cancellous bone grafting. RESULTS: Radiological evaluation revealed 5.1 degrees palmar tilt, 19.1 degrees radial tilt and the ulnar variance amounted to -0.5 mm. The articular cavity depth in the sagittal plane measured with 4.6 mm, 1.2 mm more than the non-involved side. Articular step-off was noticed in 6 patients. According to the Knirk and Jupiter classification system, two patients healed without arthritis, 43 patients presented arthritis stage 1, and 27 stage 2. Evaluation of the data showed a significant correlation between arthritis and articular cavity depth. But arthritis had neither influence on the DASH, nor the pain level. On the other hand, arthritis led to decreased sagittal wrist motion. CONCLUSION: ORIF of distal intraarticular radius fractures led to predictable results concerning restoration of length and form of the distal radius. Arthritis had a minor influence on the clinical end result.

Delayed single Kirschner wire compression technique for mallet fracture.

Twenty-four mallet fractures which involved at least one third% of the articular surface of the distal interphalangeal joint were treated by open reduction and internal fixation using a single double-ended Kirschner wire at a mean of 9 days after injury (range 4-15). At a mean follow-up of 43 (range 12-18) months the active range of motion, pain and the Warren and Norris criteria were evaluated. The mean active range of motion was from - 2 degrees extension (range 0-10 degrees ) to 72 degrees flexion (range 50-90 degrees ). Nineteen patients were pain free and five suffered from mild pain during strenuous work. The Warren and Norris results were successful in 22 and improved in two cases. Radiographs showed, that all the fractures united in a near-anatomic position but with joint narrowing in six digits.

Sagittal wrist motion of carpal bones following intraarticular fractures of the distal radius.

Forty patients (mean age, 37 years) with intraarticular C2 and C3 Colles fractures were treated by open reduction, internal fixation and bone grafting. At a mean follow-up of 8 years radiocarpal and midcarpal motion was evaluated, the depth of the articular surface of the distal radius in the sagittal plane was measured and the presence of arthritis was noted. The fractures healed with a mean palmar tilt of 6 degrees , a mean ulnar tilt of 18 degrees and ulna variance within 1 mm of the contralateral side. The depth of the articular surface of the distal radius was 1.3 mm greater than the uninvolved side. Measurement of carpal bone angles relative to the radius in maximum flexion and extension revealed lunate extension of 23 degrees , lunate flexion of 15 degrees , capitate extension of 62 degrees , capitate flexion of 40 degrees . There was a significant correlation between articular surface depth and radiocarpal motion.

Cortical motor activation patterns following hand transplantation and replantation.

We studied cortical activation patterns by functional MRI in a patient who received bilateral hand transplantation after amputation 6 years ago and in a patient who had received unilateral hand replantation within 2 hours after amputation. In the early postoperative period, the patient who had had the hand transplantation revealed strong activation of a higher motor area, only weak activation of the primary sensorimotor motor cortex and no activation of the primary somatosensory cortex. At 1-year follow-up, a small increase in primary sensorimotor motor cortex activation was observed. Activation of the primary somatosensory cortex was only seen at the 2 year follow-up. By contrast, after hand replantation, the activation pattern was similar to that of the uninjured hand within 6 weeks. This included activation of the primary sensorimotor motor cortex, higher motor areas and primary somatosensory cortex. Transplantation after long-standing amputation results in cortical reorganization occurring over a 2-year period. In contrast, hand replantation within a few hours preserves a normal activation pattern.

[Therapy for static scapholunate instability -- reconstruction of the dorsal part of the scapholunate ligament with a periosteal flap of the iliac crest]. / Therapie der statischen skapholunären Instabilität -- Bandrekonstruktion des dorsalen skapholunären Bandes mit einem Perioststreifen vom vorderen Darmbeinkamm.

Recurrent instability is frequent following capsulodesis, tenodesis, or ligament reconstruction in static scapholunate instability. Therefore a periosteal flap of the iliac crest was designed to reconstruct the dorsal part of the SL ligament, which is known to be the biomechanically strongest portion and also the axis of rotation between the scaphoid and lunate. Biomechanical testing of ten fresh frozen dorsal SL ligaments and ten periosteal flaps of the iliac crest showed similar properties concerning failure force, failure displacement, failure stress, energy to failure and stiffness. Results of eight specimens in each group were available following successful testing. Failure force of the dorsal SL ligament was 171.8 N (SD 44.2), energy to failure amounted 269.1 N-mm (SD 98.9), failure stress was 10.3 N/mm (2) (SD 1.3), failure displacement 2.9 mm (SD 0.4), and stiffness 77.2 N/mm (SD 21.4). Testing of the periosteal flap gave the following values: failure force 144.3 N (SD 38.7), energy to failure 217.9 N-mm (SD 85.0), failure stress 9.9 N/mm (2) (SD 1.7), failure displacement 3.0 mm (SD 0.4) and stiffness 60.5 N/mm (SD 14.7). In addition to these test values, clinical and radiological data of eleven patients were available following reconstruction of the dorsal SL ligament with a periosteal flap of the iliac crest. The interval between trauma and surgery was 15 months, mean follow-up was 29 months. One patient was free of pain, whereas ten mentioned pain during or following strenuous work. Two patients were completely satisfied, nine complained about some restriction during special activities. Active range of motion amounted to 56 degrees extension, 46 degrees flexion, 17 degrees radial abduction, 30 degrees ulnar abduction. Grip strength was 38.5 kg, which was 79 % of the contralateral side. Radiological evaluation demonstrated a correction of the static instability in nine cases. In two patients recurrence of static instability was obvious. The prerequisite for success of the procedure is the easy reduction of the carpals. In cases of a fixed rotatory subluxation of the scaphoid, the technique cannot maintain the reduction.

Vascularized bone graft from the iliac crest for the treatment of nonunion of the proximal part of the scaphoid with an avascular fragment.

BACKGROUND: It was hypothesized that nonunion of the proximal third of the scaphoid associated with avascular necrosis could be treated successfully with a free vascularized bone graft obtained from the iliac crest. METHODS: Fifteen patients who had a nonunion of the proximal part of the scaphoid that had been present for an average of two years and three months (range, nine months to seven years) were managed with use of a free vascularized bone graft obtained from the iliac crest. Avascularity of the scaphoid, as assessed on preoperative radiographs, was characterized by loss of trabecular structure, collapse of subchondral bone, and formation of bone cysts. The results of the procedure were assessed in terms of osseous union, pain, active motion of the wrist, and osteoarthritis. Postoperatively, vascularity of the scaphoid was evaluated with use of magnetic resonance imaging and color Doppler ultrasonography. The average duration of follow-up was six years and one month (range, two years and one month to eight years and one month). RESULTS: Preoperatively, one patient had had pain with any movement of the wrist and fourteen had had pain after strenuous manual labor or sports activity. The average pain score, derived with use of a 10-point visual analog scale, was 2.4 points (range, 1.0 to 6.7 points). Postoperatively, union was achieved in twelve patients; six were pain-free, and six had occasional pain during strenuous manual labor or sports activity, or both. The average pain score for these twelve patients was 1.1 points (range, 0.0 to 4.2 points) on the visual analog scale. Preoperatively, osteoarthritis was limited to the region between the radial styloid process and the distal part of the scaphoid in fourteen patients and to the radioscaphoid region in one patient. Postoperatively, the degree of osteoarthritis remained unchanged in seven of the twelve patients who had union and progressed to the radioscaphoid region in five. Vascularity, as seen on the imaging studies, was restored in all twelve patients who had union. The nonunion persisted in three patients, all of whom had progressive osteoarthritis leading to carpal collapse. CONCLUSIONS: The index procedure was successful in twelve of the fifteen patients who had a symptomatic nonunion of the proximal part of the scaphoid associated with avascular necrosis and osteoarthritis that was limited to the radioscaphoid joint.

Disruption of the finger flexor pulley system in elite rock climbers.

We treated 13 elite rock climbers for isolated disruptions of the pulleys of the long fingers. Diagnosis and treatment were based on the clinical finding of bow-stringing, which was confirmed by magnetic resonance imaging. Eight patients had bowstringing indicating incomplete disruption of the major pulley A2 and were treated nonoperatively (group A). Five patients showed bowstringing indicating complete disruption of the pulley A2. After failed nonoperative treatment, the pulleys were reconstructed (group B). The mechanism of injury and clinical and subjective results were evaluated. At a 31-month follow-up (range, 18 to 43 months), loss of extension in the proximal interphalangeal joint measured 5.6 degrees (range, 0 degree to 10 degrees) in group A and 4 degrees (range, 0 degree to 10 degrees) in group B. Circumference of the finger section was increased 4.2 mm in group A (range, 0 to 10 mm) and 4.8 mm in group B (range, 0 to 10 mm). Grip strength decreased 20 N in group A (range, 10 to 50 N) and 12 N in group B (range, 10 to 30 N). Four patients in group A and one in group B had bowstringing at clinical evaluation. On follow-up magnetic resonance images, bowstringing remained unchanged in group A but was reduced in all patients in group B. Good subjective results were seen in both groups.

Small free vascularized iliac crest bone grafts in reconstruction of the scaphoid bone: a retrospective study in 60 cases.

Carpal instability may result in progressive degenerative arthritis of the wrist. The surgical goal of the reconstruction of scaphoid nonunion is to achieve bone union and to restore the scaphoid. Many procedures are described to treat scaphoid nonunion for different indications. This retrospective study reports on the anatomical fundamentals, the operative procedure, and the results of 60 patients (21 with recalcitrant scaphoid nonunion that lasted longer than 4 years, 26 with an avascular pole fragment, and 13 with scaphoid nonunion after previous surgery) who were treated by a small free vascularized iliac crest bone graft. All 60 patients have routinely been followed up clinically and with magnetic resonance imaging. Union was achieved in 91.7 percent by improvement of stability and the compromised vascularity of the scaphoid. The bone flap loss rate and persisting nonunion was 8.3 percent, leading to progressive arthritis and carpal collapse. Complaints concerning discomforts caused by the scar were heard from 40.1 percent of the patients, and 31.7 percent complained of discomforts caused by the bony deformity. Bone deformations on the donor site were detected radiologically in 63.3 percent of the patients. In 31.7 percent, an impairment of the lateral femoral cutaneous nerve was noted. Reconstruction of the scaphoid by means of implantation of a vascularized iliac bone graft proved efficient to treat avascular recalcitrant scaphoid nonunion and pseudarthrosis with avascular proximal pole fragments.

The role of dynamic magnetic resonance imaging in the detection of lesions of the ulnocarpal complex.

A prospective study of 32 patients was carried out to investigate the significance of dynamic magnetic resonance imaging (MRI) in diagnosis of triangular fibrocartilage (TFC) lesions. Tears of the TFC can be diagnosed well by means of static MRI and arthroscopy. Dynamic MRI examination has an advantage in evaluating the stability of the TFC and ulnocarpal impingement. By means of dynamic MRI it was possible to make a preoperative diagnosis of an ulnocarpal impingement in five patients, a diagnosis which was confirmed through arthroscopy in all cases. In three further patients, dynamic MRI showed ulnocarpal impingement caused by instability of the ulnar attachment of the TFC. This kind of impingement could not be ascertained arthroscopically. Dynamic MRI extends the possibilities of evaluating obscure ulnar wrist pain. Its significance lies in the non-invasive examination of ulnocarpal impingement as well as the evaluation of TFC stability.

Closed reduction transarticular Kirschner wire fixation versus open reduction internal fixation in the treatment of Bennett's fracture dislocation.

Thirty two patients with fracture dislocations of the base of the thumb metacarpal with a single large fracture fragment (Bennett's fracture) were either treated by open reduction and internal fixation or closed reduction and percutaneous transarticular Kirschner wiring. All were assessed at a mean follow up of 7 (range 3-18) years. Patients with an articular step off more than 1mm were excluded. The type of treatment did not influence the clinical outcome or the prevalence of radiological post-traumatic arthritis. The percutaneous group had a significantly higher incidence of adduction deformity of the first metacarpal. This was attributed to Kirschner wire placement near the fracture line or in the compression zone of the fracture, resulting in loss of reduction. This however did not result in an inferior outcome.

The use of a graft from the second extensor compartment to reconstruct the A2 flexor pulley in the long finger.

A 10 mm wide ring graft from the second extensor compartment with periosteum from the floor of the sheath was used to correct bowstringing in six patients who sustained an isolated rupture of the A2 pulley. It was attached to the lateral rims of the sheath. Periosteum was used for additional graft fixation. Bowstringing was assessed by magnetic resonance imaging and ultrasound preoperatively and 19.5 months after surgery. It was corrected in five patients and improved in one. Pain was reduced from 35 to 7 points on a visual analogue scale. Digital circumference decreased from 76 to 71 mm. Flexion at the PIP joint increased from 88 degrees to 116 degrees. Pinch grip improved from 28 to 56 N.

The interosseous membrane and its influence on the distal radioulnar joint. An anatomical investigation of the distal tract.

From the interosseous membrane of the forearm a tract extends to the dorsal capsule of the distal radioulnar joint. The structure and function of this tract have been investigated. The tract originates from the radius 22 mm proximal to the distal dorsal corner of the sigmoid notch. Central fibres are attached there with fibrous cartilage and superficial bundles mix with the periosteum. The tract is 8 mm wide, 31 mm long and 1 mm thick. Distally it inserts at the capsule of the distal radioulnar joint between the tendon sheaths of extensor digiti minimi and extensor carpi ulnaris. Deep fibres insert directly at the triangular fibrocartilage. The tract of the interosseous membrane is taut in pronation and loose in supination. It strengthens the dorsal capsule of the distal radioulnar joint. During pronation the tract protects the ulnar head in a sling. Its attachment at the triangular fibrocartilage influences the distal radioulnar joint. Its insertion at the triangular fibrocartilage and the support of the weakest part of the dorsal capsule are of interest.

Stage 3 Kienböck's disease: reconstruction of the fractured lunate using a free vascularized iliac bone graft and external fixation.

Eighteen patients with stage 3 Kienböck's disease were treated by débridement of the necrotic core of the lunate and implantation of a free vascularized corticocancellous iliac bone. The wrist was stabilized with an external fixator during healing. The efficiency of the procedure for restoring the structure of the fractured lunate, preventing carpal collapse and improving the clinical outcome was assessed at a mean follow-up of 5 years. The graft became incorporated in the lunate in 16 of the 18 patients and no fracture of the reconstructed lunate or carpal collapse occurred in these cases. The graft did not integrate and was resorbed in the other two patients.

Double hand transplantation: functional outcome after 18 months.

In March 2000, we performed a double hand transplantation on a patient who had suffered traumatic hand amputations 6 years previously. The transplantations were both successful and, 18 months later, the patient has regained some complex hand functions and remarkably good tactile gnosis.

[Decompression of the ulnar wrist joint compartment by decompression osteotomy of the head of the ulna]. / Entlastung des ulnaren Handgelenkkompartimentes durch Dekompressionsosteotomie des Ellenkopfes.

Both post-traumatic shortening of the radius and positive ulnar variance can lead to a compression syndrome in the ulnar compartment of the wrist. The indication for a decompression osteotomy of the ulnar head after a distal radius fracture is limited to only those cases in which there is a slight shortening without a deviation of the axis of the distal radius. In order to enlarge the space between the ulnar head and proximal row of the carpal bones, a 2 to 3 mm slice is taken from the ulnar head by means of two oblique, parallel osteotomies and fragment retention with two screws. 47 patients were re-examined after an average period of 3 1/2 (1 to 8) years. In 23 cases the results were very good and in 17 cases good. In five cases the results were poor. In two cases, the bone did not heal and the Kapandji-Sauvé procedure was performed.

[Alternative surgical method in malalignment of healed distal radius fracture: Kapandji-Sauvé procedure]. / Alternative Operationsmethode bei in Fehlstellung verheilter distaler Radiusfraktur: Verfahren nach Kapandji-Sauvé.

Malunion after distal radius fracture with subluxation of the distal radioulnar joint can considerably limit the function of the hand. If the malunion cannot be eliminated by the corrective osteotomy of the radius, care must be taken not to additionally impair the stability of the wrist joint and the carpus, in the event of any necessary salvage procedure. In the Kapandji-Sauvé procedure, an arthrodesis is carried out after repositioning of the distal radioulnar joint. By segment resection of the ulnar shaft, a new joint is made to permit forearm rotation. Between 1984 and 1995, a total of 96 patients were treated with this procedure in our hospital. It was possible to re-examine 87 of those patients after an average period of 4 1/2 (1 to 11) years. The average age of the patients was 59 (14 to 72) years. In 25 cases the results were very good and in 52 cases good. In nine cases the results were poor. In one case the result was unsatisfactory.