Ligamentoplasty using the ulnotriquetral ligament with wafer procedure for chronic triangular fibrocartilage complex foveal tear: Short-tem outcome.

BACKGROUND: We developed a new ligamentoplasty technique using the ulnotriquetral ligament (UTL) via a palmar approach for cases with dorsal instability of the ulna due to a foveal tear of the triangular fibrocartilage complex (TFCC). The study aimed to evaluate the clinical outcomes of this procedure. METHODS: We retrospectively analyzed 19 cases with foveal tears of TFCC who underwent the ligamentoplasty using UTL. We harvested the UTL from the triquetrum as a pedicle graft, avoiding damage of the connection between the base of the UTL and palmar radioulnar ligament (PRUL) as possible. The graft was flipped proximally and pulled out through the bone tunnel from the ulnar fovea to the ulnar neck, then fixed to the fovea using a tenodesis screw. The function of the TFCC can be reproduced by pulling out the UTL along with the PRUL through the ulnar fovea and re-establishing the PRUL tension. Clinical results were evaluated at least 12 months following surgery. The preoperative and postoperative wrist pain level on a neumerical rating scale (NRS), the radioulnar joint (DRUJ) ballottement test, the range of motion, the grip strength, and the Patient-rated wrist evaluation (PRWE) scores were evaluated. RESULTS: In all cases, the DRUJ ballottement test became negative at the final follow up compared with the normal side on manual examination. The pain levels significantly decreased as reflected by a decrease in NRS from 6.8 to 2.5 at final follow up (p < 0.01). The range of pronation/supination motion was improved from 149° to 157°. The mean PRWE score significantly decreased from 52.1 to 22.8 (p < 0.01). The postoperative pain level on the NRS scale of the three patients poorly improved. One case of the three with the 3 mm positive ulnar variance needed additional ulnar shaft shortening using a plate seven months after the primary procedure. CONCLUSIONS: The ligamentoplasty using UTL efficiently restored the ulnar palmar stability in all 19 cases and significantly decreased the wrist pain and the PRWE scores. STUDY DESIGN: Clinical, retrospective study.

Proximal Horizontal Flap Tears of TFCC Diagnosed by Computed Tomography Arthrography: Six Case Series.

Background Proximal horizontal tears of the triangular fibrocartilage complex (TFCC) represent the tears at the proximal surface of the articular disk with a normal appearance of the distal surface. Preoperative diagnosis of TFCC flap tears is challenging. Objectives This report aims to present a diagnostic method using computed tomography (CT) arthrography for the proximal horizontal flap tears of the TFCC and to report our clinical outcomes. Patients and Methods Six patients were included who were preoperatively suspected to have proximal horizontal flap tears of the TFCC via CT arthrography. Arthrography was conducted by injecting dye into the distal radioulnar joint (DRUJ), and CT images were obtained immediately following arthrography. We performed arthroscopic or direct flap debridement with concomitant surgeries: ulnar shortening with positive ulnar variance and corrective osteotomy with the malunion following distal radius fracture. Results Preoperative CT arthrography clearly revealed the flaps to be flipped over toward the radiopalmar side of the DRUJ in four cases and a teardrop-shaped dye defect in two. We were able to identify the dislocated flap by arthroscopy avulsed from the proximal aspect of the articular disk within the DRUJ in all six cases. The mean pain level decreased from 10 preoperatively to 0.3 postoperatively on the visual analog scale. The mean patient-rated wrist evaluation score decreased from 43.5 preoperatively to 11.2 postoperatively. Conclusions Our study shows that CT arthrography can be a promising method for diagnosing proximal horizontal flap tears of the TFCC. Debridement of the flaps and concomitant surgeries showed satisfactory clinical results. Level of Evidence This is a Level 4, diagnostic study.

Shoulder and elbow evaluation of pitchers in National High School Baseball Invitational Tournaments and National High School Baseball Championships from 1993 to 2016 in Japan.

BACKGROUND: Shoulder and elbow examinations for pitchers have been performed in Japan's National High School Baseball Invitational Tournaments (NHSBITs) and National High School Baseball Championships (NHSBCs) since 1993. However, for years the results have not been analyzed. The purpose of this study was to evaluate changes in the condition of shoulders and/or elbows of pitchers from 1993 to 2016. MATERIALS AND METHODS: Pitchers in NHSBITs and NHSBCs, 1994-2016, were examined together with those who received a trial examination (Trial) in the NHSBC 1993. Shoulder and elbow symptoms were comprehensively graded into five categories; none, mild, moderate, severe and dysfunction. Standard plain radiographs of the shoulder and elbow were obtained. Average Annual Percent Changes (AAPCs) in the percentages of pitchers with symptoms and positive radiographic findings were analyzed. RESULTS: The percentages of pitchers with moderate or worse symptoms in the shoulder or elbow were 14.6% and 13.8%, respectively, in the Trial, 1.1% and 1.1% in NHSBITs and 1.3% and 2.0% in NHSBCs. The AAPC of pitchers with a symptomatic shoulder in NHSBITs was reduced over the study period, at -3.36% (P < 0.05), but that in NHSBCs was unchanged at -1.01%. The AAPCs of pitchers with a symptomatic elbow in NHSBITs and in NHSBCs decreased, at -3.13% and -3.33%, respectively (P < 0.05), while that of pitchers with residual apophyseal fragmentation at the ulnar collateral ligament insertion increased at +2.79% (P < 0.05). The decreased percentages of symptomatic pitchers suggest that joint condition is well controlled in high school days; however, the increased frequency of radiographic findings suggests the necessity of protection against overuse in younger players. CONCLUSIONS: The percentages of pitchers with symptomatic shoulders and elbows in NHSBITs and those with symptomatic elbows in NHSBCs have decreased over the 23 years. However, the increased frequency of residual medial humeral epicondyle apophyseopathy should be noted.

Correlation between playing position, elbow physical findings and elbow pain in elementary school baseball players: Results of a multi-regional study in Japan.

BACKGROUND: Elbow injuries are common in young baseball players and evaluating the characteristics of young baseball players in a large-scale population is necessary. However, few studies have compared playing position, length of baseball experience, physical findings, and elbow pain in young baseball players. This retrospective multi-regional cohort study sought to document the physical findings at the elbow in Japanese elementary school baseball players and to examine the relationship between playing position, length of baseball experience, physical findings at the elbow, and elbow pain. METHODS: In 2014, 720 fifth-grade baseball players from four regions in Japan were invited to participate in a questionnaire survey and undergo physical examination to obtain data on position played, length of baseball experience, presence of elbow pain, and physical findings at the elbow, including range of motion, tenderness, and valgus stress test results. Potential risk factors associated with elbow pain and correlations between physical findings and playing position, length of baseball experience, and elbow pain were investigated. RESULTS: The 720 subjects had a mean age of 10.4 years and 29.4% reported having experienced elbow pain for ≥1 week. Risk factors for elbow pain included playing pitcher and catcher, playing pitcher and fielder, and length of baseball experience. The most frequent finding was limitation of flexion (21.1%) followed by tenderness of the medial epicondyle (18.3%) and a positive valgus stress test (14.3%). These three findings were also significantly associated with elbow pain. Elbow extension was limited in 14.9% of subjects but there was no correlation with length of baseball experience or elbow pain. CONCLUSIONS: Our data show that elementary school baseball players who experienced elbow pain are likely to have valgus stress overload. Elbow pain might be prevented by not playing pitcher and catcher.

Shoulder and elbow pain in junior high school baseball players: Results of a nationwide survey.

BACKGROUND: Despite proposals and guidelines to prevent baseball injuries in young players by societies and organizations, many shoulder and elbow injuries continue to occur among junior high school baseball players. In order to investigate the training conditions of junior high school baseball players and the risk factors for shoulder and elbow pain in the players, we conducted a questionnaire survey among junior high school baseball players throughout the country. METHODS: The questionnaire survey was conducted among junior high school baseball players in September 2016. RESULTS: A total of 11,134 junior high school baseball players belonging to 495 teams responded to the survey. Among these, 4004 players trained every day of the week and 1151 players played baseball games every month with no off-season. Among 9752 players who did not have shoulder and/or elbow pain in the spring and summer of 2015, 19.2% of players experienced elbow pain over the course of one year, 13.6% of players experienced shoulder pain, and 28.0% complained of shoulder and/or elbow pain. The frequency of elbow pain was more than that of shoulder pain. At risk for shoulder pain were pitchers and catchers and second-year students, while risk factors for elbow pain were playing pitcher and catcher positions, pitching or throwing ≥300 balls per week, playing ≥10 games on average per month and being left-handed. CONCLUSION: Risk factors for shoulder pain were different from those for elbow pain. To prevent elbow pain, coaches should pay attention to pitchers and catchers and left-handed players and not allow players to pitch or throw ≥300 full-power balls per week or participate in ≥10 games per month. They should also pay attention to pitchers and catchers and second-year students to prevent shoulder pain. It is important for coaches to train multiple pitchers and catchers.

Shoulder and elbow pain in elementary school baseball players: The results from a nation-wide survey in Japan.

BACKGROUND: Despite recommendations on how to prevent baseball injuries in youths by the Japanese Society of Clinical Sports Medicine, shoulder and elbow pain still frequently occurs in young baseball players. We conducted a questionnaire survey among baseball players at elementary schools across the country to understand the practice conditions of players, examining the risk factors of shoulder and elbow pain in baseball players. METHODS: The questionnaire survey was conducted among elementary school baseball players as members of the Baseball Federation of Japan in September 2015. RESULTS: A total of 8354 players belonging to 412 teams (average age: 8.9) responded to the survey. Among 7894 players who did not have any shoulder and/or elbow pain in September 2014, elbow pain was experienced in 12.3% of them, shoulder pain in 8.0% and shoulder and/or elbow pain in 17.4% during the previous one year. A total of 2835 (39.9% of the total) practiced four days or more per week and 97.6% practiced 3 h or more per day on Saturdays and Sundays. The risk factors associated shoulder and elbow pain included a male sex, older age, pitchers and catchers, and players throwing more than 50 balls per day. CONCLUSIONS: It has been revealed that Japanese elementary school baseball players train too much. Coaches should pay attention to older players, male players, pitchers and catchers in order to prevent shoulder and elbow pain. Furthermore, elementary school baseball players should not be allowed to throw more than 50 balls per day. STUDY DESIGN: Retrospective cohort study.

Computed tomography arthrography using a radial plane view for the detection of triangular fibrocartilage complex foveal tears.

PURPOSE: To classify triangular fibrocartilage complex (TFCC) foveal lesions on the basis of computed tomography (CT) arthrography using a radial plane view and to correlate the CT arthrography results with surgical findings. We also tested the interobserver and intra-observer reliability of the radial plane view. METHODS: A total of 33 patients with a suspected TFCC foveal tear who had undergone wrist CT arthrography and subsequent surgical exploration were enrolled. We classified the configurations of TFCC foveal lesions into 5 types on the basis of CT arthrography with the radial plane view in which the image slices rotate clockwise centered on the ulnar styloid process. Sensitivity, specificity, and positive predictive values were calculated for each type of foveal lesion in CT arthrography to detect foveal tears. We determined interobserver and intra-observer agreements using kappa statistics. We also compared accuracies with the radial plane views with those with the coronal plane views. RESULTS: Among the tear types on CT arthrography, type 3, a roundish defect at the fovea, and type 4, a large defect at the overall ulnar insertion, had high specificity and positive predictive value for the detection of foveal tears. Specificity and positive predictive values were 90% and 89% for type 3 and 100% and 100% for type 4, respectively, whereas sensitivity was 35% for type 3 and 22% for type 4. Interobserver and intra-observer agreement was substantial and almost perfect, respectively. The radial plane view identified foveal lesion of each palmar and dorsal radioulnar ligament separately, but accuracy results with the radial plane views were not statistically different from those with the coronal plane views. CONCLUSIONS: Computed tomography arthrography with a radial plane view exhibited enhanced specificity and positive predictive value when a type 3 or 4 lesion was identified in the detection of a TFCC foveal tear compared with historical controls. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic II.

Reliability, validity, and responsiveness of the Japanese version of the patient-rated elbow evaluation.

BACKGROUND: The patient-rated elbow evaluation (PREE) is a joint-specific, self-administered questionnaire consisting of a pain scale (PREE-P) and a functional scale (PREE-F), the latter consisting of specific function (PREE-SF) and usual function (PREE-UF). The purpose of this study was to cross-culturally adapt the PREE into Japanese (PREE-J) and to test its reliability, validity, and responsiveness. METHODS: A consecutive series of 74 patients with elbow disorder completed the PREE-J, the Japanese version of the disabilities of the arm, shoulder, and hand (DASH-JSSH) questionnaire, and the official Japanese version of the 36-Item Short-Form Health Survey (SF-36). Of the 74 patients, 53 were reassessed for test-retest reliability 1 or 2 weeks later. Reliability was investigated in terms of reproducibility and internal consistency. The validity of the PREE-J was examined by factor analysis, and correlation coefficients were obtained using the PREE-J, DASH-JSSH, and SF-36. Responsiveness was examined by calculating the standardized response mean (SRM) and effect size after elbow surgery in 53 patients. RESULTS: Cronbach's α coefficients for PREE-P, PREE-F, and PREE were 0.92, 0.97, and 0.97, respectively, and the corresponding intraclass correlation coefficients were 0.92, 0.93, and 0.94, respectively. Unidimensionality of PREE-P and PREE-F was confirmed by factor analysis. The coefficients of correlation between PREE-P and PREE-F or DASH-JSSH were 0.81 and 0.74, respectively; that between PREE-F and DASH-JSSH was 0.86, and those between DASH-JSSH and PREE-SF or PREE-UF were 0.85 and 0.82, respectively. Moderate correlation was observed in "physical functioning" for SF-36 and PREE-F (r = -0.69) or PREE (r = -0.68). The SRMs/effect sizes of PREE-P (1.31/1.32) or PREE (1.28/1.12) were more responsive than the DASH-JSSH (0.99/0.85), "bodily pain" (-1.15/-1.43), and "physical functioning" (-0.70/-0.44) in SF-36. CONCLUSION: The PREE-J represents a reliable, valid, and responsive instrument and has evaluation capacities equivalent to those of the original PREE.

Three-dimensional analysis of acute plastic bowing deformity of ulna in radial head dislocation or radial shaft fracture using a computerized simulation system.

BACKGROUND: Little 3-dimensional biomechanical investigation of plastic bowing deformity of the ulna has been reported, and the purpose of this study was to conduct such an investigation to elucidate mechanisms of injury and appropriate treatments. METHODS: Ten cases of traumatic plastic deformity of the ulna in pediatric patients, 4 with chronic radial head dislocations (Monteggia equivalent) and 6 with malunited radial shaft fractures, were analyzed for rotational deformities in the axial plane and bending deformities in the sagittal and coronal planes in Euler angle space by use of a 3-dimensional computerized simulation system with a markerless registration technique. RESULTS: Deformed ulnae with radial head dislocations had 18.7° ± 17.4° of external rotation in the axial plane and 10.4° ± 7.0° of extension in the sagittal plane whereas those with malunited radial shaft fractures had 12.5° ± 12.7° of internal rotation and 6.3° ± 5.6° of flexion displacement compared with mirror images of the opposite ulnae. Absolute values of rotational deformities in both groups were larger than those of sagittal and coronal bending deformities. DISCUSSION: Most major traumatic plastic bowing deformities of the ulna involved rotation rather than bending. External rotational stress on the ulna is suspected to cause radial head dislocation, and internal rotational stress results in radial shaft fracture during falls onto outstretched arms. Therefore the correction of rotational deformities of the ulna should be considered in the treatment of chronic radial head dislocations and malunited radial shaft fractures.

Corrective osteotomy and ligament repair for longstanding radial collateral ligament tear of the proximal interphalangeal joint: case series.

PURPOSE: To evaluate the clinical outcomes of corrective osteotomy and ligament repair for longstanding radial collateral ligament tears of the proximal interphalangeal (PIP) joint. METHODS: We retrospectively evaluated 4 patients with 5 longstanding tears in the radial collateral ligaments of the PIP joints. The average age at the time of surgery was 51 years (range, 40-62 y). The average time from the initial injury to surgery was 31 years (range, 22-40 y). Plain radiographs revealed an ulnar slope at the PIP joint surface with degenerative changes in all fingers. We corrected the slope using a closing wedge osteotomy of the neck of the proximal phalanx secured with a headless screw. We then repaired the radial collateral ligament by overlapping the elongated ligament. Range of motion exercises were started 2 weeks after surgery. To evaluate the results, we compared preoperative and postoperative range of motion, ulnar deviation, instability, pain, and level of satisfaction. Average follow-up was 27 months (range, 18-48 mo). RESULTS: All osteotomies had united at an average of 3 months. We observed no major changes in range of motion, but flexion contracture gradually appeared in 1 high-demand patient. The average preoperative angle of ulnar deviation was 36° and was corrected to a postoperative angle of 2°. The average angle of lateral instability improved after surgery from 22° to 1°. Finger pain disappeared or decreased in 3 low-demand patients but persisted in 1 high-demand patient. Two low-demand patients were very satisfied and 1 low-demand patient was satisfied; however, 1 high-demand patient was dissatisfied with the results of surgery. CONCLUSIONS: Corrective osteotomy and ligament repair can result in a straight and stable joint with a good range of motion in low-demand patients. This method could be a treatment option for carefully selected patients.

In vivo and 3-dimensional functional anatomy of the anterior bundle of the medial collateral ligament of the elbow.

BACKGROUND: Although the anterior bundle of the medial collateral ligament (AMCL) is a critical stabilizer of the elbow joint, little information exists on in vivo and 3-dimensional functional anatomy of the AMCL. The purposes of this study were to investigate in vivo changes in the length of the AMCL during elbow flexion and to clarify the 3-dimensional functional anatomy of the AMCL. METHODS: We created 3-dimensional models of the AMCL and bones from computed tomography data of 4 healthy elbows in 5 different elbow positions. The AMCL was subdivided into 9 ligaments. We calculated changes in lengths of ligaments during flexion and related ligament origins to the axis of rotation of the elbow joint. RESULTS: There were 4 uniquely configured isometric ligaments, where their origins aligned broadly along the course of the axis of rotation in the coronal plane. The medially originating ligaments inserted on the posterior portion of the tubercle of the coronoid process, whereas the laterally originating ligaments inserted on its anterior portion. There were 5 non-isometric ligaments, 3 of which had origins proximal to the axis and became taut only in extension and the other 2 having origins distal to the axis and becoming taut only in flexion. CONCLUSIONS: Isometric ligaments within the AMCL do not originate from a narrow area; rather, they originate from a broader area that extends more medially in the coronal plane than previously thought, which explains how the AMCL reconciles isometricity and robustness. The proximal and distal ligaments act as checkreins that work only at the limits of elbow motion.

Arthroscopic debridement of the humeral capitellum for osteochondritis dissecans: radiographic and clinical outcomes.

PURPOSE: Although arthroscopic debridement of the humeral capitellum is an accepted procedure for osteochondritis dissecans, some patients develop radial head enlargement or osteoarthritic lesions after the procedure. The aim of this study was to investigate the radiographic and clinical outcomes of arthroscopic debridement and consider its indications. METHODS: We retrospectively evaluated 106 patients who had arthroscopic debridement between 1997 and 2007. Surgery was performed after closure of the capitellar physis. We categorized the patients into 4 groups by lesion size and by whether the proximal radial physis was open or closed. The average patient age at surgery was 15 years (range, 12-18 y), and the average follow-up period was 13 months (range, 8-46 mo). RESULTS: In patients with large lesions and open proximal radial physes, radiographic and clinical outcomes were poor. Three of 4 patients developed early osteoarthritic lesions of the radiohumeral joint, secondary to radial head enlargement. Radial head resection was required in 2 of 3 patients. Conversely, osteoarthritic lesions did not occur, and we observed noteworthy improvement in elbow pain routinely after the procedure in the other 3 groups. For range of motion, clinically important changes were not observed. Overall, postoperative elbow pain was absent in 89 patients. Mild pain was present in 15 patients and moderate or severe pain in 2 patients. A total of 90 patients returned to sports at pre-injury levels. Time of return to sports varied from 1 month to 5 months (mean, 2.4 mo). CONCLUSIONS: Arthroscopic debridement of the capitellum can provide excellent short-term results for the treatment of osteochondritis dissecans. However, it is contraindicated in cases with large lesions when the proximal radial physis remains open.

Open repair of foveal avulsion of the triangular fibrocartilage complex and comparison by types of injury mechanism.

PURPOSE: Little attention has been paid to injury mechanisms of foveal avulsion of the triangular fibrocartilage complex (TFCC). The purpose of this study was to determine whether the mechanism of injury is associated with different anatomic disruptions as well as different preoperative clinical symptoms. We also evaluated the clinical results of an open repair method for foveal avulsion according to the mechanism of injury. METHODS: Fifteen patients with a traumatic foveal TFCC avulsion were treated with an open repair technique. The injury mechanism was forced wrist extension in 10 patients (group E) and forced forearm rotation in 5 patients (group R). All patients in group E and 3 in group R showed positive fovea signs. Surgical and clinical findings were compared according to the 2 types of injury mechanism. RESULTS: Foveal insertions of TFCC were found in surgery to be disrupted in all 15 patients. In addition, disruption of the dorsal styloid insertions of the radioulnar ligament showed a significantly greater association with group R than with group E. Clinical results showed significant postoperative improvement but were marginally different between the 2 groups. CONCLUSIONS: The most common mechanism of foveal TFCC avulsions is forced wrist extension, an injury that commonly shows positive fovea signs and leaves the dorsal styloid insertion of the radioulnar ligament intact. Forced forearm rotation is the second most common injury mechanism that is more frequently associated with disruption of the dorsal styloid insertion. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.

Osteosynthesis for longstanding nonunion of the lateral humeral condyle in adults.

HYPOTHESIS: Osteosynthesis for longstanding nonunion of the lateral humeral condyle in adults has a high rate of complications, including failure of bony union and restriction of elbow motion. We hypothesized that rigid fixation may contribute to higher union rate and the placement of the condyle fragment with proper tilting may minimize the reduction of elbow motion. MATERIALS AND METHODS: Ten patients were treated with osteosynthesis. Average age at operation was 38.6 years. Three patients had dysfunction of the ulnar nerve, 2 experienced pain, and 5 had both presentations. According to Toh et al's radiographic criteria, nonunion was categorized as Group 1 in 2 patients and Group 2 in 8 (J Bone Joint Surg Am 2002;84:593-598). We performed osteosynthesis with iliac bone graft and ulnar nerve anterior transposition, with efforts to fix the fragment rigidly and to manage the fragment position properly. RESULTS: Osseous union was achieved in all 8 Group 2 patients, while 1 Group 1 case showed delayed union and the other did not achieve union. Pain resolved and ulnar nerve symptoms improved in all cases. In 9 patients with union, total arc of motion was reduced by an average of 20°. The preoperative mobility of the condyle fragment determined by maximum flexion and extension lateral radiographs had a correlation to the postoperative loss of motion (P = .047); however, loss of motion was less than that expected by radiographs. CONCLUSION: Osteosynthesis appears to be indicated for Group 2 nonunion with pain. Rigid fixation with care of the position of the fragment is important for the good outcomes.

A biomechanical study of activities of daily living using neck and upper limbs with an optical three-dimensional motion analysis system.

In activities of daily living such as eating meals, the neck and upper limbs move in coordination. However, no methods have been established to analytically and quantitatively capture motion of the neck and limbs during these activities. We used a Vicon 512 system to simultaneously measure ranges of motion (ROMs) for the cervical spine, shoulders, elbows, and forearms. Correlations between the motion analyzer and the universal goniometer were >0.76. Repeatability of measurements using this analyzer were

Spontaneous divergent elbow dislocation after Sauve-Kapandji procedure.

This is a report on an unusual complication of the Sauve-Kapandji procedure in patients with rheumatoid arthritis. Two women with rheumatoid arthritis who previously had an ipsilateral Sauve-Kapandji procedure experienced spontaneous transverse divergent elbow dislocations without evident trauma. Their radiographs showed medial dislocation of the proximal ulna, which was separated from the radial head. The radial head and distal end of the ulnar shaft showed remarkable instability by a pronation and supination motion without the radial and ulnar shafts being separated from each other. Stress radiographic examination showed significant loosening of all ligaments except the medial collateral ligament around the elbow and did not show disruption of the interosseous membrane. A unique chronic twist radioulnar dissociation which consists of gross instability of the radial head and the distal ulna without disruption of the interosseous membrane was considered to cause instability of the humeroulnar joint, which results in medial dislocation of the proximal ulna. This report suggests that there is a direct cause and effect relationship between the residual distal ulnar instability and the development of transverse divergent dislocation of the elbow in patients with rheumatoid arthritis after the Sauve-Kapandji procedure.