Locked Distal Ulna Volar Dislocation Associated with a Malunited Fracture of the Distal Radius.

Background The volar dislocation of the distal ulna is an uncommon injury and often missed due to its rarity. If diagnosed early, it can be managed with a simple closed reduction followed by immobilization. Open reduction is recommended in case of any interposition preventing reduction. Case Description In this case report, we present a rare case of neglected volar distal ulna dislocation associated with a distal radius fracture presenting with a fixed supination deformity that was managed successfully with a Sauvé- Kapandji procedure using a modified approach to restore forearm rotation. At 10 months, the patient had a good union at the distal radio ulnar joint (DRUJ) with improved forearm rotations. Literature Review To our knowledge no previous cases of neglected volar distal ulna dislocation with distal radius fracture has been reported in the literature. Clinical Relevance If DRUJ stability cannot be restored after closed reduction of distal radius fracture, open reduction and internal fixation of the fracture should always be performed to avoid subsequent DRUJ subluxation/dislocations.

Radially Displaced Perilunate Injuries: A Report of Two Cases.

We present two unusual cases of radially displaced perilunate dislocations, one of which involved acute ulnar nerve compression requiring Guyon's canal release. The first case underwent closed reduction and cast immobilization but developed scapholunate instability, necessitating secondary ligament reconstruction. The second case, treated with open reduction and fixation, resulted in persistent volar intercalated segment instability of the proximal row and ulnar nerve paresthesia 1 year after surgery.

Carpal Instability Nondissociative Following Acute Wrist Fractures.

PURPOSE: Carpal malalignment following intra-articular fractures has been reported in the literature, with no clear description of possible ligamentous injury leading to the radiological appearance. This study presents a series of patients that developed carpal instability nondissociative (CIND) following acute wrist fractures. The mechanism of injury is postulated by using a cadaveric laboratory investigation. METHOD: Twelve patients with average age of 32 years were identified with CIND, between 2013 and 2018. Ten patients with a normal carpal alignment in the initial postoperative radiographs exhibited CIND-palmar radiographically at different postoperative periods, and 2 patients showed CIND-dorsal in the initial postoperative x-rays. Four cadaveric specimens were used to validate this injury pattern. RESULTS: In cadaveric dissections, CIND-palmar could be reproduced by applying an axial loading and dorsal shearing force on a wrist with sequential sectioning of dorsal and palmar extrinsic wrist ligaments. For the intra-articular fractures with CIND-dorsal, the cause is likely a result of volar radiocarpal extrinsic ligament injury combined with intra-articular incongruity of the scaphoid fossa. Eight out of the 12 patients had severe wrist pain and underwent additional surgery. Three patients with reducible CIND-palmar had open capsular repair, and 5 patients with fixed nonreducible malalignment were treated with radioscapholunate arthrodesis. At an average follow-up of 2.3 years, pain relief was noted, together with an improvement in grip strength and range of movement. Radiographically, the wrist alignment was corrected and maintained. CONCLUSIONS: This article highlights the existence of possible concomitant radiocarpal ligament lesions and residual articular incongruity, associated with acute intra-articular fractures and radiocarpal fracture-dislocations, that destabilize the proximal carpal row into a pattern of nondissociative carpal instability. Early detection of this condition may preserve wrist function by capsular repair, whereas cases with fixed deformity and residual joint incongruity may be best managed with a limited radiocarpal arthrodesis. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic IV.

Organización y desarrollo de un programa de trasplante hepático en Mar del Plata: Resultados iniciales (2010-2018) / Organization and development of a liver transplant program in Mar del Plata: Initial Results (2010-2018)

Antecedentes: en los últimos 30 años, la creación de nuevos programas de trasplante hepático ha respondido a la difusión de esta terapéutica para el tratamiento de la insuficiencia hepática irreversible. Objetivo: describir la organización y el desarrollo de un Programa de Trasplante Hepático en una institución sanatorial de Mar del Plata, y sus resultados iniciales. Material y método: se constituyó un equipo profesional con especialistas en trasplante hepático en las disciplinas: cirugía, anestesia, terapia intensiva, hepatología, instrumentación, enfermería, hemoterapia y hematología, que se acreditaron ante los organismos fiscalizadores. La institución fue adecuada edilicia y tecnológicamente para este tipo de emprendimiento. Se trasplantaron con donante cadavérico completo 32 pacientes de localidades vecinas (55%) y de Mar del Plata (45%). Las etiologías más frecuentes de la cirrosis fueron hepatitis C y abuso de alcohol. Resultados: la mortalidad operatoria fue 12,5%. La supervivencia actuarial de los trasplantados fue 75% a los 55 meses. Seis pacientes desarrollaron de inmediato estenosis biliares , que fueron tratadas satisfactoriamente en forma conservadora. Conclusiones: el Programa de Trasplante Hepático de Mar del Plata asiste al área geográfica del sudeste de la provincia de Buenos Aires. Los resultados iniciales alcanzados encuadran en lo esperable para los estándares actuales en la materia.

Background: Over the past 30 years, new liver transplant programs have emerged as a response to the increasing use of this therapy to treat irreversible liver failure. Objective: the aim of this presentation is to describe the organization, development and initial results of a Liver Transplant Program in Mar del Plata. Material and methods: A team of professionals trained in liver transplantation was created, with specialists in surgery, anesthesiology, intensive care, hepatology, hemotherapy, hematology, and registered nurses and nurse scrubs granted by regulatory agencies. Building alterations, and technical and adaptations were implemented. Thirtytwo transplantations were performed with complete cadaveric donor in patients from neighboring localities (55%) and from Mar del Plata (45%). The most common etiologies of cirrhosis were chronic hepatitis C virus infection and alcohol abuse. Results: Operative mortality was 12.5%. Actuarial survival at 55 months of the 32 recipients was 75%. Six bile drug strictures late postoperative period which were treated successfully trated with a conservative approach Conclusions: the Liver Transplant Program in Mar del Plata provides care to the geographic area of the southeast of the province of Buenos Aires. The initial results are consistent with those expected for the current standards in liver transplantation.

Dorsal Barton fracture is a variation of dorsal radiocarpal dislocation: a clinical study.

Dorsal Barton fractures may be better described as variants of dorsal radiocarpal dislocations. We aimed to better characterize these fractures by reviewing 111 patients in the ICUC® dataset who had a dorsally displaced, intra-articular distal radius fracture. We identified 13 patients with a dorsal Barton fracture on radiographs (dorsal articular margin fracture with radiocarpal subluxation and intact volar cortex). All patients with a dorsal Barton fracture had radial styloid involvement and volar cortical disruption that was subsequently identified on three-dimensional CT. Based on three-dimensional CT and intra-operative findings, none of the patients had classically described dorsal Barton fractures. All patients were treated using a volar exposure. A volar capsular tear was identified intra-operatively in three patients and the volar capsule repaired. This series supports the contention that dorsal Barton fractures are better characterized and treated as a variation of a dorsal radiocarpal dislocation. Level of evidence: IV.

The Author's Technique for the Management of Unstable Scaphoid Nonunions: Tips and Tricks.

This article presents historical aspects, rationale, indications, planning, and execution of anterior interpositional bone grafting technique for unstable scaphoid nonunions. The author's original technique considers four points: (1) preoperative planning based on comparative anteroposterior radiographs in maximal ulnar deviation was used to calculate resection zone, size of the graft, and scaphoid length; (2) a volar approach was used; (3) an iliac crest wedge-shaped corticocancellous graft was interposed; and (4) Kirschner wires were inserted for fixation. Contemporary refinements of the technique including a modification to treat nonunions with failed previous screw fixation with tricks and hints and results are shown.

Midterm Outcomes of the Use of a Spherical Ulnar Head Prosthesis for Failed Sauvé-Kapandji Procedures.

PURPOSE: The use of a spherical ulnar head prosthesis (UHP) for the treatment of symptomatic radioulnar convergence after Sauvé-Kapandji (SK) procedure has shown promising results in the short term. This study aims to evaluate the midterm outcome of the original cohort of patients treated with this technique. METHODS: Seventeen patients with unstable ulnar stumps confirmed both clinically and radiographically were studied. The etiology for the initial SK procedure included posttraumatic distal radioulnar joint (DRUJ) incongruity, primary DRUJ arthrosis, and dysplastic DRUJ. Fourteen of the 17 patients had a minimum of 2, and a maximum of 6, operations prior to having a spherical UHP. All patients suffered from severe pain with difficulty in performing work and daily activities. Ceramic UHP was used for all patients, except 2 in whom a cobalt chrome head was used. RESULTS: The average follow-up was 6 years (range, 4-17 years). A marked reduction in pain was observed with 11 patients reporting that they remained pain free. The range of motion of the wrist and power grip was maintained and showed a statistically significant improvement at the late follow-up. The Disabilities of the Arm, Shoulder, and Hand score also significantly improved from 77 to 41. There were no signs of prosthetic loosening at the midterm follow-up. The 2 patients with cobalt chrome prostheses had pain and osteolysis requiring revision to total DRUJ prosthesis. Two patients with dorsal prosthetic subluxation were successfully treated with distal radial osteotomy. CONCLUSIONS: The midterm results of ceramic spherical UHP for failed SK procedures in this small patient series are encouraging. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Current Perspectives on Complex Wrist Fracture-Dislocations.

Although perilunate injuries represent only 5% of all carpal injuries, they compose a spectrum of devastating complex wrist injuries. Perilunate injuries result from high-energy trauma to the wrist and may be associated with multiple fractures, dislocations, and ligament injuries. Although the diagnosis of a perilunate injury is made via radiographic assessment, missed diagnosis occurs in 25% of patients with a perilunate injury. Immediate diagnosis of perilunate injuries is critical to optimize patient outcomes. Closed reduction of perilunate injuries is performed to avoid permanent damage to the median nerve and other compromised structures. As swelling subsides, open reduction is performed to restore anatomic alignment, attain stable fixation, and repair the ligaments. Despite optimal management of perilunate injuries, complications, including median nerve dysfunction, complex regional pain syndrome, carpal instability, and late posttraumatic arthritis, may occur. Satisfactory outcomes can be achieved in patients with a perilunate injury via prompt recognition and timely surgical management. Although radiographic signs of arthritis develop in many patients with a perilunate injury, these radiographic signs do not necessarily correlate with functional outcomes. Some patients with a perilunate injury require salvage procedures for the management of persistent complications. Radiocarpal fracture-dislocations are a complex wrist fracture-dislocation pattern. Radiocarpal fracture-dislocations generally result from high-energy trauma and are characterized by a carpal dislocation, which usually involves a small portion of the rim of the dorsal or volar aspect of the distal radius. Neurologic dysfunction and elevated intracompartment pressure may be present in patients with a radiocarpal fracture-dislocation. Wrist fracture-dislocations are associated with a number of complications, including intercarpal instability, later arthrosis, carpal nonunion, and loss of radiocarpal mobility.

Manejo percutáneo y endoscópico combinado de las estenosis benignas de la vía biliar / Combined endoscopic and percutaneous management of benign biliary strictures

Antecedentes: las estenosis benignas de la vía biliar (EBVB) tradicionalmente han sido tratadas con derivaciones biliodigestivas. En la actualidad existe una clara tendencia para resolverlas en forma mínimamente invasiva (endoscópica o percutánea o de ambos modos). Objetivo: describir el manejo y los resultados del tratamiento percutáneo y/o endoscópico de las estenosis biliares benignas. Material y métodos: período del estudio: enero de 2009 a junio de 2015. Etología de las EBVB: 8 lesiones quirúrgicas de la vía biliar (LQVB), 5 trasplantes hepáticos (TH), 5 hidatidosis hepáticas (HH), 2 quistes de colédoco (QC). Se realizaron 4 procedimientos promedio por paciente (r. 1-11). Se colocaron 3 stentis (endoprótesis) promedio por paciente (r. 1-5). Seguimiento promedio: 21 meses con una mediana de 13 meses. Resultados: mortalidad relacionada con los procedimientos: 0%. Morbilidad relacionada con los procedimientos: 35% (bacteriemia, colangitis, hemorragia digestiva, síndrome febril, hemoperitoneo leve, sepsis). Diecinueve pacientes (95%) evolucionaron con control satisfactorio de la estenosis; un paciente (5%) presentó recidiva de la estenosis y debió ser tratado nuevamente. Conclusiones: el tratamiento mininvasivo puede lograr resultados satisfactorios en un alto porcentaje de pacientes con estenosis benignas de la vía biliar.

Background: although benign strictures of the bile duct (BSBD) have traditonally been treated by constructon of a surgical biliodigestive anastomosis at present, there is a clear tendency to resolve them in a minimally invasive way (endoscopic or percutaneous or both). Objective: to describe the management and Results of percutaneous and / or endoscopic treatment of BSBD. Materials and methods: study period: January 2009 to June 2015. Etology of BSBD, 8 surgical injury to the bile duct (BDI), 5 liver transplantis (LT), 5 liver hydatidosis (LH), 2 choledochal cystis (CC). As an average, 4 procedures per patent were done (range, 1-11); and 3 stentis were placed (range, 1-5). Average and median follow up were 21 months, and 13 months, respectively. Results: mortality related to the procedure was 0%. Morbidity was 35% (bacteremia, cholangitis, gas-trointestinal bleeding, febrile syndrome, mild hemoperitoneum, and sepsis). 19 patentis (95%) had satisfactory outicome; one patentis (5%) developed a re-stricture that required a new procedure. Conclusions: mininmally invasive treatment can achieve satisfactory Results in a high percentage of patentis with benign stricture of the bile duct.

Nonunion of greater trochanter following total hip arthroplasty: Treated by an articulated hook plate and bone grafting.

BACKGROUND: Trochanteric osteotomy still has an important role in hip arthroplasty in cases of (1) preexisting developmental hip dysplasia with superior subluxation, (2) revision arthroplasty, specifically with acetabular component revision in the face of well-fixed femoral component, and (3) recurrent dislocation without component loosening or malalignment, in treatment of complicated trochanteric fixation in osteoporotic bone and nonunions may be difficult. This study reports the clinical outcomes of trochanteric fixation following total hip arthroplasty (THA) utilizing a hook plate construct in a cohort of ten patients. MATERIALS AND METHODS: The Arbeitsgemeinschaft für Osteosynthesefragen (AO) articulated hook plate was used in nine cases of established approach related nonunion following THA and in one case of osteopenic bone during primary THA. All ten patients returned for interviews and clinical examination. The average time for clinical followup was 35 months (range 5-48 months). The mean age of the study cohort was 65 years (range 56-74 years). Time to union and incidence of postoperative complications were assessed. RESULTS: Union occurred in all ten cases at an average of 3.3 months postoperatively. One patient developed symptomatic trochanteric bursitis and required plate removal. Another patient developed a superficial infection which was successfully treated with local wound debridement and antibiotics. A third patient developed a symptomatic neuroma at the site of the iliac crest bone harvest and was successfully treated with excision of the neuroma. No catastrophic implant failures occurred. CONCLUSIONS: The articulated design of the plate allows for ease in application and functional construct stability. The articulated hook plate is an option for fixation of osteopenic bone fragments and established nonunions of the greater trochanter.

Extensor Pollicis Longus Ruptures Following Distal Radius Osteotomy Through a Volar Approach.

PURPOSE: To investigate the cause and pathological process of extensor pollicis longus (EPL) ruptures after correction of distal radius malunion through a volar approach. METHODS: We included patients with EPL ruptures who underwent distal radius osteotomies performed through a volar approach. Data were pooled from members of the International Wrist Investigators Workshop. Patient demographics, initial injury parameters, imaging studies, preoperative and postoperative examination, intraoperative findings, surgical technique, and outcomes were compared and analyzed. Preoperative and postoperative radiographic images were evaluated and compared. RESULTS: We evaluated 6 cases from 5 surgeons in 4 institutions. Length of follow-up ranged from 1 to 5 years. On initial radiographic evaluation all malunions were healed with dorsal angulation (20° to 60°) and with positive ulnar variance. Deformity correction in the sagittal plane was 25° to 55°. Osteotomies were fixed with volar locking plates with autologous bone graft except for one patient who received calcium phosphate-based bone void filler. Postoperative x-rays suggested prominent osteotomy resection edges, osteophytes, or dorsal bony prominence resulting from healed callus. Average time from osteotomy to EPL rupture was 10 weeks (range, 2-17 weeks). Two patients initially refused to undergo tendon transfers. One was pleased with the outcome despite the ruptured EPL. The other patient ruptured 2 more tendons and chose to have tendon transfers. One patient also ruptured the transferred tendon after 2 months and underwent successful tendon grafting. CONCLUSIONS: In the absence of screw prominence and technical flaws, it is likely that dorsal callus, prominent osteotomy resection edges, and osteophytes may contribute to attritional rupture of the EPL tendon after a corrective osteotomy through a volar approach. Exposure and debridement of excessive callus, dorsal ridge, or a prominent Lister tubercle performed during the osteotomy may reduce subsequent EPL rupture. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Chronic scapholunate instability treated with temporary screw fixation.

PURPOSE: To determine the efficacy of scapholunate (SL) temporary screw fixation to maintain the reduction of SL interval after ligament debridement, repair, or reconstruction. METHODS: A total of 36 patients who had chronic SL instability were included. Arthroscopic debridement was performed for dynamic instability, and primary repair or reconstruction of the SL ligament was performed for static instability. We then used SL screw fixation for the protection of the repair or reconstruction. Screws were removed when loosening was noted on x-ray. RESULTS: The average patient age was 43 years. Eleven had dynamic instability, and 25 had static instability. The average follow-up was 7.9 years. Nearly 95% of the patients had no more than mild pain. The average ranges of movement of the wrist were 55° extension, 51° flexion, 26° ulnar deviation, and 15° radial deviation. Postoperative x-ray revealed an average SL angle of 56°. The average SL gap was 2.5 mm. Both of these radiographic parameters were maintained at final follow-up. Dorsal intercalated segmental instability (DISI) deformity was not corrected in 2 patients. One patient had avascular changes in the proximal scaphoid and lunate but remained asymptomatic at 7 years postoperatively. There was no further intercarpal and radiocarpal degeneration. CONCLUSIONS: Temporary SL screw fixation together with arthroscopic debridement, ligament repair, or reconstruction provided a stable closure of the SL interval and satisfactory clinical and functional results along with a low incidence of complication. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Rupture of the flexor digitorum superficialis at the musculotendinous junction due to a forearm fracture: a case report.

We present a case of a closed distal-third forearm fracture, in which the flexor digitorum superficialis was found ruptured at its musculotendinous junction. We diagnosed the ruptured tendon during the exploration of the ulnar nerve for observed preoperative palsy. Although there are numerous reports about avulsions at the bony insertions, there are very few about avulsion at the musculotendinous junction in the literature. This consideration leads to the conclusion that this kind of rupture may be more frequent than recognized.

Volar plate fixation of intra-articular distal radius fractures: a retrospective study.

Background Intra-articular fractures of the distal radius represent a therapeutic challenge as compared with the unstable extra-articular fractures. With the recent development of specifically designed internal fixation materials for the distal radius, treatment of these fractures by fragment-specific implants using two or more incisions has been advocated. Purpose The purpose of this study was to investigate the efficacy of a fixed-angle locking plate applied through a single volar approach in maintaining the radiographic alignment of unstable intra-articular fractures as well as to report the clinical outcomes. We only excluded those with massive comminution, as is discussed in greater detail in the text. Patients and Methods This is a multicentered, retrospective study involving three hospitals situated in Spain, Switzerland, and the United States. In the period between January 2000 and March 2006, 97 patients with 101 intra-articular distal radius fractures, including 13 volarly displaced and 88 dorsally angulated fractures were analyzed. Over 80% were C2/C3 fractures, based on the AO classification. 16 open fractures were noted. Results With an average follow-up of 28 months (range 24-70 months), the range of movement of the wrist was very satisfactory, and the mean grip strength was 81% of the opposite wrist. The Disabilities of the Arm, Shoulder, and Hand (DASH) score was 8. The complications rate was < 5%, including loss of reduction in two patients. All fractures healed by 3 months postinjury. Conclusions Irrespective of the direction and amount of initial displacement, a great majority of intra-articular fractures of the distal radius can be managed with a fixed-angle volar plate through a single volar approach. Level IV retrospective case series.

Corrective osteotomy for combined intra- and extra-articular distal radius malunion.

PURPOSE: This study evaluated the functional outcome of corrective osteotomy for combined intra- and extra-articular malunions of the distal radius using multiple outcome scores. METHODS: We evaluated 18 skeletally mature patients at an average of 78 months after corrective osteotomy for a combined intra- and extra-articular malunion of the distal part of the radius. The indication for osteotomy in all patients was the combination of an extra-articular deformity (≥ 15° volar or ≥ 10° dorsal angulation or ≥ 3 mm radial shortening) and intra-articular incongruity of 2 mm or greater (maximum stepoff or gap), as measured on lateral and posteroanterior radiographs. The average interval from the injury to the osteotomy was 9 months. The average maximum stepoff or gap of the articular surface before surgery was 4 mm. RESULTS: All 18 patients healed uneventfully and the final articular incongruity was reduced to 2 mm or less. Final range of motion and grip strength significantly improved, averaging 89% and 84% of the uninjured side and 185% and 241% of the preoperative measures, respectively. The rate of excellent or good results was 72% according to the validated rating system Mayo Modified Wrist Score, and 89% according to the unvalidated system of Gartland and Werley. The mean Disabilities of the Arm, Shoulder, and Hand score was 11, which corresponds to mild perceived disability. Of the 18 cases, 11 normalized upper limb function. Five patients had complications; all were successfully treated. According to the rating system of Knirk and Jupiter, 4 had grade 1 and 1 had grade 2 osteoarthritis of the radiocarpal joint on radiographs. Two of those patients reported occasional mild pain. Radiographic osteoarthritis did not correlate with strength, motion, and wrist scores. CONCLUSIONS: Outcomes of corrective osteotomy for combined intra- and extra-articular malunions were comparable to those of osteotomy for isolated intra- and extra-articular malunions. A successful corrective osteotomy for the treatment of complex intra- and extra-articular distal radius malunions can improve wrist function. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Salvage of failed resection arthroplasties of the distal radioulnar joint using an ulnar head prosthesis: long-term results.

PURPOSE: The aim of this prospective multicenter study was to evaluate the long-term outcome of the Herbert ulnar head prosthesis for painful instability of the distal radioulnar joint (DRUJ) following resection of the ulnar head. METHODS: Twenty-three patients were treated with a Herbert ulnar head prosthesis in 3 international hand centers. One patient was excluded from the study because a septic prosthesis had to be removed after 3 months. Sixteen of the remaining 22 patients could be assessed at 2 follow-up times, 28 months (range, 10-43 mo) and 11 years and 2 months (range, 97-158 mo) after surgery, for DRUJ stability, forearm rotation, grip strength, pain level (0-10), and satisfaction (0-10). Standardized radiographs of the wrist were evaluated for displacement of the ulnar head and loosening or bony reactions at the sigmoid notch or the ulna shaft. RESULTS: All patients demonstrated a clinically stable DRUJ at the latest examination, and no patient required further surgery at the DRUJ since the short-term evaluation in 1999. Average pain measured 3.7 before surgery, 1.7 at the short-term follow-up, and 1.7 at the long-term follow-up; patients' satisfaction, 2.2, 8.2, and 8.9; pronation, 73°, 86°, and 83°; supination, 52°, 77°, and 81°; and grip strength, 42%, 72%, and 81% of the unaffected side. All clinical parameters improved significantly from before surgery to the short-term follow-up, with no further statistically significant change between the short-term and long-term follow-up. Radiographs demonstrated no signs of stem loosening or incongruity of the DRUJ. CONCLUSIONS: The previously reported short-term results with the Herbert prosthesis did not deteriorate in the long term. Reconstruction of the DRUJ with this prosthesis in painful radioulnar impingement following ulnar head resection is a reliable and reproducible procedure with lasting results.

Scaphocapitolunate arthrodesis and radial styloidectomy for posttraumatic degenerative wrist disease.

Long-standing scaphoid nonunion, scaphoid malunion, and chronic scapholunate dissociation result in malalignment of the carpal bones, progressive carpal collapse, instability, and osteoarthritis of the wrist. The most commonly used procedures to treat scaphoid nonunion advanced collapse (SNAC) and scapholunate advanced collapse (SLAC) wrists are the four-corner fusion (4CF) and the proximal row carpectomy (PRC). The purpose of this study was to evaluate the clinical outcome of a different treatment modality: radial styloidectomy and scaphocapitolunate (SCL) arthrodesis. This treatment option is chosen in an effort to maintain the joint contact surface and load transmission across the radiocarpal joint. We conducted a retrospective review of 20 patients (average age 62 years, range: 27 to 75 years) treated from 1994 to 2010. Seven patients were treated for SNAC, 12 patients for SLAC wrists, and 1 for degenerative joint disease following a transscapho-transcapitate perilunar dislocation. Sixteen patients had Herbert screw fixation, and four had Spider plate fixation. All patients had autologous bone graft used for the arthrodesis. The mean follow-up was 4.6 years (range: 2 to 9.6 years). Patients were evaluated clinically and radiographically. Nineteen of 20 arthrodeses healed on an average of 9.6 weeks. One patient was reoperated 8 months after the initial operation with salvage of the SCL arthrodesis with a spider plate with an adequate result. The mean active flexion-extension arc was 70 degrees and the radioulnar deviation arc was 23 degrees. Pain decreased in all patients, 13 of whom were pain free postoperatively. The average postoperative disabilities of arm, shoulder, and hand score was 24. Radiographically, neither radiolunate nor radioscaphoid arthritis was noted on follow-up. SCL arthrodesis with radial styloidectomy resulted in an adequate residual range of motion and pain relief. This method preserves the normal ulnar sided joints of the carpus and maintains a more physiologic joint surface for radiocarpal load sharing.

Reconstruction of posttraumatic disorders of the forearm.

Forearm rotation is crucial for full upper extremity mobility. The two-bone unit with its proximal and distal radioulnar joints should be considered as a single bicondylar articulation. After a traumatic bony forearm injury, surgical treatment for complications, such as deformity, bone loss, or failed fracture healing is challenging because complete return of forearm rotation can be difficult to achieve. It is important to be aware of methods for assessing and managing posttraumatic forearm bony complications, including preoperative assessment and osteotomy techniques for malunited fractures. The vascularized fibular transplant also has been proven as an effective treatment method. Although nonunion of forearm fractures is uncommon, it can prove problematic; therefore, it is beneficial to review options for surgical management.