Compartment reconstruction for De Quervain's disease.

A new surgical treatment for De Quervain's disease is presented, in which the anatomy and function of the first dorsal compartment is preserved. Our findings in 11 wrists in ten patients revealed complete relief of the pre-operative symptoms in all instances. The advantages of this technique are its ease, its restoration of normal anatomy, and the prevention of tendon prolapse.

Distal scaphoid resection arthroplasty for the treatment of degenerative arthritis secondary to scaphoid nonunion.

Nineteen patients with chronic scaphoid nonunion and associated degenerative arthritis between the distal fragment and the radial styloid were treated by resection of the distal fragment. All patients had a dorsal intercalated segment instability wrist collapse pattern with an average radiolunate angle of -32 degrees and a 10% reduction in the carpal height, both of which changed minimally during the follow-up period. The duration of the nonunion averaged 12 years and the follow-up period averaged 49 months. Range of motion improved 85% and grip improved 134%. Thirteen of the patients experienced complete pain relief. One patient required additional surgery and elected wrist arthrodesis. Resection of the distal fragment is not recommended for patients with capitolunate arthritis. Two of the 4 patients with capitolunate arthritis had persistent symptoms; 3 had progressive degenerative changes.

The volar plate reconstruction for fracture-dislocation of the proximal interphalangeal joint.

This article discusses the volar plate arthroplasty utilized to resurface the proximal interphalangeal joint, for fracture subluxations involving the lower 60%. The procedure is effective when open reduction and internal fixation are not feasible because of excessive comminution or delay in treatment. The procedure has been used up to 2 years postinjury if certain conditions are met. The article also emphasizes the volar approach to the joint as an optimal exposure to fix these fractures.

Permissible limits of flexor digitorum profundus tendon advancement--an anatomic study.

Lacerations of the profundus tendon distal to the superficialis insertion can be treated by advancement of the proximal cut end of the tendon to its insertion. In the English-language literature, limits cited for the distance a profundus tendon can be safely advanced vary from 0.75 to 2.5 cm and appear to be based on clinical impressions. Our cadaver model suggested the degree of tendon advancement tolerable was 1 cm. A delicate balance exists in the profundus tendon system, and this should be considered when surgical advancement is contemplated.

Volar plate arthroplasty of the proximal interphalangeal joint: a review of ten years' experience.

In 10 years 24 patients had a volar plate advancement arthroplasty for acute or chronic fracture dislocations of the proximal interphalangal joint. Seven were done within 6 weeks of injury, 17 at 6 weeks to 2 years following injury. Final ranges of motion averaged 95 degrees for the former and 78 degrees for the latter group. Radiographs frequently demonstrated a marked remodeling of the disrupted contour of the joint surface of the middle phalanx.

Complete dislocation of a little finger metacarpal phalangeal joint treated by closed technique.

Complete dorsal dislocation of the metacarpal phalangeal joint almost always requires an open reduction. This case report presents an unusual set of circumstances allowing a closed reduction to be performed. The metacarpal-phalangeal joint of the patients' little finger was reduced before the carpal-metacarpal joint, followed by placement of percutaneous Kirschner wires.