Bolt fixation for syndesmotic injuries.

We performed a retrospective study of 28 patients who underwent bolt fixation for a syndesmotic injury to the ankle. The mean follow-up period was 66 months (range: 24-139 months). The results of surgery were assessed clinically and radiographically. Overall, this fixation device was found to adequately stabilise the syndesmosis during healing. Radiologically accurate syndesmosis reduction was achieved in 26 patients. The mean AOFAS score was 86 (range: 33-100). The majority of patients were very satisfied with the overall result. It is a simple and quick operative procedure providing reliable syndesmotic reduction. The material should not be removed prior to walking. The only drawback is the greater need for removal in the event of local symptoms.

Proximal row carpectomy versus four-corner arthrodesis as a treatment for SLAC (scapholunate advanced collapse) wrist.

Four-corner arthrodesis and proximal row carpectomy are motion-preserving salvage solutions for the scapholunate advanced collapse wrist. We compared both procedures in a non-randomised, retrospective study of 30 cases with a mean follow-up of 3(1/2) years. Pain relief and functional gain were equal in both treatment groups. However, the complication rate was higher in the four-corner arthrodesis group, partly because of the need for internal fixation. The higher incidence of carpal tunnel syndrome following four-corner arthrodesis is intriguing. We also found significant differences in the duration of hospital stay and of postoperative sick leave in favour of proximal row carpectomy. If the cartilage on the capitate head is well preserved (Stages I-II), we prefer proximal row carpectomy because of the socio-economic benefits, the lower complication rate and the ease of the procedure. Degenerative changes following proximal row carpectomy may be a concern in young manual labourers, but have not been observed.