Radiological imaging of the trapeziometacarpal joint: a historical and clinical perspective.

The opposable thumb provides both stability and mobility and is needed to accomplish different prehensile tasks. The trapezium is a complex bone, with a distal articular surface that is convex in the sagittal plane of the thumb and concave in the coronal plane of the thumb. The numerous additional articulations with the carpus and the oblique orientation to the main plane of the hand makes it difficult to evaluate the trapeziometacarpal joint using standard hand or wrist radiographic views. This review gives an overview of the different radiological views that have been described for the thumb with an emphasis on their historical origin and positioning during radiography. We also describe different measurements and classifications that can be obtained using different thumb radiographs.

Pronator sparing plate osteosynthesis in distal radius fractures: early functional outcome.

Thanks to modern anatomic stable angle plate and screw designs in distal radius fractures, early mobilization is possible and pronation torque of the wrist is more important in early recovery. Pronator sparing plate osteosynthesis of the distal radius is a relatively new approach. A short overview of the technique is given with some tips and tricks. The objective of the study is to investigate whether pronator sparing approach to distal radius fractures gives better pronation force or grip force in the postoperative rehabilitation. Two randomly assigned groups of 30 patients with dorsally displaced unstable wrist fractures, operated with or without pronator sparing plate osteosynthesis, were retrospectively evaluated. Early postoperative grip force, pronator force and swelling were compared to the contralateral side. The pronator force on 3 weeks and 6 weeks was significantly higher in the "pronator sparing" group, respectively 57% and 80% of the contralateral side compared with 43% and 67% in the "non sparing" group. Also swelling was significant less in the pronator sparing group. There was no significant difference in grip force between the two groups. Pronator sparing plate osteosynthesis in distal radius fractures seems to give better pronation force and less swelling in early recovery after volar plate osteosynthesis. This technique seems not to have beneficial results on grip force.

Innervation of the elbow joint: Is total denervation possible? A cadaveric anatomic study.

The aim of this anatomical study was to find out if total denervation of the elbow joint is technically feasible. The endbranches of the brachial plexus of eight fresh-frozen upper arm cadavers were dissected with optical loupe magnification. All major nerves of the upper limb (except the axillary and the medial brachial cutaneous nerve) give some terminal articular endbranches to the elbow. The articular endbranches arise from muscular endbranches, cutaneous endbranches, or arise straight from the main nerves of the brachial plexus. A topographic diagram was made of the different nerves innervating the elbow joint. The ulno-posterior part of the elbow is innervated by the ulnar nerve and some branches of medial antebrachial cutaneous nerve. The radial-posterior part of the elbow is innervated exclusively by the radial nerve. The ulno-anterior part of the elbow is innervated by the median nerve and the musculocutaneous nerve. The radio-anterior part of the elbow is innervated by the radial nerve and the musculocutaneous nerve. These elbow innervation findings are relevant to both anatomical and clinical field as they provide evidence that the total denervation of the elbow joint is impossible. Nevertheless, partial denervation, like denervation of the lateral epicondyle or the ulnar part of elbow, is technically possible.