The holmium:yttrium-aluminum-garnet laser in wrist arthroscopy: a five-year experience in the treatment of central triangular fibrocartilage complex tears by partial excision.

Arthroscopic debridement of the articular disk is an accepted method for the treatment of symptomatic central tears of the triangular fibrocartilage complex. Current techniques use punches, knives, and shavers to debride the torn disk back to a stable peripheral rim. The holmium:yttrium-aluminum-garnet laser offers an alternative method for disk debridement with potential advantages of enhanced speed, precision, and hemostasis. We present a retrospective review of 35 patients who underwent arthroscopic laser debridement for a Palmer type IA tear in the triangular fibrocartilage complex. Overall response to treatment was good to excellent in 68% of patients and return to work was seen in 88%. One patient developed a deep wound infection. Clinical results after arthroscopic laser debridement are comparable to those reported by other investigators using conventional techniques.

Early wrist arthrodesis for irreparable intra-articular distal radial fractures.

When articular restoration and congruity cannot be accomplished in distal radial fractures owing to severe articular bone loss or comminution, early wrist arthrodesis should be considered. This procedure rapidly restores wrist alignment and stability and controls pain. Arthrodesis is a highly reliable and definitive procedure that optimises the opportunity for early functional and occupational recovery while minimising the risks of developing stiff digits or chronic pain in injuries otherwise doomed from the start of treatment to result in severe wrist stiffness and post-traumatic arthritis. Simultaneous proximal row carpectomy or the use of ipsilateral local bone graft donor sites, such as the distal radius or proximal ulna, decrease both initial treatment and hospital costs and morbidity. Wrist arthrodesis is also effective when polytrauma or multiple fractures co-exist. Successful early treatment may expedite return to work and reduce lost time and wages resulting from the injury.