Rare septic arthritis of the wrist and carpus primary osteoarticular manifestation of Mycobacterium tuberculosis: A case report.

Mycobacterium tuberculosis is one of the oldest and most studied infections, yet it remains one of the most common causes of infection-related death worldwide. The majority concern pulmonary tuberculosis. Therefore, extrapulmonary cases are rare and are often neglected in the differential diagnosis, especially in chronic musculoskeletal complaints. Nevertheless, osteoarticular manifestation of tuberculosis can cause disabling destruction of bone, cartilage, and surrounding soft tissues which may be exacerbated by a delay in diagnosis. This case report documents a case of primary osteoarticular tuberculosis causing septic arthritis of the wrist and carpus. In our case, the patient had no pulmonary burden of tuberculosis, which further delayed diagnosis and lead to irreversible damage to the wrist as well as carpus. This case illustrates the need to consider this diagnosis in at risk populations in order to prevent a delay in diagnosis and treatment.

Subcutaneous anterior transposition versus decompression and medial epicondylectomy for the treatment of cubital tunnel syndrome.

A review of the literature often fails to uncover the best procedure for the treatment of cubital tunnel syndrome. This article compares 2 frequently used methods (subcutaneous anterior transposition vs decompression and medial epicondylectomy) for their effectiveness in relieving both subjective and objective symptoms of cubital tunnel syndrome. Between August 1991 and October 1993, nineteen patients underwent surgical decompression by a single surgeon for ulnar neuropathy at the elbow. Factors evaluated included upper extremity range of motion, elbow valgus stress, grip strength, pinch, 2-point discrimination, and pre- and postoperative nerve conduction. A standardized questionnaire was administered to assess subjective relief of symptoms.In the transposition group, grip strength averaged 71.2% of normal and pinch strength 86.6% of normal, and 2-point discrimination averaged 8.0 mm. The derived subjective assessment score was 23.2 of a possible 40. The average ulnar motor conduction velocity across the elbow was 50.1 m/sec preoperatively and 56.3 m/sec postoperatively. In the medial epicondylectomy group, grip strength averaged 79.5% of normal and pinch strength 81.7% of normal, and 2-point discrimination averaged 8.0 mm. The average ulnar motor conduction velocity across the elbow was 45.7 m/sec preoperatively and 55.7 m/sec postoperatively. No statistically significant difference existed between the 2 groups for the aforementioned indexes. These results do not indicate a difference between the outcomes of the patients undergoing either of the procedures. Because epicondylectomy is less technically demanding, with less soft tissue dissection of the nerve, it may be preferred over ulnar transposition.

External fixation of distal radius fractures: effect of distraction and duration.

PURPOSE: To assess the effects of the amount of distraction across the wrist and the duration of fixator placement on the clinical outcome of patients with distal radius fractures treated with external fixation. METHODS: A total of 42 patients with closed distal radius fractures were treated with a spanning external fixator plus supplementary percutaneous K-wires over a 6-year period. All fractures were extra-articular (A type) or simple intra-articular (C type). Twenty-four of these patients were evaluated retrospectively for clinical and radiographic outcomes at an average follow-up time of 22 months (range, 4-49 months). The amount of distraction attained by the fixator was determined by measuring the carpal height ratio on plain radiographs. Wrist and forearm range of motion were recorded, as well as grip and pinch strength. Standard radiographs were taken to evaluate healing and bony alignment. RESULTS: Using the Gartland Werley classification, there were 11 excellent, 10 good, and 3 fair results. Statistical analysis indicated that a higher carpal height ratio at the initial reduction positively correlated (p = .041) with an excellent outcome. Duration of external fixation did not have a significant impact on the final outcome within the parameters studied (p = .891). Average wrist range of motion at follow-up was as follows: flexion, 54.1 degrees (75% of the contralateral side); extension, 59.0 degrees (78%); radial deviation, 18.0 degrees (85%); ulnar deviation, 22 degrees (73%); pronation, 79.0 degrees (95%); and supination, 76.6 degrees (93%). None of the individual components of range of motion were negatively correlated with higher carpal height ratio at fixator application or duration of fixation, within the parameters studied. CONCLUSIONS: Moderately increased distraction of the carpus at the initial fracture reduction is correlated with improved clinical outcome and does not have an adverse affect on subsequent wrist range of motion. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.