Clinical experience of open carpal tunnel release and Camitz operation in elderly Chinese patients.

OBJECTIVE: To report preliminary experience on the Camitz operation for elderly Chinese patients in a Hong Kong public hospital. DESIGN: Retrospective study. SETTING: Tertiary referral hospital with hand surgery service in Hong Kong. PATIENTS: Between January 2000 and January 2004, patients with carpal tunnel syndrome having the Camitz operation were recruited. They were assessed using the measurements of pinch and grip power, sensation, the Kapandji score, and functional grading as well as complications encountered during the subsequent follow-up. INTERVENTION: The Camitz operation. RESULTS: A total of 21 patients (8 male and 13 female; mean age, 70 years) were recruited. The mean duration of follow-up was 15 months. There was significant improvement in pinch power, grip power, and hand functions, as well as a positive correlation between the functional score and the Kapandji score. No major complication was recorded. One patient with pre-existing osteoarthritis of the ring finger developed contracture of the proximal interphalangeal joint. CONCLUSION: The Camitz operation is a simple, effective, and safe means of improving hand function in elderly Chinese patients with long-standing carpal tunnel syndrome and thenar muscle atrophy. Newly acquired strength in antepulsion of thumb resulted in improved pinch, grip, and hand function in this patient group.

Carpal ligament injuries with acute scaphoid fractures - a combined wrist injury.

Fifty-two consecutive patients with acute scaphoid fractures were treated by closed reduction and percutaneous screw fixation. In addition, all underwent a wrist arthrogram and 22 patients also underwent a wrist arthroscopy. Eighteen patients (34%) had an associated carpal ligament injury (four scapholunate ligament, eight lunotriquetral ligament, two combined, three TFCC and one minor leak from the distal carpal row). These patients had worse Mayo wrist scores (no ligament injury median score=95: ligament injury median score=85) at a mean final follow-up of 61 weeks. We advocate that scaphoid fractures with associated carpal ligament injuries should be defined as a combined wrist injury.

Chronic finger joint instability reconstructed with bone-ligament-bone graft from the iliac crest.

Five patients with chronic instability of digital joints presented with instability and functional disability. Two patients had ulnar collateral ligament damage of the thumb metacarpophalangeal joint and another had chronic multidirectional instability due to radial collateral ligament, dorsal capsule and palmar plate laxity of the metacarpophalangeal joint of the thumb. The fourth patient had a lax radial collateral ligament and palmar plate of the proximal interphalangeal joint of the little finger and the fifth had chronic laxity of the ulnar collateral ligament of the interphalangeal joint of the thumb. All were reconstructed with bone-ligament-bone graft harvested from the iliac crest. The graft was fixed with screws and joint stability was achieved intra-operatively in all patients. All patients achieved a stable joint with improved functional performance at final follow-up.

Cyclic flow characteristics in an idealized asymmetric abdominal aortic aneurysm model.

The flow characteristics and the corresponding hydrodynamic stability in an idealized asymmetric abdominal aortic aneurysm (AAA) model have been investigated using a laser Doppler anemometer. A rectified sine waveform was used to simulate aortic flow conditions (Re(delta) = 806 and alpha = 12.2). The flow around the distal neck of the AAA model undergoes transition and becomes turbulent for a fraction of time shortly after the commencement of the deceleration phases at every flow cycle while the rest of the flow inside the model stayed laminar throughout the cycle. As a result of non-symmetric vortical structure development inside the model, the distribution of turbulent shear stresses was found to be highly uneven along the radial direction of the model; this is in contrast to results found by the present authors in the symmetrical AAA model. The maximum turbulent shear stress found at the straight side of the distal neck are four times more than the maximum turbulent shear stress measured at the most dilated side of the distal neck. One of the interesting biological implications of the results is that the outward dilation of the arterial wall may be a physiological response to avoid the high turbulent shear load from the momentarily turbulent blood flow.