Scope-assisted release of the cubital tunnel.

We report on a technique of endoscopic release of the cubital tunnel, which is a modification of Bruno and Tsai's technique. This article covers the history, complications, indications, and postoperative management of ulnar nerve entrapments treated endoscopically, with a special focus on our technique. This minimally invasive alternative to transposition requires no mobilization of the ulnar nerve, which could potentially reduce iatrogenic trauma to the nerve and its vascularity.

Fractures of the distal radius treated with cross-pin fixation and a nonbridging external fixator, the CPX system: a preliminary report.

PURPOSE: To present the preliminary findings of distal radius fractures (DRF) treated with percutaneous cross-pin fixation and a nonbridging external fixator, the Cross-Pin Fixation (CPX) system. METHODS: Thirty-five consecutive patients with 37 DRFs were selected from a series of 51 DRFs for closed reduction, percutaneous pinning, and external fixation with the CPX system. Outcome was determined by studying (1) radiological measurements of radial height, palmar tilt, radial inclination and ulnar variance (UV); (2) grip and pinch strength; (3) wrist active range of motion; and (4) patient outcome instruments-the Patient-Rated Wrist Hand Evaluation and the Disabilities of the Arm, Shoulder, and Hand. RESULTS: We are reporting on 21 patients, 13 females and 8 males, mean age 54 years (range, 27 to 87 y) with AO type fractures A2, B2, B3, C1, C2, and C3. Follow-up was a minimum of 1 year (range, 12 to 36 months). Wrist rehabilitation began at a mean of 10 days (range, 4 to 16 d) after surgery. There was no loss of reduction. Final mean grip and lateral pinch strength recovered 86% and 94%, respectively, and active range of motion increased to a minimum of 89% of the noninjured side. Disabilities of the Arm, Shoulder, and Hand showed change in functional status (minimal detectable change at 95% confidence level) at 4 and 12 weeks. The Patient-Rated Wrist Hand Evaluation results reported resumption of usual activities in the early postoperative period. One patient developed type I complex regional pain syndrome, which resolved, and one patient had residual transient mild superficial radial nerve sensitivity. There were no pin track infections, nonunions, or tendon injuries. All patients returned to their prior employment and activities. CONCLUSIONS: The CPX system is a minimally invasive technique of closed reduction and internal fixation for displaced, reducible extra-articular and nondisplaced and displaced reducible intra-articular fractures of the distal radius, allowing rehabilitation of the wrist and resumption of usual activities while maintaining fracture reduction. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Index radial collateral ligament repair with titanium mini-suture anchor: osteolysis complication of an underreported injury.

We are reporting on a case of an index radial collateral ligament tear repaired with a titanium Mitek bone suture anchor. The development of cystic radiographic changes and increased pain and weakness led to suture anchor removal at 10 months post-repair. Periprosthetic osteolysis due to titanium-induced osteoclastogenesis and micromotion was suspected to be the cause. This case report provides a dual focus by stressing the importance of the diagnosis and treatment of this underreported ligament tear and highlighting our osteolysis complication via the mechanism of titanium-induced osteoclastogenesis for future therapeutic preventive measures.

Treatment of distal radius fractures with a nonbridging cross-pin fixator (the CPX system).

Many treatment methods exist for patients presenting with a fracture of the distal radius. With the evolution of innovative procedures and devices, treatment of these particular fractures is shifting to more contemporary approaches. The minimally invasive technique with the cross-pin fixator (CPX) system offers a new biomechanical concept for relatively rigid fixation of distal radius fractures (DRF). The CPX system uses percutaneous cross Kirschner wire fixation in combination with a nonbridging external fixator. The stability of the model is derived from the external unilateral frame and the positioning of multiple 1.6 mm Kirschner wires at various angles and planes to each other. This allows for maintenance of DRF reduction, early wrist mobilization, and a prompt return to the usual activities. Between September 2004 and September 2008, there were 54 patients with 56 DRF who were treated with the CPX system. Excluded from the report are 2 patients who had a bone graft and 1 patient who was not willing to adhere to the postoperative protocol. Of the 51 patients with 53 DRF, no major complications were reported. This article describes the CPX surgical technique, the indications, the complications, and the postoperative management.