The Sauve-Kapandji procedure for post-traumatic disorders of the distal radio-ulnar joint.

We present the results of a retrospective series of 41 Sauve-Kapandji procedures carried out for complications of fractures of the distal radius. All the operations were undertaken by one surgeon with a mean follow-up of 32 months. A total of 37 patients was available for clinical review. The indications for surgery were pain on the ulnar side of the wrist and decreased rotation of the forearm. Intraperiosteal and extraperiosteal techniques were used for resection of the ulna, with no difference in outcome. Patients were assessed for pain, rotation of the forearm and complications. A Mayo Modified Wrist Score was used. Pain was improved in 25 of the 37 patients, and unchanged in ten. Rotation of the forearm returned to within 7 degrees of the uninjured side. The results are discussed in relation to the presence of preoperative malunion of the distal radius, age and the functional outcome. Age is not a contraindication for this procedure.

A method for the measurement of three-dimensional scapular movement.

Many disorders of the shoulder complex are accompanied by changes in the pattern of scapular motion which is difficult to measure except radiographically. In order to study the three-dimensional motion of the scapula which accompanies arm movements, a technique has been developed using a three-pointed locater which can be applied over three bony landmarks - the acromial angle, the inferior angle, and the root of the scapular spine. The spatial orientation of the locater relative to the trunk was measured using an electromagnetic movement sensor (isotrak) which has been shown to be clinically reliable. Measurements of scapular plane rotations during abduction showed particularly good agreement with published data; variations in measurements of the out-of-plane angles were attributed to difficulties of contacting the acromion reliably when the deltoid muscle was contracted. It is concluded that the system is suitable for clinical use in the study of shoulder pathology.

Pronator quadratus revisited.

The pronator quadratus muscle has been neglected to a great extent in the anatomical and functional literature. This study confirms the consistent presence of two distinct heads to the muscle, and defines the gross and microscopic anatomy. The functional significance of these heads has been studied using in vitro and in vivo techniques to demonstrate that the superficial head is the prime mover in forearm pronation, and that the deep head is a dynamic stabilizer of the distal radioulnar joint.

Open carpal tunnel release. Does a vascularized hypothenar fat pad reduce wound tenderness?

Carpal tunnel decompression gives relief of symptoms of tingling and numbness in the fingers in around 90% of carpal tunnel syndrome cases. The most common complaint after operation is pain and tenderness about the operation scar. The normal median nerve slides back and forth during wrist movement. Loss of this movement due to scar adhesion is suggested as a cause of wound pain and residual symptoms. We performed a controlled, blinded study of bilateral primary carpal tunnel releases comparing standard closure with a hypothenar fat pad flap modified closure. No significant differences in pain or other symptoms were found.

The early history of arthroplasty of the wrist. From amputation to total wrist implant.

During the past 3 decades implant arthroplasty of the destroyed wrist has become a reliable and satisfying procedure. However, the first total wrist replacement was performed in Berlin as early as 1890. This paper describes the history of resection and interposition arthroplasty of the wrist leading to the first total wrist implant arthroplasty performed by Themistocles Gluck. An overview of recent designs is given, and the relevant historical cases are reported.

Closed extensor tendon rupture and distal radial fracture with use of a gymnast's wrist support.

We report a case of delayed closed rupture of the tendon of extensor indicis proprius in a skeletally immature individual. This occurred following a minor greenstick fracture during use of a gymnast's wrist-finger support. To our knowledge this unusual complication has not been described previously.

Habitual hip dislocation.

A snapping hip is a common problem in children and young adults. The common etiologies of the syndrome have been well described. We believe that habitual dislocation may be a more frequent cause of the snapping hip syndrome than has been previously described. We report two cases of this rarely reported clinical entity presenting as a snapping hip.

Internal fixation of pubic symphysis diastasis with a tension banding technique.

We present the details of a method of internally fixing diastasis of the pubic symphysis with stout wires and a tension band which can be employed with speed and ease, through a minimal exposure or minimally extended laparotomy wound. The technique is suitable for those with little experience of internal fixation of the pelvis. Our initial cases are presented.

Comparative study of functional bracing and plaster cast treatment of stable lateral malleolar fractures.

In a prospective, randomized study, the use of the Aircast pneumatic air stirrup was compared with a standard below-knee walking cast in the management of Lauge-Hansen supination-eversion, stage II ankle fractures. Forty patients were randomly allocated to the two treatment groups. The use of the air stirrup led to a significant improvement in early patient comfort, post-fracture swelling, range of ankle motion at union, and time to full rehabilitation. We advocate the use of pneumatic air stirrup in the cost-effective management of stable ankle fractures.

Hepatitis B immunization: a survey of orthopaedic surgeons.

In 1988 a survey of 72 orthopaedic surgeons was performed to determine the rate of immunization against the hepatitis B virus (HBV). 54% had received the vaccine. Offers of immunization from occupational health departments doubled the rate of uptake. Only 51% of surgeons had been offered this service. A repeat survey was performed in 1992 to assess the effect of recent publicity on viral transmission during surgery. 81% have now received the vaccine.

The dorsopalmar stability of the distal radioulnar joint.

Sixteen fresh-frozen adult human cadaveric upper extremities were used in a biomechanical analysis of distal radioulnar joint (DRUJ) stability. The relative contribution to stability of the DRUJ by the surrounding anatomic structures presumed to stabilize the joint was analyzed with respect to forearm rotation and wrist flexion and extension using a purpose-built 4-axis materials testing machine. The dominant structures stabilizing the DRUJ were the ligamentous components of the triangular fibrocartilage complex proper. The major constraint to dorsal translation of the distal ulna relative to the radius is the palmar radioulnar ligament. Palmar translation of the distal ulna relative to the radius is constrained primarily by the dorsal radioulnar ligament, with secondary constraint provided by the palmar radioulnar ligament and interosseous membrane. The ulnocarpal ligaments and extensor carpi ulnaris subsheath did not contribute significantly to DRUJ stability; however, approximately 20% of DRUJ constraint is provided by the articular contact of the radius and ulna. These relationships were consistent regardless of wrist position or degree of forearm rotation.

A transmission electron microscope study of the effects of ion etching on cells.

The effects of ion etching on blood cells have previously been studied by scanning electron microscopy. This present study by transmission electron microscopy was undertaken to evaluate the effects of the etching process on the cells. Critical point dried preparations were made, etched and subsequently processed and embedded in Araldite. Examination of thin sections of erythrocytes revealed disintegration of the plasma membrane; the residual membrane destruction products formed the tips of cones produced by long etching times. The effect of etching varied in erythrocytes in the same preparation. Nucleated cells showed a similar disintegration of the plasma membrane, but membranes of mitochondria, granules, vesicles and vacuoles did not exhibit effects of etching comparable to those of the plasma membranes. After treatment with a number of different fixatives, erythrocytes on carbon-coated copper grids were also etched and examined directly in a high voltage electron microscope at 1 MV. The effects were comparable to those seen in thin sections. To study the etch rates of biological materials, the resonant frequencies of quartz crystals were measured after application of thin films of albumen and cholesterol and again after these had been etched. the ratio of the frequency changes indicated that the etch rate of albumen was approximately 2-5 times that of cholesterol. The results are discussed in the light of theories of the mechanisms involved in ion etching.

Rotational stability of the carpus relative to the forearm.

To perform rotational tasks adequately, the rotational laxity between the radius and the carpus must be constrained within a certain limit. The contribution of nine individual capsuloligamentous structures to the rotational stability of the radiocarpal joint was studied using 14 fresh-frozen human cadaveric specimens. Torque-rotation curves, with sequential section of the soft-tissue structures, were used to calculate the percentage contribution of each individual structure. The primary pronation constraint was the palmar radioscaphocapitate ligament. The contributions to supination constraint were more complex; the dorsal radiotriquetral ligament was dominant, assisted by the palmar ulnolunate ligament. Structures originating from the ulna changed their major constraint contribution with forearm orientation, whereas those with a radial origin had a constant contribution independent of forearm rotation. Injury of these structures may lead to rotational instability at the radiocarpal level and should be considered when treating carpal instabilities.

Rotational laxity and stiffness of the radiocarpal joint.

OBJECTIVE: To investigate the constraint and potential mechanism of torque transmission across the wrist joint. DESIGN: In vitro experiment using human cadaveric specimens. BACKGROUND: Transmission of torque from the forearm to the hand requires rotational stability at the wrist. Better appriciation of the constraints would have applicability to several clinical problems where the stability is compromised. METHODS: Thirteen fresh-frozen cadaveric specimens were used in this experiment to investigate the rotational laxity and stiffness of the radiocarpal joint in unloaded and axially loaded (100 N) conditions, and three forearm orientations in a neutral, pronation (60 degrees ), or supination (60 degrees ) position. RESULTS: In pronation or supination, there was no difference between loaded and unloaded conditions in primary or total laxity at a maximum torque of 2.3 Nm. Unloaded specimens showed a mean total rotational laxity of 42.1 degrees. Supination or pronation of the forearm caused a decrease in laxity with respect to neutral forearm rotation (35 degrees and 41.6 degrees versus 49.6 degrees respectively). The primary rotational laxity accounted for half of the total laxity. With axial compression, total rotational laxity did not change, but primary laxity dropped to 50% of its unloaded value. The primary stiffness was very low -- approximately 11% of the secondary stiffness. CONCLUSION: The ligamentous structures and the joint articulation restricted excessive axial rotation of the wrist. However, a laxity of approximately 20 degrees was identified for normal wrists. RELEVANCE: This study demonstrated that the primary axial rotational laxity of the radiocarpal joint was approximately 20 degrees. In the mathematical model and implant design, muscular balance of the joint within such laxity should be considered.