John F. Mosher

Limited wrist arthrodesis: a laboratory study.

By means of an external fixator, 11 limited wrist fusions in eight freshly frozen cadaver wrists were studied. An electrogoniometer measured perfusion and postfusion range of motion, and the percentage of loss of motion was determined and then averaged for all eight wrists. The three fusions that crossed the radiocarpal row lost approximately 55% flexion/extension (F/E). The five fusions that crossed the intercarpal row lost approximately 27% F/E, and the three fusions within a single carpal row lost approximately 12% F/E. These results may be helpful to determine which limited wrist fusion to perform.

The long-term results of Swanson silicone rubber interpositional wrist arthroplasty

Fifty-three Swanson silicone rubber interpositional wrist arthroplasties were done in 42 patients. A painful rheumatoid wrist was the most common operative indication. Very acceptable clinical results were obtained early in follow-up, with more than 90% of the wrists obtaining significant pain relief. However, in the group of wrists followed for more than 2.5 years, only 61% had good or excellent results. The reoperation rate in this group was 25%. Postoperative complications included prosthetic breakage (9.4%), ulnar cap breakage (71%), and a very high incidence of progressive radiographic deterioration (70%).

A review of scaphoid fracture healing in competitive athletes

A fractured scaphoid is a common disabling injury occurring in contact sports. Plaster immobilization is the most frequently used form of therapy. However, the rules governing most amateur sports do not allow an unyielding form of immobilization distal to the elbow. We describe a method of treating scaphoid fractures with custom-made Silastic (Dow Corning Wright, Arling ton, TN) casts for competitive athletes. A retrospective review of 14 scaphoid fractures oc curring in athletes competing in contact sports was completed to determine if effective immobilization could be maintained with this technique. The study covered a 10 year period with an average followup of 3.9 years (range 2 to 9 years). Ten of 11 middle third scaphoid fractures healed uneventfully. One nonunion occurred following a 7 week delay in diagnosis. Two of three proximal third scaphoid fractures went on to nonunion, while the third healed after a prolonged period of treat ment. Our data indicate that nondisplaced middle third scaphoid fractures can be effectively immobilized for competition in contact sports with the custom-made Silastic cast described.

Long-term results of Swanson interpositional wrist arthroplasty: Part II

Fifty-eight Swanson silicone interpositional wrist arthroplasties were done in 47 patients between 1974 and 1984. Thirty-nine of these original wrists were available for follow-up an average of 5.8 years after operation. This is a continuation of our study previously published in this Journal. With increased follow-up, progressive deterioration of clinical results was noted. With a follow-up of less than 2.5 years, 75% had relief of pain. After a follow-up of 4.8 years, 67% had relief of pain. Finally, with an average follow-up of 5.8 years, only 51% had relief of pain. Progressive radiographic changes are now obvious in each case compared with 70% of those cases reviewed at 4.8 years. Furthermore, we now have noted cystic changes in a significant proportion of the wrists radiographically. In several of these, silicone synovitis has been documented histologically. Our indications for this procedure have drastically narrowed.

X-ray changes after expanded polytetrafluoroethylene (gore-tex) interpositional arthroplasty

Thirty-one patients with degenerative osteoarthritis at the trapeziometacarpal joint underwent 34 expanded polytetrafluoroethylene interpositional arthroplasties. The average follow-up period for the group of patients was 41 months (range, 15-82 months). Subjective results and objective measurements for the patients at the time of review were favorable. X-ray analysis, however, revealed a high incidence of osteolytic lesions associated with microparticulate degeneration consistent with reactive particulate synovitis. Owing to the unacceptably high rate of secondary osteolysis, the authors recommend that use of this material for trapeziometacarpal or pantrapezial arthroplasty be abandoned.

Osteoid osteoma of the capitate: A case report

An osteoid osteoma of the capitate in a patient with Marfans syndrome is described. Considerable difficulty was encountered in establishing the diagnosis.

Treatment of Multiple Enchondromatosis (Ollier's Disease) of the Hand

The clinical treatment and results for three hands in two patients with multiple enchondromatosis (Olliers disease) are presented. Diaphyseal resection (total or subtotal) in 27 phalanges and metacarpals preceded autogenous fibular bone grafting to the defects. All bone grafts subsequently healed and were well incorporated. Hand function and cosmesis were restored satisfactorily in each case. There were no infections or recurrences.

Two modifications for insertion of the Herbert screw in the fractured scaphoid

Since its introduction in 1984, the Herbert screw system has been used increasingly for fracture fixation and reconstruction of the scaphoid. The differential pitch of the double-threaded screw is designed to fix and compress the fracture fragments such that external immobilization is not necessary. The thread design alxad lows the trailing threads to be countersunk so that the screw does not impinge on articular surfaces and thus does not have to be removed. As experience with the fixation system has develxad oped, several technical difficulties have become apparxad ent. A common difficulty involves excessive palmar placement of the screw with resultant inadequate frac xad ture fixation (Fig. 1). A second common difficulty is accurately determining the prospective course of the screw after jig placement. Two modifications of the insertion technique are prexad sented to help eliminate these difficulties. The first inxad volves creation of a trough in the palmar aspect of the trapezium to allow adequate dorsal jig placement. The second is a Kirschner (K) wire insert sleeve designed for the jig, which simplifies wire placement, allowing accurate radiologic determination of the eventual course of the screw. Technique

Split Thickness Hypothenar Grafts for Skin Defects of the Hand

Split thickness hypothenar grafts provide excellent coverage for fingertips as well as other areas of the hand. The method is simple and readily applied in the emergency room with little additional equipment.