Kaori Shionoya

Corrective ulnar osteotomy for malunited anterior Monteggia lesions in children: 12 patients followed for 1-12 years

We reviewed 12 children, mean 5 (1-12) years, after corrective osteotomy of the ulna, combined with open reduction of the radial head for malunited anterior Monteggia lesions (Bado type I). A simple corrective osteotomy was used in the first 6 patients (group A) and a posterior angular osteotomy was used in the second group of 6 patients (group B). All osteotomies healed uneventfully, but 3 patients had a persistent dislocation of the radial head. Children who had been treated with an angular osteotomy had the best clinical outcome).

Herbert screw fixation for scaphoid nonunions: An analysis of factors influencing outcome

A retrospective review of 160 cases of scaphoid nonunion treated by internal fixation using a Herbert screw with bone grafting was conducted at an average followup of 24 months. Definite radiographic union was achieved in 90% of cases. Based on Cooneys clinical scoring system, 80 cases had an excellent result, 37 had a good result, 33 had a fair result, and 10 had a poor result. Failure of union was related to the existence of avascular changes of the proximal fragment, instability of the fracture fragment, the prolonged delay in surgery, and the location of the fracture site. In the united scaphoids, the lengthy period of postoperative immobilization, the existence of osteoarthritis, and the prolonged delay in surgery were significant factors in the patients functional outcome. Overall, the results do not support the view that a residual flexion deformity of the scaphoid is less likely to yield a satisfactory outcome, although it seems worthwhile to correct excessive angulation at the time of repair to promote an anatomic union, thereby preventing early arthritis. A bone graft with internal fixation using a Herbert screw and a shorter period of immobilization may give a satisfactory functional result when the nonunion is treated before the onset of arthritic changes in the wrist.

Arthrography is superior to magnetic resonance imaging for diagnosing injuries of the triangular fibrocartilage

The ability of single-injection radiocarpal arthrography and magnetic resonance imaging (MRI) to detect full-thickness tears of the triangular fibrocartilage were compared with wrist arthroscopy in 102 patients with wrist pain. The sensitivity of arthrography was 85%, and of MRI was 73%. Specificity was 100% for arthrography and 72% for MRI. Accuracy was 92% for arthrography, and 73% for MRI. Although future advances in MRI technology will probably improve its usefulness, single-injection wrist arthrography currently is superior to routine MRI for the detection of full-thickness triangular fibrocartilage tears.

Ulnar Styloid Malunion with Dislocation of the Distal Radioulnar Joint

Four patients with dorsal dislocation of the distal radioulnar joint and ulnar styloid malunion had corrective osteotomy of the ulnar styloid. Dislocation of the distal radioulnar joint was reduced in three of four patients. Subluxation persisted in the remaining patient. Wrist function improved in all patients. These results support the contention that a displaced ulnar styloid fracture with distal radioulnar joint dislocation should be reduced and internally fixed. Corrective osteotomy is recommended for malunion of the ulnar styloid associated with dislocation of the distal radioulnar joint.

Importance of distal radioulnar joint arthroscopy for evaluating the triangular fibrocartilage complex

BackgroundThe present study evaluated the importance of visualizing both sides of the triangular fibrocartilage complex (TFCC) when diagnosing ulnar wrist pain.MethodsA total of 20 patients with ulnar wrist pain who underwent both radiocarpal joint (RCJ) and distal radioulnar joint (DRUJ) arthroscopy were studied retrospectively. TFCC was graded as normal or as having wear or tear. The definitive diagnosis was made by evaluating the TFCC from both joints. The medical records were reviewed to document the preoperative diagnosis, arthroscopic findings, postoperative diagnosis, and operative procedure(s) performed after the arthroscopic examinations. The patients’ status at final follow-up was evaluated using the modified Green and O’Brien wrist scoring system. The TFCC grading on RCJ and DRUJ arthroscopies was compared.ResultsThe final diagnosis was modified after arthroscopic examination in three cases (15%). In six patients (30%), DRUJ arthroscopy revealed pathological TFCC findings that could not be detected on RCJ arthroscopy. The DRUJ arthroscopy detected wear or degenerative changes seen only on the proximal aspect of the TFCC in four patients and tear in two patients. On the other hand, in only one patient (5%) were there no pathological findings observed from the DRUJ portal, although RCJ arthroscopy found wear. In eight patients (45%), the arthroscopic grading of TFCC was the same on RCJ and DRUJ arthroscopy; of these, the TFCC was graded as normal in one patient, showing wear in three patients, and with a tear in five patients. For diagnosing TFCC pathology, RCJ arthroscopy had a sensitivity of 68% and a negative predictive value (NPV) of 14%, whereas the sensitivity was 95% and the NPV was 50% for DRUJ.ConclusionsAdding DRUJ arthroscopy to RCJ arthroscopy enables more accurate diagnosis of TFCC pathology because the proximal aspect of the articular disk and the foveal insertion of the distal radioulnar ligament can be visualized.

Ununited proximal pole scaphoid fractures: Treatment with a Herbert screw in 16 cases followed for 0.5-8 years

We treated 16 cases of delayed union and nonunion of proximal one-third scaphoid fractures with cancellous bone grafting and retrograde insertion of a Herbert screw through a dorsal approach. Definite radiographic union was obtained in 13 of 16 patients after a median of 2 (0.5-8) years of follow-up. Using Cooneys clinical scoring system, 5 cases were excellent, 5 good, 5 fair and 1 poor. The treatment of ununited proximal pole scaphoid fractures with retrograde insertion of the Herbert screw offers the advantages of a short period of immobilization and a good function.

Loose Body in the Wrist: Diagnosis and Treatment

PURPOSE The purpose of this study was to report on 10 cases of symptomatic loose bodies in the wrist joints diagnosed using arthroscopy. TYPE OF STUDY Retrospective review. METHODS From 1986 to 2000, we performed wrist arthroscopy for 707 patients, 10 of whom had loose bodies in the wrist joints. The clinical records were reviewed retrospectively. The patients included 8 men and 2 women, and the average age was 28 years (range, 16 to 67 years). The chief complaint was wrist pain in all patients, but locking was uncommon. Preoperative diagnosis was difficult in all but 3 cases; in those cases, an osseous component was found within the loose bodies. The remaining cases were diagnosed by wrist arthroscopy. RESULTS The loose bodies existed in the radiocarpal joint in 5 cases, and all could be removed arthroscopically. In the other 5 cases, the loose bodies were in the distal radioulnar joint, and arthrotomy was needed to remove them. After removal of the loose bodies, the pain was relieved in all cases without any surgical complications. CONCLUSIONS Loose bodies in the wrist joint should be included in the differential diagnosis for chronic wrist pain. Wrist arthroscopy is of value because the preoperative diagnosis is usually difficult.