L. De Smet

Arthrodesis of the wrist for osteoarthritis: outcome with a minimum follow-up of 4 years

The outcome of total wrist arthrodesis was reviewed in 36 patients with osteoarthritis after a minimum follow-up of 4 years. Pain relief was not complete, and although 20 were pain free at rest, only six were pain-free during manual activity. Grip strength was 63% of the contralateral side and the DASH score remained high. Only 21 of the 34 could be re-employed. The mean time off work was 14 months. Complications were numerous and additional surgery was required in 21 patients.

Outcome study of arthroscopic suturing of ulnar avulsions of the triangular fibrocartilage complex of the wrist

INTRODUCTION Ulnar wrist pain due to a TFCC lesion is frequent. Based on studies of the vascularity, ulnar avulsion can be sutured. Arthroscopic techniques have been designed but results are sparsely published. MATERIALS AND METHODS This is a retrospective study of 35 patients with an ulnar avulsion of the TFCC. All the patients were treated with an originally designed arthroscopical technique. The evaluation was focused on the subjective and functional ouome. A pain score and a DASH score were used. RESULTS The general impression was positive with a mean DASH score of 15 points. Two-thirds of the patients had a DASH score totaling less than 20. Twenty-nine patients had a good outcome, six were fair or poor. CONCLUSION Arthroscopical repair of the TFCC is a reliable and useful technique.

Pedicled fat flap coverage of the median nerve after failed carpal tunnel decompression.

We reviewed 14 patients treated with either an ulnar or a hypothenar fat flap for recurrent carpal tunnel syndrome and scar tenderness. Nine patients were satisfied and there were few complications. One patient had delayed skin healing and another developed a hypertrophic scar.

Salvage of Failed Sauvé–Kapandji Procedure with an Ulnar Head Prosthesis: Report of Three Cases:

Three failed Sauvé–Kapandji procedures were salvaged using an ulnar head prosthesis. At 7–22 month follow-up, all three patients were much improved. However, the stem of one implant subsequently fractured in a fall and this implant had to be removed.

Corrective osteotomy for malunion of the distal radius in young and middle-aged patients: an outcome study

Abstract Introduction. – We report the outcome of osteotomy for malunion of the distal radius. Material and methods. – Twenty-one wrists in 21 patients (mean age 38 years) with a malunion of the distal radius were treated with an osteotomy. An opening wedge osteotomy was performed when the distal radioulnar joint (DRUJ) could be saved; a closing wedge osteotomy was done when the DRUJ was treated with resection (Darrach) or arthrodesis (Sauve-Kapandji). The clinical and radiographic outcomes were evaluated together with the DASH score (disability of shoulder and hand). Results. – Extension improved to an average of 48° in the Smith-type group and flexion improved to an average of 51.8° in the Colles-type group. The postoperative DASH-score averaged, respectively, 17.3 and 33. There were four poor, four fair, seven good and six excellent scores on the scale of Fernandez and there were four poor, seven fair, three good and seven very good results on the Fernandez point score. Grip strength postoperatively averaged 70% of the contralateral side. Radiographically, there was a correction of increased volar tilt of the articular surface from 30.6 to 4.0° in the Smith-type group and a correction of increased dorsal tilt of the articular surface of 24.6° (from –21.3 to 3.3°) in the Colles-type group. Nine patients had surgery on the distal ulna at the time of the radial correction. Their average DASH score was 16.8 compared to the 33.97 average DASH score of those with radial correction without ulnar surgery. Conclusion. – Osteotomy of the distal radius in cases of malunion gives favorable outcomes. Treatment of the DRUJ is mandatory.

Avascular Necrosis of the Metacarpal Head

A case of avascular non-traumatic necrosis of the metacarpal head in a 36-year-old woman is reported. Treatment was by curettage of the necrotic bone and packing with cancellous grafts.A case of avascular non-traumatic necrosis of the metacarpal head in a 36-year-old woman is reported. Treatment was by curettage of the necrotic bone and packing with cancellous grafts.

Fast-Growing Pseudomalignant Osseous Tumour (Myositis Ossificans) of the Finger. A Case Report.

A case of pseudomalignant osseous tumour of the soft tissues of the finger is reported. The benign diagnosis is confirmed by the histologically characteristic zone phenomenon.

Changes in key pinch strength after excision of the trapezium and total joint arthroplasty.

Key pinch force was measured preoperatively and at follow-up (mean 25 months) in patients treated for basal joint arthritis by either trapziectomy with ligament reconstruction and tendon interposition (n=26) or total joint arthroplasty (n=27). There was a significant increase in key pinch strength with both treatments, but no difference between the two treatments. Total joint arthroplasty does not appear to produce stronger key pinch than trapziectomy with ligament reconstruction and tendon interposition.

Factors influencing return to work after surgical treatment for carpal tunnel syndrome

BACKGROUND Controversy exists regarding the factors influencing the duration of work incapacity after surgically treated carpal tunnel syndrome (CTS). AIM To determine relevant factors related to return to work. METHODS Surgical technique, clinical factors, demographic factors, other medical problems, psychosocial factors, work-related and economical factors were reviewed in patients operated on for CTS. Statistical multivariate analyses were performed to identify the baseline factors influencing the work incapacity period. RESULTS A total of 107 cases were reviewed. Professional exposure to repetitive movements and heavy manual handling activity were associated with a longer return-to-work interval. The duration of work incapacity period was not significantly related to the socioprofessional category of the patient (self-employed or employee) or to the type of the procedure (open versus endoscopic surgery). CONCLUSION Work-related features have a more important influence on return to work than personal, pathological or surgical features.

Avascular necrosis of the scaphoid: Report of three cases treated with a proximal row carpectomy

Three cases of avascular necrosis of the scaphoid are reported. One patient, who was using corticosteroids on a regular basis, had other areas of bone necrosis. None of the patients had a history of trauma. All three patients were treated with proximal row carpectomy with satisfactory results.