Masataka Yasuda

Palmar plating for dorsally displaced fractures of the distal radius.

Extensor tendon rupture and irritation caused by implants or surgical intervention are serious complications in the treatment of fracture of the distal radius when a dorsal approach is used. To prevent complications, the dorsally displaced fracture of the distal radius was treated using a palmar approach. The subjects were 18 men and 15 women with a mean age of 54 years at the time of the injury (range, 23–75 years). All the patients had internal fixation with a plate and screws using the palmar approach. Union was achieved in all patients. Radiographic parameters, including the palmar tilt, radial inclination, radial length, and ulnar variance have been maintained since the operation. According to the rating scale of Gartland and Werley, there were 12 excellent, 20 good, and one fair result. There were no extensor tendon injuries that occurred during use of the palmar approach in this small series of patients. Palmar plating can be safe and effective for treatment of a dorsally displaced fracture of the distal radius.

Modified Sauvé-Kapandji Procedure for Disorders of the Distal Radioulnar Joint in Patients with Rheumatoid Arthritis

BACKGROUND The Sauvé-Kapandji procedure has become popular for the treatment of disorders of the distal radioulnar joint in patients with rheumatoid arthritis, but this procedure is impossible to perform in patients with poor bone quality in the distal part of the ulna. We have modified the procedure for patients with poor bone quality in the distal part of the ulna. The modified procedure involves resecting the distal part of the ulna, making a drill-hole in the ulnar cortex of the distal part of the radius, rotating the resected portion of the ulna 90 degrees , inserting it into the distal part of the radius, and fixing it at that site with use of an AO cancellous-bone screw. In the present report, we describe the new operative technique and report the results after a minimum duration of follow-up of three years. METHODS This operation was performed in fifty-six patients (sixty-six wrists) with rheumatoid arthritis. The mean age at the time of the operation was 59.3 years. The mean duration of follow-up was forty-eight months. Patients were evaluated in terms of wrist pain, grip strength, and range of motion. Radiographic evaluation included calculation of the carpal translation index to assess the extent of ulnar translation of the carpus. RESULTS Osseous union was achieved in all cases. Wrist pain resolved or decreased in all patients. The mean total range of forearm rotation increased from 144 degrees preoperatively to 167 degrees at the time of the most recent follow-up (p < 0.01). The mean carpal translation index did not change after the operation. CONCLUSIONS The modified Sauvé-Kapandji procedure results in rigid fixation of the grafted bone. The technique provides sufficient osseous support of the carpus even in patients with rheumatoid arthritis and poor bone quality in the distal part of the ulna.

Temporary scapho-trapezoidal joint fixation for Kienböck's disease in a 12-year-old girl : A case report

Temporary scapho-trapezoidal joint fixation with Kirschner wires was performed for stage IIIB Kienböcks disease in a 12-year-old girl. Preoperative evaluation with radiographs and magnetic resonance imaging confirmed the diagnosis. After 4 months of fixation, wrist range of motion was improved and pain was decreased. Postoperative magnetic resonance imaging revealed revascularization and fracture healing. Temporary scapho-trapezoidal fixation may be useful in the treatment of selected cases of Kienböcks disease in children.

Modified Sauve-Kapandji procedure for disorders of the distal radioulnar joint in patients with rheumatoid arthritis. Surgical technique.

BACKGROUND The Sauvé-Kapandji procedure has become popular for the treatment of disorders of the distal radioulnar joint in patients with rheumatoid arthritis, but this procedure is impossible to perform in patients with poor bone quality in the distal part of the ulna. We have modified the procedure for patients with poor bone quality in the distal part of the ulna. The modified procedure involves resecting the distal part of the ulna, making a drill-hole in the ulnar cortex of the distal part of the radius, rotating the resected portion of the ulna 90 degrees, inserting it into the distal part of the radius, and fixing it at that site with use of an AO cancellous-bone screw. In the present report, we describe the new operative technique and report the results after a minimum duration of follow-up of three years. METHODS This operation was performed in fifty-six patients (sixty-six wrists) with rheumatoid arthritis. The mean age at the time of the operation was 59.3 years. The mean duration of follow-up was forty-eight months. Patients were evaluated in terms of wrist pain, grip strength, and range of motion. Radiographic evaluation included calculation of the carpal translation index to assess the extent of ulnar translation of the carpus. RESULTS Osseous union was achieved in all cases. Wrist pain resolved or decreased in all patients. The mean total range of forearm rotation increased from 144 degrees preoperatively to 167 degrees at the time of the most recent follow-up (p < 0.01). The mean carpal translation index did not change after the operation. CONCLUSIONS The modified Sauvé-Kapandji procedure results in rigid fixation of the grafted bone. The technique provides sufficient osseous support of the carpus even in patients with rheumatoid arthritis and poor bone quality in the distal part of the ulna.

Scaphotrapeziotrapezoid arthrodesis for the treatment of Lichtman stage 3B Kienböck disease.

We evaluated the results clinically and radiologically of 10 cases of Lichtman stage 3B Kienböck disease treated by scaphotrapeziotrapezoid (STT) arthrodesis alone. We retrospectively reviewed pain, range of movement, grip strength, and physical examination of the wrist as well as subjective satisfaction. We measured carpal height ratio and radioscaphoid angle. The median follow-up period was 53 months (range 10–109). At final evaluation, eight patients reported no pain and two had mild pain. Median range of movement was 60° (range 45–70°) in extension, 33° (range 20–45°) in flexion without appreciable loss. Grip strength had improved considerably. Employed patients went back to work within four months. The median final radioscaphoid angle was 67° (range 55–81°). STT arthrodesis done properly for the right indications for Lichtman stage 3B Kienböck disease achieves quick relief of pain and excellent function of the wrist.

Enchondroma Protuberans of the Phalanx: A Case Report

Enchondroma protuberans, which is defined as an exophytic enchondroma of a long bone, is a rare condition. There have been 6 previously reported cases with only 1 case occurring in the hand. We report a case of an enchondroma protuberans of the ring finger middle phalanx treated by marginal excision of the soft-tissue component, intramedullary curettage, and placement of calcium phosphate cement. There was no evidence of local recurrence at the 1-year follow-up examination.

Temporary Scaphotrapezoidal Joint Fixation for Adolescent Kienböck's Disease

PURPOSE There are few therapeutic guidelines for adolescent Kienböcks disease. The purpose of our study was to investigate the clinical and radiographic outcomes of temporary scaphotrapezoidal (ST) joint fixation for adolescent Kienböcks disease. METHODS This was a retrospective review of 6 adolescent patients with Kienböcks disease treated by temporary ST joint fixation. All patients had pain with rest and activity before surgery. The mean patient age at the time of surgery was 14 years, and final follow-up examination was at a mean of 23 months. Under general anesthesia, 2 or 3 K-wires were inserted from the dorsal trapezoid to the scaphoid. The wires were removed at 3 to 6 months. RESULTS Mean postoperative wrist extension and flexion were increased from 46 degrees and 48 degrees to 68 degrees and 77 degrees , respectively. These improvements were statistically significant compared with preoperative wrist extension and flexion. Grip strength significantly increased from 52% to 86% of the unaffected side. None of the 6 patients had postoperative pain either at rest or with activity. On final follow-up wrist x-ray films, none of the patients had sclerotic change or fragmentation of the lunate, although decreased lunate height remained in all patients. Magnetic resonance imaging revealed improvement to nearly normal intensity of the lunate on T1- and T2-weighted images in all patients. CONCLUSIONS Both clinical and radiographic outcomes of temporary ST joint fixation for adolescent Kienböcks disease were excellent. We therefore recommend this procedure for the surgical treatment of adolescent Kienböcks disease. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.

TECHNIQUE OF INTRAMEDULLARY FIXATION FOR ARTHRODESIS OF THE WRIST IN RHEUMATOID ARTHRITIS

We did 18 arthrodeses of the wrist in 16 patients with rheumatoid arthritis using an intramedullary fixation technique. There were 15 women and one man, whose ages at operation ranged from 47 to 71 years (mean 58). Follow up ranged from 13 to 68 months (mean 27). The operative technique consists of a combination of intramedullary placement of two Kirschner (K)-wires and an autogenous bone graft. At follow up bony union was apparent in all cases. K-wires came out of the metacarpal joints in two cases. Paraesthesiae in the median nerve distribution occurred in two cases which both recovered within three months.

Lateral lunate morphology: An x-ray study

The lunate has been described by Kauer as being thinner dorsally than volarly when measured proximal to distal. We used an x-ray method to measure the shape of the lunate in order to compare dorsal and volar thicknesses after recognizing clinically a group of patients with scapholunate dissociation in whom volar flexed lunates were present. Using this method, 292 standard lateral views of the lunate were collected randomly and measured. The shape of the lunate could be classified into 3 types: type D lunates have a thinner dorsal segment and correspond to Kauers description; type V lunates have a thinner volar segment; type N lunates have equal dorsal and volar segments. There were 196 type D lunates (67%), 67 type V lunates (23%), and 29 type N lunates (10%). The radiolunate angles were measured in a random selection from type D and type V lunates to determine any relationship between the volar segment to dorsal segment thickness (wedge) ratio. No relationship within these groups was identified. However, there was a significant difference in the radiolunate angles between these two groups. Recognition of the prevalence of the type V lunate alters concepts proposed by Kauer and warrants further investigation of factors influencing lunate position.

Correction of dorsi-flexed intercalated segment instability after restoration of scaphoid height in a cadaver model of scaphoid non-union

Models of scaphoid non-union with static dorsi-flexed intercalated segment instability were produced in five frozen arms from cadavers or subjects following accidents by repetitive mechanical loading of the wrist joints longitudinally after a bone defect has been made at the mid-portion of the scaphoid. We designed four models of reduction: anatomical reduction; reduction with a shortened scaphoid; anatomical reduction but with the radio-lunate ligament sectioned, and a shortened scaphoid with the radio-lunate ligament sectioned. Results suggested that anatomical reduction with rigid fixation with a Herbert screw was most effective for correction of malalignment with DISI. Preservation of the radio-lunate ligament during the palmar approach to the scaphoid seemed to be important to prevent ligamentous carpal instability.