Michael V. Birman

The Use of Thermal Shrinkage for Scapholunate Instability

Scapholunate interosseous ligament (SLIL) instability is the most common form of carpal instability. There is a lack of consensus among hand surgeons as to the appropriate treatment of various stages. This article reviews the background and results of thermal treatment of predynamic instability of the SLIL. Case examples are discussed as well as a series of patients treated with our protocol for this injury.

How to Volunteer Overseas

B p VOLUNTEERING OVERSEAS ALLOWS a hand surgeon the opportunity to simultaneously step into the role of caregiver, educator, colleague, and inernational liaison. Such trips can be an invaluable earning experience for both the volunteer and those ith whom he or she comes in contact. However, when onsidering whether to pursue humanitarian work, it is mportant to approach it with the appropriate mindset to ncrease the likelihood of having a positive experience. ome of the most valuable attributes of a successful olunteer include humility, compassion, patience, and exibility. You must be willing to look at a situation rom multiple viewpoints and adopt therapeutic strateies that accommodate and respect local conditions, ultures, traditions, politics, resources, educational ackgrounds, demographics, and social norms. You hould also consider whether you are prepared to operte and teach under sometimes challenging conditions nd often with limited resources. An initial challenge in planning your volunteer exerience is identifying where to dedicate your time and nder the umbrella of which organization. For many, ime restrictions dictate the ideal site location for a olunteer assignment. Some locations can accommoate doctors for one week, whereas others may require longer time commitment. When considering a voluneer organization, ask yourself these questions: Do they ave a history of effective, long-lasting service? Is their ission consistent with my philosophy? Do they have a ood support system for their volunteers and family embers? Is the host organization/country well orgaized and enthusiastic about collaborating with this roup? One such organization, through which both auhors have conducted humanitarian work, is Health olunteers Overseas (www.hvousa.org), a non-profit rganization endorsed and financially supported by the

Dorsoradial ligament imbrication for thumb carpometacarpal joint instability.

Dorsoradial ligament imbrication is a direct and effective alternative to ligament reconstruction or metacarpal osteotomy in patients with symptomatic thumb carpometacarpal (CMC) joint instability. This procedure is performed by imbricating either the trapezial or the metacarpal attachment of the dorsoradial ligament with the use of a suture anchor. The procedure is indicated in the setting of chronic hyperlaxity or instability of the thumb CMC joint. Significant arthritic changes in the thumb CMC joint are a contraindication for this procedure. We present our technique along with an anatomic dissection to demonstrate the ligament and surgical procedure on an anatomic specimen. We also present results from 3 patients who underwent this technique with images and clinical results for 3 patients with long-term follow-up. Level of Evidence: Level IV—Therapeutic.

Management of late-presenting isolated flexor digitorum profundus injuries.

HE PATIENT 40-year-old, right-handed man sustained a laceration ver the palmar surface of the middle phalanx of his ight middle finger. The wound was sutured in a local mergency room, and he presented 3 months later comlaining of an inability to actively flex the distal interhalangeal (DIP) joint of the middle finger. Our examnation found that he had full active proximal nterphalangeal (PIP) joint flexion and extension but no ctive DIP joint flexion. Passive motion of the DIP joint as 0° to 45° of flexion. The patient was unhappy with is inability to actively flex the DIP joint of the digit and anted to discuss options for surgical correction.

Arthroscopic Wrist Debridement and Radial Styloidectomy for Advanced Scapholunate Advanced Collapse Wrist: Long-term Follow-up

Background: Symptomatic stage 2 or 3 scapholunate advanced collapse (SLAC) wrist is aggressively treated with salvage procedures, such as proximal row carpectomy or partial wrist fusion with resultant pain relief but limited motion. We hypothesize that arthroscopic synovectomy, radial styloidectomy, and neurectomy will preserve wrist motion, relieve pain, and delay or avoid salvage procedures. Methods: We evaluated outcomes in 13 wrists through questionnaires and 11 of these through additional physical examination at a mean follow-up of 5.0 years. Eight wrists were stage 2 and 5 were stage 3. Data at final follow-up included mobility/strength measurements, subjective outcome scores (Disabilities of the Arm, Shoulder, and Hand [DASH] and visual analog scale [VAS] pain), patient satisfaction, and return to work statistics. Results: Patients had an average flexion-extension arc of 88.0° in the treated wrist and an average grip strength that was 95.0% of the contralateral side. No patients required revision surgery at follow-up. The 13 wrists reported an average DASH score of 16.4 and mean VAS pain score at rest and with activity of 17.9 and 31.6, respectively. All patients working prior to the procedure (n = 8) were able to immediately return to work. In all, 84.6% of patients were satisfied. Conclusions: The procedure studied may have advantages in relieving pain, while preserving wrist motion for SLAC stage 2 or 3 disease. This procedure does not preclude future salvage procedures in those patients with severe disease who prefer to maintain wrist motion for the short term. Patients experience good functional outcomes with the majority experiencing a reduction in pain with the ability to return to work.