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When using open reduction of dorsal displaced fractures of the radius to restore congruency and extra-articular anatomy, the authors recommended the use of their double-plating method. This method is reliable in providing stable internal fixation and in allowing early function. It is, however, and as earlier mentioned, a demanding technique, as ot requires careful; attention to detail.
Carter, P.B. And PR Stuart. The Sauva-Kapankji Procedure for Post-Traumatic Disorders of the Distal Radio-Ulnar Joint. Journal of Bone and Joint Surgery: British Editorial Society of Bone and Joint Surgery, September 2000
Only one surgeon performed all the operations on a total of 37 patients for pain on the ulnar side of the wrist and decreased rotation of the forearm. The authors reported that most of the tested patients were better after the operation, although a significant number had some pain. Relief from pain could not be guaranteed and that residual pain associated with the wrist damage could occur. On the whole, the procedure was clearly a good choice for the restoration of forearm rotation. The authors advocated mobilization in the immediate postoperative period to achieve restoration. Close supervision was necessary and the patient may spend an average of 4.5 days in the hospital. Grip strength was usually satisfactorily restored, although the patient would usually experience weakness. From among the tested patients, only two-thirds were able to return to work. The results of this study were less favorable than those of previous studies. Patients who performed heavy manual work were the last ones to return to work. They would still experience residual mild to moderate pain in the so-called "high-demand wrist." Only a few patients did not benefit from the operation. Its poor results were limited to the young and thus be restricted in those with high demands on the wrist. The study yielded good results from older patients without a high level of complications. Problems of the ulnar stump have been linked to this procedure. After the injury, the structure supporting the shaft of the ulna could be damaged. These structures are the interosseous membrane, the tendons of ECU and FCU and the pronator quadratus muscle. The rupture of the interosseous membrane could lead to a very mobile ulna. Problems with pain and clicking of the ulna stump have been largely reported, but these are only minor inconveniences. The subject patients were not too troubled by the symptoms of instability an experienced only minor discomfort. Modifications have been introduced to decrease these symptoms. Good results continued to be reported. Intraperiosteal resection was recommended to increase stability. No correlation between the size of the ulnar gap and the results of the operation was found. But the recommendation was to leave a short distal ulnar fragment, shape the ulnar gap as far distally as possible and create a pseudarthrosis of 10 mm could reduce instability and retain gap strength. Bridging heterotropic calcilification of the pseudarthrosis is a complication. However, the results showed no increased risk of ossification in the pseudarthrosis when an intraperiosteal excision was done.
Shih, Jui-Tien et al. Chronic Triangular Fibro Cartilage Complex Tears with Distal Radioulna Joint Stability. Journal of Orthopedic Surgery: Western Pacific Orthopedic Association, June 2000
From September 1996 to September 1997, the team used the new procedure reconstruction with partial extensor carpi ulnaris tendon combined with or without ulnar shortening on 27 adult patients. Their average age was 22.4 years. There was a follow-up period from 22 to 28 months with a mean of 26.2 months. Using the Mayo Modified Wrist Score, 5 out of 27 patients rated their wrists as excellent, 18 as good and 4 as fair. On the whole, 23 or 85% of them rated their condition as satisfactory and returned to work or sports activities. The 4 patients who rated their condition as fair had mild pain at work or exercise. They had mildly limited supination, but their grip strength was improved to at least 54%, as compared with the opposite hand. This experiment demonstrated that TFCC reconstruction with partial ECU combined with the ulnar shortening procedure was an alternative method for chronic TFCC tears with distal radioulna joint instability. It provides a potentially satisfactory combination, restores the TFCC integrity and stability, maintains the motion of supination and pronation of the joint, and decreases the force transmitted to the ulna. These benefits would reduce the patients' symptoms and improve their wrist functions. The patients would, thus, be able to tolerate work, sport and military training.
Doets H.C. And EEJ. Raven. Radioulnate Arthrodesis. Journal of Bone and Joint Surgery: British Editorial Society of Bone and Joint Surgery, November 1999
Radioulnate arthrodesis yields good clinical results at five years, although there has been some radiological deterioration. The authors studied 38 patients between 1989 and 1994. Results with the use of the method produced a stable and comfortable wrist with improved mobility after five years. Conversion to a total wrist arthrodesis is seldom required. It should be recommended in early-to-medium-stage wrist disease with persistent symptoms.
Grechenig, W., et al. Denervation of the Radiocarpal Joint. Journal of Bone and Joint Surgery: British Editorial Society of Bone and Joint Surgery, May 1998
Denervation surgery has been a traditional mode of management of chronic pain in the wrist. It has been the choice if there remains useful movement at the wrist, the preference would be denervation over arthrodesis. It was used on a sampling of 22 patients at 50 months. Of the 22, 17 were very satisfied or improved, 3 were satisfied and only 2 rated the surgery as unsatisfactory. None was made worse. The patients did not have adverse symptoms or had only minor pain when stressing the wrist. Six of them had pain during the normal use of the joint, while 2 had no improvement of their symptoms. Twelve had improvement in strength and 10 found no change. The patients had no postoperative complications, although 11 reported a loss of sensation in the first dorsal interosseous space. Their mean hospital stay was 3 days. Early movement resulted in pain and swelling in 2 patients but both returned to heavy work before their stitches could be removed. Their symptoms, however, disappeared after four weeks of conservative care. They were advised to use a removable splnt for two to four weeks after surgery between sessions of physiotherapy.
The team, however, noted that some patients were influenced by social security and disability payments. Symptoms could also recur after years of complete absence of pain. This could be on account of the simultaneous innervating of the joint by several nerves. All the nerve trucks in the wrist could contribute to its innervation. There are extensive connections between individual nerve branches. A successful procedure would involve meticulous evaluation and surgery and adequate motivation in patients.
Bozentka, David J. Scapholunate Instability. UPOJ. Vol 12, Spring 1999
Bozentka discusses scapholunate instability as the most common type of carpal instability, its evaluation and treatment controversial and the outcome unpredictable. It occurs between the scaphoid and lunate after a traumatic event or from repetitive use. Patients often complain of weakness and pain of the wrist. Care for the injury requires a consideration of the findings on the patient's history, physical examination and correlation with the diagnostic studies. Options for therapy are many. The best depends on the chronicity of the injury, the integrity of the SL limagement, the reducibility of the carpus, the presence or absence of wrist arthritis and other patient-related factors. Treatment modes improve with increased and improved understanding of altered kinematics.
Hambridge, J.F., et al. Acute Fractures of the Scaphoid. Journal of Bone and Joint Surgery: British Editorial Society of Bone and Joint Surgery, January 1999
The author and his team treated 121 fractures by cast immobilization with either 20% wrist 20% flexion or extension. After six months, 108 of these had united. The team observed that the nonunion was not influenced by the position of immobilization. Fractures of the scaphoid are usually immobilized with the wrist slightly extended. Some authors, however, advocated a flexed position. Results of the team's experiment suggested that the position in which the wrist was immobilized did not influence the rate of the nonunion of fractures of the wrist and distal pole. The reason for immobilization at 20 degrees flexion was unknown, although extension would have improved with time. Increased flexion of the fracture could have caused mild malunion. The team's results confirmed the preference for immobilization of the wrist, rather than the position of immobilization, is important for the union of the fractured scaphoid. The team recommended that fractures be immobilized in a Colles' cast with the wrist at roughly 20 degrees extension.
Cooney, William P., et al. Post-Traumatic Arthritis of the Wrist. The Library of Congress: Mosby-Year Book, Inc., 1998
The authors recommended radial styloid excision cobined with either STS fusion or scaphocapitate fusion for Stage I of scapholunate advanced collapse or SLAC; PRC or scaphoid excision and midcarpal fusion or scaphocapitate fusion for Stage II; and scaphoid excision and limited wrist fusion for Stage…[continue]
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