Radial Border Research Articles

Avoiding radial nerve palsy in proximal radius shaft plating – a cadaver study

BackgroundOpinions vary concerning the position of forearm rotation during detachment of the supinator in radial nerve palsy Henry’s and Thompson’s approaches. PurposeTo define the optimal forearm position for a safe detachment of the supinator during these approaches and to clarify their close relationship to the posterior interosseous nerve (PIN). MethodsThe study sample comprised 90 upper extremities of 45 human adult cadavers, embalmed using Thiel’s method. After detection of the radial nerve in the interval between the brachialis and brachioradialis, its pathway was traced to the Arcade of Frohse (AF). Measurements involved the distance between the AFand the radial border of the distal biceps tendon (DBT) in pronation and supination, the interval between the AF and the radiocapitellar joint space (RCJS) in supination and the radial length (RL). ResultsDistances between the DBT and the AF were significantly shorter during pronation (right side: 14.1 ± 3.4mm; left side: 13.5 ± 3.2mm) compared with supination (right side: 20.5 ± 3.6mm; left side: 19.8 ± 3.5mm) for both right and left extremities. The mean interval between the AF and the centre of the RCJS was 25.2 ± 5.9mm for the right side and 24.7 ± 5.6mm for the left side, which correlated positively with the RL. ConclusionThese results indicate a safe detachment of the supinator from the radius with the forearm placed in supination during both Henry’s and Thompson’s approaches.

Surgical Correction of Dysplastic Coxarthrosis and Endoprosthesis Replacement by TiNi-based Implants

Dysplastic coxarthrosis is predominating among children orthopedic cases and its surgical correction continues to be an urgent issue. Despite the application of advanced therapies and medical treatment, such patients constitute a significant percentage of the total patient number, i. e. from 19 to 35%. In this article a detailed literature review of surgical correction methods for missing acetabular roof by applying different implants has been described. The authors have proposed applying titanium nickelide materials in surgical correction method, as such materials possess the following properties: high corrosion stability, full compatibility with the body tissues, as well as, high porosity to provide radial border structure regeneration of the acetabular roof, which in its turn, improves the support ability of extermity. In the event of coxarthrosis progression iliac segment is reserved for the replacement.

Thoracic member (pectoral girdle and forelimb) bones of Mylodon darwinii Owen (Xenarthra, Mylodontidae) from the Late Pleistocene of Central Argentina and their phylogenetic implications

A nearly complete skeleton, including most of the thoracic member bones of the sloth Mylodon darwinii, have been found in Upper Pleistocene strata from Anisacate River, Argentina. The thoracic member bones resemble their homologues in Glossotherium robustum, Paramylodon harlani, and Mylodonopsis ibseni in the following traits: (1) the olecranon is mediolaterally compressed; (2) the radius has an acute styloid process; (3) the radial diaphysis medial border is straight for two thirds of its length; (4) the radial shaft medial border forms an angle with the medial border of the styloid process. The radius presents a distinctive, mostly proximally facing articular circumference. The unfused epiphyses and feeble muscle attachment ridges indicate a sub-adult ontogenetic stage. Deviation of the olecranon and weak M. teres major origin and insertion, suggest a low fossorial specialization. The structure of the thoracic limb bones does not support climbing habits, because pronation-related features are reduced and the humeral head is not prominent. The structure of the radius suggests graviportal adaptations: the proximal head is mediolaterally expanded and the diaphysis straight. A phylogenetic analysis adding thoracic member characters recovers M. darwinii as part of a clade that includes Glossotherium robustum and Paramylodon harlani, but excludes Lestodon armatus. This contrasts with the results of previous analyses focusing on the head skeleton, highlighting the relevance of sampling postcranial characters in phylogenetic analyses of mylodontine sloths.

Current Concepts in Radial Club Hand.

Radial club hand is a complex congenital abnormality of the radial or pre-axial border of the upper extremity. It has a wide range of phenotypes from hypoplasia of the thumb to complete absence of the radius and the first ray. Centralization with tendon transfer is a popular method for maintaining the correct position of radial club hand. On the other hand, various corrections were devised, e.g. radialization after distraction to emphasize the fact that the head of the ulna is positioned under the radial carpal bones and is no longer placed in a slot in the center of the carpus, microvascular epiphysis transfer, gradual correction using Ilizarov method, for Bayne Type III or Type IV. We should pay attention to the recurrence of radial deformity or circulatory impairment with the tension. Lunate excision or ulnar shortening can be selected for tension-free correction. Radialization can be indicated for avoiding the recurrence of radial flexion. However, we should pay attention of the radial protrusion of the ulnar head. For avoiding the recurrence of radial deformity or circulatory impairment, gradual correction using Ilizarov external fixation can be indicated, especially in the cases with severe radial deviation or with short forearm. In the mild cases, Bayne Type I or Type II, radius lengthening is accompanied by a soft-tissue distraction or release at the ulnar carpal joint with keeping wrist and forearm motion without producing growth plate damage.

Arthroscopically Assisted Transosseous Foveal Repair of Triangular Fibrocartilage Complex

The radioulnar ligament of the triangular fibrocartilage complex (TFCC), especially the deep fibers inserted at the ulnar fovea, is the key component for the distal radioulnar joint (DRUJ) stability. Traumatic injuries to the TFCC foveal insertion would cause DRUJ instability. Traditionally, arthroscopic techniques of the TFCC repair are suturing the ulnar-sided disruption peripherally to the dorsal or ulnar capsule instead of suturing the TFCC to the fovea and thus fail to restore the DRUJ stability if the TFCC is detached from the fovea. Recently, some arthroscopic foveal repair techniques have been reported using a suture anchor or transosseous sutures to address the foveal tear. This technical note describes an arthroscopic transosseous technique to reattach the foveal-disrupted TFCC. A 1.6-mm small osseous tunnel is created on the radial border of the fovea and 4 sutures are passed into the tunnel by using a 16-gauge needle. The TFCC could be sutured arthroscopically with these 4 sutures and be compressed against the fovea. Our technique provides not only a good suture construct for TFCC foveal reattachment but also an anatomic contact surface between the torn TFCC and its foveal footprint for healing. We recommend this technique as an alternative for repairing TFCC foveal tear.

Post-Traumatic Pseudoaneurysm of the Common Digital Artery in a Child.

Dear Sir, Pseudoaneurysm of the digital artery in the hand rarely occurs following hand injury. Since first described by Heuston in 1973, less than 25 cases have been described in the literature. Owing to the small caliber of digital artery, complete disruption of the digital artery is more common [1]. Hence, it is rarely suspected and misdiagnosis is common. A 15-year-old left hand dominant male was referred with increasing swelling and pain in the right palm for 3 days duration. Two weeks prior to this, he sustained a penetrating injury with a chisel in the school while doing woodwork. He attended his general practitioner on the day of injury and received wound care. He represented 2 weeks later with increasing pain and swelling, which restricted movement in the right hand. A 3 cm x 3 cm soft non-pulsatile discrete mass with surrounding ecchymosis on his right palm was identified. Mild altered sensation over the radial side of the right ring finger was elicited with palpation over the mass. Radiograph of the right hand was unremarkable. Wound exploration under general anaesthesia was performed via a limited Brunner’s incision. The swelling was identified at the level of the common digital artery supplying the third web space (ulnar and radial borders of the middle and ring fingers, respectively). The corresponding digital nerves and flexor tendon sheath were intact. A traumatic arteriotomy identified on the common digital artery was identified. The pseudoaneurysm and the traumatized vessel were isolated and excised under microscopic vision. End-to-end anastomosis of the common digital artery was performed with 9/0 Ethilon. The postoperative recovery was uneventful. Pseudoaneurysms are usually due to penetrating trauma that results in a traumatic arteriotomy. The formation of hematoma is followed by organization and subsequent recanalisation of the hematoma surrounding the injured vessel. The hematoma is eventually replaced by fibrous and scar tissue, and a false aneurysm remains. Signs of digital ischaemia may not occur in digital artery pseudoaneurysm as collateral circulation is usually sufficient. However, sensory disturbance may be present if the pseudoaneurysm is compressing the digital nerve, as presented in this case. Although one will expect to find a pulsatile mass, this does not always hold true as few cases involving non-pulsatile pseudoaneurysm has been reported in the literature [2]. Cases of pseudoaneurysm following repetitive blunt injury have also been reported, such as in baseball and softball players [1, 2]. The management of a pseudoaneurysm varied in the literature. Some authors performed ultrasonographic, CT angiography or MR angiography evaluation to define the lesion preoperatively. Excision of the pseudoaneurysm is always recommended and ligation of the affected artery is most commonly performed. When perfusion is not compromised, concern regarding long term digital cold intolerance is a motivating factor to reconstruct the digital artery. As microvascular techniques are becoming commonplace, microvascular reconstruction with end-to-end anastomosis [1], or reconstruction using a reversed interpositional vein [3] or arterial graft [4] had been described. Although pseudoaneurysm of the digital artery is rare, it should be suspected when a seemingly trivial hand injury represents with a new swelling days after the initial trauma. The pseudoanerysm must be isolated and excised, and where possible, reconstruction of the digital artery with microvascular technique is encouraged (Fig. ​(Fig.11). Fig. 1 Organised hematoma overlying the injured common digital artery and end-to-end anastomosis of the common digital artery following excision of the damaged segment

Laparoscopic Confocal Laser Microscopy Without Fluorescent Injection: A Pilot Ex Vivo Study in Colon Cancer.

Introduction Histological analysis of surgical specimen is the gold standard for cancer classification. In particular, frozen histological diagnosis of vague peritoneal spots or uncertain excision of tumors plays a crucial role for proceeding with or without change of the operation procedure. Confocal laser microscopy (CLM) enables in vivo and real-time high-resolution tissue analysis. To evaluate a novel technique of CLM without any fluorescent dye, this pilot ex vivo study demonstrates a CLM camera device for minimal invasive surgical approach. Methods In 5 cases, a laparoscopic CLM camera was used for examining colon and rectum specimen. Images of nonmalignant and malignant intestinal mucosa were characterized in terms of specific signal-patterns. No fluorescent dye was used. Correlations to findings in conventional histology were systematically recorded and described. Results Using this CLM camera device, it is possible to analyze colon specimen mucosa. Nonmalignant and malignant intestinal mucosa show specific signal patterns. Nonmalignant mucosa is defined by honeycomb structure. There is deregulated structure in colon and rectum carcinoma mucosa. The inside lumen is irregular. The radial border appears swollen with reduced contrast. Discussion This pilot study shows that the assessment of colon mucosa with a prototype of CLM camera for minimally invasive surgical approach without any fluorescent dye is feasible. It is possible to differentiate between benign and malignant mucosa in colon specimen by easy to evaluate and reproducible parameters. These first steps of this pioneering achievement to establish CLM in minimal invasive surgical procedures show a great potential for a more reliable intraoperative evaluation of suspect foci.

Anatomical study of variations of musculocutaneous nerve

Abstract Background and aim: The musculocutaneous nerve is responsible for the innervation of the flex or musculature of the elbow and the skin sensitivity from elbow to wrist by an anterior and posterior branch along the radial border of the forearm Variation in the origin, course, branching pattern and termination of musculocutaneous nerve in the arm has been often reported earlier and the present study about the variations of musculocutaneous nerve was carried out to identity more such variations in South Indian Subjects. Materials and methods: The study was carried out on 40 formalin preserved cadavers i.e. 80 upper limbs. Results: Variations were found in four separate limbs, in two limbs the musculocutaneous nerve was absent (2.5%), in one limb there was a distal communication between musculocutaneous nerve and median nerve associated with the three - headed biceps muscle (1.25%) and in one limb the musculocutaneous nerve neither pierced the coracobrachialis nor had any communication with median nerve (1.25%). Conclusion: Such anatomical variations in musculocutaneous nerve would be of value to the practicing neurosurgeons, orthopedic surgeons, anesthetists during surgical procedures including brachial plexus block.

Endoscopic Compared with Open Operative Treatment of Carpal Tunnel Syndrome.

Carpal tunnel syndrome is the most common peripheral nerve compression syndrome. Treatment options include wrist-neutral bracing, corticosteroid injections, operative release of the transverse carpal ligament, and symptom-relief options. Endoscopic carpal tunnel release may give patients a faster recovery compared with traditional open release, but there are no ultimate differences in outcome among the various surgical options.

Relation of Lateral Antebrachial Cutaneous Nerve to the Volar Approach to Distal Radius.

The anatomy of the lateral antebrachial cutaneous nerve (LABCN) in relation to volar approaches to the distal radius is not well visited. With the increasing popularity of distal radius fracture fixation with volar locking plates, it is prudent to study the innervation pattern of the LABCN to minimize the risk of nerve injury. Ten cadaveric distal radial forearms were dissected to study the relationship between the LABCN, flexor carpi radialis (FCR), superficial branch of radial nerve (SBRN), and scaphoid tubercle (ST). The LABCN coursed closer to the FCR than the SBRN, with branches traversing the tendon in two specimens. The LABCN was also noted to be intimately related to the radial artery, with an average distance of the LABCN from the lateral border of FCR was 6.4mm distally and 9.6mm proximally. There is a sparsely innervated corridor between the radial border of the FCR and terminal branches of the LABCN that provides safe access for volar approach to the distal radius.

Sex Determination Using Finger Print Ridge Density among the Medical Students of NIMS Medical College, Jaipur

To determine the sex of an individual plays an important role among forensic pathologists and scientists particularly when the fingerprints recovered from the crime scene does not match any of the criminal record so in that case fingerprint ridge density plays an important role in determining the sex of an individual. The present study was done among the 100 medical students of NIMS Medical college (50 males and 50 females) shobha nagar, Jaipur. Finger ridge density was counted on the radial border of each print. Result of the study shows that females have higher number of finger ridge density count as compared to males. Application of Baye's theorem suggests that finger print ridge density count 14ridges/25mm2 is more likely to be female.

A Brachioradialis Splitting Approach Sparing the Pronator Quadratus for Volar Plating of the Distal Radius.

Fractures of the distal radius account for up to 15% of all extremity fractures. Volar plating has become more popular, as it allows locking plate technology to be applied. Traditionally, access to the volar radius has been achieved through the approach of Henry using the interval between flexor carpi radialis and the radial artery, involving incising the radial border of the pronator quadratus (PQ). With this approach, PQ repair is difficult, and when attempted is often incomplete or tenuous, as it is a direct muscle-to-muscle repair. Theoretical advantages of repairing the PQ include the provision of plate coverage, a protective gliding layer, a well-vascularized coverage of the fracture fragments, and a protective barrier against deep infection in the case of superficial infection. Techniques have been developed to try and improve on the Henry approach. We have developed a surgical approach to volar plating that utilizes the anatomic relationship between brachioradialis and PQ in a way that allows simple and stable reattachment of the PQ muscle. We have termed the technique the "Brachioradialis splitting" approach. We present it here.

Determination of the Central Axis of the Scaphoid.

Purpose Determine the central axis of the scaphoid and its relation to surrounding anatomic landmarks to facilitate internal fixation of the scaphoid. Methods Seventeen cadaveric dissections of the wrist were performed. Measurements of the height and width of the proximal pole, waist, and distal pole were made. The midpoint of the height and width of each measurement were plotted on a scatter plot graph and a forecast line was developed. The formula of the resultant line was used to calculate the position of the central axis at the proximal pole, waist, and distal pole. The inverse tangent of the slope of the line was then used to determine the angle of the line from proximal to distal. Results The average central axis fell along a line measuring at points from the ulnar to the radial border and from the dorsal to the volar border of the proximal pole, waist, and distal pole at 7.86 mm, 7.61 mm, and 7.31 mm respectively; an angle of 13.78 degrees from ulnar to radial and dorsal to volar. The proximal point can be determined by measuring ∼44 mm radially from the ulnar styloid along the watershed line of the radius and 14 mm volar from the dorsal tip of the Lister tubercle. The distal point can be determined by measuring ∼4 mm ulnar from a line extending distally from the volar radial corner, and 7 mm volar from the most dorsal point of the combined surface of the trapezium and triquetrum. No significant difference existed between male and female specimens. Conclusions The central axis of the scaphoid can be described to exist along a line extending from the relative central point of the proximal pole, measured 7.86 mm radial from the scapholunate ligament and 8.31 mm volar of the most dorsal point; through the waist, and extending to the relative central point of the distal pole measured 3.77 mm ulnar of the volar radial corner and 7.36 mm volar of the most dorsal point at an angle directed radially and volarly at 13.78 degrees. Level of Evidence Level III Type of Study Diagnostic/ therapeutic.

Effect of fixing distal radius fracture with volar locking palmar plates while preserving pronator quadratus

Background L-shaped incision of pronator quadratus (PQ) muscle along its radial and distal borders was always taken for distal radius fractures reduction and internal fixation. Repair of the PQ muscle was always recommended at the end of operation for some instructive reasons. But repair of PQ is not satisfied because of poor quality of muscle and fascial tissues which may cause pain or impede forearm pronation and supination for post-operative scarring around PQ. Inserting the locking palmar plate to pass under the pronator quadratus muscle and the locking screws are inserted through miniincisions in pronator quadratus in some patients with distal radius fractures is a reasonable technique which can preserve the pronator quadratus. The purpose of this study was to evaluate and compare the clinical effects after volar plating of the distal radius fractures while preserving the pronator quadratus and pronator quadratus repair. Methods Between September 2010 and April 2012, 65 patients (42 males and 23 females; aged 20-68 years and a mean age of 42.5 years) with distal radius fracture underwent open reduction and internal fixation using the volar locking palmar plates (Depuy or Smith companies). The patients were classified as 23A-2 through 23C-3 according to the Orthopaedic Trauma Association (OTA) classifications. All surgeries were completed by the same trained team. The volar locking palmar plates of distal radius performed with preserving pronator quadratus group involved 30 patients including 19 males and 11 females and performed with pronator quadratus repair group involved 35 patients including 23 males and 12 females. We compared the two groups for wrist pain, forearm range of motion, grip strength, perioperative complications and wrist functional recovery score. Results The minimum follow-up for the whole cohort was one year. The differences between the two groups were significant with regard to wrist pain, forearm range of motion, grip strength and wrist function at 1, 2, and 6 weeks postoperatively, but insignificant at 6 and 12 months postoperatively. No significant differences were found in the perioperative complications and radiographs postoperatively. Conclusions Preservation of the pronator quadratus muscle is a satisfactory method for the treatment of majority of the fractures of the distal radius with volar locking palmar plates, as this technique can yield better early wrist function and shorten the rehabilitation.

Anatomical landmarks for safer carpal tunnel decompression: an experimental cadaveric study

BackgroundCarpal tunnel syndrome is a common presentation to surgical outpatient clinics. Treatment of carpal tunnel syndrome involves surgical division of the flexor retinaculum. Palmar and recurrent branches of the median nerve as well as the superficial palmar arch are at risk of damage.MethodologyThirteen cadavers of Sri Lankan nationality were selected. Cadavers with deformed or damaged hands were excluded. All selected cadavers were preserved with the conventional arterial method using formalin as the main preservative. Both hands of the cadavers were placed in the anatomical position and dissected carefully. We took pre- determined measurements using a vernier caliper. We hypothesized that the structures at risk during carpal tunnel decompression such as recurrent branch of the median nerve and superficial palmar arch can be protected if simple anatomical landmarks are identified. We also hypothesized that an avascular area exists in the flexor retinaculum, identification of which facilitates safe dissection with minimal intra operative bleeding. Therefore we attempted to characterize the anatomical extent of such an avascular area as well as anatomical landmarks for a safer carpal tunnel decompression.Ethical clearance was obtained for the study.ResultsIn a majority of specimens the recurrent branch was a single trunk (n =20, 76.9%). Similarly 84.6% (n = 22) were extra ligamentous in location. Mean distance from the distal border of the TCL to the recurrent branch was 7.75 mm. Mean distance from the distal border of TCL to the superficial palmar arch was 11.48 mm. Mean length of the flexor retinaculum, as measured along the incision, was 27.00 mm. Mean proximal and distal width of the avascular area on TCL was 11.10 mm and 7.09 mm respectively.ConclusionWe recommend incision along the radial border of the extended ring finger for carpal tunnel decompression. Extending the incision more than 8.16 mm proximally and 7.75 mm distally from the corresponding borders of the TCL should be avoided. Incision should be kept to a mean length of 27.0 mm, which corresponds to the length of TCL along the above axis. We also propose an avascular area along the TCL, identification of which minimizes blood loss.

Radiographic assessment of ligamentous injuries in distal radius fractures after open reduction and internal fixation

Concomitant ligamentous injury in distal radius fractures (DRF) may explain continued pain following surgery. The purpose of this study was to compare radiographic measurements assessing scaphoid translation in DRF after reduction, to measurements performed on normal radiographs. This may allow noninvasive evaluation of radiocarpal ligamentous integrity. Fifty postoperative radiographs were evaluated. The distance between the ulnar border of the radial styloid and the radial border of the scaphoid was measured midway between the styloid tip and scaphoid base, and then divided by scaphoid width at the same level. The measured ratios were compared to previously established normal data, established radiographic measurements of fracture reduction, fracture characteristics and fixation methods. Radiographic scaphoid position measurements differed significantly from normals (p = 0.0001). Fracture characteristics, surgical difficulty, and technique were not associated with scaphoid position. Despite accurate surgical reduction, abnormal positioning of the scaphoid may persist. This may reflect ligamentous injury, which generates suboptimal clinical results. Identifying and addressing ligamentous injury during surgery may prevent the development of instability and improve outcome after DRF.

Superficial radial nerve–lateral antebrachial cutaneous nerve anatomic variation

IntroductionThis study focuses on an anatomic variation in which the lateral antebrachial cutaneous nerve (LACN) innervates the radial border of the dorsum of the hand and thumb in addition to, or replacing, the superficial radial nerve (RSN). Here, we propose a technique of nerve conduction that identifies this variation.MethodsWe studied nerve conduction in 200 upper limbs of two series of 50 volunteers. We sought evidence of the aforementioned variation on the dorsum of the hand and in the thumb.ResultsWe found eight occurrences of this variation on the dorsum of the hand and 11 variants on the thumb within the two respective series of 100 upper limbs studied.DiscussionThe RSN–LACN anatomic variation can be studied using nerve conduction. The knowledge of this variation is particularly important for the evaluation of proximal radial nerve injury.

English

INTRODUCTION: Giant cell tumours of the tendon sheath are the second commonest tumours of the hand after ganglion cysts. Usually they involve volar aspect of the proximal interphalangeal joint of fingers. Here is a case where dorsal aspect of the distal interphalangeal joint of the middle finger is involved which is a rare presentation. CASE DETAILS: 47 yrs male patient came with swelling in the middle finger of left hand since two years, examination of it reveals 2.5x2 cm firm lobulated swelling adherent to underlying tissues, skin over it is free from the swelling. X- ray examination reveals rounded soft tissue shadow with erosion of the dorsal surface and radial border of the distal phalanx. It was treated with marginal excision of the tumour and a part of tendon sheath. Histopathological examination confirms the diagnosis of giant cell tumour of the tendon sheath. CONCLUSION: Giant cell tumour of tendon sheath involving the dorsal aspect of the distal interphalangeal joint of the fingers is rare. Radiologically it produces bone erosion. Involving the dorsal aspect, distal interphalangeal joint and erosion of bone in X-ray are the factors for the high recurrence rate. Surgical marginal excision is the treatment of choice.

Hand Surface Landmarks and Measurements in the Treatment of Trigger Thumb

To determine hand surface landmarks and measurements that may be useful in localizing the A1 pulley and digital neurovascular structures in the treatment of trigger thumb. We highlighted 4 surface landmarks in 20 adult cadaveric hands: the radial border of the index finger, the ulnar border of the thumb, the thumb interphalangeal joint flexion creases, and the thumb metacarpophalangeal joint creases. We injected the radial arteries with red latex and dissected the thumbs. The proximal margin of the A1 pulley was located an average of 0.3 mm proximal (range, 3.2 mm proximal to 2.3 mm distal) to the most proximal metacarpophalangeal joint flexion crease. The ratio of measurements from the thumb tip to the midpoint of the interphalangeal joint flexion creases and from this point to the proximal margin of the A1 pulley averaged 1.1:1. The radial digital nerve crossed obliquely over the flexor pollicis longus tendon and approached the proximal margin of the A1 pulley at a mean distance of 2.7 mm (range, 0-12.9 mm). The ulnar digital nerve was located deep to intersecting lines drawn along the radial border of the index finger and the ulnar border of the thumb and coursed parallel to the A1 pulley at a mean distance of 5.4 mm (range, 0-11.1 mm). At the level of the A1 pulley, the digital arteries were positioned dorsal to the digital nerves, and both nerves were located 1.0 to 4.2 mm from the skin surface. The findings from our study clarify hand surface landmarks in localizing the thumb A1 pulley and digital neurovascular structures. Awareness of topographical landmarks in localizing the A1 pulley and digital neurovascular structures and the relationships between the digital neurovascular structures and the A1 pulley may improve the safety and efficacy of trigger thumb treatment.

Die dorsale Kapseldoppelung zur Therapie der dorsalen Instabilität des distalen Radioulnargelenks

To stabilize the distal radioulnar joint (DRUJ) by performing dorsal capsular imbrication in patients presenting with dorsal instability. The goal was to reduce pain and prevent the occurrence of posttraumatic arthrosis. Posttraumatic dorsal instability of the DRUJ with missing block while performing translational activities in the DRUJ or subluxation while actively rotating the forearm. Cases, in which other stabilizing techniques, such as, sutures of the triangular fibrocartilage complex failed. DRUJ arthrosis, previous surgical interventions to the capsule area of the DRUJ, instabilities due to osseous reasons (malposition or pseudarthrosis) should already have been treated. Dorsal approach and opening of the 5th extensor compartment to expose the dorsal joint capsule. A longitudinal division of the capsule was performed and sufficient tissue on the radial and ulnar border was retained to ensure a solid suture technique. Then 2 U-shaped sutures using FiberWire suture material were made. Correction of the malposition and repositioning the forearm into supination. Tightening of the prepared capsule sutures and closing of the retinaculum with a resorbable suture. Patients wore a long-arm cast with the forearm being in supination for a period of 4 weeks. Following cast removal, patients wore a forearm splint for a period of 4 weeks to limit forearm pronation/supination at 45°. Full load on the wrist was allowed after 12 weeks. The subjective and functional outcomes of 20 patients having received capsular imbrication using this technique were good and entailed no significant complications. The postoperative DASH was 15.8 points. Of the 20 patients, 17 patients (85%) had a reduction of pain. Symptoms of DRUJ instability could be reduced in 18 patients (90%). Pronation/supination of the wrist was not restricted postoperatively.