Short Arm Splint Research Articles

The role of arthroscopic triangular fibrocartilage complex repair in a case of bilateral Galeazzi fracture-dislocation

This report presents the case of a 23-year-old man with bilateral distal one-third radial shaft fractures and associated distal radioulnar joint disruption, known as Galeazzi fractures, resulting from a fall from a kickboard. After open reduction and plate internal fixation for both radial shafts, the radioulnar joints remained unstable on both sides. We performed arthroscopic repair of the triangular fibrocartilage complex on the left side and used a short arm splint to immobilize the right side. At the 6-month postoperative follow-up, the patient reported mild stiffness in the left wrist, although both sides showed a full range of motion and distal radioulnar joint stability. In conclusion, when achieving anatomic reduction and stable fixation of the radial shaft in a Galeazzi fracture, favorable results can be achieved without additional surgical treatment, even if the distal radioulnar joint is unstable during surgery.

Primary Arthroscopy-Assisted Foveal Repair of Triangular Fibrocartilage Complex Associated with Acute Distal Radius Fractures in Young Adults

Abstract Background In distal radius fractures (DRFs) occurring in nonosteoporotic age groups, it is known that triangular fibrocartilage complex (TFCC) injuries are frequently combined, with some experiencing persistent symptomatic instability. However, a gold standard treatment for these associated lesions has not yet been established. Purpose Our purpose was to investigate the outcomes of primary arthroscopy-assisted transosseous foveal repair of the TFCC associated with DRFs in young adults. Methods Fifteen patients aged <65 years who underwent open reduction and internal fixation for DRF and arthroscopy-assisted repair for foveal tear of the TFCC were included. Those patients were observed to have complete peripheral TFCC tear on preoperative wrist magnetic resonance imaging and intraoperative distal radioulnar joint (DRUJ) stability tests. This was confirmed with an arthroscopic examination. The transosseous technique was used to repair the TFCC after firm fixation of the DRF. The patients were immobilized with the long-arm splint in a neutral position for 2 weeks postoperatively and a removable short-arm splint was applied for another 2 weeks. DRUJ stability, grip strength, and patient-reported outcomes, including disabilities of the arm, shoulder, and hand (DASH) and Patient-Rated Wrist Evaluation scores, were evaluated as primary outcomes at 3, 6, and 12 months postoperatively. Results All patients showed a stable DRUJ throughout the follow-up period. The average grip strength ratio compared to the unaffected side was 69, 83, and 90% at 3, 6, and 12 months after surgery, respectively. The mean DASH score was 26.9, 18.4, and 6.7 at 3, 6, and 12 months postoperatively, respectively. Conclusion Primary arthroscopy-assisted transosseous foveal repair of the TFCC with internal fixation of the distal radius resulted in early recovery and good clinical outcomes in young patients. Level of evidence Therapeutic, level IV.

Does Immobilization of Distal Radius Torus Fractures Affect Treatment Outcome?

The aim of this study is to compare the clinical results of splint, short arm circular plaster, and soft bandage immobilization methods applied in the treatment of wrist torus fractures in a single center. Patients treated for torus fractures at a tertiary trauma hospital between January 2018 and January 2022 were analyzed retrospectively. According to the physician's preference, a splint, short arm circular plaster, or soft bandage was applied to each patient. The treatment modalities, the number of hospital admissions during the treatment, the number of radiological imaging procedures used during the treatment, immobilization time, and the follow-up periods of the patients were checked and noted on the hospital data processing system. Six hundred ten patients were included in the study. It was determined that 351 patients were treated with a short arm splint, 155 with a short arm circular cast, and 104 with soft bandaging. The number of radiological imaging procedures, the number of hospital admissions during the treatment, the duration of the pain complaint, and the complication rate of the patients treated with splint were significantly lower than the groups treated with short arm circular plaster and soft bandage (P < 0.001). It was observed that patients who were immobilized with a short arm splint required less follow-up time and fewer imaging procedures and hospital admissions and experienced earlier pain relief and lower complication rates. We think that the use of short arm splints in the treatment of torus fractures is sufficient, safe, and advantageous.

Arthroscopic Management of the Hamate Proximal Pole Arthrosis.

In this retrospective study, all patients with arthrosis of the proximal pole of the hamate encountered in a 10-year period treated with arthroscopy were reviewed. Patient demographics, arthroscopic details, associated injuries, and procedures were reviewed. Functional and patient-reported clinical outcomes after arthroscopic osteochondroplasty were analyzed. An analysis of 39 patients who underwent arthroscopic osteochondroplasty showed a type II lunate prevalence of 87.2%. On wrist arthroscopy, a triangular fibrocartilaginous complex tear was the most common diagnosis (64.1%), followed by scapholunate ligament tear (61.5%) and lunotriquetral ligament tear (35.9%). All patients were managed arthroscopically with 100% procedural success. Average follow-up of 42.8 ± 37.7 months showed statistically significant improvements in the visual analog score and Mayo wrist score postoperatively (P < 0.01). Three patients (7.7%) failed the procedure at a mean of 23 ± 31.4 months. Risk factors for salvage operations were nondominant wrist involvement 100% (P = 0.04), lunotriquetral ligament injury 100% (P = 0.04), the absence of triangular fibrocartilaginous complex injury 100% (P = 0.04), and the presence of scapholunate advanced collapse 100% (P < 0.01). Wrist arthroscopy is valuable for accurately diagnosing and treating hamate arthrosis and identifying a wide variety of pathologies associated. This study showed arthroscopic osteochondroplasty produced satisfactory clinical results. Furthermore, the presence of scapholunate advanced collapse wrist offers its prognostic value in determining treatment failure.

Özel Radyografi Bulgusu ile Bilateral Triquetrum Kırığı

A 44-year-old male patient presented to the emergency department with pain in both wrists because of falling. It was learned that both wrists of the patient were in dorsiflexion while falling, and there was no additional injury. The Glasgow coma scale score was 15; vital values were within normal limits. The patient had bilateral wrist tenderness, pain with ulnar deviation, and edema on the dorsal side. In addition, he had pain with palpation of the left snuff box. Examinations of the ulnar and radial nerves and arteries were normal. X-rays showed a triquetrum fracture in the right hand, and a triquetrum and scaphoid fracture in the left hand. While triquetrum fractures were not apparent on anterior-posterior radiographs, they were clearly visible on both lateral radiographs (Figure 1). With a short-arm splint for the right hand and a scaphoid cast for the left hand, the patient recovered without sequelae after 6 weeks of wrist immobilization.&#x0D; Triquetrum fractures are generally classified as dorsal cortex fractures and body fractures. Dorsal cortex fractures are more common and are usually seen as avulsion fractures. They occur with trauma, especially in the form of falling with wrist dorsiflexion. Our patient also fell with the same mechanism. To diagnose triquetrum fractures, lateral and oblique radiographs should be performed in addition to anterior-posterior radiographs. In particular, dorsal cortex fractures may not be visible on the anteroposterior radiograph, while the avulsion fragment is better seen on the lateral radiograph. The appearance of triquetral fractures on the lateral radiograph is called the "pooping duck sign" because of the typical shape it forms with the scaphoid and lunate bone (Figure 2). In our case, although both triquetrum fractures could not be clearly seen on the anterior-posterior radiograph, they were seen more clearly with typical findings on the lateral radiograph. Triquetrum fractures are typical of carpal bone fractures, which can be seen more prominently on lateral radiographs, and knowing the specific finding on the lateral radiograph may help with the diagnosis.

Application of Simulated Arms with Real-Time Pressure Monitor in Casting and Splinting by Physiological Sensors.

In the real condition, the small sensor found it difficult to detect the position of the pressure sore because of casting displacement clinically. The large sensor will detect the incorrect pressure value due to wrinkles without close to arm. Hence, we developed a simulated arm with physiological sensors combined with an APP and a cloud storage system to detect skin pressure in real time when applying a short arm cast or splint. The participants can apply a short arm cast or splint on the simulative arm and the pressure in the cast or splint could be immediately displaced on the mobile application. The difference of pressure values from six pressure detection points of the simulated arm between the intern and the attending physician with 20-year working experience were 22.8%, −7.3%, 25.0%, 8.6%, 38.2%, 49.6%, respectively. It showed that the difference of pressure values in two farthest points, such as radius stab and ulnar styloid, was maximal. The pressures on the skin surface of the short arm cast were within acceptable range. Doctors would obtain reliable reference data and instantly understand the tightness of the swathed cast which would enable them to adjust it at any time to avoid complications.

Predictors for poor outcome for conservatively treated traumatic triangular fibrocartilage complex tears.

The primary aim of this study was to assess if traumatic triangular fibrocartilage complex (TFCC) tears can be treated successfully with immobilization alone. Our secondary aims were to identify clinical factors that may predict a poor prognosis. This was a retrospective analysis of 89 wrists in 88 patients between January 2015 and January 2019. All patients were managed conservatively initially with either a short-arm or above-elbow custom-moulded thermoplastic splint for six weeks. Outcome measures recorded included a visual analogue scale for pain, Patient-Rated Wrist Evaluation, Disabilities of the Arm, Shoulder and Hand score, and the modified Mayo Wrist Score (MMWS). Patients were considered to have had a poor outcome if their final MMWS was less than 80 points, or if they required eventual surgical intervention. Univariate and logistic regression analyses were used to identify independent predictors for a poor outcome. In total, 76% of wrists (42/55) treated with an above-elbow splint had a good outcome, compared to only 29% (10/34) with a short-arm splint (p < 0.001). The presence of a complete foveal TFCC tear (p = 0.009) and a dorsally subluxated distal radioulnar joint (DRUJ) (p = 0.032) were significantly associated with a poor outcome on univariate analysis. Sex, age, energy of injury, hand dominance, manual occupation, ulnar variance, and a delay in initial treatment demonstrated no significant association. Multiple logistic regression revealed that short-arm immobilization (p < 0.001) and DRUJ subluxation (p = 0.020) were significant independent predictive factors of an eventual poor outcome. Nonoperative management of traumatic TFCC injuries with above-elbow immobilization is a viable treatment method, particularly in patients without DRUJ subluxation. Early surgery should be considered for patients with dorsal ulnar subluxation treated with short-arm splints to prevent prolonged morbidity. Cite this article: Bone Joint J2021;103-B(8):1386-1391.

Efficacy of Half-length vs. Standard-sized Short Arm splint in Soft Tissue Injuries of the Hand and Wrist: a Randomized Controlled Trial.

Introduction:Hand and wrist soft tissue injuries are common orthopedic problems that are traditionally treated with short arm splint, which covers the forearm to 1 cm distal to the elbow crease. Objective:The present study was conducted to compare the treatment efficacy of traditional standard-size splint with half-length short arm splint. Method:In this randomized, controlled, clinical trial, patients with hand and wrist soft tissue injuries were randomly assigned to two groups. Group one received standard-sized short arm splints and the other group received half-length short arm splints. The swelling and pain scores were compared between the groups by the end of weeks one, two and three.Results:A total of 256 patients with a mean age of 36.96 ± 12.27 years were enrolled in this study, and 71.9% of them were male. No statistically significant differences were observed in terms of swelling between the two groups after one and two weeks (P=0.41, P=0.18). None of the patients had swelling after three weeks. No statistically significant differences were observed between the two groups in terms of the pain score after one, two and three weeks (P=0.47, P=0.29, P=0.92).Conclusion:In this study, half-length short arm splints were found to be as effective as standard short arm splints.

Single-Centered; Social Media Sharing After Cast and Splint Application of Orthopedic Patients

Objective: Using orthopedic splint and cast is a basic orthopedic treatment method after orthopedic fracture, dislocation and soft tissue injury. We want to examine the sharing of these orthopedic practices in social media areas and their results. Method: in a single-centered study; we asked about face-to-face questions at the controls of the patients who suffered from cast and splint. Patients were asked questions before we prepared. Results: 105 patients who participated in the study 61 were male (58.1%) and 44 were female (41.9%). The mean age of patients was 14.5 ± 42.2 years.35 patients had distal radius fracture and had short arm cast,42 patient had ankle soft tissue injury and had short leg splint,6 patient had ankle fracture and had short leg cast,20 patient had boxer fracture and had short arm splint,2 patient had humerus shaft fracture and had long arm cast.56(53.3%) patients had social media account. Thirty-two (57.1%) of the 56 patients shared cast and splint in the official social media. Conclusion: increasing use of social media and orthopedic treatments such as cast, and splint are shared in social media, unnecessary splint application is requested from patients. Some of the patients comes in control in a later date late due to social media sharing.

A novel surgical approach for treating distal radial extraarticular malunion: Oblique osteotomy with buttress plate stabilization.

Distal radial extraarticular malunions are not uncommon. However, requirements of surgical correction depend on multiple conditions. Traditionally, surgical techniques include closing or opening wedge osteotomies. Each has unique advantages and disadvantages. An oblique osteotomy was developed to simplify the revision surgery. Forty-eight consecutive adult patients with 48 malunions were surgically treated. An oblique osteotomy of 45° vertical to the radial longitudinal axis was performed from medio-distally to latero-proximally. Consequently, the osteotomized fragments were compressed with a bone clamp. The proximal part of the distal fragment was pushed backward to correct the dorsal tilt. A 7-hole buttress plate was inserted volarly and cancellous bone graft was packed. Postoperatively, a short-arm splint or brace without restriction of all five metacarpophalangeal joints was applied for 6 weeks. Forty-one patients were followed for an average of 2.8 years (range, 1.1-5.8 years). All malunions healed within 6 weeks. The union rate was 100% and no complications occurred. Radiographically, ulnar variance, volar tilt of radial articulation, and radial inclination restored to acceptable criteria in all patients. Patients with Modified Mayo Wrist Score (MMWS) improved from 17% to 80% ( p < 0.001) and Disability of Arm, Shoulder and Hand (DASH) Score improved from 0% to 80% ( p < 0.001). The relationship between MMWS and DASH Score was highly correlated (correlation coefficient = -0.90). The described approach may be an excellent alternative for treating distal radial extraarticular malunions. The technique is not difficult but the satisfactory rate is high.

The effects of below-elbow immobilization on driving performance

IntroductionThere is limited research to guide physicians and patients in deciding whether it is safe to drive while wearing various forms of upper extremity immobilization. The purpose of this study is to evaluate the effect of below-elbow removable splints and fiberglass casts on automobile driving performance. Methods20 healthy subjects completed 10 runs through a closed, cone-marked driving course while wearing a randomized sequence of four different types of immobilization on each extremity (short arm thumb spica fiberglass cast, short arm fiberglass cast, short arm thumb spica splint, and short arm wrist splint). The first and last driving runs were without immobilization and served as controls. Performance was measured based on evaluation by a certified driving instructor (pass/fail scoring), cones hit, run time, and subject-perceived driving difficulty (1–10 analogue scoring). ResultsThe greatest number of instructor-scored failures occurred while immobilized in right arm spica casts (n=6; p=0.02) and left arm spica casts (n=5; p=0.049). The right arm spica cast had the highest subject-perceived difficulty (5.2±1.9; p<0.001). All forms of immobilization had significantly increased perceived difficulty compared to control, except for the left short arm splint (2.5±1.6; p>0.05). There was no significant difference in number of cones hit or driving time between control runs and runs with any type of immobilization. ConclusionsDrivers should use caution when wearing any of the forms of upper extremity immobilization tested in this study. All forms of immobilization, with exception of the left short arm splint significantly increased perceived driving difficulty. However, only the fiberglass spica casts (both left and right arm), significantly increased drive run failures due to loss of vehicle control. We recommend against driving when wearing a below-elbow fiberglass spica cast on either extremity.

Isolated Fracture of the Trapezoid. A Rare Injury.

Dear Sir, Trauma to the wrist can result in carpal bone fractures that are not always apparent on initial radiographic examination. Fractures of the trapezoid bone are the rarest of carpal fractures, with only a few reported cases in the published literature. We present a case of isolated fracture of the trapezoid that was managed conservatively and had a full functional recovery. A 20 year old male presented to the Emergency Department reporting having a car door accidentally close against the back of his wrist a few hours prior. The patient presented with localized edema and tenderness proximal to the base of the 2nd metacarpal. Radiographic evaluation was normal. Nonetheless some suspicion remained that an occult fracture of either a carpal bone or the base of the 2nd metacarpal was present. A CT scan of the wrist was obtained, which revealed a minimally displaced fracture of the trapezoid extending in the axial plane (Fig. 1). The patient was placed in a short arm splint for 6 weeks. At the follow – up visit, the pain had subsided and the edema had completely resolved, albeit some wrist stiffness was present. A new CT scan was obtained at that time, which demonstrated near complete union of the fractured parts. After a 2 week self-exercise program for the stiffness the patient was completely symptom free. At 1 year, he remains symptom free and reports being entirely satisfied with the outcome. Fig. 1 Axial thin slice (1 mm) CT demonstrating the fracture line through the trapezoid bone The trapezoid is the least commonly fractured carpal bone, with the literature containing only a few case reports and case series. These fractures can occur in isolation or in combination with other injuries to the carpus or metacarpals. Most authors describe the mechanism of injury to be either an axial loading or bending force through the 2nd metacarpal [1, 2] or a direct blow to the wrist [2]. The presentation is typically that of pain and tenderness at the base of the 2nd metacarpal. Initial radiography is invariably normal, and diagnosis was made through the use of CT [1, 2], MRI [3] or even technetium bone scan [3]. The ease and availability of CT scans and other advanced imaging modalities is probably the reason that these injuries are identified more frequently in recent years. The limited number of published cases prevents the recommendations regarding treatment of trapezoid fractures from carrying much power or weight. Nonetheless, the literature thus far suggests that for isolated fractures with minimal displacement, cast immobilization results in satisfactory outcomes [1]. Surgical treatment was performed for displaced fractures or for complex injuries [3]. Still, there are differences regarding type of casting (whether short -arm cast or thumb spica), length of time of immobilization, and so forth. Similarly, operative treatments were individualized based on the pattern and complexity of osseo –ligamentous injuries. Not much is known about the long –term outcomes of trapezoid fractures. Adverse outcomes of other carpal bone fractures, especially the scaphoid, such as non- union, avascular necrosis and development of arthritis are well known. In some of the cases reported in the literature so far, delayed union and non-union resulted in persistent pain [3, 4] and diminished grasp power [4]. Thus, a missed fracture could very well result in loss of function and diminished quality of life. It is only proper that in any patient with trauma to the base of the 2nd metacarpal, the appropriate mechanism of injury, or persistent pain after a period of rest and splinting that this fracture be suspected and sought after.

Acute Calcific Tendinitis in the Distal Interphalangeal Joint.

Acute calcific tendinitis is a form of acute inflammation of the tendon, causing severe pain, swelling, and limited joint motion, and is characterized by radiologic evidence of periarticular calcification. The pathogenesis is not clear, but some believe that calcification may result from tendon hypoxia or a traumatic event [1]. Although it is a self-limited disease, in which periarticular calcification is eventually found to be resolved in radiologic imaging, it is often misdiagnosed, which can lead to unnecessary surgical intervention. It occurs most frequently in the shoulder and wrist, and least frequently in the hand, especially the phalanx [2,3,4]. We encountered a rare case of acute calcific tendinitis in a postmenopausal woman in the distal interphalangeal (DIP) joint and developed an appropriate management plan based on the correct diagnosis. A 72-year-old female patient visited the emergency department due to severe pain in the left fourth finger that had developed three days previously. Simple radiography and ultrasonography were first performed, along with routine laboratory examinations, including C-reactive protein levels. A careful history was taken and a physical examination was then performed with the presumptive diagnosis of acute calcific tendinitis or gout, based on radiographic findings. The patient showed redness, swelling, and local heat and tenderness of the radial side of the DIP joint of the left fourth finger, but denied any history of trauma or other inflammatory disease. The patient's history revealed that she used the DIP joint extensively because of her occupation (operating a mill). The initial radiographs showed an ovoid calcification on the radial collateral ligament of the DIP joint of the left fourth finger (Fig. 1), and ultrasonography revealed ovoid hyperechoic calcification (Fig. 2). Her C-reactive protein level was elevated. Based on previous studies of the treatment of acute calcific tendinitis of other regions, an anesthetic agent (2% lidocaine, Huons Co., Seongnam, Korea) and a corticosteroid (Triam, Shinpoong Co., Seoul, Korea) were locally injected into the lesion [3,4]. Nonsteroidal anti-inflammatory drugs (NSAIDs) were administered to the patient, and a short arm splint was applied for immobilization. One day after conservative treatment, the symptoms were dramatically alleviated and simple radiographic findings showed that the appearance of the calcification had become mottled (Fig. 3), and the patient's C-reactive protein level decreased gradually. After one week of treatment, the patient experienced a complete resolution of pain and exhibited a full range of motion without difficulty. Follow-up radiographic findings after two months showed spontaneous resolution of the calcification (Fig. 4) [5]. Fig. 1 The initial radiographs showed an ovoid calcification on the radial collateral ligament of the distal interphalangeal joint of the left fourth finger. Fig. 2 Ultrasonography revealed ovoid hyperechoic calcification. Fig. 3 One day after conservative treatment was initiated, simple radiographic findings showed a change from an ovoid calcification to a mottled appearance, which co-occurred with the dramatic alleviation of the symptoms. Fig. 4 Follow-up radiographic findings after two months showed the spontaneous resolution of the calcification. Acute calcific tendinitis of the DIP joint is a rare condition, and, to the best of our knowledge, has not previously been reported in this anatomical location. Careful attention to the history of the patient and simple radiography helped us to diagnose this case of acute calcific tendinitis correctly. Misdiagnosis of this disease can lead to unnecessary surgical treatment and delay symptom relief. Based on reports of this condition in other regions, such as the shoulder, elbow, and wrist, conservative management with NSAIDs and a local injection of an anesthetic agent and a corticosteroid were able to relieve the symptoms dramatically in our patient. In light of our experience, acute calcific tendinitis of the hand should be considered as part of the differential diagnosis of a painful finger joint.

The Effect of Distal Location of the Volar Short Arm Splint on the Metacarpophalangeal Joint Motion.

BackgroundThe goals of this study were to compare maximal metacarpophalangeal joint (MCPJ) flexion angles after application of a volar short arm splint at 3 different locations and verify the relations between the three different physical and radiological locations.MethodsForty dominant hands of healthy subjects were analyzed in the study. We defined a transverse skin folding line as a line drawn from the radial aspect of the thenar crease to the ulnar aspect of the distal transverse palmar crease. The distal end of the volar short arm splint was applied on 3 parallel locations to this line. Location A was on this transverse skin folding line; location B was 1 cm proximal to location A; and location C was 1 cm distal to location A. Two orthopedic surgeons measured the maximal MCPJ flexion angles of each finger except the thumb with the application of a volar short arm splint at 3 different locations as well as without a splint as a control. Radiological locations of the 3 different distal ends of the volar short arm splint were also assessed by anteroposterior radiographs of the wrist.ResultsWhen the splint was applied at location A and C, the maximal MCPJ flexion angle decreased to a mean of 83° (91% of control value) and 56° (62% of control value), respectively (compared to the control, p < 0.001). At location B, the maximal MCPJ flexion angle was a mean of 90° (99% of control value); no significant difference was observed compared to the control or without the splint (p = 0.103). On radiography, the average length from the metacarpal head to the distal end of the splint at all fingers decreased in the order of location B, A, and C (29 mm, 19 mm, and 10 mm, respectively; p < 0.001).ConclusionsWe recommend applying the distal end of a volar short arm splint at proximal 1 cm to the transverse skin folding line to preserve MCPJ motion perfectly, which is located at distal 44% of the whole metacarpal bone length radiologically.

Bifid Median Nerve Complete Transection at the Wrist.

A 17-yr-old male patient was admitted with a transverse sharp transection caused by broken glass at the volar aspect of his left wrist. Clinical examination showed loss of sensation at the distribution of the median nerve to the thumb, index, and middle finger and an inability to flex the middle finger. Under regional anesthesia and a high humerus tourniquet, surgical exploration of the wound with binocular loupe magnification showed a bifid median nerve with a persistent thin median artery running between the two nerve trunks. The bifid median nerve was sharply and transversely transected, slightly proximal to the transverse carpal ligament. The palmaris longus tendon and the flexor digitorum superficialis tendon of the middle finger were also cut. The flexor digitorum tendon was sutured with a two-strand technique augmented with a running epitendinous suture. The two trunks of the bifid median nerve were repaired separately using microsurgical technique and 8-0 nylon epineural sutures. Postoperatively, the hand was immobilized in a palmar short-arm splint that was removed at 40 d. A progressive Tinel sign was evident 30 d postoperatively. At 3 mo, the patient experienced light touch sensation at the tip of the index and middle fingers. At the last follow-up, 2.5 yr after his injury, the patient has complete nerve functional recovery without atrophy of the thenar muscles and with strong thumb opposition.

K-Wire Breakage During Metalware Removal Due to a Defective K-Wire Shaft

K-Wire Breakage During Metalware Removal Due to a Defective K-Wire Shaft

Enchondroma of the Lunate

Enchondroma of the Lunate

Spontaneous Rupture of the Extensor Pollicis Longus Tendon

Spontaneous Rupture of the Extensor Pollicis Longus Tendon

Comparison of Forearm Rotation Allowed by Different Types of Upper Extremity Immobilization

The purpose of this study was to compare the active forearm pronation and supination allowed by a short arm splint, short arm cast, sugar tong splint, long arm splint, and long arm cast in normal, healthy subjects. Forty healthy, right-handed volunteers (twenty men and twenty women) with a mean age of thirty-five years (range, twenty-three to sixty-six years) were recruited. Two examiners used a goniometer developed for the study to measure the active forearm supination and pronation in each subject with and without the application of the different types of upper extremity immobilization. Forearm pronation and supination were compared among the immobilization methods and between men and women. The inter-rater reliability of the measurements was evaluated with use of the intraclass correlation coefficient. The long arm cast decreased active forearm rotation to <10% of the value with no immobilization. The short arm cast, sugar tong splint, and long arm splint decreased active forearm rotation to <40% of the baseline measurement. No significant difference in active forearm supination or pronation was observed among the short arm cast, sugar tong splint, and long arm splint in the overall study cohort or in the men. However, forearm supination and pronation in the women differed significantly between the short arm cast and both the sugar tong splint and the long arm splint. The long arm cast provided the greatest restriction of forearm rotation. Overall, no significant difference in active forearm supination or pronation was observed among the short arm cast, sugar tong splint, and long arm splint.

Treatment of Trans-Scaphoid Perilunate Dislocations Using a Volar Approach With Scaphoid Osteosynthesis and Temporary Kirschner Wire Fixation

Trans-scaphoid perilunate fracture dislocations (TSPLD) are uncommon injuries and constitute about 3% of all carpal injuries. Up to 25% of these high energy trauma cases go undiagnosed. Presented are 43 (3 female, 40 male) consecutive patients treated for dorsal TSPLD, all were closed fractures. Patients were between 17 and 66 years old. Twenty male patients were injured in active duty military service. Surgical treatment was made with a volar approach using titanium cannulated headless compression screws (3.2 mm) placed via a guide wire. Repositioning the dislocated carpus is then conducted using 3 temporary fixation Kirschner wires (1.6 mm). The patient had a volar short arm splint for 4 weeks, then given an orthosis. Triple fixation Kirschner wires were removed 6-8 weeks postoperatively. Mean followup period was 29 months (range 20-38). The average Mayo wrist score for all 43 patients is 87 (good) (range 65-99). All patients returned to their previous employment.