We aimed to devise a simple and reproducible method of shoulder strength measurement with reference to the Constant and Murley shoulder score. Fifteen male and 15 female patients were tested. The average age was 32 years. None had previous shoulder pathology. We used a simple spring balance and an electronic load cell to measure force. The system was attached to the floor and connected to the patients arm with an adjustable strap. Strength was measured at 90 degrees of flexion and abduction (in the plane of the scapula), with both dominant and non-dominant limbs. The strap was placed on the upper arm a fixed distance from the tip of the acromion. In addition measurements were taken with the strap attached at the patients wrist. Measurements were repeated after a rest period. There was no significant difference between strength measured in abduction or flexion or between dominant and non-dominant limbs. The mean measurement for females (13.38kg) is 56 of the male mean (23.92kg). The mean measurement with the strap at the wrist was 47.6 of the mean measurement with the strap on the arm for females and 56.25 for males. In their original description Constant and Murley use the method described by Moseley to measure shoulder strength. This involved the examiner pulling down on a spring balance held at arms length by the patient. The value assigned to the scale (0.5 kg scores one point to a maximum of 25) is arbitrary. By placing the strap on the upper arm the lever arm is shortened and a higher strength measurement is obtained, the position is standardised by measuring a fixed distance from the tip of the acromion. By adjusting the scoring scale accordingly a greater margin for error and thus greater accuracy and reproducibility can be obtained. In addition there is a large difference in mean strength between males and females that is not taken into account in the Constant and Murley score. A simple multiplier could be used to correct this factor. We suggest minor modifications to strength measurement for the Constant and Murley score could improve accuracy and reproducibility and correct scoring differences between the sexes

The Constant score is widely used as a measure of assessing outcome from surgery. The pre and post-operative Scores are usually compared to assess outcome. The expected Scores for an age-matched population however are not known. Patients attending fracture and general orthopaedic clinics with lower limb problems only were assessed. Age, handedness, occupation and Constant Score results were recorded. The score for differing sections of the Constant score were reviewed and analysed in combination with the above parameters. The overall Constant Score decreased with age, as one would expect. However the decrease in the strength measurement was out of all proportion to that of the remainder of the Score-79% of total strength in the under 40 year age group compared with 11.2% of total strength in the over 80 year age group. This compared with a percentage of 97.8% for the remainder of the Score in the under 40 year group compared to 70.4% in the over 80 year age group. If one is using the Constant Score as a measure of surgical outcome one should be aware of the expected age-matched figures and in particular the poor strength measurements in the older populations. We suggest that a more useful measurement would be one without strength and just score out of 75

Purpose

Handgrip dynamometry has previously been used to detect pre - operative malnutrition and predict the likelihood of post - operative complications. This study explored whether a relationship exists between pre-operative pinch and power grip strength and length of hospital stay in patients undergoing hip and knee arthroplasty. We investigated whether handgrip dynamometry could be used pre - operatively to identify patients at greater risk of longer inpatient stays.

Objectives

The aim of this study was to determine whether there is any significant difference in temporal measurements of pain, function and rates of re-tear for arthroscopic rotator cuff repair (RCR) patients compared with those patients undergoing open RCR.

Thumb Carpometacarpal (CMC) arthritis is a common pathology of the hand. Surgical treatment with thumb reconstruction is well described. Retrospective outcomes have been described for multiple techniques, suggesting patient satisfaction with multiple different techniques. The Thompson technique uses a slip of Abductor Pollicis Longus for suspension and interposition as well as excision of the trapezium. Retrospective outcomes suggest good patient satisfaction. We describe the improvement in Patient rated outcomes scores (PROS) and changes in pinch and grip strength in a prospectively collected cohort of patients treated with a modification of the Thompson technique. To assess changes in Patient-Rated Wrist Evaluation (PRWE) and Disabilities of the Arm, Shoulder, and Hand (QDASH) scores, as well as to determine the percentage of patients that surpassed the Minimal Clinically Important Difference (MCID) figure that has been described in the literature for these tests. In addition, measurements for evaluation of pinch and grip strength prior to surgery, at six, and at twelve months follow-up were done. Between June 2016 and February 2019, a consecutive prospective series of Thirty-seven LRTI procedures with APL suspension arthroplasty (Thompson technique) were performed on 34 patients with osteoarthritis of the thumb CMC joint (24 women / 13 men; age 63±8.553). All surgeries were performed by the senior surgeon. Data was collected as part of a wrist pain database. Patients failing conservative treatment and electing surgical management of thumb arthritis were enrolled into the database. Patients were evaluated pre-operatively with the PRWE and QDASH questionnaires and grip and pinch strength measurements, and postoperatively at 6 and 12 months. The MCID for QDASH and PRWE is 14 and will be evaluated at the same time points for each patient. Paired student T-test was used to determine differences in the means. Data are presented as mean ± SD unless stated otherwise. Differences with p<.05 were considered significant. Compared to the pre-operative assessment, at six months, the means of PRWE pain score and PRWE functional score decreased significantly (32.824 SD±10.721 vs. 19.265 SD±12.268 and 30.262 SD±10.050 vs. 16.431 SD± 9.697 respectively, n=34,, p<0.05). 69% of the patients surpassed the MCID of 14 six months after the surgery. In addition, QDASH mean score also dropped from 56.108 to 32.219 (SD± 21.375 n=32. p<0.05) at six months. At one year, 76% of the patients were above the MCID of 14. The mean scores of these three questionnaires did not show significant change between six and twelve months. Compared to the initial pre-operative assessment, we found no statistically significant difference in the means of grip strength, point pinch, and lateral key pinch at six and twelve months. Thumb reconstruction with APL suspension arthroplasty demonstrates significant improvement in pain and functionality. No significant improvement in grip and pinch strength is observed, even at one year postoperatively

Introduction The Constant-Murley Score is the functional score currently recommended by the British Shoulder and Elbow Society and by the European Society for Surgery of the Shoulder and Elbow. Normal Values for shoulder assessment are imperative for the diagnosis of pathology and measurement of treatment outcome. Normal values for the UK are currently not known. Several techniques have been described for the assessment for strength and measurement of this paraemeter differs between published series. Patients and method 122 patients over 50 (62 male) attended a GP surgery for a Constant Score measurement. Constant Score was assessed using three techniques for strength measurement: maximum strength with myometer (Mmax), mean strength with myometer (Mmean) and maximum strength with fixed spring balance (FSB). Results Maximum strength values measured by myometer or fixed spring balance were very similar with a mean difference of 0.5 (less than the calibration of a spring balance). Mean strength measurements were consistently lower than maximum strength measurements with a mean difference of 3 points. Age and sex both significantly affected Constant Score (P< 0.001, P< 0.001). Constant Score falls by 0.4 points per year over 50. Males have a score 8 points greater than females. Conclusions Constant Score decreases predictably with age in the UK. Methods of strength assessment are not the same. A uniform method of shoulder strength assessment or correction for method is required to allow meaningful comparisons between series

The Constant-Murley score has gained wide acceptance for evaluation of shoulder function. The strength component of the Constant score accounts for 25 out of 100 points. It has been criticized for lack of consistency in defined measurement method. The aim of this study was to evaluate the effect of various variables on the strength component measurement of the Constant score. Material & Methods We conducted a series of experiments using a digital force gauge (EZ force). We evaluated the effect of strength measurements with 1) patient in sitting & standing positions 2) strength gauge fixed to an immobile platform or hanging free fixed to the floor by the examiners foot 3) patient’s arm in 45 degrees and 90 degrees of abduction 4) plane of elevation in frontal or scapular plane and 5) patient making a fist or keeping the palm open during the test. These experiments were done in groups of 20 patients. We have compared as well this device and the Isobex Myometer. Results No statistical differences were found between individual measurements with regard to patient’s position (standing-sitting), device setting (Fixed –Hanging), position of the arm in varying degrees of abduction or the plane of elevation. Strength assessment obtained when patient made a fist compared to open palm was found to be higher (p=0.006). The measurements showed good intra-observer reliability. The readings of the EZ force and the Isobex myometer were comparable. Conclusions It seems that the shoulder strength measurements as part of the Constant functional score may be performed with the patient sitting or standing, with the arm at varying degrees of abduction and in different planes of elevation without causing any significant deviation in the measurement. No influence was found as well to the device being either fixed to an immobile platform or fixed to the floor by the examiner’s foot. These make these measurements easy to perform and reproducible using the newly designed digital force gauge (EZ force)

Purpose: It is known from previous studies that reduced grip strength is associated with tennis elbow; however; assessment of muscular strength over other parts of upper limb, particularly wrist and shoulder, has received a little or no attention in the literature. To address possible other upper extremity muscular strength weakness-imbalances in Tennis Elbow, this study aimed to investigate the strength of various upper limb muscle groups in tennis elbow patients and compare them with those of healthy subjects. Methods: A total of 32 participants were assigned into two groups of Control (N=16) and Tennis Elbow (N=16). In both groups, upper limb maximal isometric muscular of dominant and non-dominant sides was measured at various joints including metacarpophalan-geal (extension & flexion), wrist extension & flexion), grip, and shoulder (internal and external rotation and abduction) using appropriate either commercial or purpose-built dynamometers. Muscular strength and important strength ratios were analyzed and compared in each group (dominant vs non-dominant) and also between Control and Tennis Elbow group using various statistical methods. Results: Significant dominance difference was found in all strength measurements for Control group but not for Tennis Elbow group indicating a generalized and widespread upper limb muscular weakness associated with tennis elbow. In addition, significant differences were found not only for various hand strength measurements but also for shoulder strength between Control and Tennis Elbow groups (p < 0.05). Conclusion: This is the most comprehensive study of upper limb isometric muscular strength assessment in Tennis Elbow during recent years. Distributed upper limb muscle strength weakness exists in Tennis Elbow which needs to be addressed within both preventative and treatment strategies

Introduction: This study was designed to investigate which parameters of the Constant Score are most influenced by the presence of a Rotator Cuff Tear (RCT). Methods: 28 patients attending the Shoulder Clinic took part in this study for which Ethics approval had been obtained. Strength measurements were assessed in three ways: 1) maximum force using a fixed spring balance (FSB) 2) maximum force using the Nottingham Mecmesin Myometer 3) mean force during 2nd to 4th seconds using Nottingham Myometer. The CS assessor was blind to the volunteer’s history and state of their rotator cuff. Ultrasonography was used to establish the presence of a full-thickness RCT. Results: The CS values for the left and right shoulders were analysed separately. No statistically significant difference (p> 0.05) was found between shoulders with a RCT and without a RCT in the pain, ADL and ROM parameters. Left shoulders with a RCT scored significantly different strength scores to those without (p< 0.05) but this significance was not seen in the right shoulders (p> 0.05). Shoulder strength measurements were highest with the FSB and lowest when measured using the mean force. Discussion: The results obtained so far suggest that a shoulder with a full-thickness tear of the RC may obtain a significantly lower strength score than a normal shoulder. It does not suggest that any of the other three parameters of the CS can indicate the presence of a tear. Conclusion: A reduction of shoulder strength alone might be a good indicator of a full-thickness RCT. However, this study indicates the importance of standardising the method of shoulder strength assessment for the Constant Score

Objectives. To investigate the differences of open reduction and internal fixation (ORIF) of complex AO Type C distal radius fractures between two different models of a single implant type. Methods. A total of 136 patients who received either a 2.4 mm (n = 61) or 3.5 mm (n = 75) distal radius locking compression plate (LCP DR) using a volar approach were followed over two years. The main outcome measurements included motion, grip strength, pain, and the scores of Gartland and Werley, the Short-Form 36 (SF-36) and the Disabilities of the Arm, Shoulder, and Hand (DASH). Differences between the treatment groups were evaluated using regression analysis and the likelihood ratio test with significance based on the Bonferroni corrected p-value of < 0.003. Results. The groups were similar with respect to baseline and injury characteristics as well as general surgical details. The risk of experiencing a complication after ORIF with a LCP DR 2.4 mm was 18% (n = 11) compared with 11% (n = 8) after receiving a LCP DR 3.5 mm (p = 0.45). Wrist function was also similar between the cohorts based on the mean ranges of movement (all p > 0.052) and grip strength measurements relative to the contralateral healthy side (p = 0.583). In addition, DASH and SF-36 component scores as well as pain were not significantly different between the treatment groups throughout the two-year period (all p ≥ 0.005). No patient from either treatment group had a step-off > 2 mm. Conclusions. Differences in plate design do not influence the overall final outcome of fracture fixation using LCP.

This is largest collection of outcomes of distal biceps reconstruction in the literature. 8 subjects prospectively measured pre and post reconstruction Strength deficit in patients with chronic tendon deficit is described. To describe outcomes for 53 chronic distal biceps reconstructions with tendon graft. Clinical outcomes as well as strength and endurance in supination and flexion are reported. To examine eight patients measured pre- and post-reconstruction. To identify deficit in supination and flexion in chronic reconstruction. 53 reconstructions of chronic distal biceps with tendon graft were carried out between 1999 and 2015. 26 subjects agreed to undergo strength testing after minimum one year follow up. Eight subjects were tested both before and after reconstruction. Primary outcomes were strength in elbow flexion and forearm supination. Strength testing of supination and flexion included maximum isokinetic power and endurance performed on a Biodex. Clinical outcomes measures included pre-operative retraction severity, surgical fixation technique, postoperative contour, range of motion, subjective satisfaction, SF-12, DASH, MAYO elbow score, ASES and pain VAS Non-parametric data was reported as median (interquartile range), while normally-distributed data was reported as mean with 95% Confidence Limits. Hypothesis testing was performed according to two-tailed, paired t-tests. Median time from index rupture to reconstructions 9.5 (range 3–108) months. Strength measurements were completed at a median follow-up time of 29 (range 12–137) months on 26 subjects. The proportion of patients that achieved 90% strength of the contralateral limb post-reconstruction was 65% (17/26) for peak supination torque, and 62% (16/26) for peak flexion torque. Supination and flexion endurance was 90% of the contralateral arm in 81% (21/26) and 65% (17/26) of subjects, respectively. Ten subjects (39%) achieved 90% strength of the contralateral arm on at least four of five strength tests. Eight of the 26 patients were evaluated pre- and post-surgery. As compared to the contralateral limb, chronic distal biceps rupture was found to have a mean [95%CI] deficit in peak supination torque of 31.0 [21.0, 42.9]% (p=0.002). Mean deficit in peak flexion torque of 34.2 [23.1, 45.4]% (p <0.001). Reconstruction resulted in an increase in peak supination torque of 33.5 [8.7, 58.3]% (p=0.0162), increase in peak flexion torque of 35.0 [6.4, 63.6]% (p=0.023), increase in isometric strength of 57.6 [36.1, 79.1]% (p<0.001), increase in supination endurance of 0.6 [-22.2, 23.4]% (p=0.668), and a decrease in flexion endurance of 4.8 [-23.3, 13.7](p=0.478). Ninety-six percent of the patients (25/26) were satisfied, or very satisfied with the overall outcome of the surgery, while median Mayo score post-reconstruction was 100 (range: 55–100). Chronic distal biceps tendon rupture results in less supination loss and greater flexion loss than previously reported. Reconstruction with tendon graft results in a significant, but incomplete recovery of peak supination and flexion torque, but no significant change in endurance. Clinical patient satisfaction with surgical outcomes is high

Summary Statement. Bio-impedance analysis (BIA) provides a convenient method for the estimation of whole body and segmental measurement of skeletal muscle mass (SMM). BIA-measured SMM parameters may be effectively used for the normalisation of muscle strength and removing body-size dependence. Introduction. Despite an increasing interest in using bio-impedance analysis (BIA) for the estimation of segmental skeletal muscle mass (SMM); existing data is sparse. On the other hand, there is a need for better understanding of the influence of SMM on gender-related differences in muscle strength. Using BIA technique, this study aimed to measure the SMM, determine its correlation with muscle strength, and examine its relation with gender-related differences in muscle strength. Patients and Methods. Segmental and whole body SMM (3-segment electrode configuration) and maximum voluntary contraction in five distinct shoulder planes (forward flexion, abduction in scapular plane, abduction in coronal plane, and internal- and external rotation) were measured in 45 healthy participants (22 males, 23 females) with a mean age of 30.3 years. Independent t-tests and Pearson Correlation test were applied for comparative and correlational analysis, respectively. Results. All muscle-related parameters including muscle volume, SMM, and SMM index were significantly different between men and women. There was a significant gender-related difference in the absolute shoulder strength but not after normalisation to SMM. A strong correlation was found between strength and SMM and in-between strength measurements. Conclusion. BIA provided a convenient method for SMM estimation. SMM parameters may be effectively used for strength normalisation allowing comparisons of individuals with differing body masses. Strong correlations between SMM and muscle strength supported the use of BIA in assessing muscle size-strength relations and its applicability in muscle function assessments

Aims

The aim of the HIPGEN consortium is to develop the first cell therapy product for hip fracture patients using PLacental-eXpanded (PLX-PAD) stromal cells.

Summary. Arthroscopic decompression of the lunate decreases clinical symptoms and slows progression of Kienböck's Disease. Introduction. The purpose of this study was to investigate the outcomes of patients suffering from avascular necrosis of the lunate, or Kienböck's Disease, who received arthroscopic decompression to treat the ischemic lunate. Previous studies have demonstrated an elevated intraosseus pressure in the ischemic lunate, and it has been hypothesised that ischemia in the lunate is secondary to this elevated pressure and subsequent venous congestion, as opposed to diminished arterial supply. Based on this work we have used decompression of the lunate to prevent progression of the disease. Patients and Methods. 21 patients, (22 wrists), reported to a single surgeon with a chief complaint of unremitting wrist pain and the subsequent diagnosis was Kienböck's disease, stages I, II, IIIA or IIIB. Range of motion measurement and grip strength, as well as self-reported outcome measures such as Disabilities of the Arm, Shoulder and Hand (DASH) and Modified Mayo, were obtained preoperatively and post operatively at 2, 7 and 12 months. The patients were treated operatively with arthroscopic decompression of the lunate. The lunate was approached dorsally at the interosseous lunotriquetral and the scapholunate ligament areas with an arthroscopic shaver until brisk bleeding was achieved upon deflating the tourniquet. In some cases, the core of the lunate had to be penetrated with a 45 k-wire until bleeding was obtained. Of the 22 wrists treated arthroscopically with lunate decompression, 18 had both pre-surgical and post-surgical follow-up evaluations. Results. The patients who underwent lunate arthroscopic decompression surgery demonstrated a statistically significant improvement in DASH score at 7 and 12 months postoperatively (p<0.05). The preoperative DASH score average for this cohort was 51, while post-operative DASH scores averaged 23 and 17 at 7 and 12 months, respectively. The patients also demonstrated some overall improvement in pain, functionality, range of motion, and grip strength as demonstrated by the Modified Mayo wrist score. Notably, the patients demonstrated statistically significant improvement in grip strength post-operatively at 7-months (p<0.05) and 12-months (p<0.01). In addition, there was noted to be improvement in supination and ulnar deviation measurements post-operatively at 7 months and 12 months, respectively. Conclusion. This study demonstrates the clinical outcome of arthroscopic decompression of the lunate in patients suffering from Kienböck's Disease using the patient's subjective evaluations as well as range of motion and grip strength measurements. Arthroscopic decompression of the lunate decreases clinical symptoms and slows progression of Kienböck's Disease using a less invasive surgical intervention

A retrospective analysis of the treatment of distal radius fractures with an angularly stable locking plate (Matrix Plate, Stryker, UK) via a dorsal approach performed at Southend University Hospital in the United Kingdom. 91 fractures were treated over a three year period between 2004 and 2007. Dorsally angulated and displaced (including intraarticular) fractures were included. All patients commenced early mobilization without splintage on the first post-operative day. The study group consisted of 42 men and 49 women with a mean age of 63 years. The average time to follow up was 19 months (range 6–29). The average tourniquet time was 44 minutes (20–81). Assessment consisted of range of motion and grip strength measurement, Mayo wrist score, quick DASH questionnaire and Gartland and Werley scoring. Complications consisted of 1 EPL rupture and 3 patients suffered extensor irritation. To date only 5 plates (5.4%) have been removed. We demonstrate that dorsal plating using a low profile, angularly stable plate produces comparable results to volar plating. The combination of a low profile, angular stable plate, together with a modification of the standard dorsal approach, a sub-periosteal approach via the fourth and deep to the third extensor compartment reduces the incidence extensor tendon irritation. The modified approach has the benefit of direct visualization of the articular surface and direct reduction with the plate being used in both and angularly stable and buttress mode

The expansion of arthroscopic treatment to serious and catastrophic injuries to the weightlifters of the Hellenic National Weightlifting Team. The evaluation of the results of this specific arthroscopic treatment. 45 athletes (36 male, 9 female) with shoulder injuries 2000–2009. 15 yrs – 35 yrs, average: 27 yrs. One 3-times Golden Olympic. One Bronze medalist, Two Silver Olympic, Three Olympic winners, Five World championsetc. Clinical examination and musculoskeletal ultrasound. Plain X-rays. E.M.G, M.R.I.-arthrography, 3DC/T when that was required. Strength measurement with Nottingham McMecin Myometer for ipsi-contro lateral shoulder. Full ROM was necessary for the operated shoulder before starting exercise for a competition. All 48 underwent arthroscopic treatment (3 mini-open). Arthroscopic stabilization using absorbable or non anchors. 45 athletes, 48 shoulders operated,(3 bilat-erally).36 RC tears, 6 bony-bankart, 2 posterior and 28 anterior labrum detachment, 3 avulsion osteochondral fractures, 2 AMBRII, 4 deranged LH of biceps, 4 underwent SSN release. All patient returned at same sport level except one with AMBRII and cervical spine pathology. Rehabilitation time for basic weightlifting exercise was 3.5 months and for competition level was 4,5 -6 months. The shoulder demands during the snatch, clean and jerk of the weightlifters provoke often shoulder injuries. The arthroscopic surgery gives thorough and broad knowledge of their shoulder injuries. The minimal detachment, less postoperative joint stiffness and decreased shoulder pain are encouraging factors for the arthroscopic treatment. Additionally, the returning time for training and competition combining with a proper rehabilitation seems to be less than open surgery

Long-term follow up after replacement arthroplasty has become established as a “Gold Standard”, providing information that can aid optimisation in future prosthetic design and use. In less mainstream joint replacements however, the evidence for use of prostheses, and in particular long-term outcome, is scarce. A cohort of 71 patients (93 implants) was reviewed in 1997 having had a De la Caffinière prosthesis implanted between 1980 and 1989. The conclusions of the study included the findings that the replacement was generally well regarded by recipients, pain was improved and survivorship was comparable with data from the best hip replacements. Ethical permission was obtained to review the same cohort ten years on (16 – 26 years post-op). Similar outcome measures were employed as in the original study but in addition formal grip strength measurements were taken, along with newer outcome scores including the DASH (Disability of arm, shoulder and hand) and EQ-5D (a European quality of life measure). Radiographs allowed assessment of radiological failure using the criteria from the original study. We found a significant mortality rate in the interim period since the original review (27 patients, 36 implants). A further 8 implants in 8 patients had been removed and were not clinically reviewed as per patients’ wishes. However, 39 implants in 26 patients were available for follow up at a mean 19 years (SD 6.3) leaving a “lost to follow up” rate of 10 patients (10 implants). Survivorship at 26 years was 73.9% (95% CI 61.2, 86.6) with the end-point as revision. Our data also demonstrated continued patient satisfaction without pain, satisfactory power and thumb mobility. Such information may be used to counsel future patients requiring surgery that there is a functional alternative to excision arthroplasty (trapeziectomy)

The purpose of this prospective and randomized study was to objectively evaluate isokinetic strength, clinical, and radiographical outcome in bilateral TKA using the same prosthesis with and without patella resurfacing. Bilateral TKA, one with, one without patella resurfacing was performed in 22 osteoarthritic patients, mean age was 68 years using the Low-Contact-Stress prosthesis. Minimum Follow-up was one year. Evaluation included clinical investigation, specific patella scores, radiographic analysis and isokinetic strength measurement of both knee flexion and extension at 60 degrees per second (Biodex). surement at 60 degrees per second (Biodex). There was no significant clinical score difference, but mean isokinetic strength of knee extension was significantly (p< .0001) stronger in the non-resurfaced patella TKA (40.5 Nm) compared with the resurfaced TKA (38,5 Nm). Flexion was also significantly stronger in the patella non-resurfaced group with 22.4 Nm versus 19.5 Nm in the resurfaced group. Mean lateral deviation was significantly (p< .001) less ideal in the resurfaced group as was postoperative patellofemoral congruent contact (p< .001). However, there was no correlation between lateral patella deviation or congruent contact and iso-kinetic strength. The results of this study indicate that mean isokinetic strength of both knee flexion and extension was significantly stronger in the non-resurfaced patella TKA. This study provides encouraging data for patella non-resurfacing. However, clinical scores or patient’s preference did not show any difference

The ‘Pi’ plate is an anatomical titanium plate recently introduced for the internal fixation of comminuted intra-articular distal radius fractures. We report our experience with this implant in a prospective series of twelve patients with an average age of thirty six years (range, 26–52 years). A dorsal approach with release of the EPL tendon and extra-compartmental exposure of the radius between the second and fourth extensor compartments was employed in all cases. Iliac bone graft and a styloid K-wire were used to augment the plate fixation. Post-operatively, active mobilisation was started after wound healing. Wrist motion and grip strength measurements were made at six weeks, three months and six months by the therapist. At six months, patients recovered an average of 85% of range of movement compared with the opposite wrist, except for palmar flexion (65%). No loss of reduction was observed on follow-up radiographs. Complications were compartment syndrome, intraoperative EPL rupture and two cases of extensor tendonitis requiring implant removal. The ‘Pi’ plate affords rigid fixation of distal radius fractures permitting early rehabilitation. It is however a demanding technique that is not without complications

To compare the results of standard open carpal tunnel release against minimal access release using the ‘Stryker Knifelight’ in the same patients. A prospective, randomised trial was carried out recruiting all patients with bilateral carpal tunnel syndrome. There were 26 patients (18 females and 8 males), with a mean age of 48 years. The patients were randomised to having the ‘Knifelight’ on one side and therefore acted as their own controls. They were assessed preoperatively, and at 2 and 6 weeks postop by questionnaire, and grip strength measurements. All sides were improved following release but those done by the open method were more likely to have complete resolution at 6 weeks. In contrast, the ‘Knife-light’ sides had better grip strength and allowed earlier return to work. In terms of preference, the patients were split equally between the 2 techniques. 2 patients had minor complications following minimal access release including one with numbness over the thenar eminence for 6 weeks. This study shows that open carpal tunnel release remains the ‘gold standard’ but the minimal access technique offers some advantages in terms of quicker recovery