Pathologies such as Scapho-Lunate Advanced Collapse (SLAC), Scaphoid Non-union Advanced Collapse (SNAC) and Kienbock's disease can lead to arthritis in the wrist. Depending on the articular surfaces that are involved, motion preserving surgical procedures can be performed. Proximal Row Carpectomy (PRC) and Four Corner Fusion (4CF) are tried and tested surgical options. However, prospective studies comparing the two methods looking at sufficient sample sizes are limited in the literature. The purpose of this study was to prospectively compare the early results of PRC vs 4CF performed in a single centre. Patients with wrist arthritis were prospectively enrolled (2015 to 2021) in a single centre in Vancouver, Canada. Thirty-six patients and a total of 39 wrists underwent either a PRC (n=18) or 4CF (n=21) according to pre-operative clinical, radiographical, and intra-operative assessment. Patient-Rated Wrist Evaluation (PRWE) scores were obtained preoperatively, as well as at six months and one year post operatively. Secondary outcomes were range of motion (ROM) of the wrist, grip strength, reoperation and complication rates. Statistical significance was set at p=0.05. Respectively for PRC and 4CF, the average PRWE scores at baseline were 61.64 (SD=19.62) and 63.67 (SD=20.85). There was significant improvement at the six-month mark to 38.81 (SD=22.95) (p=0.031) and 41.33 (SD=26.61) (p=0.007), then further improvement at the 12month mark to 33.11 (SD=23.42) (p=0.007) and 36.29 (SD=27.25) (p=0.002). There was no statistical difference between the two groups at any time point. Regarding ROM, statistical difference was seen in pronation for the PRC group at the 6month mark from an average of 72.18 deg to 61.56 deg and in flexion at the 12 month mark from 47.89 deg to 33.50 deg. All other parameters did not show statistically significant difference post operatively. For ROM of the 4CF group, only flexion at the 12month mark showed statistically significant change from an average of 48.81 deg to 38.03 deg. There was no statistical difference in pre-operative ROM between the two groups. One patient in the 4CF group required a revision for delayed union, and three patients ended up with ulnar sided wrist pain. Patients undergoing PRC and 4CF showed significant improvement in post operative PRWE scores, this reflects existing literature. For 4CF care must be taken to minimise ulnar sided wrist pain by relatively shortening the unar sided carpal column mass. ROM analysis showed that patients lost some wrist flexion ROM post-operatively at the 12month mark with both PRC and 4CF. However, other ROM parameters were unchanged

Introduction: Long-term results of radial osteotomy for Kienbock’s disease seldom are seen in the literature. The purpose of this study was to evaluate its outcome. Material: Fifteen patients submitted to radial osteotomy were followed by a mean period of 9,5 years. Mean age at the time of surgery was 32,1 years. On the basis of the Lichtman classification, one patient had Stage II, eight had Stage IIIA and six had Stage IIIB disease. Methods: Patients were evaluated clinically for pain, grip and range of motion (ROM); radiologically, according to carpal height ratio, Stahl’s index (lunate colapse), and for sclerotic, cystic and degenerative carpal changes. These data were classified according to the Nakamura Scoring System for Kienbock (NSSK). Results: Ten patients are asymptomatic and five have mild pain. ROM improved significantly by 20,8°. When compared with the contralateral wrist, mean range of motion was 78% in flexion and 76% in extension and mean grip strength was 82,3%. Carpal height ratio and Stahl’s index improved, as shown by a mean NSSK of 24,3 (ten Excellent and five Good results). There was no progression to wrist arthritis. Discussion: Pain, ROM and grip strength improved significantly after surgery. Despite the mild radiologic changes, there seems to have been an improvement in inner structure of the ischemic lunate. Conclusions: These results show that Radial Osteotomy is an effective procedure in improving clinical and functional scores, and in preventing wrist arthritis

Introduction: The literature gives ample evidence to discourage sub-optimal reductions of perilunate fracture/dislocations. These, inevitably, lead to poor long-term results. Aim: To evaluate critically the results of open reduction, fracture stabilisation and ligament repair in a cohort of greater and lesser arc perilunate dislocations treated by one surgeon at a single institution. Method: Ten patients who underwent reconstructive surgery for perilunate wrist injuries were reviewed at least 18 months following their surgery. The pathology included three pure perilunate dislocations (PD), three trans-scaphoid perilunate fracture-dislocations (TSPD), one TSPD with a lunate fracture, one trans-scaphoid PD, and two trans radial styloid PDs. Each patient was assessed at a single clinic visit. A clinical rating based on the modified Mayo Wrist Scoring Chart was applied noting pain, satisfaction, range of motion and grip strength. Radiographic analysis was also performed. Results: Nine out of 10 patients had returned to their preoperative employment. Overall, 70% of the patients were satisfied with their wrist function and 50% had mild pain only on vigorous activities. There were five ‘fair’ results and five ‘poor’ results. The range of scores was 30 to 75 (average = 55). Average arc of motion was 78 degrees. Three patients showed evidence of wrist arthritis. One patient had a pin site infection. Two patients still had mild nerve symptoms – one ulnar and one median nerve. One patient needed a proximal row carpectomy. Conclusions: Greater and lesser arc injuries of the wrist are associated with high energy trauma. These injuries result in significantly reduced wrist function, however they are treated. Open reduction and ligament repair with fracture stabilisation lead to a high degree of patient satisfaction and pain relief. In this study the clinical wrist score did not support this

Aim: Treatment of unrecons tructible comminuted fractures of the radial head remains a therapeutic challenge. There is limited information on the outcome of management of these injuries with metal radial head implant. Before choosing one of them, two groups of patients were rewieved in a retrospective study comparing resection and Swanson implant. Material and methods: 39 patients sustained unreconstructible radial head fracture between 1969 and 1992. Two groups of 24 patients were reviewed clinically and radiologically by a surgeon not involved in treatment. Functionnal outcomes of the elbow (morrey scoring – SOO scoring system, instability, cubitus valgus) and involvement of the wrist (pain, grasp, RUD instability) were evaluated with a mean follow up of 15 years (6–27,7). Elbow or wrist arthritis, ulnar variance, and evolution of Swanson implant’s were evaluated on standard Xray. 1/2 patient was a man and 1/3 cases consisted in a professional injury. Resec tion group: 16 patients with a mean age of 39 (19–65), treated with a mean preoperative delay of 29,6 days (0–150) were rewieved with a mean follow up of 18,9 years (6–27,7). There were 75% Mason type-III injuries associated with dislocation of the elbow in 18% cases. Swanson group: 8 patients with a mean age of 36 (21–57), treated with a mean preoperative delay of 4,1 days (0–15) were rewieved with a mean follow up of 12 years (8,1–20). There were 88% Mason type-III injuries with no dislocation in that group. Results: The following criteria did not show any significant differences between both groups: Morrey scoring 77/100, SOO scoring 7,4/11, mean flexion was 130°, mean deficient extension was 18°, mean pronation 60°, mean supination 67°, grasp reached 90% of the contralateral side. Arthritis was pointed in same frequency at the elbow level (87%), and wrist level (66%) in each group. 94% of pa tients in resection group and 89% in Swanson group were satisfied. Excellent and good results are reported most frequently in Swanson group (37% resection group, 51% Swanson group). In resection group following complications were significantly more frequent: ulnar nerve irritation (2x), ulnar head dislocation (2x), ulnar head instability (3x), paraarticular ossification (5x), ulnar variance positive in all cases (mean value 3,20 mm). In the Swanson group only one implant was destroyed at the follow up