The equinovarus hind foot deformity is one of the most common deformities in children with spastic paralysis and is usually secondary to cerebral palsy. Split posterior tibialis tendon transfer is performed to balance the flexible spastic varus foot and is preferable to posterior tibialis lengthening, as the muscle does not loose its power and therefore the possibility of a valgus or calcaneovalgus deformity is diminished. The cohort of the study consisted of 50 children with cerebral palsy who underwent split posterior tibial lengthening to manage spastic equinovarus hind foot deformity. Our inclusion criteria were: ambulatory patients with cerebral palsy, age less than 6 years at the time of the operation, varus deformity of the hind foot during gait, flexible varus hind foot deformity, and the follow-up at least 4 years. We retrospectively evaluated 33 ambulant patients with flexible spastic varus hind foot deformity. Twenty-eight patients presented unilateral and 5 bilateral involvement. The mean age at the time of the operation was 10,8 years (6–17) and the mean follow-up was 10 years (4–14). Eighteen feet presented also equinus hind foot deformity, requiring concomitant Achilles cord lengthening. Clinical evaluation was based on the inspection of the patients while standing and walking, the range of motion of the foot and ankle, callus formation and the foot appearance using the clinical criteria of Kling et al. Anteroposterior and lateral weight-bearing radiographs of the talo-first metatarsal angle were measured. The position of the hind foot was evaluated according to the criteria of Chang et al for the surgical outcome. 20 feet were graded excellent, 14 were graded good and 4 were graded poor. Feet with recurrent equinovarus deformity or overcorrection into valgus or calcaneovalgus deformity were considered as poor results. There were 23 feet presenting concomitant cavus foot component that underwent supplementary operations performed at the same time with the index operation. None of the feet presented mild or severe valgus postoperatively, while 4 feet presented severe varus deformity and underwent calcaneocuboid fusion sixteen and eighteen months after the index operation. On the anteroposterior and lateral weight-bearing radiographs the feet with severe varus had a negative talo-first metatarsal angle (mean −26,8 ± 18,4), those with mild varus had a mean of −14,5 ± 12,2. In feet with the hind foot in neutral position the mean value was 5.0 ± 7.4. The results of the feet in patients with hemiplegic pattern were better and significantly different than the diplegic and quadriplegic ones (p = 0.005). The results in our cases were in general satisfactory as 34 out of 38 feet were graded excellent and good. The feet with poor results presented a residual varus deformity due to intraoperative technical errors.

Because ankle inversion trauma can result in persistent isolated subtalar joint instability and can contribute to chronic lateral ankle instability, optimization of subtalar joint ligament injury diagnosis and treatment is essential.

12 fresh-frozen cadaver lower extremities were used. The cradle was a component of a gimbal system that allowed unrestricted inversion/eversion and anterior-posterior and medial-lateral translation of the subtalar joint. The bearing system to which the tibia/fibula were attached allowed unconstrained internal/external rotation and superior-inferior translation. 4N-m inversion/ eversion and internal/external rotational moments and translational forces of 67N were applied. All measurements were performed sequentially in neutral, 10° dorsiflexion and 20° plantarflexion, and were repeated as the cervical, calcaneofibular, and interosseous ligaments were consecutively sectioned in all possible different orders.

In neutral position, inversion increased after sectioning of the cervical (3.7°), interosseous (0.8°), and calcaneofibular (1.9°) ligaments individually. Combined sectioning of all three ligaments showed an increase in inversion of 8.3°, 8.5° and 1.4° in the neutral, plantarflexed, and dorsiflexed positions, respectively, compared to the intact ankle. External rotation also increased in neutral position after sectioning the cervical ligament (2.0°). Combined sectioning of all ligaments showed an increase in external rotation of 3.6° and 5.4° for neutral and dorsiflexion, respectively.

This is the first comprehensive biomechanical cadaver study of the contributions of the cervical, calcaneofibular, and interosseous ligaments to stabilization of the subtalar joint. The surgeon may refer to the findings in both diagnosing and planning treatment of problematic subtalar joint instability

The objective of this study was to evaluate the functional outcome of the elbow joint in patients with heterotopic ossification of the elbow joint who underwent surgical excision of pathologic bone.

From 5/1994 to 12/2006, 24 patients (33 joints) with heterotopic ossification of the elbow joint were evaluated. All patients were attended in the Intensive Care Unit (ICU). The patient\’s age ranged from 19–48 years (mean; 32 years) The median ICU hospitalization was 3 weeks. In nine patients both elbows were affected. Unilateral involvement was equally noticed to the right (seven cases) and the left elbow (eight cases). The DASH SCORE and the range of motion were used for the evaluation of the results. All patients underwent surgical treatment in order to extract heterotopic bone and to improve the range of motion of the affected elbow joint.

Postoperatively 18 out of 33 operated elbow joints (54.54%) demonstrated improvement of the range of motion, whereas no improvement was observed in the remaining 15 elbow joints (45.45%). Higher DASH SCORE was obtained in 19 out of 24 patients (79.17%). Surgical excision of the ectopic bone around the affected elbow significantly improves the range of motion of the joint providing better use of the upper extremity and therefore a superior quality of life in these patients.

We present a case of a 19-year-old white female patient with neurofibromatosis type I who, 10 years ago, underwent free vascularized fibular grafting for isolated congenital pseudarthrosis of her left radius.

An external fixator was applied for gradual distraction and correction of the deformity of the pseudarthrosic site for five weeks. Wide resection of pseudarthrosis with surrounding fibrotic and thick scar tissue and bridging of the gap with a free vascularized fibular graft followed. Four months postoperatively, union was established in both graft ends. At the last follow-up, 10 years postoperatively, the patient has excellent function with full wrist flexion-extension and forearm pronation-supination.

Free vascularized fibula transfer is considered the treatment of choice for congenital radial pseudarthrosis. It allows complete excision of the pathologic tissue and covering of the gap in one operation. Due to the vascularity of the free vascularized fibular graft both sides of fibula unite easily with no additional intervention.

To compare the effects of botulinum toxin injection with and without electromyographic (EMG) assistance for the treatment of spastic muscles.

In a prospective comparative study, botulinum toxin was injected intramuscularly into 17 patients with spasticity due to CNS damage (CP, SCI, head injury, stroke). All patients were evaluated using the modified Ashworth scale and the score was 2–4. In 9/17 patients, group A (53%), the injection was given with EMG assistance, while in 8/17 patients, group B (47%), without, always from the same injectionist. The follow-up period ranged from 4 to 24 months.

Average spasticity decreased in all injected muscles and new scores were 1–2 grades less according the modified Ashworth scale. No complications or side effects were noted. The average reduction of spasticity reached 1.66 (SD 0.5) in group A and 1.25 (SD 0.46) in group B. The average reduction of spasticity was statistically more pronounced in group A (p< 0.001).

The effectiveness of botulinum toxin injection for the treatment of muscle spasticity in patients with CNS damage increases when used with EMG assistance and this is attributed to the appropriateness of points for injection.

To compare usual practices against published guidelines of Perioperative Antimicrobial Prophylaxis (AP), which is an established method to reduce the risk of postoperative infection in TJR.

We prospectively evaluated AP in 616 patients, who underwent TJR of the hip and the knee in an ongoing cohort study. Teicoplanin was administered once perioperatively (10mg/kg iv) in one group A (n=278), while in the other group B (n=338) AP was administered according to the usual practice (various antibiotic combinations, including hemisynthetic penicillins/penicillinase inhibitors, cephalosporins, aminoglycosides and quinolones for 2–10 days). An evaluation form and personal examination were used for data collection and monitoring. Patients were followed up for 2 years minimum.

The two groups did not statistically differ (p> 0.05) regarding overall postoperative infections. Superficial soft tissue infection developed in 9/616 pts. 1/278 in group A (0.4%) vs 8/338 in group B (2.4%) (p< 0.05). Deep SSI was rarely seen, 4/616 pts (0.6%). 2/278 in group A (0.7%) vs 2/338 in group B (0.6%) (p=NS). Mean duration of AP was significant higher in group B [6(IQR: 5–8.25)], p< 0.001 Mann-Whitney test. Only in group B, MRSA-MRCNS postoperative infections did appear. The duration (days) of glycopeptide antibiotic usage, therapeutic (group B) or prophylactic (group A), was comparable in both groups (p> 0.05).

Glycopeptide antibiotic prophylaxis for TJR leads to less postoperative infections compared to other antibiotic prophylaxis, but similar duration of overall glycopeptide usage (prophylactic and therapeutic) in both groups.

The purpose of this study is to evaluate the long-term results of the surgical treatment of cubital tunnel syndrome by comparing the in-situ decompression and release of the ulnar nerve with or without partial medial epicondylectomy and the anterior transposition and release respectively.

Material and Method: From 1991 since 2008, 119 patients, (81 men and 38 women) with an average age of 51(13–72 years) years were treated surgically for ulnar nerve compression at the elbow. The average duration of symptoms before surgery was 15 months (2–48 months). Preoperatively 2 patients were grade I, 52 patients were grade IIA, 31 patients were IIB and 34 were grade III according to the modified McGowan score. We performed in-situ decompression of the ulnar nerve in 35 patients, release with partial medial epicon-dylectomy in 44 patients and release with anterior transposition of the nerve in 40 patients.

17 patients were lost to follow-up. 108 patients were clinically assessed. Comparing the results among different surgical procedures, an improvement of at least one McGowan grade was obtained in 26 of 30 patients treated with simple decompression, in 29 of 35 patients treated with release and anterior transposition of the nerve and in 38 of 43 patients treated with release and medial epicondylectomy.

The results of this study show that the possibility for complete recovery is inversely related to the initial neuropathy grade. Partial medial epicondylectomy is a valuable surgical procedure for treating grade I to IIB ulnar neuropathy because is an anatomic method with minimal nerve manipulation preserving regional blood supply.

Background: Perioperative Antimicrobial Prophylaxis (AP) is an established method to reduce the risk of intraoperative infection in TJR. Usual practices are not always compatible with published guidelines leading to excess morbidity, antibiotic overuse and emergence of resistance.

Methods: We prospectively evaluated AP in 616 patients, who underwent TJR of the hip and the knee in an ongoing cohort study. Teicoplanin was administered once perioperatively (10mg/kg iv) in one group A (n=278), while in the other group B (n=338) AP was administered according to the usual practice (various antibiotic combinations, including hemisynthetic penicillins/penicillinase inhibitors, cephalosporins, aminoglycosides and quinolones for 2–10 days). An evaluation form and personal examination were used for data collection and monitoring. Patients were followed up for 2 years minimum.

Results: The two groups did not statistically differ (p> 0.05) regarding overall postoperative infections. Superficial soft tissue infection developed in 9/616 pts. 1/278 in group A (0.4%) vs 8/338 in group B(2.4%) (p< 0.05). Deep SSI was rarely seen, 4/616 pts (0.6%). 2/278 in group A (0.7%) vs 2/338 in group B (0.6%) (p=NS). Mean duration of AP was significant higher in group B [6(IQR:5–8.25)], p< 0.001 Mann-Whitney test. Only in group B, MRSA-MRCNS postoperative infections did appear. The duration (days) of glycopeptide antibiotic usage, prophylactic (group A) or therapeutic (group B), was comparable in both groups (p> 0.05).

Conclusions: Glycopeptide antibiotic prophylaxis for TJR leads to less postoperative infections compared to other antibiotic prophylaxis, but similar duration of overall glycopeptide usage (prophylactic or therapeutic) in both groups.

Aim: To compare the effects of botulinum toxin injection with and without electromyographic (EMG) assistance for the treatment of spastic muscles.

Methods: In a prospective comparative study, botulinum toxin was injected intramuscularly into 17 patients with spasticity due to CNS damage (CP, SCI, head injury, stroke). All patients were evaluated using the modified Ashworth scale and the score was 2–4. In 9/17 patients, group A (53%), the injection was given with EMG assistance, while in 8/17 patients, group B (47%), without, always from the same injectionist. The follow-up period ranged from 4 to 24 months.

Results: Average spasticity decreased in all injected muscles and new scores were 1–2 grades less according the modified Ashworth scale. No complications or side effects were noted. The average reduction of spasticity reached 1.66 (SD 0.5) in group A and 1.25 (SD 0.46) in group B. The average reduction of spasticity was statistically more pronounced in group A (p< 0.001).

Conclusions: The effectiveness of botulinum toxin injection for the treatment of muscle spasticity in patients with CNS damage increases when used with EMG assistance and this is attributed to the appropriateness of points for injection.

Introduction: Digital nerve lesions with nerve gaps require reconstruction with the use of some form of graft or guide. Neurotube, a bioabsorbable polyglycolic acid (PGA) conduit, has been proposed as an effective solution for this kind of defect in emergency and planned surgery.

Methods: Nineteen posttraumatic lesions of common (5 cases) or proper (14 cases) palmar digital nerves were repaired by means of Neurotube from January 2003 till January 2006. The nerve gap size averaged 22 mm (range 15–35 mm). Thirteen lesions had associated vascular, tendon or osseous injury.

Results: Nerve regeneration was evaluated at a mean of 17 months postoperative interval. Positive results in recovery of sensibility were noticed in 73 % of the cases; static and moving two point discrimination was excellent (less than 6mm and 4mm respectively) in 9 cases and fair in 5 (7–15mm and 5–7mm respectively). Dysesthesia was present in 6 patients, cold intolerance in two, delayed wound healing in one and one patient complained for painful scar. There was no infection, conduit extrusion or allergic reaction.

Discussion and Conclusion: Bioabsorbable polyglycolic acid conduit presents an attractive and useful alternative for the reconstruction of digital nerve lesions with a small nerve gap, especially when a direct anastomosis of the two stumps is not possible, or when the suture appears to be in tension. Its use is simple, safe and also eliminates the donorsite morbidity associated with nerve-graft harvesting.

Traditionally open extensor tendon injuries in zones III to V (PIP to MP joints) have been treated with repair and immobilization in extension for 4 to 6 weeks. Early controlled motion protocols have been successfully used in zones VI and VII of the extensors. An early controlled mobilization protocol combined with strong repair for zones III to V extensor tendon lacerations was studied prospectively.

From 1999 to 2003, 27 extensor tendon lacerations in 26 patients, mean age 34 years (range 14–70), were treated using dynamic extension splinting. Inclusion criteria were zone III to V, complete lacerations involving the extensor mechanism and possibly the dorsal capsule (without associated fractures or skin deficits) in patients without healing impairment. All injuries were treated in the emergency department with a core Kessler-Tajima suture and continuous epitendon suture. After an initial immobilization in a static splint ranging from 5 days (for zone V) to 3 weeks (for zone III), controlled mobilization was initiated with a dynamic splint that included only the injured finger. The patient was weaned off the dynamic splint 5 weeks after the initial trauma. The patients were treated in an outpatient basis and did not attend any formal physiotherapy program.

The mean follow up was 16 months (range 10–24 months). No ruptures or boutoniere deformities were observed and no tenolysis was necessary. The mean TAM was 242deg for the fingers and 119deg for the thumbs. The mean grip and pinch strength averaged 85% and 88% that of the contralateral unaffected extremity. 77% of the patients achieved a good or excellent result in Miller’s classification. The mean loss of flexion was found to be greater than the mean extension deficit.

The protocol described above was found to be safe, simple, functional, cost effective and reproducible for zone III to V simple extensor tendon injuries. Success is based on strong initial repair, close physician observation and a cooperative patient. The addition of physiotherapy for patients with flexion deficits in the period immediately after dynamic splinting may ameliorate results.

Aim: Adequate length is an important prerequisite for a functional digit. Over the last 20 years small external fixators have been developed allowing the principles of distraction osteogenesis to be applied to the small bones of the hand. We present our experience in digital lengthening with the contemporary designs of external fixators. Methods: From 1998 to 2001, 20 patients (26 rays) were treated with metacarpal or phalangeal lengthening through distraction osteogenesis using a monolateral frame with two half-pins on each site of the osteotomy. The mean age of the patients was 21 years (6–48) and indications included traumatic amputation in 13 and congenital amputation (transverse deficiency, brachydactyly, constriction band syndrome) in 7. The mean distraction period was 3 weeks and the mean consolidation period 7 weeks. No protective splinting or additional bone grafting was necessary. Results: The distraction callus consolidated in all patients. The mean total length gained was 17,5 mm (68% of the original length). The mean treatment time was 2,8 days for every mm of length gained. One patient suffered angulation at the distraction site and the fixator had to be revised. No infection, fracture or half pin loosening were observed. Conclusions: Callotasis is a reliable technique for digital ray lengthening. Meticulous surgical technique and close observation of the patient during the distraction phase are necessary in order to avoid complications. Over 2 cm of lengthening can be achieved without bone grafting

Aim: To describe a new technique, the Ç Ioannina method È, which aims to improve the precision of targeting the lesion of the femoral head, thus increasing the survival of the femoral head in patients with osteonecrosis treated with a free vascularized þbular graft. Material: Twenty-seven patients (30 hips) with femoral head osteonecrosis were treated with this technique in our Orthopaedic Department during the last four years.

With use of CAD-CAM the lesion is located and a custom-made metallic aiming device is manufactured. This aiming device is then used to place the graft in its optimal position in the center of the lesion. This group was compared with 20 patients with conventional targeting. Results: Outcome was evaluated both clinically and radiologically. The short-term results showed precision of targeting in 89% of the patients, compared to 55% with the conventional method. X-ray exposure and operative time were also signiþcantly reduced.

Conclusions: This technique is the result of more than 12 years of experience in the treatment of osteonecrosis with transfer of free vascularized þbular graft. It was designed and developed by the þrst of the authors and expresses the contemporary trend for precision in location and description of the lesion. It decreases X-ray exposure, minimizes operative time and optimizes the placement of the graft.

Aim: Although primary ßexor tendon repair in children yields satisfactory results, some children end up with poor function because of delay in diagnosis, technical difþculties and the inability to follow a structured rehabilitation program. The aim of this study is to evaluate the functional outcome after two stage reconstruction with the modiþed Paneva technique (which includes creating a loop between the proximal stumps of Flexor Digitorum Profundus and Superþcialis in the þrst stage and reßecting the latter as a Ç pedicled È graft through the pseudosheath created around the silicone rod, in the second stage) in children. Methods: Nine patients (9 digits) with a mean age of 8,2 years (range 3 Ð15) were treated for zone II lesions. Their pre-operative status in the Boyes and Hunter scale was grade two in 3, grade three in 3, grade four in 1 and grade þve in 2 patients. Results: After a mean of 42 months of follow-up (minimum 12 months), according to the Buck-Gramco scale there were 4 excellent, 4 good and 1 poor result and according to the revised Strickland scale 3 excellent, 5 good and 1 poor. Children over the age of 10 had slightly improved Total Active Motion (mean +350) compared to younger ones. No signiþcant length discrepancies were noted. Two postoperative infections were treated and one graft-related re-operation was necessary. Conclusions: Staged ßexor tendon reconstruction in children is technically feasible and efþcient. Delaying such a reconstruction in younger children does not seem justi-þed.

Aim: To investigate the natural history and the impact of reconstruction in shoulder deformities due to obstetrical brachial plexus palsy. Methods: Pre and postoperative CT scans of bilateral upper extremities of 28 patients with obstetrical palsy were studied. The age during the preoperative CT scan ranged from 1.5 months to 10 years (average: 4 ± 3 years). 17 patients had Erbñs palsy and 11 global plexus involvement. Eighteen had primary shoulder reanimation mainly via intraplexus neurotization. Palliative surgery in 25 patients included trapezius transfer for shoulder abduction, adductors release and rerouting of the latissimus dorsi and terres major for external rotation, scapula stabilization and rotational osteotomy of the humerus. The CT measurements included: humeral head retroversion, spinoscapular angle, glenoid fossa inclination, congruence of the humeral head to the glenoid and distance of the lower angle of the scapula from the midline. Results: Preoperatively the humeral head was subluxated or dislocated posteriorly and had decreased retroversion. The hypoplastic scapula had winging and increased distance from the midline, while the glenoid fossa was more retroverted. Postoperatively all the above measurements were improved. Conclusions: Novel measurements on CT scans of bilateral shoulders provide valuable information. Surgical intervention signiþcantly improves the functional anatomy and the dynamics of the shoulder joint.

Aim: To study the functional outcome ofmusculocutaneous nerve neurotization in brachial plexus palsy patients. Methods: From 1998 to 2001, 51 adult patients (mean age 24,6 years) with posttraumatic brachial plexus palsy were operated. Exploration of the brachial plexus was performed in 39 patients with a mean denervation time of 6 months (1 to 14 months). Seven patients had an extended infraclavicular lesion, while from the 32 supraclavicular lesions, 21 had the element of avulsion (4 global, 10 four-root and 7 three-roots avulsions). Neurotization of the musculocutaneous was performed in 25 via nerve grafts from intraplexus donors (C5, C6, C7)and from extraplexus donors in 14. In 7 patients, the phrenic was used alone or with intraplexus donor (5), in 3 cases the accessory nerve, in one patient the accessory and cervical plexus motor branches and þnally in 3 patients 3 intercostal nerves were used. Results: All intraplexus neurotizations of the musculocutaneous nerve, but two, regained useful biceps function (M3+ to M4+). From the extraplexus neurotizations the phrenic n. as a conjunctant donor gave functional result, when used alone gave M3 and M3−; the accessory n. gave M3+ in combination with cervical motors and M3− when used alone. The intercostal neurotizations gave M2+ and M3−. Conclusions: In brachial plexus paralysis, when avulsion is present the reconstruction often is based in extraplexus donors. The return of biceps function is greater and faster when intraplexus donors are used. Extraplexus neurotizations yield satisfactory results used in combinations Vertebral osteoporosis and fracture

Aims: In the present study we reviewed 105 patients who had had Galeazzi fractures with particular emphasis on classiþcation (þve types according to the fracture patterns), treatment, and þnal results. Methods: One hundred and þve cases (75 males and 30 females) were included in this study. Most of the fractures (70 cases) occurred in the distal third of radial shaft (Type I). Seventeen fractures were in the middle third (Type II), and 11 fractures were in the proximal third of the shaft of the radius (Type III). In four cases disruption of the distal radio-ulnar joint associated with fractures of both bones (Type IV). Finally three cases considered as Galeazzi-equivalent lesions (Type V). Results: The mean follow-up time was 7 years. The overall results were good in 81% of the patients, fair in 14% and poor in the 5% of the patients. Union achieved in 102 cases and non union in three cases (two had had primary conservative treatment and one case was treated surgically). Supination ranged from 40 to 90 degrees (average 77.5 degrees), and pronation from 50 to 90 degrees (average 81.6 degrees). Conclusions: The Galeazzi fracture is uncommon injury with an incidence varying from 3% to 6% of all forearm fractures. The key to satisfactory results in the treatment of the Galeazzi lesion is anatomic restoration of the length of the radius, with application of rigid internal þxation to maintain the reduction. Although most of the reports do not recommend exposing the distal radioulnar joint, we suggest that once the anatomic reduction is secured, anteroposterior and true lateral x-rays planes to control the distal radioulnar joint.

Aims: The purpose of this study is to to assess the surgical results, complications, and long-term results of vascularized fibula in the treatment of congenital pseudarthrosis of the tibia. Methods: Seven patients who had congenital pseudarthrosis of the tibia were treated consecutively at our clinic between 1992 and 2000 with free vascularized fibular graft. There were four females and three males. The mean age at the time of operation averaged 6.5 years (range 1–12 years). Four left tibias and 3 right tibias were involved. Stability was maintained with internal fixation in four patients, external fixation in two patients and intramedullary pin in one patient. Results: The average follow-up was 2.6 years (range 6 months to 8 years). In five patients, both ends of the graft healed primarily within 2.7 months (range 1.5 to 3 months), and hypertrophy of the fibular graft occurred rapidly with a well-formed medullary canal. In one patient the distal junction did not unite and although required three subsequent operations still not healed. Stress fracture occurred in one patient underwent four additional operations before union achieved. Conclusions: Despiting the continuing problems and the relatively high complication rate, the ultimate results with free vascularized fibula transplant are generally good specially as compared with published series in whom conventional grafting techniques had failed. However, even achieving union of pseudarthrosis is not enough for the resolution of this disease and is only half of the problem; the other half is to maintaining

Aim: To study the carpal geometry in patients with symptomatic scaphoid non-union without arthritis or with early arthritic changes. Method: The preoperative x-rays of 58 patients were retrospectively reviewed and x-rays of 35 of those fulfilling strict criteria for true projections were digitized and measured using CAD methodology. Patients’ mean age was 31,3 years and mean time from fracture 50,4 months. The measured variables concerned the carpal height, possible displacement of the carpal bones and carpal instability. The Herbert and Fisher classification was used and two subgroups concerning the absence (14) or presence (21) of early arthritic changes were created. Results: 62,5% of the patients (including patients without radiologicaly obvious arthritis) were presented with increased radial height and radial inclination, 28% with an affected carpal height, 17% with ulnar translocation of the wrist and up to 48% (varying according to the method of measurement) with a DISI pattern of instability. No statistically significant differences could be established between the morphological groups or between the two subgroups concerning early arthritis. Conclusions: Carpal geometry in scaphoid non-union although altered does not seem to change significantly with the appearance of early arthritis and thus treating non-union with early arthritis with osteosynthesis and bone grafting seems justified. In view of our findings it seems appropriate to supplement this procedure with distal radial osteotomy or with temporary lunate stabilization in selected patients.

This study describes the clinical features and treatment of the 53 patients with primary tumors of the hand. A review of primary tumors of the small bones of the hand during a 9 year period (1991–2001) was done. There were 14 enchondromas, 1 malignant fibrous histiocytoma, 15 ganglions, 5 haemangiomas, 1 haemangioma of median nerve, 4 giant cell tumors of tendon sheath, 4 osteoid osteomas, 1 lymphangioma, 1 exostosis, 1 dermatofibrosarcoma, 1 neurilemoma, 2 neurinomas, 1 glomus tumor, 1 benign fibrous histiocytomas and 1 papillary endothelial hyperplasia. There were 34 males and 19 females with an average age 37.7 years. The mean follow-up was 6y (1–8y). There were 33 lesions in the fingers, 3 in the metacarpals, 13 in the carpus and 4 in the palm. Swelling and localized tenderness were the most common presenting complaints. One patient died of metastatic disease. 3 patients were seen initially with locally reccurent lesion. All the patients were treated surgically. The material was analyzed in terms of diagnosis, localization, surgical management and post-operative complications. Primary tumors of the hand are rare. The cases in these series are similar to that of other reports. As in other musculoskeletal neoplasms, a treatment plan must be formulated based on the location, size and biologic behaviour of the lesion.