One hundred and sixty-two patients with a diagnosis of scapholunate instability underwent a modified Brunelli procedure over a 7 year period. One hundred and seventeen were assessed with the help of a questionnaire and, of these, 55 patients attended for clinical evaluation. The mean follow-up was 4 (1-8) years. There were 72 patients with dynamic scapholunate instability and 45 patients with static instability. The average age was 38 years. There were 50 males and 67 females. 77 (62%) patients had no to mild pain with a mean visual analogue score of 3.67 (SD=2.5)). The loss in the arc of flexion-extension was due to a reduced range of flexion (mean 31% loss), while 80% of extension was maintained, compared with the contralateral side. The grip strength on the operated side was reduced by 20% of the non-operated side. There was no statistically significant difference (p>0.05) in the range of movement or the grip strength between the static and dynamic group or the claims and non-claims group. Ninety (79%) patients were satisfied with the result of the surgery (good to excellent) and 88% of the patients felt that they would have the same surgery again. We feel that these results compare favourably with the early results published from this unit and recommend this procedure for dynamic and static scapholunate instability

Ulnar drift is a common deformity in the hands of patients with rheumatoid arthritis. There is little in the literature regarding the value of crossed intrinsic transfer with MCPJ arthroplasty (Hellum 1968, Stothard et al 1991). In addition the significance of recurrent ulnar drift on hand function is unknown. The aim of this study is to assess if the addition of crossed intrinsic transfer to metacarpophalangeal arthroplasty has an effect on the recurrence of ulnar drift and to overall hand function.

This is a retrospective comparative study. 73 hands in patients with rheumatoid arthritis undergoing primary 2nd to 5th metacarpophalangeal joint (MCPJ) replacements were studied. In 28 hands a crossed intrinsic transfer was performed and in 45 hands it was not . A similar splintage and rehabilitation programme was followed in each group. Mean follow up was 50 months.

Ulnar drift and active range range of motion, Sequential Occupational Dexterity Assessment (SODA) functional score, patient satisfaction , grip strength.

The two groups had similar preoperative ulnar drift (crossed intrinsic transfer group mean 27 degrees, comparative group 29 degrees, p=0.44). At follow up the crossed intrinsic transfer group had statistically less ulnar drift (crossed intrinsic transfer group mean 6 degrees, comparative group 14 degrees, p=0.01). There was no difference at follow up in active flexion, extensor lag, SODA score, grip strength and patient satisfaction (both groups had 70% improved function).