Aims

Patients with midcarpal instability are difficult to manage. It is a rare condition, and few studies have reported the outcomes of surgical treatment. No prospective or retrospective study has reported the results of arthroscopic palmar capsuloligamentous suturing. Our aim was to report the results of a prospective study of arthroscopic suture of this ligament complex in patients with midcarpal instability.

Aims

Occult (clinical) injuries represent 15% of all scaphoid fractures, posing significant challenges to the clinician. MRI has been suggested as the gold standard for diagnosis, but remains expensive, time-consuming, and is in high demand. Conventional management with immobilization and serial radiography typically results in multiple follow-up attendances to clinic, radiation exposure, and delays return to work. Suboptimal management can result in significant disability and, frequently, litigation.

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The aims of this study were to identify means to quantify coronal plane displacement associated with distal radius fractures (DRFs), and to understand their relationship to radial inclination (RI).

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A conventional arthroscopic capsuloligamentous repair is a reliable surgical solution in most patients with scapholunate instability. However, this repair does not seem to be sufficient for more advanced injuries. The aim of this study was to evaluate the functional results of a wide arthroscopic dorsal capsuloligamentous repair (WADCLR) in the management of severe scapholunate instability.

Using a reverse engineering capability to quantify the factors that control the rigid body mechanics of the wrist, a mathematical forward animation capability and model of wrist motion that allows the carpus to move under its own rules is being developed. This characterises the isometric connections, from which was developed the Stable Central Column Theory of Carpal Mechanics - which incorporates the Law of Rules Based Motion. This work has now advanced to the ability to reapply the extracted rules to allow rules-based rigid body reanimation of an individual wrist. As each wrist is unique, there is a given reality that each reanimation must be based on an individual wrist's unique rules, and the aspiration to create a standard or normal wrist is unrealistic. Using True Life Anatomy (Adelaide, Aust) analysis software, the specific rules (morphology / connectivity / interaction / loading) of individual wrists have been characterised, and then reapplied in a rigid body reanimation environment using Adams (MSC Software, U.S.) software. In the preliminary application of this biomechanics environment, by using the reverse engineering / forward reanimation process, wrist motion can be recreated - based purely on the unique rules, extracted from individual wrists. Instability of the proximal scaphoid was evident in several of the animations, and there was confirmation that the spatial attachment points of the isometric constraints are very exacting. The actual attachment and specific morphology of the carpal bones varied between individual wrists. Using a reverse engineering and then forward reanimation process, we have been able to recreate wrist motion using the rigid body mechanics based on the Law of Rules Based Motion. Further work is required, but the potential to apply “what if” virtual surgery options to an individual injured wrist and more precisely characterise and test solutions to wrist dysfunction are becoming realised

Injury to the triangular fibrocartilage complex (TFCC) may result in ulnar wrist pain with or without instability. One component of the TFCC, the radioulnar ligaments, serve as the primary soft-tissue stabilizer of the distal radioulnar joint (DRUJ). Tears or avulsions of its proximal, foveal attachment are thought to be associated with instability of the DRUJ, most noticed during loaded pronosupination. In the absence of detectable instability, injury of the foveal insertion of the radioulnar ligaments may be overlooked. While advanced imaging techniques such as MRI and radiocarpal arthroscopy are well-suited for diagnosing central and distal TFCC tears, partial and complete foveal tears without instability may be missed without a high degree of suspicion. While technically challenging, DRUJ arthroscopy provides the most accurate method of detecting foveal abnormalities. In this annotation the spectrum of foveal injuries is discussed and a modified classification scheme is proposed.

Cite this article: Bone Joint J 2023;105-B(1):5–10.

Aims

This observational cross-sectional study aimed to answer the following questions: 1) how has nonunion incidence developed from 2009 to 2019 in a nationwide cohort; 2) what is the age and sex distribution of nonunions for distinct anatomical nonunion localizations; and 3) how high were the costs for surgical nonunion treatment in a level 1 trauma centre in Germany?

Aims

The purpose of this systematic review was to determine the rates of union for vascularized versus non-vascularized grafting techniques in the operative management of scaphoid nonunion. Secondary aims were to determine the effect of the fixation techniques used, the source of grafting, as well as the influence of fracture location (proximal pole) and avascular necrosis (AVN).

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The purpose was to evaluate early clinical, patient-reported, and radiological outcomes of the scapholunate ligament 360° tenodesis (SL 360) technique for treatment of scapholunate (SL) instability.

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This observational study examines the effect of the COVID-19 pandemic upon the paediatric trauma burden of a district general hospital. We aim to compare the nature and volume of the paediatric trauma during the first 2020 UK lockdown period with the same period in 2019.

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The primary aim of this study was to describe patient satisfaction and health-related quality of life (HRQoL) following corrective osteotomy for a symptomatic malunion of the distal radius.

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Carpal malalignment after a distal radial fracture occurs due to loss of volar tilt. Several studies have shown that this has an adverse influence on function. We aimed to investigate the magnitude of dorsal tilt that leads to carpal malalignment, whether reduction of dorsal tilt will correct carpal malalignment, and which measure of carpal malalignment is the most useful.

Aim. Skeletal tuberculosis (TB) accounts for up to one third of cases of extra-pulmonary TB but comprises a minority of osteoarticular infection in areas with low TB incidence. Consequently, unexpected cases may receive surgical management targeted at non-tuberculous orthopaedic infections. This study reviewed treatment and outcomes of non-spinal osteoarticular TB to assess outcomes from modern surgical techniques. Method. All patients with a diagnosis of non-spinal osteoarticular TB between 2009–2017 from one tertiary referral centre were included. Retrospective review of surgical intervention, antibiotic treatment and outcome was conducted. Results. Fourteen patients with an average age of 48 (range 20–77) were identified; all were HIV-negative. Articular infections affected 7 patients, including one prosthetic joint infection. Osteomyelitis affecting the carpus, femur, tibia, olecranon and metatarsals was diagnosed in the remaining patients. Only 4 patients had radiological findings consistent with prior pulmonary TB, and only 3 had a history of prior TB or TB exposure. In 2 cases, symptom exacerbation was associated with local steroid injection. Diagnostic biopsy was employed in 5 cases, of whom 4 proceeded to medical management. Diagnosis was made following positive culture in 86% of cases; all TB isolates were fully sensitive. 71% of cases underwent surgical treatment according to best practice for biofilm-forming infection, including excision of osteomyelitis with local antibiotic therapy for three patients, and first-stage excision with spacer implantation for four patients. Quadruple therapy for an average of 8.5 months, range 6–12 months, was administered. Patients were followed up for a mean of 15.2 months. Half of the patients treated with surgery reported ongoing pain at 3 months and 4 patients underwent further surgery for persistent signs of infection (2 for probable persistent TB, 2 for bacterial super-infection). Conclusions. The role of surgical debridement in management of osteoarticular TB is unclear. In patients with a previous history of TB exposure a pre-operative diagnosis of TB could prevent unnecessary surgery and therefore prevent associated post-operative complications including bacterial super-infection and pain. Pre-op biopsy should therefore be considered in all patients with a history of TB exposure