Aims:There is little published on the clinical impact of radial styloidectomy, although resultant instability has been studied in cadaveric models. Methods: Over a ten-year period 31 patients had a radial styloidectomy performed within the Upper Limb Unit. The surgery was performed arthroscopically in 22 patients and via an open approach in 9 cases. A retrospective review of the arthroscopically managed patients is presented. There were 4 females and 18 males with an average follow up of 13.1 months (range 6–53 months) and an average age of 35.4 years (range 18–64). The underlying condition treated was scaphoid non-union in 11 cases, scapholunate collapse in 7, primary osteoarthritis in 3, and one each of scaphoid avascular necrosis and Keinbochñs disease with a SLAC wrist.

Patients were independently clinically reviewed or completed a wrist assessment questionnaire. The outcome was good or satisfactory in 75% of cases and unsatisfactory in the other 25%. Surgery had been carried out in 13.4% (3 patients) previously and all these patients had a satisfactory outcome. In those patients with a poor outcome, the average time to failure or further surgery was 9 months. Conclusions:Arthroscopic radial styloidectomy is a simple procedure with low morbidity. In patients with localised radial styloid impingement it can reliably provide lasting symptomatic relief in the majority of patients.

This study describes percutaneous method of tennis elbow release and medium term results.

Materials and Methods: Eighteen patients (20 elbows) were reviewed following percutaneous tennis elbow release. All patients in this series underwent non-operative management with limited or no relief prior to surgery. The mean duration of treatment was 34.04 months prior to surgery. A percutaneous release of common extensor origin was performed under local anaesthetic. A small 1 cm skin incision was employed in all cases. Mean follow- up was 73 months with a range of 8–121 months. All patients except returned to work and normal level of activity. There was one poor result. The mean time to return to work was 5 weeks, with a range of 1 day –12 weeks. Thirteen patients (fifteen elbows) have been clinically examined. Five patients were contacted by phone.

Results: Pain after surgery was evaluated with a visual analogue scale. Eighteen elbows (90% of cases) had an excellent result. Pain was rated at zero in seventeen cases. One case rated at zero at rest and two after heavy activity. One elbow (5%) had a good result with pain at zero at rest and raising four on the visual analogue scale after sporting activities (playing tennis for more than one hour). There was no improvement in one case (5%) with a visual analogue score of eight before and after surgery. There were no complications recorded. These results prove that percutaneous elbow release is a viable option in treatment of failed conservative tennis elbow management though astringent selection criteria should be observed.

This novel modification of the posterior approach allows a low hazard exposure and easier surgery to the radial head.

Methods and Materials: The most commonly used approaches are from the lateral aspect. The limitations of this approach in particular for radial head replacement is that it is a tight exposure, there is a risk of damage to the posterior interosseous nerve and there is always a difficulty in dislocation due to the presence of the interosseous membrane. The posterolateral approach to the proximal radius and ulna was described by Boyd, Gordon and Thompson. This approach avoids damage to the posterior interosseous nerve but the annular ligament requires incision and repair.

Approach: Position the forearm in pronation aligning the ulnar styloid with lateral epicondyle of the humerus. A tencentimetre long incision is then made on the lateral border of the ulna exposing deep fascia. Following this a 1cm flap of fascia is left on the ulna and anconeus is lifted off the bone. This exposes underlying radial head, annular ligament and interosseous membrane. After identifying the ulnar insertion of annular ligament a 0.5 cm bone is osteotomised with annular ligament attached from the supinator tuberosity. The radial head osteotomy is performed with the radial head in pronation to align it with shaft of radius using specially designed jig. Osteotomy of the radial head has to be at right angles to the axis of the forearm. This is a line between centre of the radial neck to the ulnar styloid process. Radial head can now be subluxed out of the wound and preparing for a replacement. The trial prosthetic radial head is then inserted and reduced. The bone fragment with annular ligament attachment is then reduced back into the original slot. This allows one to judge the size of prosthetic radial head if ligament is too tight a small diameter implant is required. The bone fragment is reattached using especially devised washer with, wire holes and a 2mm AO screw.

Results: This approach is easier, safer and reproducible. When compared to lateral approach it provides an easier access and excellent stability in radial head replacement. We recommend this approach for radial head replacements and difficult trauma cases.

We wish to draw attention to the potential dangers of using the C-arm radiolucent plate of an image intensifier as an operating table.