Aim. To evaluate the correlation between the clinical Kirk Watson test and arthroscopic Geissler classification in scapholunate instability. Methods. All patients undergoing wrist arthroscopy between April 2006 and April 2010 were evaluated. Patients were included in the study if they had a Kirk Watson test and a wrist arthroscopy with an assessment of the stability of the scapholunate joint using the Geissler classification. Patients who had a Kirk Watson test performed with subsequent normal scapholunate joint at arthroscopy were included as a control group. Geissler grades 1 and 2 and grades 3 and 4 were grouped for further analysis into low and high grade instability groups respectively. Results. 76 patients were included in the study. 62 had scapholunate pathology and 14 had normal arthroscopic examinations of the stability of the joint. A positive test was found in 30% (3) of patients with grade 1 instability, 29% (4) with grade 2, 60% (12) with grade 3 and 78% (14) with grade 4 instability demonstrated at arthroscopy. The test was positive more commonly in those with grade IV instability compared with others (78% vs. 43%; p=0.015). There was a higher number with a negative test in the low grade instability group (71% vs. 32%; p=0.01) and a higher number with a positive test in the high grade instability group (68% vs. 29%; p=0.006). The test was most sensitive (78%) and most specific (57%) for those classified with Geissler grade IV instability and sensitivity and specificity were also high for those with high grade instability (68% and 66% respectively). Conclusions. The Kirk Watson test is a sensitive and specific test for diagnosis of higher grade instability of the scapholunate joint. We found a positive correlation between increasing scapholunate instability when assessed using the Geissler classification and positivity of the test. This confirms that the Kirk Watson test can be a useful test in the assessment of those with symptomatic instability of the joint and may reflect damage not only to the scapholunate ligament but to the secondary stabilisers of the joint as well

INTRODUCTION. Scapholunate instability is a common form of carpal instability and Brunelli procedure has been advocated as a surgical intervention for this difficult problem. MATERIALS AND METHODS. Twenty five patients with clinical and radiological diagnosis of scapholunate dissociation were included in the study. Mean age of the patients was 37 years. All the patients were treated by modified Brunelli procedure, with the flexor carpi radialis tendon being passed through a drill hole in scaphoid and sutured to radiotriquetral ligament. All patients had a wrist arthroscopy prior to the index procedure and associated injuries recorded. The average postoperative follow up for the patients was 60 months. RESULTS. Patient rated wrist evaluation score improved from an average of preoperative score of 108 to a postoperative score of 33.8. The hand grip strength improved in 22 out of 25 patients. 21 (84%) patients were satisfied with the procedure and would undergo the operation again if required. CONCLUSION. This case series reaffirms the current literature regarding efficacy of modified Brunelli procedure in scapholunate instability. Early and midterm results suggest this procedure to be a useful option in carefully selected patients group

This study describes the introduction of a virtual pathway for the management of suspected scaphoid fractures and reports patient-reported outcome measures (PROMs) and satisfaction following treatment with this service. All adult patients that presented with a clinically suspected scaphoid fracture that was not visible on presentation radiographs over a one-year period were eligible for inclusion in the pathway. Demographics, examination findings, clinical scaphoid score (CSS) and standard four view radiographs were collected at presentation. All radiographs were reviewed virtually by a single consultant hand surgeon, with patient-initiated follow-up on request. PROMs were assessed at a minimum of one year post presentation and included the QuickDASH, EQ-5D-5L, the Net Promoter Score (NPS) and return to work. There were 221 patients referred to the virtual pathway. The mean age was 41 (range 16–87; SD 18.4 years) and there were 99 men (45%). There were 189 (86%) patients discharged with advice and 19 (9%) patients were recalled for clinical review (seven undisplaced scaphoid fractures, six other acute fractures of the hand or wrist, two scapholunate ligament injuries, and four cases where no abnormality was detected). Thirteen patients (6%) initiated follow-up with the hand service; no fracture or ligament injury was identified within this group. PROMs were available for 179 (81%) patients at a mean of 19 months follow-up (range: 13 – 33 months). The median QuickDASH score was 2.3 (IQR, 0–15.9), the median EQ-5D-5L was 0.85 (IQR, 0.73–1.00), the NPS was 76, and 173 (97%) patients were satisfied with their treatment. There were no documented cases of symptomatic non-union one year following injury. This study reports the introduction of a virtual pathway for suspected scaphoid fractures, demonstrating high levels of patient satisfaction, excellent PROMs, and no detrimental effects in the vast majority of cases

In a randomised prospective study, 20 patients with intra-articular fractures of the distal radius underwent arthroscopically- and fluoroscopically-assisted reduction and external fixation plus percutaneous pinning. Another group of 20 patients with the same fracture characteristics underwent fluoroscopically-assisted reduction alone and external fixation plus percutaneous pinning. The patients were evaluated clinically and radiologically at follow-up of 24 months. The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and modified Mayo wrist score were used at 3, 9, 12 and 24 months postoperatively. In the arthroscopically- and fluoroscopically-assisted group, triangular fibrocartilage complex tears were found in 12 patients (60%), complete or incomplete scapholunate ligament tears in nine (45%), and lunotriquetral ligament tears in four (20%). They were treated either arthroscopically or by open operation. Patients who underwent arthroscopically- and fluoroscopically-assisted treatment had significantly better supination, extension and flexion at all time points than those who had fluoroscopically-assisted surgery. The mean DASH scores were similar for both groups at 24 months, whereas the difference in the mean modified Mayo wrist scores remained statistically significant. Although the groups are small, it is clear that the addition of arthroscopy to the fluoroscopically-assisted treatment of intra-articular distal radius fractures improves the outcome. Better treatment of associated intra-articular injuries might also have been a reason for the improved outcome

Aims

There has been an increasing use of early operative fixation for scaphoid fractures, despite uncertain evidence. We conducted a meta-analysis to evaluate up-to-date evidence from randomized controlled trials (RCTs), comparing the effectiveness of the operative and nonoperative treatment of undisplaced and minimally displaced (≤ 2 mm displacement) scaphoid fractures.

A total of 118 consecutive patients with a fracture of the distal radius were treated with a volar locking plate; 50 patients had no ulnar styloid fracture, 41 had a basal ulnar styloid fracture, and 27 had a fracture of the tip of the ulnar styloid. There were no significant differences in radiological and clinical results among the three groups. The outcome was good and was independent of the presence of a fracture of the ulnar styloid. A total of five patients (4.2%) had persistent ulnar-sided wrist pain at final follow-up. Nonunion of the ulnar styloid fracture did not necessarily lead to ulnar wrist pain. Patients with persistent ulnar pain had a higher mean initial ulnar variance and increased post-operative loss of ulnar variance.

The presence of an associated ulnar styloid fracture of the ulnar styloid does not adversely affect the outcome in patients with a fracture of the distal radius treated by volar plating.