Aims. Wrist arthroscopy is a standard procedure in hand surgery for diagnosis and treatment of wrist injuries. Even though not generally recommended for similar procedures, general administration of perioperative antibiotic prophylaxis (PAP) is still widely used in wrist arthroscopy. Methods. A clinical ambispective dual-centre study was performed to determine whether PAP reduces postoperative infection rates after soft tissue-only wrist arthroscopies. Retrospective and prospective data was collected at two hospitals with departments specialized in hand surgery. During the study period, 464 wrist arthroscopies were performed, of these 178 soft-tissue-only interventions met the study criteria and were included. Signs of postoperative infection and possible adverse drug effects (ADEs) of PAP were monitored. Additionally, risk factors for surgical site infection (SSIs), such as diabetes mellitus and BMI, were obtained. Results. The overall infection rate of SSI was zero. Neither in the PAP group (n = 69) nor in the control group (n = 109) were signs of postoperative infection observed. Observed symptoms of ADEs were three-times higher in the PAP group when compared to the control-group (16.3 vs 5.5%; p = 0.043). No major ADEs were observed, but one in ten patients in the PAP group reported mild to severe intestinal or hypersensitivity symptoms. Conclusion. We demonstrate that the number needed to treat (NNT) with PAP to prevent one postoperative infection in soft-tissue arthroscopies of the wrist is > 109. Conversely, symptoms of ADEs were reported by one out of ten patients given PAP. Considering the high NNT to prevent postoperative infection and the large number of ADEs caused by PAP, we recommend not to use PAP routinely in soft-tissue arthroscopies of the wrist. Subsequent large-scale studies should be conducted to substantiate these results. Cite this article: Bone Jt Open 2023;4(4):219–225

Introduction. The wrist arthroscopy has been performed since 1979. With the advances in technology and surgical expertise, wrist arthroscopy has become third commonest procedure after knee and shoulder joint. Wrist arthroscopy has become a gold standard for diagnosing TFCC pathologies and other intercarpal disorders. Our aim was to compare the clinical, MRI and arthroscopic findings while treating various wrist pathologies. Materials/Method. In retrospective trial, 30 patients (19 male and 11 female) with clinical evidence of wrist lesions were evaluated with MRI followed by wrist arthroscopy. The mean age of the patients at the time of outpatient appointment was 44 years with an average waiting time of 6.6 months. Inclusion criteria: all patients undergoing wrist surgery. Exclusion criteria: septic arthritis, acute distal radius fractures. Kappa analysis was used to compare the three methods of wrist pathology assessment. The total 30 patients were assessed for clinical findings, MRI report and corresponding arthroscopic findings. Results. According to the clinical findings, 22 patients (68% of all patients) were diagnosed with suspected TFCC injury. In 21 patients, the MRI showed TFCC tear (partial to complete) and this was confirmed by arthroscopy in 22 patients. There was a correlation of clinical, MRI and arthroscopy in detecting TFCC lesions in 95% cases. Sensitivity 93%, specificity 90%, positive predictive value 89% and negative predictive value 94%. The Scapho-lunate ligament tear was suspected in 8 (28% of all patients). In 6 patients, MRI showed scapho-lunate tear and this was confirmed by wrist arthroscopy in 10 patients. Correlation with wrist arthroscopy was 80%, sensitivity 94%, specificity 92%, positive predictive value 90% and negative predictive value 93%. 15 patients (50% of all patients) showed signs of moderate to severe cartilage wear and 12 patients had confirmation with MRI. Correlation with wrist arthroscopy was 75%, Sensitivity 90%, Specificity 91%, positive predictive value 89% with negative predictive value 92%. However clinical examination and MRI had poor correlation with wrist arthroscopy in diagnosing synovitis. Discussion. The MRI and wrist arthroscopy has fair correlation, though MRI sensitivity approaches that of arthroscopy, it cannot replace it at the moment. However, it is a potent additional tool for wrist diagnosis if intra-articular contrast is used. It can facilitate diagnosis and indications for surgery of the wrist. It may make arthroscopic and more invasive interventions for diagnostic purposes avoidable in future. Our results showed clinical examination is crucial for diagnosing wrist pathologies, MRI can be used as an adjunct but the wrist arthroscopy still remains the gold standard tool for diagnosis and therapeutic interventions

Scaphoid non-union usually requires surgical treatment in form of reconstructive or salvage procedure. Imaging helps in planning the surgical procedure. Wrist arthroscopy may also be helpful in the pre-operative assessment. This study was conducted to find the usefulness of wrist arthroscopy in formulating a management plan to treat scaphoid non-union. We prospectively studied 17 patients of scaphoid non-unions by wrist arthroscopy. Non-union was assessed; and site and extent of any articular wear if present was noted. Some patients had additional procedures such as synovial debridement, removal of loose bodies or debridement of TFC tears. It was possible to formulate the further management plan at the same time. Our study included 14 men and 3 women with a mean age of 34.5 years (range 18 to 49). Arthroscopic findings included mild radiocarpal wear in 3 cases and severe articular wear in 1. Additionally, in two thirds of cases there was some degree of wear present over the radial styloid region. 6 cases had TFCC tears. 4 patients had synovial debridement and in 5 cases loose bodies were removed. Based on the arthroscopic findings, it was decided to proceed to a reconstructive procedure in 12 cases and a salvage procedure in remaining 5. We concluded that in scaphoid non-unions:. Articular surface wear is often less than suggested by imaging. Limited wear is often present at radial styloid area which could be debrided. Associate abnormalities such as loose bodies, synovitis and TFC tears are commonly present. State of union can not be accurately assessed due to presence of fibrocartilage at the non-union site

Aims: Chronic wrist pain has always been a diagnostic challenge. With the introduction of wrist arthroscopy and MRI, previously used techniques such as arthrography and cineradiography were made redundant. However the gold standard of wrist arthroscopy can still fail to diagnose the problem in some patients with chronic wrist pain. The aim of this study was to demonstrate that the combination of arthroscopy with arthrography gives more information, therefore permitting a clearer diagnosis in these patients. Methods: A retrospective cohort study of 40 consecutive patients who underwent wrist arthroscopy for chronic wrist pain, between November 2003 and October 2005. All patients had their investigation and management by a single upper limb consultant orthopaedic surgeon. All had plain x-rays, 42.5% had MRI prior to surgery, and all but one had an intra-operative arthrogram, performed under the same anaesthetic as for the wrist arthroscopy. All demographic data was collected along with history of the patient’s wrist pain, examination, investigations and management. Results: The results showed a ratio of patients 21M: 19F with mean age of 38 years in males and 40 years in females. On examination 15% demonstrated pain with carpal instability. 55% showed pathological findings on their X-rays. 82% of those who had an MRI, had a pathological finding. 97.5% had wrist arthrograms intra-operatively. 56% of these showed pathological findings on wrist arthrogram. In 18%, it altered the differential diagnosis prior to performing the arthroscopy and 38% it reinforced our diagnosis. The final diagnoses after wrist arthrogram and arthroscopy were 42.5% with TFCC injuries, 20% with SNAC pathology, 20% with synovitis with no other pathology, 10% with carpal ligamentous pathology and 7.5% with radiocarpal osteoarthritis. Conclusions: Performing an arthrogram initially provided more information, thereby allowing the surgeon to undertake the arthroscopy with increased accuracy. It also permitted the diagnosis of more subtle findings. Therefore, the arthrogram is another tool in the diagnosis of wrist pathology, and should not be forgotten. It is especially useful in patients with chronic wrist pain, where the diagnosis may be more complicated

To assess whether by improving patient’s knowledge about the wrist arthroscopy procedure would positively affect the amount of postoperative pain. We tested the effect of a fact sheet that contained detailed information about the procedure on the outcome of such a surgery. Fifty-five patients undergoing diagnostic wrist arthroscopy were randomly allocated into 2 groups. Group 1 included 28 patients to whom an explanatory form named fact sheet was provided prior to the procedure. 27 patients in the second group did not have the fact sheet. However both groups had the usual preoperative verbal instructions during consenting and all patients had Visual analogue scale pain assessment before surgery. Pain scores were recorded over a 10 day period postoperatively, the end point being the day on which the patient returned to the preoperative pain status. There were 34 females and 21 males with 47 right and eight left wrists but all were the dominant side. The mean age of the patients was 35 years (range of 16 to 54 years). In the first 48 hours all patients had flare up of pain in their wrists but by day five, 75% of patients who had the fact sheet, recovered to their preoperative pain status whereas only 22% of patients in the control group had done so. Furthermore, Patients in group 1 resumed their routine daily activities on average three days earlier (day seven) when compared to the control group in whom this return was not complete up to day 10. Supplying a fact sheet prior to wrist arthroscopy has a positive influence in terms of decreasing the preoperative pain score and reducing the time patients required off work. Given the clear benefits demonstrated by this simple manoeuvre, it is now our practice to provide such a fact sheet to all patients

Purpose of the study. To evaluate the changes of the wrist by arthroscopy without distraction in patients with multiple hereditary osteochondromatosis (MHO), and enchon-dromatosis in relation to the forearm deformity, and the combination with the following surgical procedure. Introduction. Arthroscopy of the wrist in childhood was not published previously. Wrist arthroscopy was used to evaluate the changes in the wrist in patients with MHO and enchondromatosis and to correlate these changes to specific deformities of the forearm bones. Material and Methods. The arthroscopy without distraction was used in 11 children in 13 wrist joints, with MHO (nine patients) and enchondromatosis (two patients). Conventional 2.4 mm arthroscope and the III/IV, VI/R and MCU approaches were used in combination mostly with the following surgical procedures according to the presented deformities (11 times). The arthroscopic find-ings were correlated to the conventional X-ray examinations of the wrist (radial articular angle, carpal slip, and relative ulna shortening). Results. 1. Wrist arthroscopy without distraction offers sufficient information about wrist anatomy in children to make it possible to continue with the surgical procedure in the same session. 2. The arthroscopic findings in the radiocarpal and mediocarpal space were normal in all wrist joints. 3. The articular disc of the triangular fibro-cartilage complex failed in seven wrists where shortening of the ulna was present or the head of ulna was not centered to the incisura radii. 4. A normal or reduced disc was found in six wrists where the ulna was not shortened or a normal position of the head of the ulna was re-established after lengthening. No correlation was obtained between discus anatomy and the radial articular angle and the carpal slip. Conclusions. Shortening of the ulna by MHO or enchon-dromatosis leads to the disappearance of the articular disc. Centering the ulna to the distal radioulnar joint can lead to re-establishment of the articular disc. Arthros-copy without distraction permits evaluation of the condition of the wrist, the results of treatment, and enables the surgical procedure to be performed in the same session

This is a retrospective audit of 25 wrist arthroscopies performed between January 2002 and March 2004. A 2.7-mm 30° small joint arthroscope was used. The procedure was done as a diagnostic tool, to aid decision-making in chronic wrist pathology and as definitive treatment. Trauma had played a role in most of the joints. There were interesting findings about the sequelae of distal radius fractures, despite apparently good radiological appearances. Visualisation and assessment of wrist cartilage is of cardinal importance in making long-term treatment decisions. Some wrist pathology is amenable to arthroscopic treatment

We describe a technique for arthroscopy of the wrist which is carried out without traction and with the arm lying horizontally on the operating table. The wrist is not immobilised, which makes it possible to assess the extent of instability after a ligamentous tear. In a prospective study of 30 patients we compared this technique with conventional wrist arthroscopy, performing the new method first followed by conventional arthroscopy. The advantages are that the horizontal position of the arm allows the surgeon to proceed directly from arthroscopic diagnosis to treatment, and that no change of position is required for fluoroscopy. In terms of diagnostic sensitivity, we found our technique matched that of conventional arthroscopy. We had no difficulty in carrying out minor surgical procedures such as debridement and suturing

Arthroscopic procedures may be associated with considerable pain in the first 24 hours. Intra-articular bupi-vacaine provides good analgesia but is short lasting. Intra-articular morphine has been shown to prolong postoperative analgesia in knee and ankle arthroscopy. The aim of this study is to assess the safety and analgesic effect of intra-articular morphine following day case wrist arthroscopy. Ethical approval was firstly obtained. 31 patients were randomly assigned to one of 2 groups in a double blind clinical study. Group 1 received 5ml of 0.5% bupi-vacaine intra-articularly with 5mg of morphine subcutaneously. Group 2 received 5ml of 0.5% bupivacaine and 5mg of morphine intra-articularly. There were 15 patients (mean age 41.2 years) in group 1, and 16 patients (mean age 38.9 years) in group 2. Postoperatively pain was assessed using a 100mm visual analogue pain scale (VAPS) at 1, 2, 6 and 24 hours. Analgesia requirements were recorded at these times post operatively. The presence of nausea, vomiting, other complications and patient satisfaction were recorded. Visual analogue pain scores did not show any significant difference between the groups at 1, 2, 6 and 24 hours. Supplementary analgesic consumption over the 24 hour period was slightly greater in group 1 than in group 2. None of the patients who had intra-articular Morphine had vomiting nor any other complications and did not require anti-emetics. Most patients in either group were satisfied with the level of postoperative analgesia. Intra-articular bupivacaine with or with out morphine provides adequate postoperative pain relief following wrist arthroscopy. There seems to be little difference between the two methods studied

The aim of the study was to compare the radiological findings of wrist arthrogram with wrist arthroscopy. This allowed us to establish the accuracy (sensitivity, specificity) of MRI arthrogram as a diagnostic tool. Thirty patients (20 female and 10 male) have undergone both wrist MRI arthrogram and wrist arthroscopy over the last 3 years at Macclesfield District General Hospital. The mean age at arthrogram was 42.4 years with an average 6.7 month gap between the two procedures. The MRI arthrogram was reported by a consultant radiologist with an interest in musculoskeletal imaging and the arthrosopies performed by two upper limb surgeons. Patients undergoing both procedures were identified. The arthrogram reports and operation notes were examined for correlation. Three main areas of pathology were consistently examined: TFCC (triangular fibrocartilage complex), scapholunate and lunatotriquetral ligament tears. The sensitivity and specificity of arthrogram was calculated for each. Other areas of pathology were also noted. In the case of TFCC tears MRI arthrogram had a 92.3% sensitivity and 54.6% specificity. The lunatotriquetral ligament examination with this technique was 100% sensitivity and specificity. However for scapholunate ligament tears it only had 50% sensitivity and 77.8% specificity. Wrist arthrogram and arthroscopy are both invasive techniques and equally time consuming. In cost terms the arthrogram remains cheaper but is superseded by arthroscopy as it is both diagnostic and therapeutic

Purpose: Arthroscopy of the wrist can be an alternative to open surgery for joint fractures of the radius by checking reduction of often impacted fragments and analysing associated injuries.

Material: Twenty-eight patients (15 men and 13 women) were treated arthroscopically. Mean age was 51 years (range 19–82). There were four fractures of the styloid process of the radius, six posteromedial fractures, eleven 3-fragment T fractures and seven fractures with four or more fragments. There were 19 associated injuries (six lesions of the triangular ligament, four lesions of the luno-triquetral ligament, and nine lesions of the scapho-lunate ligament including four requiring pinning.

Methods: Loco-regional anaesthesia was used for all patients. The elbow was flexed at 90° and the wrist placed under axial traction using a “Japanese” device. After careful cleaning of the joint, reduction was achieved by pinning under arthroscopic and fluoro-scopic guidance. In certain very unstable cases (i.e. the fractures with four or more fragments), additional plate fixation was required. An external prosthesis was worn for 45 days.

Results: Mean follow-up was 21 months (6–36 months). Wrist movement was normal in 24 patients and pain had totally resolved for 27. There were no secondary displacements requiring surgical revision. Horizontalisation of the radius was observed in two cases and inversion of the lower radio-ulnar index (about 0.5 cm) in four. The functional outcome was excellent or good in 22 patients, fair in five, and poor in one due to reflex dystrophy.

Discussion: The indication for surgical treatment of joint fractures is now well recognised. Our results are comparable to those in other series where arthroscopic management has been used for this type of fracture. The quality of the functional results appears to be directly related to the quality of the reduction and fixation achieved under traction.

Conclusion: Arthroscopic management of joint fractures of the lower quarter of the radius enables anatomic reduction necessary for good functional outcome.

Chauffeur fractures or isolated radial styloid fractures (IRSF) are known to be associated with scapholunate ligament (SL) injuries. Diagnosis without arthroscopic confirmation is difficult in acute fractures. Acute management of this injury with early repair may prevent the need for more complex reconstructive procedures for chronic injuries. We investigated if all IRSF should be assessed arthroscopically for concomitant SL injuries. We performed a prospective cohort study on patients above the age of 16, presenting to the Gold Coast University Hospital with an IRSF, over 2 years. Plain radiographs and computerized tomography (CT) scans were performed. All patients had a diagnostic wrist arthroscopy performed in addition to an internal fixation of the IRSF. Patients were followed up for at least 3 months post operatively. SL repair was performed for all Geissler Grade 3/4 injuries. 10 consecutive patients were included in the study. There was no radiographic evidence of SL injuries in all patients. SL injuries were identified arthroscopically in 60% of patients and one third of these required surgical stabilisation. There were no post operative complications associated with wrist arthroscopy. We found that SL injuries occurred in 60% of IRSF and 20% of patients require surgical stabilisation. This finding is in line with the literature where SL injuries are reported in up to 40-80% of patients. Radiographic investigations were not reliable in predicting possible SL injuries in IRSF. However, no SL injuries were identified in undisplaced IRSF. In addition to identifying SL injuries, arthroscopy also aids in assisting and confirming the reduction of these intra-articular fractures. In conclusion, we should have a high index of suspicion of SL injury in IRSF. Arthroscopic assisted fixation should be considered in all displaced IRSF. This is a safe additional procedure which may prevent missed SL injuries and their potential sequelae

Aims. 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. Methods. This was a prospective single-centre study undertaken between March 2019 and May 2021. The primary outcome was the evaluation of the reduction of the radiological deformity and the functional outcomes after WADCLR. A secondary outcome was the evaluation of the effectiveness of this technique in patients with the most severe instability (European Wrist Arthroscopy Society (EWAS) stage 5). The patients were reviewed postoperatively at three, six, and 12 months. Results. The study included 112 patients (70 male and 42 female). Their mean age was 31.6 years (16 to 55). A total of three patients had EWAS stage 3A injuries, 12 had stage 3B injuries, 29 had stage 3C injuries, 56 had stage 4 injuries, and 12 had stage 5 injuries. There was a significant improvement of the radiological signs in all patients with a return to normal values. There was also a significant improvement in all aspects of function except for flexion, in which the mean increase was negligible (0.18° on average). There was also a significant improvement in all criteria for patients with a stage 5 injury, except for some limitation of extension, flexion, and radial and ulnar deviation, although these showed a trend towards improvement (except for flexion). Conclusion. WADCLR is a minimally invasive, easy, and reproducible technique with few complications, offering a clear improvement in function and a reduction in the radiological deformity at one year postoperatively. Cite this article: Bone Joint J 2023;105-B(3):307–314

Physical examination is critical to formation of a differential diagnosis in patients with ulnar-sided wrist pain. Although the specificity and sensitivity of some of those tests have been reported in the literature, the prevalence of positive findings of those provocative maneuvers has not been reported. The aim of the study is to find the prevalence of positive findings of the most commonly performed tests for ulnar sided wrist pain in a population presenting to UE surgeon clinics, and to correlate those findings with wrist arthroscopy findings. Patients with ulnar sided wrist pain were identified from a prospective database of patients presented with wrist pain from September 2014. Prevalence of positive findings for the following tests were gathered: ECU synergy test, ECU instability test (Ice cream and Fly Swatter), Lunotriquetral ballottement, Kleinman shear, triquetrum tenderness, triquetrum compression test, triquetral-hamate tenderness, pisotriquetral shuck test, ulnar fovea test, ulnocarpal impaction (UCI) maneuver, UCI maneuver with fovea pressure (ulnar carpal plus test), piano key sign. A subgroup was then created for those who underwent wrist arthroscopy, and analysis of the sensitivities, the specificities and the predictive values of these provocative tests was carried out with correlation to arthroscopic finding. Prevalence of ECU instability tests was t 1.13% (ice cream scoop) and 1.5% (fly swatter). Lunotriquetral ballottement test's positive findings range from 4.91% (excessive laxity) to 14.34% (pain reproducing symptoms. The Kleinman shear test yielded pain in 13.58% of patients, and instability in only 2.26%. Triquetrum compression test reproduces pain in 32.83% of patients, and triquetral-hamate tenderness reproduced pain in 13.21%. Pisotriquetral grind test yields 15.85% positive findings for pain, and 10.57% for crepitus with radioulnar translation. The ulnar fovea test revealed pain in 69.05% of cases. The UCI maneuver yielded pain in 70.19%. The UCI maneuver plus ulnar fovea test reproduced pain in 80.38% of cases. Finally, the piano key sign yields positive finding in 2.64% of cases. For patients who underwent surgery, sensitivities, specificities and predictive values were calculated based on arthroscopic findings. The lunotriquetral ballottement test has 59.6% sensitivity, 39.6% specificity, 20.3% positive predictive value and 85.4% negative predictive value. The sensitivity of Kleinman test was 62.4%, the specificity was 41.3%, the positive predictive value was 23.5%, and the negative predictive value was 83.2%. The sensitivity of fovea test was 94.3%, the specificity was 82.5%, the positive predictive value was 89.5% and the negative predictive value was 92.3%. The UCI maneuver plus ulnar fovea test has 96.5% sensitivity, 80.7% specificity 86.4% positive predictive value, and 95.3% negative predictive value. Among the provocative tests, the prevalence of positive findings is low in the majority of those maneuvers. The exceptions are the fovea test, the UCI maneuver, and the UCI plus maneuver. With regard to the sensitivity and the specificity of those tests, the current study reproduces the numbers reported in the literature. Of those patients who underwent wrist arthroscopy, the tests are better at predicting at the absence of injury rather than at predicting its presence

Aims: To assess the usefulness of wrist arthroscopy in the assessment of symptomatic scaphoid non-unions and associated injuries and to evaluate the implications on the definitive treatment. Methods: A prospective cohort study of patients undergoing wrist arthroscopy with established scaphoid non-union was performed between January 2006 and April 2009. This study included 17 men and 6 women with a mean age of 39 years. Results: Majority of the study population (61%) had normal radiocarpal articular cartilage. Articular cartilage wear was mostly limited to the radial styloid and could be effectively debrided. Injuries to the TFCC (39%) followed by the LT joint (35%) and the SL joint (26%) were the most common arthroscopic findings. Other identified pathologies included: Loose bodies, protruding Herbert screw from previous fixation, Chondrocalcinosis, Distal Radio-ulnar joint (DRUJ) instability, Capitohamate (CH) instability and Ulnar styloid fracture non-union. Assessment of the state of the fracture union was best done from the mid carpal joint rather than the radiocarpal joint due to a more prominent fibrocartilage covering of the fracture site from the radiocarpal side Concomitant procedures performed during the wrist arthroscopy included debridement of synovitis (48%) and TFCC repair (4%). Post wrist arthroscopy 6 patients (26%) required a further course of conservative treatment (Physiotherapy +/− local anaesthetic and steroid injection) prior to discharge. In the remaining patients, based upon clinical and arthroscopic findings, a range of other therapeutic and salvage procedures were performed. Conclusion: This study demonstrates an important role for the wrist arthroscopy in patients with symptomatic scaphoid non-union and in assessing the true extent of the articular cartilage wear and associated carpal injuries. Further it helped in most cases with the decision making in choosing the appropriate definitive surgical option when required

Purpose of the study. To evaluate the changes of the wrist by arthroscopy without distraction in patient with multiple hereditary osteochondromatosis (MHO) and enchondromatosis in relation to the forearm deformity and the combination with following surgical procedure. Introduction. Wrist arthroscopy was used to evaluate the changes in the wrist in patients with MHO and enchondromatosis and to correlate these changes to specific deformities of the forearm bones. Material and Methods The new technique of wrist arthroscopy without distraction was used in 16 children in 20 wrist joints, with MHO (12 patients) and enchondromatosis (4 patients). Conventional 2.4mm arthro-scope and the III/IV, VI/R and MCU approaches were used in combination mostly with the following surgical procedures according to present deformities (15 times). The arthroscopical findings were correlated to the conventional X-ray examinations of the wrist (radial articular angle, carpal slip, and relative ulna shortening). Results. 1. Wrist arthroscopy without distraction offers the sufficient information about wrist anatomy in children and it was possible to continue with the surgical procedure in the same session. 2. The arthroscopic findings in the radiocarpal and mediocarpal space were normal in all wrist joints, with exception of one patients with cartilage lesions. 3. The articular disc of triangular fibrocartilage complex failed in 11 wrists, where shortening of the ulna was present or head of ulna was not centred to incisura radii. 4. The normal or reduced disc was found in 5 and 4 wrists, respectively, where ulna was not shortened or where normal position of head of ulna was re-established after lengthening. No correlation was obtained between discus anatomy and radial articular angle and carpal slip. Conclusions. Shortening of the ulna by MHO or encho-dromatosis leads to elimination of the articular disc and later to degenerative changes in wrist joint. Lengthening of the ulna to distal radioulnar joint leads probably to re-establishment of the articular disc. Arthroscopy without distraction evaluates the wrist conditions and the results of treatment and enables a surgical procedure in the same session in children of the school age

Introduction. We reports the accuracy of direct Magnetic Resonance Arthrography (MRA) in detecting Triangular Fibrocartilage Complex (TFCC), Scapho-Lunate Ligament (SLL) and Luno-Triquetral Ligament (LTL) tears using wrist arthroscopy as the gold standard. Methods. We reviewed the records of all patients who underwent direct wrist MRA and subsequent arthroscopy over a 4-year period between June 2007 and March 2011. Demographic details, MRA findings, arthroscopy findings and the time interval between MRA and arthroscopy were recorded. The scans were performed using a 1.5T scanner and a high resolution wrist coil. All scans were reported by a musculoskeletal radiologist. Sensitivity, specificity, positive and negative predictive values (PPV & NPV) were calculated. Results. Two hundred and thirty four (234) MRA were performed over the study period. Fifty patients (50), who subsequently underwent 51 wrist arthroscopies (one bilateral), were included. The mean age was 35 years (range 16–64 years). The average delay between MRA and arthroscopy was 4.8 months (median 4 months, range 17 days–18 months). All patients were symptomatic with wrist pain. At arthroscopy, 26 TFCC tears, 7 SLL tears and 3 LTL tears were found. For TFCC, sensitivity was 96%, specificity 88%, PPV 89% and NPV 96%. For SLL, the values were 57%, 66%, 21% and 91% respectively. For LTL, 67%, 79%, 17% and 97%, respectively. Receiver Operating Characteristic (ROC) curve analysis showed that MRA only reliably differentiates between patients with and without TFCC tears (Area Under Curve AUC = 0.92, p < 0.0001) but not SLL (AUC = 0.62, p=0.28) or LTL (AUC = 0.73, p=0.17) tears. Conclusion. MRA is a sensitive and specific imaging modality for diagnosing TFCC tears. However, the diagnostic accuracy for SLL and LTL tears was not satisfactory. Wrist arthroscopy remains the gold standard if there is a clinical suspicion of inter-carpal ligament tears

The August 2012 Children’s orthopaedics Roundup. 360. looks at: whether 3D-CT gives a better idea of coverage than plain radiographs; forearm fractures after trampolining accidents; forearm fractures and the Rush pin; the fractured distal radius; elastic stable intramedullary nailing for long-bone fractures; aponeurotic recession for the equinus foot; the torn medial patellofemoral ligament and the adductor tubercle; slipped capital femoral epiphysis; paediatric wrist arthroscopy; and Pirani scores and clubfoot

The April 2012 Wrist & Hand Roundup. 360 . looks at releasing the trigger finger, function in the osteoarthritic hand, complex regional pain syndrome, arthroscopic ligamentoplasty for the injured scapholunate ligament, self-concept and upper limb deformities in children, wrist arthroscopy in children, internal or external fixation for the fractured distal radius, nerve grafting, splinting the PIPJ contracture, and finding the stalk of a dorsal wrist ganglion

It is common practice in wrist arthroscopy to suspend the patient’s arm using Chinese finger traps and to distract the wrist joint by applying weight to the arm at the elbow. It is possible that this may cause significant pressure to be applied to the fingers, and potentially damage the digital nerves. We examined the pressure applied by finger traps and consider the risk this poses to the digital nerves. Standard finger traps were suspended from a spring balance and the author’s fingers inserted along with a length of rubber tubing. The tubing was filled with saline and connected to a digital compartment pressure monitor. The hanging mass was gradually increased and the pressure in the rubber tubing noted. This pressure was taken as analogous to the pressure affecting the neurovascular bundle. Pressure increases linearly with increasing mass. A pressure of 500mmHg has been suggested as necessary to cause nerve injury1. Using non-invasive technique it was not possible to accurately measure the absolute pressure acting on the digital nerves. However the increase in pressure was noted. Using weight to distract the wrist during arthroscopy has potential to cause nerve injury. We suggest that pressure insufflation combined with Chinese finger traps with minimum weight traction provides a more than satisfactory view at wrist arthroscopy and can avoid potential digital nerve injury. However traction through finger traps for other purposes such as fracture reduction may be used with caution