Injection of corticosteroids into the digital flexor tendon sheath is an accepted and effective treatment for stenosing tenosynovitis. However, despite long historical experience with this procedure, there remains no guide in the literature as to the optimal dose of steroid. Furthermore, the accuracy of these injections has not been well established. Using a prospective, randomized, blinded design, this study compares the outcomes of high (20 mg) and low (10 mg) dose depomedrol injection. Furthermore, the accuracy of tendon sheath injections was assessed radiographically. The findings demonstrate increased effectiveness of the higher steroid dose and a significant learning curve associated with intra-thecal injections.

Injection of corticosteroids into the digital flexor tendon sheath is an accepted and effective treatment for stenosing tenosynovitis (trigger finger). However, despite long historical experience with this procedure, there remains no guide in the literature as to the safe and effective dose of steroid to be administered. Furthermore, the accuracy of digital tendon sheath injections has not been well established. One study has suggested that steroid injected outside the tendon sheath was as effective as intra-thecal injection and may result in reduced complications of infection and tendon rupture.

Using a prospective, blinded design, patients were randomized to receive either high (20 mg) or low (10 mg) dose depomedrol injection. The accuracy of the steroid injections was determined radiographically using non-ionic radio-opaque dye. Outcome measures included pain, tenderness, presence of a palpable nodule, triggering, and limitation of activities (work, hobbies, ADLs). Complications such as pain, stiffness, bruising, thinning of the fat or skin, infection and tendon rupture were also recorded.

Higher dose depomedrol (20 mg) was found to be more effective for relieving pain and triggering than lower dose depomedrol (10 mg). No increase in complication rate was encountered. Stenosing tenosynovitis in diabetic patients was markedly less responsive to treatment.

Injection accuracy was found to increase with clinical experience from approximately 50% for beginners to over 90% for experienced hand surgeons. At the time of submission of this abstract, patient numbers (currently forty-one participants) do not allow analysis regarding the effect of injection accuracy on clinical outcome.

Previously, we have described a novel, computer assisted technique of osteotomy for distal radius malunion. Laboratory and clinical results demonstrate excellent realignment of the articular fragment, but incomplete correction of the radioulnar convergence and loss of radial bow. This study describes an innovation whereby both the proximal and distal fragments of the malunited radius are manipulated in 3D relative to an external template. Two case studies demonstrate the improve restoration of anatomy with this technique.

The purpose of this study was to develop a method of computer-assisted planning and image guided surgery to restore the normal bow to the malunited radius.

Manipulation of a virtual model of a distal radius malunion can only restore the full anatomical bow to the radius if both the distal and proximal fragments are corrected to match a normal template.

This is a novel method of restoring normal anatomy in which both fragments of a malunited bone are corrected relative to an external normal template.

A previously developed CT-based research software system for conducting computer-assisted distal radius osteotomy allowed three-dimensional manipulation of the distal fragment only, to restore the alignment of the distal articular surface. Results of the first six cases demonstrated that this system did not fully correct the convergence of the radius and ulna with persistent loss of radial bow, although it does provide excellent realignment of the articular fragment. The system was modified to include the ability to manipulate the proximal fragment of the radius. This fragment is rotated and translated to match an external reference template derived from a mirror image CT surface mesh of the opposite forearm. Results of two case studies are evaluated, demonstrating the computer models and post-operative radiographs confirming improved restoration of radial anatomy compared to the previous system.