One hundred and sixty-two patients with a diagnosis of scapholunate instability underwent a modified Brunelli procedure over a 7 year period. One hundred and seventeen were assessed with the help of a questionnaire and, of these, 55 patients attended for clinical evaluation. The mean follow-up was 4 (1-8) years. There were 72 patients with dynamic scapholunate instability and 45 patients with static instability. The average age was 38 years. There were 50 males and 67 females. 77 (62%) patients had no to mild pain with a mean visual analogue score of 3.67 (SD=2.5)). The loss in the arc of flexion-extension was due to a reduced range of flexion (mean 31% loss), while 80% of extension was maintained, compared with the contralateral side. The grip strength on the operated side was reduced by 20% of the non-operated side. There was no statistically significant difference (p>0.05) in the range of movement or the grip strength between the static and dynamic group or the claims and non-claims group. Ninety (79%) patients were satisfied with the result of the surgery (good to excellent) and 88% of the patients felt that they would have the same surgery again. We feel that these results compare favourably with the early results published from this unit and recommend this procedure for dynamic and static scapholunate instability

Between 1994 and 2002, 81 patients underwent ulnohumeral arthroplasty for elbow arthritis at our institution. All patients were sent a questionnaire with a request to attend for a clinical evaluation. Forty replied and 34 attended for clinical examination, 6 females and 34 males with an average age of 63 years (32-80) and a mean follow-up of 6 years (2-10). There were 22 (55%) patients with primary osteoarthritis, 14 (35%) with osteoarthritis secondary to trauma, two patients with rheumatoid arthritis and one patient each with arthrogryphosis multiplex congenital and post-septic arthritis of the elbow.

Using the VAS (0-10), the pain score was seen to improve from a mean pre-operative score of 8 (6-10) to 4 (0-9). 21 patients (50%) were on minimal or no analgesia and 31 (75%) patients felt they would have the surgery again for the same problem. The arc of motion as regards flexion/extension was found to increase by 19% while prono-supination was found to increase by 30%. There was one patient each with superficial infection, anterior interosseous nerve neuropathy and myositic ossificans while two patients had triceps rupture. Radiological examination showed that in 12 cases the trephine hole was partially obliterated while in 4 cases it was completely obliterated. This could not be correlated clinically. Patients with loose bodies seemed to do better in the post-operative phase.

Ulnohumeral arthroplasty has a role in the management of the arthritic elbow as it provides pain relief in the post-operative period; however, the improvement in the range of movement is limited particularly as regards the arc of extension.