Purpose

Clavicular anatomy is variable and this has implications when osteosynthesis is undertaken especially while using the newer generation pre-contoured anatomical plates. This study aimed to examine the anatomy of the clavicle and its variations.

Failure of conservative treatment for tennis elbow is an indication for surgical decompression. The Topaz® technique utilises radiofrequency to decompress(detension) the tendon and in addition, it is thought to stimulate angiogenesis thereby facilitating healing. Initially we reviewed the three month follow up of 25 tennis elbow decompressions performed using the Topaz® technique. The case notes were reviewed and findings recorded on a structured proforma. After a minimum of 1 year we re-reviewed the case notes to identify recurrences or patients requiring revision surgery. The majority of patients were aged between 35–50 years. 87% of patients had symptoms for more than 12 months and symptoms experienced were mainly pain (100%). All patients had a full trial of physiotherapy and had minimum of two steroid injections. At three month follow up symptoms were completely relieved or improved in 88%. All patients were given an open appointment to review if symptoms recurred. On review of the notes after a minimum of one year, 84% had no further clinic attendances. Four elbows re-attended with symptom recurrence, two underwent traditional open release and two declined revision surgery. In the two patients who declined further surgery, symptoms had resolved at one year. The results of the Topaz® technique are comparable to that of the results of the traditional release from the literature both in terms of success and problems. It would be important to compare it to the traditional release to gauge its benefits against the standard practice.

Various authors have linked hypermobility at the trapeziometacarpal joint to future development of arthritis. When examining hypermobility, the anterior oblique ligament (AOL) and ulnar collateral ligament (UCL) are the two most important supporting structures. Literature suggests that reconstructive techniques to correct the hypermobility can prevent subsequent development of osteoarthritis. Eaton and Littler proposed a surgical technique to reconstruct the ligamentous support of this joint in 1973. This cadaveric biomechanical study aimed to evaluate the resultant effect on the mobility of the thumb metacarpal following this reconstructive technique. Seventeen cadaveric hands were prepared and strategically placed on a jig. Movements at the trapeziometacarpal joint were created artificially. Static digital photographs were taken with intact AOL and UCL at trapeziometacarpal joint (controls), for later comparison with those after sectioning of these ligaments and following Eaton-Littler reconstructive technique. The photographic records were analyzed using Scion.Image. Statistical analysis was performed using Minitab. A paired T-test was used to establish statistical relevance. Results confirmed that the AOL and UCL had a major role in limiting excessive motion at the trapeziometacarpal joint, principally in extension. Division of these ligaments produced a significant degree of subluxation of the metacarpal at this joint with thumb in neutral position (p-value = 0.013). Reconstruction of the ligamentous support using the Eaton-Littler technique reduced the degree of extension available (p-value = 0.005). This study confirmed the important role of the AOL and UCL in maintaining trapeziometacarpal joint stability, and that the Eaton-Littler reconstructive technique reduces the degree of hyperextension at this joint.