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This study aimed to describe the intraosseous blood supply of the distal radius and its clinical implications in distal radius fractures. Twelve adult wrists from fresh cadavers (six males, six females, 50–90 years of age, mean 68 years) were injected through the brachial artery with latex. Dissections were performed using magnifying loupes and hands were processed using the Spalteholz technique....
This study’s objective was to compare the use of two biplanar angled radiographs versus standard posterioanterior (PA) and lateral radiographs in determining preservation of the articular space with regard to pin placement in the distal radius. Various combinations of inclination (pitch) and clockwise/counterclockwise rotation (roll) were used to determine the best view of the distal radius articular...
The authors report a case of isolated symmetrical metacarpia of the first metacarpal in a 33-year-old serving soldier. The patient was totally unaware of the deformity, which was found incidentally while radiographs were done for the wrist to rule out scaphoid fracture. To the best of our knowledge, there have been no similar reports in the English literature before.
Free omental tissue transfer is a versatile reconstructive option for trunk, head and neck, and extremity reconstruction. Its utility is due to the length and caliber of the vascular pedicle and the malleability and surface area of the flap. We report our experience with omental free flap coverage of complex upper-extremity defects. A retrospective analysis of eight omental free-tissue transfers in...
Elbow motion is essential for upper extremity function to position the hand in space. Unfortunately, the elbow joint is prone to stiffness following a multitude of traumatic and atraumatic etiologies. Elbow stiffness can be diagnosed with a complete history and physical exam, supplemented with appropriate imaging studies. The stiff elbow is challenging to treat, and thus, its prevention is of paramount...
The Manchester-Modified Disability of Arm, Shoulder and Hand questionnaire (M2 DASH) was developed by the authors as a modification to the original DASH questionnaire. In this study, we assessed the validity, reliability, responsiveness, and bias of the M2 DASH questionnaire for hand injuries using completed M2 DASH, Patient Evaluation Measure, and Michigan Hand Outcome questionnaires from 40 patients...
Optimal acute management of the highly comminuted distal ulna head/neck fracture sustained in conjunction with an unstable distal radius fracture requiring operative fixation is not well established. The purpose of the present study was to determine the clinical, radiographic, and functional outcomes following acute primary distal ulna resection for comminuted distal ulna fractures performed in conjunction...
This is a surgical technique report concerning the treatment of a 32-year-old male who had a giant cell tumor of distal ulna with suspected metastatic disease to the lungs. Three curettage procedures and a Darrach procedure were performed at an outlying facility. Upon the fourth reoccurrence, the patient was referred to our facility. It was established that the patient needed a distal ulna en bloc...
The purpose of this study was to evaluate the opinions and practices of peripheral nerve surgeons regarding assessment and treatment of pain in patients following nerve injury. Surgeons with expertise in upper extremity peripheral nerve injuries and members of an international peripheral nerve society were sent an introductory letter and electronic survey by email (n = 133). Seventy members responded...
Between 1994 and 2004, seven patients (nine thumbs) at our institution were treated for trigger thumb with hyperextensible metacarpophalangeal (MP; >60°) anomaly with surgical release of the A1 pulley and proximal advancement of the MP volar plate. There were four girls and three boys (three right, two left, and two bilateral thumbs) with a mean age at surgery of 46 months (range, 26 to 82 months)...
Exercise-induced chronic compartment syndrome in the first dorsal compartment is an uncommon entity and relatively rare condition which is not very well understood. It is a usually activity-related condition and is associated with decreased function of muscle with intracompartmental swelling. We present a case with proven exercise-induced raised compartment pressure that responded well to surgical...
The decision-making process in the diagnosis and treatment of an ulnar nerve entrapment (UNE) at the elbow is presented from the viewpoint of the patient and from that of a physician who in this case, were the same individual. The problems of diagnosis and the selection of the appropriate therapy-conservative or surgical and the choice of a particular surgical approach are discussed in the light of...
The quality of ultrasound imaging to examine anatomical structures in the wrist and hand has improved highly over the last years. The value of ultrasonography (US) performed by hand surgeons on treatment decisions was investigated in this study. One hundred and ninety-five patients with an unclear clinical hand problem were evaluated by high-definition ultrasonography from January 2005 until June...
The type IV flexor digitorum profundus avulsion is a rare injury involving fracture of the volar base of the distal phalanx and separation of the tendon from the fracture fragment. Recommendations for management are sparse and are substantiated only by a few isolated case reports. We recently encountered two of these injuries, both of which proved challenging, particularly with regard to joint incongruity...
Four cases of flexor tendon problems which developed after volar plate fixation of distal radius fractures are presented. All cases were associated with close contact of the screws or distal edge of the plate with the flexor tendons. Poor bone stock or multiple bone fragments allowing loosening of the plate or non-locking screws cause the hardware to irritate the flexor tendons and ultimately lead...
Madelung’s deformity is a well-known congenital anomaly of the wrist. A number of procedures have been described to correct the deformity and thus improve function at the wrist. Most of these procedures have to a large extent addressed the alignment and consequent function of the radiocarpal joint but not the persistent problem of painful stiffness at the distal radioulnar joint (DRUJ). The availability...
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