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Objective: To examine the safety of threaded-pin placement for fixation of distal radial fractures using a limited open approach., Design: A cadaver study., Methods: Four-millimetre Schanz threaded pins were inserted into the radius and 3-mm screw pins into the second metacarpal of 20 cadaver arms. Each threaded pin was inserted in the dorsoradial oblique plane through a limited open, 5- to 10-mm longitudinal incision. Open exploration of the threaded-pin sites was then carried out., Outcome Measures: Injury to nerves, muscles and tendons and the proximity of these structures to the threaded pins., Results: There were no injuries to the extensor tendons, superficial radial or lateral antebrachial nerves of the forearm, or to the soft tissues overlying the metacarpal. The lateral antebrachial nerve was the closest nerve to the radial pins and a branch of the superficial radial nerve was closest to the metacarpal pins. The superficial radial nerve was not close to the radial pins., Conclusion: Limited open threaded-pin fixation of distal radial fractures in the dorsolateral plane appears to be safe.

Objective: To compare the sensitivity of traditional motion studies, bone scintigraphy and radiocarpal arthrography to a "carpal stretch test," for evaluation of dynamic dissociative carpal instability., Design: Experimental study comparing the results of the tests to the findings of arthroscopy, the "gold standard.", Setting: A university hospital-based upper extremity practice., Patients: Six patients with chronic wrist pain, arthroscopically confirmed proximal row ligamentous disruption and radiographs not suggestive of proximal row instability., Interventions: The carpal stretch test: both affected and unaffected wrists were subjected to the same testing, wherein the wrist was suspended from finger traps for 10 minutes by a 4.5-kg weight. Standardized posteroanterior radiographs were taken of the suspended wrists., Main Outcome Measures: Disruption of Gilula's arcs I and II, and sensitivity of the carpal stretch test compared with other investigations., Main Results: Step deformities ranging from 2.5 to 6 mm (average 3.7 mm) were recorded in the affected wrists and 0 to 4 mm (average 1.5 mm) in the "unaffected" wrists. The test was more sensitive than traditional radiography, arthrography and scintigraphy in defining both presence and site of proximal carpal row ligamentous tears and was almost as sensitive as arthroscopy., Conclusion: In patients with chronic wrist pain and dynamic dissociative wrist instability, the carpal stretch test may prove to be a valuable screening tool for detecting ligamentous tears of the proximal carpal row.