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Purpose: Whereas the goal of distal radius fracture treatment is anatomical restoration, controversy exists as to whether it is the severity of the disruption of joint alignment at the time of fracture or residual malalignment after healing that determines outcome. The objective of this study was to compare joint contact mechanics bilaterally a minimum of 3 years following a distal radius fracture. Our hypothesis was that 3-dimensional joint space would be reduced in individuals following wrist fracture and that these changes in joint load lead to the development of degenerative arthritis. To test the hypothesis, an interbone spacing algorithm was used to determine whether 3-dimensional joint space and contact mechanics were altered in the distal radioulnar (DRUJ) and radiocarpal joints following a wrist fracture., Methods: In 16 subjects with previous unilateral wrist fractures, 3-dimensional interbone distance (joint space), a measure of joint congruency and 3-dimensional alignment, was quantified from reconstructed computed tomography bone models of the distal radius, ulna, scaphoid, and lunate., Results: At an average of 8 years following fracture, joint interbone spacing area was reduced in the radiolunate joint of the injured wrist in comparison with the uninjured wrist. The joint interbone spacing area was decreased in the DRUJ and radioscaphoid joint of the injured wrist compared with the uninjured wrist but this difference was not statistically significant., Conclusions: This study demonstrates the use of a noninvasive tool that can be used to examine joint loading and suggests that further investigation into the association between altered joint loading and the development of posttraumatic arthritis is needed, especially in the radiocarpal joints., Clinical Relevance: This paper provides a noninvasive image-based framework that can be used to examine joint contact area over time and provides preliminary data examining the effect of a distal radius fracture on the joint congruency of the DRUJ and radiocarpal joints., (Copyright © 2021 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine if ulnar styloid fractures (USF) affect clinical outcome following distal radius fracture (DRF) in adults under 65 years of age., Methods: This study involved 312 patients (aged 18-64) with surgically and nonsurgically treated DRFs. Patients were followed prospectively at baseline and 3, 6, and 12 months. The primary outcome was the Patient-Rated Wrist Evaluation (PRWE), and secondary outcomes were range of motion and grip strength. The USFs were classified by location (tip, middle, and base) and union status., Results: There were 170 patients with isolated DRFs and 142 with associated USF (64 tip, 32 middle, and 46 base fractures). The mean age of the entire cohort was 48 years with 218 (70%) women. All USFs were treated nonoperatively. There was a trend of higher PRWE scores in DRFs associated with USFs compared to isolated DRFs throughout the study. Associated ulnar styloid base fractures had higher but clinically insignificant PRWE scores than isolated DRFs at 6 and 12 months. Patients with an associated USF had a slower recovery of wrist flexion and grip strength compared to isolated DRF, but values were comparable at 12 months. United USFs and nonunited USFs had similar PRWE scores at all time points., Conclusions: Adults under 65 years old with DRFs and associated USFs initially have greater pain and disability than those with isolated DRFs; however, this difference dissipated over time and was not significant at one year. No long-term differences in measured impairments were observed, but the presence of an associated USF resulted in a slower recovery of grip strength and wrist flexion. Presence of a USF nonunion did not significantly affect outcomes., Type of Study/level of Evidence: Prognostic II., (Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Measurement is a fundamental cornerstone in all aspects of scientific discovery, including clinical research. To be useful, measurement instruments must meet several key criteria, the most important of which are satisfactory reliability, validity, and responsiveness. Part 1 of this article reviews the general concepts of measurement instruments and describes the measurement of general health, pain, and patient satisfaction., (Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Part 1 of this article outlined the basic characteristics of useful clinical measurement instruments and described scales used to measure general health, pain, and patient satisfaction. Part 2 describes the features of some of the scales most commonly used in clinical research in the hand, wrist, elbow, and shoulder., (Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate retrospectively the functional and radiographic outcome of patients who had a thumb metacarpophalangeal joint arthrodesis with a single longitudinal K-wire., Methods: We performed a retrospective review of 27 patients who had a thumb metacarpophalangeal joint arthrodesis with a single longitudinal K-wire. Outcomes were assessed using self-reported measures (Patient-Rated Wrist/Hand Evaluation; AUSCAN Osteoarthritis Hand Index; Disabilities of the Arm, Shoulder and Hand questionnaire; Short Form-36 General Health questionnaire), measured physical impairments (range of motion, strength, manual dexterity), and radiographic review., Results: Patient-rated outcome scores indicated mild pain, difficulty with specific and usual tasks, and minimal concern with hand appearance. Most physical impairment measures were not significantly different from the side not surgically treated, and patient satisfaction was high. There was a slight decrease in tripod pinch strength, manual dexterity, interphalangeal joint flexion, handspan, and thumb opposition compared with the contralateral side. The overall complication rate was 11% (3 complications). Twenty-five patients (89%) were able to return to their previous occupations. There were no radiographic malunions or nonunions. Radiographic evidence of degenerative changes was present in 20% of patients at the carpometacarpal joint and 30% of patients at the interphalangeal joint., Conclusions: Our technique of performing a thumb metacarpophalangeal joint arthrodesis with a single longitudinal K-wire is effective, with high overall patient satisfaction and a relatively low complication rate, despite small losses of strength, manual dexterity, and motion., Type of Study/level of Evidence: Therapeutic IV.

The purposes of this study were to determine the overall incidence of distal radius fracture (DRF) complications, determine the incidence and types of DRF complications in a consecutive cohort of 250 patients with DRFs, describe DRF complications reported by patients compared with those reported by physicians, and formulate a DRF complication checklist to improve recording of DRF complications. We found that the overall complication rates vary widely (6% to 80%). Physician-reported complication data were collected for 236 patients, and a physician-reported complication rate of 27% was determined. A patient-reported complication rate of 21% was found for 207 patients whose patient-reported data were collected. We also noted that patients and physicians assess DRF complications differently: patients are more focused on symptoms than diagnoses. A DRF complication checklist was developed to improve prospective data collection. The checklist includes a classification for all DRF complications and allows for assessment of severity of each complication.

Computed tomography was used to image the distal radioulnar joint (DRUJ) for instability. Four methods were used to quantify subluxation of the DRUJ: the Mino criteria, the epicenter method, the congruency method, and a new method called the radioulnar ratio (RUR). Validity of the various methods was evaluated in clinical and laboratory situations. Rheumatoid patients with symptomatic DRUJ pathology had significantly more abnormal RUR values (100% vs 73% [epicenter method] and 88% [Mino criteria]). The RUR detected instability sooner in a progressive laboratory-induced instability model. The intraobserver and interobserver reliability of the RUR was high, with intraclass correlation coefficients of 0.89 and 0.87, respectively. The RUR demonstrated superior performance in the diagnosis of DRUJ subluxation.

Twenty-two consecutive patients (23 wrists) underwent open reduction internal fixation of dorsal perilunate dislocations and fracture-dislocations through combined dorsal and volar approaches. One of 5 experienced wrist surgeons performed these procedures within an average of 3 days of injury (range, 0-26 days) and intercarpal fixation was kept within the proximal carpal row. Motion was instituted an average of 10 weeks (range, 5-16 weeks) after injury. All patients were males. The average age at the time of injury was 32 years (range, 16-60 years). The average follow-up period was 37 months (range, 13-65 months). Average flexion-extension motion arc and grip strength in the injured wrist were 57% and 73%, respectively, compared with the contralateral wrist. The scapholunate angle increased and the revised carpal height ratio decreased over time, which was statistically significant for both measurements. Three patients (3 wrists) required wrist arthrodesis and a fourth patient had an immediate scaphoid excision and 4-corner arthrodesis secondary to an irreparable scaphoid fracture. One patient required a proximal row carpectomy to treat septic arthritis. Nine of the remaining 18 wrists had radiographic evidence of arthritis, most often at the capitolunate or scaphocapitate articulations. Short form-36 mental summary scores were significantly greater than age- and gender-matched US population values; physical summary scores were significantly less. The disabilities of arm, shoulder, and hand evaluation, Mayo wrist score, and patient-rated wrist evaluation all reflected loss of function. Seventy-three percent of all patients had returned to full duties in their usual occupations and a total of 82% were employed.

We evaluated the responsiveness of patient questionnaires and physical testing in the assessment of recovery after distal radius fracture. Patients (n = 59) were assessed at their baseline clinic visit and again 3 and 6 months after injury. At each visit patients completed a short form-36, Disability of the Arm, Shoulder, and Hand questionnaire, and patient-rated wrist evaluation (PRWE). At 3 and 6 months grip strength, range of motion, and dexterity were analyzed. Standardized response means (SRM) and effects sizes were calculated to indicate responsiveness. The PRWE was the most responsive. Both the PRWE (SRM = 2.27) and the Disability of the Arm, Shoulder, and Hand (SRM = 2.01) questionnaire were more responsive than the short form-36 (SRM = 0.92). The physical component summary score of the short form-36 was similar to that of the physical component subscales. Questionnaires were highly responsive during the 0- to 3-month time period when physical testing could not be performed. Of the physical tests, grip strength was most responsive, followed by range of motion. Responsive patient-rating scales and physical performance evaluations can assist with outcome evaluation of patients with distal radius fracture., (Copyright 2000 by the American Society for Surgery of the Hand.)

The intra- and interobserver variability of 3 techniques for measuring the humpback deformity of 37 scaphoids using longitudinal computed tomography was assessed. The 3 measuring techniques were the lateral intrascaphoid angle, the dorsal cortical angle, and the height-to-length ratio. The intraobserver reliability of the intrascaphoid angle was poor; the dorsal cortical angle was moderate to excellent, and the height-to-length ratio was excellent. The interobserver reliability of the intrascaphoid angle was poor to moderate, the dorsal cortical angle was moderate to excellent, and the height-to-length ratio was moderate to excellent. For all 3 observers, the intra- and interobserver reliability was the best for the height-to-length ratio and worst for the intrascaphoid angle. The height-to-length ratio is the most reproducible method of assessing the humpback deformity. Clinical correlation is required to establish whether the height-to-length ratio will be of value in predicting the outcome of fractures of the scaphoid.

Forty cadaveric flexor digitorum profundus tendons were repaired using the Tajima, Halsted, Silfverskiold, or Savage techniques. The tendons were cyclically loaded in sets of 4,000 cycles beginning at 25 N and increasing by 10-N increments until failure occurred. Gap formation was continuously monitored with an extensiometer. Only the Savage repair group consistently withstood 4,000 cycles of 25-N loading, with respect to 2-mm gap formation and repair rupture. Tendon repairs subjected to cyclic loading demonstrated gap formation and repair rupture at lower loads than with static testing. Of the methods of flexor tendon repair tested, only the Savage technique could withstand simulated early active motion.

Since 1986 the senior author has performed a matched hemiresection with retinacular/capsular interposition for patients with painful disorders of the distal radioulnar joint. A retrospective review of 55 wrists was performed by an independent hand surgeon and hand therapist. Forty-nine of 54 wrists in the surviving patients were clinically and radiographically reviewed with an average follow-up interval of 36 months. Subjective assessment included a visual analog rating of pain improvement and satisfaction with treatment. Objective assessment included examination of range of motion, strength, stability, and standardized functional testing with the Jebsen and Minnesota Rate of Manipulation tests. Thirty-five patients reported pain improvement and 41 patients were satisfied. The range of supination and pronation increased from 54 degrees and 67 degrees, respectively, to 72 degrees and 72 degrees. Functional ability as measured by the Jebsen test was similar to the contralateral wrist. Patients had most difficulty turning large objects. The clinical, objective, functional, and x-ray films results correlated poorly with pain improvement and patient satisfaction. Complications included one infection, one reflex sympathetic dystrophy, one neuroma of the dorsal sensory branch of the ulnar nerve, and four cases of ulnar-carpal impaction. Pain relief was the primary determinant of patient satisfaction and should be considered the indication for surgery.