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Controversies continue concerning the treatment of the posttraumatic caput ulna syndrome. We have treated 12 patients, mean age 42 (23-77) years, with arthrodesis ad modum Sauvé-Kapandji of the distal articulation between the radius and ulna, combined with resection of the ulnar neck. Before the operation, all patients had persistent ulnar wrist pain and restricted pronation-supination movement. At follow-up, after a mean of 2 (1.5-4) years, 8 patients had an excellent outcome, 3 a good, and 1 patient had a fair outcome. 10 patients had no wrist pain. The average grip-score improved from 53% preoperatively to 76% at the follow-up.

We compared wound infiltration with small-dose tenoxicam (7.5 mg) to intramuscular (IM) administration of the same dose to treat pain after herniorrhaphy. In a randomized, double-blind study, 50 patients received either preoperative wound infiltration with tenoxicam, 7.5 mg in 40 mL of 0.9% saline (WI group; n = 25) or IM tenoxicam 7.5 mg (IM group; n = 25). In each group a saline placebo of equal volume was given by the alternate route, i.e., those who received wound infiltration with tenoxicam received 0.75 mL of 0.9% saline IM; those who received IM tenoxicam received 40 mL of 0.9% saline for wound infiltration. Postoperative pain was assessed with a verbal pain scale and a visual analog scale (VAS) at rest and during movement and cough, 1, 2, 4, 6, and 24 h postoperatively. Wound tenderness was assessed with an electronic algometer preoperatively, and 2, 4, and 6 h postoperatively. The need for supplementary analgesics (acetaminophen and morphine) was registered. No differences were observed between groups in VAS pain scores, verbal rating pain scores, pain pressure thresholds, or in need for supplementary analgesics. We conclude that tenoxicam 7.5 mg has no local analgesic effect on postoperative pain after herniorrhaphy.

The frequency of bilateral physiolysis colli femoris was evaluated in 62 patients. At first admission, 5 patients had a bilateral slipping. Further, 9 patients had slipping diagnosed in the contralateral hip during adolescence 1-3 years after the primary operation. At the follow-up examination 22 years after the primary operation, radiographs showed bilateral sequelae of slipping in 30 of 62 patients. Of the nine slips diagnosed later during adolescence, one showed mild and two severe arthrosis. Among the 16 slips diagnosed at follow-up, mild arthrosis was found in four hips. We recommend bilateral pinning at first admission in all patients with a slipped capital femoral epiphysis.

Twenty-five wrist joints treated with immobilization for Kienböck's disease were reexamined after 8 (1-11) years. Six patients had no pain, but 14 had daily problems with the wrist, and of these, 7 had to change their occupation. Five wrist joints were arthrodesed during the follow-up period. We conclude that nonoperative treatment of Kienböck's disease is ineffective.