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Arthroscopy during ulnar shortening osteotomy for ulnar impaction syndrome is subject to debate regarding its clinical usefulness. The purposes of this study were to analyze the arthroscopic findings in patients who underwent ulnar shortening osteotomy and to assess the role of arthroscopic evaluation during osteotomy. Medical records and arthroscopic findings of 50 consecutive patients who had been diagnosed with idiopathic ulnar impaction syndrome were retrospectively evaluated. Pathologic changes of the articular disk of the triangular fibrocartilage complex (TFCC), chondromalacia of the lunate and triquetrum, and tears of the lunotriquetral interosseous ligament (LTIL) were evaluated during arthroscopy. Palmer’s classification was used to classify the TFCC lesions. Perforation of the TFCC was observed in 20 patients, and central tears were observed in 10. Thirty-eight patients exhibited chondromalacia of the lunate, including 4 unstable cartilage flaps. Partial tears of the LTIL were detected in 24 patients, including 9 unstable flap tears. In 21 (42%) of 50 patients, arthroscopic findings were not appropriate to define the disease stage with Palmer’s original description. Eight wrists exhibited tears or perforations of the TFCC without evidence of chondromalacia. Seven patients had an LTIL tear without perforation of the TFCC. Lunotriquetral interosseous ligament tears without lunate chondromalacia were found in 7 patients. Arthroscopic debridement was performed in 23 patients based on the clinical judgment that the procedure would help alleviate symptoms postoperatively. Arthroscopy during ulnar shortening osteotomy addresses intra-articular pathologies and may be helpful for symptom improvement.

Purpose To investigate the outcomes of vascularized distal radius pedicled bone grafting secured with K-wires for scaphoid nonunions with small avascular proximal fragments. Methods We included patients with scaphoid nonunions and small, avascular proximal fragments that were too small for screw fixation. The mean size of the proximal pole fragments was 21% (range, 9% to 28%) of the entire scaphoid, based on quantitative radiographic measurement. All patients had distal radius bone grafting based on the 1,2-intercompartmental supraretinacular artery pedicle and fixation with K-wires. There were 21 wrists in 18 men and 2 women with the mean age of 34 years (range, 22 to 57 y). The mean duration of postoperative follow-up was 40 months (range, 12 to 103 mo). Radiographic union and clinical outcomes, including the ranges of wrist motion, grip strength, and the modified Mayo wrist score, were evaluated. Results Union was achieved in 18 of 21 wrists (86%) at a mean time of 14 weeks after surgery (range, 8 to 28 wk). Nonunions with proximal fragments less than 20% of the total scaphoid healed in 6 of 8 wrists. In a subset of these 8 wrists in which the proximal fragment was less than 15%, healing occurred in 2 of 4. The modified Mayo wrist score significantly improved from 46 to 78 points, and final wrist functions were rated as excellent in 5, good in 5, fair in 10, and poor in 1. Ranges of motion and grip strengths did not show significant changes after surgery. Conclusions Vascularized distal radius bone grafting and K-wire fixation can heal scaphoid nonunions with small avascular proximal fragments, although motion and grip strength remain unchanged. Healing may be related to the size of the proximal pole fragment. Type of study/level of evidence Therapeutic IV.

Purpose: To compare mechanical properties of a multistrand suture technique for flexor tendon repair with those of conventional suture methods through biomechanical and clinical studies. Methods: We describe a multistrand suture technique that is readily expandable from 6 to 10 strands of core suture. For biomechanical evaluation, 60 porcine flexor tendons were repaired using one of the following 6 suture techniques: Kessler (2-strand), locking cruciate (4-strand), Lim/Tsai’s 6-strand, and our modified techniques (6-, 8-, or 10-strand). Structural properties of each tenorrhaphy were determined through tensile testing (ultimate failure load and force at 2-mm gap formation). Clinically, we repaired 25 flexor tendons using the described 10-strand technique in zones 1 and 2. Final follow-up results were evaluated according to the criteria of Strickland and Glogovac. Results: In the biomechanical study, tensile properties were strongly affected by repair technique; tendons in the 10-strand group had approximately 106%, 66%, and 39% increased ultimate load to failure (average, 87 N) compared with those in the 4-, 6-, and 8-strand groups, respectively. Tendons in the 10-strand group withstood higher 2-mm gap formation forces (average, 41 N) than those with other suture methods (4-strand, 26 N; 6-strand, 27 N; and 8-strand, 33 N). Clinically, we obtained 21 excellent, 2 good, and 2 fair outcomes after a mean of 16 months (range, 6.53 months) of follow-up. No patients experienced poor results or rupture. Conclusions: The 10-strand suture repair technique not only increased ultimate strength and force at the 2-mm gap formation compared with conventional suture methods, but it also showed good clinical outcomes. This multistrand suture technique can greatly increase the gap resistance of surgical repair, facilitating early mobilization of the affected digit.

This article describes a case of a 24-year-old man with a total volar extrusion of the lunate and scaphoid proximal pole with concurrent scapholunate dissociation. The viability of the lunate and the proximal pole of the scaphoid are at high risk in this type of injury. Scaphoid nonunion, avascular necrosis of the lunate and proximal pole of the scaphoid, and carpal instability are inevitable unless the blood supply is restored. Thus, proximal row carpectomy at injury may be an acceptable option to avoid these complications and late sequelae, including chronic wrist pain and dysfunction. However, the authors attempted accurate reduction of the extruded bones and internal fixation.Final radiographs and magnetic resonance imaging 12 years postoperatively showed healing without avascular necrosis. Carpal indices involving the scapholunate angle, radiolunate angle, and carpal height ratio were similar in both wrists without evidence of carpal instability or collapse. Range of motion and grip power were 75% and 76%, respectively, compared with those of the uninjured wrist. Clinical scores showed good results, and the patient reported no pain during activities of daily living and was satisfied with his surgical results. Open reduction and internal fixation can be a viable option in this rare pattern of injury.

Loss of motion is common after intercondylar fracture of the distal humerus despite proper management. The purpose of the current study was to report the results of contracture release for stiffness that developed after open reduction and internal fixation (ORIF) of distal humeral intercondylar fractures.Twenty-four consecutive patients with a stiff elbow after ORIF of intercondylar fractures (20 AO type C2 and 4 type C3 fractures) were managed with contracture release at a median of 13 months. The surgical indication was total arc of motion of less than 100° despite physical therapy for more than 6 months. Plates and screws for ORIF were removed concomitantly in 16 patients. Each patient was evaluated by final arc of motion and Mayo Elbow Performance Score (MEPS).The main lesions causing stiffness were heterotopic ossification or excessive callus in 13 patients and capsular fibrosis in 11. The mean total range of motion (ROM) was improved from 60.2° preoperatively to 104.8° postoperatively. At the final follow-up, 17 of the 24 elbows (71.8%) obtained a total ROM of more than 100°. The mean MEPS improved from 69 points preoperatively to 87 points at the final follow-up (P.05). Refracture occurred during ROM exercise in 4 patients who had undergone concomitant implant removal during the contracture release.Surgical release of a stiff elbow that develops after ORIF of intercondylar fractures can result in satisfactory restoration of ROM in most patients. However, potential risk of refracture after release should be considered when implants are concomitantly removed.

We evaluated fourteen patients who had restricted supination as a major impairment related with a malunited radius fracture. All patients underwent an opening wedge corrective osteotomy, bone grafting, and volar plate fixation. Clinical results were assessed based on range of motion, visual analogue scale for pain, grip power, and a Modified Mayo Wrist Score. The mean supination increased from 24 degrees preoperatively to 71 degrees postoperatively (p0.01). Dorsiflexion range, grip power and pain score improved significantly after the operation. The mean value for the Modified Mayo Wrist score improved from 58.6 points to 83.9 points (p0.01). Radiological measurements showed that the degree of dorsal angulation decreased from a mean of 9.0 degrees to -2.5 degrees after the corrective osteotomy. This study demonstrated that a malunited radius fracture with dorsal angulation, even if the latter appears mild, can induce functional impairment due to limited range of supination. Supination can be restored by an appropriately performed corrective osteotomy.

Recent studies have found that the radial collateral ligament (RCL) plays a key role in the lateral stability of the elbow joint, and there is no truly isometric location for LUCL tendon graft reconstruction tunnels using the original technique. However, no report has been issued on the treatment including RCL reconstruction and the modification of LUCL reconstruction in patients with posterolateral rotatory instability (PLRI). Three patients with PLRI were treated using two different ways and produced good results. First, dual reconstruction of the LUCL and RCL was performed, and second, the insertion of the reconstructed LUCL was shifted to the AL instead of to the original ulna to produce a more flexible isometric point setting. We want to report on the management of PLRI by dual reconstruction of the RCL and LUCL and a modification of the original technique of LUCL reconstruction.

Through cytotoxicity screening with naphthoquinone derivatives, a novel compound 6-(1-oxoallkyl)-5,8-dimethoxy-1,4-naphthoquinone-S17 (DMNQ-S17) showed its potency against human myeloid leukemia U937 cells. Thus, to elucidate the apoptotic mechanism of DMNQ-S17, this study was performed in myeloid leukemia U937 cells by 2,3-bis [2-methoxy-4-nitro-5-sulfophenyl]-2H-tetrazolium-5-carboxanilide (XTT) assay, eletrophoretic mobility shift assay (EMSA), terminal deoxynucleotidyl transferase mediated dUTP nick end labeling (TUNEL) assay, 4',6-diamidino-2-phenylindole (DAPI) staining, and Western blotting. In the present study, DMNQ-S17 inhibited constitutive NF kappaB activation and its transcriptional activity in U937 cells. In addition, DMNQ-S17 induced apoptotic features such as apoptotic bodies, cell shrinkage and chromatin condensation in U937 cells. Consistently, flow cytometric analysis showed that DMNQ-S17 increased sub-G1 portion and TUNEL positive cells in a concentration-dependent manner. Furthermore, DMNQ-S17 effectively attenuated mitochondrial membrane potential, released cytochrome C, activated caspase-3 expression, and cleaved poly (ADP-ribose) polymerase (PARP). Reversely, caspase-3 and -9 inhibitors also blocked the DMNQ-S17 induced caspase-3 activation and PARP cleavage in U937 cells. Taken together, these findings suggest that DMNQ-S17 can be a potent anticancer candidate for myeloid leukemias by the suppression of NF-kappaB activation leading to the activation of caspase-3 in human myeloid leukemia U937 cells.

Several techniques have been proposed to measure translation of the distal radioulnar joint on computed tomography scans, but the criteria for diagnosing abnormal subluxation have not been standardized. The aims of this study were to evaluate the reliability of the current methods and to derive normal population values with these methods.Computed tomography scans of forty-five asymptomatic wrists were performed with the hand in supination, neutral, and pronation. Four methods for diagnosing subluxation of the distal radioulnar joint were used: the radioulnar line method; the epicenter method; the radioulnar ratio method; and the subluxation ratio method, which is a modification of the radioulnar line method that involves use of a line perpendicular to the sigmoid notch. Three observers measured all of the scans independently and repeated the measurements three months later to determine the interobserver and intraobserver reliability. All of the measurements for each subject were averaged, and the average was considered to be the normal value for that subject.Interobserver reliability was best (substantial to almost perfect) with use of the subluxation ratio method. The intraclass correlation coefficients showed substantial to almost perfect reliability of the radioulnar line method, substantial reliability of the radioulnar ratio method, and moderate to substantial reliability of the epicenter method. The intraobserver reliability of all methods was almost perfect. The radioulnar line and subluxation ratio methods always showed the ulnar head to be located outside of the dorsal line in pronation and outside of the volar line in supination. The normal epicenter values indicated that the center of rotation of the distal radioulnar joint fell in the middle half of the sigmoid notch in all positions. The normal ranges derived with the radioulnar ratio method demonstrated larger variation than originally reported.This study suggests that the subluxation ratio method is the most useful technique for measuring translation of the distal radioulnar joint as a result of its reliability and simplicity. Substantial variations in normal values derived with the current methods should be considered in a computed tomography evaluation of the distal radioulnar joint in symptomatic patients.

Purpose To compare computed tomography (CT) and clinical stress test findings in terms of the assessment of distal radioulnar joint (DRUJ) instability after distal radius fracture. Methods Thirty-four patients with a healed unilateral distal radius fracture were evaluated after a mean follow-up period of 18 months. Stress test and CT were performed to detect DRUJ instability. Three CT methods were used: the modified radioulnar line, the epicenter, and the radioulnar ratio methods. The results of CT assessments were compared with stress test findings using kappa statistics. Relationships between DRUJ instability and the radiographic parameters of volar tilt, radial inclination, and radial shortening were analyzed. Results Twelve patients were considered to have DRUJ instability based on the stress test. DRUJ instability was diagnosed in 15, 8, and 11 patients by the modified radioulnar line, the epicenter, and the radioulnar ratio methods, respectively. Reliability analysis of stress test and CT results showed moderate or fair agreement (kappa value: .33 for the modified radioulnar line, .56 for the epicenter, .41 for the radioulnar ratio). DRUJ instability diagnosed by the stress test and by CT showed no statistical correlation with radiographic parameters, but instability determined by CT appeared to be related to dorsal tilt deformity. Conclusions After distal radius fracture, CT assessments of DRUJ instability were found to be influenced by residual deformities, such as dorsal tilt, but not well correlated with stress test findings. Although CT assessments are objective, CT scans primarily show alterations of DRUJ alignment and have several risks of bias in patients with a prior distal radius fracture.

Indole-3-carbinol, a natural compound found in cruciferous vegetables, is known to have anticancer activity. In the present study, the antiplatelet and antithrombotic activities of indole-3-carbinol were investigated in vitro and in vivo. Indole-3-carbinol significantly inhibited collagen-induced platelet aggregation in human platelet rich plasma (PRP) in a concentration-dependent manner. Indole-3-carbinol significantly inhibited fibrinogen binding to the platelet surface glycoprotein IIb/IIIa (GP IIb/IIIa) receptor by flow cytometric analysis. In addition, the levels of thromboxane B2 (TXB2) and prostaglandin E2 (PGE2) in collagen stimulated PRP were significantly inhibited in a concentration-dependent manner by indole-3-carbinol. Furthermore, indole-3-carbinol dose-dependently suppressed the death of mice with pulmonary thrombosis induced by intravenous injection of collagen and epinephrine. These results suggest that indole-3-carbinol can be a potent antithrombotic agent with antiplatelet activity through the inhibition of GP IIb/IIIa receptor and thromboxane B2 formation.

We performed 118 percutaneous releases of the locked trigger digits in an office setting using a specially designed knife. Thirty-five digits were locked in flexion, 79 digits in extension and the remaining four were fixed in a semiflexed position. Successful percutaneous release was achieved for 107 digits (91%), with the remaining 11 digits requiring an open surgical procedure. Although there were no persistent triggering in 98 digits with a follow-up of at least 6 months, painful stiffness at the interphalangeal joints remained in ten digits despite of physical therapy. No neurovascular injury occurred. We suggest that a locked trigger digit can be successfully released with the percutaneous technique.

The movements of the carpal bones during the scaphoid shift test were evaluated radiographically in 60 wrists. The clinical results were graded according to the degree of subluxation of the scaphoid and pain on the dorsum of the wrist. Lateral radiographs at rest and under stress were taken and the relative movements of the scaphoid with respect to the radius and lunate, and the rotation of the scaphoid and lunate were calculated. Dorsal displacement of the scaphoid with respect to the radius was significantly associated with the clinical grade of subluxation. There was correlation between the amount of pain and the displacement of the scaphoid from the lunate, but not from the radius. The wrists with a painful shift test had greater relative displacement of the scaphoid from the lunate than those with painless subluxation. These observations support the view that pain associated with subluxation of the scaphoid during the shift test is a significant finding, and that radiographic analysis of the test may confirm a positive result when dynamic scaphoid instability is suspected.

We found a unique anatomical variant of the distal ulnar nerve, a neural loop encompassing the flexor carpi ulnaris during Guyon’s canal exploration. Compression by the flexor carpi ulnaris during active wrist movement was suspected as the cause of ulnar neuropathy. The symptom was relieved after neurolysis and release of surrounding tissue. With regard to the ulnar side wrist pain, which is suspicious for ulnar compression syndrome at the wrist level, the surgeon should always suspect anomalous nerve branch as source of compressive neuropathic pain.

Purpose: Early stage Kienbock's disease is commonly treated with a surgical intervention to avoid progression to degenerative change. The purpose of this study was to evaluate the clinical and radiographic outcomes of conservative management in patients with an early stage Kienbock's disease with a hypothe- sis that the lunate can be maintained in patients with no pain or tolerable pain. Methods: Twenty-three patients with a Lichtman stage I, II or IIIA Kienbock's disease were managed conservatively and investigated prospectively. There were ten men and thirteen women. Mean age at first visit was 53.9 years old and mean follow-up period was 51.3 months. The clinical outcomes were evaluated by range of motion, subjective satisfaction of patients at final follow-up. Radiographic measurements of the Lichtman stage were assessed at first visit and at the final follow-up. Three patients were Lichtman stage I, eleven patients were II and nine patients were IIIA. Results: Range of motion improved in all cases. According to Dornan's criteria, eleven patients were excellent, another eleven patients were good and one patient was fair. Based on Lichtman stage, no change was seen in sixteen patients, while seven showed progression. Three patients revealed improved radiographic findings of the lunate at final follow-up. Conclusion: We found that conservative management including close observa- tion of clinical and radiographic changes can provide satisfactory clinical improvement in patients with no pain or tolerable pain in early stage Kienbock's disease.

류마토이드 관절염은 전신성, 염증성, 자가 면역성 질환으 로, 대칭적으로 다발성 관절을 침범하는 양상을 보인다. 류마 토이드 관절염의 손목 관절 침범은 조기에 흔하게 발생하며 약물 치료의 발달에 의해 수부 및 손목의 변형과 기능 손상은 의미 있게 감소하였으나 일부의 내과적 치료에 반응하지 않는 환자들에서는 심한 골 조직의 파괴와 통증 및 활막염의 주변 연부 조직 침범으로 인한 굴곡 및 신전 건 파열 등으로, 개인 적, 사회적인 장애가 유발되는 경우가 흔하다. 이러한 외과적 인 치료를 적극적으로 고려해야 하며, 병의 진행 상태를 정확 하게 평가하여 기능적, 증상적, 미용적인 개선을 목적으로 환 자에게 적용되어야 한다. 본 종설에서는 완관절의 류마토이드 관절염에 대한 외과적 치료의 원칙들에 대해 소개하고 적절한 수술의 적응증에 대해 논의해 보고자 한다.

Purpose The purpose of this study was to review clinical and radiographic outcomes of perilunate dislocations and fracture-dislocations treated with arthroscopic reduction and percutaneous fixation. Methods Twenty patients who had an acute dorsal perilunate dislocation or fracture-dislocation were treated with an arthroscopic technique at a median interval of 3.9 days from the time of injury. They were retrospectively reviewed at a mean follow-up of 31.2 months (range, 18 to 61 months). Range of motion and grip strength were measured. Radiographic evaluations included time to scaphoid union, measurement of radiologic parameters, and any development of arthritis. Functional outcomes were determined by the modified Mayo wrist score; Disabilities of the Arm, Shoulder and Hand questionnaire; and Patient-Rated Wrist Evaluation score. Results The flexion-extension motion arc and grip strength of the injured wrist averaged 79% and 78%, respectively, of the corresponding values for the contralateral wrists. The mean Disabilities of the Arm, Shoulder and Hand score was 18, and the mean Patient-Rated Wrist Evaluation score was 30. According to modified Mayo wrist scores, overall functional outcomes were rated as excellent in 3 patients, good in 8, fair in 7, and poor in 2. Nonunion developed in 2 patients with a trans-scaphoid perilunate injury; 1 of the 2 underwent scaphoid excision and midcarpal fusion. On the basis of radiographic parameters, reduction obtained during the operation was maintained within normal ranges in 15 patients. Arthritis had not developed in any patient by the last follow-up. Conclusions This study suggests that arthroscopic reduction with percutaneous fixation is a reliable minimally invasive surgical method for acute perilunate injuries in that it provides proper restoration and stable fixation of carpal alignment and results in satisfactory functional and radiologic outcomes on a midterm basis. Level of Evidence Level IV, therapeutic case series.

Purpose : This study examined the clinical usefulness of a pedicled vascularized bone graft for the treatment of a scaphoid nonunion. Materials and Methods : Twenty-one patients with a scaphoid nonunion were treated with a pedicled vascularized bone graft using the 1, 2 intercompartmental supraretinacular branch of the radial artery. The average age of the patients was 29.3 years (range, 16-47) and the mean follow-up period was 19.6 months (range, 12-36). Punctate bleeding of the proximal fragment was evaluated intraoperatively and complete avascular necrosis was observed in 10 patients (47.5%). Results : Radiographic union was observed in 19 patients (90%). The other 2 patients were considered to have clinical union although it was unclear radiographically. The average union time was 10.7 weeks (range, 6-16). Eight of the ten patients with an avascular proximal pole showed radiographic union. Sixteen patients (76%) showed satisfactory subjective results at the time of the last follow up based on the scaphoid score. Conclusion : Pedicled vascularized bone graft is a good method for treating a scaphoid nonunion and is strongly recommended in cases of scaphoid nonunion with proximal pole avascular necrosis.

Purpose : To evaluate the necessity and effectiveness of a lunate excision in triscaphe fusion for the treatment of advanced Kienbock's disease. Materials and Methods : Twenty-six patients who underwent a triscaphe fusion for Kienbock's disease (IIIb) were analyzed. Fifteen patients received triscaphe fusion only and 11 patients received triscaphe fusion and a lunate excision. The indication for a lunate excision included pain and limited motion due to posterior impingement associated with a severely collapsed lunate. The range of motion and modified Mayo wrist score in the two groups were compared. The carpal height ratio, ulnocarpal distance ratio and radioscaphoid angle were measured on the plain radiographs, and the presence of degenerative change was evaluated. Results : The mean extension range was more preserved in the lunate excision group than in the lunate preserving group. Several radiology indices were similar in the two groups, but a degenerative change in the radioscaphoid joint was observed in 45.5% of the lunate excision group and in 13% of the lunate preserving group. Conclusion : When performing the triscaphe fusion in advanced Kienbock's disease, excision of the lunate can relieve the symptoms of posterior impingement. However, this procedure should be carried out carefully because degenerative changes in the radioscaphoid joint are frequently observed.

Purpose : This study examined the displacement of the ulnar head with respect to the distal radius after distal radius malunion on the axial plane using computed tomography. Materials and Methods: Twenty-four patients with a residual dorsal tilt ＞10˚ or radial shortening ＞2 mm than the normal side, and no limitation in wrist rotation after radius union were enrolled in this study. The bilateral CT scans were obtained in 70˚ pronation, neutral, 70˚ supination. The radioulnar ratio was measured and the ratios of the abnormal side were compared with those of the opposite normal side. The results were statistically analyzed using a two-tailed paired t-test. Results : The ulnar head of the patients with a malunited radius had a tendency for anterior translation compared with the normal side. In patients with a dorsal tilt deformity, the anterior translation of the ulnar head with respect to the radius was significant, particularly in the supination and neutral position. However, no significant difference was found in patients with radial shortening in terms of the ulnar head translation between the normal and abnormal side. Conclusion : These results might explain the mechanism of distal radioulnar joint instability and low incidence of ulnocarpal impingement in patients with distal radius malunion.

Perilunate injuries are severe disruptions of the wrist joint that produce variable patterns of injury to the carpal anatomy. Most surgeons advocate an open reduction followed by ligament repair or internal fixation. We tried to reduce and fix the carpal bones under arthroscopic control to minimize surgical trauma and to preserve blood supply. While viewing the articular surface with the arthroscope, the disrupted proximal carpal row was anatomically reduced using Kirschner wires as joysticks, and fixed percutaneously without any repair of the capsuloligamentous tears. Three patients with dorsal perilunate dislocations or fracture-dislocations were treated by this technique. All the patients achieved accurate reduction and stable fixation, and showed successful healing of the carpal fractures with proper alignment after 10 to 12 weeks of immobilization. At 16 to 22 months follow-up, all patients showed normal radiographic findings with no evidence of instability or arthritis. The arthroscopic treatment of acute dorsal perilunate injuries is technically feasible in achieving anatomic reduction and stable fixation. Our preliminary clinical results were encouraging, but the long-term results need to be observed.

Purpose: The purpose of this study was to make an assessment of distal radioulnar joint (DRUJ) instability after the treatment of intra-articular fractures of the distal radius using computed tomography (CT) including contralateral normal wrist. Materials and Methods: Twenty-seven intra-articular fractures of the distal radius in twenty-seven patients who had had the surgical treatment were evaluated at follow-up of mean 17.9 months (range, 10-36 months). The DRUJ was assessed with clinical examination, plain radiography, and bilateral CT. CT scans were obtained in pronation, neutral, and supination. The radioulnar ratio and the subluxation ratio which was modified radioulnar line method were used to measure DRUJ instability. Results: Eight patients were diagnosed as DRUJ instability based on CT assessment. Nine patients were considered to have DRUJ instability in clinical examination, but 4 patients of them were confirmed to have DRUJ instability based on CT measurements. Nonunions of ulnar styloid or malunions of the distal radius were not found to have statistical correlation with DRUJ instability (p>0.05). Conclusion: In patient with suspicious DRUJ instability following distal radius fractures, we recommend computed tomography scans of both the injured and uninjured wrists in pronation, neutral, and supination position for objective assessment.

Purpose: The purpose of this study was to investigate the usefulness of wrist arthroscopy for treating intra-articular fractures of the distal radius. Materials and Methods: Twenty-two patients with intra-articular fracture of the distal radius received arthroscopic surgery. Fourteen patients with displaced intra-articular fractures were managed by arthroscopically assisted reduction and fixation. Three patients were treated with limited open reduction and fixation. We analysed the radiologic results, and measured the ranges of motion and grip strengths. Fuctional results were evaluated using the Modified Mayo Wrist Scoring System. The postoperative follow-up period averaged 16.8 months. Results: All showed articular step-off of less than 1 mm on wrist X-rays taken at the final follow-up (mean 0.3 mm; range, 0-1 mm). The mean arc of range of motion was 89.6% of that on the uninjured side, and the mean grip strength was 87.3% of that of the uninjured side. The average Modified Wrist Score was 91.8 (range, 75-100). Conclusion: Arthroscopic-assisted surgery is an useful method that provides excellent results with few complications in the treatment of intra-articular fractures of the distal radius.

ity using both the Purdue pegboard test and the Crawford small parts dexterity test. After surgery there was a significant (P

Purpose : We analyzed the clinical results of surgical treatment in patients with post-traumatic stiff elbow. Materials and Methods : We performed surgical release in 22 elbows with posttraumatic stiffness of extraarticular origin. The average preoperative arc was 48.3 degrees, with an average flexion contracture of 39.5 degrees and an average further flexion of 87.2 degrees. Depending on their radiographic findings, cases were divided on the basis of whether ectopic ossification was present (16 cases) or not (6 cases); and as to whether the articular surface was involved (11 cases) or not (11 cases). The postoperative final arc and ratio of desired gain were compared between the groups. Results : The average final arc was 108.9 degrees in the ectopic ossification group and 85.7 degrees in the non-ectopic ossification group, and showed a significantly higher arc in the ectopic ossification group. The ratios of desired gain were 89.3% and 62.6%, respectively, being significantly higher in the ectopic ossification group. In terms of articular surface involvement, no significant difference was observed between the two groups. Conclusion : When performing operative treatment for post-traumatic stiff elbow, assessment of the cause plays an important role. In case of ectopic ossification, satisfactory results can be expected with operative treatment after the ectopic bone has matured.

Purpose : We evaluated surgical cases of ulnar neuropathy combined with post-traumatic conditions of the elbow. Materials and Methods : Fourteen patients who received ulnar nerve decompression at the cubital tunnel combined with elbow injury were assessed retrospectively. Ulnar nerve showed McGowan grade I in eight patients, grade II-A in one, grade II-B in four and grade III in one. The decompression procedures included nine anterior transpositions, four epicondylectomy, and one in situ decompression. Pain, sensory and motor status were evaluated after a mean follow up of 17.9 months. Results : Symptoms were completely resolved in ten patients and markedly improved in four. Decreased motor function was improved by at least one grade in all patients. Ulnar neuropathy did not compromise flexion exercise in postoperative rehabilitation. Conclusion : Development of ulnar neuropathy has close relationships with elbow trauma and its symptoms tend to be underestimated because elbow flexion is frequently limited due to post-traumatic contracture. Proper evaluation and decompression of the ulnar nerve should be considered as one of the factors influencing the clinical result in the management of post-traumatic problems of the elbow.

Purpose : The aim of this study was to compare the results of medial epicondylectomy and anterior submuscular transposition of the ulnar nerve in patients with primary cubital tunnel syndrome. Materials and Methods : Thirty patients with primary cubital tunnel syndrome formed the basis of this study. Eighteen patients underwent medial epicondylectomy and twelve patients underwent anterior submuscular transposition of the ulnar nerve. The mean follow-up period was 35 months. Postoperative clinical results were assessed using Gabel and Amadio's rating scale which evaluats pain, sensory and motor function in four grades. Clinical results were compared between two groups in McGowan grades two and three. Results : Two excellent, twelve good and six fair results were obtained in patients with McGowan grade II. In McGowan grade III, three were good, six fair and one was poor. No significant difference in the results was observed between two surgical groups. Conclusion : Medial epicondylectomy and anterior submuscular transposition of the ulnar nerve showed no difference in results between patients with primary cubital tunnel syndrome. It seems that medial epicondylectomy is more appropriate because of its simplicity during operation and in terms of postoperative management.