Search

The Belgian User Support and Operations Centre (B.USOC) was responsible for the preparations and in-flight operations of the PCDF PROTEIN Mission that took place in ISS during four months in the first half of 2009. The Protein Crystallisation Diagnostics Facility (PCDF) allowed in-situ observation of nucleation and crystal growth behaviour of protein crystallisation experiments in microgravity. Therefore, incoming data could be analysed on-the-fly which permitted to modify the experiment in near-real-time. To achieve this experimental and operational flexibility, extensive preparation was needed. This paper reports on the various preparation and in-flight activities performed by the B.USOC operators and the PCDF science team that led to the successful PCDF PROTEIN Mission accomplishment.

SOLAR is a European payload installed on the Columbus External Payload Facility (CEPF) and mounted on a Columbus External Payload Adapter (CEPA). This paper first presents the SOLAR payload and mission and then focuses on the progressive achievements of the Belgian User Support and Operations Center (B.USOC) towards adapting its initial operational concept to ensure sustainable support to the SOLAR mission. SOLAR was among the very first Columbus payloads switched on after Columbus installation in February 2008 and continues to perform science as of today. To maximize science return during a foreseen three year mission, the B.USOC had to adapt to the various constraints of real-time operations such as 24/7 on-console staffing, ISS constraints and interaction with Columbus Control Centre. Two major axes of improvement have been followed: first adapting on-console staffing to the various operational modes, and improving the flexibility of SOLAR activities planning. © 2010 by Space Applications Services.

Five cases of symptomatic acquired positive ulnar variance are described. All cases occurred due to premature physeal closure of the growth plate in teenage girl gymnasts. All cases demonstrated ulno-carpal impingement, for which we describe a clinical test. Arthroscopic assessment of the wrist allowed us to assess the integrity of the TFCC (triangular fibrocartilaginous complex) and decide on the most appropriate surgery. Two patients needed distal ulna recession and one needed shaving for a TFCC perforation, with a good result.

In a 7-year-old boy, with isolated radioulnar synostosis, an isodicentric Y-chromosome was revealed.

Summary A case of a 66-year-old female patient with hyperlipaemia, corticosteroid osteoporosis and chronic obstructive lung disease with avascular necrosis of the proximal row of the carpus and hamate is described. No other sites of avascular bone necrosis were found. A proximal row carpectomy was performed with an excellent outcome.

This study evaluates if the Disabilites of the Arm, Shoulder and Hand (DASH) questionnaire is an adequately responsive outcome measure in lateral extensor release for tennis elbow. To measure responsiveness (sensitivity to clinical change), 21 patients with operated tennis elbow completed the DASH questionnaire pre-operatively and again postoperatively. The effect size (2.03) and standardized response (1.54) mean that, as well as the correlation with patient satisfaction and the Roles & Maudsley score (10), the DASH questionnaire is a useful tool to evaluate the outcome of surgical treatment of tennis elbow.

A case of lipofibromatous hamartoma of the median nerve with macrodactyly of 2 digits is described. Nerve stripping resulted in a growth control.

Summary Background Percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction can be complicated by spontaneous or angioplasty-induced embolisation of atherothrombotic material. Distal blockage induces microvascular obstruction and can result in less than optimum reperfusion of viable myocardium. The Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS) found that thrombus aspiration resulted in improved myocardial reperfusion compared with conventional PCI, but whether this benefit improves clinical outcome is unknown. We aimed to investigate whether the early efficacy of thrombus aspiration seen in TAPAS translated into clinical benefit after 1 year. Methods Patients with ST-elevation myocardial infarction enrolled at the University Medical Centre Groningen were randomly assigned in a 1:1 ratio to either thrombus aspiration or conventional treatment, before undergoing initial coronary angiography. Exclusion criteria were rescue PCI after thrombolysis and known existence of a concomitant disease with life expectancy less than 6 months. Of the 1071 patients enrolled between January, 2005, and December, 2006, vital status at or beyond 1 year after randomisation was available for 1060 (99%). The primary endpoint was cardiac death or non-fatal reinfarction after 1 year, and analysis was by intention to treat. The TAPAS trial is registered with Current Controlled Trials number ISRCTN16716833. Findings Cardiac death at 1 year was 3·6% (19 of 535 patients) in the thrombus aspiration group and 6·7% (36 of 536) in the conventional PCI group (hazard ratio [HR] 1·93; 95% CI 1·11–3·37; p=0·020). 1-year cardiac death or non-fatal reinfarction occurred in 5·6% (30 of 535) of patients in the thrombus aspiration group and 9·9% (53 of 536) of patients in the conventional PCI group (HR 1·81; 95% CI 1·16–2·84; p=0·009). Interpretation Compared with conventional PCI, thrombus aspiration before stenting of the infarcted artery seems to improve the 1-year clinical outcome after PCI for ST-elevation myocardial infarction. Funding Medtronic and the Thorax Centre of the University Medical Centre Groningen.

Objectives: To compare Angio-Seal (AS) and StarClose (SC) and manual compression (MC) on efficacy of hemostasis, complication rate, safety of early mobilization, and patient comfort. Background: Closure of the femoral artery after cardiac catheterization can be obtained through different methods. Today, physicians can choose from a number of different devices to achieve arterial closure. Methods: In a prospective trial 450 patients were randomized to AS, SC, or MC. Patients were mobilized 1 to 2 hr after device placement, and 6 hr after MC. Data were collected during hospital admission and by telephone at one month after hospital discharge. Results: Devices were used in 138/150 allocated to AS and 124/150 allocated to SC patients (92% vs. 83%, P = 0.015) Patients with MC experienced more pain during sheath removal than patients receiving a device, and rated their period of bed rest as less comfortable. Oozing and need for pressure bandage at the puncture site were observed in 37 AS patients and 57 SC patients (25% vs. 38%, P = 0.002). Hematoma occurred in 15 AS patients, in 17 SC patients, and in 14 MC patients (11 vs. 14 vs. 9%, Ins). Conclusion: There is no difference in safety between the three methods of arterial closure. SC was more often not used or successfully deployed. SC patients more often had continuing oozing. On patient comfort, closure devices performed better than MC. Early ambulation in patients with a closure device is safe. AS is the preferred method of arterial closure after cardiac catheterization. (C) 2008 Wiley-Liss, Inc.

Background Primary percutaneous coronary intervention (PCI) is effective in opening the infarctrelated artery in patients with myocardial infarction with ST-segment elevation. However, the embolization of atherothrombotic debris induces microvascular obstruction and diminishes myocardial reperfusion. Methods We performed a randomized trial assessing whether manual aspiration was superior to conventional treatment during primary PCI. A total of 1071 patients were randomly assigned to the thrombus-aspiration group or the conventional-PCI group before undergoing coronary angiography. Aspiration was considered to be successful if there was histopathological evidence of atherothrombotic material. We assessed angiographic and electrocardiographic signs of myocardial reperfusion, as well as clinical outcome. The primary end point was a myocardial blush grade of 0 or 1 (defined as absent or minimal myocardial reperfusion, respectively). Results A myocardial blush grade of 0 or 1 occurred in 17.1% of the patients in the thrombus-aspiration group and in 26.3% of those in the conventional-PCI group (P

The $^{26}\mathrm{Al}$($n,\ensuremath{\alpha}$)$^{23}\mathrm{Na}$ reaction cross section has been studied at the linear accelerator GELINA of the Institute for Reference Materials and Measurements in Geel, Belgium, and has been determined up to a neutron energy of about 100 keV using the time-of-flight technique. Six resonances could be observed in this energy region, whereas before only one had been identified experimentally. For four of them, resonance parameters such as resonance energy, total width, area, and spin of the state could be determined. From the obtained $^{26}\mathrm{Al}$($n,\ensuremath{\alpha}$)$^{23}\mathrm{Na}$ cross section data, Maxwellian averaged cross section (MACS) values were calculated by numerical integration. Since neutron induced reactions are among the major destruction mechanisms of $^{26}\mathrm{Al}$ in our Galaxy, these new MACS values contribute to a better understanding of the observed $^{26}\mathrm{Al}$ abundance.

A rare polydactyly of the foot, mixed central and pre-axial type, is described; no other dysmorphic features were present. Early surgery was performed with good results.

Objectives: To investigate the incidence and angiographic predictors of functional collateral perfusion in patients with stable coronary artery disease, scheduled for elective PCI. Background: Functional collateral perfusion is defined as a Pw/Pa ratio >= 0.24. Since this can only be measured intracoronary, it is important to investigate baseline clinical and angiographic predictors for functional collateral perfusion. Methods: Collateral perfusion was measured during balloon inflation, with the use of a pressure-monitoring guide wire. Baseline clinical and angiographic characteristics were analyzed and collateral grading was done according to Rentrop's classification for coronary angiograms. Results: Functional collateral perfusion was found in 40 of the 89 patients (45%). Angiographic signs of collaterals (Rentrop >= 1) were present in 15 of the 89 patients. Of the 40 patients with the functional collateral perfusion 11 patients (28%) had Rentrop >= 1; of the 49 patients without functional collaterals there were 4 patients with Rentrop >= 1 (8%) (P = 0.02). There were no significant differences in baseline clinical characteristics or in other angiographic characteristics. Conclusions: In patients with stable coronary artery disease scheduled for elective PCI, 45% have functional collaterals. Rentrop's angiographic classification can be used to predict the presence or absence of functional collaterals, however with a rather modest positive and negative predictive value. (C) 2007 Wiley-Liss, Inc.

A case with bilateral scaphoid osteochondroma (exostosis) with scapholunate dissociation. In both the cases a proximal row carpectomy was performed with excellent outcome.

A case is presented of chronic dislocation of the elbow after tennis elbow surgery combined with posterior interosseous nerve (PIN) release. An open reduction with repair of the collateral ligaments was performed. Postoperative rehabilitation involved the use of an articulated external fixator and there was a successful outcome. Possible causes of the dislocation are discussed.

The {sup 36}Cl(n,p){sup 36}S and {sup 36}Cl(n,{alpha}){sup 33}P reaction cross sections have been studied with resonance neutrons at the linear accelerator GELINA of the IRMM in Geel (Belgium) and have been determined up to approximately 250 keV using the time-of-flight technique. In this energy region, 17 resonances were observed, whereas eight were identified before. For some resonances the resonance strength, the spin, and the total width could be determined. From the obtained cross section data, the MACS has been calculated by numerical integration. These updated MACS values were used in stellar models to trace the origin of the rare isotope {sup 36}S.

The 236 U(n,f) cross section has been measured in the neutron energy region from 0.5eV to 25keV at the GELINA neutron facility of the IRMM in Geel, Belgium. A highly enriched 236 U sample was mounted back-to-back with a 10 B sample in the centre of a Frisch-gridded ionisation chamber; a control measurement was performed with a 235 U sample in the same configuration. Besides a dominant resonance at 5.45eV, for which a resonance analysis was performed, the next resonance (cluster) only occurs at about 1.3keV. It is demonstrated that the fission resonance integral and the thermal fission cross section adopted in all commonly used evaluated data libraries are too large by two orders of magnitude.

A case of avascular non-traumatic necrosis of the metacarpal head in a 36-year-old woman is reported. Treatment was by curettage of the necrotic bone and packing with cancellous grafts.

Ulnar clubhand is a rare deformity. In a patient with postnatal osteomyelitis of the ulna, the wrist had an ulnar deviation with marked ulnar slope of the radius. Good hand function precluded surgical correction.

We report a patient with unilateral absence of the scaphoid and lunate bone of the wrist. Remarkably he had severe osteoarthritis in several other joints.

Purpose : to compare a motion preserving procedure of the wrist with the wrist arthrodesis, the so-called gold standard in patients with posttraumatic wristpain. Design : non randomized retrospective Setting : University Hospital - referral centre Patients : we studied two groups of patients with posttraumatic wrist pain due to osteoarthritis of the radiocarpal joint : one group of 35 patients underwent a radiocarpometacarpal arthrodesis, the other group of 26 patients a proximal row carpectomy (PRC). There were no significant differences in age and gender or hand dominance distribution. Intervention : proximal row carpectomy versus radiocarpal arthrodesis. Outcome measurements : DASH (disability of arm, shoulder and hand) gripping force, return to activity, complications and reintervention frequence. Results : Disability (DASH score) and regaining professional activity was significantly better in the PRC group. There was no significant difference in gripping force between the PRC and the arthrodesis group. Complications were less numerous. Conclusion : A mobility saving procedure as a PRC is preferable over an arthrodesis in patients with posttraumatic wrist osteoarthritis.

A case with closed sequentional rupture of all flexor tendons of the fingers, 17 years after a Colles fracture is described. The repair with free tendon grafts resulted in a fair result.

We report a case of periprosthetic fracture of the shoulder, treated operatively. A special plate/cable system (ECG) was used with an excellent outcome. This easy technique is recommended for such fractures.

A cohort of 119 patients with carpal tunnel syndrome completed the questionnaire of the Dutch version of the DASH score pre-operatively and one year postoperatively. The mean DASH score decreased from 38.2 to 22.0. There was a significant correlation with the Boston carpal tunnel outcome score ( r =0.78). With an effect size of 0.87 and a standardized mean response of 0.69, the Dutch version of the DASH is highly responsive for the evaluation of the outcome of surgery for carpal tunnel syndrome.

A case of soft tissue chondroma or extraskeletal chondroma is described. The tumour caused compression of the posterior interosseous nerve. Excision and biopsy were performed with complete resolution of the symptoms.

We report a new case of pediatric carpal tunnel syndrome in a patient with juvenile rheumatoid arthritis. Symptoms were mainly motor weakness and severe atrophy of the thenar.

Oculo-dento-digital dysplasia (ODDD) is an autosomal dominant disorder characterized by developmental anomalies of the face, the eyes, the limbs and the teeth. Patients with ODDD usually present with complete syndactyly of the fourth and fifth fingers (type III syndactyly), ocular changes, abnormalities of primary and permanent dentition and specific craniofacial malformations. Mutations in GJA1, a gene that encodes the gap junction protein connexin 43, are responsible for ODDD. Gap junctions are assemblies of intercellular channels that allow exchange of various ions and signaling molecules between cells. In this way, gap junctions play an important regulatory role in a variety of physiologic and developmental processes. We identified three novel and one previously described GJA1 mutation in two large ODDD families and two sporadic ODDD cases.

In order to evaluate diagnostic and therapeutic wrist arthroscopy we analyzed 129 arthroscopies with a follow-up of at least 6 months. Seventy-seven arthroscopies were performed for therapeutic purposes; 52 arthroscopies were diagnostic. There were diagnostic benefits in 55 arthroscopies (42.5%), therapeutic benefits in 29 arthroscopies (22.5%), combined diagnostic and therapeutic benefits in 39 (30%) and no benefits in six (5%).In 65 cases of the therapeutic group (with preoperative diagnosis) the authors found that the arthroscopy had been worthwhile. For the diagnostic group without a preoperative diagnosis, an arthroscopic diagnosis was made in 44 cases.Complications occurred in two patients: one tendon incision over a Kirschner wire in the therapeutic group and one superficial infection in the diagnostic group.

This retrospective study assessed the outcomes of 21 patients (16 male and 5 female, mean age 39 years) with advanced Kienbock’s disease treated by resection of the proximal carpal row. They were clinically reviewed. The mean follow-up was 67 months, with all but two patients having had a follow-up of 2 years. No or mild pain was being experienced by 13 patients, moderate pain by 3 and severe pain by 5. Grip strength increased from 19 kg preoperatively to 26 kg postoperatively (or 65% of the normal contralateral side). There was a slight increase of mobility. The DASH score was 22 points (range 0–78) and the Patient Rated Wrist Score (PRWS) was 30 points (range 0–84). Two patients developed Complex Regional Pain Syndrome which was ongoing at the time of review and one developed a superficial wound infection. Proximal carpal row resection arthroplasty gave satisfactory results in patients with advanced Kienbock’s disease.

A case with complete paralysis of the deltoid muscle with irreperable axillary nerve lesion was treated with a functional muscle transfer. The latissimus dorsi muscle was preparated as an island flap, turned over and sutured to the trapezius at one side and to the original deltoid insertion on the humerus at the other side. Function and cosmesis were excellent.

A case of metastasis into the index metacarpal is described. It appeared 11 years after mastectomy and progressed slowly. The patient has already survived this metastasis for 4 years.

We present a boy with bilateral aplasia of the thumb, bilateral proximal radioulnar synostosis and unilateral fusion of metacarpals 4 and 5. Apart from a small, asymptomatic ASD, no other abnormalities were noted.

Key pinch force was measured preoperatively and at follow-up (mean 25 months) in patients treated for basal joint arthritis by either trapziectomy with ligament reconstruction and tendon interposition ( n=26) or total joint arthroplasty ( n=27). There was a significant increase in key pinch strength with both treatments, but no difference between the two treatments. Total joint arthroplasty does not appear to produce stronger key pinch than trapziectomy with ligament reconstruction and tendon interposition.

Background Vascular injury results in specific temporal patterns of increased matrix metalloproteinase (MMP) activity. MMPs are known to play a role in remodeling and neointimal (NI) thickening. Although in vitro data on the role of metalloproteinases and their inhibitors on smooth muscle cell migration and proliferation are compelling, evidence for inhibition of NI thickening in vivo is inconsistent and is mostly generated in models of balloon angioplasty instead of the more prevalent stent placement. Data from atherosclerotic models are scarce. The objective of the study was to investigate whether the nonspecific MMP inhibitor batimastat, in concentrations known to influence remodeling, could also inhibit NI thickening following stent placement in an atherosclerotic model. Methods Stents were placed in atherosclerotic femoral arteries in Yucatan micropigs on a high cholesterol diet and followed for 6 weeks. Batimastat or vehicle was administered intraperitoneally. NI thickening was assessed by morphometry. Results The main finding was that batimastat did not result in a significant decrease in NI thickness. Only following correlation to the amount of preexisting plaque was the difference of 146 μm (19%) statistically significant. Batimastat did not impair wound healing following stenting. Conclusion Batimastat does not significantly influence the degree of NI thickening at 6 weeks following stenting of atherosclerotic porcine femoral arteries, except when correlated to plaque thickness. Batimastat does not affect vascular wound healing.

The outcome of total wrist arthrodesis was reviewed in 36 patients with osteoarthritis after a minimum follow-up of 4 years. Pain relief was not complete, and although 20 were pain free at rest, only six were pain-free during manual activity. Grip strength was 63% of the contralateral side and the DASH score remained high. Only 21 of the 34 could be re-employed. The mean time off work was 14 months. Complications were numerous and additional surgery was required in 21 patients.

Introduction. – We report the outcome of osteotomy for malunion of the distal radius. Material and methods. – Twenty-one wrists in 21 patients (mean age 38 years) with a malunion of the distal radius were treated with an osteotomy. An opening wedge osteotomy was performed when the distal radioulnar joint (DRUJ) could be saved; a closing wedge osteotomy was done when the DRUJ was treated with resection (Darrach) or arthrodesis (Sauve-Kapandji). The clinical and radiographic outcomes were evaluated together with the DASH score (disability of shoulder and hand). Results. – Extension improved to an average of 48° in the Smith-type group and flexion improved to an average of 51.8° in the Colles-type group. The postoperative DASH-score averaged, respectively, 17.3 and 33. There were four poor, four fair, seven good and six excellent scores on the scale of Fernandez and there were four poor, seven fair, three good and seven very good results on the Fernandez point score. Grip strength postoperatively averaged 70% of the contralateral side. Radiographically, there was a correction of increased volar tilt of the articular surface from 30.6 to 4.0° in the Smith-type group and a correction of increased dorsal tilt of the articular surface of 24.6° (from –21.3 to 3.3°) in the Colles-type group. Nine patients had surgery on the distal ulna at the time of the radial correction. Their average DASH score was 16.8 compared to the 33.97 average DASH score of those with radial correction without ulnar surgery. Conclusion. – Osteotomy of the distal radius in cases of malunion gives favorable outcomes. Treatment of the DRUJ is mandatory.

Three failed Sauvé–Kapandji procedures were salvaged using an ulnar head prosthesis. At 7–22 month follow-up, all three patients were much improved. However, the stem of one implant subsequently fractured in a fall and this implant had to be removed.

Shewanella oneidensis couples anaerobic oxidation of lactate, formate, and pyruvate to the reduction of vanadium pentoxide (V V ). The bacterium reduces V V (vanadate ion) to V IV (vanadyl ion) in an anaerobic atmosphere. The resulting vanadyl ion precipitates as a V IV -containing solid.

This study was set up to test our hypothesis that using the Jamar dynamometer a voluntary submaximal effort has a greater variability compared to a real maximal effort, especially when there is a long interval between different measurements. We tested 32 volunteers without a history of upper limb injury or operation in our hospital, with an interval of four to five weeks between tests. Each volunteer was asked to grip first right-handed then left-handed, first with a real maximal effort and then with a submaximal effort. This test was performed twice during the same session. The same individuals were seen again one month later and were studied using the same protocol. Sensitivities and specificities for the grip test were calculated using six different criteria to indicate a submaximal effort. Repeated grip testing with a time interval of one month cannot reliably detect voluntary submaximal effort in healthy volunteers.

This prospective study compared the outcome — subjective, objective and radiographic — of two surgical techniques for treating basal joint arthritis of the thumb: a "simple" trapeziectomy (group I) and a ligament reconstruction/tendon (group II) interposition technique. There were respectively 22 patients in group I and 34 in group II, all women with primary osteoarthritis. Both techniques gave favourable results and there were no significant differences for pain relief, patient satisfaction, mobility, DASH-score, key pinch force and gripping force. However in group II, the trapezial height was better preserved indicating that the proximal migration of the thumb was prevented or limited. There was also a significant correlation between the remaining trapezial space and key pinch force.

We describe another observation of asymmetrical Larsen syndrome. The unilateral manifestation of the typical skeletal defects indicates that this condition might be due to unilateral somatic cell-line mosaicism.

A case of mallet thumb, with a closed rupture of the extensor pollicis longus at its distal insertion, is presented. Conservative treatment resulted in a near normal function.

The purpose of the present study was to review the long-term results of surgical arthrolysis of the elbow. We reviewed 16 patients, with a mean follow-up of 47 months. Elbow motion before, during and after operation was measured. DASH score, pain and patient satisfaction were assessed. We found a significant (p0.05) improvement in elbow motion postoperatively. The total arc of motion improved from 47 to 87 degrees. However part of the initially obtained arc of elbow motion was lost with longer follow-up when compared to the immediate postoperative result. Results were significantly (p0.05) better when performing the arthrolysis no later than one year after onset of symptoms. Treating an extrinsic contracture resulted in greater improvement of elbow motion when compared to treating an intrinsic contracture. The amount of improvement in elbow motion and the overall elbow motion achieved postoperatively correlate significantly (p0.01 and p0.05 respectively) with better results of the DASH score and the patient satisfaction score.

Compression of the median and ulnar nerves at the wrist is frequently encountered. Carpal tunnel syndrome usually occurs without any obvious extrinsic cause; several cases have however been reported caused by anomalous or hypertrophic muscles. A survey of the literature shows that compression neuropathy of the median nerve has been reported in relation with anomalies affecting three muscles: the first (or second) lumbrical, the palmaris longus and its anatomic variants and the superficial flexor of the index finger. In the ulnar tunnel the situation is thoroughly different: so-called idiopathic ulnar tunnel syndrome is rare and an extrinsic compressing structure can usually be disclosed. Anomalous muscles belong to the palmaris longus/abductor digiti minimi group; the flexor carpi ulnaris is sometimes involved. One can suspect the presence of such an anomalous muscle when the compression syndrome concerns a patient who is not within the "usual" age group with symptoms initiated or aggravated by physical exercise.

We report a female patient with unilateral absence of the trapezius and pectoralis major muscles without other associated limb abnormalities. We believe that this anomaly belongs to the spectrum of anomalies resulting from disruption of the blood supply in the embryonic subclavian and vertebral arteries, as suggested in Poland syndrome.

Ulnar variance was measured in standardized conditions in 125 normal wrists and in 52 patients with Kienböck's disease. No significant difference in ulnar variance between a sex/age-matched control group and a group of patients affected with Kienböck's disease was found. A positive correlation was found between age and ulnar variance. No significant difference was found between men and women. Based on these results, negative ulnar variance does not seem to be an important factor in the etiology of Kienböck's disease.

The growing precision of diagnostic techniques (MRI, arthrography, arthroscopy) and the consequent increase of the diagnosis of cartilaginous and ligamentous lesions of the wrist led us to undertake a detailed anatomical study of the carpus and to extend this study to the search for correlations between these lesions and the radio-ulnar index. Fifty one cadaveric wrists were dissected from an elderly population (mean age of 76 years). Cartilaginous lesions were found in two-thirds of radioulnar joints of the wrist with a marked predominance for the lunate bone (43%). The triangular cartilage of the fibrocartilaginous complex (TFCC) was perforated in 23 wrists (46%). We established a correlation between the radio-ulnar index and perforations of the TFCC (p0.05), as well as the thickness of this structure (p0.05). The relationship between age and rupture of intrinsic ligaments (p0.05), and the radio-ulnar index (p0.05) and age was also established. We present our figures, discuss the clinical implications, and draw the following conclusions from this study. 1) The carpus is a complex joint which is subject to age-related degeneration. 2) The large number of cartilaginous lesions observed in this study must be taken into account in the interpretation of MRI and the "over" precise results of arthroscopy.

The purpose of a classification for clinical problems which, except for a few specialized centers, occur only sporadically is to provide a system where these cases can be stored. This should allow all involved investigators to speak the same language; so-doing syndromes can be delinated, frequencies of occurence established and results of--different--treatments compared. A classification system should be simple to use, reliable and uniformly accepted. It should allow space for adaptations and/or extensions. The IFSSH proposed a 7 categories classification based on the proposed classification of Swanson et al. in 1976. This classification, was based on, which was thought in the seventies, etiopathogenic pathways. These 7 groups are: I. Failure of formation; transverse (A), or longitudinal (B) II. Failure of differentiation III. Polydactyly IV. Overgrowth V. Undergrowth VI. Amniotic band syndrome VII. Generalized skeletal syndromes. The extended classification proposed by IFSSH was used to classify 1013 hand differences in 925 hands of 650 patients. We found associated anomalies in 26.7%. The classification was straightforward in 86%, difficult in 6.6% and not possible in 7.8%. Group II was the most numerous group including 513 anomalies. We propose to include in this group the Madelung deformity, the Kirner deformity and congenital trigger fingers and trigger thumbs. In group I the radial and ulnar deficiencies, limited to the hand without forearm deficlencies should be Included. Triphalangeal thumbs are a problem, we suggest it to be listed in group III and consider it as a duplication in length. It is not always possible to evaluate the (transverse) absence of the fingers or hand. Longitudinal deficiencies (group IIB), symbrachydactyly (group V), and amniotic bands (group IV) occasionally develop a phenotype similar to the genuine transverse deficiency (group IA). Recently, the Japanese Society for Surgery of the Hand (JSSH) (16) proposed an extension/modification of the IFSSH classification. Based on newer knowledge on teratology, symbrachydactyly in all stages were transfered to group I. Two new groups were introduced. A group "failure of finger ray induction" including typical cleft hand (IC), central polydactyly (III) and (bony) syndactyly (II)--was included. Also a group of "unclassifiable" cases was added. This Japanese proposed classification is a real improvement and most clinicians and surgeons tend to use it in the future.