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Purpose: The purpose of this study was to evaluate the effects of epineurotomy on the post-surgical median nerve volume and clinical outcomes in carpal tunnel syndrome (CTS) patients with a prominent nerve narrowing., Methods: This was a prospective, randomised, double-blind controlled trial. Patients (n = 50) were randomised (1:1) to open-field surgical carpal tunnel release followed by a longitudinal epineurotomy of the nerve (test), or to open-field release without epineurotomy (control)., Results: The nerve volume was slightly larger in the test group 90 days post-surgery (by 10.5 %, p = 0.157) but not 180 days post-surgery. No relevant electropyhsiological or clinical difference between groups and no effect of the nerve volume was observed. The subjective pain reduction was slightly more prominent in the control group at 180 days. Larger post-surgical nerve volume was associated with lower pain, but only in the control group., Conclusions: Even in selected CTS patients, longitudinal epineurotomy confers no benefit regarding the nerve volume or clinical outcomes over a simple carpal tunnel release.

The aim of this study was to compare osteotomy for malunited distal radius fracture with embedment of a corticospongious graft into a periosteal flap of the recipient bone (test) with the standard procedure (control) with respect to graft resorption. A retrospective assessor-blind analysis of consecutive patients (test: n = 19, control: n = 30) was performed. Ulnar tilt, palmar tilt and capitate-ulna distance were assessed from radiographs taken before, two to four days after and over three months after the surgery to determine loss of correction achieved by the surgery and estimate graft resorption during the postoperative period. In both unadjusted and adjusted comparisons, loss of correction of all parameters was lower in the test group (P < 0.05). The odds of "none to mild" resorption were greater in the test group with an adjusted odds ratio of 5.43 (95% confidence interval: 1.32-26.5, P = 0.025). Total graft collapse occurred in five of 30 controls and in none of 19 test patients. Graft embedment into the periosteum may improve its preservation.

Carpal tunnel syndrome (CTS) is a somewhat neglected medical and economic problem, and surgery is one of the therapeutic options. We analyze the outcomes of surgical treatment in 114 consecutive patients (154 hands). Before the surgery, physical therapy was implemented (96% cases) and the patients were frequently on a sick leave (42% cases). Immediately before the surgery, the patients suffered intensive pain (median 7 on a 0-10 scale), and had a reduced hand function (median 2 on a 0-10 scale). After the surgery (6-12 months), the pain was reduced (difference -5.0, 95% CL -5.5, -4.5, p<0.001), and the function improved (difference 4.5, 95% CLs 4.0, 5.0, p<0.001). Longer time interval between referral to a primary care physician and referral to an orthopeadic surgeon (>1 year in 48% of the cases) was an independent negative predictor for these outcomes. Total difference in costs for sick leaves and physical therapies between the pre- and postoperative periods was estimated at approximately 269.030,00 to over 375.315,00 euros. The time between the entrance into the healthcare system and recognition of the need for surgical treatment of CTS needs to be reduced in order to get better medical and economic results.

We present the case of an 11-year-old girl who had a corrective osteotomy reconstruction using absorbable implants for a malunited capitellar fracture 3-1/2 months after a dislocation of her elbow joint. This operative stabilization enabled early joint mobilization and, finally, excellent results in terms of anatomy and function at a 2-year follow-up. We were not able to find any similar report in the English literature dealing with corrective osteotomy reconstruction using absorbable implant fixation for a malunited capitellum in a child.

Functional ability of a hand determines person's creative and social abilities. Thus any functional inability of upper limb causes huge unfavourable, practical and economic, consequences for both an affected person and the whole community. The goal of treating affected upper limbs is to restore their function. Subsequently, identification of urgent and relatively urgent pathology of an upper limb and early diagnostics and treatment are of great importance because belated, secondary and reconstructive surgical procedures achieve significantly poorer results. Identifying pathology of an upper limb requiring urgency, leading us towards early diagnostics and timely treatments, functional restoration of upper limbs and enable prevention of permanent consequences.

Purpose of the Study: This is a cross section retrospective study which shows undertaken in order to determine the frequency and degree of postoperative alterations in size of cortico-cancellous autografts used in corrective osteotomies of the distal radius., Patients and Method: In the period from 1987 to 2002, 50 patients (21 females and 29 males, mean age 38 years, range 18-64, were treated with corrective osteotomy, bone grafting and internal fixation after mal-united Colles' fracture. The patients were followed up from 6 months to 5 years (average 15 months). Heights of volar, ulnar, dorsal and radial sides of the graft were determined from radiographs (preoperative, immediately after the surgery and at the late follow-up examination) according to the BIZCAD method and put into the computer program, which compared them in three dimensions., Results: In sixteen patients (32 %) one or more sides of the graft decreased in height during the postoperative period by more than three millimeters. In five cases there was a complete resorption of the implanted graft. In the other thirty-four cases, an average decrease in all sides of graft was statistically significant. Unequal decrease led to an increase of volar inclination angle of the distal articular surface of the radius, averaging 3 degrees. Influence of age on the diminution of the graft size was found. More distally placed grafts had less incidence of significant resorption. A correlation between initial height of the side of the graft and its alterations was also found (r=0.49, p<0.001)., Conclusion: Postoperative changes in the size of graft are frequent and represent a serious obstacle to the success of corrective osteotomies. We recommend that: 1. the use of a the higher bone graft for elongating of the radius, however with a greater chance of resorption; the alternative method of ulna shortening should be considered; 2. the osteotomy line and the grafts should be placed more distally to decrease the risk of resorption; 3. if osteotomy can't be performed distally enough, postoperative immobilization for about three weeks should be considered.

The basic role of the shoulder, upper arm, elbow, forearm, and wrist is to place the hand in the appropriate position, so that it can fulfill its function. The upper extremity, especially the wrist and the hand, has a very complex anatomy with a large number of bones, muscles, tendons and nerves. They are essential to work and sport activities and are subject to acute and/or chronic mechanical injuries. This is why overuse injuries are the most common in these regions. They are often characterised by tendinitis, tenosynovitis, tunnel syndromes, or stress fractures. This paper gives an overview of the most common overuse syndromes of the hand, wrist, forearm and elbow, describing their characteristic symptoms and methods of diagnosis and treatment. The syndromes are trigger finger, dorsal radiocarpal impingement syndrome (gymnast's wrist), DeQuervain's disease, tenosynovitis of other dorsal compartments, intersection syndrome (oarsman's wrist), flexor carpi ulnaris tendinitis, flexor carpi radialis tendonitis, humeral epicondylitis (tennis elbow), posterior impingement syndrome of the elbow, medial tension and lateral compression syndrome, stress fracture in the hand, wrist, forearm and elbow, and tunnel syndromes.

In a prospective study 61 patients with recurrent anterior shoulder dislocation were evaluated by sonography, radiography, and surgery to determine the value of sonography in the detection of a HillSachs lesion. The group consisted of 57 male and four female patients with an average age of 27 years. Hill-Sachs lesion was found in 54 (88%) shoulders of the 61 surgically treated patients. Using surgical findings as the gold standard, we found sonography to be 96% (52 of 54 cases) sensitive, 100% specific (seven of seven cases), and 97% (59 of 61 cases) accurate in the diagnosis of HillSachs lesion. The average size of the lesion measured by sonography was 19.2 mm long, 16.0 mm wide, and 4.1 mm deep. The lesion was of small or medium size (up to 6 mm deep) in 88% of patients. Results of our study show that sonography is a valuable imaging technique in the diagnosis of Hill-Sachs lesion. It produced only two false-negative results when compared with surgical findings.

A computer-assisted method of preoperative planning was used to create virtual models of the deformed distal end of the radius after malunion of a fracture. By comparison with a similar model of the uninjured wrist, values were calculated for the angles and lengths to be corrected by osteotomy. Shifts of the distal fragment were analysed for 33 deformed wrists, 27 of which underwent corrective osteotomy and bone grafting. In more than half the cases there was dorsal or volar shift of 3 mm or more. The accuracy of the correction was measured by comparing the three-dimensional models before and after osteotomy with the model of the normal wrist. The volar and ulnar inclination angles of the articular surface of the radius and the radial length were regularly restored to normal.