Search

The purpose of this study was to evaluate the relationship between radiological and functional results in patients with extra-articular fractures of the distal radius. We conducted a prospective study of radiological and functional assessment in 95 consecutively selected extra-articular distal radius fractures. There were two patient groups: more than 60 and less than 60 years of age. The final fracture union radiographs were analysed for their functional outcome using the Michigan Hand Outcomes Questionnaire (MHQ) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. In patients with acceptable radiological results, 62% (MHQ group) and 72% (DASH group) of patients had satisfactory functional outcome. Analysing patients with satisfactory functional results, 56% (MHQ group) and 59% (DASH group) had satisfactory radiological results. There was a higher proportion of patients with better functional results, despite poor radiological results, in both of the age groups. There was a statistically significant correlation between satisfactory radial tilt and functional outcome in the younger patients. In the older age group, patients with satisfactory radiological results had satisfactory functional outcome (p<0.05). However, in the older age group, satisfactory functional results were achieved, despite unsatisfactory radiological results. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the changes in alignment during the course of treatment for extra-articular distal radius fracture and the relationship of initial and intermediate radiographs, with the final radiograph taken at fracture union. A cohort of 96 consecutive patients who were conservatively managed for extra-articular distal radius fracture in an 18-month period was undertaken. The radiographs analysed were taken at prereduction, postreduction, a week later and at fracture union. The radiological parameters analysed were radial tilt, radial length, radial inclination, dorsal comminution and ulnar styloid fracture. There was a significant change in radiographic alignment between initial and immediate postreduction radiographs, and between postreduction 1 week later radiographs (p < 0.05), but the number of patients in the 1 week later and fracture union groups remained similar (p > 0.05). All patients with poor radiological outcome had ulnar styloid fractures. This was also associated with dorsal comminution in 86% of patients. Patients with satisfactory radiological outcome had ulnar styloid fracture and comminution in 34% and 43% of patients respectively. The final radiological outcome was not found to be influenced by initial unsatisfactory alignment of radial tilt, radial length and radial inclination individually or in combination. We suggest that two clinic visits after initial reduction of the fracture should be sufficient to manage such injuries; the first visit 1 week after manipulation to detect unacceptable displacement and if found satisfactory, the last visit at fracture union for final review, advice and referral to physiotherapy. [ABSTRACT FROM AUTHOR]

The majority of orthopaedic screws are designed, tested and manufactured by existing orthopaedics companies and are predominantly developed with healthy bone in mind. The timescales and costs involved in the development of a new screw design, for example, for osteoporotic bone, are high. In this study, standard wood screws were used to analyse the concept of using three-dimensional printing, or rapid prototyping, as a viable stage of development in the design of a new bone screw. Six wood screws were reverse engineered and printed in polymeric material using stereolithography. Three of the designs were also printed in Ti6Al4V using direct metal laser sintering; however, these were not of sufficient quality to test further. Both the original metal screws (metal) and polymeric rapid prototyping screws were then tested using standard pull-out tests from low-density polyurethane blocks (Sawbones). Results showed the highest pull-out strengths for screws with the longest thread length and the smallest inner diameter. Of the six screw designs tested, five showed no more than a 17% variance between the metal and rapid prototyping results. A similar pattern of results was shown between the screw designs for both the metal and rapid prototyping screws in five of the six cases. While not producing fully comparable pull-out results to orthopaedic screws, the results from this study do provide evidence of the potential usefulness and cost-effectiveness of rapid prototyping in the early stages of design and testing of orthopaedic screws.

An amphiphilic pyrene derivative exhibiting unusually stable excimer emission due to strong aggregation is presented. The aggregated system served as an intelligent sensor for metal ions and nitro explosives in aqueous media. The excimer displayed excellent selectivity toward Cu 2+ among the tested cations. The observation was interpreted on the basis of chelation of metal ions involving the hydroxyl and amino groups of two molecules, leading to the ligand-to-metal charge-transfer (CT) process. The excimer was further applied for the cell imaging of Cu 2+ ions. Also, while treating the excimer with various nitro explosives, it displayed efficient 2,4,6-trinitrophenol sensing, corroborating mainly the CT process from pyrene to the analyte due to intercalation of the analyte within pyrene., Competing Interests: The authors declare no competing financial interest.

We report the stereoselective synthesis of an alkynyl side-chain containing (2S,3R)-α-hydroxy-β-amino acid ((2S,3R)-AHBA) analogues. The Cu(I)-catalyzed reactions of (R)-glyceraldehyde acetonide and dibenzylamine with terminal alkynes provided the corresponding (2S,3R)-α-amino alcohols with good-to-excellent diastereoselectivity. Subsequent chemical transformations provided easy access to the alkynyl side-chain containing (2S,3R)-AHBAs. The utility of the methodology was demonstrated by the stereoselective synthesis of valinoctin A and (2S,3R)-3-amino-2-hydroxydecanoic acid ((2S,3R)-AHDA). Photophysical properties and cell permeability of a pyrene-labeled (2S,3R)-AHBA were also determined.

Background: Fractures of the distal radius are common, with volar locking plates being increasingly used in their treatment. They aim to provide stable internal fixation and are designed to mirror the natural anatomy. Current volar plate designs incorporate a volar cortical angle (VCA) of 25 degrees., Hypothesis: The aim of this study is to determine whether the VCA in uninjured distal radii corresponds accurately with modern volar plate designs., Materials and Methods: A retrospective radiological analysis utilizing Computed Tomography scans to assess the VCA of 100 distal radii. Each distal radius was subjected to 3 measurements of the VCA in the sagittal plane., Results: One hundred patients were identified (67 male, 33 female; mean age 37.4 years). The mean VCA was 32.9 degrees (S.D.±5.14 degrees). The VCA in male patients was significantly greater than in females (33.6 vs 31.5 degrees; P=0.04). There was a statistically significant difference between the lateral VCA and medial VCA (32.2 vs 34.3 degrees, P=0.02)., Discussion: Our study clearly demonstrates that the VCA measured in the distal radius is significantly greater than the volar angulation incorporated within modern plate design. Given that the aim of ORIF is to anatomically reconstruct the distal radius, our study highlights that this may not be possible with current plates., Levels of Evidence: Level IV Retrospective case series., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

An air-lift bioreactor (ALR) system, applied for the treatment of waste-gas-containing monochlorobenzene (MCB) was seeded with pure culture of Acinetobacter calcoaceticus, isolated from soil as a starter seed. It was found that MCB was biologically converted to chloride as chloride was mineralized in the ALR. After the built up of the biomass in the ALR, the reactor parameters which have major influence on the removal efficiency and elimination capacity were studied using response surface methodology. The data generated by running the reactor for 150 days at varying conditions were fed to the model with a target to obtain the removal efficiency above 95% and the elimination capacity greater than 60%. The data analysis indicated that inlet loading was the major parameter affecting the elimination capacity and removal efficiency of >95%. The reactor when operated at optimized conditions resulted in enhanced performance of the reactor.

Background: We retrospectively reviewed 20 patients (21 elbows) after arthroscopic debridement and capsulectomy of the elbow for primary osteoarthritis. We aimed to see if there was an improvement in pain, function, and range of movement in the medium-term., Materials and Methods: Outcomes of 20 patients (18 men, 2 women) with primary osteoarthritis of the elbow (21 elbows) operated on by the senior surgeon were reviewed at a mean of 5.5 years postoperatively. Inclusion criteria were patients with undergoing arthroscopic debridement and capsulectomy after failure of previous conservative treatment. Exclusion criteria were patients undergoing additional intra-articular procedures at surgery and patients with post-traumatic or inflammatory arthritis. Mean age was 42 years (range, 22-79 years). Preoperatively, osteoarthritis was classified based on plain x-ray images. Functional outcome was assessed using preoperative and postoperative Disabilities of the Arm, Shoulder and Hand (DASH) scores, Mayo scores, and range of movement., Results: Radiographically, osteoarthritis was assessed as class I in 9 elbows, class II in 10 elbows, and class III in 3 elbows. There was a mean significant improvement in DASH score from 34.0 to 12.7 (P < .05). This was true for all grades of osteoarthritis and significant for classes II and III (P < .05). Mayo scores postoperatively were "excellent" in 11 elbows, "good" in 5, "fair" in 4, and "poor" in 1. Nineteen of the 20 patients said they would have had the surgery again., Conclusion: Arthroscopic debridement and capsulectomy is an effective procedure for patients with primary osteoarthritis of the elbow. We propose this may work as a partial neurectomy to denervate pain sensation in the joint., (Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.)

A Cu(I)-catalyzed α-oxyaldehyde-dibenzylamine-alkyne coupling reaction was delineated for the construction of α-oxyamines with excellent yields and diastereoselectivity. Crystal structure analysis and theoretical calculations were also supportive of the formation of syn-α-oxyamines as the major products. Application of the methodology addresses the synthesis of (+)-β-conhydrine along with analogs having two different diversity features. A ring size variation allows construction of piperidine and pyrrolidine rings while a variation of side arm functionality is achieved by complete regioselective opening of epoxide by different organocopper ylides (Gilman reagents). A lactam-Cu(I) complexation motif is proposed which allows an intramolecular attack of ylides at the terminal epoxy carbon via the six-membered cyclic transition state. The present work features the synthesis of (+)-β-conhydrine over eight steps in 26% yield and its seven analogs in 21-28% yields.

The present work describes the biofiltration of mixture of n-propanol (as a model hydrophilic volatile organic compound (VOC)) and toluene (as a model hydrophobic VOC) in a biofilter packed with a compost-woodchip mixture. Initially, the biofilter was fed with toluene vapours at loadings up to 175 g m(-3) h(-1) and removal efficiencies of 70%-99% were observed. The biofilter performance when removing mixtures of toluene and n-propanol reached elimination capacities of up to 67g(toluene) m(-3) h(-1) and 85 g(n-propanol) m(-3) h(-1) with removal efficiencies of 70%-100% for toluene and essentially 100% for n-propanol. The presence of high n-propanol loading negatively affected the toluene removal; however, n-propanol removal was not affected by the presence of toluene and was effectively removed in the biofilter despite high toluene loadings. A model for toluene and n-propanol biofiltration could predict the cross-inhibition effect of n-propanol on toluene removal.

Four-corner fusion is an accepted surgical treatment for established SLAC and SNAC wrist. We describe a technique of bone grafting to be used in conjunction with any of the standard fusion techniques. A step by step, illustrated approach allows the easy placement of an autograft which is in contact with all surfaces of the bones involved in the fusion.

Background. "Lead hands" are frequently used to maintain hand and finger position in hand surgery. The malleability and strength of lead make it ideal for this purpose. The aim of this study was to determine the amount of lead transferred to a surgeon's glove during handling of a lead hand. Method. Sterile surgical gloves were wiped over the surface of a lead hand. The number of wipes was varied, the gloves were then sent to a trace elements laboratory, and the lead content transferred to each glove was determined. Results. The amount of lead transferred to each glove increased with increasing exposure to the lead hand. After twenty wipes, up to 2 mg of lead was transferred to the surgeon's glove. Covering the lead hand with a sterile drape markedly reduced the lead transferred to the surgeon's glove. Conclusion. Significant amount of lead is transferred on to the gloves after handling a lead hand. This risks wound contamination and a foreign body reaction. Covering the lead hand with a sterile drape may minimise the risk of surgical wound contamination.

The paper outlines treatment of waste gas containing monochlorobenzene (MCB) and benzene in a mixture using biofilter packed with compost and woodchips seeded with Acinetobacter calcoaceticus. The biofilter could treat waste gas containing MCB and benzene effectively with an efficiency of (99+/-5%) and (97+/-6%) at optimal empty bed contact time (EBCT) of 3 min with a loading of 57 g/m(3)/h of MCB and 2g/m(3)/h of benzene. At optimum loading of MCB and benzene, the biofilter showed total bacterial count of 13 x 10(5)CFU/g of compost, while the MCB and benzene degrading bacterial count was 71 x 10(4)CFU/g and 5 x 10(4)CFU/g compost respectively. The experimental removal efficiency of MCB and benzene were in good agreement with the model predicted value., (Copyright (c) 2010 Elsevier Ltd. All rights reserved.)

Hypothesis: Several studies have shown good results with internal fixation of distal humeral fractures; however, few have focused specifically on anatomic parallel plate fixation using the same implant and postoperative regimen. The purpose of this study was to determine the functional outcome after open reduction and internal fixation of these complex fractures using parallel precontoured anatomic plates., Materials and Methods: This was a retrospective single-surgeon series involving 16 patients (12 women, 4 men) treated with a double-column parallel plating technique. Clinical assessment included the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand Score (DASH). Mean age was 43 years (range, 20-78 years). Average follow-up was 35 months. Four fractures were AO type A and 12 were AO type C., Results: Union was achieved in all patients. There was no superficial or deep infection or hardware failure. Two patients required removal of plates for pain and prominence but not all screws could be completely removed. The mean flexion was 132 degrees and extension was 29 degrees . The mean DASH score was 46.1. Grip strength was 56% of the uninjured side. Mean flexion and extension force was 72% and 70%, respectively, of the uninjured elbow. The mean MEPS score was 72.3., Discussion: Anatomically precontoured parallel plates are effective in achieving bony union with low implant failure with acceptable functional outcomes. However, screw extraction can be difficult when the implant is removed., (Copyright 2010 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.)

Biological treatment of dimethyl sulphide (DMS) was investigated in a bench-scale biofilter, packed with compost along with wood chips, and enriched with DMS degrading microorganism Bacillus sphaericus. The biofilter could remove 62-74% of the inlet DMS, at an optimum loading of 0.484 g/m(3)/h with optimum empty bed contact time (EBCT) of 384 s and an average moisture range of 65-70%. The biodegradative products of DMS were sulphide, thiosulphate and sulphate. Evaluation of microbiological status of the biofilter indicated the presence of other bacterial cultures viz. Paenibacillus polymyxa, and Bacillus megaterium, besides B. sphaericus., (Copyright 2009 Elsevier Ltd. All rights reserved.)

Previous descriptions of the pattern of communication between the digital flexor tendon sheaths have been largely based on imaging studies. An anatomic study on 12 cadaveric hands was conducted using water soluble dye and directly observed patterns of communication between the digital flexor tendon sheaths and the radial and ulnar bursae. Four out of twelve specimens (33%) demonstrated a communication between the radial and ulnar bursae. The ulnar bursa communicated with the ring finger flexor sheath in two specimens, and the index finger flexor sheath in two specimens. One hand (8.3%) showed communication between the middle finger tendon sheath and radial bursa and between the index finger flexor tendon sheath and radial bursa. These findings show a considerable level of variation in communicating patterns between the synovial sheaths of the hand and wrist. Clinicians should be aware of the possibility of variations to the classical presentation of spread of infection through the digital flexor sheaths.

Background: Bicortical fixation of proximal phalangeal fractures may damage underlying flexor tendons secondary to drilling and screw protrusion in the dorsal-ventral direction. The aim of this study was to measure and compare the pull-out force of unicortical screws compared to bicortical screws in human cadaveric proximal phalanges to identify optimal configuration for internal fixation., Methods: Forty proximal phalanges were harvested. Bicortical and unicortical self tapping 1.7mm screws were inserted into paired phalanges at the distal and proximal metaphysis and at the mid-diaphysis placed in the dorso-ventral direction. Pull-out force of unicortical and bicortical screws were measured and compared., Findings: Bicortical screw pull-out force is significantly higher than that of unicortical screws in the dorsal-ventral direction. Pull-out strength of unicortical screws at the mid-diaphysis was significantly higher than the pull-out strength of bicortical screws at the proximal metaphysis (181.8N versus 31.5N, P<0.0001)., Interpretation: Diaphyseal fixation is stronger than metaphyseal for both unicortical and bicortical configurations. Unicortical mid-diaphyseal is stronger than bicortical proximal metaphyseal screw pull-out strength. This study provides biomechanical data that may be helpful for individualizing fracture fixation techniques at the proximal phalanx.

Perilunate dislocations, lunate dislocations and perilunate fracture dislocations are rare injuries comprising of less than 10% of all wrist injuries. Volar peri-lunate dislocations (VPLDs) account for less than 3% of perilunate dislocations. These severe carpal injuries occur after high-energy trauma to the wrist and falls on the outstretched hand. We present a case of a missed VPLD who developed parasthesia in the distribution of the median nerve 18 months after the initial injury. A plain film radiograph revealed a stage II VPLD. Nerve conduction studies confirmed compression of the median nerve at the carpal tunnel. VPLDs are extremely rare injuries. A quarter of perilunate dislocations are missed on initial presentation. The outcome is poor for missed injuries and this patient is aware that a wrist fusion may be required in the future for to treat symptoms.

The aim of this study was to assess the value of direct magnetic resonance (MR) arthrography of the wrist for detecting full-thickness tears of the triangular fibrocartilage complex (TFCC). Twenty-four consecutive patients who had ulnar-sided wrist pain and clinical suspicion of TFCC tear were included in the study. All patients underwent direct MR arthrography and then wrist arthroscopy, and the results of MR arthrography were compared with the arthroscopic findings. The positive predictive value of MR arthrography in detecting TFCC full-thickness tear was 0.95, and the negative predictive value was 0.50. The sensitivity of MR arthrography in detecting a TFCC full-thickness tear was 74% (15/19), and specificity was 80% (4/5). The overall accuracy of MR arthrography in detecting a full-thickness tear of the TFCC in our study was 79% (19/24). We believe that diagnosis of tears in the TFCC by direct MR arthrography is not entirely satisfactory, although MR arthrography has a high positive predictive value for detecting TFCC tears. Negative results of MR arthrography in patients with clinical suspicion of TFCC tear should be interpreted with caution.

Introduction: Dorsally displaced fractures of the distal radius fractures are one of the commonest in day-to-day practice. There is still no consensus among surgeons regarding the suitability of using volar or the dorsal cortex as basis for internal fixation for dorsally displaced fractures., Background: We report an anatomical study, which compares the thickness of the volar and dorsal cortices of cadaveric adult radii using digital photography., Results: Results of this study show that the volar cortex was statistically, significantly thicker than the dorsal cortex. We believe that the volar cortex may behave as the calcar of the distal radius and hence internal fixation devices applied to the volar cortex may provide a more stable internal fixation compared to those based on the dorsal cortex.

The aim of this study was to assess whether surgical decompression for carpal-tunnel syndrome (CTS) in the presence of primary or secondary osteoarthritis of the wrist is associated with poorer patient satisfaction. We did a retrospective matched cohort study. Twenty-four patients who underwent surgical decompression for CTS secondary to osteoarthritis were identified by reviewing the notes and the radiographs. A control group consisted of 24 patients without osteoarthritis of the wrist who underwent carpal-tunnel decompression. The control group was matched for age, sex, side, and neuro-physiological severity of the nerve compression. In the group with osteoarthritis of the wrist, 17 (71%) patients reported their symptom relief as satisfactory, and 7 (29%) reported the results as unsatisfactory. In the control group, 23 (96%) patients reported their symptom relief as satisfactory, and 1 (4%) reported the results as unsatisfactory (P=0.0325). In conclusion, patient satisfaction following surgical decompression in patients with secondary CTS due to osteoarthritis was significantly lower compared to patients without osteoarthritis of the wrist.

Management of type II fractures of the lateral end of the clavicle is controversial. Different treatment options have been advocated with varying results. In this paper, we report the results of a group of 22 patients who underwent hook plate fixation for these fractures between 1997 and 2004. The mean follow-up was 39 months. There were 4 significant complications. Twenty-one patients regained their preinjury level of activity, and 19 patients were satisfied with their outcome. We recommend hook plate fixation as an acceptable alternative method for the treatment of type II fractures of the lateral end of the clavicle.

Anatomical variations of the ulnar nerve have been described at the level of the elbow and in Guyon's canal, while the path in the forearm has always been assumed to be constant. We present a case of compressive ulnar neuropathy at the wrist pre-disposed by a presumed congenital variation of the path of the ulnar nerve at the level of the wrist which improved following surgical release of the constriction caused as a result of it.

Power grip and thumb key pinch strength were measured pre- and immediately postoperatively in 30 patients with carpal tunnel syndrome while the wrist was in flexion and extension. The carpal tunnel decompression was performed under local infiltration with 1% lignocaine. Grip strength decreased more in wrist flexion than in wrist extension. No difference was found in thumb pinch strength. The authors conclude that some of the immediate postoperative loss of grip strength in wrist flexion can be attributed to prolapse of flexor tendons out of the carpal tunnel in this position.

We reviewed 13 patients with a complex fracture-dislocation of the proximal interphalangeal joint of a finger and one patient with a complex fracture-dislocation of the interphalangeal joint of thumb. We had treated these injuries using a pins and rubbers traction system which had been modified to avoid friction of the pins against the bone during mobilisation of the joint in order to minimise the risk of osteolysis. A Michigan hand outcome questionnaire was used for subjective assessment. The active range of movement (AROM) of the proximal and distal interphalangeal joints and the grip strength were used for objective assessment. The mean follow-up was 34 months (12 to 49). The mean normalised Michigan hand outcome score was 84. The mean AROM of the proximal interphalangeal joint was 85 degrees and that of the distal interphalangeal joint 48 degrees. The mean grip strength was 92% of the uninvolved hand. Twelve patients have returned to their original occupations. There has been no radiological osteolysis or clinical osteomyelitis. This modified traction system has given acceptable results with a low rate of complications. It is light, cheap, effective and easy to apply.

The average of three consecutive measurements is the most frequently used method for grip strength assessment. The purpose of this study was to compare the consistency of the maximum value with that of the average value of three consecutive measurements of grip strength. One hundred healthy volunteers participated in this study. Three measurements of grip strength were taken on two occasions separated by 2 weeks. For each hand, two average values and two maximum values were obtained. Ninety-five per cent limits of agreement for the average method were - 8.3 (-23%) to +7.2 (+20%)kg and for the maximum method were - 8.8 (-23%) to + 8 (+21%)kg. Both methods of grip strength assessment were found to be highly consistent with no statistically significant difference.

Using a digital vernier calliper, measurements of the position of the centre of the distal radial articular surface in the sagittal plane with respect to the long axis of the distal radius were made on 50 lateral radiographs of normal wrists. In all 50 cases, the centre of the distal radial articular surface was palmar on the long axis of the radius. The mean value for this palmar position was 5.3mm (44% of the radial shaft width). There was no correlation between the position of the centre of the distal radial articular surface and either the width of the radial shaft, the length of the articular surface of the distal radius or the age or sex of the individuals. However, the position of the centre of rotation was found to correlate with palmar tilt. The palmar position of the centre of the distal radial articular surface on the long axis of the radius may be biomechanically important.

Fifty lateral radiographs of normal wrists were viewed to determine the palmar cortical angle of the distal radius. The palmar cortical angle is different to its previously described palmar tilt or angulation. The mean value for the palmar cortical angle was 37 degrees (range, 26-50 degrees). This may be clinically important in the design of palmar plates for the distal radius.

Open reduction and internal fixation of comminuted, displaced intra-articular or potentially unstable fractures of the distal radius with plate and screws has increasingly become a favoured treatment. Intra-operative assessment of fixation with the help of an image intensifier has always been difficult because of the anatomy of the distal radius. Imaging of the implants placed as distal as possible to achieve satisfactory fixation often shows the screws to be penetrating the joint. We describe two new radiographic views of the wrist joint, which we used intra-operatively in ten patients undergoing open reduction and internal fixation of distal radius fractures. Screws were thought to have been penetrating the joint in the standard lateral views of all of them and in the standard antero-posterior views of eight of them.However, no screw was seen penetrating the joint in these new views. It was hence possible to place the plate distal enough to enable the screws to engage the sub-chondral bone. We recommend the use of these views in the open reduction and internal fixation of distal radius fractures.

Coronal sections of the distal radioulnar joint (DRUJ) were studied in 13 preserved cadaveric wrists specimens before and after 2 mm of shortening of the ulna. The DRUJs were subclassified on the basis of the DRUJ angle and depth of the sigmoid notch. The changes in extent and location of area of contact and radioulnar separation were noted. Although reduction in area of contact occurred in every specimen and DRUJ type, the maximum radioulnar separation and reduction in area of contact occurred in the DRUJ type IB and IIB. This could be a possible factor producing point loading and subsequent occurrence of DRUJ remodelling in the long-term after shortening of the ulna., (Copyright 2000 The British Society for Surgery of the Hand.)

We have reviewed prospectively 44 cases of chronic scapholunate dissociation treated by Blatt's dorsal capsulodesis. The diagnosis was based on clinical and arthroscopic criteria. The minimum follow-up was 2 years. The results were analysed clinically and radiologically. Postoperatively statistically significant reductions in wrist movements and grip strengths were noted. Delay in surgery and presence of compensation claims were also statistically significant factors. Patients with a high column/row index had higher overall good and excellent results. The scapholunate gap, scapholunate angle, carpal height and the type of instability as diagnosed on arthroscopy and cineradiography did not affect the outcome significantly. The scapholunate gap, scapholunate angle and the carpal height did not change significantly after operation.