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Background: Cubital tunnel syndrome and the resulting loss of hand dexterity and strength may necessitate surgical management. Studies have demonstrated no difference in outcome between surgical techniques. In an attempt to leave more ulnar nerves in situ while providing for stability within the cubital tunnel, we suggest a surgical treatment approach., Methods: The approach addresses individual anatomy methodically, eliminating muscular obstruction first and providing further decompression and stability as required. A retrospective review of 27 adult patients with ulnar neu- ropathy treated according to this method was performed., Results: The mean duration of symptoms prior to surgery was 2.75 years (SD = 2.4). The mean follow-up was 17.1 months (SD = 16.9). All patients improved following surgery. Two revision surgeries were performed 4 years following the original surgery., Conclusions: We believe the nerve recovers best when left in situ, provided it is stable and not compressed within the cubital tunnel. A further comparison study is necessary to substantiate the advantage of this "personalized" approach over other surgical techniques for cubital tunnel release.

Background: Scapholunate advanced collapse (SLAC) of the wrist is the most common degenerative condition of the wrist. Four-corner fusion (4CF) is performed as salvage surgery, though there is limited information on its long-term results. We hypothesized that 4CF is a durable surgery with good clinical long-term function., Methods: A retrospective chart review of patients undergoing 4CF as well as an interview and recent radiographs were obtained. Patients with a follow-up period of less than 10 years were excluded. Long-term evaluation included standard wrist radiographs, wrist range of motion, and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Radiographs were evaluated and described by the Kellgren-Lawrence classification., Results: Four hundred eighty-nine wrists underwent a 4CF for SLAC wrist from 1982 to 2003. Twelve patients (15 wrists) were available for follow-up. Average age at surgery was 49.1 years (range, 25-67 years). Average follow-up postsurgery was 18 years (11-27). Scapholunate advanced collapse was the etiology in 13 wrists and scaphoid nonunion advanced collapse in 2 wrists. Average extension/flexion arc was 68.6° (0°-96°), and radial/ulnar deviation arc was 32.9° (0°-5°). QuickDASH scores averaged 7.8 (range, 0-32.5), with only 1 score above 16. Seventy-three percent of radiographs showed minimal to moderate joint destruction, and 27% showed severe joint destruction., Conclusions: Scaphoid excision and 4CF remains a reliable procedure for patients with advanced wrist arthritis. Functional results were good at long-term follow-up despite radiographic changes in the radiolunate joint in 73% of patients. Patient satisfaction was high, and functional impairment was low.

We report the case of a 15-year-old girl with a red, swollen, and painful right hand. She first developed symptoms when she was 7 years old. Numerous physicians evaluated her at various institutions but were able to classify her only with chronic pain syndrome. She continued with regular occupational therapy and had to use special aids to compensate throughout school. After 8 years of treatment with no improvement, she presented to our office, where we diagnosed carpal tunnel syndrome. Intraoperative findings revealed a large proximal muscle belly of the index lumbrical, a thickened transverse carpal ligament, and marked compression of the median nerve. Two weeks after the surgery, her symptoms cleared; at 5 months, she remained symptom free., (Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

This paper synthesizes lessons learnt from research that aimed to identify land in the dryland regions of eight sub-Saharan African study countries where bioenergy feedstocks production has a low risk of detrimental environmental and socio-economic effects. The methodology involved using geographical information systems (GISs) to interrogate a wide range of datasets, aerial photograph and field verification, an extensive literature review, and obtaining information from a wide range of stakeholders. The GIS work revealed that Africa's drylands potentially have substantial areas available and agriculturally suitable for bioenergy feedstocks production. The other work showed that land-use and biomass dynamics in Africa's drylands are greatly influenced by the inherent 'disequilibrium' behaviour of these environments. This behaviour challenges the sustainability concept and perceptions regarding the drivers, nature and consequences of deforestation, land degradation and other factors. An assessment of the implications of this behaviour formed the basis for the practical guidance suggested for bioenergy feedstock producers and bioenergy policy makers.

Basal joint arthritis of the thumb is commonly treated surgically. Although the results are good, there is still controversy regarding the treatment of young people with low radiographic stages of disease. Our purpose was to evaluate the durability of a tendon arthroplasty procedure in this population. Thirty patients aged 55 years or under, with early stage arthritis, were evaluated. Eight patients were available for long-term (average 86 months) follow-up. No deterioration in the strength and mobility of the operated thumbs in the long-term was found. There was a significant increase in tip pinch strength between short- and long-term follow-up evaluations. This study supports the durability of this surgery in younger patients, potentially reducing the need for multiple surgeries.

Chronic radial wrist pain with no radiographic evidence of scapholunate instability or other wrist disease can be difficult to diagnose and treat. Our purpose was to evaluate the results of an operation to treat chronic radial or periscaphoid wrist pain that has failed to respond to conservative treatment. We examined the scapholunate ligament and performed a dorsal capsulodesis. One hundred-and-two patients were reviewed retrospectively. Casenotes were available for 88 patients. Function, pain, range of movement (ROM), and grip and pinch strengths were evaluated. Twenty (23%) of the patients were found to have a scapholunate ligament tear of 0-30%, 55 (61%) had a tear of 30%-60%, and 14 (16%) had a tear of 60%-100%. Mean postoperative grip strength was 29.5 kg (80% of the normal side). Postoperative range of movement was significantly limited in flexion compared with the normal side. All patients returned to their previous employment. Seventy (80%) of the patients described improvement in pain and function. Twenty-two (25%) required further operation on the same wrist. This procedure may be indicated in patients with chronic radial wrist pain and no overt instability that is resistant to conservative treatment. It has minimal morbidity and gives good results.

Background: Diagnosis of carpal tunnel syndrome remains clinical, despite many objective clinical and electrophysiologic tests. There is also a need to objectively assess the severity of involvement and the need for surgery, and to document response to treatment. The authors evaluated a hand-held strength-testing device for assessment of abductor pollicis brevis strength in patients with carpal tunnel syndrome., Methods: Sixty-two hands in 50 patients (39 women and 11 men) aged 26 to 57 years were examined. All hands were evaluated before and 6 weeks after surgery. Nineteen hands were available for 7-year follow-up., Results: Abductor pollicis brevis strength following carpal tunnel release increased significantly from a mean of 2.3 kg to 3.1 kg. The strength further increased in all long-term follow-up patients., Conclusions: Quantitative strength testing can be used to document changes in abductor pollicis brevis strength in response to treatment in patients with carpal tunnel syndrome. Further study is needed to assess the reliability of this testing method using multiple examiners in patients with carpal tunnel syndrome, and to evaluate the utility of using this device in tracking the long-term outcome of patients after carpal tunnel release.

Steroids are injected into joints for various indications. All steroid preparations relieve pain similarly over the long term. Therefore, decisions about which preparation to use are often arbitrary. We evaluated methylprednisolone acetate and a combination of betamethasone diproprionate and betamethasone sodium phosphate for short-term pain and the predictive value of short-term pain. Eighty-five patients were injected in prospective double-blind randomized fashion. Pain was evaluated by visual analog scale (1 = no pain, 10 = severe pain) at baseline, 3 days, and 3 weeks. No patient had joint pain immediately after injection. Three days after injection, mean (SD) pain levels were 5.1 (2.9) for methylprednisolone and 5.2 (2.6) for betamethasone (P = .97); 3 weeks after injection, they were 4.0 (2.8) and 3.7 (2.5), respectively (P = .57). Short-term pain increased from baseline for both preparations and decreased from 3 days to 3 weeks. Pain at 3 days and 3 weeks was positively correlated. This study does not support a difference in short-term pain between preparations. The significant correlation between short- and long-term pain may justify early decisions regarding treatment, especially in patients with high levels of initial pain.

In South Africa, until recently, veterinary waste has not been included in definitions of health care waste, and so has been neglected as a contributor to the hazardous waste stream. Despite the application of, for example, the "Polluter Pays" principle in South African environmental legislation, to generators of waste, which would include veterinarians, there appears to be little awareness of and even less enforcement of the legislation in this regard. This paper reports on a 2001-2003 survey of management practices of the five waste contractors servicing just over half of the veterinarians in Durban, South Africa's second largest city. Some of their activities, when evaluated in terms of the legislation, guidelines and policies relating to waste handling and disposal, were found to be non-compliant. Since any discussion on waste management should take cognisance of waste from generation to final disposal, the responsibility of veterinarians as waste generators is also discussed in the light of the recent developments in health care waste management in South Africa. This study presents a review of past and current policies, legislation and guidelines that have application to veterinary waste. This is the first study to address veterinary waste disposal in any South African city.

Background: The authors delineate a subgroup of proximal interphalangeal joint injuries with chronic pain and limitation of movement, despite a stable joint, and describe and evaluate a surgical procedure., Methods: Through a volar approach, the volar plate is freed from scar but remains connected on either the ulnar or radial border. A new connection to the middle phalanx is established by creating a bony groove, and the volar plate is loosely attached distally. Fifty-four joints with chronic volar plate avulsion injuries of the proximal interphalangeal joint were evaluated. All patients had chronic pain and limitation of motion and function in a stable and congruent joint. Patients were examined at 6 weeks, 3 months, and 1 year after surgery. Range of motion, grip strength, and pain were evaluated. The average time to surgery was 10.5 +/- 11.8 months (range, 2 to 65.4 months). The mean postoperative follow-up period was 10.0 +/- 12.8 months (range, 3 to 73.5 months)., Results: All patients had an improved range of motion following surgery. The difference from the preoperative range of motion was statistically significant (p < 0.0001). None of the patients reported pain on rest after surgery, and five patients reported activity pain. The mean grip strength was 32.4 +/- 13.4 kg for hand that had been operated on and 41.0 +/- 14 kg for the hand that had not been operated on., Conclusions: This technique for repair of chronic volar plate avulsion injuries allows early motion and results in significant improvement in range of motion, pain, and overall function in this subgroup of patients.

Traditionally the scaphotrapezium-trapezoid joint is imaged through a posteroanterior view of the wrist. We describe an x-ray view that is aimed directly at the joint, which gives better visualization than the standard views.

The main indications for scaphotrapeziotrapezoid (STT) fusion are STT arthritis, rotary subluxation of the scaphoid, and Kienbock disease. The results of this procedure in the literature for each indication are discussed, as are the advantages, disadvantages,and alternative procedures. This article discusses the authors' surgical technique and results. The authors believe this procedure is a viable one in specific clinical scenarios.

The excision of distal digital glomus tumors has traditionally been performed directly over the involved nail bed. This can lead to nail deformities that are often unacceptable for the surgeon and the patient. The authors describe their experience with successful excision of digital glomus tumors using a lateral subperiosteal approach, which creates a dorsal flap. In 29 years, 19 patients were diagnosed with digital glomus tumors. All patients underwent excision using the lateral subperiosteal approach. The mean tumor size was 0.52 cm. The tumors were located on the pulp of the distal phalanx in two patients (10.5 percent) and subungually in 17 patients (89.5 percent). In all patients, preoperative clinical diagnosis was confirmed postoperatively with the biopsy result. Complications occurred in only two patients and included one paronychia and one temporary nail loss. The overall recurrence rate was 15.7 percent. All patients remained asymptomatic after surgery and regained full active and passive range of motion. There were no nail deformities by this approach. This technique represents a safe and effective approach to excising digital glomus tumors.

A 30-year analysis of 128 patients with flexor tendon sheath ganglion was investigated. The majority of patients were females with sex ratio of 2.6 : 1. Most of the patients are in their third to fifth decade of life. Hand dominance, previous trauma as well as other illnesses involving the hand did not show any correlation to the formation of ganglion. The middle finger was most commonly affected and 69% of the ganglion were located on A1 and A2 pulley. Recurrence was high (89%) after multiple percutaneous puncture and treatment was successful with no cases of recurrence after surgical excision.

Dupuytren's disease, although not altogether uncommon, has eluded scientists who have sought to explain the cause of this palmar fibroproliferative disorder. It can lead to severe limitations of hand function if left untreated. This study is the first broad genetic survey using microarray technology to find gene products that are overexpressed or underexpressed in diseased tissues. The authors found 23 genes with levels that differ consistently from control levels. Nine were selected for further verification using reverse transcription-polymerase chain reaction. These genes hold potential promise in explaining some of the demographic trends seen with disease, such as correlation with alcoholism and the striking predisposition for the male gender.

Purpose: The purpose of this study was to review the results of 800 scaphotrapeziotrapezoid fusions performed over a 27-year period., Methods: The patients were evaluated for postoperative range of motion, grip and pinch strength, pain, return to work, arthritis, and complications., Results: The overall range of motion was 70% to 80% of the nonoperated side and strength was 69% to 89%. Of the patients 88% returned to previous employment. Arthritis developed in 1.8% of the patients. The overall complication rate was 13.4%., Conclusions: Scaphotrapeziotrapezoid fusion is a viable treatment option especially for a high-functional-demand young population with significant wrist pathology. Complications, specifically nonunion, can be minimized with careful technique.

A 32-year-old woman with a longstanding history of bilateral forearm pain had been unable to open her fingers and use her left arm (treated as reflex sympathetic dystrophy) since the age of 14. On physical examination there was fullness and tenderness of the distal volar forearms bilaterally; the quadriga test (when the patient was asked to make a tight fist quickly, with one finger fully extended passively) elicited burning pain. Operation confirmed that she had anomalous reversed forearm muscles bilaterally, and these were successfully resected.

We present a simple compression technique for treatment of difficult nonunions and joint fusions in the hand. This technique utilizes only K-wires and small vessel loops. The results of 44 consecutive cases were studied retrospectively. Union was achieved in 37/44 cases. The average time to union was 7 weeks and our results were comparable to those of other studies. We found this technique useful, especially in complicated cases.

We report a modified arthroplasty technique for limited degenerative arthritis of the distal radio-ulnar joint, in which the proximal hyperemic portion of the joint is resected with preservation of the unaffected distal portion. The charts of ten patients, one bilateral, were retrospectively reviewed and all 11 wrists were examined after an average of 30 months. All patients reported decreased pain and increased joint function. Grip strength, supination and pronation were comparable to the opposite, unaffected side.

Previous reports of lunotriquetral arthrodesis suggest relatively low rates of primary fusion without the use of permanent fixation and/or prolonged immobilization. We performed 26 lunotriquetral arthrodeses in 24 patients with a technique using cancellous bone graft to fill a biconcave space created in the adjoining bones with parallel K-wire fixation. The indications included symptomatic lunotriquetral instability and degenerative arthritis. All patients received conservative treatment before surgery. Primary fusion was achieved in all wrists in an average of 50 days. Postoperative wrist flexion/extension averaged 77%/80% of unaffected sides. Radial/ulnar deviation averaged 95%/91% of unaffected sides. Pain relief was good or very good in 83%. Eight-eight percent returned to the workforce. This study shows reliable, effective results with a technique that adheres to the principles of intercarpal arthrodesis and avoids permanent internal fixation.

Myxoma is a rare benign tumor composed of stellate or spindle-shaped cells in a loose myxoid stroma. Few cases involving the hand have previously been described. We present a rare case of recurrent myxoma in the intermetacarpal space and detail the clinical behavior of this indolent tumor.

We conducted this study to establish reliability and normative values for abductor pollicis brevis strength. A portable microprocessor-controlled hand-held device was used for testing. Twelve healthy subjects were used for intrarater and interrater reliability testing. Intraclass correlation coefficients were 0.92 for intrarater testing and 0.89 for interrater reliability. Normative values for abductor pollicis brevis strength are presented by gender and age from the test results of 297 volunteers (121 men and 176 women; age range, 20-59 years) with at least 30 subjects in each subgroup. Abductor pollicis brevis strength was significantly greater in the men than in the women in all age groups. No significant differences were found related to age, side, or dominance. The results suggest that quantitative muscle testing produces consistent values for abductor pollicis brevis strength that remain fairly constant in patients aged 20 to 59 years.

The current literature universally suggests that submuscular anterior transposition is the standard operative treatment for recurrent cubital tunnel syndrome. Regardless of the type of initial failed procedure, including submuscular transposition, 20 patients underwent anterior subcutaneous transposition of the ulnar nerve. All patients were monitored for a minimum of 2 years after surgery. The most common sites of compression were the medial intermuscular septum and the flexor-pronator aponeurosis. Fifteen patients had a good or excellent outcome; 5 patients had a fair or poor outcome. Relief of pain and paresthesias were the most consistent favorable results. Fair and poor outcomes were significantly associated with increasing age and the number of previous surgeries. Subcutaneous anterior transposition of the ulnar nerve proved to be an effective treatment for recurrent cubital tunnel syndrome.

Limited wrist arthrodesis is a useful method for treating specific carpal disorders that maximizes residual wrist motion and strength while eliminating pain. Selective fusion of specific carpal units can be used in degenerative arthritis, rotary subluxation of the scaphoid, midcarpal instability, scaphoid nonunion, Kienbock's disease, and congenital synchondrosis or partial fusion of specific carpal joints. This report presents our experience with more than 1000 limited wrist arthrodeses, and provides a review of the indications and technical considerations for specific intercarpal fusions, and subsequent results. To date this is the largest series of intercarpal arthrodeses and the study has demonstrated that these techniques are reliable and effective in dealing with a wide range of wrist disorders.

Ulnar-wrist pain is a complex problem whose cause often remains elusive. A diagnostic triad of localized triquetral pain, history of a wrist hyperflexion injury, and normal radiographs, accompanied by ulnar wrist swelling and limited wrist motion, is often attributable to a syndrome we have termed triquetral impingement ligament tear (TILT). The mechanism of injury causes a cuff of fibrous tissue to be displaced distally from the ulnar sling mechanism, resulting in chronic impingement on the triquetrum that causes hyperaemia, loss of articular cartilage, and softening of the bone. Surgical repair consists of simply excising the impinging fibrous cuff. The outcome of 44 patients treated for TILT over a 6-year period is reviewed. In all cases, TILT repair resulted in improved wrist motion and strength. Ninety-five percent of patients reported a significant improvement in pain both at rest and with activity.

A retrospective review of patients with carpal tunnel syndrome (CTS) identified 20 patients (26 wrists) who had persistent or recurrent CTS after having undergone endoscopic carpal tunnel release (ECTR). Seven wrists never had relief of the original CTS symptoms; for the remaining 19 wrists, the average time to recurrence of CTS following ECTR was 4.8 months. All cases recurred within 12 months from the ECTR. All but 1 patient reported nocturnal pain. All patients experienced morning numbness and stiffness. All wrists had positive Phalen's test results. Once diagnosed with persistent or recurrent CTS, each of the wrists underwent open carpal tunnel release (OCTR). Twenty-two wrists were available for follow-up, with all patients reporting greater satisfaction and relief after the OCTR compared with the ECTR. It is important to recognize that CTS may persist or recur after ECTR. These patients should be treated with OCTR to provide symptomatic relief and prevent the sequelae of ongoing CTS.

Giant cell tumor recurrence is certainly not an uncommon event. In fact, recurrence rates as high as 50% have been reported. When recurrence does occur, it is usually within several years of the original tumor excision, if not sooner. The present report illustrates the recurrence of such a lesion twice over a 23-year period and serves to remind one that despite all attempts at complete excision, recurrence of giant cell tumor may still occur even decades following the initial resection.

Extensor tendon subluxation at the metacarpophalangeal joint occurs only rarely in patients without rheumatoid arthritis. Almost all reported cases involve disruption of the radial sagittal band with ulnar subluxation of the extensor tendon. A technique of sagittal band reconstruction is described that entails weaving a retrograde segment of extensor tendon upon itself after passing it through the deep transverse metacarpal ligament. Twenty-one sagittal band reconstructions were performed in 16 patients. This series included 18 cases of ulnar subluxation secondary to radial sagittal band disruption and 3 cases of radial subluxation secondary to ulnar sagittal band disruption. Using this technique, pain was eliminated in every case and there has been no recurrence of extensor tendon subluxation.

Wrist injury or repeated wrist sprains probably result in injury to the scapholunate ligament more commonly than previously recognized, which may allow abnormal scaphoid skid under load. This results in a common clinical entity termed DWS. Scaphoid instability is a spectrum condition ranging from minor, asymptomatic findings (seen in 20% of normal adults) through symptomatic findings in patients with normal radiographs to abnormal instability on radiographs, to degenerative change, and, ultimately, to SLAC wrist (see Fig. 1). Appropriate diagnosis and management of each of these wrist disorders are highly dependent upon a keen understanding of normal periscaphoid anatomy as well as the anatomic derangements that occur within the wrist that predispose a given patient to subsequent degenerative changes. With that understanding, the appropriateness of conservative therapy, SL exploration and arthroplasty, ligament repair, triscaphe arthrodesis, or SLAC reconstruction can be readily determined in each case.

A complete examination of the wrist requires both an accurate history and a thorough understanding of carpal anatomy, biomechanics, and pathology. A thorough examination may necessitate evaluation of the radial and ulnar aspects of the carpus as well as potential extra-articular causes of wrist pain. A carefully obtained history is essential to focus the examination. Our standard approach to the examination of radial wrist pain consists of five maneuvers: (1) ANA, (2) scaphotrapezial trapezoid (STT), (3) DWS, (4) SS, and (5) FET. Additional diagnostic tests, as described, are indicated by ulnar wrist or extra-articular symptomatology. Substitution maneuvers serve to distinguish between actual and fictitious findings on examination.

Incomplete cavitation of the cartilaginous precursor of the carpus during the fourth to eighth weeks of intrauterine life results in carpal synostosis or synchondrosis, which becomes radiographically apparent as the carpus ossifies. Such anomalies occur rarely, are generally believed to be asymptomatic, and are usually discovered as incidental radiographic findings. We present two cases of symptomatic, nonsyndromic congenital synchondrosis of the scaphotrapezio-trapezoidal joint, a type of carpal coalition not previously reported.

The lunate has been described by Kauer as being thinner dorsally than volarly when measured proximal to distal. We used an x-ray method to measure the shape of the lunate in order to compare dorsal and volar thicknesses after recognizing clinically a group of patients with scapholunate dissociation in whom volar flexed lunates were present. Using this method, 292 standard lateral views of the lunate were collected randomly and measured. The shape of the lunate could be classified into 3 types: type D lunates have a thinner dorsal segment and correspond to Kauer's description; type V lunates have a thinner volar segment; type N lunates have equal dorsal and volar segments. There were 196 type D lunates (67%), 67 type V lunates (23%), and 29 type N lunates (10%). The radiolunate angles were measured in a random selection from type D and type V lunates to determine any relationship between the volar segment to dorsal segment thickness (wedge) ratio. No relationship within these groups was identified. However, there was a significant difference in the radiolunate angles between these two groups. Recognition of the prevalence of the type V lunate alters concepts proposed by Kauer and warrants further investigation of factors influencing lunate position.

We retrospectively reviewed the records of seven patients with forearm fascial hernias that were painful with activity. Pain was due to muscle protrusion and hernia course against the proximal fascial edge of the defect. All but one of the symptomatic forearm fascial hernias were located in the midforearm. Theoretically, proximal hernias do not have sufficient muscle excursion to elicit pain. Likewise, distal fascial hernias do not overlie muscle bellies to protrude through the hernia. Based on this concept, each patient was treated by fasciotomy extending from the proximal and distal fascial edges. At least 1 year after surgery, six patients had improvement of their symptoms, three of whom had complete relief.

The long-term results of 28 cases of Kienböck's disease treated with scaphotrapezio-trapezoid arthrodesis between 1980 and 1990 are presented. The average follow-up period was 51 months. Of these wrists, nine required late lunate excision for pain and limited motion; however, only three patients in the entire series required further wrist salvage procedures (wrist arthrodesis, proximal row carpectomy). At late follow-up examination, range of motion averaged 48 degrees in extension, 52 degrees in flexion, 11 degrees in radial deviation, and 27 degrees in ulnar deviation. Using a subjective pain relief rating scale, patients reported excellent results in 12 cases, good results in 9, fair results in 4, and poor results in 2 (1 case was omitted because of a coexisting different disease).

Between 1969 and 1989, 116 patients were evaluated and treated surgically for symptomatic carpal boss. Their mean age was 32 years and male and female patients were equally affected. 28 patients gave a history of previous injury. Surgical treatment consisted of excision of the localized bony abnormality and the associated degenerative arthritic process to the level of normal articular surfaces and normal adjacent cancellous bone. The mean follow-up period for the patients in this study was 42 months. Complete symptomatic relief was observed in 94% of the patients undergoing surgical treatment. Recurrence or persistence of symptoms developed in seven surgical patients. Six had a second operation with more extensive removal of sclerotic bone and degenerate cartilage, and all patients had relief of symptoms.

Patients with scapholunate advanced collapse (SLAC) wrist do not have to undergo total wrist arthrodesis; the SLAC pattern spares the radiolunate articulation, providing a basis for salvage. We report the results of 100 cases in which a technique comprised of scaphoid excision and limited wrist arthrodesis was used. The average followup period of 44 months revealed excellent functional status and a high rate of patient satisfaction. The majority of employed patients were able to return to their original jobs, and many chose to resume wrist-related recreational activities. Pain relief was good to excellent in most cases. Extension/flexion averaged 72 degrees (53% of a normal opposite wrist), radioulnar deviation 37 degrees (59%), and grip strength 80% of the opposite side. X-ray films revealed only two instances of radiolunate destruction, both in conjunction with ulnar translation of the carpus. The other 98 patients demonstrated a well-preserved radiolunate joint regardless of followup interval. Complications were few. Nonunion occurred in three cases. A dorsal impingement of the capitate and radius (12%) was felt to be technique-related and avoidable by careful capitolunate alignment.