Based on the present data, we could not clarify the factors influencing the final functional outcome after floating elbow injury. These injuries, however, potentially have many complications, such as infection or nonunion, especially when there is associated brachial plexus injury. We consider that floating elbow injuries are severe injuries and that surgical stabilization is needed; beyond that, there are no specific forms of surgical treatment to reliably guarantee excellent results.
For surgical treatment of rheumatoid wrists, we have routinely selected the Sauve-Kapandji (S-K) procedure or the Darrach procedure based on predetermined indications. In this study, we conducted a retrospective radiographic comparative evaluation of the changes in the carpus after the two procedures. The S-K group and the Darrach group each consisted of 13 wrists of 10 patients (all women). The indications for the Darrach procedure were the presence of radiolunate fusion, radial shelf formation, and old age. The carpal height ratio (CHR) and the ulnocarpal distance ratio (UCDR) were determined on wrist radiograms obtained before operation and at the final follow-up. The mean follow-up period was 4 years. Fisher's test was used to analyze the differences between the two groups. Both groups showed a decrease in mean CHR and an increase in mean UCDR at the final follow-up compared to the values before the operation, and there were no statistically significant differences. Furthermore, in the Darrach group, no significant differences in changes of the carpus were observed between patients with or without a radial shelf. We concluded that the present results do not support the superiority of the S-K method over the Darrach procedure for rheumatoid wrist reconstruction based on a radiographic evaluation.
Five cases of flexor tendon rupture in surgically treated rheumatoid wrists were studied. The tendon ruptures occurred in the thumb and index finger, and the ruptures site was in the carpal tunnel in all five cases. The main cause of rupture was the formation of bony irregularities in the form of bony spurs in the carpal bones, mainly in the scaphoid, or at the volar aspect of the distal radius, as a result of rheumatoid erosion. In all five cases, tendon reconstruction and bony spur excision were conducted, and good recovery of phalangeal function was achieved. To clarify the causes of the rupture of the flexor pollicis longus in rheumatoid hands, we used three-dimensional computed tomography on 19 rheumatoid wrists without tendon rupture to investigate the presence or absence of bony spurs in the volar aspect of the scaphoid. The results showed a correlation between the frequency of scaphoid spurs and progression of bone changes as checked by radiography.
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