This study did not demonstrate a true long-term benefit of internal fixation, compared with nonoperative treatment, for acute nondisplaced or minimally displaced scaphoid fractures. The long-term risks of surgery should be considered when recommending operative treatment.

There was a longer period of absence from work after cast than after surgery in manuals, but not in non-manuals. In non-manuals, total costs were lower after cast than after surgery. Socioeconomic classification had a greater influence on cost than mode of treatment.

A chemical-shift imaging technique was used for the study of small subcutaneous lesions. This study concerns micro-imaging of two females suffering from a tenosynovial giant cell tumor and an epidermal cyst. High-resolution water, fat and chemical-shift artifact-free images were obtained on a whole-body MR unit (1.5 T) equipped with a 23-mm microscopy surface coil and standard gradients (23 mT/m). A significant improvement in signal-to-noise ratio was achieved by reducing the receiver bandwidth to values below +/-10 kHz. The image data sets were acquired with resolution 0.1 x 0.13 mm in the plane, slice thickness 0.5 mm and with acquisition time less than 3 min. Spatial resolution, fat suppression, image texture and edge delineation were improved on spectroscopic images compared with those on conventional MR images.

Locking of the second metacarpal joint is common, but locking of other metacarpal joints is unusual. We present a case, in which the joint of the third finger locked and the mechanism was an osteophyte catching of the ulnar accessory collateral ligament. In such a case, the joint should be explored through a palmar approach. Conservative treatment is not recommended.

Thirty-two patients had silicone implant arthroplasty of the scaphoid in our unit between 1974-1988. Ten years later eight had had their implants removed because they had failed. Twenty-four of the 32 were reviewed at an intermediate clinical follow up examination between 1988-89 and 21 by patient rated wrist evaluation 10 years later. Grip strength compared to the non-injured hand varied between 38% and 136% (mean (SD) 78 (25)%). Nine of the 24 wrists showed no signs of bone cysts, while 15 had intraosseous cysts of various sizes. Patient-rated evaluation gave a median subjective long term overall wrist score of 25, a pain score of 27, and a function score of 22 on a scale from 0 (best) to 100 (worst). Nine out of 21 patients had little or no pain, and 13 out of 21 had total scores of under 25. Many of these patients reported good subjective benefit from silicone scaphoid arthroplasty.

No abstract

Avascular necrosis (AVN) of the proximal pole and humpback deformity have been recognized as predisposing factors for recalcitrant scaphoid nonunions.1 Vascularized bone graft has been demonstrated to enhance the union rate in this particularly difficult subset of nonunions. In a 2002 metaanalysis of the literature, an 88% union rate was reported with vascularized bone grafts in the presence of avascularity of the proximal pole, while nonvascularized bone grafts had only a 47% union rate under the same circumstances. 2A vascularized pedicled bone graft from the distal radius has been widely used for scaphoid nonunions in recent decades. The bone graft based on the 1,2-intercompartmental supraretinacular artery (ICSRA) has been particularly prevalent.3 However, the reported union rate varies significantly. concluded that it is difficult to obtain a sufficiently large and well-placed bone graft based on the 1,2-ICSRA to correct a significant humpback deformity. 4Significantly higher union rates have been reported with the free vascularized bone graft from the medial femoral condyle (MFC).5 In a comparative study, Jones et al reported a 100% union rate with the MFC graft (n ¼ 12) and only a 40% union rate with the 1,2-ICSRA graft (n ¼ 10). Moreover, the median time to healing was significantly shorter in the MFC group (13 weeks) compared with the 1,2-ICSRA group (19 weeks). 1In 1989 Hertel and Masquelet described the MFC graft as a periosteal and osteoperiosteal graft.3 Subsequently, Sakai et al included the cortex, and in 1991 they described it as a corticoperiosteal graft. 3 Currently, the graft is often used as a free structural corticocancellous graft, including the dense cancellous part of the bone. The structural basis of the graft is well suited to correct a humpback deformity, and its robust vascularity has the ability to revascularize an AVN. 3 The graft is based on the descending genicular artery or, less frequently, the superomedial genicular artery. These arteries are much larger (1-2 mm in diameter) 6 than the 1,2-ICSRA (0.3 mm in diameter). 7 Iorio et al recently showed that the arteries nourish a very large portion of the medial femoral condyle. 8The high union rate and few complications have popularized the MFC graft in recent years, and it has been described as one of the new workhorses in reconstructive hand surgery.3 The consistently good results encouraged us to try the method. Our experience has in general been positive; Keywords► ectopic bone formation ► free vascularized bone graft ► medial femoral condyle ► ossification ► scaphoid nonunion AbstractFree vascularized bone graft from the medial femoral condyle has been described as a superior method for treatment of recalcitrant scaphoid nonunion with proximal pole avascularity and humpback deformity. Few complications and high union rates have been reported. In a series of three patients we describe an undesired volar ossification as a potential complication of the method. The risk of developing the ectopic bone formation can be minimized if t...

Background Osteoarthritis in the distal radioulnar joint (DRUJ) is a challenging condition with few really reliable surgical options, particularly in young individuals. Traditional methods as hemiresection, the Darrach procedure, and the Sauvé-Kapandji procedure have less favorable results in the nonrheumatoid patient. The results after implant arthroplasty have improved, but long-term results are yet to be presented before implant arthroplasty can be recommended to young individuals with osteoarthritis in the DRUJ. An alternative method to treat osteoarthritic joints is surface replacement with free costal perichondrium. The technique has been used since the 1970s for other joints. Case Description We adapted the method and used it in two female patients (37 and 38 years old) with nontraumatic osteoarthritis in the DRUJ. Both patients had severe pain and were unable to work. The eroded joint surfaces were resected down to bleeding subchondral cortex. Perichondrium from the seventh rib was osteo-sutured and glued to the ulnar head and the sigmoid notch. Results The maximum follow-up-time in this retrospective review is 25 months. Our short-term results are encouraging in terms of pain relief, motion, grip strength, and return to work. The first patient had an excellent result and was completely normalized. The second patient has improved significantly and experiences only slight pain on heavy lifting and rotational load. Clinical Relevance Free costal perichondrium may be a useful alternative for treating osteoarthritis in the DRUJ, especially in young individuals. The option for a later implant arthroplasty is preserved because most of the anatomy of the joint and all the soft tissue stabilizers are intact. Level of Evidence Therapeutic IV, Case series.