This prospective, randomized trial compares the infection rates of Kirschner wires left percutaneously and those buried deep to the skin in a group of patients with isolated distal radial fractures. Percutaneous wires had a significantly greater infection rate than wires which were buried deep to the skin.

Midcarpal instability is an uncommon problem in which deficient static and dynamic wrist stabilisers cause sudden, uncontrolled movement of the proximal carpal row. We studied 15 wrists prospectively in 13 patients who underwent arthroscopic thermal capsulorrhaphy for palmar midcarpal instability. Capsulorrhaphy was performed using standard wrist arthroscopic techniques and a small diameter monopolar radiofrequency probe. One hundred percent follow-up was achieved at a mean of 42 (range 14 - 67) months. With regards to instability, all wrists showed improvement or resolution of instability. Functional improvement was confirmed by an improvement in the mean DASH score from 38 pre-operatively to 17 at final follow-up. Our early results show that thermal capsulorrhaphy is effective in reducing the instability symptoms of palmar midcarpal instability.

Midcarpal instability is a collective term for a number of conditions where the instability of the wrist is predominantly between the proximal and distal carpal rows. It has been regarded as relatively rare and infrequently requires surgical treatment. Palmar midcarpal instability is the most commonly found type of midcarpal instability and can be responsible for causing a clunking and painful wrist. The diagnosis is made on clinical grounds using the midcarpal instability provocative tests. Standard imaging and arthroscopic inspection do not usually confirm a definite diagnosis, but are important in excluding other pathologies. The classification and staging has been described using the extent of palmar translocation of the distal carpal row, which is elicited on passive stress tests. As this is a functional instability, it may be that a functional staging description might be better, and a proposed scheme is described. Treatment options including partial wrist fusions, tenodesis stabilizations and arthroscopic capsular shrinkage have been described in small case series with limited follow-up. There are no comparative series or randomized studies because of the relative rarity of this condition.

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