Fifty preserved cadaver wrist specimens were studied. The anatomy of the distal radioulnar joint is complex, with varying configurations in the transverse and midcoronal planes. There is disparity in the radii of curvature of the sigmoid notch and the ulna-articular surface in the transverse plane, with resultant articular incongruity. Motion at the distal radioulnar joint is, hence, likely to be a combination of sliding and rotation with a small area of true appositional contact. The palmar osteocartilaginous lip of the sigmoid notch, along with the interosseous membrane, may be of importance in distal radioulnar stability. Palmar and dorsal radioulnar ligaments may act as "check-rein" ligaments, especially when seen with the "flat face" (type A) sigmoid notch.

Twenty-two patients with a diagnosis of scapholunate instability underwent a modified Brunelli procedure. The overall results of this short follow-up study showed that a majority of patients (17 out of 22) had relief of pain. Grip strength recovered well. Postoperative range of motion was reduced in extension and flexion, remained unchanged for radial deviation and improved for ulnar deviation. The radiological appearance of dynamic or static scapholunate instability did not change after the procedure. Most patients (17 out of 22) felt subjective improvement and would have the operation again. A significantly poorer result was seen in those patients with an unresolved medicolegal claim. Although short-term results are encouraging for some patients, the authors feel that more long-term follow-up is needed before recommending the procedure.

One hundred and sixty-two patients with a diagnosis of scapholunate instability underwent a modified Brunelli procedure over a 7-year period. One hundred and seventeen were assessed with the help of a questionnaire and, of these, 55 patients attended for clinical evaluation. The mean follow-up was 4 (1-8) years. There were 72 patients with dynamic scapholunate instability and 45 patients with static instability. The average age was 38 years. There were 50 males and 67 females. A total of 77 (62%) patients had no to mild pain with a mean visual analogue score of 3.67 (SD=2.5). The loss in the arc of flexion-extension was due to a reduced range of flexion (mean loss 31%), while 80% of extension was maintained, compared with the contralateral side. The grip strength on the operated side was reduced by 20% of the non-operated side. There was no statistically significant difference (P>0.05) in the range of movement or the grip strength between the static and dynamic group and patients with or without legal claims. Ninety (79%) patients were satisfied with the result of the surgery (good to excellent) and 88% of the patients felt that they would have the same surgery again. We feel that these results compare favourably with the early results published from this unit and recommend this procedure for dynamic and static scapholunate instability.

The following suture materials have been evaluated for their suitability for use in flexor tendon repairs: 4/0 gauge monofilament and multifilament stainless steel, mono-filament nylon, monofilament polypropylene, monofilament polybutestor, braided polyester, braided polyglycolic acid and a monofilament polyglyconate. These were investigated for their tensile strength (both knotted and unknotted), their extension to failure and knot-holding properties. Stainless steel and monofilament polyglyconate appeared to be the most suitable in that they had high tensile strengths, both knotted and unknotted, and had good knot-holding security. The only disadvantages are that stainless steel is difficult to use and monofilament polyglyconate is absorbable. Polypropylene and braided polyester, although having lower tensile strengths, are reasonable alternatives.

From the Centre tfr Hand Twenty-three wrists in 22 patients (mean age, 37 years) with ulnar impaction syndrome were treated by ulnar shortening. The mean ulnar shortening was 2 mm (range, 1-4 mm). At a mean follow-up time of 33 months, 17 patients had obtained good subjective pain relief and 16 were shown to have a good overall outcome using the Wrightington Hospital Wrist Function Evaluation.