In this model of dorsally comminuted extra-articular distal radial fractures, dorsal pi-plate fixation demonstrated better resistance to fracture gap motion than did the four types of volar plate fixation. The AO volar locking and DVR plates conferred the greatest resistance to fracture gap motion among the four volar plates tested. Volar locking technology conferred a significant increase in resistance to fracture gap motion as compared with nonlocking plate technology.

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Purpose: While the etiology of de Quervain's disease is unknown, repetitive motion coupled with awkward wrist position and septation within the first dorsal compartment are considered causative factors. We hypothesize that these conditions might produce high gliding resistance, which could then induce micro-damage of the tendons and retinaculum. The purpose of this study was to measure the gliding resistance of the extensor pollicis brevis and abductor pollicis longus tendons within the first dorsal compartment in a human cadaver model.Methods: Fifteen human cadaver wrists, which included eight septation and seven non-septation wrists in the first dorsal compartment, were used. Gliding resistance of the extensor pollicis brevis and abductor pollicis longus tendons was measured in seven wrist positions: 60" extension, 30" extension, O", 30" flexion, 60" flexion in neutral deviation and 30" ulnar deviation, 15" radial deviation in neutral extensiodflexion.Results: The overall gliding resistance was not different between septation and non-septation wrists (0.21 versus 0.19 N for abductor pollicis longus and 0.21 versus 0.15 N for extensor pollicis brevis, respectively), but there was a significant effect on gliding resistance due to wrist position (p < 0.05) in both tendons. Interaction between wrist position and septation status was observed in the extensor pollicis brevis tendon (p < 0.05). With septation, the gliding resistance of the extensor pollicis brevis was significantly higher in 60" wrist flexion (0.51 N) compared to all other wrist positions tested (all less than 0.26 N) (p < 0.05). In the non-septation group, gliding resistance was significantly higher in 60" flexion (0.20 N) and 60" extension (0.22 N) compared to the other five wrist positions (all less than 0.15 N) (p < 0.05). Although no significant difference was observed, the extensor pollicis brevis tendon with septation tended to have higher gliding resistance than that without septation in wrist flexion. In 60" of wrist flexion the abductor pollicis longus tendon had significantly higher gliding resistance (0.33 N) than the other wrist positions (all less than 0.26 N) (p < 0.05).Conclusions: A combination of septation and wrist position significantly affected extensor pollicis brevis tendon gliding resistance in this cadaver model. These factors may contribute to the development of de Quervain's disease.

We treated 18 patients (8 males and 10 females) with bone or soft tissue tumors in the extremities by vascularized fibular grafts (VFGs). The average age was 29 years. Two had malignant soft tissue tumors in the forearm (angiosarcoma and synovial sarcoma) and the other 16 had bone tumors [osteosarcoma (8), chondrosarcoma (3), angiosarcoma (1), adamantinoma (1), and giant cell tumor (3)]. Affected sites of the bone tumor cases were tibia (5), femur (5), humerus (3), radius (2), and ulna (1). According to the surgical staging system of Enneking et al. 1 patient was in stage III, 12 in IIB, 2 in IB, and 3 in IA. The surgical margin was curative in 5 patients, wide in 9, marginal in 2, and intralesional in 2. One patient died due to lung metastasis although bone union was obtained by the VFGs. Functional results of the bone reconstruction in the remaining 17 patients were evaluated according to the modified scale of Enneking et al. The VFGs resulted in substantial bone unions in all patients except 1. Bone unions in all 17 patients occurred in less than 10 months. Overall clinical results were satisfactory. Based on a 30-point scale overall clinical results ranged from 10 to 30 points with an average of 21 points. Functional evaluation in the upper extremity were, generally, superior to those in the lower extremity. Postoperative complications were 5 metastases (4 in the lung and 1 in the mediastinum) in 4 patients, 1 recurrence, and 2 fractures after obtaining bone union. One patient died from metastasis.(ABSTRACT TRUNCATED AT 250 WORDS)

There are several surgical options for osteoarthritis (OA) of the thumb carpometacarpal (CMC) joint. This paper presents our long-term clinical and radiographic review of 12 thumbs in ten patients treated by partial trapezial excision and silicone-rubber interposition arthroplasty. The follow-up period averaged 15; three years with a ten-year minimum. Although the procedure provided early pain relief in most thumbs, all but two had mild to severe pain at follow-up. The average range of post-operative palmar abduction was 23 degrees. The average post-operative grip strength was 9.5 kg. Both tip and key pinch between thumb and index finger averaged about 50% that of normal subjects. Dislocation of the implant occurred in two joints and breakages in five. Bony erosions around the implant, which we attributed silicone synovitis, were found in four thumbs. The indications for silicone-rubber interposition arthroplasty for OA of the thumb CMC joint should be severely restricted as these produced unsatisfactory long-term results.