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Management of scaphoid nonunion after failed surgery for acute scaphoid fracture presents a unique treatment challenge. Prior surgery complicates patient evaluation and increases the technical difficulty of future procedures. Healing of nonunion is crucial to prevent carpal collapse and progressive arthritis. A thorough workup is required to identify technical factors or treatment decisions that may have resulted in a poor outcome after initial fixation attempts. CT is particularly useful for characterizing nonunion and planning revision surgery. Several studies have described the use of bone grafts and fixation devices for scaphoid nonunion repair, including nonvascularized and vascularized bone grafts, screws, pins, and plates. Reliable rates of union have been achieved using nonvascularized bone graft supplemented with screw or wire fixation, particularly in the absence of osteonecrosis. Although vascularized grafts are more technically challenging, they improve the odds of union in the setting of osteonecrosis.

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Thumb basal arthritis is evaluated using the Eaton classification. However, the shape and orientation of the trapezium do not allow easy visualization of this bone. The purpose of this study was to determine if the intra- and interobserver reliability of the Eaton classification could be improved using a combination of X-rays. Six hand surgeons independently evaluated 40 sets of X-rays. First, the X-rays were staged using the posterior-anterior and lateral views of the wrist, and then using just the Bett's (Gedda's) view. Subsequently, all three views were evaluated together. The process was repeated at least 1 week later. Intra- and interobserver reliability was measured using kappa statistics. Results show a trend toward increased reliability when the three views are used. Agreement between the stages using the posterior-anterior and lateral X-rays and the Bett's view was only fair. With three views, intraobserver reproducibility is good while interobserver reliability is moderate.

Painful wrist arthritis is a debilitating condition for which current treatment options are limited. The primary goal of treatment for the symptomatic, arthritic wrist is to achieve a pain-free, functional, and stable joint that is able to bear load. This is ideally achieved while preserving wrist motion. The causes of wrist arthritis are varied and include the sequelae of trauma, carpal instability, Keinböck disease, and inflammatory arthropathy. 1,2 The pattern and severity of articular involvement differ according to the etiology and guide the surgeon in recommending treatment. Ultimately, patients AbstractMidcarpal hemiarthroplasty is a novel motion-preserving treatment for radiocarpal arthritis and is an alternative to current procedures that provide pain relief at the expense of wrist biomechanics and natural motion. It is indicated primarily in active patients with a wellpreserved distal row and debilitating arthritic symptoms. By resurfacing the proximal carpal row, midcarpal arthroplasty relieves pain while preserving the midcarpal articulation and the anatomic center of wrist rotation. This technique has theoretical advantages when compared with current treatment options (i.e., arthrodesis and total wrist arthroplasty) since it provides coupled wrist motion, preserves radial length, is technically simple, and avoids the inherent risks of nonunion and distal component failure. The KinematX midcarpal hemiarthroplasty has an anatomic design and does not disrupt the integrity of the wrist ligaments. We have implanted this prosthesis in nine patients with promising early results. The indications for surgery were as follows: scapholunate advanced collapse wrist (three), posttraumatic osteoarthritis (three), inflammatory arthritis (two), and Keinböck disease (one). Prospective data has been collected and the results are preliminary given the infancy of the procedure. The mean follow-up was 30.9 weeks (range: 16 to 56 weeks). The mean Mayo wrist score increased from 31.9 preoperatively to 58.8 (p < 0.05) and the mean DASH score improved significantly from 47.8 preoperatively to 28.7 (p < 0.05). There was a trend toward increased motion but statistical significance was not reached. Two patients required manipulation for wrist stiffness. There was no evidence of prosthetic loosening or capitolunate narrowing. The procedure is simple (average surgical time was 49 minutes) and maintains coupled wrist motion through preservation of the midcarpal articulation. The preliminary data show that it appears safe but considerably longer follow-up is required before conclusions can be drawn as to its durability, reliability, and overall success. The level of evidence for this study is therapeutic level IV (case series).

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