A retrospective review of 14 cases of acute perilunate dislocations without fracture of the scaphoid managed by three different forms of treatment was conducted at an average follow-up of 29 months. Treatment included closed or open reduction with cast immobilization only (n=2), closed reduction followed by percutaneous K-wire fixation of the carpus (n=4), and open reduction with repair of the torn scapholunate ligaments and K-wire fixation of the carpus (n=8). Based on Cooney's clinical scoring system, there were five excellent, five good, two fair and two poor results. The patients without ligamentous repair did as well as those with ligamentous repair when the scaphoid was reduced anatomically and stabilized with K-wires. In the latter, however, the scapholounate relationship was maintained more consistently. We believe that open reduction through a dorsal approach, direct repair of the scapholunate ligaments, and K-wire fixation of the carpus is a reliable method for obtaining satisfactory clinical and radiographic results in the management of acute perilunate dislocations without fracture of the scaphoid.
Five active athletes with acute medial elbow rupture were treated with muscle-ligamentous repair and a spiked washer. All patients regained full strength as well as stability of the elbow, and resumed previous sporting activities within 3 months of surgery. Early surgical repair of the ligament and flexor mass should be considered for active athletes who exhibit gross instability of the elbow on a valgus stress test without anaesthesia.
Seven patients (eight elbows) with osteochondritis dissecans were treated with cancellous bone grafts and internal fixation of the fragment using a Herbert screw. Average follow-up was 32 months. All patients were pain-free and returned to previous sporting activities. The postoperative range of motion of the elbow increased by an average of 18°. Radiographs showed complete reossification of the capitular cyst and normaly contoured joint surface.
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