The Journal of hand surgery
-
A new surgical technique is described for the treatment of longstanding scaphoid nonunions with established degenerative changes and carpal malalignment. The technique is based on natural history and biomechanical studies and includes the excision of the distal scaphoid fragment and a limited arthrodesis that incorporates the proximal pole of the scaphoid, the lunate, and the capitate. Six men were treated with the procedure for symptomatic chronic scaphoid nonunions, and all limited arthrodeses fused. Pain relief was good to excellent, and range of motion averaged 50% of the contralateral side.
-
A new epitendinal suture technique (cross-stitch) was used for flexor tendon repair in zone II in 46 consecutive patients with 55 injured digits. For the first 4 weeks after the operation, the digits were mobilized with a combination of active extension and passive and active flexion. Postoperative tendon excursions and gap formation were measured with intraoperatively placed metal markers. ⋯ Six months postoperatively the corresponding figures were 63 degrees and 94 degrees. Three weeks postoperatively the mean tendon excursions per 10 degrees of joint motion varied from 82% (distal interphalangeal joint motion) to 88% (proximal interphalangeal joint motion) of the maximum possible. The results indicate that the cross-stitch is a reliable suture technique that, when used in combination with a program incorporating early active and passive flexion, can produce very good results after flexor tendon repair in zone II.