The Journal of hand surgery
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With their intrinsic vascularity vascularized bone grafts provide an alternative solution to the challenging problem of scaphoid nonunions. The union rate (after imaging evaluation including magnetic resonance imaging [MRI]) and functional outcome of using vascularized bone grafts pedicled on the palmar carpal epiphyseal artery for waist nonunions of the scaphoid are reported in this prospective case series. ⋯ Therapeutic, Level IV.
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For chronic dynamic scapholunate (SL) instability (>3 months after injury) open procedures (capsulodesis, limited intercarpal fusions, tenodesis, SL ligament reconstruction) have become popular in recent years but their long-term results have been suboptimal. We evaluated retrospectively the results of aggressive arthroscopic debridement of the SL ligament to bleeding bone in an effort to induce scar formation and closed pinning of the SL joint in patients unwilling to have an open procedure. ⋯ Therapeutic, Level IV.
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To assess the demographic patterns, clinical morbidity, and treatment costs associated with domestic animal bites to the hand. ⋯ Prognostic, Level IV.
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Painful instability of the minimally osteoarthritic thumb carpometacarpal (CMC) joint can be treated successfully by either ligament reconstruction or metacarpal extension osteotomy. The purpose of this study was to measure the laxity of cadaveric thumb CMC joints and to determine the influence of ligament reconstruction and metacarpal osteotomy on joint laxity and contact area. ⋯ In the position of lateral pinch the 15 degrees osteotomy and total ligament reconstruction significantly reduced laxity of the thumb CMC joint in all directions tested. The isolated dorsal or volar ligament reconstructions both reduced dorsal-volar laxity. Metacarpal extension osteotomy may stabilize the thumb CMC joint in lateral pinch to a degree similar to that of a standard ligament reconstruction.
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Over the past decade vascularized bone grafts that use a 1,2-intercompartmental supraretinacular artery (1,2-ICSRA) pedicle have gained popularity in the treatment of scaphoid nonunions. The purpose of this study was to evaluate critically the outcome, complications, and failures of 1,2-ICSRA-based vascularized bone grafting at our institution to understand better the appropriate indications, methods, and possible contraindications. ⋯ Therapeutic, Level IV.