– See: Kinematics Carpal Instability – Discussion: – pts w/ dynamic instability can actively subluxate wrist w/ forearm pronated & wrist in or out of ulnar deviation; – dynamic forms of dorsal or volar intercalated-segment instability are secondary to loss of support across ulnar half of mid-carpal … Read more
Case Example by James R. Urbaniak MD. – Discussion: – regional fasciectomy is the most commonly performed procedure … Read more
Diff Dx Ganglionic cyst probably the most common cause of dorsal wrist pain (when obvious causes such as frx or SLD have been ruled out); in the study by Steinberg and Kleinman (1999), 18 out of 21 patients with dorsal wrist pain had an occult scapholunate ganglion; result from cystic degeneration within scapholunate ligament and … Read more
– See Compartments: I, II, III, IV, V,VI and approach to the distal radius; – Technique: – straight dorsal incision centered over the wrist; – because the skin is loose over the dorsum of the wrist, contractures are uncommon; – incise skin and subcutaneous tissue down to the retinaculum; – careful to preserve dorsal veins and … Read more
– Discussion: – distal radius fracture w/ dislocation of radiocarpal joint; – most common frx dislocation of the wrist joint; – comminuted frx of distal radius may involve either anterior or posterior cortex and may extend into the wrist joint; – frx dislocation or subluxation … Read more
– See: – Carpal Instability – Kinematics of the Wrist – Discussion: – lunate will tend to flex w/ loss of ulnar ligamentous support from the triquetrum; – lunate extends when there is loss of radial ligamentous stability; – DISI may arise as a result of: – scaphoid frx; – scapho-lunate dissociation; – perilunate dislocation … Read more
– See: – Plating Techniques – Radial Shaft Fractures: Discussion – Discussion: – dorsolateral approach is best suited to frxs of proximal & middle thirds of radius as well as to address injury to proximal RU joint; – advantages: – … Read more
– Discussion: – adduction contractures of shoulder and flexion contractures of elbow are not a problem in themselves, as muscle weakness renders patient unable to abduct the arm above the level of the shoulder or to extend the elbow against gravity; – pronation contractures of the forearm and flexion contractures … Read more
– See: Distal RU Joint – Surgical Options: – Hemi-resection Arthroplasty of RU Joint – Darrah’s Procedure – Modified procedure (Bower’s) – Sauve Kapandji – Complications: – distal ulna resection can lead to carpal migration and ulnar snapping; – w/ failed arthroplasty arthrodesis (in neutral or slight dorsiflexion) may be required; – fusion is often favored … Read more
– Discussion: – longitudinal traction restores skeletal length and improves fracture alignment, – radial styloid frx and scaphoid facet are usually amenable to reduction through ligamentotaxis or by manipulation and reduction with a large, pointed bone clamp; – residual incongruity usually involves the lunate facet of the distal end of … Read more