INTRODUCTIONThe preliminary results of a pyrocarbon interpositional radiocarpal implant in a small cohort of patients were reviewed. As it is currently only a limited release product, we describe to potential users early complications and negative outcomes.METHODSPatients were assessed using pain levels, ranges of motion, grip strength, type of and time to return to work as well as pre-operative and post-operative DASH (Disabilities of the Arm, Shoulder and Hand) scores. Radiographs were taken and patient satisfaction was recorded.RESULTSAll six patients were contacted. One was not satisfied. Three had reduced motion. None experienced squeaking. There were no immediate or late post-operative complications. There was one early volar displacement of an implant.CONCLUSIONSAlthough our early results are somewhat encouraging, further and longer studies are warranted before supporting the use of this particular pyrocarbon implant as a primary procedure.

Introduction: Scaphoid nonunion advanced collapse (SNAC) and radioscaphoid osteoarthritis are difficult to treat. Options include proximal row carpectomy (PRC), four corner fusion (4CF) and wrist arthroplasty or arthrodesis. However, with inevitable disease progression, a significant proportion of patients undergo total wrist fusion. This reduces function by abolishing wrist movement. We review the preliminary results of a pyrocarbon interpositional radiocarpal implant in a small cohort of patients from our prospective study and challenge the assumption that there are no surgical alternatives. Materials and Methods: This study prospectively studied 12 consecutive pyrocarbon interpositional arthroplasty day cases over 3 years. Patients were assessed using level of pain, ranges of motion, grip strength, key pinch, type of and time to return to work and the disabilities of the arm, shoulder and hand (DASH) score, both preoperatively and postoperatively. Radiographs were also taken and patient satisfaction recorded. Results: All 12 patients could be contacted and were satisfied with their surgery. There were no immediate, early or late postoperative complications associated with the procedure. Promising results were noted in terms of pain, ranges of motion, grip strength, key pinch, type of and time to return to work, DASH scores, photographs and radiographs. The mean follow-up was 18 months, range between 11 months and 3 years. Conclusion: Our early results are encouraging, warrant further and longer studies and support the use of pyrocarbon implants as a primary procedure in what is a generally young and active subgroup of patients. Key words: Proximal scaphoid replacement, Wrist arthroplasty, Wrist replacement

Bilateral facial palsy in Möbius syndrome remains one of the greatest challenges in reconstructive plastic surgery. Facial reanimation is an invaluable aid to such patients because it allows for greater social interaction by means of the ability to smile. In performing facial reanimation surgery on patients with Möbius syndrome, it is the observation of the senior author (Harrison) that upper labial deficiency is a consistent and previously unreported feature of the syndrome. It has been the practice of the senior author to perform upper labial augmentation on Möbius syndrome patients by insertion of a lipodermal autograft, in addition to facial reanimation. Nine patients with Möbius syndrome who presented to the Department of Plastic Surgery during an 8-year period were reviewed. All nine possessed bilateral facial palsy and upper labial deficiency in addition to other abnormalities consistent with Möbius syndrome. Six patients underwent bilateral facial reanimation and upper labial augmentation alone. One patient refused facial reanimation surgery but consented to upper labial augmentation. One patient, with concomitant micrognathia, underwent bilateral facial reanimation, upper labial augmentation, and insertion of a Silastic chin implant. In one patient, a child who also exhibited micrognathia, bilateral facial reanimation alone was carried out, with further procedures for upper labial and chin cosmesis being postponed until adulthood. The indication for performing upper labial augmentation was cosmetic. The procedure improved upper labial appearance and restored balance to the mouth. Patients also expressed higher satisfaction with eating and drinking, which they related to the improved fullness of the upper lip. This was before the facial reanimation had become functional. Upper labial deficiency warrants addition to the list of facial features of Möbius syndrome and is something that must be assessed in the context of facial reanimation surgery.