Despite technical advances in implant material, design, and instrumentation, plate fixation of metacarpal fractures remains fraught with complications and unsatisfactory results.

Our data show that, in emergency settings, US can be used for the triage to CT in patients with clinical suspicion of scaphoid fracture and normal radiographs.

W199age, 54 years). Three right wrists and six left wrists were affected. Four patients were referred with a presumptive diagnosis of complete extensor pollicis longus (EPL) tear and three had a diagnosis of tenosynovitis; one, a dorsal mass; and one, a ganglion cyst. Patients presented with local pain (n = 8), swelling (n = 7), and inability to extend the distal phalanx of the thumb (n = 4). Informed consent was obtained to search patients' data retrospectively. Institutional review board approval was obtained.All sonography examinations were performed by a trained musculoskeletal radiologist with 22 years of experience in musculoskeletal sonography. The mean delay between surgery and sonography examination was 7 months (range, 1-27 months). The dorsal aspect of the wrist was examined on transverse and sagittal sonograms obtained while the patient was seated in front of the examiner with the pronated wrist resting on an examination table. All 12 extensor tendons, running inside the six compartments, were carefully analyzed (Fig. 1). A broadband 17-5-MHz linear transducer (model iU22, Philips Healthcare) was used. No standoff pad was used, and transmission gel was used liberally. Attention was directed to looking for changes in the internal structure of the extensor tendons, thickening of the tendons' sheaths, and evidence of synovial effusions. The presence or absence of tendon tears was noted. We also evaluated focal interruption of the dorsal cortex of the distal radius, the number and location of detectable screw tips, and the length that each screw tip protruded using electronic calipers. In M u s c u l o s ke l e t a l I m ag i ng • C l i n ic a l O b s e r v a t io n ractures of the distal radius are frequent and their incidence can be expected to increase because the older population continues to increase in number [1]. Surgical treatment allows optimal fragment reduction and is advocated when a significant dorsal tilt is present or fractures are unstable. The most commonly performed surgical procedure is open reduction and internal fixation of the volar plate [1,2]. Tendon inflammation and tears are possible complications of that procedure due to dorsally protruding screw impingement on the extensor tendons. Sonography is a readily available and atraumatic imaging technique that allows accurate and inexpensive assessment of the musculoskeletal system [3]. The extensor tendons of the wrist are well depicted by high-resolution broadband electronic transducers because of their superficial location [3,4]. We present a retrospective analysis of the sonography examinations of nine consecutive patients presenting with screw impingement on the extensor tendons examined in the past 3.5 years. ObjeCtIve. The objective of our study was to analyze the sonography examinations of nine consecutive patients with a history of distal radius fracture treated by open reduction and internal fixation of the volar plate who were referred by hand surgeons for sonography of the dorsal aspect of the wrist. Screw Impingement o...

We reviewed 20 patients with 23 displaced extraarticular fractures of the distal end of the long metacarpals, treated by fasciculated pinning. At a mean follow-up of 5 years, all the patients were subjectively satisfied with the result. All the patients but one, who fractured four metacarpals, had a normal range of motion. The average grip strength was 43.4 kg for the operated side compared to 43.4 kg for the uninjured hand. Radiologically, the fractured fifth metacarpal had a shortening of 2.2 mm compared to a control group, whereas the volar angulation was 16.6 degrees (13.2 degrees for the control group). The technique of intramedullary fasciculated pinning is a reliable alternative when conservative treatment of fractures of the metacarpal neck has failed or is inappropriate. The procedure provides sufficient stability to allow early mobilization and a good functional result.

capsule of the wrist (60-70%) near the dorsal band of the scapholunate ligament. A less common location is the radial aspect of the volar face of the wrist, close to the radial artery, and the palmar aspect of the fingers, near the A1 pulleys. Ganglia on sonography usually appear as hypoechoic or anechoic, well-delineated masses that can show internal septa and are usually located near a joint or a tendon sheath [1,2,[4][5][6][7] (Fig. 1).The sonographic appearance of ganglia depends on their size and chronicity [6]. Larger cysts are often anechoic, and old lesions are echogenic and show internal thick septa. Color Doppler sonography can show a hypervascular wall in symptomatic patients (Fig. 2), although vascularity does not always correlate with symptoms and vice versa. Smaller dorsal ganglia, also known as occult ganglia, are difficult to detect clinically and frequently cause local pain and limitation of movement [7]. Sonography shows them as 1-to 3-mm unilocular, anechoic cysts located near the dorsal band of the scapholunate ligament (Fig. 3). Sonography can assess their relation to the overlying extensor tendons and to the posterior interosseus nerve. In addition, sonography can assess the scapholunate ligament [8,9] and rule out effusions of the radiocarpal joint.Volar wrist ganglia usually are found near the flexor carpi radialis tendon and often displace the radial artery and its palmar branch. Color Doppler sonography easily assesses the internal flow of the artery and can differentiate ganglia from arterial pseudoaneurysms. The differential diagnosis of volar ganglia also includes tenosynovitis of the