A method of treatment of chronic flexion contractures of the PIP joint is presented, with the results obtained in 19 patients treated between 1989 and 1992 after a follow-up of from 6 to 53 months. The flexion contractures, with an extension deficit which ranged between 70 and 90 degrees, had been present for a period of between 2 months and 24 years. Our treatment program involves the surgical release of the unreducible PIP joint followed by the use of static and/or dynamic splints. Surgery is performed using a midlateral approach; the accessory collateral ligament and the flexor sheath are incised and, after the volar plate and check-rein ligaments have been excised, forced hyperextension is applied. The main collateral ligaments are carefully spared and freed from the condyle if there are any remaining adhesions. In our 19 patients, complete extension of the finger was achieved in 11 cases (57.9%); in the remaining 8 cases (42.1%) the residual extension deficit ranges from 10 to 15 degrees. In our experience this combined surgical and rehabilitative approach had led to consistently good results with minimal complications.

A clinical and radiological review of 119 distal radial fractures sustained in young adults to assess the longterm development of symptomatic arthritis and functional impairment. Eight hundred and one patients who had sustained a distal radial fracture between 1960 and 1968 were identified from the hospital records. Of these 119 who were below the age of 40 (mean 25 years) at the time of injury were reviewed at an average of 38 (33-42) years. one hundred and eighteen had been treated in a Colles plaster with or without manipulation for 6 weeks. All underwent a detailed physical examination, completed a self-reported validated questionnaire and underwent standardized radiographs of both wrists. No patient had changed occupation as a result of the fracture and none reported significant limitation of function. No salvage procedures had been performed. Eighty nine percent reported troublesome pain once per month or less. Flexion-extension was significantly reduced in the fractured wrist but by only 71. Grip strength was also significantly reduced but by an average of only 2 kg. Ninety percent of fractures had malunited in at least one radiological parameter and the fractured wrists had significantly more radiological arthrosis than the uninjured side. Logistic regression and ordinal logistic regression analysis demonstrated no relation between either malunion or radiological arthrosis and the objective or subjective outcome measures. Objective and subjective measures were however significantly related. The strongest predictor of fracture outcome was the function of the uninjured wrist. Malunion was well tolerated in this group of patients. We demonstrated no significant incidence of symptomatic posttraumatic osteoarthritis.Purpose: To compare the functionnal and radiological results concerning the ''same'' distal radius fracture of three different and consecutive procedures: dorsal plate, pins and palmar plate.Material and method: Sixty-two patients with a dorsally displaced extraarticular fracture of the distal radius were treated by dorsal plating [group 1, 20 patients, mean age 59.9 years (25-87)], pinning [group 2, 22 patients, mean age 55.6 years (17-83)] and volar plating [group 3, 20 patients mean age 57.1 years (17-78)]. Patients were evaluated by a surgeon not involved in treatment. Evaluations consisted of measurements of range of motion, grip strength, radiographic evaluations between postoperative time and last follow-up, and evaluation by Herzberg scoring, associated with Gartland and Werley rating system and completion of disability of arm, shoulder, and hand questionnaires. Comparison of three groups was performed with Kruskall-Wallis or ANOVA test and w 2 (P-value o0.05). Results: Operative time was the same for both plate groups but two times more than for the pin group. In Group 1 most complications and fair functional results were reported (32%) in spite of the longest follow-up. Group 3 showed the best results in flexion-extension, with DASH scoring, ulnar variance conservation, and most excellent...

Based on modified Geissler's classification we had 16 stage II, 36 stage III and 12 stage IV scapholunate lesions. Results: Our average follow up period is 34 months (range 12-62 months). Mobility was normal in 57 cases. Pain disappeared in 59 cases, was moderate in three cases and disabling in two cases. Grip strength increased in comparison to pre-operative levels but in seven cases it never came back to the level of the normal contralateral side. We had one radial nerve lesion, two minor Sudeck's dystrophy and one radio-scaphoid arthritis. Mayo-wrist score showed 89% excellent or good results. Discussion: Prolonged immobilization of the scapholunate space permits satisfying and long-lasting healing in acute cases. The use of wrist arthroscopy facilitates the quality of the reduction and wiring and limits the surgical exposure with a negligible aesthetic price to pay.Background: The use of arthroscopic thermal shrinkage with radiofrequency (RF) for the treatment of scapholunate (SL) ligament injuries is a recent technique and the real effectiveness is undetermined. Aim: To determine the effectiveness for the treatment of symptomatic SL ligament injuries. Study design: Clinical prospective randomized study. Methods: From 2001 to 2004, 120 patients presenting with chronic dorsoradial wrist pain unresponsive to conservative treatment for a mean period of 10 weeks were included in this study. Forty patients with Geissler grades I and II SL injuries were treated with shrinkage (group A) and 40 patients with the same lesion (group B) were treated with arthroscopic debridement. Twenty patients with Geissler grades III SL injuries (group C) were treated with shrinkage plus pinning with K-wire and twenty patients with the same lesion (group D) were treated with arthroscopic debridement plus pinning with K-wire. The shrinkage of the SL ligament was performed with a 2.3 mm monopolar RF probe excluding the most palmar aspect of the ligament and extending to the entire dorsal section of the ligament and to the dorsal capsula. Clinical outcome was evaluated at 3, 6, 12, 18 month and final evaluation was 28 months average after the treatment. Instruments for outcome evaluation included pre and postoperative use of modified wrist-scoring system of Mayo Clinic and DASH questionnaire.

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