In a 4 year period (1996-1999), 42 total wrist fusions in 25 men and 17 women were performed using the AO/ASIF Titanium wrist fusion plate. The median age of the patients at the time of surgery was 41 (range, 19-72) years. The indication for fusion was post-traumatic arthritis in 29 wrists, Kienböck's disease in eight, rheumatoid arthritis in three, mono-arthritis in one and Volkmann's contracture in one. All patients were reviewed at a median follow-up of 23 (range, 6-50) months. The Buck-Gramcko and Lohmann score for functional evaluation was excellent in 35, good in 5 and satisfactory in 2 patients. We conclude that wrist arthrodesis with the AO/ASIF Titanium wrist fusion plate is an excellent option for treatment of various painful disorders of the wrist.

We present our experience with correction of Madelung's deformity by the Ilizarov technique. Seven patients (eight deformities) were treated by osteotomy of the radius with subsequent lengthening and angular correction. They were reviewed at a mean of 30 months (1.5 to 5.5 years). At the time of operation their mean age was 19 years (9 to 44). At follow-up all were free from pain and supination had improved by a mean of 34 degrees and pronation by 9 degrees. Flexion had increased in most cases with a median increase of 15 degrees, but only one patient gained further extension. Radial and ulnar deviation were increased by a mean of 6 degrees and 9 degrees, respectively. Radiographic measurements showed that the mean volar angulation had been reduced from 25 degrees to 11 degrees, ulnar inclination from 45 degrees to 30 degrees and carpal malalignment (volar translation) from 7 to 2 mm. The mean lengthening of the radius was 12 mm (6 to 25). All the patients were satisfied with the functional and cosmetic results.

Ulnar shortening is well accepted in the treatment of ulnar abutment but less so in patients with a shortened radius and ulnar-sided wrist pain as a result of a Colles fracture. Sixteen patients with pain and reduced range of movement (ROM) and a median preoperative ulnar positive variance of 5 mm (range 0.5-11) had 17 osteotomies. Nine were male and seven female with a median age of 35 (range 15-55) years were operated on. Fifteen patients with 16 osteotomies could be reached for follow-up. The ulna was shortened by a median of 4.5 mm (range 3-12). The median pain score was reduced by 3 points (range 0-5). Postoperative ROM was improved in nine, unchanged in six, and reduced in one wrists. There were four complications: one re-fracture, two transient paraesthesiae, and one superficial infection. Seven of the patients regarded the result as excellent, six as good, three as fair, and none regarded it as poor. Thirteen of the 16 would have chosen the operation again, three would not.

Twenty-seven chronic flexion contractures of the proximal interphalangeal joint were treated with the Compass((R)) hinge external fixator without open surgery. The fixator was removed after a mean of 33 (range, 14-68) days. The mean time from injury to operation was 4 (range, 1-19) years and all patients were reviewed at a mean follow-up of 21 (range, 12-50) months. The mean extension gain was 38 degrees (range, 0-70 degrees), and the mean flexion-extension arc improved by 42 degrees (range, 0-80 degrees). Complications included superficial pin-track infection in 11 cases and pin loosening in four cases.

We present a new and simple technique for the treatment of proximal interphalangeal (PIP) joint contractures by mini Orthofix external fixator without open surgery. The technique was tested on 10 patients. We found that the fixator is easy to apply and effective in reducing contractures of the PIP joint by soft tissue distraction.