No abstract

Surgical findings show important alterations of the extrinsic and intrinsic vascularity of the ulnar nerve in the epitroclear groove. Current procedures are only able to solve the mechanical aspect of nerve compression. Transposition may cause additional iatrogenic ischaemic damage of endoneural vascularity if the nerve is separated from the ulnar collateral artery to achieve anterior mobilization. Our technique of transposition of the ulnar nerve with its vascular bundle maintains the advantages of anterior transposition currently in use, but is able to preserve the whole vascularity of the nerve, thus solving the biological aspect of nerve compression. This allows quicker recovery of axonal activity that was chronically compromised by the entrapment neuropathy. The technique and the results in 30 patients (90% excellent and good, 10% fair) treated since 1987 are presented.

Scapholunate interosseous ligament (SLIOL) tears, according to the studies of Mayfield, develop in a predictable pattern after a trauma in extension, ulnar deviation, or intercarpal supination. The volar part of the scapholunate ligament is involved first, then the whole SLIOL, then the extrinsic ligaments such as the radioscaphocapitate (RSC) ligament and the radiotriquetral (RT) ligament with a variable degree of ligament damage. 1They occur mainly in young patients of working age, who may develop wrist instability, which can eventually lead to degenerative arthritis and a scapholunate advanced collapse (SLAC) wrist.2,3 Once arthritis has developed, the treatment of these lesions is not simple and generally requires salvage procedures with a significant loss of wrist function. Treatment of a chronic scapholunate ligament tear is still a challenge for the surgeon, even before wrist arthritis has developed, since it is not always possible to regain complete wrist strength, motion, and AbstractTreatment of scapho-lunate (SL) injuries is still a challenge for the surgeon, especially in chronic cases. The aim of the study isto experimentally cut, specific portions of scapholunate ligament and extrinsic ligaments and check their corresponding arthroscopic finding in order to understand the pathogenesis and develop a new classificationsystem which is an evolution of the present arthroscopic classifications. Materials and Methods Thirteen cadaver wrists were studied under arthroscopy. Different portions of the scapho-lunate ligament were subsequently sectioned. In group A the sectioning sequence was: anterior SLIOL, RSC, LRL, SLIOL's proximal and posterior, DIC, DRC ligament and ST ligaments (8 cases). In group B it was: SLIOL's posterior and proximal, DIC, SLIOL's anterior, LRL, RSCL, DRC, ST ligaments (5 cases). The anatomo-pathological findings after each sectioning were correlated to the classification system proposed (

In 13 patients (18 fingers) we used two types of external fixator as progressive static splints for the preoperative correction of the deformities of severe Dupuytren's disease before conventional fasciectomy. The duration of treatment was from one to four weeks.At a mean follow-up of 18 months the mean total fixed flexion deficit had been reduced from 138° to 39°a nd the mean proximal interphalangeal joint contracture from 80° to 29°. The mean total active range of movement had increased from 123° to 175°. These preliminary results are promising, but continued follow-up is needed since recurrence is common.J Bone Joint Surg [Br] 1998;80-B:126-9.