Dysplastic trapezium is a condition that is characterized by an exaggerated slant (slope) of the distal articular surface of the trapezium in relation to the axis of the second metacarpal. Usually, it becomes evident in the late teens and early 20s with proximolateral subluxation of the base of the first metacarpal and is associated with pain at the base of the thumb. It is more common in the dominant hand of women, but can affect both hands and either sex. The condition can be progressively painful and incapacitating, and those patients will require early support with medical treatment. Surgical management is indicated in persistent cases. In this study, we aimed at correcting theabnormal trapezial tilt in nonarthritic trapeziometacarpal joints by a dorsoradial open wedge osteotomy and bone graft, restoring the normal biomechanics around the joint, abolishing the abnormal loads sustained by the ligaments, and aiming to prevent the development of arthritic changes.

Background: During the last decades, anatomical studies on skin vascularization provided the base for the development of flaps nourished by perforating arteries and preserving major vessels. In the last years, perforator flaps have become an appealing option for coverage of a large range of defects as they allow for great freedom in design and for reconstruction of difficult wounds with minimal donor-site morbidity, but doubts regarding their reliability have overshadowed its safety in clinical practice. Aim of the Work: This prospective clinical study is conducted to assess the reliability and efficacy of local perforator flaps in coverage of hand, wrist, and forearm skin defects. Patients and methods: We conducted a prospective study involving 20 patients with hand, wrist, and forearm skin defects and were covered with local radial and ulnar arteries perforator flaps. Postoperative complications were recorded and assessment of patients' satisfaction as regards donor site morbidity and aesthetic outcome of the flap was done by a questionnaire at the outpatient clinic and the results were classified as unsatisfactory, satisfactory, good, and very good. Vancouver Scar Scale was applied as an objective tool for scar assessment postoperative. Three-month follow up was the end point of this study. Results: Radial artery perforator flaps were done in 11 cases (55 %) and ulnar artery perforator flaps in 9 cases (45%).Temporary venous congestion happened in 19 cases, distal tip necrosis in 10 cases, superficial epidermolysis in 8 cases, and arterial insufficiency in one case. Mean operative time was 63.8 min., 70.64 min. in RA perforator flaps and 55.44 min. in UA perforator flaps. Conclusion: Perforator flaps are a reliable tool for upper extremity coverage, with a low rate of failure and secondary surgery. These flaps are particularly useful for covering small and medium sized defects in the distal one third of the forearm, wrist, and hand; and they represent a reliable and effective alternative to free flaps.

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Background The wrist joint is a common site of traumatic, degenerative and inflammatory disease that, when symptoms are severe, can be treated by partial or complete arthrodesis, arthroplasty and/or wrist denervation. Aim of the Work to review systematically studies about total and partial wrist denervation for chronic painful wrist conditions and meta-analyze the long term improvement. Materials and Methods Literature searches was conducted using the following databases: "PubMed, Ovid, Web of Science, Science Direct, Scopus, Cochrane Library, Google Scholar, Medline" using the following key words: wrist joint, total denervation, partial denervation for published studies. Results This study provides long-term data regarding the outcomes of partial and total wrist denervation. We have found that this is a reliable motion preserving procedure for patients with chronic wrist pain. In the series, 85% and 70% of patients did not undergo revision surgery at average follow-up of approximately 54.7 months and 47.5 months in total and partial denervation respectively. Conclusion Denervation is a relatively quick procedure with low complication rates and does not preclude salvage procedures if pain persists. It has been shown that neurectomy of the articular branches is possible without any injury to the important sensory and motor nerves of the hand. Total denervation of the wrist is a useful method for treating wrist pain when other choices compromise functional capacity or a long period of post-operative recovery is not desired.

Background:The coronoid process is considered the keystone of bony elbow stability, in addition to its soft tissue attachment. Aim of the work:To compare conservative treatment versus fixation of type I coronoid fracture in terrible triad injuries as regard elbow stability, functional outcome, and possible complications. Patients and methods:We performed a prospective randomized control study on 20 patients with terrible triad injuries and were divided into two equal groups. Randomization was done using Microsoft Excel. Group (1) including 10 patients where the coronoid fracture was not repaired, and Group (2) including 10 patients where the coronoid fracture was repaired. All patients were operated using the lateral approach. In the second group, the coronoid fracture was fixed using pull-out sutures. In both groups, internal fixation was done for the radial head or neck fracture with reattachment of the lateral ulnar collateral ligament (LUCL) to its humeral origin by transosseous sutures. Postoperative patient assessment was done according to the Disabilities of the Arm, Shoulder and Hand (DASH) Score, and the Broberg-Morrey rating system. Results:In the first group, the mean Broberg-Morrey score was 91.2 (range, 85-98) with four excellent results and six good results. The average DASH score was 13 (range, 2.5-30). In the second group, the mean Broberg-Morrey score was 94.4 (range, 89-98) with seven excellent results and three good result. The average DASH score was 9.6 (range, 0-23.3).Two patients experienced postoperative complications in the first group, one implant failure of the radial neck fracture after 3 weeks follow up and the other did not reach complete union of his radial neck. Both patients refused a second operation. Conclusion:We conclude that fixation of type I coronoid fractures in terrible triad injuries did not show significant difference regarding elbow stability and clinical outcome at short-term follow up.