Background Kienbock's disease, in spite of an uncertain natural history, is known to cause lunate compromise, leading to central column collapse, carpal instability, and degenerative arthritis of the wrist. Joint leveling procedures are performed in the early stages of Kienbock's disease to “unload” the lunate. Capitate shortening is the preferred procedure in Kienbock's patients with positive ulnar variance. Description of Technique We describe the rationale and a simplified technique of capitate shortening in early Kienbock's disease. This is a single-cut osteotomy with single-screw stabilization. Patients and Methods We have performed this technique in three cases. We present a case of a 26-year-old male who presented with a 1-year history of pain in his right wrist. Radiology performed demonstrated lunate sclerosis. Diagnostic arthroscopy revealed healthy articular surfaces. Single osteotomy capitate shortening was performed with an oscillating saw and fixed with a single cannulated compression screw. A shortening of 1.5mm was obtained with this technique. Results At 1- to 2-year follow-up, all three patients had considerable pain relief but did not have a complete resolution of pain. There was a significant improvement in function and grip strength. There have been no cases with infection, nonunion, avascular necrosis or a need for a salvage procedure. Conclusion The simplified technique of capitate shortening is easy to perform, less traumatic to the capitate vascularity, and leads to good short-term functional results.

At 1 year of follow-up, the ankle had good union and function of the tendon was restored. Posterior tibial tendon ruptures, although rare, should be suspected in cases of closed ankle fracture, irrespective of the mechanism of injury.

Closed rupture of the flexor digitorum profundus (FDP) tendon causes loss of flexion at the distal interphalangeal joint. Following trauma, these are known to present as avulsion fractures (Jersey finger) commonly in ring fingers. Traumatic tendon ruptures at the other flexor zones are seldom noted and are often missed. In this report, we present a rare case of closed traumatic tendon rupture of the long finger FDP at zone 2. Though it was missed initially, was confirmed with Magnetic Resonance Imaging and underwent successful reconstruction using an ipsilateral palmaris longus graft. Level of Evidence: Level V (Therapeutic)

Background Scapholunate instability (SLI) has a wide range of clinical and radiological presentations. The management depends on the stage of the disorder. Subluxation of scaphoid is pathognomonic feature of the SLI. We describe a patient with SLI with a dislocated proximal pole of scaphoid, out of the distal radius scaphoid fossa. The 4D (three-dimensions + time) computed tomography (CT) scan demonstrated that the scaphoid did not reduce throughout wrist motion. Case Description A 20-year-old male presented with SLI following a fall skateboarding. The 4D CT scan revealed the dislocated scaphoid that did not reduce with wrist motion. He underwent open reduction of the proximal pole of scaphoid and SL reconstruction using flexor carpi radialis (FCR) tendon graft with the Quad tenodesis technique. At 1 year, he had improved pain, wrist functions, and maintained satisfactory radiological alignment. Literature Review We are not aware of any previous description of the dorsal scaphoid dislocation in association with scapolunate instability. Clinical Relevance We recommend that the SLI staging classification needs to be expanded to include dislocation (locked) stage. The 4D CT has a significant role in identifying the instability and its reducibility. Level of Evidence This is a level V study.

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