The Bone and Joint Journal May 2016
- On page 647 there is a review of 77 wrist fusions performed by a single surgeon between 1993 and 2012. The commonest technique, using a dorsal plate from the radius to the 3rd metacarpal was used. The patients were aged around 60. There were slightly more men. There were slightly more right wrists than left wrists. 64% of non-inflammatory disease and the rest had inflammatory disease. Non-union only occurred in 3 patients at the carpometacarpal joint. About two thirds returned to their preoperative vocation. All but one patient stated that they were satisfied with the fusion and would have undergone the same operation again. Only 3 patients required removal of their plate. There were no reported cases of infection.
- On page 654 there is a very nice epidemiological study by Prof Dias and his unit in Leicester. They reviewed their 415 patients with scaphoid fractures over a three-year period. Scaphoid fractures were more than 7 times more common in males than females. Interestingly the average age was quite young at 22 years on average. The youngest was 9 and the oldest was 35. The incidence in the lowest socio-economic status group was twice that of the highest socio-economic group. The incidence in June was highest and was twice that in December. Most fractures occurred at the waist (64%).
The American Journal of Hand Surgery May 2016
- On page 602 there is a review of scaphoid non-union cases treated with bone morphogenetic protein. BMP2 was used between 2011 and 2014. 6 cases were studied. All were revision cases. The time from primary to secondary surgery was an average of 6 months. 4/6 United. There were 4 cases of hetero topic ossification. Only one patient healed without complications. This is an off label indication and the message was that this was not a successful treatment.
- On page 615 there is a review of 31 patients who had an ulnar shortening osteotomy and unstable TFCC tears. Half had arthroscopic repair and half had arthroscopic debridement. Both groups improved. Instability symptoms were helped by arthroscopic repair.
- On page 624 there is a study of force in the scapho-lunate ligament in the neutral clenched fist push-up position vs the open palm push-up position. The average force across the scapho-lunate interval increased from 25 N to 44 N going from clenched fist to open palm. This is consistent with patients symptoms. Pathology in the scapho-lunate ligament frequently presents with an inability to open palm weight bear.
- On page 630 there is a new classification of Kienboch’s disease of the lunate. This is one of many and there are still many different treatments proposed. The best treatment for each of the stages is still not clear. Further research is required into this rare disorder.