Aims. Diagnostic wrist arthroscopy is considered the gold standard for evaluating wrist joint complaints. Although this tool is often used to diagnose and stage scapholunate ligament (SLL) lesions, reports about the possible findings and their clinical relevance are scarce. Therefore, this study describes the patient characteristics, arthroscopic findings, and treatment of patients who underwent diagnostic arthroscopy for suspected SLL injury. Methods. We conducted a retrospective cohort study of patients who underwent diagnostic wrist arthroscopy due to suspicion of a SLL lesion based on medical history, physical examination, and imaging. We systematically gathered arthroscopic findings and complications. Results. This study included 324 patients, predominantly male (55%), with a median age of 44 years (IQR 29 to 54) and symptom duration of ten months (IQR 5 to 24). The indication of SLL injury was arthroscopically confirmed in 253 patients (78%). Isolated SLL injuries were found in 92 patients (28%) (Geissler I/II: 32%; III: 37%; IV: 32%). SLL lesions and SLL-associated cartilage damage were discovered in 31 patients (10%). Additional findings were found in 181 patients (56%), such as triangular fibrocartilage complex lesions (36%), lunotriquetral ligament lesions (7%), and radioscaphocapitate ligament lesions (11%). No pathology was found in 20 patients (6%). In 27 patients (8%), complications occurred due to wrist arthroscopy. The most common follow-up surgeries were 3LT (40%), salvage procedures (9%), and ulnar shortening osteotomy (6%). Conclusion. While diagnostic wrist arthroscopy commonly confirms the suspected SLL lesions and their severity, it often reveals additional pathologies (un)related to the suspected pathology. It is essential to perform the procedure thoroughly to establish all possible pathologies. Determining the appropriate treatment for these additional findings is not always straightforward and needs further investigation. Cite this article: Bone Jt Open 2025;6(3):312–320

The wrist is arguably the most complex joint in the body and is essential for optimal hand function. The joint may be represented as two roughly orthogonal hinge axes, providing flexion-extension and radial-ulnar deviation. The location and orientation of these axes with respect to the underlying anatomy is essential for the design of successful joint prostheses. A population study was performed in order to obtain the parameters of this two-hinge joint. Data for 108 normal right wrists was gathered using a Fastrak electrogoniometer with sensors fixed to the distal medial radial styloid and the distal third metacarpal head. Data was recorded as a series of three-dimensional coordinates covering the entire locus of movement. The two-hinge geometry of the joint was represented mathematically with nine parameters describing the configuration of the axes and two angles controlling rotation about these axes. The configuration giving the closest kinematic match to the experimental data was determined using two nested optimisation processes. During the inner optimisation process, the third metacarpal head was brought as close as possible to each of the experimental points in turn by adjusting the two positioning angles. The sum of distances from each experimental point to the point of closest approach gave the “cost” of the current configuration. The outer optimisation process repeated the inner process iteratively, minimising the cost by adjusting the nine configuration parameters. The double optimisation method was found to offer an innovative solution to the problem of analysing kinematic data from a population study. The mean joint configuration showed the axis of radial-ulnar deviation to be 1.9 mm (sd = 12.5 mm), distal to the flexion-extension axis, with axes almost orthogonal to one another. This data together with the radii of the rotations is invaluable in determining the optimal articulation geometries for wrist joint replacement prostheses

The aim of the study was to investigate, firstly, the force distribution between scaphoid/radius and lunate/radius in the normal wrist and in the presence of a scaphoid fracture, secondly, how stresses and strains at the fractured area change during the healing process and thirdly, how the direction of the applied forces affects load transmission.

A 3D finite element model of the normal wrist was initially developed. Two typical scaphoid fractures B2 and B3 according to Herbert’s classification, were investigated. The fractured areas were modeled with a range of modulus of elasticity to resemble the various stages of the healing process. Furthermore, three different directions of the externally applied loads were examined.

The applied compressive vertical load in the normal joint was transmitted to the radius through the radioscaphoid and the radiolunate articular surfaces at a ratio equal to 56:46 respectively. The ratio was equal to 54:48 and 53:49 for the B2 and the B3 fracture respectively. The load direction resembling an ulnary deviated wrist caused the appearance of a significantly higher strain field at the fractured area. The maximum developed stresses at the fractured area for scaphoid fracture B2 were approximately 37%–58% higher than those of B3, for all three loading directions.

Based on our results, the onset of osteoarthritic changes in a wrist with a scaphoid fracture is due to carpal collapse and scaphoid deformity. The recorded maximum developed strains for both B2 and B3 scaphoid fractures suggested intense bone remodeling activity. Among the examined three different load directions, the one simulating an ulnary deviated wrist corresponded to the most severe effects.

Introduction. The human wrist is a highly complex joint, offering extensive motion across various planes. This study investigates scapholunate ligament (SLL) injuries’ impact on wrist stability and arthritis risks using cadaveric experiments and the finite element (FE) method. It aims to validate experimental findings with FE analysis results. Method. The study utilized eight wrist specimens on a custom rig to investigate Scapho-Lunate dissociation. Contact pressure and flexion were measured using sensors. A CT-based 3D geometry reconstruction approach was used to create the geometries needed for the FE analysis. The study used the Friedman test with pairwise comparisons to assess if differences between testing conditions were statistically significant. Result. The study found significant variations in scaphoid and lunate bone movement based on ligament condition. Full tears increased scapholunate distance in the distal-proximal direction and decreased in the medial-lateral direction. Lunate angles shifted from flexion to extension with fully torn ligaments. Conversely, the scaphoid shifted significantly from extension to flexion with full tears. A proximal movement was observed in the distal-proximal direction in all groups, with significant differences in the partial tear group. Lateral deviation of the scaphoid and lunate occurred with ligament damage, being more pronounced in the partial tear group. All groups exhibited statistically significant movement in the volar direction, with the full tear group showing the least movement. Also, radiocarpal joint and finger contact pressure and contact area were studied. Whereas the differences in contact area were not significant, scapholunate ligament tears resulted in significantly decreased finger contact pressures. FEA confirmed these findings, showing notable peak radiocarpal contact pressure differences between intact and fully torn ligaments. Conclusion. Our study found that SLL damage alters wrist stability, potentially leading to early arthritis. The FEA model confirmed these findings, indicating the potential for the clinical use of computer models from CT scans for treatment planning

Distal radius fractures are the most common fracture of the upper extremity. Malunion of the distal radius is a common clinical problem after these injuries and frequently leads to pain, stiffness loss of strength and functional impairments. Currently, there is no consensus as to whether not the mal-aligned distal radius has an effect on carpal kinematics of the wrist. The purpose of this study was to examine the effect of dorsal angulation (DA) of the distal radius on midcarpal and radiocarpal joint kinematics, and their contributions to total wrist motion. A passive wrist motion simulator was used to test six fresh-frozen cadaveric upper extremities (age: 67 ± 17yrs). The specimens were amputated at mid humerus, leaving all wrist flexor and extensor tendons and ligamentous structures intact. Tone loads were applied to the wrist flexor and extensor tendons by pneumatic actuators via stainless steel cables. A previously developed distal radius implant was used to simulate native alignment and three DA deformity scenarios (DA 10 deg, 20 deg, and 30 deg). Specimens were rigidly mounted into the simulator with the elbow at 90 degrees of flexion, and guided through a full range of flexion and extension passive motion trials (∼5deg/sec). Carpal motion was captured using optical tracking; radiolunate and capitolunate joint motion was measured and evaluated. For the normally aligned radius, radiolunate joint motion predominated in flexion, contributing on average 65.4% (±3.4). While the capitolunate joint motion predominated in extension, contributing on 63.8% (±14.0). Increasing DA resulted in significant alterations in radiolunate and capitolunate joint kinematics (p<0.001). There was a reduction of contribution from the capitolunate joint to total wrist motion throughout flexion-extension, significant from 5 degrees of wrist extension to full extension (p = 0.024). Conversely, the radiolunate joint increased its contribution to motion with increasing DA; significant from 5 degrees of wrist extension to full extension as the radiolunate and capitolunate joint kinematics mirrored each other. A DA of 30 degrees resulted in an average radiolunate contribution of 72.6% ± 7.7, across the range of motion of 40 degrees of flexion to 25 degrees of extension. The results of our study for the radius in a normal anatomic alignment are consistent with prior investigators, showing the radiocarpal joint dominated flexion, and the midcarpal joint dominated extension; with an average 60/40 division in contributions for the radiocarpal in flexion and the midcarpal in extension, respectfully. As DA increased, the radiocarpal joint provided a larger contribution of motion throughout flexion and extension. This alteration in carpal kinematics with increased distal radius dorsal angulation may increase localised stresses and perhaps lead to accelerated joint wear and wrist pain in patients with malunited distal radial fractures

It is generally appreciated that the internal structure and external shape of living bone adapt to mechanical stimuli according to Wolff’s law. However, the precise details of bone adaptation to external forces are not fully understood and there has been no previous investigation of the association between specific loading conditions and the skeletal architecture of a particular anatomical area using case-specific observations in a group of individuals. The aim of the present study was to investigate a previously unreported correlation between the maximum wrist joint reaction force and the volar tilt angle of the distal radius using parameters radiographically obtained parameters from normal wrist joints. Using free body analysis of the forces acting on the distal radius for the loading condition that corresponds to the lift of a weight using the supinated hand, the wrist joint reaction force F and the angle formed between the vector of F and the long axis of the radius have been expressed as a function of the lifted weight, the lever-arm of the wrist flexor tendons and that of the lifted weight. Measurements of the volar tilt angle of distal radius and the lever-arms of the flexor tendons and the lifted weight were performed from lateral wrist radiographs of 30 normal wrists. Subsequently, using the equations obtained from free body analysis, the maximum wrist joint reaction force F and the angle that the latter forms with the long axis of the radius were calculated for each the cases. Statistical analysis compared the angle of the maximum wrist force and the volar tilt of the distal radius (two-tailed paired t-test) and correlated (a) the angle of the maximum wrist force and the volar tilt angle and (b) the maximum joint reaction force and the volar tilt angle. Results showed no significant difference (p=0.33, 95% confidence interval −0.64° to 0.22°) but a statistically significant correlation (R. 2. = 0.74, r = 0.86, p < 0.001) between the angle of the maximum wrist force and the volar tilt angle of the distal radius. Additionally, an inverse relationship between the volar tilt angle and the magnitude of the maximum wrist force (R. 2. = 0.71, r =−0.84, p< 0.001) was found. These observations may explain the mechanism of the phylogenetical development of the volar tilt angle and support the ‘minimum effective strain’ theory of adaptive bone remodeling. 1. The importance of accurate restoration of the volar tilt during treatment of distal radius fractures, especially in wrists that are normally characterised by a low volar tilt angle, is also emphasized by the results of the present study

Abstract. Objectives. The scapholunate interosseous ligament (SLIL) has a unique C-shape following the arc of the scaphoid and lunate surfaces from distal dorsal around to distal volar. This ligament comprises of three subregions: dorsal, proximal and volar. The SLIL enthesis, a specialized region where this ligament attaches to the scaphoid and lunate, has not previously been studied despite its important mechanical function in the biomechanics of the wrist joint. This study therefore aims to compare the histomorphological differences between the SLIL subregions, including at their entheses. This study will examine the qualitative and quantitative differences between the three subregions, as well as between the scaphoid and lunate attachments. Methods. Twelve fresh-frozen human cadaveric wrists were dissected and the gross dimensions of each SLIL subregion measured. Subregions were then histologically processed for qualitative and quantitative morphological and compositional analyses, including quantification of enthesis calcified fibrocartilage (CF) area. Results. From the gross measurements taken, the dorsal subregion was the thickest. There were no significant differences in lengths and widths between the three subregions. Qualitatively, the dorsal and volar subregions had fibrocartilaginous entheses while the proximal subregion inserted into cortical bone via articular cartilage. Quantitatively, the dorsal subregion had significantly more CF than the volar subregion. There was no significant difference in the enthesis CF between scaphoid and lunate attachments in the three subregions. Conclusions. There are significant histomorphological differences between the SLIL subregions. The dorsal subregion has the largest amount of CF, which is consistent with the greater biomechanical force subjected to this subregion compared to the other subregions. This result confirms that the dorsal subregion is the strongest of the three subregions. The similar histomorphology of the ligament at the scaphoid and lunate entheses suggests that similar biomechanical forces are applied to both attachments. Declaration of Interest. (a) fully declare any financial or other potential conflict of interest

Purpose of the study. To evaluate the changes of the wrist by arthroscopy without distraction in patient with multiple hereditary osteochondromatosis (MHO) and enchondromatosis in relation to the forearm deformity and the combination with following surgical procedure. Introduction. Wrist arthroscopy was used to evaluate the changes in the wrist in patients with MHO and enchondromatosis and to correlate these changes to specific deformities of the forearm bones. Material and Methods The new technique of wrist arthroscopy without distraction was used in 16 children in 20 wrist joints, with MHO (12 patients) and enchondromatosis (4 patients). Conventional 2.4mm arthro-scope and the III/IV, VI/R and MCU approaches were used in combination mostly with the following surgical procedures according to present deformities (15 times). The arthroscopical findings were correlated to the conventional X-ray examinations of the wrist (radial articular angle, carpal slip, and relative ulna shortening). Results. 1. Wrist arthroscopy without distraction offers the sufficient information about wrist anatomy in children and it was possible to continue with the surgical procedure in the same session. 2. The arthroscopic findings in the radiocarpal and mediocarpal space were normal in all wrist joints, with exception of one patients with cartilage lesions. 3. The articular disc of triangular fibrocartilage complex failed in 11 wrists, where shortening of the ulna was present or head of ulna was not centred to incisura radii. 4. The normal or reduced disc was found in 5 and 4 wrists, respectively, where ulna was not shortened or where normal position of head of ulna was re-established after lengthening. No correlation was obtained between discus anatomy and radial articular angle and carpal slip. Conclusions. Shortening of the ulna by MHO or encho-dromatosis leads to elimination of the articular disc and later to degenerative changes in wrist joint. Lengthening of the ulna to distal radioulnar joint leads probably to re-establishment of the articular disc. Arthroscopy without distraction evaluates the wrist conditions and the results of treatment and enables a surgical procedure in the same session in children of the school age

Wrist arthrodesis is a common surgical procedure that provides a high level of functional outcome and pain relief among patients.[1] Upon partial arthrodesis, the wrist experiences changes in load transmission that are influenced by the type of arthrodesis performed. Measuring the load through the wrist joint is difficult, however, combined with computational models [2], it is possible to obtain data regarding the load mechanics of the wrist joint. Although successful fusion rates among patients have been reported, it remains unclear what the biomechanical consequences are. The aim of the study is to quantify pre and post operative load transmission through a cadaveric wrist which has undergone simulated arthrodesis of the radiolunate(RL) joint. An embalmed human wrist was dissected dorsally exposing distal radius, radiocarpal and carpometacarpal joints, and dorsal ligaments. The radioscaphoid(RS) ligament was sacrificed to accommodate insertion of a PPSEN-09375 force sensitive resistor (FSR) into the RS joint. The FSR was calibrated prior to measuring the contact force on the RS joint. The wrist was aligned in the neutral position in cardboard piping, and secured proximally and distally with Dental Plaster (OthoBock Healthcare Plc, Surrey, UK). The midsection of piping was windowed to permit placement of the FSR in the RS joint, and fixation of the RL joint using 2 Kirschner wires. The window was completed circumferentially and the specimen was placed in the Instron where a graduated axial compression was applied at 20 N/min. The results showed that when the radiolunate joint is fused, and a total axial load of 100N is applied, the load transmitted through the RS joint was approx 65N. i.e. 65% of the force. This is greater than the 56% measured experimentally by Blevens et al (1989) in an unfused specimen[3]. We plan to repeat our measurements and compare to an untreated cadaveric wrist

Introduction: Silicon-implant-arthroplasty in cases of severe destruction of the radiocarpal joint was a routinely used procedure in rheumatoid arthritis to restore mobility and function. However in many cases an implant failure with a fracture rate of up to 50% with massive synovitis and a severe carpal collaps must be documented. Main problem is the extensive bone loss which makes further procedures difficult. Revision-wrist-arthrodesis with bone grafting (iliac bone, allograft or free fibula-graft) is the commonly used procedure. Therefore non-union in these cases is documented in up to 40%. Material and Methods: Between 1999 and 2003 we performed in 2 cases of severe seropositive rheumatoid arthritis and in one case of psoriatic wrist joint destruction with extensive bone loss only a revision arthroplasty with debridement and insertion of a new Swanson silicon implant. At the time of revision mean age was 61 years and primary silicon arthroplasty was done 11 years ago. In one case a decompression of the median nerve in the carpal canal was necessary. In one case a transposition of the ECU to ECRB was performed to neutralize the ulnar drift of the remaining carpus. Results: In all patients a good mobility in the wrist with pain free function could be achieved. All patients were satisfied with this procedure. Clinical, subjective and radiological results are presented. Conclusion: Revision after silicon-wrist arthroplasty with severe bone loss without or only minimal carpal bone stock and a thin trumpet-like distal radius is difficult. Revision arthrodesis often ends in a non-union despite substantial bone-grafts. Debridement and revision with a new silicon implant is easy to perform and respectable function and a pain free situation might be achieved

Purpose of the study. To evaluate the changes of the wrist by arthroscopy without distraction in patients with multiple hereditary osteochondromatosis (MHO), and enchon-dromatosis in relation to the forearm deformity, and the combination with the following surgical procedure. Introduction. Arthroscopy of the wrist in childhood was not published previously. Wrist arthroscopy was used to evaluate the changes in the wrist in patients with MHO and enchondromatosis and to correlate these changes to specific deformities of the forearm bones. Material and Methods. The arthroscopy without distraction was used in 11 children in 13 wrist joints, with MHO (nine patients) and enchondromatosis (two patients). Conventional 2.4 mm arthroscope and the III/IV, VI/R and MCU approaches were used in combination mostly with the following surgical procedures according to the presented deformities (11 times). The arthroscopic find-ings were correlated to the conventional X-ray examinations of the wrist (radial articular angle, carpal slip, and relative ulna shortening). Results. 1. Wrist arthroscopy without distraction offers sufficient information about wrist anatomy in children to make it possible to continue with the surgical procedure in the same session. 2. The arthroscopic findings in the radiocarpal and mediocarpal space were normal in all wrist joints. 3. The articular disc of the triangular fibro-cartilage complex failed in seven wrists where shortening of the ulna was present or the head of ulna was not centered to the incisura radii. 4. A normal or reduced disc was found in six wrists where the ulna was not shortened or a normal position of the head of the ulna was re-established after lengthening. No correlation was obtained between discus anatomy and the radial articular angle and the carpal slip. Conclusions. Shortening of the ulna by MHO or enchon-dromatosis leads to the disappearance of the articular disc. Centering the ulna to the distal radioulnar joint can lead to re-establishment of the articular disc. Arthros-copy without distraction permits evaluation of the condition of the wrist, the results of treatment, and enables the surgical procedure to be performed in the same session

Purpose: A retrospective study was performed in order to evaluate the results of fixation of displaced unstable fractures of both bones of the forearm in children by intramedullary pins. Materials and methods: During the last fifteen years 121 children with displaced midshaft fractures of the forearm were treated by open or closed reduction and smooth intramedullary pin fixation. The age range was 5–16 years, the mean 11 years. Seventy five children (62%) were operated upon primarily because of an irreducible fracture, and the remaining 46 (38%) were operated upon within two weeks after failed closed reduction. The arm was then immobilized in a plaster cast extending above the elbow. The average time for fracture healing and cast removal was 8 weeks. Afterwards the children were encouraged to move the elbow and wrist joints. The hardware was removed following a period of between 6 weeks to 5 years (average 5.5 months), under sedation or general anesthesia. Results: Follow up was available in 91 of the 121 children for between 6 months to 15 years (mean 5.5 years). Using the grading scheme of Price, functional results at follow up were excellent in 79/91 patients (87%) and good in 12/91 children (13%). There were no fair or poor results. Of them, in 80 cases (88%), within one year from injury, a full range of movement was obtained in the elbow and wrist joints. 11 patients (12%) had an average loss of 10 degree of supination. In two cases there was a neuropraxia of interosseous nerves which disappeared spontaneously within 3 months. In one patient, a 16 year old boy, there was a delayed union of 6 months until solid healing. 4 patients had a mild degree of angulation of the distal third of the forearm. There were no incidences of deep infection, nonunion or damage to the epiphyseal plate. Conclusion: In conclusion we found that smooth intra-medullary pinning for displaced midshaft fractures of the forearm in children is a good, simple and safe method

Introduction: The aim of this study is to correlate the long-term functional outcome of the wrist joint to the establishment of radiological osteoarthritic disfigurements that develop after treating comminuted intrarticular fractures of the distal radial epiphysis with external fixation. Materials and Methods: Forty patients (22 male and 18 female) aging between 19 and 72 y.o who suffered a comminuted intrarticular fracture of the distal radial epiphysis from 1996 to 2002 and were treated with external fixation. The follow up started in 1996 and ended in 2007 (m.t 8 years). The fracture pattern was classified according to the Melone classification, the osteoarthritis stage according to the radiological findings and the functional outcome according to PRWE and UEFS forms. Results: From 40 overall patients, twenty seven (67,5%) were classified as Melone II fracture pattern, nine (22,5%) as Melone III and four (10%) as Melone IV. In addition, 15% (6 pts) developed stage I osteoarthritic disfigurements, 45% (18 pts) stage II, 25% (10 pts) stage III and 15% (6 pts) stage IV. It’s quite remarkable the fact that among the patients with Melone II fracture pattern, 22,2% developed stage I osteoarthritis, 55,5% stage II and 11,1% stage III and IV respectively. The patients with Melone III fracture pattern developed stage II, III and IV osteoarthritis in a percentage of 33,33%. All the patients with Melone IV fracture pattern developed stage III osteoarthritis. The PRWE wrist evaluation form showed that 77,5% of the patients scored equal or less than 10/150 and 22,5% between 11/150 and 30/150. The UEFS wrist evaluation form showed similar results with 62,5% score of 8/80 and 27,5% score between 9/80 and 14/80. As final result, it seems that the development of osteoarthritis does not affect the functional outcome of the wrist in 95% of the patients whereas the rest 5% experienced minor or moderate wrist joint impairment. Discussion and Conclusions: Fractures that are either unstable and/or involve the articular surfaces can jeopardize the integrity of the articular congruence and/or the kinematics of these articulations. However, the limitation of external fixation to achieve articular congruity in the comminuted intra-articular fractures of the distal radius has been documented in the literature. The fracture pattern, the degree of displacement, the stability of the fracture and the age and physical demands of the patient determine the best treatment option. In addition, it seems that the radiological findings do not walk along with the clinical features and the wrist functionality in a major percentage. Our results indicate the importance of anatomical reduction and especially the restoration of radial length in order to obtain good functional future outcome

Introduction. The wrist is the ”key-stone” of hand function. Painless stability is a prerequisite for the rheumatoid wrist to perform various manual tasks. Synovectomy of the extensor tendons and the wrist joint with a Darrach procedure is offered for painful wrists, which are not controlled by conservative treatment with medication and orthosis. Radiolunate arthrodesis is performed on wrists with an unstable radiocarpal joint and preserved midcarpal joint space. This study describes the long-term (more than 10 years) follow-up of these operative procedures. Materials and methods. The follow-up study was performed on 25 wrists in 25 rheumatoid patients (22 women and 3 men), whose average age was 52 years (range, 33 to 66 years) with an average disease duration of 12 years (range, 1 to 38 years). The average follow-up period was 12. 5 years (range, 10 to 18 years). Five wrists were Larsen-Dale-Eek’s grade II, 14 were grade III, and 6 were grade IV. Depending on the severity of bone destruction, the scaphoid in 6 wrists and the triquetrum in 3 wrists were included in the fusion site. Results. Preoperative pain (88%) and swelling (96%) decreased remarkably at follow-up (12%, 4%). Average grip strength increased significantly from 100mmHg to 140mmHg (p< 0. 01). The total arc of wrist extension/ flexion decreased to two-thirds of the preoperative arc with a major loss in flexion (preop. : 26/28degrees, follow-up: 23/13degrees). The range of forearm rotation increased due to a Darrach procedure. In periodical X-ray assessments of 23 wrists, carpal collapse initially improved following the operation, however, it returned to the preoperative level after 5 years. Ulnar carpal shift improved significantly after the operation (p< 0. 01), and the position remained unchanged over 10 years. In palmar carpal subluxation, no remarkable change was noted. Bone union occurred in 87% of the operated wrists and the remaining 13% had fibrous union. Widening at the lunocapitate joint (> 2mm) was noted in 4 wrists (17%) and progressive instability at the midcarpal joint occurred in one wrist with the mutilating type of disease. Narrowing (< 1mm) was noted in 5 wrists (22%) and 3 wrists were totally fused in the functional position. Discussion. Radiolunate arthrodesis provides good stability with some motion for the moderately deteriorated rheumatoid wrist more than 10 years after the operation, in spite of some radiological progression of the disease. This operation is considered to convert the natural course of the rheumatoid wrist from the unstable form to the stable form

Introduction. The wrist is the ”key-stone” of hand function. Painless stability is a prerequisite for the rheumatoid wrist to perform various manual tasks. Synovectomy of the extensor tendons and the wrist joint with a Darrach procedure is offered for painful wrists, which are not controlled by conservative treatment with medication and orthosis. Radiolunate arthrodesis is performed on wrists with an unstable radiocarpal joint and preserved midcarpal joint space. This study describes the long-term (more than 10 years) follow-up of these operative procedures. Materials and methods. The follow-up study was performed on 25 wrists in 25 rheumatoid patients (22 women and 3 men), whose average age was 52 years (range, 33 to 66 years) with an average disease duration of 12 years (range, 1 to 38 years). The average follow-up period was 12. 5 years (range, 10 to 18 years). Five wrists were Larsen-Dale-Eek’s grade II, 14 were grade III, and 6 were grade IV. Depending on the severity of bone destruction, the scaphoid in 6 wrists and the triquetrum in 3 wrists were included in the fusion site. Results. Preoperative pain (88%) and swelling (96%) decreased remarkably at follow-up (12%, 4%). Average grip strength increased significantly from 100mmHg to 140mmHg (p< 0. 01). The total arc of wrist extension/ flexion decreased to two-thirds of the preoperative arc with a major loss in flexion (preop. : 26/28degrees, follow-up: 23/13degrees). The range of forearm rotation increased due to a Darrach procedure. In periodical X-ray assessments of 23 wrists, carpal collapse initially improved following the operation, however, it returned to the preoperative level after 5 years. Ulnar carpal shift improved significantly after the operation (p< 0. 01), and the position remained unchanged over 10 years. In palmar carpal subluxation, no remarkable change was noted. Bone union occurred in 87% of the operated wrists and the remaining 13% had fibrous union. Widening at the lunocapitate joint (> 2mm) was noted in 4 wrists (17%) and progressive instability at the midcarpal joint occurred in one wrist with the mutilating type of disease. Narrowing (< 1mm) was noted in 5 wrists (22%) and 3 wrists were totally fused in the functional position. Discussion. Radiolunate arthrodesis provides good stability with some motion for the moderately deteriorated rheumatoid wrist more than 10 years after the operation, in spite of some radiological progression of the disease. This operation is considered to convert the natural course of the rheumatoid wrist from the unstable form to the stable form

The scaphotrapeziotrapezoid (STT) joint is one of the key link joints between the proximal and the distal carpal rows. We assessed the relationship between the scaphotrapezium (STm) andscaphotrapezoid (STd) joints using computerised tomographyand hypothesised the ratio of STm is =/< STd joint due to which, the possibility of failure of trapeziectomy due to metacarpal collapse is insignificant. We reviewed CT scans of wrist joints of 113 eligible patientsfrom our wrist database between 2009 and 2014 for our study. 31 patients were randomised for interobserver correlation. Reformatted multi-planar sequences were analysed. The ratio of theSTm: STdin sagittal and coronal measurementswas evaluated. Interobserver variations were assessed using the Pearson coefficient. The sex distribution included 68 males and 29 females, 49 left and 64 right wrists. The STm area was larger in 86 (76%) as compared to STd in 27(24%). Average trapezium to trapezoid ratio was 1:1.5. Ratio of area of trapezium: trapezoid joint is 0.30. The anatomic ratio of the STm in the coronal and sagittal planesis 0.3 and that of the STd joint is 0.2. Ratio of the STm: STd in the coronal plane is 0.29. Pearson's coefficient > 0.8. A small subset of patients undergoing trapeziectomy alonefor stage II- IV carpometacarpal arthritis of the thumb are at risk of impingement of the first metacarpal due to collapse. Our assessment of the anatomical relationship of the STT joint with CT scan proves that although the area the STm joint is generally larger than the STd joint, there is no significant correlation on the whole

Aims

The evidence demonstrating the superiority of early MRI has led to increased use of MRI in clinical pathways for acute wrist trauma. The aim of this study was to describe the radiological characteristics and the inter-observer reliability of a new MRI based classification system for scaphoid injuries in a consecutive series of patients.

Aims

The primary aim of this study was to report the radiological outcomes of patients with a dorsally displaced distal radius fracture who were randomized to a moulded cast or surgical fixation with wires following manipulation and closed reduction of their fracture. The secondary aim was to correlate radiological outcomes with patient-reported outcome measures (PROMs) in the year following injury.

Aims

The aim of this study was to create artificial intelligence (AI) software with the purpose of providing a second opinion to physicians to support distal radius fracture (DRF) detection, and to compare the accuracy of fracture detection of physicians with and without software support.

Aims

In the treatment of basal thumb osteoarthritis (OA), intra-articular autologous fat transplantation has become of great interest within recent years as a minimally invasive and effective alternative to surgical intervention with regard to pain reduction. This study aims to assess its long-term effectiveness.