Only a few studies have assessed the outcome of ulnar nerve decompression, most comparing various forms of decompression. A review of the case notes of patients undergone ulnar nerve decompressions was undertaken looking at the pre-op symptoms, nerve conduction studies, the co-morbidities, operative procedures and the post-operative outcomes. We reviewed the case notes of ulnar nerve decompressions surgery performed over a period of six year period. Outcome grading was recorded as completely relieved, improved, unchanged or worse. The significance level was set at 5%.Introduction
Material/methods
Various authors have linked hypermobility at the trapeziometacarpal joint to future development of arthritis. When examining hypermobility, the anterior oblique ligament (AOL) and ulnar collateral ligament (UCL) are the two most important supporting structures. Literature suggests that reconstructive techniques to correct the hypermobility can prevent subsequent development of osteoarthritis. Eaton and Littler proposed a surgical technique to reconstruct the ligamentous support of this joint in 1973. This cadaveric biomechanical study aimed to evaluate the resultant effect on the mobility of the thumb metacarpal following this reconstructive technique. Seventeen cadaveric hands were prepared and strategically placed on a jig. Movements at the trapeziometacarpal joint were created artificially. Static digital photographs were taken with intact AOL and UCL at trapeziometacarpal joint (controls), for later comparison with those after sectioning of these ligaments and following Eaton-Littler reconstructive technique. The photographic records were analyzed using Scion.Image. Statistical analysis was performed using Minitab. A paired T-test was used to establish statistical relevance. Results confirmed that the AOL and UCL had a major role in limiting excessive motion at the trapeziometacarpal joint, principally in extension. Division of these ligaments produced a significant degree of subluxation of the metacarpal at this joint with thumb in neutral position (p-value = 0.013). Reconstruction of the ligamentous support using the Eaton-Littler technique reduced the degree of extension available (p-value = 0.005). This study confirmed the important role of the AOL and UCL in maintaining trapeziometacarpal joint stability, and that the Eaton-Littler reconstructive technique reduces the degree of hyperextension at this joint.
Ulnar nerve entrapment is the second most common nerve entrapment syndrome of the upper extremity. Despite this, only a few studies have assessed the outcome of ulnar nerve decompression. The objectives of the study were to review the pre-operative symptoms, nerve conduction studies, the co-morbidities, operative procedures undertaken and the post-operative outcomes; and investigate and ascertain prognostic factors particularly in cases of persistence of symptoms after the surgery. We reviewed the case notes of ulnar nerve decompressions surgery performed over a period of six year period. A structured proforma was created to document the demographics, patient complaints, method of decompression, per-operative findings and symptom status at the last follow up. Outcome grading was recorded as completely relieved, improved, unchanged or worse. Analysis of data was carried out using the SPSS software (Version 16.0; Illinois). The significance level was set at 5%.Introduction
Methods
Proximal humeral fractures are common injuries but there is no general agreement on the best method for fixing unstable and displaced 3 &
4 part fractures. A new implant – Proximal Humeral Internal Locking System (PHILOS) – has recently been introduced to fix these fractures. The aim of this study was to assess the effectiveness of the PHILOS plate in the surgical treatment of these fractures. We operated upon 36 patients between March 2002 and December 2004. 33 of them were available for follow up, which ranged from 12–45 months. Assessment at follow up included radiological review, Constant and DASH scoring. While recovery of movements and relief in pain was satisfactory, the strength of shoulder did not recover fully in any patient. There were two failures in our series, one due to breakage of plate. 4 patients have shown radiological signs of avascular necrosis of humeral head. The plate was removed in 4 patients due to impingement and / or mechanical block in abduction. Another 2 patients had to undergo arthroscopic subacromial decompression for the same reasons. We encountered the problem of cold welding and distortion of screw heads, while removing the PHILOS plate. The broken plate was subjected to biomechanical and metallurgical analysis, which revealed that the plate is inherently weak at the site of failure. The PHILOS plate does have inherent advantages over other implants for fixation of 3 and 4 part proximal humeral fractures but we are not convinced about its strength. Design of its proximal screws also appears less than satisfactory. The plate may cause impingement in some patients necessitating its removal later on, which itself may not be easy.
MATERIAL AND METHODS: We studied 123 ultrasound and looked for its use in different hand and wrist conditions. These were categorized in different groups such as diagnostic, anatomical and therapeutical.
Disorders of the pisotriquetral joint are well recognised as the cause of pain on the ulnar side of the wrist. The joint is not usually examined during routine arthroscopy because it is assumed to have a separate joint cavity to the radiocarpal joint, although there is often a connection between the two. We explored this connection during arthroscopy and in fresh-frozen cadaver wrists and found that in about half of the cases the pisotriquetral joint could be visualised through standard wrist portals. Four different types of connection were observed between the radiocarpal joint and the pisotriquetral joint. They ranged from a complete membrane separating the two, to no membrane at all, with various other types of connection in between. We recommend that inspection of the pisotriquetral joint should be a part of the protocol for routine arthroscopy of the wrist.
Disorders of the pisotriquetral joint can cause ulnar sided wrist pain. This joint is not usually seen during routine wrist arthrosopy because it often has a separate joint cavity. The senior author believes that it is more commonly seen from the 6R portal if looked for, than one would expect from the assumed anatomy. This study assessed the frequency with which the pisotriquetral joint could be observed in 36 consecutive wrist arthroscopies. The connection between the radiocarpal and the pisotriquetral joint were found to vary from a complete membrane separating the two, to no membrane at all, with variations in between. The types of connections are described. The anatomy of the connections was also studied by dissecting the wrist joints of eight fresh frozen cadavers. The findings matched the arthroscopic observations. In more than 50% of patients, the pisotriquetral joint could be clearly visualised by arthroscopy. The technique and findings have been recorded on video and form part of the presentation.