Aim: Total Wrist fusion is the main procedure for treatment of postraumatic and degenerative wrist osteoarthritis. During the last decade, midcarpal fusion has become more and more popular as it preserves motion. The purpose of this study was to compare the functional and workers compensation results of both treatments on active workers.

Material and Methods: A prospective study to evaluate 77 patients (76 male and 1 female) who underwent wrist fusion, between 2002 to 2006, with an average of 28 months of follow-up (range, 12–58 months) were made. The mean age were 32 years (range, 25–48 years) and all patients were medium or high level workers with postraumatic and degenerative wrist osteoarthritis. The aethiology in 67% of the patients was SNAC wrist. Right hand was involved in 65% of the patients.

Thirty-eight patients were treated with scaphoid excision and 4-corner fusion using dorsal circular plate. Thirty-nine patients were treated with total wrist fusion using one single, dorsal, precontoured and tapered plate for osteosynthesis and third carpometacarpal joint (CMCJ-3) was included. All patients were immobilised in a cast for 4 weeks after surgery.

Postoperative complications, pain (visual analogue scale), clinical and functional outcome based on Green and O’Brien score, grip strength, X-ray evaluation, time to return to work and activity level were evaluated and compared.

Results: Consolidation was obtained in all cases at 10 weeks. Pain evaluation score was 19,2 (4-corner) and 13,8 (total fusion) on post-op time. The mean modified Mayo wrist score was 70,4 (4-corner) and 69 (total wrist). Average lost of pinch strength was 43% (4corner) and 21% (total fusion). 2 patients with 4-corner fusion required total wrist arthrodesis. Three cases who had a total wrist fusion, required implant removal.

The average time to return to work was 17 weeks (4-corner) and 16,2 weeks (total fusion). All patients return to work. Twelve percent of four-corner fusion and 72% of total wrist fusion return to the same work level with restrictions (until 33% of activity). Twenty-two percent of 4-corner fusion and 28% of total wrist fusion were unable to return to their previous activity level, performing lower intensity work activities. Overall satisfaction was high in both groups with 85% (4corner) and 93% (total fusion).

Conclusion: Both fusion techniques allows an effective stabilization, maintaining the bone stock and eliminate wrist pain with fast return to work.

Total wrist fusion had less surgical failures, better level of satisfaction, lesser lost of force than 4-corner fusion, with less potential for further deterioration with time. However, 4-corner fusion allows return to work with a similar activity level and preserve a functional range of motion in patients with high levels of activity.

Introduction: Intraarticular fractures of distal radius are associated with high energy mechanisms, are severe and difficult to obtain a surgical reduction. The aim of our paper is to compare the clinical, radiographically and activity results in workers treated with surgical and conservative procedures.

MATERIAL AND METHODS: A prospective study was organized in 43 heavy-labour workers (34 male and 9 female) with unstable fractures of distal radius, treated between 2003 and 2005. The minimal follow-up was of one year. The mean age were 40 years (22–65 years) and dominant limb was involved in 40% of the cases. To treatment groups were established. Group 1, conservative treated with indirect reduction and cast immobilization (n=20) and Group 2 surgically treated with indirect reduction and percutaneous fixation with K-wires and cast immobilization (n=24).

Pain, mobility and radiograhs were evaluated and also strength (isokinetics), functionality (DASH score) and, finally, the return to work at 3, 6 and 12 months.

RESULTS: Fracture healing was obtained at 7 weeks but the time to return to work were 14 weeks after surgery. Pain score, at 12 months, were 2,3 points for conservative treatment and 2,9 points for the surgically group. The flexion – extension mobility loss, in relation to the contralateral wrist, was lesser in the conservative group at 3 and 6 month but similar (11°) at 12 months in both groups. Radiographs corrections were anatomically in 38% of the cases of group 1 and in 80% of group 2. Functional and strength results were similar in both groups. All the patients return to the same work activity.

CONCLUSIONS: Percutaneous fixation of unstable intraarticular distal radius fracture is comparable to the conservative treatment but the percentage of anatomical reductions was higher. It would be of importance in the evolution of the patients.

AIM: The scaphoid resection with four-corner fusion is an effective procedure for treatment of postraumatic and degenerative wrist osteoarthritis. Few studies that evaluated the functional and workers compensation results are available in the literature. We presented the results of 4-corner fusion on active heavy labour workers.

MATERIAL AND METHODS: A prospective study to evaluate 38 patients (37 male and 1 female) who underwent 4-corner fusion, between 2002 to 2005, with an average of 24 months of follow-up (range, 12–48 months) were made. The mean age of the patients were 32 years (range, 25–48 years). All patients were heavy-labour workers. The aethiology in 77% of the patients was SNAC wrist. Dominant limb was involved in 65% of the patients. All patients were immobilised in a cast for 4 weeks after surgery. Patients were assessed clinically and radiographically. Functional analysis of grip and pinch strenght were performed.

RESULTS: Consolidation was obtained in all cases at 10 weeks. Pain evaluation score was 77 at pre-op and 19 on post-op time. The range of flexion – extension movement postoperative was 57°. Average lost of pinch strength was 25%. All patients return to work, 80% to the same activity level and 20% to a different work performing less strenuous activities. After surgery, the range time to return to work was 160 days.

CONCLUSION: The four-corner fusion allows an effective stabilization, maintaining the bone stock and eliminate wrist pain. This technique permit a fast return to work with a great level of satisfaction and preserve a functional range of motion with a minimum lost of force in heavy labour workers.

AIM: We present the results of scaphoid non-unions treated with open reduction, bone grafting and internal fixation with biodegradable implants on active heavy labour workers.

MATERIAL AND METHODS: Between 2002 to 2004, 20 patients with scaphoid non-unions were treated by open reduction, bone grafting and internal fixation using self-reinforced poly-L-lactic acid screws. The mean prospective follow-up was 24 months (range, 12–38 months). The mean age was 28 years (range, 18–42 years). All patients were male and heavy-labour workers.

The patients were assessed clinically (modified Mayo wrist score) and radiograhically. The grip and pinch strength were also studied.

RESULTS: We find 13 excellent results, good in 5 cases and poor in 2 cases. A Matti-Russe group patient was revised 6 months after the first intervention. Any fragment displacement, implant loosening or adverse reaction was found. Most of the patients (90%) return to the same work and the same level without complications.

CONCLUSION: Both groups are a good alternative for the scaphoid non-unions treatment. However, biodegradable implants disappears in the time, the removal are no necessary, facilitate the revision surgery, if necessary, and permitted MRI studies to evaluated the graft viability.

Purpose: To assess the mid-term result of untreated stable longitudinal tears diagnosed during ACL reconstruction surgery.

Materials and methods: The study comprised 19 patients who had peripheral longitudinal tears of the internal meniscus and 6 with longitudinal tears in the external meniscus, diagnosed during ACL reconstruction surgery. No surgical procedure was applied to these tears. In 14 of the 25 patients, the ACL was reconstructed using RIGIDFIX (Mitek) and in 11 the SWIN-BRIDGE (Citieffe) was used. The mean follow-up was 20.5 months. The clinical evaluation was made using the IKDC score.

Results: None of the 25 patients had to be revised for meniscal problems in the two years after surgery. Three of them were subjected to minor revisions (mobilizations under anesthesia). All patients went back to work after an average of 3.2 months after surgery. 4 patients were classified as belonging to class A in the IKDC score, 16 fell into class B and 5 into class C. None of the patients was rated as belonging to class D.

Conclusions: Conservative treatment of stable longitudinal meniscal tears diagnosed during ACL surgery yields good mid-term results. The number of revisions due to meniscal problems is very small.