Martin A. Posner’s research while affiliated with Gracie Square Hospital, New York, NY and other places

We performed an in vitro study using canine flexor tendons to compare the tensile properties of a suture technique for flexor tendon repair with the standard modified Kessler technique. The technique employs a central wire loop that connects the two transverse limbs of the modified Kessler suture. Both techniques were studied with and without a Lembert epitendinous stitch. The technique combined with an epitendinous suture provided the strongest resistance to gap formation, and its load at gap initiation was 100% greater than the load in tendons repaired with the modified Kessler and an epitendinous suture. Because of its increased resistance to gap formation, this suture technique may provide a safer margin for controlled early active motion after flexor tendon repair.

Simultaneous rupture of the flexor superficialis and profundus tendons is an exceedingly rare injury, particularly if the tendons have not been previously damaged, either by disease or attrition. This case report involves ruptures of both tendons at their respective insertions, and injury that to our knowledge has not been previously reported.

Dorsal capsular injuries, volar plate injuries, ulnar collateral ligament injuries, and radial collateral ligament injuries are all discussed in this article. Treatment is both discussed and illustrated for ease of comprehension.

A new "bloodless" technique (Ilizarov) was used to correct 36 limb deformities in 29 children. There were six leg length discrepancies, five achondroplasias, four deformed feet, five joint contractures, one rotational deformity of tibia, and in three the apparatus was used as an external fixator after corrective osteotomy. Lengthening was accomplished in 15 of the 16 procedures (93%). Average increase in femur length was 10 cm (32%), in tibial length 7.5 cm (30%), in humerus 11 cm (40%). Bony union was achieved in two out of five pseudoarthroses. Four deformed feet were fully corrected. Joint contractures were corrected in four out of five. The complication rate is as high as in other methods but with the Ilizarov apparatus, longer segments of bone were lengthened and more complex deformities were treated. Complications lessened as experience was gained.

Instability of the ulnar side of carpus centers around the triquetrum, which is suspended by the ulnar triquetral ligaments and supported proximally by the TFCC. The triquetrum guides the lunate by an interosseous membrane and stout palmar ligaments that provide a relatively rigid connection between the two bones. Disruption of the LT ligament is frequently associated with pathology in the ulnar carpal area and may progress to triquetral instability, VISI, and finally, degenerative arthritic changes on the ulnar side of the carpus. The diagnosis of LT injuries is made by stress radiographs, arthrography, video-fluoroscopy, and arthroscopy. Treatment is initially nonoperative, but if symptoms persist, surgery is warranted. Arthroscopic debridement and pinning the LT joint, ligament repair or reconstruction, and intercarpal arthrodesis have all been reported as successful treatments. For the chronic problem confined to the LT joint, a limited intercarpal arthrodesis of the joint is the most predictable procedure for relieving pain without causing any significant restrictions in wrist motions. When there is a dissociation pattern in addition to LT instability, a more extensive intercarpal arthrodesis is required. Midcarpal instability occurs at the triquetral-hamate joint and is characterized by a dynamic subluxation of the joint. During ulnar deviation, the joint undergoes an exaggerated shift from volar flexion to dorsiflexion. Supportive care is generally successful; although in chronic cases, a midcarpal joint arthrodesis is often required.

A fresh cadaver study of the effects of a variety of scaphoid stabilizations on wrist motions is reported. Scaphoid-trapezium-trapezoid stabilizations with the scaphoid in its normal anatomic position and the same stabilizations with the scaphoid in malposition, either vertical or horizontal in relation to the radius, were compared. Scaphoid-capitate stabilizations with the scaphoid in its normal position were also studied. With the scaphoid vertical, a scaphoid-trapezium-trapezoid stabilization resulted in greater loss of wrist flexion and ulnar deviation whereas, with the scaphoid horizontal, wrist extension and radial deviation were more severely affected than when the scaphoid was stabilized in its normal position. With the scaphoid in its anatomic position, both scaphoid-trapezium-trapezoid and scaphoid-capitate stabilizations resulted in similar patterns of wrist motion.

Scapholunate dissociation is a common wrist problem that can result in a significant disability. The pathognomonic radiographic sign is widening of the space between the scaphoid and lunate due to rotatory subluxation of the scaphoid. Wrist radiographs in the anteroposterior (AP) rather than the posteroanterior (PA) projection facilitate visualizing the widened intercarpal space. Scapholunate dislocations can also be dynamic in nature and motion radiographic studies are necessary to make the diagnosis in these rare cases. Treatment for a scapholunate dissociation continues to pose a dilemma for the clinician. For chronic cases, reducing the scaphoid subluxation and arthrodesing it to the capitate is an effective procedure. Although the fusion, as with other intercarpal fusions involving the scaphoid alters wrist mechanics, it succeeds in restoring stability and reducing pain.