Rheumatoid arthritis is a systemic inflammatory disorder inducing multiple joint destruction. The wrist joint is frequently involved in early stage and proper management can preserve the ability to maintain a daily living and to work. Advances in medical treatment modalities can halt most joint destruction, however, not in all instances of joint inflammation and deformities. Most patients want to improve their own functional disability, pain, aesthetic problems in addition to medication. We review the current concept of rheumatoid wrist surgery and discuss the surgical treatment strategies for optimizing outcomes for patients with rheumatoid wrist.
Arthritis, Rheumatoid* ; Congenital Abnormalities ; Humans ; Inflammation ; Joints ; Wrist Joint ; Wrist*

No abstract available.
Cerebral Palsy* ; Congenital Abnormalities* ; Forearm* ; Humans ; Muscle Spasticity* ; Pronation* ; Wrist*

Even though closed treatment of Colles' fracture leads to satisfactory clinical results, many patients who have had such a fracture are found to have permanent disability and poor function of hand and wrist. Malunion occurs frequently following Colles' fracture and there is considerable disability, pain and deformity associated with this lesion. Such deformity of wrist can usually be prevented by proper treatment, but if deformity developes, better function and a normal appearing wrist can be restored by a corrective osteotomy. The authors experienced 6 cases of malunited Colles' fracture which had been treated by corrective osteotomy, Darrach resection, and osteoclasis, etc.
Colles' Fracture ; Congenital Abnormalities ; Hand ; Humans ; Osteotomy ; Wrist

During imaging studies or surgical procedures, anomalous forearm and wrist muscles are occasionally encountered. Among them, the flexor carpi radialis brevis is very rare. Because the trend is growing toward treating distal radius fractures with volar plating, the flexor carpi radialis brevis is worth knowing. Here, we report two cases with a review of the literature.
Female ; Forearm/*abnormalities ; Fractures, Comminuted/surgery ; Humans ; Middle Aged ; Muscle, Skeletal/*abnormalities ; Radius Fractures/surgery ; Ulna Fractures/surgery ; Wrist/*abnormalities

PURPOSE: We evaluated clinical and radiographic results of the pure cancellous bone grafting and internal fixation for the treatment of scaphoid waist nonunions with humpback deformity. METHODS: The subject of this study were 46 patients who had a scaphoid waist nonunion with humpback deformity treated with bone grafting between January 2005 and December 2011. The average follow-up period was 18.6 months (range, 12-26 months). We performed open reduction through an anterior approach with correction of the deformity and insertion of a screw from distal to proximal. We filled the resultant defect with pure cancellous autograft. The clinical results were evaluated with range of motion of the wrist joint, Disabilities of the Arm, Shoulder, and Hand (DASH) score, modified Mayo wrist score and visual analogue scale. For radiographic evaluation, we assessed lateral scapholunate angle and intrascaphoid angle. RESULTS: Bony union was achieved in 39 out of 46 patients (84.8%). DASH score significantly improved from 24.0 to 7.3 postoperatively. The modified Mayo wrist score also increased from 64.8 to 88.6 postoperatively. There were 17 excellent results 18 good results. The average scapholunate angle and intrascaphoid angle improved from 70.6degrees, 51.5degrees to 52.4degrees, 33.9degrees postoperatively. CONCLUSION: Pure cancellous bone grafting and internal fixation provide good clinical result in patients with a scaphoid waist nonunion with successful restoration of the humpback deformity.
Arm ; Autografts ; Bone Transplantation* ; Congenital Abnormalities* ; Follow-Up Studies ; Hand ; Humans ; Range of Motion, Articular ; Shoulder ; Wrist ; Wrist Joint

Multiple pterygium (Escobar) syndrome is a rare disorder manifested by growth retardation, facial and genital anomalies, and widespread musculo-skeletal deformities. This disorder was originally described by Bussiere in 1902. And then in 1976, Gorlin et al. described an autosomal recessive disorder characterized by congenital arthrogryposis, skin webs across joints and unusual faces. It was fully delineated as a distinct entity by Escobar et al. in 1978 and an alternative name, Escobar syndrome. In this report, we present an multiple pterygium syndrome that manifested by arthrogryposis, pterygium in shoulder, elbow, wrist, severe deviation of lower leg and ankle, webbed neck, microphthalmia, low set ears, small mouth and high arched palate, and genital anomalies.
Ankle ; Arthrogryposis ; Congenital Abnormalities ; Ear ; Elbow ; Joints ; Leg ; Microphthalmos ; Mouth ; Neck ; Palate ; Pterygium* ; Shoulder ; Skin ; Wrist

PURPOSE: To evaluate the long-term results of treatment of epiphyseal fractures of the distal radius in children. MATERIALS AND METHODS: 23 cases of distal radial epiphyseal fracture, treated by two methods: group 1, closed reduction (CR) plus cast (6 cases); group 2, CR and K-wire fixation (under anesthesia due to marked translation of the distal fragment and swelling) plus cast (17 cases), were selected for this study. All patients were followed up for more than 1 year (average: 3.2 years). Postoperatively, epiphyseal displacement and epiphyseal angulation were measured on anteroposterior and lateral radiographs. At follow-up, the affected and normal sides were compared. Final results were classified by radiologic (radial inclination, volar tilting and radial shortening) and clinical (limitation of ROM, wrist pain, grip strength and wrist deformity) criteria. RESULTS: Group 1 had 5 good, 1 fair result; group 2 had 14 good, 2 fair and 1 poor - there was no statistically significant difference between two groups. All cases where the epiphyseal displacement was less than 30% had good results. A poor case showed a radial shortening, wrist deformity and pain due to premature epiphyseal closure. Premature epiphyseal closure was treated by bar resection and free fat, along with corrective osteotomy when necessary and lengthening of radius with or without epiphysiodesis of the ulna. CONCLUSION: Remodeling can be expected in epiphyseal fractures of the distal radius. Repeated forceful attempts to achieve accurate reduction should be avoided to prevent secondary physeal injury.
Anesthesia ; Child ; Congenital Abnormalities ; Displacement (Psychology) ; Follow-Up Studies ; Hand Strength ; Humans ; Osteotomy ; Radius ; Wrist

Carpal malalignments in malunion of distal radius fracture are considered as an adaptive response of the carpus to loss of normal architecture of the distal radius. This condition leads to mechanical overload, ligament attenuation and progressive dynamic instability around the wrist joint. Radial corrective osteotomy is suggested as a treatment option of carpal malalignment after distal radius malunion. In radiocarpal malalignment, the lunate is usually observed in flexion in contrast to its extension posture in the more common midcarpal malalignment. We report two cases of fixed lunate flexion deformity after a distal radius fracture, in which reduction and fixation of fresh fracture or corrective osteotomy of malunion were not successful. Arthritic changes were observed in the radiolunate joint on arthroscopy. Thus, fixed flexion deformity of the lunate might be associated with posttraumatic arthritic change in the radiolunate joint.
Arthroscopy ; Congenital Abnormalities* ; Joints ; Ligaments ; Osteotomy ; Posture ; Radius Fractures* ; Radius* ; Wrist Joint

Carpal malalignments in malunion of distal radius fracture are considered as an adaptive response of the carpus to loss of normal architecture of the distal radius. This condition leads to mechanical overload, ligament attenuation and progressive dynamic instability around the wrist joint. Radial corrective osteotomy is suggested as a treatment option of carpal malalignment after distal radius malunion. In radiocarpal malalignment, the lunate is usually observed in flexion in contrast to its extension posture in the more common midcarpal malalignment. We report two cases of fixed lunate flexion deformity after a distal radius fracture, in which reduction and fixation of fresh fracture or corrective osteotomy of malunion were not successful. Arthritic changes were observed in the radiolunate joint on arthroscopy. Thus, fixed flexion deformity of the lunate might be associated with posttraumatic arthritic change in the radiolunate joint.
Arthroscopy ; Congenital Abnormalities* ; Joints ; Ligaments ; Osteotomy ; Posture ; Radius Fractures* ; Radius* ; Wrist Joint

Scapholunate advanced collapse (SLAC) deformity most often occurs with chronic rotary scaphoid instability from scaphoiunate ligament tear and scaphoid fracture. Prior to 1984 when Watson HK reported his concept on SLAC wrist deformity, the most popular procedure for this pathology was scaphoid implant arthroplasty with or without midcarpal fusion. We have reviewed 15 cases of SLAC deformity treated with scaphoid excision and midcarpal fusion from 1984 to 1993. Among them, scaphoid implants made of silicone were inserted in 4 cases. Scaphoid implant arthroplsty without carpal fusion has been excluded. The mean period of follow-up was 8.8 years and the mean age of patients was 47.5 years. Males and right wrists were predominant. Wrist motion was 56% and grip power was 71% of the normal opposite side. On the average overall, 8 patients had no pain and 7 patients had mild pain. The grade of pain was minimal, 0.5 in grade (Rating system: no pain-0, mild- 1, moderate-2, severe-3). However, all of the 4 cases of limited carpal fusion with a scaphoid implant developed silicone particulate induced synovitis and pain. The procedure appears to be effective in maintaining function of the hand with minimal pain up to 5.8 years. However, silicone scaphoid implant appears not to be necessary and is not recommended with a limited carpal fusion for this pathology.
Arthroplasty ; Congenital Abnormalities ; Follow-Up Studies ; Hand ; Hand Strength ; Humans ; Ligaments ; Male ; Pathology ; Silicones ; Synovitis ; Wrist