Izadpanah, Ali

Background: The objective of the study was to evaluate and compare the clinical outcomes of in situ decompression with subcutaneous and submuscular transpositions for surgical management of advanced (McGowan stage III) cubital tunnel syndrome (CuTS). Methods: A retrospective review of patients in our institution undergoing primary surgery for CuTS from February 1989 to May 2009 was performed. Patients with advanced CuTS with a minimum of 12 months of follow-up without any previous bony or soft tissue procedures around the elbow were included. Seventy-four patients underwent 80 primary ulnar nerve surgeries. Patients’ demographics, presenting symptoms, physical examination, electrodiagnostic findings, and perioperative complications were recorded. Primary surgical techniques were compared and the risk factors for revision surgery were assessed. Results: Of the 80 surgical procedures, there were 17 decompressions (21%), 47 subcutaneous transpositions (59%), and 16 submuscular transpositions (20%). Fifty-two percent of patients had resolution of their symptoms after primary surgery. The overall complication rate after primary surgery was 12.5%. Nineteen patients (24%) had revision surgery at a median of 30 months after their primary procedure. Eight patients (42%) had symptomatic improvement after revision surgery. Patients with their dominant extremity affected, static 2-point discrimination (S2PD) greater than 10 mm, and age less than 50 years at presentation had a higher rate of revision surgery. Three patients had a second revision surgery and neurolysis for persistent symptoms. Conclusions: The overall revision rate in advanced CuTS was 24%. Forty-two percent of patients had reported subjective symptomatic improvement after revision surgery. Younger age at presentation and a greater S2PD were associated with a higher rate of revision surgery.

Background Management of scapholunate (SL) ligament disruption is a challenging problem. The reduction and association of the scaphoid and lunate (RASL) procedure has been described with varying results. This study assessed the outcomes of the RASL procedure. Purpose The objective of this study was to assess the outcomes of patients undergoing the RASL procedure at our institution in regard to pain relief, range of motion, radiographic and functional outcomes, complications, and reoperations. Materials and Methods Twelve patients with symptomatic chronic SL instability underwent the RASL procedure. The mean age was 35 years. The mean time from injury to surgery was 40 weeks. The mean follow-up was 89 months. Outcomes included visual analog score for pain, wrist range of motion, grip strength, and Mayo Wrist Scores. Preoperative and postoperative radiographs were reviewed. Results Pain scores improved in 10 wrists. Range of motion and grip strength worsened. The average Mayo Wrist Score was 63.3. The mean SL diastasis and angle improved, but seven wrists developed progressive degenerative changes, with two requiring a salvage procedure. Symptomatic progressive screw lucency occurred in eight wrists requiring screw removal. Conclusion The RASL procedure can improve SL widening but has a high rate of early failure and reoperation. Following reoperation, long-term follow-up demonstrates reasonable long-term durability in some cases. Level of Evidence This is a Level IV, therapeutic case study.

Background: Distal radius malunions lead to functional deficits. This study compares isolated ulnar shortening osteotomy (USO) to distal radius osteotomy (DRO) for the treatment of ulnar impaction syndrome following distal radius malunion. Methods: We retrospectively reviewed 11 patients with extra-articular distal radius malunions treated for ulnar impaction with isolated USO. This group was compared to a 1:1 age- and sex-matched cohort treated with isolated DRO for the same indication. Pain visual analog scale (VAS), wrist motion, grip strength, radiographic parameters, and perioperative complications were analyzed. Mean follow-up was 14.8 months. Results: VAS scores improved. Wrist range of motion improved in both cohorts with the exception of radial deviation, pronation, and supination in the USO cohort, which decreased from a mean of 17°-16°, 67°-57°, and 54°-52°, respectively. There was no significant difference between groups in regard to change in pain or range of motion, with the exception of pronation and ulnar deviation. The mean tourniquet time was shorter in the USO group. The final ulnar variance was 1.8 mm negative in the USO group and 1.1 mm positive in the DRO group. There was 1 reoperation following USO for painful nonunion, while there were 2 reoperations following DRO for persistent ulnar impaction. Conclusions: An improvement in range of motion, grip strength, and VAS with restoration of the radioulnar length relationship was observed in both cohorts. USO is a simpler procedure with a shorter tourniquet time that can be an attractive alternative to DRO for ulnar impaction syndrome after distal radius malunions.

Background: Chondroblastomas are benign tumors that typically occur in the epiphysis of long bones. Carpal bone chondroblastomas are very rare and are known to have less aggressive behavior with no evidence of recurrence reported. Methods: We present a case of a recurrent chondroblastoma in the capitate that was treated with repeat curettage, application of phenol, and bone grafting. Results: At 3 years post surgery, the patient is disease free with excellent functional return. Conclusion: Chondroblastomas are rare within the carpus. We present a review of the literature detailing their occurrence and treatment.