PubMed · 13778035
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A TRIAS, K MUELLER, R D RAY. 1961. Epiphysial stapling.. https://pubmed.ncbi.nlm.nih.gov/13778035/
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A bone defect of 14 cm resulted after wrist implant removal because of loosening in a 46-year-old patient. Performing wrist arthrodesis the defect was reconstructed by a vascularized fibular transfer. Solid bone fusion was complete in six weeks. Free function of the digits was seen because of length reconstruction.
PURPOSE: To examine the effects of scaphoid retention, inclusion, and excision on wrist motion and radiolunate contact characteristics in a cadaveric model after simulated 4-corner fusion with rigid internal fixation. METHODS: Seven fresh-frozen cadaveric upper extremities were examined. For all surgical manipulations the motion was measured and contact characteristics were assessed using ultra-low prescale pressure-sensitive film. RESULTS: Compared with the intact specimen, simple 4-corner fusion with scaphoid retention led to a significant decrease in extension, radial deviation, and ulnar deviation, but no change in radiolunate contact characteristics. After 4-corner fusion there was no significant difference in motion or radiolunate contact characteristics between scaphoid retention and scaphoid inclusion. After 4-corner fusion scaphoid excision allowed significantly greater radial deviation compared with scaphoid retention and scaphoid inclusion. Compared with the intact specimen 4-corner fusion with scaphoid excision also led to a significant increase in radiolunate contact area and mean contact pressure. CONCLUSIONS: When performing 4-corner arthrodesis in the absence of radioscaphoid arthritis, scaphoid excision may improve motion at the cost of increased mean radiolunate contact pressure.
The use of external fixation in foot and ankle surgery has steadily increased with the advent of devices geared toward the foot and ankle that have evolved over the past decade, as well as a greater understanding of the indications and advantages of external fixation. The application of external fixators in the forefoot may at first glance seem both limited and possibly overkill, but once the basics of external fixation and the types of devices available are understood the options for use become numerous.