POSTER ABSTRACTS - ISAKOS

suggestion of variable scaphoid motion. The
influence of scaphoid motion on the remainder of
the carpus will also be considered.
Methods
Embalmed Specimens were either dissected
(n=50) using 3x loupes, sectioned histologically
(n=30) or sectioned macroscopically (n=20) and
dynamic 3D computed tomography.
Results
Two distinct morphological patterns were
observed. Some scaphoids had a shallow capitate
facet and were supported by a series of ligaments
that may prevent flexion/extension but
allow/facilitate rotation about the longitudinal
axis of the scaphoid. Others had deeply concave
capitate facets and were supported by ligaments
that may prevent rotation but allow
flexion/extension. These patterns may be
continuous throughout the proximal row of the
carpus. Boney morphology of the midcarpal joint
varies with scaphoid types
Conclusions
Two distinct morphological patterns may dictate
the mechanical pattern of the carpus. A flexing
and extending scaphoid is restricted by the
capitate to its radial position, whilst a rotating
scaphoid may be allowed to translate along the
proximo-ulnar aspect of the capitate. The rotating
scaphoid may then push the lunate ulnarly to
facilitate radial deviation. This may not be
necessary with a flexing/extending scaphoid,
allowing the lunate to flex/extend to contribute to
similar global movements of the wrist.
E-poster w/ Standard #220
Complex, Comminuted Distal Radius Fractures:
Treatment by Modified Ligamentotaxis
employing Wrist Arthroscopy.
Sushrut Babhulkar, Nagpur, INDIA, Presenter
Ashish H Thakur, Nagpur, MS INDIA
Sushrut Hospital, Res Ctr & Post-Graduate Instt
of, Nagpur, INDIA
Complex, comminuted distal radius fractures
continue to pose dilemma in the minds of
Orthopedic surgeons worldwide. At our Institute
we prospectively studied 124 such injuries (
Frykman’s Type III VIII) being treated by a single
methodology by a single surgeon.
There were 84 males and 40 females. All victims of
road-traffic accidents. 76 patients had dominant
hand involved. Compound injuries were not
included. All of them underwent surgical
procedure within 7 days of the injury. Criteria on
deciding timing of surgery was diminution of the
swelling and edema around wrist.
A standard surgical technique was used in all the
patients which included regional anaesthesia,
application of manual reduction techniques for
comminuted fragments followed by application of
a multiplanar external fixation apparatus. This
then was followed by wrist arthroscopy using a 2.5
mm scope (Arthrex Inc). The findings included
TFCC peripheral tear ( repairable, irrepairable),
TFCC Central tear, Scapholunate dissociation,
Lunatotriquetral dissociation, DRUJ dissociation,
Ulnar styloid fracture, Chondral surface lesion on
carpal side
All the above mentioned lesions were taken care
of employing various reconstructive techniques (
TFCC repair, Scpholunate k wire fixation,
Debridement etc)
Arthroscopic technique employing these
techniques alongwith the joystick maneuver
helped in reduction of articular fragments and
holding them under vision during precutaneous
fixation. This particular method ensured precise
articular reconstruction.
All the patients were followed for a period of 3 to
5 years but minimum for 3 years. All th e findings
were evaluated using Objective, Subjective,
Clinico-radiological criteria and results then
calculated after employing Demerit Point System.
Excellent to good results were obtained in 92 %
cases. Fair in 5 % and Poor in 3% cases.
Complications encountered were mainly related
to External Fixation , early radiological collapse
and wrist stiffness.
Employing Wrist Arthroscopy techniques results
of conventional Ligamentotaxis can be improved
in terms of intra-articular soft-tissue stability thus
avoiding early collapse. This also will avoid early
arthritic changes occurying eventually. This thus
seems to be an effective and reproducible
modality of treatment for such complex injury of
distal radius though it has a steep learning curve.
E-poster w/ Standard #221
Wrist Arthroscopy in the Diagnosis of Pediatric
Wrist Conditions
Paramasivam Sathyamoorthy, Warrington,
UNITED KINGDOM, Presenter
Lore Feldberg, Merseyside, UNITED KINGDOM
Pidikiti Prasad, Merseyside, UNITED KINGDOM
Stilwell John, Merseyside, UNITED KINGDOM
Alderhey Children's Hospital, Liverpool, UNITED
KINGDOM