Fractures of the distal radius are one of the most common orthopaedic injuries, comprising 2.5% of all emergency department presentations. Radiographs are used for both diagnosis and to define the most adequate treatment, either conservative or surgical. Radial height, radial inclination, ulnar variance, dorsal/palmar tilt and, in articular fractures, step-off, are parameters often used to help the orthopaedic surgeon define the acceptable reduction for these fractures. The aim of this study is to evaluate intra and inter-observer correlation of these measurements.
Radiographs of 50 patients with distal radius fractures were reviewed (AP and lateral views) and three orthopedic consultant measured the referred parameters in all fractures, inter-observer correlation was calculated. Four weeks later the same three observers measured the same parameters in order to calculate intra-observer correlation.
Radial height, radial inclination, ulnar variance and dorsal/volar tilt all show excellent mean inter-observer correlation (0.90, 0.87, 0.85, 0.85, respectively). The measurement of the step-off shows only fair mean inter-observer correlation(0.50).
Concerning intra-observer correlation, all five parameters show excellent correlation (radial height 0.95, radial inclination 0.93, ulnar variance 0.88, dorsal/volar tilt 0.90, step-off 0.77).
Distal radias fracture treatment is based on fracture configuration and patient functional demands. The excellent intra and inter-observer correlation of radial height, radial inclination, ulnar variance and dorsal/volar tilt suggest that these parameters are adequate to measure the degree of fracture displacement. The measurement of step-off achieves only fair inter-observer correlation, therefore complex fractures that involve the articular surface benefit from CT scan for better evaluation.

The objective of this study was to report the experience of department, with the arthroscopic treatment of scaphoid non-union
A retrospective study of 11 cases was carried out, in which the inclusion criteria were non-union of the scaphoid without radio-carpal arthrosis, treated surgically in the period between 1 January 2016 and 1 January 2018, without selecting the location of the pseudoarthrosis . The preoperative study involved radiography and computed tomography and / or magnetic resonance imaging. Internal fixation was performed with kirschner wires or with a screw. The bone graft was collected from the contralateral iliac crest, percutaneously with a bone marrow biopsy needle. Pain, strength and range of mobility were assessed in the preoperative and postoperative periods. The smoking habits of each patient were also documented.
All patients were followed for a minimum period of 12 months. 10 patients were male and 1 female with an average age of 27 years. The average duration of diagnosis until surgery was 9 months. The strength of the wrist increased considerably, to levels similar to the contralateral wrist. The union was achieved in all patients.
The surgical technique presented in this study showed consistent and reliable results in the treatment of scaphoid pseudoarthrosis.

Pronator Quadratus pedicled bone graft for nonunion scaphoid
Abstract
Carpal scaphoid is notorious for nonunion, due to the anatomical, blood supply, and kinematics factors of the bone, which lead to ischemia and avascular necrosis of the proximal piece of the fracture for up to 3% of the cases. Vascular bone graft for the fracture gained a logical treatment solution that provides osteoinduction factor to the ischemic proximal bone. Aim of the study: is to evaluate the outcome of pronator quadratus muscle pedicled bone graft, in the treatment of fracture nonunion of the scaphoid with avascular necrosis of the proximal piece. Patients and Methods: A prospective case series study of 18 patients, of nonunion fracture scaphoid, with ischemia of the proximal piece. The mean age of patients was 27 years, treated by pronator quadratus pedicled bone graft, with internal fixation by K wires and a splint for eight weeks. The mean follow-up period was 24 months. Results: All the cases (100%) gained radiological union and clinical improvement, by the 12th week. There was a significant improvement in the scapholunate and intrascaphoid angles post-operatively, P. value: 0.0001.Mayo score mean was 73. Conclusion: Pronator quadratus pedicled bone graft is a good option to treat nonunion scaphoid with avascular necrosis.

Background:
Wide awake Local Anaesthesia No Tourniquet (WALANT) technique has been proposed for hand/wrist surgery including Carpal Tunnel Release (CTR). WALANT uses a combination of local anaesthetic and adrenaline to induce anaesthesia and haemostasis without the use of a tourniquet.

Objective:
The primary aim of the study was to compare outcomes between WALANT and tourniquet techniques for CTR.

Method:
This was a retrospective study carried out at a single Orthopaedic unit in London from December 2019 until March 2020. 72 patients who underwent CTR were included in the study with 36 patients in non-tourniquet and tourniquet groups respectively. Patient reported outcomes were then collected in order to assess for patient satisfaction by using the Boston Carpal Tunnel Questionnaire (BCTQ) pre-operatively and at six weeks post-operatively.

Results:
WALANT CTR was carried out in 36 patients (75% females, 25% males and mean age 64 years). This is in comparison to the tourniquet group which included 36 patients (78% females, 22% males and mean age 62 years). There were no complications such as wound infection and dehiscence. BCTQ symptom (BCTQ-S) score significantly improved at 6 weeks postoperatively in both groups. There was a mean reduction in BCTQ-S of 58.2% and 57.5% in the tourniquet and non-tourniquet groups respectively.

Conclusion:
WALANT is an excellent technique for hand and wrist surgery allowing for a bloodless surgical field without the discomfort associated with tourniquet application. This study confirms that WALANT has favourable patient outcomes and good rates of satisfaction for CTR.

Background: Triquetral fractures are the second most common carpal bone fractures after the scaphoid. Dorsal triquetral fractures are the most commonly reported fracture type; however, the management of these fractures does not appear to follow the evidence-base but rather surgeons’ preferences. Objectives: Collate the available evidence on the management and outcomes of dorsal triquetral fractures. Methods: Two researchers independently searched MEDLINE (via PubMed), Embase and Google Scholar using the following keywords: “Triquetrum” OR “Triquetral”, AND “Dorsal” OR “Dorsum” AND “Fracture”. Title, abstract and full-text screening was conducted following a predefined inclusion and exclusion criteria. References of included records were scanned for relevant articles. The internal and external methodology of studies were assessed following the CASP checklist.Results: Seven studies with a total of 261 dorsal triquetral fractures were included in this review. The most common management was conservative management by immobilisation of the wrist using a cast or a splint for an average of four weeks. Of 261 fractures, 108 were followed up and only two reported poor outcomes following treatment, such as lack of strength and restriction in wrist function. The other 104 followed up fractures had “Excellent”, “Very Good” and “Good” outcomes. Conclusion: Immobilisation in a cast or a splint for 4 weeks followed by physiotherapy is sufficient to result in the elimination of pain and return to normal function for the majority of dorsal triquetral fracture patients. If symptoms persist, further imaging (MRI/CT) should be considered to rule out TFCC or ligamental lesion.