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Scapholunate dissociation is well documented as a condition occurring in adult patients. We report it in a 14-year-old female patient. Persistent wrist pain 9 months after a well healed fracture of the distal radius triggered further investigation. Dynamic clinical and radiological studies demonstrated the instability.

Cutaneous flaps are not entirely satisfactory when used for soft tissue defects of the palm, because the skin cover is too mobile. Use of muscle flaps can therefore be advocated for this recipient site. A case is reported where the pronator quadratus muscle has been used as a free muscle flap for coverage of a small defect of the palm.

26 patients with at least one clinical symptom that could indicate a tear of the scapho-lunate interosseous ligament but normal static and dynamic radiographs were examined by arthroscopy. We found that a diagnosis of scapho-lunate instability could be established by dynamic manoeuvres during radio-carpal and mid-carpal arthroscopy. Five patients were found to have true scapholunate instability. Six tears of the interosseous ligament without instability were also detected but it was doubtful if the tear was the origin of the painful symptomatology. This experience suggests that dynamic manoeuvres during arthroscopy are superior to other methods in diagnosing scapholunate instabilities at the pre-radiographic stage.

In this work on vascularization of digital nerves, we have studied the anatomy of the deep network of venae comitantes of digital arteries, and the system of superficial palmar venules. 22 specimens of nerve and artery were dissected as one unit and were infused with Microfil prior to study under the microscope. The deep venous network, a satellite of the digital artery, can be classified into four types. A true network of deep venae comitantes exists in three of these four types, drained by deep veins arising from the transverse anastomotic arches between the palmar digital pedicles. Vascularization of the digital nerve is supplied by numerous anastomotic vessels connecting epineurial vessels, digital artery and the periarterial network (venae comitantes and vasa vasorum). This anatomical configuration lends itself to vascularized nerve grafting; for example, it is possible to use a nerve/artery graft taken as a unit from an amputated finger unsuitable for replantation. Two types of valves in this superficial venous network have been identified and their function is discussed.

In performing STT arthrodesis, the excision of the tip of the radial styloid avoids further radial styloid impingement. Cancellous bone graft can be obtained through the base of the excised radial styloid, using a trephine or a curette. The amount of bone removed is sufficient for intercarpal arthrodesis.

Since Taylor (1976) successfully performed the first vascularised free nerve graft, experimental and clinical data have not provided conclusive support for the superiority of this method of repairing loss of nerve substance. Experimental work yields conflicting results. Histologic results are in favour of vascularised grafts but non-vascularised fascicular grafts placed in a healthy bed recover sufficient neovascularisation within a short period of time (four to six days). In the field of brachial plexus repair, vascularised grafts give consistent results. However, if thrombosis of the anastomoses occurs, the grafts fail completely. In our experience, vascularised nerve grafts used for repairing digital nerves and arteries, have a high rate of thrombosis. There are few potential donor sites. A nerve graft cannot be considered to be physiologically vascularised if it relies only on an artery or on an arterialised vein. Given the present state of immunosuppressant treatments, vascularised allografts are not yet appropriate. Therefore, vascularised nerve grafts have limited applications. In general it is preferable to repair the tissue bed so as to promote revascularisation of conventional nerve grafts.