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Chronic exertional compartment syndrome of the forearm is an uncommon condition causing transient symptoms of arm pain, decreased grip strength, altered sensation and dysfunction with strenuous activities involving gripping. Symptoms fully resolve with rest. The cause is not known. It is a clinical diagnosis made from the history and a normal clinical examination. Confirmatory testing with compartment pressure monitoring is only indicated if there is any doubt regarding the diagnosis. Treatment is surgery with a fasciotomy of the affected compartment(s). The results for this procedure are excellent in the majority of cases with a full return to sporting activity within 6 weeks.

Background This was a retrospective study presenting our results and survivorship of the Acclaim total elbow when used as a revision implant. Methods Between May 2001 and July 2005, 29 revision elbow replacements were carried out on 28 patients in our institution. Five were redo revisions and one received the fourth sequential implant. A variety of implants were removed for aseptic loosening (17), periprosthetic fracture (7), dislocation (3) and infection (2). Two patients had died and one was unavailable for follow-up. Results At a mean follow-up of 50 months (12 to 80 months) pain, functional assessment scores and radiographs were assessed and a Kaplan-Meier survival curve created. Symptoms were reliably relieved with 72% reporting no pain. Mean flexion was 128° with loss of full extension of 34°. Complications were noted in six cases of which three patients underwent further surgery. None of the 29 revisions has been re-revised till date. Conclusion The medium term results for this implant suggest it is an effective revision prosthesis.

The modern practice of hand surgery was pioneered by Dr Sterling Bunnell in San Francisco, who had a keen interest in surgery of the hand. He wrote a seminal article on tendon repair in 1918. He was asked to improve the management of hand trauma patients in the Second World War by US Army Surgeon General Norman Kirk who recognized the need for specialist and coordinated care to treat the various extremity injuries seen in combat. He set up a series of hand centers at Army hospitals across the US and educated surgeons. He published ‘Surgery of the Hand’ in 1944, which was the authoritative text for 30 years, and was instrumental in the formation of the American Society for the Surgery of the Hand in 1946. Surgeons such as Kanavel treating infections, Kleinert treating tendon injuries, Buck-Gramcko and others on congenital abnormalities and Gillies on skin flap coverage made further advances in this area. More recently plastic hand surgeons have made advances in microvascular techniques and in the understanding of nerve healing to allow procedures such as digital replantation to occur.

86.5 Summary A case series of 60 patients with a Colles fracture, treated in a standard manner with closed reduction and plaster immobilization in the same institution and followed up radiologically and by clinical examination at 1 year. A radiological classifi cation scoring system was proposed based on the presence or absence of joint involvement, metaphyseal comminution and/or angular deformity. Lindstrom later expanded this in 1959 to six groups, describing the fragment displacement in further detail, along with joint involvement. The Gartland and Werley score was introduced as an outcome measurement for evaluating wrist and hand function.

Chronic exertional compartment syndrome (CECS) of the forearm may occur in sports requiring prolonged grip strength. CECS is a function of increasing pressure following muscle expansion within an inelastic tissue envelope resulting in compromise of perfusion and tissue function. Typical symptoms are pain, distal paraesthesia and loss of function. The condition is self-limiting and resolves completely between periods of activity. With no effective medical treatment, the gold standard remains four compartment open fasciotomy (Söderberg, J Bone Joint Surg Br 78(5):780–2, 1996; Wasilewski and Asdourian, Am J Sports Med 19(6):665–7, 1991). Minimally invasive techniques have been described (Croutzet et al., Tech Hand Up Extrem Surg 13(3):137–40, 2009) but have a risk of neuro-vascular injury, especially to the ulnar nerve while releasing the deep flexor compartment. We present a safe technique used with six elite rowers for mini-open fasciotomy to minimise scarring and time away from training while reducing the risk of neurovascular injury.

Introduction Acutrak 2 screws are commonly used for scaphoid fracture fixation. To our knowledge, the variation in compressive force along the screw has not been investigated before. The objectives of our study were to measure variance in compression along the length of the standard Acutrak 2 screw, to identify the region of the screw which produces the greatest compression and to discuss the clinical relevance of this to the placement of the screw for scaphoid fractures. Materials and methods A laboratory model was set up to test the compressive force at 2 mm intervals along the screw, using solid polyurethane foam (Sawbone) blocks of varying width. The Acutrak 2 screws were introduced in the standard method. Forces were measured using a custom-made load cell washer introduced between the Sawbone blocks and were plotted as a graph along the whole length of the screw. Results Maximum compression was at the mid-point of the screw. Overall compressive forces were higher in the proximal half of the screw by 19% when compared with the distal half. Minimum compression was seen at 4 mm or less from either end of the screw. Conclusions There is variation in compression along the length of the standard Acutrak 2 screw and the maximum compression was obtained at the mid-point of the screw. From this study, we would recommend when using an Acutrak 2 screw for internal fixation of scaphoid fractures, to attain maximum compressive force, place the fracture at the mid-point of the Acutrak screw. If this is not possible, then place the fracture towards the proximal half of the screw.