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The distal radioulnar joint (DRUJ) allows forearm rotation and load transmission across the wrist. Post-traumatic and degenerative joint disease of DRUJ may cause pain and disability. Deficiency of the soft tissue or bony supports may result in DRUJ instability. Various techniques have been developed to address arthritis and / or instability of the DRUJ. A comprehensive review of the spectrum of surgical techniques and arthroplasty options is presented. The concepts of these procedures are discussed in detail, with a focus on special points of interest to optimise outcomes and to avoid complications. The salvage of the complications of arthroplasties is also presented in detail.

Kienböck disease is a disorder of impaired lunate vascularity which ultimately has the potential to lead to marked degeneration of the wrist and impaired wrist function. The aetiology of the avascular necrosis is uncertain, but theories relate to ulnar variance, variability in lunate vascularity and intraosseous pressures. Clinical symptoms can be subtle and variable, requiring a high index of suspicion for the diagnosis. The Lichtmann classification has historically been used to guide management. We present a review of Kienböck disease, with a focus on the recent advances in assessment and treatment. Based on our understanding thus far of the pathoanatomy of Kienböck's disease, we are proposing a pathological staging system founded on the vascularity, osseous and chondral health of the lunate. We also propose an articular-based approach to treatment, with an arthroscopic grading system to guide management.

Little information is available about several important aspects of the treatment of melioidosis osteomyelitis and septic arthritis. We undertook a retrospective review of 50 patients with these conditions in an attempt to determine the effect of location of the disease, type of surgical intervention and duration of antibiotic treatment on outcome, particularly complications and relapse. We found that there was a 27.5% risk of osteomyelitis of the adjacent bone in patients with septic arthritis in the lower limb. Patients with septic arthritis and osteomyelitis of an adjacent bone were in hospital significantly longer (p = 0.001), needed more operations (p = 0.031) and had a significantly higher rate of complications and re-presentation (p = 0.048). More than half the patients (61%), most particularly those with multifocal bone and joint involvement, and those with septic arthritis and osteomyelitis of an adjacent bone who were treated operatively, needed more visits to theatre., (©2015 The British Editorial Society of Bone & Joint Surgery.)

The most common site of ulnar nerve compression is within the cubital tunnel. Surgery has historically involved an open cubital tunnel release with or without transposition of the nerve. A comparative study has demonstrated that endoscopic decompression is as effective as open decompression and has the advantages of being less invasive, utilizing a smaller incision, producing less local symptoms, causing less vascular insult to the nerve, and resulting in faster recovery for the patient. Ulnar nerve transposition is indicated with symptomatic ulnar nerve instability or if the ulnar nerve is located in a "hostile bed" (eg, osteophytes, scarring, ganglions, etc.). Transposition has previously been performed as an open procedure. The authors describe a technique of endoscopic ulnar nerve release and transposition. Extra portals are used to allow retractors to be inserted, the medial intermuscular septum to be excised, cautery to be used, and a tape to control the position of the nerve. In our experience this minimally invasive technique provides good early outcomes. This report details the indications, contraindications, surgical technique, and rehabilitation of the endoscopic ulnar nerve release and transposition.

Olecranon bursitis is a common clinical problem. It is often managed conservatively because of the high rates of wound complications with the conventional open surgical technique. Conventional olecranon bursoscopy utilizes an arthroscope and an arthroscopic shaver, removing the bursa from inside-out. We describe an extrabursal endoscopic technique where the bursa is not entered but excised in its entirety under endoscopic vision. A satisfactory view is obtained with less morbidity than the open method, while still avoiding a wound over the sensitive point of the olecranon.

Background: The gram-negative organism, Burkholderia pseudomallei, is responsible for the disease melioidosis. Septic arthritis and osteomyelitis due to B. pseudomallei are rare but recognised presentations of the disease., Methods: A prospective database of all cases of melioidosis in the Northern Territory of Australia has been kept since October 1989. Entries to April 2009 were reviewed and cases involving bone and/or joint were investigated. We also present in detail the case reports of 3 presentations of bone and joint melioidosis., Results: There were 536 presentations of melioidosis during the 20-year study period. Amongst these, there were 13 patients with primary septic arthritis and 7 cases of primary osteomyelitis. Septic arthritis and osteomyelitis were secondary to primary melioidosis elsewhere in 14 and 7 patients respectively. Melioidosis patients with bone/joint involvement were more likely to be Indigenous (p = 0.006) and female (p = 0.023) compared to patients with other presentations of disease., Conclusions: Timely microbiological diagnosis and prompt treatment of melioidosis involving bone and/or joint with appropriate intravenous antibiotics is important, as is adequate surgical drainage and debridement where indicated. A subsequent protracted course of antibiotic eradication therapy is important to avoid relapse of disease.

Purpose: We review the epidemiology, clinical presentation, management and outcome of prostatic abscess secondary to Burkholderia pseudomallei infection in the Northern Territory, Australia. We highlight the frequency of prostatic abscess occurrence in melioidosis, and formulate recommendations for its detection and management., Materials and Methods: We reviewed a prospective database of all culture confirmed melioidosis cases in the Northern Territory between October 1989 and July 2008. This review was supplemented with data obtained from a review of case notes and postmortem records during the same period., Results: There were 514 patients with 561 episodes of melioidosis, and of these patients 394 (70%) were male. A prostatic abscess was identified, usually by computerized tomography, in 81 (21%) of these episodes, in 77 patients. In 75 (93%) of the 81 episodes there was clinical evidence of prostatic infection or positive urine culture for B. pseudomallei. Kava use and hazardous alcohol use were independent predictors of prostatic abscesses compared to male patients without prostatic abscesses. All were treated with antibiotics and in 57 of the 81 episodes the abscesses were drained. Ultrasound guided needle drainage was used in 51 instances and open drainage in 28 (transurethral 13, transrectal 11, transperineal 4). There were 20 patients who underwent multiple procedures while 24 underwent no procedures., Conclusions: Prostatic abscess is common in melioidosis. Clinical signs are usually present but may be subtle. Detection is enhanced by routine computerized tomographic screening of the abdomen and pelvis for occult visceral abscesses in all cases of melioidosis. Ultrasound guided needle drainage is adequate initial therapy in conjunction with appropriate antibiotics.