Medical Malpractice Insurance for orthopaedic surgeons

Vascularity of the Lunate

– See:        – Blood Supply to the Wrist        – Kienbock’s Disease – Discussion:     – majority of lunates have both dorsal & palmar vessels & are thus as well vascularized as the other carpal bones;            – neither single intraosseous nor extraosseous disruption alone will cause avascular necrosis … Read more

Unstable / Displaced Scaphoid Fracture

– See: Radiographic Imaging – Discussion:     – unstable scaphoid fractures not only impact the potential for healing with non operative treatment, but they also impact on the position of             healing (and possible scaphoid non union or malunion);     – indicators of instability:            – trans-scaphoid perilunate dislocation;   … Read more

Ulnar Wrist Pain

– Discussion: – distal radioulnar subluxation/dislocation  (see TFC Injury) – tear of the lunotriquetral – ulnocarpal impingement syndromes – pisotriquetral osteoarthritis – pisotriquetral loose bodies – subluxation/dislocation of the pisiform – fractures (ulnar styloid Process) – chondromalacia – calcific tendinitis – medial carpal instability – radioulnar arthritis – subluxation of the ECU The ulnar impaction … Read more


        – See:       – Blood Supply to the Wrist       – Triquetrolunate Dissociation – Discussion:      – triquetrium is the 3rd most commonly fractured carpal bone;      – ular side of the wrist is supported by TFC, which articulates w/ both lunate and the triquetrum; … Read more

Treatment of Volar Wrist Ganglions

– Discussion:     – 20% of all ganglia     – most common site at volar wrist crease between the FCR and APL at the scaphotrapezoid joint;     – volar ganglions may be less amenable to aspiration than dorsal ganglions since the radial artery may be adjacent to the cyst     – recurrence … Read more

Treatment of Dorsal Wrist Ganglions

– Open Resection:     – short transverse incision directly over the mass;     – dorsal ganglions are often located between the EPL and EDC tendons;     – retinaculum is incised between the 2nd and 4th extensor compartments (EPL tendon sheath need not be incised);     – main cyst and its pedicle … Read more

Transstyloid Perilunar Dislocation

– See: Trans-scaphoid Perilunar Dislocation – Discussion:     – occurs as oblique frx through radial styloid, extending thru scapholunate ligament and around the lunate, through the triquetral attachments;     – due to the radiocapitate ligament, the fractured styloid process migrates  with the distal carpal row;     – because styloid is held by radiolunate … Read more

Trans-scaphoid Perilunate Dislocation

– Discussion:     – often more stable than pure perilunate dislocation if waist frx is transverse and the scapholunate ligament has remained intact;     – it is usually more unstable than an isolated scaphoid frx because of ligament damage;     – consider internal fixation for the scaphoid frx and a capsular repair … Read more

Surgical Treatment of Scaphoid Fracture

– Discussion: – primary internal fixation is treatment of choice for unstable scaphoid frxs; – frx treated by primary internal fixation, avg time for return to work is 3.7 wks w/ union rate, 97 %; – this compares very favorably with conservative treatment; – indications for surgery: – main indication is an unstable scaphoid frx … Read more