Objective: Wrist trauma is a common chief complaint in emergency departments and radiography is used to make the diagnosis. Excessive usage of radiographs would utilize resources, exert risk of radiation exposure, and overcrowding. Amsterdam wrist rules (AWR) have been proposed as a tool for clinical decision-making regarding the need for wrist fracture diagnosis. This study assessed the diagnostic test performance of this rule in wrist trauma for wrist fracture. Methods: All patients over 18 years old with the chief complaint of acute wrist trauma were included. They were excluded if Glascow coma scale (GCS) was below 15, needed emergency surgery without an X-ray, and had a history of wrist fracture in the past 3 months. Anteroposterior and lateral radiographs were obtained and the AWR predictors were assessed before going to the radiology unit. The presence of a fracture of the distal radius was confirmed by treating emergency physician or radiologist. Results: 205 participants were recruited in this study, of which 6 patients (2.9%) were excluded due to missing data. The median age was 40 (IQR: 30-50) and 74 (37.2%) patients were female. There were 66 (33.2%) patients with a wrist fracture, which distal radius accounted for most of them. The AWR had sensitivity and specificity of 0.71 (95% CI: 0.49,0.87) and 1 (95% CI: 0.92,1), respectively. Although the negative likelihood ratio of AWR was 0.29 (95% CI: 0.16,0.54), the positive likelihood ratio was infinite. The positive predicted value was 1 (95% CI:  0.80,1), whereas the negative predictive value was 0.86 (95% CI: 0.74,0.94). Conclusion: The AWR showed great specificity and positive predictive. It had fair sensitivity, negative predictive value, and negative likelihood ratio for diagnosis of wrist fracture in patients with wrist trauma.

Background: Wrist arthroscopy is an evolving diagnostic and therapeutic modality which is progressively used by Iranian surgeons. Little data is published about the procedure’s indications, outcomes, complications and prognostic factors. In following study we evaluate the outcome and complications of diagnostic and therapeutic arthroscopy in our patients.Methods: In a prospective study from September 2009 to March 2013, 100 patients entered in the study. All the patients had chronic wrist pain without any sign of improvement despite at list three months non-operative treatment and underwent diagnostic and therapeutic wrist arthroscopy. All patients were evaluated by wrist range of motion, visual analogue scale (VAS), the quick-disabilities of the arm, shoulder and hand (QDASH), and Mayo wrist functional score before and after arthroscopy. Patients were visited at 3, 6, 12 weeks intervals after surgery and every six months thereafter. The most frequent diagnoses were triangular fibrocartilage complex (TFCC) injury, dorsal wrist ganglion cyst and Kienbock disease which were treated with accordant arthroscopic methods. Major and minor complications of arthroscopy and prognostic factors were evaluated.Results: Eighty nine patients participated in long term follow-up. The follow-up duration was 19±13 months. At final fallow-up there were 28.6±9.6 degrees improvement in wrist range of motion, 5.1±3.4 reduction in VAS score (P<0.04), 37.9±30 improvement in Mayo functional wrist score (P<0.02) and 47.5±33 reduction in Q-DASH score (P=0.009).82% of patients were satisfied with postoperative results and 16% experienced recurrence. The preoperative diagnosis was not a prognostic factor for outcome of arthroscopic treatment. The rate of postoperative complications was 31.4%, which most of them were minor and transient complications. The most frequent complication of wrist arthroscopy in our patients was transient hypoesthesia in superficial ulnar nerve territory.Conclusion: According to our results, wrist arthroscopy have acceptable outcome in TFCC injuries and Kienbock disease. With the ever-expanding list of indications and procedures that can be performed with wrist arthroscopy, it can be considered as an essential diagnostic and therapeutic tool for the orthopedic surgeon.

Wrist involvement is common in patients with rheumatoid arthritis. Individual patient assessment is important in determining functional deficits and treatment goals. Patients with persistent disease despite aggressive medical management are candidates for surgery. Soft-tissue procedures offer good symptomatic relief and functional improvement in short term. Extensor and flexor tendons may rupture because of synovial infiltration and bony irritation. When rupture occurs, direct repair usually is not possible. However, when joints that are motored by the ruptured tendon are still functional, tendon transfer or grafting may be considered. Because of the progressive nature of the disease, dislocation and end-stage arthritis often require stabilization with bony procedures. The distal radioulnar joint is usually affected first and is commonly treated with either the Darrach or the Sauvé-Kapandji procedure. Partial wrist fusion offers a compromise between achieving stability of the affected radiocarpal joint and maintaining motion at the midcarpal joint. For pancarpal arthritis, total wrist fusion offers reliable pain relief at the cost of motion. Total wrist arthroplasty is an alternative that preserves motion; however, the outcomes of total wrist replacement are still being evaluated.

Objective: The aim of this survey is to determine of emergency management of spaghetti wrist functional impairments due to these injuries which demands an adequate and accurate management of such injuries. Materials & Methods: All the Patients with Spaghetti wrist (33 Persons) due to sharp injuny that was operated by one surgeon, presenting to hand Rehabilitation center whom includeded in this study, all of them were managed with early intervention programs by one therapist for 10 weeks, and they were assessed with mono semmes – weinstein mono filament asterwards.The effects of sex, age, time of surgery and outcomes were assessed. Results: Thirty-three Patients were included in this survey. In evaluation of median nerve in the given time, non of them were not tested and 40/31% of them had diminished quality of light touch. In ulnar nerve impairoment 43/7% had diminished protective touch and in Pinch Grip evaluation we found that both unlar and median nerve injuries has most affect in increasing the power. Conclusion: early surgery and early intervention has the best effect on spaghetti wrist Motor and sensory recovery found to be better in madian nevere injuries versus ulnar nerve ones.

Hand and wrist disorders are common during pregnancy. Most of these problems develop during the third trimester when hormonal changes, fluid retention, and weight gain are maximum. This review study aimed to discuss pregnancy-related hand and wrist problems, and provide an overview of their pathology, clinical presentations, clinical examinations, and treatment options. Pregnancy-related carpal tunnel syndrome and De Quervain disease are among the most encountered disorders; however, neuralgic amyotrophy, pyogenic granuloma in hand, ligamentous laxity of the joints, arthralgia, and exacerbation of hand and wrist arthritis are among other reported disorders during pregnancy. Pregnancy-related hand and wrist problems may remain undertreated and reduce pregnant females’ quality of life. Nonsurgical treatments are usually effective for pregnancy-related hand and wrist problems. In general, pregnancy-related hand and wrist problems have a good prognosis and usually resolve after childbirth.

Background: Rice bodies can be found in rheumatic diseases, infectious diseases, and osteoarthritic joints. Rice bodies' most common locations include the subacromial bursa of the shoulder and the knee, while rice body synovitis of the wrist extensor tendons is uncommon. We have presented the case of tuberculous tenosynovitis with rice body formation in the extensor tendon sheaths of the hand and wrist. Case Report: A 51-year-old man presented with swelling and mild pain in the dorsal side of left wrist, hand, and proximal phalanx of the second finger. He stated a history of traumatic injury to the proximal phalanx of the index finger. Radiographs showed a soft-tissue mass shadow, and magnetic resonance imaging (MRI) showed edema and soft tissue swelling around extensor tendons extending into the distal forearm and ulnar side of the second finger in favor of tenosynovitis. Laboratory test results were normal. The patient had a negative Mantoux test result and no history of mycobacterial exposure. Surgical exploration of the lesion revealed rice bodies in the synovial sheath of extensor tendons in the wrist, extending distally to the dorsal aspect of the hand, especially the radial side. Removal of the rice bodies and complete excision of the sheath and tenosynovectomy was performed. Conclusion: As in our case, even in the absence of past tuberculosis (TB) infection or exposure, Mycobacterium TB (MTB) should be considered in the differential diagnosis of long-standing extensor tenosynovitis in the hand and wrist.

Background: Trigger wrist is a relatively rare hand disorder that refers to the painful snapping and clicking or triggering at the wrist level during finger or wrist movements. Objectives: In this study, we aimed at reporting a series of trigger wrist and discussing their etiology, as well as their clinical manifestation and outcomes. Methods: In this retrospective study, the patients with the definitive diagnosis of trigger wrist were reviewed. Their demographics and clinical symptoms were extracted from their medical records. The symptoms of median neuropathy, including weakness or atrophy of the thenar muscles, persistent numbness, and paresthesia were recorded to investigate the association with Carpal Tunnel Syndrome (CTS). Results: A total of seven patients with the Mean± SD age of 35. 5± 10. 3 years were included in the study. A benign mass was the etiology of trigger wrist in all cases, with giant cell tumor of flexor tendon sheet as the most common etiology (57. 1%). Trigger wrist was associated with CTS in three cases (42. 8%), in all of whom the tumor size was larger than the average. Pain and snapping with or without palpable mass were the main clinical symptoms of the patients that completely disappeared by surgical removal of the lesion. A mean 40. 3 months follow-up of the patients was uneventful. Conclusion: Benign neoplasms could be considered as the most common etiology of trigger wrist. Since many patients with trigger wrist might have CTS, too, the careful differentiation of these entities is necessary. Once accurately diagnosed, surgical intervention is entirely curative.

Introduction: Complete Amputation of wrist is physical and psychological trauma that can affect person's life. During recent years, various amputated organs were replanted back into their own body leading to improvement in quality of life, function and body image.Case Report: The case was a34 years old man with complete amputation at left hand at wrist level, while working with chainsaw. Patient was admitted to the emergency unit at Fatemi hospital of Ardabil city, and underwent tosurgeryfor replantation.Conclusion: Complete amputation of wrist and its successful replantation are among rarely occured and reportable cases. The5-month follow-up indicated a successful operation. During this period, no abnormalities were found in the blood circulation. The finger grasping and nerve development were acceptable and no symptom of infection was observed.

Introduction & Background: Pain and tenderness are common in the palmer and lunar aspects of the wrist in the area of the misinform bone. When chronic, this pain may be due to a tendinopathy at the insertion site of the lunar flexor tendon, carpal fractures, or osteoarthritis of the pisotriquetral joint (PTJ). The PTJ is the second most common site of osteoarthritis in wrist after the scaphotrapezial joint, if the first carp metacarpal joint is excluded. Instability of the PTJ is a recognized complication of osteoarthritis of this joint. Degenerative changes of the PTJ often re-main undiagnosed at clinical and radiographic evaluations. Although they are not usually per-formed, several methods for PTJ imaging have been proposed. A profile view can be obtained when the hands are placed in 300 degrees of suspiration, allow-in evaluation of the joint and adjacent bone. Arthro-graphy of the PTJ has also been used alone or in com-inaction with radio carpal joint orthography to evaluate intra-particular abnormalities of the PTJ. Computed tomography (CT) and CT-orthography allow more precise visualization of this joint. These imaging methods offer more thorough analysis of the articulation but are limited because of their lack of soft-tissue contrast. A potential role of magnetic resonance (MR) imaging in the assessment of abnormalities of the PTJ has been explored in a few investigations, although to our knowledge no report exists that details the possible role of MR-orthography in the evaluation of the PTJ. The purpose of our study was to evaluate the MR imp-aging and MR orthographic findings of the PTJ and the contribution of these examinations to the assess-men of osteoarthritis of this joint. 

Clindamycin is a lincosamide antibiotic which is approved for the treatment of Anaerobic, Streptococcal and Staphylococcal infections. There has been an increased interest in the use of clindamycin since it achieves high intracellular levels in phagocytic cells, high levels in bone and appears to have an antitoxin effect against the toxin elaborating strains of streptococci and staphylococci. Clindamycin is considered as a bacteriostatic antibiotic, while it is bactericidal against some strains of Staphylococci, Streptococci and Anaerobes such as B. fragilis. Its major disadvantage is its propensity to cause antibiotic-associated diarrhea. In spite of expanded use of clindamycin in bone infections, the adverse reactions of this antibiotic are minor. Polyarthritis is a rare adverse effect of this antibiotic.In this case report, we studied a 75-year-old male patient with past history of drop attack and subdural hematoma who developed skull osteomyelitis after the surgery. After two weeks of intravenous antibiotic therapy, wound discharge was stopped and the patient was discharged from the hospital with the maintenance oral antibiotic therapy including clindamycin 300 mg q8 h, ciprofloxacin 500 mg q12 h and rifampin 600 mg fasting.Six days after the beginning of oral antibiotics, right wrist monoarthritis was developed. It was unresponsive to nonsteroidal anti-inflammatory drug and improved after decreased doses of clindamycin. As best as we know, monoarthritis was not reported with clindamycin previously.