The distal radioulnar joint (DRUJ) is highly complex in its 3-dimensional interactions resulting in wrist motion. This complicated structure is prone to injury and instability, which can be difficult to assess and treat effectively. The goal of this article is to provide a description of the anatomy, biomechanics, imaging techniques, and surgical repairs.
Although prospective randomized trials are the gold standard for evidence in clinical research, they usually are too costly and complicated to warrant their routine use in addressing most questions in hand surgery. Nonrandomized study designs generally are more feasible and although they provide less evidence than the prospective randomized trial, well-planned investigations using these methodologies can be informative. The key consideration for the clinical researcher is in recognizing the limitations of each study design and asking an appropriate research question. This article reviews some study designs that can be considered alternatives to randomized trials in evaluating issues relating to treatment, prognosis, outcome, cause, and diagnosis in hand surgery.
Scleroderma manifests itself in patterns ranging from localized to systemic types. Mainly the systemic type, called systemic sclerosis, involves the hand, leading to Raynaud’s phenomenon, ulcerations, arthropathies, and calcifications. Systemic sclerosis causes significant functional loss of the hand. Surgical intervention has been controversial because of anticipated wound healing problems arising from diminished blood circulation. Nevertheless, a surgical approach is indicated when conservative and pharmacologic treatment options fail. We review the literature and discuss the surgical techniques used for the most common manifestations of systemic sclerosis in the hand.
Understanding the physical basis of hand function and deformity requires a fundamental knowledge of the biomechanics of the human digits. Learning the anatomy of the digits as well as the anatomy, function, and physiology of the muscles that control digital motion are essential in understanding the biomechanical principles that govern hand function. Applying these principles in treating hand disorders will optimize hand function and recreate hand mechanics.
My 2003–2004 Sterling Bunnell Traveling Fellowship had 2 themes: (1) to learn about the care of the rheumatoid hand around the world, and (2) to serve the poor in developing nations. This travel report discusses the hand centers I visited and the surgeons who served as my hosts.
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