We treated three patients with malunion after comminuted intercondylar fractures of the humerus by intra-articular derotational opening-wedge osteotomy and the insertion of a tricortical iliac bone graft. Two patients required additional operations, including interposition arthroplasty and hardware removal. A mean arc of increased motion of 65 degrees was achieved in flexion and extension in two patients and a more functional arc in the third. Although this is viewed as a salvage procedure in patients who are thought to be too young for elbow arthroplasty, none of the three patients has significant pain and none has required total elbow arthroplasty after an average follow-up of 7.6 years.

Forty-six patients with Kienböck's disease were evaluated over a 2- to 27-year period; 72% had a history of wrist injury prior to diagnosis; 67% had evidence of fracture or fragmentation of the lunate. Documented fractures of the lunate were identified followed by both the presence and absence of subsequent Kienböck's disease and this may be explained by the variable blood supply of the lunate. Ten patients were not treated; 36 patients were treated surgically. Patients were relieved of pain and had functional wrists whether they were treated or not and regardless of the type of surgical treatment.

Forty-six patients with Kienböck's disease were evaluated over a 2- to 27-year period; 72% had a history of wrist injury prior to diagnosis; 67% had evidence of fracture or fragmentation of the lunate. Documented fractures of the lunate were identified followed by both the presence and absence of subsequent Kienböck's disease and this may be explained by the variable blood supply of the lunate. Ten patients were not treated; 36 patients were treated surgically. Patients were relieved of pain and had functional wrists whether they were treated or not and regardless of the type of surgical treatment.

Many injuries to the hand and wrist may be seen in the practice of sports medicine. Most of these injuries are well known and the details of their diagnosis and treatment are well documented. However, even among this group, certain injuries frequently escape detection or are not monitored carefully enough to detect their frequent residual complications. These injuries are particular sources of problems. Some little known diagnoses are seldom considered, but any diagnosis, even a presumptive one, is better than applying vague, descriptive, but nondefinitive terms to an athlete's injury. Although the ideal treatment is not yet available for any of these injuries, a lack of diagnosis will often mean that treatment is haphazard or nonexistent.