Arthrodesis for the Trapeziometacarpal Arthritis

PURPOSE: We evaluated clinical outcomes of the trapeziometacarpal arthrodesis as a treatment for trapeziom-etacarpal arthritis. MATERIALS AND METHODS: Nineteen patients that received trapeziometacarpal arthrodesis for Eaton & Litter stage III(n=18) and IV(n=1) arthritis were enrolled in this study. Mean age was 45.8(43~67) and mean follow up duration was 2.3 years(1~4 years). Posttraumatic arthritis and idiopathic arthritis were 9 and 10 cases, respectively. The assessment included a preoperative and postoperative Visual Analogue Scales (VAS) (0~10) and overall satisfaction with Roles & Maudsley score. Functional outcomes were assessed by measuring of grip and pinch strength and range of thumb motion. The evaluation also included postoperative complications. RESULTS: Mean preoperative VAS score was 6.6 points and improved to average 1.4 points postoperatively. Mean grip and pinch strength was improved from 12.1 kg to 26.5 kg and from 2.7 kg to 5.2 kg, respectively. The mean radial abduction arc of motion was 42.9 degrees. Metacarpophalangeal and thumb interphalangeal joint arc of motion was averaged 63.3 degrees and 73 degrees, respectively. Complications consisted of scaphotrapezoidal arthritis(n=1) and nonunion(n=1). CONCLUSION: The trapeziometacarpal arthrodesis could afford good functional results, pain relief in advanced arthritis patient.

The Availability of Three-Dimensional Computed Tomography Reconstructions on the Classification and Treatment Plan of Distal Radius Fractures

PURPOSE: The purpose of this study is to determine whether the three-dimensional computed tomography (3D-CT) images would increase the reliability of fracture classification and influence treatment plan of distal radius fractures. MATERIALS AND METHODS: Four independent observers evaluated radiographic images of thirty patients with distal radius fractures. The fracture classification has been performed based on (1) AO classification, (2) Fernandez classification, (3) Frykman classification. And then treatment plan was planned based on (1) closed reduction with Sugar-tong splint, (2) closed reduction with pinning, (3) closed reduction with external fixator, (4) open reduction with plate (volar approach), (5) open reduction with plate (dorsal approach). Two rounds of evaluation were compared regarding: (1) simple radiographs alone, and (2) simple radiographs and 3D-CT together two weeks after that. This cycle was then repeated to assess intraobserver reliability. RESULTS: 3D-CT improved the intraobserver and interobserver reliability regarding the fracture classification and treatment plan. And the addition of 3D-CT to simple radiographs influenced treatment recommendations, resulting in a significantly greater number of decisions for an open approach (p<0.05, McNemar test). CONCLUSIONS: 3D-CT is a reliable tool of fracture classification and improves treatment plan of distal radius fractures.