Nonunion after trapeziometacarpal arthrodesis: comparison between K-wire and internal fixation.

We reviewed 63 trapeziometacarpal arthrodeses (57 patients) performed in our unit between April 2007 and May 2013 for osteoarthritis. K-wires, plates, headless compression screws and memory staples were used for fixation. The average age of patients was 50 (range 20-78) years and there were 36 men and 21 women with a mean follow-up of 36 (range 6-62) months. K-wires were used in 31 cases, staples in 12, plates in five, and screws in 15 joints. The overall non-union rate was 11%, however, when using K-wires for fixation, it was 20%. Union was achieved in all cases when staples or screws were used for fixation. Disabilities of the Arm, Shoulder and Hand scores were higher in cases where non-union occurred compared with those that united (66.7 vs. 21.9). Trapeziometacarpal arthrodesis for osteoarthritis gives good clinical outcome with lower (DASH) scores when union occurs. K-wire fixation led to a 20% non-union rate, and as a result, the senior author no longer uses this method of fixation.

Preoperative grip strength measurement and duration of hospital stay in patients undergoing total hip and knee arthroplasty.

PURPOSE: This study explored whether a relationship exists between preoperative pinch and power grip strength, and length of hospital stay in patients undergoing hip and knee arthroplasty at a busy UK hospital. We investigated whether handgrip dynamometry could be used preoperatively to identify patients at greater risk of longer inpatient stays. This would allow focussed intervention preoperatively and facilitate predictors of length of stay postoperatively. METHODS: One hundred and sixty-four patients (64 male, 100 female) undergoing lower limb arthroplasty (83 total knee replacement, 81 total hip replacement) were assessed in pre-admission clinic. Average measurements of pinch grip, power grip and grip endurance were taken from each patient using the Jamar hydraulic dynamometer (Jamar, USA). Duration of inpatient stay of each patient was recorded. RESULTS: Average duration of hospital stay was 9.4 days. Both average pinch grip strength and average power grip strength had a significant negative correlation with duration of inpatient stay. Those patients with a pinch grip strength less than 6.3 kg remained an inpatient for an average of 2 days longer than those with a pinch grip greater than 6.3 kg. CONCLUSIONS: This simple test may be highly beneficial preoperatively in identifying those patients likely to require longer inpatient stays and therefore those who would benefit from early nutritional intervention and focussed physiotherapy. It may also facilitate predictors of length of stay postoperatively. We believe this may effect significant cost reductions in the NHS.

P-selectin antagonism reduces thrombus formation in humans.

BACKGROUND: Interaction of P-selectin with its glycoprotein ligand (P-selectin glycoprotein ligand type 1) mediates inflammatory processes that may also include vascular thrombosis. Platelet P-selectin expression is increased in patients with coronary heart disease, and its antagonism represents a potential future therapeutic target for the prevention and treatment of atherothrombosis. AIM: To investigate the effects of the novel small molecule P-selectin antagonist PSI-697 on thrombus formation in humans. METHODS AND RESULTS: In a double-blind randomized crossover study, thrombus formation was measured in 12 healthy volunteers, using the Badimon ex vivo perfusion chamber under conditions of low and high shear stress. Saline placebo, low-dose (2 m) and high-dose (20 m) PSI-697 and the glycoprotein IIb-IIIa receptor antagonist tirofiban (50 ng mL(-1)) were administered into the extracorporeal circuit prior to the perfusion chamber. As compared with saline placebo, blockade of platelet glycoprotein IIb-IIIa receptor with tirofiban produced 28% and 56% reductions in thrombus formation in the low-shear and high-shear chambers, respectively. PSI-697 caused a dose-dependent, but more modest, reduction in thrombus formation. Low-dose PSI-796 (2 m) reduced total thrombus area by 14% (P = 0.04) and 30% (P = 0.0002) in the low-shear and high-shear chambers, respectively. At the high dose (20 m), PSI-697 reduced total thrombus area by 18% (P = 0.0094) and 41% (P = 0.0008) in the low-shear and high-shear chambers, respectively. CONCLUSIONS: P-selectin antagonism with PSI-697 reduces ex vivo thrombus formation in humans. These findings provide further evidence that P-selectin antagonism may be a potential target for the prevention and treatment of cardiovascular disease.