Management of the Metacarpophalangeal and Scaphotrapeziotrapezoidal Joints in Patients with Thumb Trapeziometacarpal Arthrosis.

Basilar thumb osteoarthritis at the trapeziometacarpal joint is the second most common location of osteoarthritis in the hand. Arthritis and instability of the thumb MCP joint can be quite debilitating, given the crucial role the joint plays in thumb dexterity. Advanced basilar thumb osteoarthritis often leads to collapse of the first ray with compensatory hyperextension of the thumb metacarpophalangeal (MCP) joint and is accompanied by arthritis in the scaphotrapezialtrapezoid joint. Here the authors discuss the management of MCP hyperextension and scaphotrapezoidal osteoarthritis in the setting of basilar thumb osteoarthritis.

Varus Deformity of the Distal Tibia From Physeal Growth Arrest Treated Using a Titanium Metal Porous Wedge.

UNLABELLED: During a cheerleading event, a 14-year-old female sustained a right ankle physeal fracture that was treated nonoperatively with casting. She developed a distal medial tibial physeal arrest, and as the onset of menses was at age 16, she subsequently developed a varus distal tibial deformity. At the age of 19, she was no longer able to participate in collegiate cheerleading due to lateral ankle pain, ankle instability, and peroneal subluxation. After failing conservative treatment, she underwent an ankle arthroscopy, Broström-Gould procedure, peroneal retinacular repair with peroneal tenolysis, and a distal tibial medial opening wedge osteotomy using a porous titanium metal wedge and a one-third tubular plate. At 6-month follow-up, her osteotomy site showed abundant callus formation, and her lateral ankle pain had almost completely resolved. At 22-month follow-up, there were no residual ankle instability or pain complaints, and she had returned to collegiate cheerleading. This case report highlights a very useful, previously not described, application of porous titanium metal wedges for medial supramalleolar opening wedge osteotomies of the tibia. Such wedges are familiar to many foot and ankle orthopaedic surgeons and continue to have expanding indications. LEVELS OF EVIDENCE: Therapeutic, Level IV: Case report.

Trends in Thumb Carpometacarpal Interposition Arthroplasty in the United States, 2005-2011.

We conducted a study to investigate current trends in carpometacarpal (CMC) interposition arthroplasty across time, sex, age, and region of the United States; per-patient charges and reimbursements; and the association between this procedure and concomitantly performed carpal tunnel syndrome (CTS) and carpal tunnel release (CTR). Patients who underwent CMC interposition arthroplasty (N = 41,171) were identified in a national database. Between 2005 and 2011, the number of patients who had CMC interposition arthroplasty increased 46.2%. Females had the procedure more frequently than males at all time points, though the percentage of patients who were male increased throughout the study period. Of the patients who had CMC interposition arthroplasty, 40.9% also had a diagnosis of CTS. Between 15.5% and 17.3% of these patients had CTR performed concomitantly. Despite a lack of evidence that thumb CMC interposition arthroplasty is superior to other surgical treatment options, the number of patients who are having this procedure has increased significantly. The impetus for these trends requires additional investigation.