Long-term follow-up of first metacarpal extension osteotomy for early CMC arthritis.

BACKGROUND: The purpose of this study was to evaluate long-term outcomes of first metacarpal extension osteotomy for early trapeziometacarpal arthritis. METHODS: We retrospectively reviewed 13 patients who underwent first metacarpal extension osteotomy at our institution between 1996 and 2005 and obtained subjective and objective outcome data. RESULTS: Mean follow-up was 9.9 years (range 6 to 14 years). Ten of the 13 patients (77 %) were either satisfied or very satisfied with their results. Mean pain level was 2.00 on a scale of 1 (nonexistent) to 7 (unbearable). Mean QuickDASH score was 24.17, with a median score of 9.09. Mean pinch strength was 13.1 lbs compared to 12.8 lbs in the nonoperative extremity. Mean radial abduction of the thumb was 45.5° which was equal to the nonoperative extremity. Of the eight patients who agreed to repeat radiographs, five had no progression of degenerative changes compared to pre-op radiographs. CONCLUSIONS: Based on subjective and objective follow-up data, first metacarpal extension osteotomy can provide good long-term results in terms of patient satisfaction, pain relief, and upper extremity function. It is a reasonable alternative to ligament reconstruction in patients with early-stage trapeziometacarpal arthritis.

Surgical treatment of pediatric posttraumatic palmar midcarpal instability: case report.

We treated a 6-year-old child able to extend her wrist only to within 30 degrees of the neutral position secondary to posttraumatic palmar midcarpal instability with palmar and dorsal capsulodesis and pinning. More than 8 years after surgery, she has no complaints referable to her wrist and has 30 degrees of active wrist extension. Although unpredictable in adults, soft-tissue reconstruction is a treatment option in the pediatric patient with posttraumatic palmar midcarpal instability.

Normal ranges of variability for urodynamic studies of neurogenic bladders in spinal cord injury.

BACKGROUND/OBJECTIVE: Urodynamic studies are conducted on a regular basis to evaluate changes in bladder function after spinal cord injury. Often, differences in urodynamic parameters exist from one study or one year to the next. The objective of this study was to provide reference ranges for "normal" variability in urodynamic parameters that can be considered as "no real change" from one study to the next. DESIGN: Retrospective chart review. METHODS: Fifty consecutive individuals with spinal cord injury had 2 trials (trial 1 and trial 2) of urodynamic studies done 5 minutes apart, and the following data were collected: maximum cystometric capacity, opening pressure, maximum detrusor pressure, volume voided, and postvoid residual. The corresponding data were compared, and the frequency distribution for the change between consecutive studies was plotted. Because there is no standard, variability ranges for 5th to 95th, 10th to 90th, and 25th to 75th percentiles were calculated to give health care providers more choices. RESULTS: Ranges of variability are as follows in the following format (urodynamic parameter; mean value; +, maximum increase; -, maximum decrease)--5th to 95th percentile: cystometric capacity (234.63 mL, +213.50 mL, -158.05 mL); opening pressure (54.56 cmH2O, +30 cmH2O, -18.00 cmH2O); maximum detrusor pressure (60.82 cmH2O, +17.35 cmH2O, -27.80 cmH2O); volume voided (122.20 mL, +177.25 mL, -176.00 mL); postvoid residual (176.06 mL, +197.25 mL, -118.00 mL); 10th to 90th percentile: cystometric capacity (234.63 mL, +126.40 mL, -74.60 mL); opening pressure (54.56 cmH2O, +13.70 cmH2O, -12.00 cmH2O); maximum detrusor pressure (60.82 cmH2O, +10.00 cmH2O, -20.00 cmH2O); volume voided (122.20 mL, +105.60 mL, -82.00 mL); postvoid residual (176.06 mL, +131.00 mL, -86.00 mL); 25th to 75th percentile: cystometric capacity (234.63 mL, +72.00 mL, -27.00 mL); opening pressure (54.56 cmH2O, +4.00 cmH2O, -9.50 cmH2O; maximum detrusor pressure (60.82 cmH2O, +4.00 cmH2O, -10.00 cmH2O); volume voided (122.20 mL, +50.00 mL, -30.00 mL); postvoid residual (176.06 mL, +50.00 mL, -30.00 mL). CONCLUSIONS: Urodynamic studies have variability. Knowing these ranges of variability can be helpful in determining whether differences between filling trial 1 and filling trial 2 in a single study or year-to-year changes in urodynamic studies are significant or simply the normal variability of the urodynamic study.