Palmar approach for fixation of metacarpal fractures.

Between 2018 and 2020, 14 patients with closed metacarpal fractures requiring open reduction were operated on via a palmar approach. Reduction and fixation were done with screws or plates. We assessed range of motion, grip strength, Mayo score, possible nerve damage and cosmesis. The range of motion and grip strength were fully restored by 6 months after operation. Transient paraesthesiae in the digital nerve territory occurred in two patients and had resolved by 3 months. In selected patients the palmar approach for metacarpal shaft fractures can provide satisfactory cosmesis and function of the hand. This method can be useful in patients with history of hypertrophic scarring or in patients who would prefer to avoid a visible scar on the dorsum of the hand.Level of evidence: IV.

Is Standing Coronal Long-Leg Alignment View Effective in Predicting the Extent of Medial Soft Tissue Release in Varus Deformity during Total Knee Arthroplasty?

The aim of this study was to assess the predictive value of the femoral intermechanical-anatomical angle (IMA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibia angle (MPTA), femorotibial or varus angle (VA), and joint line convergence angle (CA) in predicting the stage of the medial collateral ligament (MCL) during total knee arthroplasty (TKA) of varus knee. We evaluated 229 patients with osteoarthritic varus knee who underwent primary TKA, prospectively. They were categorized in three groups based on the extent of medial soft tissue release that performed during TKA Group 1, osteophytes removal and release of the deep MCL and posteromedial capsule (stage 1); Group 2, the release of the semimembranosus (stage 2); and Group 3, release of the superficial MCL (stage 3) and/or the pes anserinus (stage 4). We evaluated the preoperative standing coronal hip-knee-ankle alignment view to assessing the possible correlations between the knee angles and extent of soft tissue release. A significant difference was observed between the three groups in terms of preoperative VA, CA, and MPTA by using the Kruskal-Wallis test. The extent of medial release increased with increasing VA and CA as well as decreasing MPTA in preoperative long-leg standing radiographs. Finally, a patient with a preoperative VA larger than 19, CA larger than 6, or MPTA smaller than 81 would need a stage 3 or 4 of MCL release. The overall results showed that the VA and MPTA could be useful in predicting the extent of medial soft tissue release during TKA of varus knee.