Retrograde headless intramedullary screw fixation for displaced fifth metacarpal neck and shaft fractures: short term results.

BACKGROUND: This study aimed to evaluate the early clinical outcomes of retrograde headless intramedullary screw fixation for displaced fifth metacarpal neck and shaft fractures. METHODS: We retrospectively reviewed nine patients treated with retrograde intramedullary screw fixation of fifth metacarpal neck and shaft fractures between 2011 and 2013. Patient demographics and outcomes including hand dominance, age, sex, type of injury, injury and postoperative radiographs, return to work, time to fracture union radiographically, complications, visual analog score, disabilities of the arm, shoulder, and hand scores, postoperative metacarpophalangeal joint range of motion, and grip strength were recorded. RESULTS: Nine fractures in nine patients with a mean age of 32 years (19-54) were included. There were seven metacarpal neck and two metacarpal shaft fractures. All patients sustained injury by direct impact of fist against an object. No case involved worker's compensation. Patients had a mean follow-up of 36 weeks (6-57 weeks) and at the time of latest follow-up had no pain. Mean radiographic healing was 49 days (28-85 days). Mean return to work was 6 weeks (4-10 weeks). Mean metacarpalphalangeal joint motion was 0° extension and 90° flexion. Mean disabilities of the arm, shoulder, and hand scores pre- and postoperatively improved from 43 to 0.7, respectively. The mean postoperative grip strength was measured of the injured hand (40 kg) and un-injured hand (41 kg). CONCLUSIONS: Retrograde headless intramedullary screw fixation of fifth metacarpal neck and shaft fractures has overall favorable early outcomes and offers the benefit of stable fixation, early motion without cast immobilization, and the ability for early return to work. This technique is a viable surgical option for these fractures and may be considered in the appropriate patient population.

A comparison of percutaneous needle fasciotomy and collagenase injection for dupuytren disease.

PURPOSE: To compare percutaneous needle fasciotomy (PNF) with collagenase injection in the treatment of Dupuytren contracture. METHODS: A retrospective review was performed for patients with Dupuytren disease treated with PNF or collagenase. Range of motion, patient satisfaction, and complications were recorded. RESULTS: There were 29 patients in the collagenase group with mean baseline contractures of 40° for 22 affected metacarpophalangeal joints and 50° for 12 affected proximal interphalangeal joints. The PNF group was composed of 30 patients with mean baseline contractures of 37° for 32 affected metacarpophalangeal joints and 41° for 18 affected proximal interphalangeal joints. All patients were observed for a minimum of 3 months. Clinical success (reduction of contracture within 0° to 5° of normal) was accomplished in 35 of 50 joints (67%) in the PNF group and in 19 of 34 joints (56%) in the collagenase group. Patient satisfaction was similar between groups. Only minor complications were observed, including skin tears, ecchymosis, edema, pruritus, and lymphadenopathy. CONCLUSIONS: In the short term, both PNF and collagenase have similar clinical outcomes and patient satisfaction. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.

Clinical outcomes of arthrodesis and arthroplasty for the treatment of posttraumatic wrist arthritis.

PURPOSE: To compare clinical outcomes of wrist arthrodesis and total wrist arthroplasty in the treatment of pancarpal posttraumatic arthritis. We hypothesized that arthroplasty would demonstrate better clinical outcomes than wrist arthrodesis. METHODS: We performed a retrospective review of 22 patients treated (15 arthrodeses and 7 arthroplasties) for pancarpal posttraumatic arthritis. We measured clinical outcomes with the visual analog pain scale; Disabilities of the Arm, Shoulder, and Hand questionnaire; the Patient-Rated Wrist Evaluation; and a study-specific questionnaire. Postoperative complications were recorded from chart review. RESULTS: Mean follow-up was 68 months for arthrodesis and 56 months for arthroplasty. The mean visual analog scale pain score was 2 for each group. The mean Disabilities of the Arm, Shoulder, and Hand score was 38 for the arthrodesis group and 29 for the arthroplasty group. The mean Patient-Rated Wrist Evaluation was 73 for the arthrodesis group and 31 for the arthroplasty group. The results from the study-specific questionnaire revealed that the majority of patients in both groups were satisfied. Complication rates were similar in both groups. CONCLUSIONS: Total wrist arthroplasty as an alternative to arthrodesis for the treatment of pancarpal posttraumatic arthritis may offer improved functional outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.