Study of Hamate Fractures in a Single Tertiary Hands Unit: A Retrospective Cohort Study and Literature Review.

Purpose: The primary purpose of our study was to investigate hamate fractures at a single tertiary hand surgery unit in Western Australia, particularly comparing operative and nonsurgical outcomes. Methods: Patients with hamate and/or hamate plus fifth carpometacarpal injury at our hand unit between 2019 and 2022 were identified. All patients had Quick Disability of the Arm, Shoulder and Hand (QuickDASH) patient-reported outcome measures recorded post treatment. Patients managed operatively and nonsurgically had a period of splinting with plaster of Paris and/or thermoplastic splint for a minimum of 2 weeks. All patients underwent hand therapy. Results: Forty-eight patients with hamate and/or hamate plus fifth carpometacarpal injury were included in this study. Thirteen patients had Milch type 1 fractures, and 35 had Milch type 2 fractures. Six Milch type 1 fractures were managed operatively, and seven were managed nonsurgically. The average QuickDASH score for the operative group was 0.38. The average QuickDASH score for the nonsurgical group was 0.65. Sixteen Milch type 2 fractures were managed operatively, and 19 were managed nonsurgically. The average QuickDASH score for the operative group was 1.3. The average QuickDASH score for the nonsurgical group was 3.5. Conclusions: For Milch type 2 fractures, patient-reported outcome measures were better for the operative group compared with the nonsurgical group. Type of study/level of evidence: Therapeutic IV.

Large osteophyte removal from the posterior femoral condyle significantly improves extension at the time of surgery in a total knee arthroplasty.

Removing osteophytes from the posterior compartment of the femur eliminates the tenting effects on the joint capsule and consequently increases the extension gap in total knee arthroplasty. However, there is no clear association with the size of osteophytes removed and the potential degree of additional extension achieved at time of surgery. AIMS: Correlate the size of posterior osteophytes removed with the degree of extension gained intraoperatively in total knee arthroplasty and develop a radiological classification system to grade these osteophytes. METHODS: Patients who underwent a TKA had pre and post operative sagittal radiographs assessed and classified according to 4 different categories of a proposed classification system. Knee extension was then assessed by a computer navigated system before incision and after implant insertion. Confounding factors were controlled and considered on the analysis. The study was done retrospectively. RESULTS: 147 patients were included in the study. Ninety-three (63.2%) patients had osteophytes on the posterior aspect of the femur completely removed and fifty-four patients (36.8%) did not have radiological evidence of osteophytes on the posterior aspect of the femur. There was a positive and linear correlation (Pearson correlation 0.327, p .005) between osteophyte size and degree of extension corrected at time of surgery. On Multivariate Logistic Regression Analysis, we found that small osteophytes (Grade 1) did not seem to affect the extension, while removing Grade 2 or Grade 3 osteophytes lead to a gain in extension of 2.7 and 4.5° respectively. CONCLUSION: Removing large osteophytes (Grade 2 and Grade 3) from the posterior femoral compartment can be used as an adjuvant strategy to ensure that intraoperative extension is optimal. However removing small osteophytes (Grade 1) should not be expected to affect extension at the time of surgery in TKA and could increase intra-operative time and morbidity.