Simultaneous double interphalangeal joints dislocation in a finger in a teenager.

ABSTRACT: The English literature reports a mere handful of cases involving simultaneous dislocation of two joints in the same finger. To our knowledge, all cases reported to date have been in skeletally mature individuals. We report a case of simultaneous proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints dislocations in one finger in a 14-year-old rugby player, managed by closed reduction and early mobilization, with excellent outcome. KEY WORDS: Proximal interphalangeal joint, Distal interphalangeal joint, Dislocation, Skeletally immature.

Safe femoral pin placement in knee navigation surgery: a cadaver study.

A number of navigation systems used for total knee replacement surgery currently require the insertion of a distal femoral reference sensor pin, which is placed anterior to posterior just superior to the level of the knee joint. There is potential for the posterior neurovascular bundle to be damaged during the insertion of this sensor device. The aim of this cadaveric study was to identify the structures at risk during insertion of the distal femoral sensor, and determine whether a safe zone for insertion could be identified. Sixteen cadaveric lower limbs (8 pairs) were studied. In each knee Steinman pins were passed from anterior to posterior, 5 cm proximal to the level of the femoral articular cartilage, directly AP and angled at 30 degrees passing medially or laterally. All pins that were passed directly from anterior to posterior and from lateral to medial passed within 5 mm of a major neurovascular structure, while 62.5% of pins passing from medial to lateral passed within 5 mm of a major neurovascular structure. The popliteal vessels and the sciatic nerve are at risk of injury from a navigation pin or drill placed in the distal femur during knee navigation. Caution should be exercised in passing these pins and alternate methods of fixing femoral sensors should be considered.

Excision of the trapezium and interposition arthroplasty with gelfoam for the treatment of trapeziometacarpal osteoarthritis.

Excision of the trapezium with Gelfoam interposition was performed in 35 thumbs, 34 of which were evaluated after an average 5 years. Twenty-four patients had unilateral procedures. The follow-up examination included a standardized questionnaire and clinical and radiological examinations. Pain relief was achieved in all cases. The patients considered that 32 of their operated hands had improved function, while two had not improved. All patients were satisfied with the final postoperative result. Adduction of the thumb to the index finger, and opposition to the tip of the little finger was possible in all cases. Weakness, in comparison to the other thumb, of lateral pinch (71%; P=0.0001), tip pinch (74%; P=0.007), and grip strength (85%; P=0.006) were observed. The first web span was preserved in all hands. Calculation of the trapezial space ratio demonstrated only slight, insignificant shortening (7%; P=0.06) of the thumb ray. No significant correlations between the postoperative trapezial space ratio and lateral pinch strength, tip pinch strength, and grip strength were observed. We conclude that excision of the trapezium and Gelfoam interposition has no specific complications and is a reliable surgical treatment for osteoarthritis of the trapeziometacarpal joint.

Isolated dislocation of the thumb carpometacarpal joint in a child.

Isolated thumb carpometacarpal joint dislocation in the pediatric age group is very rare. We report on a child who suffered this injury and was treated conservatively with excellent outcome.