Trapeziectomy with Ligament Reconstruction and Tendon Interposition versus Trapeziometacarpal Joint Replacement for Thumb Carpometacarpal Osteoarthritis: A Systematic Review and Meta-Analysis.

Background The trapeziometacarpal articulation in the thumb is a joint that is second-most commonly affected by osteoarthritis, and this can lead to considerable hand pain and disability. Currently, there is a multiplicity of surgical options available to address this problem, yet none has proven to be significantly superior to the others. Objective This study aims to compare the outcome of trapeziectomy with ligament reconstruction and tendon interposition versus trapeziometacarpal joint replacement for thumb carpometacarpal osteoarthritis. Materials and Methods A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards. The NICE Healthcare Databases Advanced Search (HDAS) tool was used to search articles. One randomized controlled trial (RCT), one prospective cohort study and two retrospective cohort studies were identified. Results Our results demonstrate a significant difference in the Quick Disabilities of the Arm Shoulder and Hand (QDASH) score between the trapeziectomy with ligament reconstruction and tendon interposition (LRTI) and Joint Replacement groups with the joint replacement group exhibiting better QDASH scores than the LRTI group. We also found that those who had a joint replacement had a significantly better thumb opposition than those in the LRTI group, as demonstrated by a superior Kapandji score. However, the complication rate of joint replacement appears to be higher. Conclusion Our study reveals that while both treatment options are valid, the limited body of evidence currently available shows that joint replacement carries more risks and thus should not replace the current standard treatment of trapeziectomy with LRTI. This study highlights the need for more trials to be performed to more accurately compare the two treatment modalities. For the time being, we advocate that joint replacement is only performed by surgeons who perform this procedure regularly to reduce the risk of complications.

Public Attitudes on the Ethics of Deceptively Planting False Memories to Motivate Healthy Behavior.

Researchers have proposed that planting false memories could have positive behavioral consequences. The idea of deceptively planting 'beneficial' false memories outside of the laboratory raises important ethical questions, but how might the general public appraise this moral dilemma? In two studies, participants from the USA and UK read about a fictional 'false-memory therapy' that led people to adopt healthy behaviors. Participants then reported their attitudes toward the acceptability of this therapy, via scale-rating (both studies) and open-text (study 2) responses. The data revealed highly divergent responses to this contentious issue, ranging from abject horror to unqualified enthusiasm. Moreover, the responses shed light on conditions that participants believed would make the therapy less or more ethical. Whether or not deceptively planting memories outside the lab could ever be justifiable, these studies add valuable evidence to scientific and societal debates on neuroethics, whose relevance to memory science is increasingly acute.

Scapular dyskinesis: the surgeon's perspective.

The scapula fulfils many roles to facilitate optimal function of the shoulder. Normal function of the shoulder joint requires a scapula that can be properly aligned in multiple planes of motion of the upper extremity. Scapular dyskinesis, meaning abnormal motion of the scapula during shoulder movement, is a clinical finding commonly encountered by shoulder surgeons. It is best considered an impairment of optimal shoulder function. As such, it may be the underlying cause or the accompanying result of many forms of shoulder pain and dysfunction. The present review looks at the causes and treatment options for this indicator of shoulder pathology and aims to provide an overview of the management of disorders of the scapula.

Attritional rupture of extensor pollicis longus: a rare complication following elastic stable intramedullary nailing of a paediatric radial fracture.

Elastic stable intramedullary nail fixation has become established as an acceptable method of treatment for diaphyseal fractures of both forearm bones in the paediatric population. It is considered safe, minimally invasive and does not compromise physeal growth. We report a case of delayed rupture of extensor pollicis longus due to attrition over the sharp edges of a protruding nail end after elastic stable intramedullary nailing of a paediatric radial diaphyseal fracture.

Epidemiology of spine trauma in an Irish regional trauma unit: a 4-year study.

Currently there is a lack of information on the full spectrum of spine trauma presenting to medical services in a defined geographic area. This study analyses the aetiology and demographics of a cohort of spine trauma in the West of Ireland. A regional trauma unit has been investigated for a 51-month period. Two hundred and eighty-five cases admitted with spine trauma were documented. The annual incidence of traumatic spinal injury was 19.54 cases/100,000 persons per year. Falls and low-energy trauma are shown to constitute a significant proportion of all cases (60.35%). Injury at greater than one level is frequently present. The highest peak of injury occurred in the 20-24-year-old age group (11.58%). A second peak occurred at 75-79 years of age (7.37%). The commonest cause of neurological injury was falls (n=9; 64.3%). This spine trauma register has provided valuable insights into the patterns of injury encountered in spine trauma patients in this region. It may act as a blueprint for a national spine trauma register and highlights the importance of patient education and injury prevention strategies.

Compliance and satisfaction with foot compression devices: an orthopaedic perspective.

INTRODUCTION: Although mechanical methods of thromboembolic prophylaxis have proven efficacy, relatively little is known about levels of patient compliance in the usage of these devices. Based on anecdotal evidence, we hypothesised that levels of compliance are sometimes insufficient to provide adequate thromboprophylaxis in the clinical setting. We prospectively analysed the use of foot pumps in 30 orthopaedic patients undergoing lower limb arthroplasty in order to assess levels of both patient compliance and satisfaction. MATERIALS AND METHODS: The study was carried out over a 5-month period. Levels of compliance were measured by using a system of random "spot checks". Each patient completed a questionnaire before discharge. Parameters investigated included comfort levels while using the device and identification of factors about the device which the patients disliked. RESULTS: Three hundred and ninety-one measurements were made. The utilisation of the device was found to be effective in 40.2% of measurements. We detected an overall progressive decline in the level of compliance as post-operative time increased [P < 0.001, Chi-square (chi(2)) test]. The average level of patient "comfort" was 7.1 on a visual analogue scale of 0-10. Sleep disturbance was reported by 57% of patients, while 43% complained of "heat intolerance". We have also shown that compliance is significantly reduced in those who complained of "sleep disturbance" while using the foot pumps (t-test, P < 0.05). CONCLUSIONS: These findings suggest that satisfactory levels of compliance can be difficult to achieve in the clinical setting despite the proven efficacy in clinical trials of this device. Greater emphasis on patient education may help improve compliance. Unless compliance can be strictly enforced, it appears advisable to only use foot pumps in combination with other forms of pharmacological prophylaxis.

Posterior cervical screw placement without image guidance: a safe and reliable practice.

The use of lateral mass screws for posterior cervical fixation has become widespread. It allows for stable fixation in the absence of the posterior elements and confers immediate stability. Lateral mass fixation has been shown to impart equal or greater biomechanical stability when compared to posterior interosseous wiring or anterior plating. The utilization of intraoperative fluoroscopy to guide screw placement has been recommended previously and is considered routine practice in many centers. This prospective study shows that lateral mass screws can be safely positioned without intraoperative fluoroscopy. The procedure is both safe and effective, provided that the operator has a thorough understanding of lateral mass anatomy coupled with careful adherence to the established guidelines for screw positioning. Exposure to radiation is reduced and time taken for operation can be shortened.

The association between aspirin and blood loss in hip fracture patients.

This is a cohort study involving 98 patients who presented to a regional orthopaedic unit with a hip fracture. Blood loss was assessed by pre and post operative haemoglobin concentrations, and transfusion requirements were used as outcome measures. The influence of pre-operative aspirin use and fracture type was analysed with respect to these outcome measures. Forty two percent of patients were regular aspirin users, and were comparable to the non aspirin group, apart from having a significantly greater prevalence of atherosclerotic vascular disease. There was no significant difference between the aspirin and non aspirin groups in terms of preoperative haemoglobin concentrations, perioperative changes in haemoglobin levels and transfusion requirements. Fifty one percent of patients had extracapsular hip fractures, and these patients were comparable in terms of demographic characteristics, including aspirin use, to the group with intracapsular hip fractures. The extracapsular hip fracture group were found to have significantly increased peri-operative blood loss as measured by changes in the haemoglobin level, and in transfusion requirements when analysed against the intracapsular hip fracture group. We found that it is the fracture site, rather than aspirin use pre-operatively, that is predictive of blood loss and transfusion requirements in patients presenting with hip fractures.