Trapeziectomy With a Tendon Tie-in Implant for Osteoarthritis of the Trapeziometacarpal Joint.

PURPOSE: To evaluate the early to mid-term clinical and radiological outcomes of trapeziectomy with a tendon tie-in trapezium implant arthroplasty for moderate to severe trapeziometacarpal (TMC) joint osteoarthritis (Eaton stages III to IV). METHODS: We assessed all patients who underwent trapeziectomy and tendon tie-in trapezium implant arthroplasty stabilized with a Weilby flexor carpi radialis tendon sling for osteoarthritis of the TMC joint between 2008 and 2010 at our institution. Twenty-two patients (28 thumbs) who had had an operation at least 12 months earlier were clinically evaluated at an average follow-up of 18 months. Subjective clinical outcomes evaluation included visual analog scale scores and Disabilities of the Arm, Shoulder, and Hand score questionnaires. Objective clinical evaluation included lateral pinch and grip tests and active thumb range of motion. All patients underwent a radiological assessment by 2 independent musculoskeletal radiologists. In cases of unilateral treatment, we compared clinical results obtained from the operated hands with the contralateral hand. RESULTS: The mean preoperative visual analog scale score of the cohort was 7.4. We documented a statistically significant improvement to 1.2 at a mean of 18 months after the operation (range, 12-26 mo). The mean postoperative Disabilities of the Arm, Shoulder, and Hand score was 21. Thumb palmar abduction was 85°; thumb metacarpophalangeal joint flexion and TMC joint extension were 30° and 10°, respectively. There were 2 cases of prosthesis removal owing to implant dislocation. No late complications were recorded. CONCLUSIONS: Good short-term to mid-term results and stability of TMC arthroplasty implant can be achieved with tie-in trapezium implant stabilized with a Weilby flexor carpi radialis tendon sling. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Revision of a failed Swanson arthroplasty to a total wrist replacement restores wrist function and movements.

This study reports a case of revision of a failed Swanson silastic interpositional wrist replacement to a Universal 2 (KMI Medical Inc., San Diego, CA, Jan 2009) total wrist arthroplasty, in a 68-year-old woman with rheumatoid arthritis and pyrophosphate arthropathy. At the 2-year follow-up, the patient was pain-free and was able to perform all activities of daily living, documented by subjective assessment and objective scores. The disabilities of the arm, shoulder, and hand (DASH) scores improved from 98.3 preoperatively to 55.1 postoperatively. A failed Swanson silastic interpositional wrist replacement may be successfully revised to an uncemented primary wrist replacement with good functional results at early follow-up.

Diagnostic accuracy of clinical examination and magnetic resonance imaging for common articular wrist pathology.

The authors retrospectively compared the diagnostic accuracy of clinical examination and magnetic resonance imaging for intra-articular wrist pathology (triangular fibrocartilage complex, lunotriquetral and scapholunate injuries), using wrist arthroscopy as the gold standard. Sixty-six patients had clinical examination and arthroscopy; 38 of them also had magnetic resonance imaging. The diagnostic accuracy of clinical examination for all three injuries combined was 56.1%, and the accuracy of MRI was 55.3%. Magnetic resonance imaging was more specific, while clinical examination was more sensitive. Clinical examination was more accurate for specific triangular fibrocartilage complex (TFCC) injuries, while magnetic resonance imaging was more accurate for lunotriquetral (LT) and scapholunate (SL) ligament injuries. The study results suggest that magnetic resonance imaging has a use where clinical examination is ambiguous or where scapholunate damage is suspected.

Bilateral thumb metacarpophalangeal joint fusions for severe hyperextension deformities in conjunction with carpometacarpal joint reconstructions.

BACKGROUND: Hyperextension of the first metacarpophalangeal (MCP) joint and adduction of the first web space of the hand are features of advanced stages of carpometacarpal (CMC) joint arthrosis. Restoration of mechanical efficiency in such patients requires stabilization of both the CMC and MCP joints. This study describes a patient with bilateral secondary hyperextension of the MCP joint greater than 50° who displayed good functional outcome following staged bilateral MCP joint arthrodesis with simultaneous CMC joint reconstruction. CASE REPORT: Excision of trapezium, formation of a Weilby sling utilising flexor carpi radialis, and insertion of a Swanson's prosthesis forms the basis of CMC joint reconstruction. Fusion of the MCP joint involved placement of longitudinal K-wires and tension band wiring. The patient underwent an initial right-sided procedure in 2008 and subsequently elected for the same procedure on the contralateral side 26 months later. Good functional improvement was achieved with a pre and postoperative DASH score of 49 and 8 respectively. Follow-up and radiological imaging at 34 months from her initial surgery confirmed good positions of the prostheses and solid MCP joint fusions. The patient developed postoperative interphalangeal joint pain, which responded to steroid injection. DISCUSSION: There is currently limited evidence available addressing the management of severe hyperextension deformity greater than 50° of the MCP joint in the presence of CMC joint arthrosis. Staged bilateral fusion of the MCP joint and simultaneous CMC joint reconstruction in this case illustrates good, reproducible functional results and patient satisfaction with reduced postoperative return to function.

Distal interphalangeal joint arthrodesis in extension using a headless compressive screw.

The aim of this study was to review the clinical outcome and complications in patients who underwent distal interphalangeal joint (DIPJ) fusion in extension using an axial screw with variable thread pitch (Mini Acutrak screw Acumed, LLC, Hillsboro, OR, USA). Thirty-eight cases of DIPJ or thumb IPJ were performed and assessed through patient satisfaction (hand function and pain) and radiographs. The quickDASH scores were assessed at a mean follow up of 8 months (range : 6 to 12 months). Ninety-three per cent of participants reported good or excellent functional outcome, with Quick DASH scores of less than 30. There were five complications noted (one superficial wound infection; two fractures; two screw cut-outs). All cases progressed to radiographic bony union at six months.

Bilateral carpal tunnel syndrome with anomalous palmaris profundus tendons.

This report presents the case of a 44-year-old man who presented with elective bilateral carpal tunnel decompression. At the operation, he was found to have bilateral palmaris profundus tendons within the carpal tunnel, impinging on the median nerve. In releasing both carpal tunnels, the patient's symptoms were alleviated and there was regain of full function. There have been very few documented cases of these anomalous tendons implicated in carpal tunnel syndrome and this case highlights how such anatomical variations are important in the surgical approach to carpal tunnel decompression.

Collateral ligament injuries of the metacarpophalangeal joint of the thumb: a treatment algorithm.

The management of injury to the ulnar and radial collateral ligaments at the metacarpophalangeal joint of the thumb is complex. Treatment is dependent upon a number of factors with a wide variety of options for each ligament. Inadequate treatment has the potential to lead to a poor functional outcome. We present the relevant clinical anatomy, mechanism of injury, methods of treatment available and suggest a single treatment algorithm for use in the management of these injuries.

Complex dislocation with double sesamoid entrapment of the interphalangeal joint of the hallux.

A 23-year-old soccer player presented with a traumatic complex dislocation of the interphalangeal joint of the hallux with intraarticular entrapment of 2 sesamoid bones. Successful closed reduction was undertaken with excellent recovery of toe function.

Tenodermodesis for established mallet finger deformity.

Sixteen patients with established mallet finger deformity as a result of extensor tendon injury were treated by tenodermodesis and fixation of the distal interphalangeal joint with a Kirshner wire. The patients were followed for a mean of 36 months (range 10-60). The results were excellent in eight patients, good in six, and fair in two. The mean extension lag was decreased from 50 degrees (range 30-70) to 9 degrees (range 0-30), but not at the expense of impaired flexion capacity. All patients were pleased with their resultant function and cosmesis. No complications were encountered. We recommend the operation for passively correctable deformities with suitable joints; it is easy to do and yields consistently successful results.

Non-operative treatment of displaced avulsion fractures of the ulnar base of the proximal phalanx of the thumb.

Treatment of displaced or rotated avulsion fractures of the ulnar base of the proximal phalanx of the thumb remains controversial. There is limited information on the outcome of management of these injuries by non-surgical means. We undertook a retrospective follow-up study of the non-operative treatment of these fractures. The study included 28 thumbs that were stable to lateral stress testing at the time of initial investigation. The patients were treated by immobilisation of the thumb in a spica cast. The mean follow-up interval was 2.5 years (range 1-4). None of the patients changed their permanent employment or was unable to participate in their usual sporting activities. Twenty-six patients (93%) reported no pain on movement of the thumb. At follow-up, grip and pinch strengths did not differ significantly on the injured and non-injured sides. No thumbs showed instability on stress testing. The fractures had a 40% rate of bony union and 60% rate of fibrous non-union. All the patients were satisfied with their outcome. None of the patients was operated on after treatment. Non-operative treatment is recommended in cases of displaced or rotated avulsion fractures provided that there is no lateral instability of the metacarpophalangeal joint. Patients with unstable thumbs should always be treated surgically.