A proposal for name-tagging three-dimensional distal radial fracture fragments based on preliminary results.

Melone introduced a classification system for distal radial fractures, emphasizing the intra-articular patterns. We explore the significance of key part fragments and introduce a three-dimensional fracture tagging system based on an updated version of Melone's concept.

Role of Three-Dimensional Guides in Management of Forearm and Wrist Malunions.

Although its precise added value and cost-effectiveness need to be determined, three-dimensional (3D) planning and intraoperative guidance facilitate restoration of normal anatomy. The use of 3D computer planning and patient-specific intraoperative guides leads to more accurate and reproducible correction of forearm and wrist malunion. Its value augments with increasing complexity of deformities. Combined deformities and complex intra-articular malunions of the forearm and wrist benefit the most from the use of 3D techniques. New technical developments, including lower-dose scanning technology, software improvement, artificial intelligence, and in-hospital printing, may lower the associated costs and make its application more accessible.

Primary endoprosthetic replacement of the arthritic CMC-1 joint.

OBJECTIVE: Osteoarthritis of the carpometacarpal (CMC)-1 joint is a common condition that can cause significant pain and functional problems. When nonoperative management fails, surgery may be indicated. Resection of the trapezium, often combined with soft tissue stabilization, is still considered the gold standard. But recovery time is often prolonged and a significant number of patients remain unsatisfied in the long term. Knowing that total endoprosthetic joint replacement is one of the most successful achievements of orthopedic surgery, many attempts have been made to produce a replacement for the CMC­1 joint that provides a better outcome than trapeziectomy. INDICATIONS: Eaton-Glickel stage 2-3 CMC­1 osteoarthritis. CONTRAINDICATIONS: Symptomatic pan-trapezial osteoarthritis (Eaton-Glickel stage 4), infection, young manual worker, poor bone quality or insufficient trapezium size. SURGICAL TECHNIQUE: A dorsoradial approach to the CMC­1 joint is used. Minimal resection of the trapezial and metacarpal articular surfaces, including osteophytes and loose bodies. Reaming of the trapezium and broaching of the metacarpal stem with dedicated instruments. Implantation of the endoprosthetic components. Selection of the correct neck length to ensure a stable joint. Closure of the capsule and skin. POSTOPERATIVE MANAGEMENT: Immobilization of thumb for 2 weeks in a splint. Followed by a removable thumb CMC brace for 4 weeks, starting with gentle mobilization exercises. No forceful gripping or pinching the first 6 weeks. RESULTS: A specific design-the uncemented, ball in socket, metal on polyethylene total joint replacement-has stood the test of time and successful long-term clinical and radiographic outcome results have been published. Recent comparative trials have shown better pinch strength, better pain relief and faster functional recovery, when compared to trapeziectomy with ligament reconstruction and tendon interposition. The incidence of complications such as dislocation, polyethylene wear and cup loosening is acceptable.