[Translated article] Experience in major complications with total trapezometacarpal prostheses.

INTRODUCTION: The treatment of rhizarthrosis using trapeziometacarpal prostheses (TMP) is increasing. Complications may lead to loss of the implant and result in salvage surgery. Our aim was to assess major complications with the use of some TMP models and their rescue. MATERIAL AND METHOD: Retrospective study on TMP implanted between 2006 and 2021. Models studied: Arpe®, Elektra®, Ivory®, Maïa®, Isis® and Touch®. Demographic data were assessed, implant placement by radiographic study, technical data, complications, salvage surgeries and final survival. RESULTS: Review of 224 TMP, 45 Arpe® (95.5% survival, rate follow-up [R] 6-16 years), 5 Elektra® (80% survival, R 13-14), 14 Ivory® (92.8% survival, R 9-11), 7 Maïa® (100% survival, R 8-9), 115 Isis® (99.1% survival, R 1-8), 38 Touch® (100% survival, R 1-4). The medial angle of the dome with the proximal articular surface of the trapezium in the lateral plane, was: Arpe®: 8.85°, Elektra®: not assessable, Ivory®: 6.6°, Maïa®: 14.4°, Isis®: 3.8°, and Touch®: 5.95°. The Isis® was placed 100% with scopic guidance presenting a significantly lower angle respect to the medial angle of the dome with the proximal articular surface of the trapezium. As main complications, we observed 3.5% of dislocations and 4% of mobilisations, with the Elektra® being responsible for 47% of these. Nineteen salvage surgeries were performed, with 3% of the implants being lost. CONCLUSIONS: Dislocation and mobilisation are the most observed complications, the Elektra® responsible for almost half of them. Correct placement and implant design appear to be crucial to avoid them in the short and long term.

Experience in major complications with total trapezometacarpal prostheses. / Experiencia en complicaciones mayores con las prótesis totales trapeciometacarpianas.

INTRODUCTION: The treatment of rhizarthrosis using trapeziometacarpal prostheses (TMP) is increasing. Complications may lead to loss of the implant and result in salvage surgery. Our aim was to assess major complications with the use of some TMP models and their rescue. MATERIAL AND METHOD: Retrospective study on TMP implanted between 2006 and 2021. Models studied: Arpe®, Elektra®, Ivory®, Maïa®, Isis® and Touch®. Demographic data were assessed, implant placement by radiographic study, technical data, complications, salvage surgeries and final survival. RESULTS: Review of 224 TMP, 45 Arpe® (95.5% survival, rate follow-up [R] 6-16 years), 5 Elektra® (80% survival, R 13-14), 14 Ivory® (92.8% survival, R 9-11), 7 Maïa® (100% survival, R 8-9), 115 Isis® (99.1% survival, R 1-8), 38 Touch® (100% survival, R 1-4). The medial angle of the dome with the proximal articular surface of the trapezium in the lateral plane, was: Arpe®: 8.85°, Elektra®: not assessable, Ivory®: 6.6°, Maïa®: 14.4°, Isis®: 3.8°, and Touch®: 5.95°. The Isis® was placed 100% with scopic guidance presenting a significantly lower angle respect to the medial angle of the dome with the proximal articular surface of the trapezium. As main complications, we observed 3.5% of dislocations and 4% of mobilisations, with the Elektra® being responsible for 47% of these. Nineteen salvage surgeries were performed, with 3% of the implants being lost. CONCLUSIONS: Dislocation and mobilisation are the most observed complications, the Elektra® responsible for almost half of them. Correct placement and implant design appear to be crucial to avoid them in the short and long term.

Initial survival of the Isis® total trapeziometacarpal prosthesis with conical trunk threaded cups. / Supervivencia inicial de la prótesis total trapeciometacarpiana de cúpula roscada Isis®.

INTRODUCTION: The treatment of trapeziometacarpal osteoarthritis through the implantation of total trapeziometacarpal prostheses is in continuous expansion. The Isis® prosthesis is a trunk-conical threaded anchorage prosthesis. Our objective was to assess the functional results and survival of this implant for at least one year of follow-up. MATERIAL AND METHOD: Prospective study on 53 Isis® prosthesis, implanted from april 2014 to january 2019. The Van Cappelle functional test, pain, strength, mobility, return to previous activity, radiological variables and placement of the trapezial component were evaluated. The surgical technique was performed with a guide wirefocused on the trapezius and control of the scopia. Observed complications were recorded and statistical analysis was performed. RESULTS: Fifty-one implants (49 patients) were reviewed. Mean follow-up was 2.1 years (1-5.7). Van Cappelle's test, pain, mobility, and grip and clamp strength improved significantly, as did the distance between the metacarpal head and the trapezius base; 96% of the patients returned in less than 6 months to their activities. Minor complications, 3 De Quervain's tendinopathy and 2 intra-operative metacarpal and 2 trapezium fractures were recorded, and one carpal tunnel syndrome. There was no dislocation, mobilization, or implant infection. CONCLUSIONS: The functional results of the Isis® prosthesis are excellent in the short term, far exceeding the first year of 100% of survival. The complications that arose were minor and few. The anchorage and placement of the trapezial component guided by scopia seem to be crucial for the good result.

Total thumb carpometacarpal arthroplasty for failed trapeziometacarpal joint arthrodesis.

Trapeziometacarpal joint arthrodesis is a surgical option for osteoarthritis of the first carpometacarpal joint; however, it has well-known disadvantages such as non-union and reduced mobility. Revision procedures are often not discussed and lack consensus. We are reporting two cases of satisfactory thumb implant arthroplasty for failed trapeziometacarpal joint arthrodesis in order to discuss the surgical technique, its advantages compared with other surgical options and therefore its potential indications.

Distal radius fractures: Should we use supplemental bone grafts or substitutites in cases of severe osteoporotic or conminution?

OBJECTIVES: The purpose of this study was to assess the need of bone graft or bone substitutes in unstable distal radius fractures (DRF) treated with locking compression plates (LCP) PATIENTS AND METHODS: An observational and prospective study was conducted on 60 patients with DRF AO-type A3 and AO-type C3, treated surgically by LCP plates without bone grafts or substitutes. Ranges of motion in flexion (F), extension (E), pronation (P), and supination (S) were measured in the injured wrist and compared with the healthy contralateral wrist. X-ray parameters: palmar tilt (PT), radial inclination (RI), ulnar variance (UV), and radial height (RH) were calculated in the injured wrist one year after surgery and then compared, with those parameters in the healthy contralateral wrist and in the follow-up postoperative x-ray of the injured wrist. PRWE and DASH scores were used to evaluate patient satisfaction. RESULTS: The range of motion loss was F 12° ± 16.1°, E 9° ± 13.1°, P 2.5° ± 7.5°, and S 5°±10°, but they remained within functional parameters. Good results were also obtained in the PRWE and DASH scores (DASH 12.6 ± 14.16 and PRWE 9.5 ± 9.5). All the fractures were healed without significant collapse (IP 0.55 ± 1.7°, IR 0.31 ± 1.5°, VC 0.25±0.8mm, and AR 0.1 ± 0.9 mm). CONCLUSIONS: All fractures healed without problems or with significant loss of reduction. Bone graft and bone substitutes are not mandatory for treatment of unstable DRF with LCP plates. Their use increases the cost and is not exempt of morbidities. This study also reinforces the role of LCP plates in surgical treatment of unstable DRF.

Resultados funcionales y complicaciones de las placas volares bloqueadas de radio distal / Functional results and complications of locked distal radius volar plates

Introducción y objetivos: En los últimos años se está observando un aumento en la intensidad del tratamiento de la fractura de radio distal derivado hacia la fijación interna. Las placas bloqueadas evitan el colapso metafisario aun con el hueso osteoporótico o conminuto, mantienen la reducción y permiten una movilidad temprana. Sin embargo, todavía no hay suficiente evidencia de cuál es el mejor método de tratamiento para esta fractura. Nuestro objetivo es evaluar nuestro resultado funcional y las complicaciones con el uso de las placas bloqueadas de radio distal. Material y métodos: Estudio retrospectivo sobre 145 fracturas inestables de radio distal tratadas mediante placa volar bloqueada, con un seguimiento medio de 28 meses. Se usó la clasificación AO (Asociación para el Estudio de la Osteosíntesis) y la clasificación de Fernández. Se evaluó la presencia de osteoporosis, la necesidad de injerto, la diferencia de movilidad entre la muñeca sana y la muñeca fracturada y las medidas radiográficas, así como el test funcional PRWE (Patient–Rated Wrist Evaluation) y las complicaciones. Análisis estadístico. Resultados: Se revisó a 95 pacientes. La puntuación media del PRWE fue de 13 puntos. Se encontró una relación significativa entre la movilidad y el resultado funcional. Se utilizó injerto en 3 pacientes y no hubo casos de seudoartrosis o colapsos metafisarios. El 8% de los pacientes presentó alguna complicación seria (algodistrofia, dolor crónico o consolidación viciosa). Conclusiones: Las placas bloqueadas se presentan como una alternativa para el tratamiento de las fracturas inestables de radio distal, proporcionan buenos resultados funcionales, pocas complicaciones, minimizan la necesidad de aporte de injerto y permiten una movilización temprana aun con hueso osteoporótico o conminuto (AU)

Introduction and purpose: In the last few years, there has been increased aggressiveness in the treatment of distal radius fractures by means of internal fixation. Locked plates prevent metaphyseal collapse even in the presence of osteoporotic or comminuted bone; they also maintain reduction and allow early motion. Nevertheless, there is as yet not enough evidence as to what may be the best way of treating this fracture. Our purpose is to assess our functional results and the complications that can arise from the use of distal radius locked plates. Materials and methods: This is a retrospective study of 145 unstable distal radius fractures treated by means of a locked volar plate, with a mean follow-up of 28 months. AO (Association for the Study of Osteosynthesis) and Fernandez’ classifications were used to assess the presence of osteoporosis, need for a graft, difference between healthy and fractured hand in terms of mobility, the radiographic measurements and the functional PRWE (Patient-Rated Wrist Evaluation) test and any potential complications. A statistical analysis was carried out.Results95 patients were analyzed. Mean PRWE score was 13 points. A significant relation was found between motion and functional result. A graft was used in 3 patients and there were no cases of pseudoarthrosis or metaphyseal collapses. Eight percent of patients presented with some serious complication (algodystrophy, chronic pain, malunion). Conclusions: Locked plates can be regarded as an alternative to the treatment of unstable distal radius fractures. They provide good functional results and few complications, they minimize the need for grafting and they allow early mobilization even in the presence of osteporotic and comminute bone (AU)