Trapeziometacarpal Dislocations in Pediatric Age, Is There a Better Treatment? Series of Cases and a Systematic Review.

(1) Background: Dislocations of the trapeziometacarpal joint (TMC) are uncommon in children and adolescents. Only a few isolated cases are reported in the literature. Therapeutic guidance is minimal and inconclusive. (2) Methods: The authors present four patients treated for this unusual lesion. We evaluated the evolution according to treatment, age, patient activity, and quickDASH. Despite the clear limitation of the small number of patients, it is relevant to try to better understand this lesion and its evolution. A systematic review of the literature was also conducted. (3) Results: This is the largest published series of TMC dislocations in children and adolescents. Patients included a 12-year-old girl treated conservatively with a poor quickDASH; a 9-year-old girl treated surgically with the Eaton-Littler technique for a new dislocation with a partially modified quickDASH; a 13-year-old boy with two necessary closed reductions for a new dislocation and a very good final quickDASH; and a 12-year-old boy treated with closed reduction and percutaneous fixation with excellent final results with quickDASH. (4) Conclusions: In the absence of scientific evidence, conservative treatment and ligament reconstruction did not provide good functionality. In contrast, closed reduction with percutaneous fixation provided excellent results. Therefore, the authors would recommend closed reduction and percutaneous needle fixation as an elective method to treat TMC dislocations in pediatric and adolescent patients.

Lunate Reconstruction Using Osteochondral Vascularized Graft in Kienböck's Disease.

There is a general consensus that the pathogenesis for Kienböck's disease remains uncertain, though it is probably related to nonphysiologic stress transmission across the lunate, acting in concert with one of several possible vascular abnormalities. Most surgical treatments focus on mechanical aspects rather than real physiopathology, but in the recent years several articles have shown the utility of vascularized grafts in the treatment of Kienböck's disease, especially in its early stages. The authors present a case of a successfully reconstruction of a IIIA stage Kienböck's disease with an osteochondral vascularized graft from medial femoral condyle.

Long-term effectiveness of corticosteroid injections for trigger finger and thumb.

PURPOSE: To analyze the long-term response to corticosteroid injection in the management of trigger digit. METHODS: This was an observational study of a prospectively recruited series of patients with first-time diagnosis of trigger finger. Efficacy of the injections, comorbidities, digit injected, and related complications were compared and statistically analyzed. RESULTS: A total of 71 digits were included in the study. The median (interquartile range) duration of follow-up was 8 years (range, 7.0-8.3 y). At final follow-up, complete remission of symptoms was obtained in 69% of cases. There were 37 trigger thumbs (52%), with a success rate of 81% compared with 56% in the other the digits. There were 11 patients with diabetes mellitus, and 16 fingers developed trigger finger after carpal tunnel syndrome surgery. We found no complications. CONCLUSIONS: Steroid injections were an effective first-line intervention for the treatment of trigger finger. At long-term follow-up, the success incidence may be as high as 69%. In this study, the efficacy of this treatment increases when treating the thumb compared with other digits.