Review of the evidence: surgical management of 4th and 5th tarsometatarsal joint osteoarthritis.

Osteoarthritis of the lateral tarsometatarsal joints is less common than that which is seen in the 1st-3rd tarsometatarsal joints. Despite a suspected increase in incidence of tarsometatarsal arthritis and consequently the burden of disability and economic impact, guidelines for treatment and decision making remain scarce. When conservative treatment fails, lateral column osteoarthritis can severely limit a patient's mobility, lifestyle, and present a difficult management problem for the foot and ankle specialist. Evidence for the surgical techniques used in treatment of lateral column osteoarthritis is limited and sporadic within the literature. This article aims to summarise and compare the evidence for these surgical management options. This article looks at aetiology and epidemiology, with a summary of the biomechanics of the region and a comprehensive review of the literature regarding surgical treatment options.

Temporary external fixation facilitates open reduction and internal fixation of intra-articular calcaneal fractures.

Management of intra-articular calcaneal fractures during the past years has ranged from the nihilistic approach of no active treatment to open reduction and internal fixation or even to early subtalar arthrodesis. Operative treatment presents the surgeon with many challenges. Good results require atraumatic exposure, anatomic reduction, rigid fixation and early mobilization. We describe the use of a temporary external fixator as an intraoperative aid in the open reduction and internal fixation of intra-articular calcaneal fractures. We propose this operative strategy as an option for the treatment of calcaneal fractures. The controlled distractive force provides numerous benefits. These include improved exposure of the subtalar joint, correction of angulation and maintenance of temporary stability prior to definitive fixation. We have found this technique applicable and easily reproducible.

Fracture dislocation of carpometacarpal joints: a missed injury.

Fracture dislocation of the carpometacarpal joints on the ulnar side of the hand is an uncommon injury. These are high-energy injuries seen in motorcyclists and boxers. The mechanism of injury involves violent, forceful dorsiflexion of the wrist combined with longitudinal impact on the closed hand. This article reports a case of fracture of the base of the middle finger with dislocation of the ring and little finger carpometacarpal joints. On first examination, a diagnosis of isolated, minimally-displaced, middle-metacarpal base fracture was made and deemed suitable for nonoperative management. The hand was splinted in a plaster-of-Paris slab. Later, a true lateral radiograph showed the exact nature of the injury. The fracture was successfully treated with closed reduction under general anesthesia and transfixation using Kirschner wires. Functional results were excellent with return to work at 10 weeks and excellent grip strength at 14 weeks. This injury may be missed in an acute setting in a busy accident and emergency unit. Swelling around the wrist with shortening of the knuckle should alert the clinician towards the possibility of such an injury. On routine anteroposterior view, overlap of joint surfaces, loss of parallelism, and asymmetry at the carpometacarpal joints should raise suspicion of the possibility of a subtle carpometacarpal injury. This article highlights the importance of a high index of suspicion, a true lateral radiograph, and careful evaluation of radiographs in diagnosing these injuries. Intensive postoperative physiotherapy is vital to achieving a satisfactory outcome.

A simple external fixator for complex finger fractures.

Complex fractures of phalangeal bones in the hand are difficult to treat. External fixation is an effective method of treatment particularly when internal fixation is not possible due to comminution and associated soft tissue injury. A variety of commercial fixators are available for the treatment of hand fractures. However, these fixators are costly and need a sufficient degree of expertise and familiarity for their use. We describe a very simple fixator which is stable, lightweight and can be easily constructed with materials readily available in most trauma theatres.

Tarsal joint fusion using memory compression staples--a study of 10 cases.

A prospective clinical study was undertaken to assess the effectiveness of Nickel-Titanium Memory compression staples for fusion of the intertarsal joints. Ten patients underwent procedures for fusion of various hindfoot and midfoot joints with the memory staples. The patients were evaluated regarding period of immobilization in cast and time to radiographic joint fusion. Arthrodesis was achieved in all patients. The average time to fusion was 7.8 weeks, with an average period of immobilization of 6.6 weeks. The early experience with the use of these staples in hindfoot and midfoot joint surgery is encouraging. We did not encounter any technical problems, and there is a suggestion that these implants may reduce the time to fusion.