Total carpometacarpal joint dislocation combined with trapezium fracture, trapezoid dislocation and hamate fracture.

Multiple metacarpal dislocations combined with carpal fracture - dislocations are rare injuries. We report a new combination of these injuries where fracture-dislocation of the base of the 1st metacarpal bone occurred simultaneously with a comminuted fracture of the trapezium, dislocation of the trapezoid and metacarpal joints (2nd to 5th) and an avulsion fracture of the hamate. This specific carpal injury has not been previously described and our description will contribute to understanding the mechanism of these complex injuries. The injury pattern in the case featured here was multifaceted and resulted from rupture of both transverse and longitudinal carpal columns. According to the Garcia-Elias classification of axial carpal disruptions, this particular injury mechanism was a combined axial-radial-ulnar type injury. These injuries are extremely rare and are only sporadically described in the literature. Trapeziectomy, followed by open, partial, low-profile screw fixation of the fracture of the first metacarpal and open reduction and pinning of the carpometacarpal joints and the trapezoid injury yielded a good result at the 1-year follow-up.

Elektra prosthesis for trapeziometacarpal osteoarthritis: a follow-up of 39 consecutive cases.

We present a prospective follow-up of 39 Elektra prostheses in 37 patients (32 women and five men), with a mean age of 56.5 (range 46-71) years; 34 patients had osteoarthritis and three had rheumatoid arthritis. Patients were followed using clinical examination, including measurement of pain on a visual analogue scale, mobility, and strength, after 6, 12, 26, and 52 weeks, and annually thereafter. Radiological examination was done preoperatively and after 6, 26, and 52 weeks, and annually thereafter. The mean follow-up time was 48 (range 3-91) months. Although we observed a fast recovery, including maintenance of mobility and a gradual increase in grip strength, there was a revision rate of 7/38 (24%) after 36 months, increasing to 17/38 (44%) after 72 months. The main reason for revision was loosening of the trapezial component, and biomechanical properties of the trapezial fixation may be the key problem in treating trapeziometacarpal osteoarthritis using a total prosthesis.

Plasma gelsolin is reduced in trauma patients.

Tissue injury results in the release of the intracellular protein actin which is cleared from the circulation by the plasma proteins gelsolin and Gc-globulin, constituting the Extracellular Actin Scavenger System (EASS). Experimental studies have shown that excessive amounts of actin in the circulation can lead to a condition resembling multiple organ dysfunction syndrome (MODS), and we have previously demonstrated that the level of Gc-globulin is decreased after severe trauma. The purpose of the present study was to determine whether the plasma levels of gelsolin were altered in the early phase after trauma. Twenty-three consecutive trauma patients were studied. Plasma samples were assayed for gelsolin by immunonephelometry with polyclonal rabbit antihuman gelsolin prepared in our own laboratory. The median time from injury until the time the first blood sample was taken was 52 min (range 20-110) and the median Injury Severity Score (ISS) was 20 (range 4-50). The gelsolin level on admission was reduced significantly in the trauma patients compared with normal controls. The median level was 51 mg/L (7-967) vs. 207 mg/L (151-621), P < 0.0001. There was no correlation between admission levels of gelsolin and ISS or survival. This study illustrates that the plasma concentration of gelsolin is significantly diminished immediately after traumatic injury. Further studies are necessary to establish a role for gelsolin or EASS in the development of MODS in trauma patients. The level of serum or plasma gelsolin can be determined rapidly and accurately using a nephelometric assay.

[Percutaneous fixation of sacral fractures. Primary experiences with a new technique]. / Perkutan fiksering af sacrumfrakturer. Primaere erfaringer med en ny teknik.

A number of techniques have been introduced to obtain reduction and fixation of rotational and vertical unstable sacral fractures and sacro-iliac (SI) joint disruptions. The purpose of this study is to report our primary experience with percutaneous cannulated screw fixation across the joint or fracture line. Fifteen consecutive patients, seven males and eight females, were operated. Six patients had isolated sacral fractures or SI joint disruption. All patients had a type C pelvic fracture according to Tile's classification. Percutaneous fixation of sacral fractures and sacro-iliac joint disruptions allows a short operating time, minimal bleeding and soft tissue damage, and immediate non-weight bearing mobilisation. No non-unions were seen and there were no cases of infection. In two patients the material had to be removed. The method gives adequate fixation of unstable posterior pelvic-ring fractures, but is technically difficult as malposition of the screws might cause serious perioperative complications.