Surgical outcome of volar plate arthroplasty of the proximal interphalangeal joint using the Mitek micro GII suture anchor.

BACKGROUND: The mechanism of injury in dorsal dislocation is usually a hyperextensive stress simultaneous with some degree of longitudinal compression. Operative treatment is indicated for those unstable and reduction is not achieved. We report the surgical outcome of volar plate arthroplasty of the proximal interphalangeal (PIP) joint using the Mitek Micro GII suture anchor. METHODS: We reviewed the medical records of 20 patients with acute or chronic dorsal dislocation or subluxation of the PIP joint who were managed using the Mitek Micro GII suture anchor over the past 5 years by the same surgeon (J.T.S.). Fourteen patients had acute injuries (<4 weeks before surgery) and six patients had chronic injuries (average interval of 4.1 week from injury to surgery; range, 1-8 weeks). The patients had persistent pain and loss of range of motion after trauma, and the reductions were still unstable. RESULTS: All patients were evaluated an average of 25 months postoperatively (range, 12-30 months). The average arc of motion of the PIP joints of the fingers was 82 degrees . There were no obvious perioperative complications, and no patient reported pain at rest or with activity. CONCLUSION: Volar plate arthroplasty using the Mitek Micro GII suture anchor is an effective treatment choice for acute or chronic PIP joint dorsal dislocation or subluxation.

Extensor-tendons reconstruction using autogenous palmaris longus tendon grafting for rheumatoid arthritis patients.

BACKGROUND: The purpose of the study is to retrospectively review the clinical outcome of our study population of middle-aged RA patients who had suffered extensor-tendon rupture. We reported the outcome of autogenous palmaris tendon grafting of multiple extensor tendons at wrist level in 14 middle-aged rheumatoid patients. METHODS: Between Feb. 2000 to Feb. 2004, thirty-six ruptured wrist level extensor tendons were reconstructed in fourteen rheumatoid patients (11 women and three men) using autogenous palmaris longus tendon as a free interposition graft. In each case, the evaluation was based on both subjective and objective criteria, including the range of MCP joint flexion after surgery, the extension lag at the metacarpophalangeal joint before and after surgery, and the ability of the patient to work. RESULTS AND DISCUSSION: The average of follow-up was 54.1 months (range, 40 to 72 months). The average range of MCP joint flexion after reconstruction was 66 degrees . The extension lag at the metacarpophalangeal joint significantly improved from a preoperative mean of 38 degrees (range, 25 degrees -60 degrees ) to a postoperative mean of 16 degrees (range, 0 degrees -30 degrees ). Subjectively all patients were satisfied with the clinical results, and achieved a return to their level of ability before tendon rupture. We found good functional results in our series of interposition grafting using palmaris longus to reconstruct extensor tendon defects in the rheumatoid patients. CONCLUSION: Reconstruction for multiple tendon ruptures is a salvage procedure that is often associated with extensor lag and impairment of overall function. Early aggressive treatment of extensor tendon reconstruction using autogenous palmaris longus tendon as a free interposition graft in the rheumatoid wrist is another viable option to achieve good clinical functional result.

Results of arthroscopic reduction and percutaneous fixation for acute displaced scaphoid fractures.

PURPOSE: This study used percutaneous techniques augmented by simultaneous wrist arthroscopy to visualize the fracture and thus confirm the fracture alignment and reduction and also to assesses the concurrent associated ligament injuries. TYPE OF STUDY: Retrospective study. METHODS: Arthroscopy was used to help to reduce scaphoid fractures and assess soft-tissue injuries in 15 acute cases (13 male and 2 female patients). The fractures were treated by reduction under arthroscopic control and percutaneous fixation with the cannulated interosseous compression screw. Soft-tissue lesions were also treated at the same time using debridement, suture repair, or K-wire transfixation. The average age of the patients was 29.2 years (range, 19 to 48 years). RESULTS: Two patients (13.3%) had scapholunate (SL) ligament injuries, and both exhibited partial tear of the SL ligament. Four patients (26.7%) suffered lunotriquetral (LT) ligament injuries and received ligament debridement, K-wire fixation of the LT joint, and splinting. Six patients (40%) had chondral fractures. Additionally, the triangular fibrocartilage complex (TFCC) was torn in 5 patients (33%). Finally, 5 patients (33%) suffered radioscaphocapitate ligament or long radiolunate ligament injuries. All fractures healed without malunion or nonunion and, at follow-up of 24 to 28 months, 11 patients had excellent results and 4 had good results based on Mayo Modified Wrist Scores. CONCLUSIONS: We believe that arthroscopic reduction may be considered for scaphoid fractures because this approach can use a single procedure to achieve acceptable restoration of fractures as well as assessment and management of soft-tissue lesions. LEVEL OF EVIDENCE: Level IV Therapeutic Study, case series with no, or historical, control group.

Treatment of tibial pilon fractures using the Link May Anatomic Bone Plate.

BACKGROUND: The tibial pilon fracture is a relatively uncommon but a most difficult fracture to manage. Most orthopedic surgeons agree that the goal of treating such kind of fracture should be anatomic restoration of the articular surface, rigid and stable fixation, early restoration of joint motion, and finally, good functional recovery. We report our experience in managing the fracture and evaluate the operative results for patients who were treated with the Link May Anatomic Bone Plate. METHODS: A retrospective study was performed for tibial pilon fracture from January 1997 to February 2000. A total of thirty patients underwent surgical treatment using Link Distal Fibular Anatomic May Bone Plate, including twenty males and ten females with an average age of 42.6 years (range, 18 to 88 years). According to Rüedi-Allgöwer classification, the fracture patterns were type I in 30% (n = 9), type II in 53.3% (n = 16), and type III in 16.7% (n = 5). Twenty-two fractures (73.3%) were closed type; three (10%) were classified (Gustilo) as grade I open fracture; and five (16.7%) as grade II open fracture. Associated injuries included multiple fractures in five cases and head injury in four cases. All patients were evaluated clinically and radiologically after a mean time of 27.1 months (range, 17 to 39 months). RESULTS: Satisfactory results were obtained in 83.3% of cases. Complications were found in four patients (13.3%), with one nonunion, two superficial wound infections and one deep wound infection. CONCLUSIONS: We concluded that this plating system is one choice of treatment for tibial pilon fracture which provides relatively good outcome.

Dorsal capsulodesis and ligamentoplasty for chronic pre-dynamic and dynamic scapholunate dissociation.

Scapholunate (SL) instability is the most common cause of carpal instability. Pre-dynamic and dynamic type SL instability is difficult to diagnose and treat. This series reviews 17 soldiers with pre-dynamic or dynamic SL instability diagnosed by midcarpal arthroscopy and treated with dorsal capsulodesis and augmentation ligamentoplasty with partial dorsal radiocarpal (DRC) ligament procedure between 1997 and 2000. The sample included 14 males and three females. The dominant hand was involved in 15 patients. Moreover, the average patient age was 29.3 years (range 19-36 years). The diagnosis was based on clinical and arthroscopic criteria. Fifteen patients were followed up at our clinic regularly, with the follow-up period ranging from 12 to 39 months (mean 25.2 months). Fourteen patients had excellent or good results, and one patient had poor result based on Mayo Modified Wrist Score. Wrist motion in the flexion-extension plane loss averaged 18.4 degrees. Grip force increased significantly following treatment, with improvement totaling 15% of normal side. No complications were found in this series. Consequently, dorsal capsulodesis and ligamentoplasty with partial DRC ligament is considered a valuable therapeutic option for cases of pre-dynamic and dynamic SL instability.

Chronic triangular fibrocartilage complex tears with distal radioulna joint instability: A new method of triangular fibrocartilage complex reconstruction.

From September 1996 to September 1997, 27 adult patients were diagnosed with chronic triangular fibrocartilage complex (TFCC) tears with distal radioulna joint (DRUJ) instability in our clinic. They all received the procedure of TFCC reconstruction with partial extensor carpi ulnaris (ECU) tendon combined with or without ulnar shortening. There were 26 males and one female in the study with a mean age of 22.4 years. The follow-up period ranged from 22 to 28 months with a mean of 26.2 months. 24 patients who had positive or zero ulnar variance received the procedure of ulnar shortening. Three patients who had minus ulnar variance only received TFCC reconstruction. After the operation, the DRUJ was fixed by a 2.0 mm K-wire for 4 weeks. All patients underwent a rehabilitation program and they were reexamined at our outpatient department (OPD). The results were graded according to the Mayo Modified Wrist Score. Five of the 27 patients rated their wrists 'excellent', 18 rated 'good', and 4 rated 'fair. Overall, a total of 23 patients (85%) rated satisfactorily and returned to work or sport activities. In the 4 patients rated 'fair', mild pain at work and/or exercise, and mildly limited supination were found; however their grip strength was improved at least by 65% compared to the opposite hand. Therefore, as suggested by this study, TFCC reconstruction with partial ECU tendon combined with the ulnar shortening procedure is an alternative method for chronic TFCC tears with DRUJ instability.