Robert Mathys Finger prosthesis of the proximal interphalangeal joint: a retrospective case series of 19 joints in 17 patients.

INTRODUCTION: The Robert Mathys (RM) Finger is a hinged type of arthroplasty for the metacarpophalangeal and proximal interphalangeal (PIP) joint that compensates ligament instability. The aim of this study is to evaluate the outcomes and complications of RM Finger arthroplasty of the PIP joint. MATERIALS AND METHODS: A retrospective case series of 19 RM Finger arthroplasties of the PIP joint in 17 patients was performed with a median follow-up of 36 months. The active range of motion (AROM) was measured pre-operatively, at the 6-week follow-up, at the termination of hand therapy, and at the final follow-up. Complications were recorded, as well as pain on a visual analog scale (VAS), stability, deformity, pinch strength, the Michigan Hand Outcomes Questionnaire (MHQ), and the Patient Global Index of Improvement Questionnaire. RESULTS: One implant fracture occurred. Another patient had an amputation due to stiffness. For the remaining joints, AROM was 61°. One joint mobilization under local anesthesia, one arthrolysis and two extensor tendon reconstructions were also necessary. Pain at the follow-up was 1.2 on the VAS. Relative pinch strength was 69%. Joint stability was restored in all fingers, although one joint had an ulnar deviation of 15°. Eight fingers developed a snapping phenomenon, of which five had a swan neck deformity. One finger had an extension lag with a Boutonnière deformity. MHQ scores were less compared to the unaffected hand. Fifteen patients rated their outcome as improved compared to their pre-operative condition. CONCLUSIONS: RM Finger arthroplasty of the PIP joint restores joint stability with AROM improvement, and with low pain, although it has a high rate of complications. LEVEL OF EVIDENCE: IV.

Influence of controlled hypotension versus normotension on amount of blood loss during breast reduction.

SUMMARY: Controlled hypotension employed during surgical procedures results in a beneficial reduction in blood loss during the operation. Breast reduction is a common cosmetic surgical procedure. Yet, in the Netherlands, controlled hypotension is not standard during breast reduction procedures, and in fact is only occasionally employed. Our research aimed to establish a set of guidelines which would outline the application of controlled hypotension during breast reduction surgery. The set up of the study was prospective. The patients were randomised into two groups. In the test group, controlled hypotension with an average of 30% reduction in systolic tension was established during the first operative phase. For the control group, normotension was maintained during the entire procedure. The blood loss in the test group (n=23; mean 318 cc) was reduced by 54.1% compared to control (n=28; mean 598 cc), and this difference was significant. A significant positive correlation was also found between blood loss and total incision time. An overall complication rate of 5.1% was observed; however, there was no significant difference between the two groups. A trend in favour of hypotension does suggest it may also help reduce postoperative complications. Our data indicate that a reduction in blood loss of more than 50% can be achieved by employing controlled hypotension in the first operative phase of breast reduction. A reduction in systolic pressure of 20-25% with the use of nitroprusside is sufficient to achieve this reduced blood loss.

Relevance of bacterial cultures of abdominal aortic aneurysm contents.

BACKGROUND: To establish further insight into the relevance of intraoperative bacterial cultures of abdominal aortic aneurysm contents a study was performed of the rate of occurrence of prosthetic graft infection after aneurysm repair. METHODS: Bacterial cultures were obtained from 216 patients, who were followed up for more than 3.5 years after operation and studied retrospectively in a single center analysis. RESULTS: Thrombus cultures yielded bacteria in 55 of 216 (25.5%) cases, including 11 of 44 (25%) cases with ruptured aneurysms. Prosthetic infections (4 of 216; 1.9%) occurred more frequently (p < 0.02) in patients with positive thrombus cultures (3 of 55; 5.5%) than in patients with negative cultures (1 of 161; 0.6%). In two patients the species isolated from the thrombus was also cultured from the vascular prosthesis, although in one graft infection other organisms were also isolated. CONCLUSIONS: The presence of bacteria in the intraluminal thrombus does not appear to be an important factor in the development of graft infection after primary elective and urgent abdominal aortic aneurysm repair. Therefore routine intraoperative cultures are unnecessary unless clinical signs of infective aortitis are present.