Trapeziometacarpal Joint Arthroplasty, a Salvage Technique for Failed Open Reduction Internal Fixation of the First Metacarpal.

This report describes the case of a 61-year-old man reporting a painful subluxation and instability of the first metacarpal of the right hand after surgery for a multifragment fracture-subluxation of the thumb base. The fracture (considered irreducible) had been previously treated with K-wire stabilization of the trapeziometacarpal joint and subsequent removal of the K-wires at another clinical center. We advocate the use of trapeziometacarpal arthroplasty after the failure of open reduction internal fixation of the previous articular fracture, with successful results at follow-up.

Surgical Management of the Trapezium Canal Syndrome: An Uncommon Presentation of Tenosynovitis of Flexor Carpi Radialis.

Flexor carpi radialis (FCR) tenosynovitis is a condition characterized by pain over the volar radial wrist caused by inflammation of the FCR tendon sheath. It is an uncommon and often unrecognized pathology that could be misleading from a diagnostic and therapeutic point of view. Treatment usually involves immobilization, nonsteroidal anti-inflammatory drugs, and injections. In refractory cases, operative release of the FCR tendon sheath may be indicated. In this article, we report our experience in treating FCR tenosynovitis by surgically decompressing the trapezium canal, through which the tendon runs, at the wrist. In our experience, this surgical technique allows a good functional recovery with the resolution of painful symptoms without notable complications.

Traumatic bilateral isolated palsy of Flexor Pollicis Longus: an uncommon case report.

INTRODUCTION AND IMPORTANCE: Flexor Pollicis Longus (FPL) lies in the volar compartment of the forearm and is responsible for the flexion of the distal phalanx of the thumb. The innervation of FPL is provided by an isolated motor branch of the anterior interosseus nerve (AIN), a branch of the median nerve. AIN disfunction causes symptoms of exclusive motor involvement concerning the FPL muscle. Solitary paralysis of the FPL is very uncommon in clinical practice. PRESENTATION OF THE CASE: We report the case report of a bilateral isolated paralysis of Flexor Pollicis Longus (FPL) that occurred after a trauma. Two years after the injury, no organic lesions were found and instrumental exams did not suggest any diagnosis. Surgical exploration of FPL and its innervation allowed to diagnose a pure post-traumatic bilateral neuroapraxia sustained by the presence of post traumatic connective fibrous bands. DISCUSSION: Diagnostic and therapeutic bands release allowed the immediate functional recovery of the nerve function and the consequent restoration of FPL function. The surgical exploration of the suspected injured nerve was the resolutive procedure for diagnosis and treatment of the disease. During the surgical exploration, the cause of FPL palsy was identified and removed with a complete recovery of the neuromuscular unit function. CONCLUSION: This case is very peculiar because of the clinical presentation with an important bilateral functional limitation of FPL. The release allowed the complete restoration of FPL function. No similar cases were described in literature.

The Treatment of Chronic Ulnar Collateral Ligament of the Thumb Injury Using Extensor Pollicis Brevis: Surgical Technique.

Chronic rupture of the ulnar collateral ligament of the thumb is a complex lesion that typically results in chronic joint instability, functional limitation in pinch, and persistent pain at the metacarpophalangeal (MCP) joint of the thumb. Different surgical techniques have been proposed, including tendon graft and transpositions. In this article, we report our experience in treating chronic ulnar collateral ligament injuries using extensor pollicis brevis tendon in a Sakellarides modified technique. During the surgical procedure, we detach the extensor pollicis brevis proximally and drive the tendon through the neck of the first metacarpal and the base of the proximal phalanx to reconstruct the ligament at the ulnar side. In our experience, the surgical technique provides good MCP joint strength and stability and allows a good functional recovery with few postoperative complications. This technique provides good stability of the MCP joint using an absorbable suture and allows early mobilization of the joint with minimal stiffness.