Effectiveness of Arthroscopic Debridement, Trapeziectomy, and Joint Replacement for Trapeziometacarpal Joint Osteoarthritis: A Meta-Analysis of Pre and Postoperative Pain Scores.

Trapeziometacarpal joint osteoarthritis (TMJO) affects up to 33% of postmenopausal women, leading to pain, reduced mobility, and grip strength, with initial treatments focusing on non-surgical options like injections, orthoses, and exercises before considering surgery. A major challenge in managing TMJO involves selecting the optimal surgical strategy that is customized to individual clinical conditions. This study aimed to compare the effectiveness of three common surgical interventions for TMJO in relieving pain, including arthroscopic debridement (AD), trapeziectomy (TRAP), and joint replacement (JR). PubMed, Cochrane, Embase, and MEDLINE databases were queried according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for studies that presented pain outcomes following intervention for TMJO. Pain scores were reported preoperatively and postoperatively using the visual analog scale (VAS). Inclusion criteria included studies published in Q1 and Q2 journals and those with a follow-up of > six months. The final selection comprised 18 studies with 763 patients treated with AD (n = 102, 13%), TRAP (n = 428, 56%), and JR (n = 233, 31%) between 2010 and 2023, with a mean follow-up period of 38 ± 28 months. The studies included a total of 24 groups, five of which received AD, 13 of which received TRAP, and six of which received JR. The mean preoperative VAS was 6.7 ± 1.7, and the mean postoperative VAS was 1.7 ± 1.3 for all groups (P < 0.001). The meta-analysis demonstrated a mean preoperative pain score of 5.8 (95% CI, 4.1-7.5) for AD, 6.6 (95% CI, 5.7-7.5) for TRAP, and 7.8 (95% CI, 7.0-8.7) for JR. Postoperatively, there was a mean pain score of 2.2 (95% CI, 0.1-4.2) for AD, 1.4 (95% CI, 1.1-1.7) for TRAP, and 0.9 (95% CI, 0.6-1.2) for JR. This study showed that, if appropriately indicated, joint preservation with AD may be as effective as TRAP and JR for reducing pain associated with TMJO in the short term. However, the rate of conversion or revision should be assessed in future studies.

Sliding Osteotomy, a New Simple Technique for Olecranon Nonunion Treatment.

Nonunion is a rare complication after surgical treatment of olecranon fracture, but indeed it is a devastating one because of the high potential for elbow stiffness, pain, soft tissue and skin problems, and device complaining. To our knowledge, there is no treatment of choice for olecranon nonunion in the literature. Here we describe a unique and new technique by sliding osteotomy of the olecranon in the form of prism and refixation with tension band wiring. Then, we report the clinical results for our 2 patients operated using this technique.

Total Wrist Arthrodesis: An Update on Indications, Technique and Outcomes.

Painful end-stage wrist osteoarthritis (OA) unresponsive to conservative treatment is frequently managed with total wrist arthrodesis (TWA), which might render pain alleviation and ameliorate function, pain, and grip strength. Usual indications for TWA include inflammatory arthritis, idiopathic degenerative OA and posttraumatic OA, Kienböck's illness, brachial plexus palsy, cerebral paralysis, infraclavicular brachial plexus blocks and other spastic and contracture base illnesses, scapholunate advanced collapse, scaphoid nonunion advanced collapse, and failure of other surgical techniques such as after failed total wrist arthroplasty, four-corner fusion, proximal row carpectomy and severe ligament injuries (this procedure is carried out when all other treatment alternatives have failed to control the individual's symptoms). TWA is commonly carried out with a dorsal plate fixed from the distal radius to the third metacarpal. However, other surgical procedures have been reported, including intramedullary fixation and new implants that do not cross the third carpometacarpal joint or some procedures without utilizing hardware for example using a vascularized fibular grafting In individuals with rheumatoid arthritis. TWA has been shown to give persistent and painless stability for 20 years or more. The rate of adverse events for TWA ranges from 0.1% to 6.1%, though some authors have published that it can be as high as 27%. The most common adverse events are tendon ruptures, peri-implant fractures of the third metacarpal, the need for hardware removal, and constant pain at the third carpometacarpal joint. In idiopathic degenerative OA, the reoperation rate following TWA has been reported as high as 63%. While TWA can render foreseeable pain alleviation and ameliorate function, orthopedic surgeons should remember that this surgical technique is not without its risks and that the accessibility of many surgical procedures requires orthopedic surgeons to scrupulously contemplate the risks and benefits of each alternative for the individual in front of them.

A Simple Surgical Technique for Arthroscopic Repair of Traumatic Radial-Side Peripheral TFCC Tear.

Conventionally, The Triangular Fibrocartilage Complex (TFCC) surgical procedures are complex in nature with open explorations and long hospital stays not to mention the added costs and the psychological stress for both the surgeon and the patient. Nowadays, surgical procedures are looked at in a different scope with the rapid progress of arthroscopic technology and equipment. To elaborate, here we introduce a simple surgical technique for arthroscopic repair of traumatic radial - side peripheral TFCC tear. In spite of the various surgical techniques found in the literature, we just used a k-wire and a couple of needles in order to repair Radial-sided peripheral TFCC tear. the simplicity of the current technique, adequate satisfaction and eliminating the use of a targeting device, is what sets this apart. For emphasis, this technique is less time consuming and is cost-effective with satisfactory result.

Distal Radioulnar Joint Instability: Diagnosis and Treatment.

Distal radioulnar joint (DRUJ) instability and triangular fibrocartilage complex (TFCC) tears are more usual than estimated and are frequently overlooked. Diagnosis is often clinical, which can be confirmed using computed tomography (CT) scan and magnetic resonance imaging (MRI). In doubtful cases, bilateral computed tomography in neutral forearm rotation, supination, and pronation should also be performed. Wrist arthroscopy can be diagnostic and therapeutic for ulnar-sided wrist pain. Two systematic reviews showed equivalent outcomes between open and arthroscopic repair of the TFCC. There is scant proof to advise one technique over the other in clinical practice. TFCC repair and reconstruction are contraindicated when there is a bony deformation of the radius or ulna or osteoarthritis of the DRUJ. With the advancement of implant arthroplasty, salvage procedures are less desirable. Constrained distal radioulnar arthroplasty is stable, and the longevity is encouraging.

Bilateral Arm-Abduction Shoulder Radiography to Determine the Involvement of the Scapulothoracic Motion in Frozen Shoulder.

BACKGROUND: We hypothesize that there is no difference in the motion of the scapula with respect to the thoracic wall (scapulothoracic interface) between the affected versus non-affected shoulder on 0° and 90° standard arm abduction radiography. METHODS: We enrolled 30 patients with the diagnosis of unilateral frozen shoulder after ruling out of other pathologies. Bilateral standard shoulder radiography was done in two position of 0° and 90° of arm abduction. Non-affected side was used as a control group. RESULTS: The mean scapulothoracic angle of the affected side was significantly larger than the non-affected side in both 0° and 90°of abduction in spite that the scapulohumeral angles were comparable in 0°, indicating potential alteration in scapular positioning. CONCLUSION: Scapulothoracic motion and position can be affected in frozen shoulder along with other areas. All treatment modalities should be applied to this area as well if substantial difference was detected between the two sides.

Validation of the Persian Version of the American Orthopedic Foot and Ankle Society Score (AOFAS) Questionnaire.

BACKGROUND: American Orthopedic Foot and Ankle Society Score (AOFAS) is a reliable and reproducible measurement tool which is commonly used for the assessment of foot and ankle conditions. In this study we aimed to translate and assess the psychometric properties of the Persian version of AOFAS questionnaire. METHODS: In this study, we enrolled 53 patients with ankle and hindfoot conditions. Our study was conducted according to five staged cross-cultural adaption steps including translation, synthesis, back translation, expert committee review, and pretesting. After that reliability of the subjective parts calculated by Cronbach's alpha and the intraclass correlation coefficient (ICC) and the reliability of the objective items estimated using Cohen's kappa test. Also, construct validity was assessed by testing the Persian AOFAS against the SF-36 questionnaire. RESULTS: Chronbach's alpha coefficient was 0.696, which was considered acceptable. Furthermore, the test-retest reliability measured by using the ICC for the subjective subscales was 0.853 (P<0.001). The reliability of testing the objective subscales was calculated by using Kappa, which indicated acceptable values. Pearson correlation coefficient between AOFAS and SF-36 was 0.415 (P=0.008). In addition, floor and ceiling effects were calculated 1.9% and 7.5% respectively. CONCLUSION: In our study, Persian translation of AOFAS demonstrated acceptable validity and reliability with no need to be culturally adapted.

Intraoperative Technique for Evaluation of the Interosseous Ligament of the Forearm.

PURPOSE: To introduce a technique for the diagnosis of interosseous ligament (IOL) disruption based on lateral displacement of the radius after radial head resection and to determine the cutoff value of the lateral displacement for the diagnosis of disruption, the best elbow position for testing, and the diagnostic performance of the technique in different positions. METHODS: We used 10 fresh-frozen cadavers. After resection of the radial head, a Steinman pin was placed into the radius medullary canal and used to mark the pin location on the capitellum. We applied 1 kg force to pull the proximal radius laterally and measured the displacement in full supination, neutral, and full pronation of the forearm with the elbow in extension and then in 90° flexion. All measurements were performed once with the IOL intact and again with it cut. To assess diagnostic efficacy, receiver operating characteristics curves were constructed. To determine the quality of the technique, we measured the area under the receiver operating characteristics curve for each position. We also determined the cutoff value to obtain the highest sensitivity and specificity. RESULTS: The area under the curve of the test in extension-supination and flexion-supination showed that these positions were excellent for the diagnosis of IOL disruption. The cutoff value of 5.5 mm lateral displacement in extension-supination had 100% sensitivity and 90% specificity. In flexion-supination, the cutoff value of 9 mm had 100% sensitivity and 90% specificity for the diagnosis of IOL disruption. CONCLUSIONS: This maneuver was reliable and accurate in cadavers with complete IOL disruption. It is likely that in an intraoperative setting, these results will be reproducible. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic II.