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Fan XL, Wang WT, Wang J, Xiao R. Current management of avascular necrosis of the metacarpal head: a comprehensive literature review. Int J Surg 2023; 109:1509-1517. [PMID: 37042565 PMCID: PMC10389567 DOI: 10.1097/js9.0000000000000377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/24/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Avascular necrosis (AVN) of the metacarpal head is a rare disease that may lead to progressive destruction of the metacarpophalangeal joint and hand function. This study aimed to describe the epidemiology, possible risk factors, clinical presentation, diagnostic workup, and treatment of the rare condition of avascular necrosis of the metacarpal head. METHODS Articles were searched using the subject words "Dieterich disease","Mauclaire's disease", and "avascular necrosis of metacarpal head" in the PubMed and Scopus databases. Studies were retained for review after meeting the inclusion criteria. Those outcomes relevant to diagnose and assessing AVN of the metacarpal head and those related to curative management were extracted. RESULTS The literature search revealed 45 studies with 55 patients. Although the aetiology of osteonecrosis has not been clearly delineated, AVN of the metacarpal head most commonly arises from trauma but other risk factors may also be involved. Plain radiographs are often negative and therefore likely to be missed. Early-stage osteonecrosis of the metacarpal head was best assessed using MRI. Given the rarity of this condition, there is no clear consensus on the treatment. CONCLUSIONS Avascular necrosis of the metacarpal head should be considered in the differential diagnosis of painful metacarpophalangeal joints. An early understanding of this unusual disease will provide an optimal clinical outcome, restoring joint activity, and resolving pain. Nonoperative treatment cannot cure all patients. Surgical management is based on the patient and lesion characteristics.
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Affiliation(s)
- Xiao-Lei Fan
- Department of Orthopedics, Honghui Hospital, Xi’an Jiaotong University, Xi’an
| | | | - Jian Wang
- Orthopedics, Karamay Central Hospital of Xinjiang, Karamay, China
| | - Rui Xiao
- Orthopedics, Karamay Central Hospital of Xinjiang, Karamay, China
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Tang R, Yang J, Liu H, Zhou K, Fei J. Metacarpal tuberculosis with Nocardia infection: A case report. Medicine (Baltimore) 2020; 99:e18804. [PMID: 32176026 PMCID: PMC7440352 DOI: 10.1097/md.0000000000018804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Isolated metacarpal tuberculosis is rare in orthopedic surgery. In the case of poor efficacy of traditional treatment methods, such as debridement surgery and anti-tuberculosis treatment, it is necessary to consider whether there is a special type of infection. We describe a case of metacarpal tuberculosis with Nocardia infection in a patient. PATIENT CONCERNS A 65-year-old male patient who suffered from pain and dysfunction lasted for 6 years. DIAGNOSES Confirmation of the diagnosis was finally achieved by isolation of M tuberculosis and Nocardia actinomycetes from bone specimens. INTERVENTIONS The patient underwent debridement surgery, Masquelet technique was used during the operation, and oral antibiotics were combined after surgery. OUTCOMES Bone graft surgery was performed 6 weeks after the first surgery. We followed up on bone healing at 1 and 3 months postoperatively. CONCLUSION Tissue-specific necrosis usually occurs in particular types of infections such as tuberculosis, which limits the spread of antibiotics. Masquelet technique seems to bring new options to solve this problem. The performance of Nocardia infection is similar to that of tuberculosis infection, so it is difficult to identify clinically. Therefore, for cases where tuberculosis is suspected, and anti-tuberculosis treatment is ineffective, the possibility of Nocardia infection needs to be considered.
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Affiliation(s)
| | - Jing Yang
- Emergency Department of Daping Hospital
| | - Huayu Liu
- Trauma center of Daping Hospital, Third Military Medical University (Army Medical University)
| | - Kai Zhou
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University
| | - Jun Fei
- Emergency Department of Daping Hospital
- State Key Laboratory of Trauma, Burns and Combined Injury, Third Military Medical University (Army Medical University), Chongqing, China
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Abstract
BACKGROUND Surgery is used to treat persistent pain and dysfunction at the base of the thumb when conservative management, such as splinting, or medical management, such as oral analgesics, is no longer adequate in reducing disability and pain. This is an update of a Cochrane Review first published in 2005. OBJECTIVES To assess the effects of different surgical techniques for trapeziometacarpal (thumb) osteoarthritis. SEARCH METHODS We searched the following sources up to 08 August 2013: CENTRAL (The Cochrane Library 2013, Issue 8), MEDLINE (1950 to August 2013), EMBASE (1974 to August 2013), CINAHL (1982 to August 2013), Clinicaltrials.gov (to August 2013) and World Health Organization (WHO) Clinical Trials Portal (to August 2013). SELECTION CRITERIA Randomised controlled trials (RCTs) or quasi-RCTs where the intervention was surgery for people with thumb osteoarthritis. Outcomes were pain, physical function, quality of life, patient global assessment, adverse events, treatment failure or trapeziometacarpal joint imaging. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by the Cochrane Collaboration. Two review authors independently screened and included studies according to the inclusion criteria, assessed the risk of bias and extracted data, including adverse events. MAIN RESULTS We included 11 studies with 670 participants. Seven surgical procedures were identified (trapeziectomy with ligament reconstruction and tendon interposition (LRTI), trapeziectomy, trapeziectomy with ligament reconstruction, trapeziectomy with interpositional arthroplasty (IA), Artelon joint resurfacing, arthrodesis and Swanson joint replacement). We did not find any studies that compared surgery with sham surgery or surgery with non-surgical interventions.Most included studies had an unclear risk of most biases which raises doubt about the results. No procedure demonstrated any superiority over another in terms of pain, physical function, quality of life, patient global assessment, adverse events, treatment failure (re-operation) or trapeziometacarpal joint imaging. One study demonstrated a difference in adverse events (mild-moderate swelling) between Artelon joint replacement and trapeziectomy with tendon interposition. However, the quality of evidence was very low due to a high risk of bias and imprecision of results.Low quality evidence suggests trapeziectomy with LRTI may not provide additional benefits or result in more adverse events over trapeziectomy alone. Mean pain (three studies, 162 participants) was 26 mm on a 0 to 100 mm VAS (0 is no pain) for trapeziectomy alone, trapeziectomy with LRTI reduced pain by a mean of 2.8 mm (95% confidence interval (CI) -9.8 to 4.2) or an absolute reduction of 3% (-10% to 4%). Mean physical function (three studies, 211 participants) was 31.1 points on a 0 to 100 point scale (0 is best physical function, or no disability) with trapeziectomy alone, trapeziectomy with LRTI resulted in sightly lower function scores (standardised mean difference 0.1, 95% CI -0.30 to 0.32), an equivalent to a worsening of 0.2 points (95% CI -5.8 to 6.1) on a 0 to 100 point scale (absolute decrease in function 0.03% (-0.83% to 0.88%)). Low quality evidence from four studies (328 participants) indicates that the mean number of adverse events was 10 per 100 participants for trapeziectomy alone, and 19 events per 100 participants for trapeziectomy with LRTI (RR 1.89, 95% CI 0.96 to 3.73) or an absolute risk increase of 9% (95% CI 0% to 28%). Low quality evidence from one study (42 participants) indicates that the mean scapho-metacarpal distance was 2.3 mm for the trapeziectomy alone group, trapeziectomy with LRTI resulted in a mean of 0.1 mm less distance (95% CI -0.81 to 0.61). None of the included trials reported global assessment, quality of life, and revision or re-operation rates.Low-quality evidence from two small studies (51 participants) indicated that trapeziectomy with LRTI may not improve function or slow joint degeneration, or produce additional adverse events over trapeziectomy and ligament reconstruction.We are uncertain of the benefits or harms of other surgical techniques due to the mostly low quality evidence from single studies and the low reporting rates of key outcomes. There was insufficient evidence to assess if trapeziectomy with LRTI had additional benefit over arthrodesis or trapeziectomy with IA. There was also insufficient evidence to assess if trapeziectomy with IA had any additional benefit over the Artelon joint implant, the Swanson joint replacement or trapeziectomy alone. AUTHORS' CONCLUSIONS We did not identify any studies that compared surgery to sham surgery or to non-operative treatments. We were unable to demonstrate that any technique confers a benefit over another technique in terms of pain and physical function. Furthermore, the included studies were not of high enough quality to provide conclusive evidence that the compared techniques provided equivalent outcomes.
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Affiliation(s)
- Anne Wajon
- Macquarie University ClinicMacquarie Hand Therapy2 Technology PlaceMacquarie UniversityNew South WalesAustralia2109
| | - Toby Vinycomb
- Monash UniversityDepartment of Surgery (MMC)MelbourneAustralia
| | - Emma Carr
- Pacific Hand Therapy Services812 Pittwater RoadDee WhyNew South WalesAustralia2099
| | - Ian Edmunds
- Hornsby Hand Centre2/49 Palmerston RdHornsbyNew South WalesAustralia2077
| | - Louise Ada
- University of SydneySchool of PhysiotherapyCumberland CampusPO Box 170LidcombeNew South WalesAustralia1825
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Abstract
The purpose of this retrospective study was to evaluate the clinical outcome of distraction lengthening of the thumb metacarpal without bone grafting in seven patients with traumatic thumb loss. The distraction was stopped after 57 (range, 42 to 91) days, giving a median lengthening of 28 (range, 20–36) mm. It took an average of 155 (range, 118–196) days for bony consolidation to occur. The mean pinch power was 72% of that of the uninjured hand. The two-point discrimination on the pulp of the reconstructed thumb was 10 (range, 8–12) mm. There were no major complications.
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Affiliation(s)
- C Heitmann
- Division of Plastic, Reconstructive, Maxillofacial and Oral Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
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Akmaz I, Kiral A, Pehlivan O, Mahirogullari M, Solakoglu C, Rodop O, Kuşkucu M. Late Reconstruction of Neglected Metacarpal Shaft Defects Due to Gunshot Wound. ACTA ACUST UNITED AC 2016; 29:585-9. [PMID: 15542221 DOI: 10.1016/j.jhsb.2004.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2004] [Accepted: 05/25/2004] [Indexed: 10/26/2022]
Abstract
We evaluated eight patients after delayed treatment of nine metacarpal bone defects due to gunshot injuries. The mean length of the metacarpal defects was 3 cm and the average time between the gunshot injury and the reconstruction surgery was 10 months. Although all of the patients had been treated with wound irrigation and debridement immediately following injury, no attempt had been made to repair the metacarpal defect or to maintain metacarpal length. As a result, serious shortening had occurred. After the original length of the metacarpal had been restored by distraction of the soft tissues (1 mm/day), a tri-cortical iliac bone graft was inserted into the bone defect. The average follow-up time was 15 months. Clinical and radiological union was established in all cases after an average of 12 weeks. The mean grip strength of the hand and the mean range of motion of the metacarpophalangeal joint increased by 24% and 60%, respectively.
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Affiliation(s)
- Ibrahim Akmaz
- Department of Orthopedics and Traumatology, Gulhane Military Medical Academy and Medical Faculty Hospital, Istanbul, Turkey
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Bain GI, Unni PMR, Mehta JA, Eames MHA. Arthrodesis of Ring Finger and Little Finger Metacarpal Bases for Little Finger Carpometacarpal Joint Arthritis. ACTA ACUST UNITED AC 2016; 29:449-52. [PMID: 15336747 DOI: 10.1016/j.jhsb.2004.03.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2003] [Accepted: 03/10/2004] [Indexed: 11/18/2022]
Abstract
Five patients with localized little finger carpometacarpal arthritis were treated by excision of the little finger metacarpal base and arthrodesis of the little and ring metacarpals. A dorsal periosteal/capsular flap was used as an interposition graft. All patients achieved significant pain relief, good cosmesis and satisfactory grip strength. All returned to activities of daily living. This procedure, the Dubert procedure, is indicated for localized pathology of the hamate-little finger metacarpal joint. It has theoretical advantages over arthrodesis and resection or interposition arthroplasty as it preserves little finger length, rotation and alignment and maintains some mobility of the transverse carpal arch and the little finger ray.
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Affiliation(s)
- Gregory I Bain
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
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8
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Lee JYL, Pho RWH, Yeo DSC. Central Column Reconstruction Following Total Resection of a Third Metacarpal Giant Cell Tumour. ACTA ACUST UNITED AC 2016; 30:650-5. [PMID: 16140443 DOI: 10.1016/j.jhsb.2005.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2004] [Accepted: 07/06/2005] [Indexed: 10/25/2022]
Abstract
A wide resection of a giant cell tumour involving the entire middle metacarpal is presented. Reconstruction preserving the central column and metacarpophalangeal joint was achieved using autologous iliac crest bone as a spacer and structural support. The fibro-osseous cartilage portion of the iliac graft was used as a “hemi-joint” replacement. By using a bridging bone graft and screw to fuse the adjacent proximal phalanges of the middle and index fingers, a stable “internal syndactyly” was achieved. Although independent index and middle finger motion was sacrificed, the approach allowed wide resection for local tumour control, re-established structural integrity, preserved metacarpophalangeal joint motion and allowed early motion. The aesthetic result was also good.
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Affiliation(s)
- J Y L Lee
- Department of Hand Surgery, Singapore General Hospital, Singapore, Department of Hand and Microsurgical Reconstruction, National University Hospital, Singapore.
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9
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Duan WJ, Chen JM, Zhang ZC, Dong Y. [Osteofibrous dysplasia of metacarpus: a case report]. Zhongguo Gu Shang 2016; 29:570-572. [PMID: 27534092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Abstract
BACKGROUND Surgery is used to treat persistent pain and dysfunction at the base of the thumb when conservative management, such as splinting, or medical management, such as oral analgesics, is no longer adequate in reducing disability and pain. This is an update of a Cochrane Review first published in 2005. OBJECTIVES To assess the effects of different surgical techniques for trapeziometacarpal (thumb) osteoarthritis. SEARCH METHODS We searched the following sources up to 08 August 2013: CENTRAL (The Cochrane Library 2013, Issue 8), MEDLINE (1950 to August 2013), EMBASE (1974 to August 2013), CINAHL (1982 to August 2013), Clinicaltrials.gov (to August 2013) and World Health Organization (WHO) Clinical Trials Portal (to August 2013). SELECTION CRITERIA Randomised controlled trials (RCTs) or quasi-RCTs where the intervention was surgery for people with thumb osteoarthritis. Outcomes were pain, physical function, quality of life, patient global assessment, adverse events, treatment failure or trapeziometacarpal joint imaging. We excluded trials that compared non-surgical interventions with surgery. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by the Cochrane Collaboration. Two review authors independently screened and included studies according to the inclusion criteria, assessed the risk of bias and extracted data, including adverse events. MAIN RESULTS We included 11 studies with 670 participants. Seven surgical procedures were identified (trapeziectomy with ligament reconstruction and tendon interposition (LRTI), trapeziectomy, trapeziectomy with ligament reconstruction, trapeziectomy with interpositional arthroplasty (IA), Artelon joint resurfacing, arthrodesis and Swanson joint replacement).Most included studies had an unclear risk of most biases which raises doubt about the results. No procedure demonstrated any superiority over another in terms of pain, physical function, quality of life, patient global assessment, adverse events, treatment failure (re-operation) or trapeziometacarpal joint imaging. One study demonstrated a difference in adverse events (mild-moderate swelling) between Artelon joint replacement and trapeziectomy with tendon interposition. However, the quality of evidence was very low due to a high risk of bias and imprecision of results.Low quality evidence suggests trapeziectomy with LRTI may not provide additional benefits or result in more adverse events over trapeziectomy alone. Mean pain (three studies, 162 participants) was 26 mm on a 0 to 100 mm VAS (0 is no pain) for trapeziectomy alone, trapeziectomy with LRTI reduced pain by a mean of 2.8 mm (95% confidence interval (CI) -9.8 to 4.2) or an absolute reduction of 3% (-10% to 4%). Mean physical function (three studies, 211 participants) was 31.1 points on a 0 to 100 point scale (0 is best physical function, or no disability) with trapeziectomy alone, trapeziectomy with LRTI resulted in sightly lower function scores (standardised mean difference 0.1, 95% CI -0.30 to 0.32), an equivalent to a worsening of 0.2 points (95% CI -5.8 to 6.1) on a 0 to 100 point scale (absolute decrease in function 0.03% (-0.83% to 0.88%)). Low quality evidence from four studies (328 participants) indicates that the mean number of adverse events was 10 per 100 participants for trapeziectomy alone, and 19 events per 100 participants for trapeziectomy with LRTI (RR 1.89, 95% CI 0.96 to 3.73) or an absolute risk increase of 9% (95% CI 0% to 28%). Low quality evidence from one study (42 participants) indicates that the mean scapho-metacarpal distance was 2.3 mm for the trapeziectomy alone group, trapeziectomy with LRTI resulted in a mean of 0.1 mm less distance (95% CI -0.81 to 0.61). None of the included trials reported global assessment, quality of life, and revision or re-operation rates.Low-quality evidence from two small studies (51 participants) indicated that trapeziectomy with LRTI may not improve function or slow joint degeneration, or produce additional adverse events over trapeziectomy and ligament reconstruction.We are uncertain of the benefits or harms of other surgical techniques due to the mostly low quality evidence from single studies and the low reporting rates of key outcomes. There was insufficient evidence to assess if trapeziectomy with LRTI had additional benefit over arthrodesis or trapeziectomy with IA. There was also insufficient evidence to assess if trapeziectomy with IA had any additional benefit over the Artelon joint implant, the Swanson joint replacement or trapeziectomy alone.We did not find any studies that compared any other combination of the other techniques mentioned above or any other techniques including a sham procedure. AUTHORS' CONCLUSIONS We did not identify any studies that compared surgery to sham surgery and we excluded studies that compared surgery to non-operative treatments. We were unable to demonstrate that any technique confers a benefit over another technique in terms of pain and physical function. Furthermore, the included studies were not of high enough quality to provide conclusive evidence that the compared techniques provided equivalent outcomes.
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Affiliation(s)
- Anne Wajon
- Macquarie Hand Therapy, Macquarie University Clinic, 2 Technology Place, Macquarie University, New South Wales, Australia, 2109.
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Shaw T, James F, Beierer L, Hosgood G. Bilateral phalangeal fillet technique for metacarpal pad reconstruction in a dog. Can Vet J 2014; 55:955-960. [PMID: 25320383 PMCID: PMC4187370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Loss of the metacarpal or metatarsal pad requires reconstruction with other pad tissue to allow functional weight-bearing on the limb. This report describes the use of a bilateral phalangeal fillet technique to reconstruct a weight-bearing surface in a dog following complete excision of its right metacarpal pad for malignant melanoma. This resulted in a functional weight-bearing limb.
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Serra R, Buffone G, Dominijanni A, Molinari V, Montemurro R, de Franciscis S. Application of platelet-rich gel to enhance healing of transmetatarsal amputations in diabetic dysvascular patients. Int Wound J 2013; 10:612-5. [PMID: 23433034 PMCID: PMC7950643 DOI: 10.1111/iwj.12052] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Transmetatarsal amputation (TMA) represents an effective surgical procedure used to treat several clinical conditions such as forefoot infection, gangrene and chronic ulceration in diabetic patients. TMA permits walking without the need for prosthesis, but nevertheless is burdened with a high complications rate. The aim of this study was to evaluate the possibility to use platelet gel (PG) as an adjuvant therapy when performing TMA procedure in diabetic patients. In a 6-year period, 26 diabetic patients had undergone TMA procedure followed by autologous PG applications (group A) and 32 patients had undergone TMA as sole procedure (group B). After TMA procedure, the treatment is based on outpatient management and consists of a weekly platelet-rich plasma gel application on the surgical wound for 1 month in group A and on clinical evaluation only for group B. For group A, healing rate was of 96.15% and one patient (3.84%) presented wound dehiscence, and no postoperative wound infections occurred. For group B, healing rate was of 59.37%; severe infection of the stump prompted to the proximal amputations in 40.62% of patients during the follow-up period. PG application may be an effective adjuvant treatment to improve wound healing in diabetic dysvascular patients.
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Affiliation(s)
- Raffaele Serra
- Department of Surgical and Medical Science, University Magna Graecia of Catanzaro, Catanzaro, Italy
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Zhang W, Zhang W, Jiao C, Liu Y. [Repair of finger soft tissue defect with island flap based on vascular chain of cutaneous branch of dorsal metacarpal artery]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2013; 27:440-442. [PMID: 23757872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To investigate the operative procedure and the clinical results of the island flap based on the vascular chain of the cutaneous branch of dorsal metacarpal artery for repairing finger soft tissue defect. METHODS Between January 2008 and March 2012, 28 cases of tissue defect of fingers (32 fingers) were repaired with the island flaps based on the vascular chain of the cutaneous branch of dorsal metacarpal artery. There were 20 males (23 fingers) and 8 females (9 fingers), with an average age of 29.5 years (range, 14-67 years). The injury causes included 14 cases of crush injury, 6 cases of pressing injury, 5 cases of cutting injury, and 3 cases of avulsion injury. The locations included 10 index fingers, 13 long fingers, 6 ring fingers, and 3 little fingers. There were 9 defects of proximal segment, 12 defects of middle segment, and 11 defects of distal segment. The area of defect ranged from 1.0 cm x 0.8 cm to 5.2 cm x 3.5 cm. The disease duration was 1 hour to 15 days. The area of flaps ranged from 1.2 cm x 1.0 cm to 5.5 cm x 3.8 cm. The donors were closed by suture or were repaired with skin graft. RESULTS Tense blister occurred in 3 cases, which was cured after dressing change; the other flaps survived. Wound obtained primary healing. Twenty-five patients (27 fingers) were followed up 6-25 months (mean, 16.8 months). The flaps had soft texture and satisfactory appearance. Two point discrimination was 6-9 mm (mean, 7.7 mm) at 6 months after operation. The total active movement of fingers was 105-230 degrees (mean, 204.6 degrees). The results were excellent in 17 fingers, good in 8 fingers, and fair in 2 fingers with an excellent and good rate of 92.6%. CONCLUSION The island flap based on the vascular chain of the cutaneous branch of dorsal metacarpal artery has the advantages of the deverting point from the dorsal point to the palm, the extended vessel pedicle, and expanded operation indications, so it is not necessary to cut the dorsal metacarpal artery. It can be used to repair finger tissue defect.
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Affiliation(s)
- Wenjing Zhang
- Department of Orthopedics, Traditional Chinese Medicine Hospital of Tangshan, Tangshan Hebei, 063000, P.R.China
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Gundes H, Tosun B, Muezzinoglu B, Tosun A. TOTAL DESTRUCTION OF THE FOURTH METACARPAL BONE BY ANEURYSMAL BONE CYST: RECONSTRUCTION WITH STRUT FIBULAR GRAFT — A CASE REPORT. ACTA ACUST UNITED AC 2012; 10:265-9. [PMID: 16568525 DOI: 10.1142/s021881040500267x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2004] [Accepted: 09/01/2005] [Indexed: 11/18/2022]
Abstract
Total destruction of the fourth metacarpal bone by aneurysmal bone cyst is presented. Despite the benign nature of the lesion on plain radiograms, magnetic resonance imaging (MRI) has revealed total destruction of metacarpal bone with shelling off the articular cartilages on both ends of the metacarpal. Both adjacent dorsal interosseous muscles were also involved with tumour. After removal of the metacarpal bone and third and fourth interossei, fibular bicortical strut graft was used for reconstruction. Arthrodesis was done both at the carpometacarpal and metacarpophalangeal (MCP) joints. The follow-up radiograms at one year revealed excellent incorporation of the graft with no evidence of local recurrence. A careful pre-operative work-up including MRI seems necessary even in lesions that look typically benign with intraosseous location on plain radiograms. This approach may prevent unpredicted morphologic picture during surgery, high recurrence rate and the number of operations.
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Affiliation(s)
- Hakan Gundes
- Department of Orthopedics, Maltepe University School of Medicine, Maltepe, Istanbul, Turkey
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15
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Jiao W, Wang B. [Progress of metacarpal and phalange lengthening]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2011; 25:624-627. [PMID: 21675126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To review the methods of metacarpal and phalange lengthening and to point out the problems at present as well as to predict the trend of development in the field. METHODS Domestic and abroad literature concerning the methods of metacarpal and phalange lengthening in recent years was reviewed extensively and thoroughly analyzed. RESULTS At present, there are many methods to treat the short finger disability, but the methods of metacarpal and phalange lengthening have an advantage, which include closed osteotomy lengthening, callus-lengthening, and modified Ilizarov method. Each surgical method has its advantages and limitations. However, the part of osteotomy, the length and speed, and the postoperative complications etc. have been disputed. CONCLUSION The modified Ilizarov method has the advantages of simple operation, minimal invasion, and less complications, but the long-term results of each treatment method are unknown and need more further studies.
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Affiliation(s)
- Wei Jiao
- Department of Hand Surgery, the Second Hospital of Tangshan, Affiliated Orthopedic Hospital of North China Coal Medical University, Tangshan Hebei, 063000, PR China
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Matysiakiewicz J, Tomasik P, Miszczyk L, Spindel J, Widuchowski J, Koczy B, Chrobok A, Mrozek T. Manifestations, diagnosis and surgical treatment of enchondroma--own experience. Ortop Traumatol Rehabil 2010; 12:155-159. [PMID: 20453254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND An enchondroma is a rather common benign tumour of bone that originates from cartilage.The course is usually benign but they have a tendency to recur and are sometimes invasive, especially when developing in long bones. The aim of the study was to analyze the manifestations and methods of treatment as well as to assess the results of surgical treatment in patients with enchondroma. MATERIAL AND METHODS A total of 150 patients with enchondroma, including 90 women and 60 men aged 10-74 years, were treated in the Regional Trauma Surgery Hospital in Piekary Slaskie between 1998 and 2006. RESULTS The tumours were mostly located in phalanges of the fingers--55 cases (37%), and metacarpal bones--21 cases (14%). Multiple locations were seen in 13 patients. A total of 170 surgical procedures were performed, mostly (120 procedures) tumour resections with bone graft implantation. A recurrence of enchondroma was observed in 17 patients (11%). There was also one case of malignant transformation in to a chondrosarcoma. CONCLUSION Total resection of the enchondroma combined with spongy bone grafting is the main treatment of chondroma.
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Syrko M, Jabłecki J. Quality of life-oriented evaluation of late functional results of hand replantation. Ortop Traumatol Rehabil 2010; 12:19-27. [PMID: 20203342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Forearm amputation in different zones via a similar mechanism in a group of patients of similar age is associated with different possibilities of functional recovery. The degree of postoperative recovery of function is invariably partial compared to pre-amputation function; this kind of trauma inevitably leads to disability. The patients adapt to their new circumstances to a different extent. That is why a quality of life evaluation should be included in the assessment of replantation outcomes. The aim of the study was to evaluate functional outcomes in patients after replantation at the metacarpal, wrist and mid-forearm level with regard to the quality of life of this patients. MATERIAL AND METHODS Thirty patients (29 men, 1 woman) of an average age of 41 years who had had replantation or revascularization surgery of an upper limb at different levels took part in a randomized study. The patients were divided into 3 groups depending on the level of amputation: metacarpal, wrist, mid-forearm, with 10 patients in each group. Amputations had been done by a circular saw (21) or via a guillotine mechanism (9). The patients were evaluated on average 4.2 years postoperatively. The following parameters were assessed: total range of active motion (the long finger with the greatest range of motion was assessed) (TAM), grip strength, and sensation; patients performed the Nakamura-Tamai test (modified). Overall functional outcomes were assessed according to Chen's classification. The quality of life (QoL) was measured with the SF-36 questionnaire (0-136 points). The correlation of functional and QoL results was assessed by Spearman's non-parametric test. RESULTS Average TAM was: 167 degrees in metacarpal, 174 degrees in wrist, 114 degrees in mid-forearm group; grip strength was 0.7 N, 0.9 N and 0.6 N respectively. All patients had at least protective sensation, whereas a 2PD of less then 10 mm was present in 4 patients in the metacarpal group, and 6 patients in the wrist group. In Chen's classification 5 patients in metacarpal group were rated as grade I and II, compared to 7 in the wrist group, and 2 in the forearm group. QoL scores were 98.9, 104 and 82 respectively. A strong QoL-function correlation was confirmed in the wrist and forearm groups (0.73 - 0.81 respectively), and in the metacarpal group it was weak (0.43). CONCLUSION The quality of life of patients of the designated groups was correlated with their functional results.
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Affiliation(s)
- Marcin Syrko
- Department of General Surgery, Limb Replantation Ward St Hedwig's Hospital, Trzebnica
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Lewicky YM, Sheppard JE. Closed-reduction percutaneous pinning of a complex divergent carpometacarpal fracture-dislocation involving the 4 ulnar carpometacarpal joints. Am J Orthop (Belle Mead NJ) 2009; 38:191-193. [PMID: 19440575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Yuri M Lewicky
- Summit Center Sports Medicine Northern Arizona Orthopaedics, Flagstaff, AZ 86011, USA.
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del Piñal F, Innocenti M. Evolving concepts in the management of the bone gap in the upper limb. Long and small defects. J Plast Reconstr Aesthet Surg 2007; 60:776-92. [PMID: 17452133 DOI: 10.1016/j.bjps.2007.03.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Accepted: 03/07/2007] [Indexed: 11/18/2022]
Abstract
Vascularised bone graft is a well accepted technique when dealing with long defects. Its role in refractory nonunion, in small defects and in the growing patient is rarely discussed. In this paper the authors review the different alternatives to deal with bone defects in the upper extremity. The indications of vascularised corticoperiosteal graft for solving small defects harbouring refractory nonunion, and the use of vascularised bone phalanx and metatarsal for complex - but small - defects in the fingers is presented. The ability of the bone to grow and remodel when a living epiphysis is included, and to maintain the cartilage viability when a composite osteochondral graft is transferred are also discussed.
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Affiliation(s)
- Francisco del Piñal
- Unit of Hand-Wrist and Plastic Surgery, Hospital Mutua Montañesa, Instituto de Cirugía Plástica y de la Mano, Santander, Spain.
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20
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Paavilainen P, Nietosvaara Y, Tikkinen KAO, Salmi T, Paakkala T, Vilkki S. Long-term results of transmetacarpal replantation. J Plast Reconstr Aesthet Surg 2007; 60:704-9. [PMID: 17466610 DOI: 10.1016/j.bjps.2007.02.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Revised: 02/23/2007] [Accepted: 02/28/2007] [Indexed: 10/23/2022]
Abstract
UNLABELLED The aim of this study was to evaluate subjective, functional and occupational outcome after transmetacarpal amputations. PATIENTS AND METHODS Forty-three patients (mean age 34, range 1-71) with a transmetacarpal injury devitalizing three or more finger rays were treated with revascularization (22 patients) or replantation (21 patients). Most of the injuries (60%) were caused by a circular saw. Altogether 174 rays were injured of which 14 were doomed unsalvageable. An attempt was made to save the rest (n=160). Metacarpals were shortened on average 8 (range 0-22)mm. The number of arteries repaired varied from 2 to 5 and a vein graft was used in 16 patients. Thirty-eight patients (88%) attended a clinical follow-up examination performed by an independent observer at mean 9 years (range 2-24 years) after the injury. Subjective result was documented. Sensation was tested by two-point discrimination and Semmes-Weinsten filaments. Total active motion of MP- and IP-joints was measured. Grip and pinch strength was recorded. Functional results were assessed by Tamai's and Chens scoring systems. Cold intolerance and occupational history was registered. RESULTS Primary survival of the replanted or revascularized digital rays was 86% (137/160). Subjective result was excellent in 11, good in 11, fair in 10 and poor in 6 patients. Out of 110 revascularized/replanted digits 86 (78%) achieved 2PD, among those the mean 2PD was 14.7 mm (range 6-25 mm). Total active motion (TAM) was on average 154 degrees (range 20-270 degrees ) per injured digit. The mean grip strength measured 56% (range 3-100%, n=33) and pinch strength 58% (10-100%, n=30) of the uninjured side. Using Tamai's scoring system the outcome was excellent in eight, good in 11, fair in 12 and poor in seven patients. According to Chen's criteria the result was excellent in seven, good in eight, fair in 18 and poor in five patients, respectively. The majority experienced cold intolerance. Sixteen of the 30 manual workers resumed to their previous or related occupation, ten were re-educated and four retired. CONCLUSIONS The majority of transmetal carpal injuries with devascularized rays can be revascularized/replanted with a good subjective and satisfactory functional end result. Most patients can resume their old occupations or be employed after re-education.
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Affiliation(s)
- Pasi Paavilainen
- Department of Hand and Microsurgery, Tampere University Hospital, Tampere, Finland.
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21
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Risselada M, Verleyen P, van Bree H, Verhoeven G. The use of an external skeletal traction device for distal fractures in the dog. A clinical case series of 11 patients. Vet Comp Orthop Traumatol 2007; 20:131-5. [PMID: 17546215 DOI: 10.1160/vcot-06-03-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Metacarpal and metatarsal fractures in 11 patients were treated 'closed' with a specially designed External Skeletal Fixation (ESF) frame with a walking bar and traction applied to the digits. Mediolateral angulation had improved postoperatively in 10 of the 11 patients. Craniocaudal angulation had improved in eight patients and could not be evaluated in three due to ESF frame superimposition. At follow-up, eight patients had a good clinical function, whereas three patients were still slightly lame. Only minor ESF-related complications were seen (pin loosening, pin tract infection, cerclage wire breakage and bending of the frame), which resolved without intervention after frame removal.
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Affiliation(s)
- M Risselada
- Department of Medical Imaging of Domestic Animals, Ghent University, Merelbeke, Belgium.
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22
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Zyluk A, Walaszek I. [An assessment of the results of upper limb replantation]. Chir Narzadow Ruchu Ortop Pol 2007; 72:165-173. [PMID: 17941577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
During the period 1996-2005, in General and Hand Surgery Department in Szczecin, 47 patients, 45 males and 2 females, with a me an age of 42 years, with total (72%) and subtotal (28%) amputations within the metacarpus and more proximal were operated. 35 replants survived, however 10 (21%) necrotized, in 2 cases (5%) blood flow was not re-established during the operations. The study presents results of assessment of objective parameters of 19 patients who received replantation of amputated extremities at the level of metacarpus - 5 cases, wrist - 9, forearm - 3, elbow - 1 and arm - 1 case. Patients were followed-up at mean of 2.5 years after injury (range 6 months -10 years). The average active range of motion of fingers in replanted extremities was 116 degrees (range 26-224 degrees). The average total grip strength was 8.3 kG (range 2-12 kG). The subjective assessment of hand dexterity with DASH questionnaire was mean of 103 points, (range 72-148). Range of motion was satisfactory in most of metacarpals and wrist replantations and less pleasing in forearm and arm amputations. Simultaneously better objective results were achieved in metacarpals and wrist replantations (14 cases, mean DASH 98), than forearm and arm replantations (5 cases, mean DASH 117). The Semmes-Weinstein monofilament testing revealed feeling of light touch good in 2 cases, satisfactory in 4 cases (median nerve) and in 2 cases (ulnar nerve). Only protective sensation in 8 cases (median nerve) and 10 cases (ulnar nerve). In Chen's classification 3 patients were scored I grade, 2 patients II grade and 9 patients III grade. The patients underwent 78 corrective operations (mean 2.3 per patinet, range 1-5) in order to improve function or cover skin defect. The results support an opinion that these time consuming operations result in salvage of functionally acceptable extremity what advocates that in every case of major amputation, regardless the mechanism or extend of injury an attempt of replantation should be considered, when patient's general health condition is stable.
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Affiliation(s)
- Andrzej Zyluk
- Klinika Chirurgii Ogólnej i Chirurgii Reki Pomorska Akademia Medyczna w Szczecinie
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del Piñal F. Severe mutilating injuries to the hand: guidelines for organizing the chaos. J Plast Reconstr Aesthet Surg 2007; 60:816-27. [PMID: 17449339 DOI: 10.1016/j.bjps.2007.02.019] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Accepted: 02/06/2007] [Indexed: 11/23/2022]
Abstract
Major hand injuries have become a rarity in Western countries. The fact that there are well trained teams devoted to their management, should not obscure the fact that the first emergency surgeon has the major role of setting the foundations for a reconstruction. Understanding the goal to be sought: the 'acceptable hand' (one with three fingers, with near normal length, near normal sensation and a functioning thumb), is hoped to be of great help in primary care. Preservation of vital structures such as joints, flexor tendons, and vessels, in the initial debridement, which will help to build this 'acceptable hand' are discussed. The general guidelines for management of finger amputation and soft tissue problems are also given.
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Koch H, Bruckmann L, Hubmer M, Scharnagl E. Extended reverse dorsal metacarpal artery flap: clinical experience and donor site morbidity. J Plast Reconstr Aesthet Surg 2007; 60:349-55. [PMID: 17349587 DOI: 10.1016/j.bjps.2006.03.066] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2006] [Accepted: 03/22/2006] [Indexed: 10/24/2022]
Abstract
Extended reverse dorsal metacarpal artery (RDMA) flaps use the skin from the dorsum of the hand to cover defects of the long fingers up to the distal phalanx. The authors present a series of 12 patients who underwent closure of defects of the long fingers with these flaps. As relevant literature is scarce, special emphasis was put on donor site morbidity. Active and passive total range of motion (TRM) and pinch grip strength of the finger neighbouring the reconstructed one were evaluated and compared to the corresponding finger of the contralateral hand. The donor site was furthermore evaluated for cosmetic appearance and pain. There was no statistically significant difference for active and passive TRM. The difference for pinch grip reached statistical significance (p=0.04). Subjective evaluation of pain and cosmetic appearance by the patients revealed a mean pain value of 1.25 on a visual analogue scale (0=no pain, 10=maximal imaginable pain) and a mean estimation of cosmetic appearance of 8 (visual analogue scale, 0=worst cosmetic result, 10=best cosmetic result). In conclusion, compared to other flaps, the extended RDMA flap is a fast, secure and single-stage procedure for defect coverage on the long fingers with low donor site morbidity.
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Affiliation(s)
- H Koch
- Division of Plastic Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036 Graz, Austria.
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25
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Zhang Y, Wang Y, Xie J. [Treatment of distal radius fracture by combination of external fixator and volar approach fixation]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2007; 21:269-71. [PMID: 17419208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To investigate the operative indication and clinical efficacy of combination of external fixator and volar approach fixation in treating distal radius fracture. METHODS From March 2000 to March 2005, 28 patients with distal radius fracture were treated with combination of external fixator and volar approach fixation. Dorsal external fixator was used to maintain wrist in functional position, combinated volar plate or Kirschner wire fixation after reduction was achieved. Bone graft was necessary if there were severe comminuted cortical bone or compress of cancellous bone. Of 28 patients, there were 21 males and 7 females, aging from 18-54 years with a median age of 41 years. The locations were the left side in 4 cases and the right side in 24 cases. According to typing criterion for AO, 18 cases were classified as C2 and 10 cases as C3. One case was accompanied with dislocation of lunate bone. RESULTS Among 28 patients, 24 were followed up for an average of 8.5 months. The anatomical relationship of their wrist joint were re-established and retained. Overall good to excellent results were achieved in 87%, excellent in 16 cases, good in 5 cases and fair in 3 cases. CONCLUSION A combination of external fixator and volar approach fixation is an effective method of treating fractures of the distal radius, because distal radius fracture is unstable or difficult to close reduction. Volar fixation can avoid operative complication, and external fixator can obtain satisfactory reduction and function.
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Affiliation(s)
- Ying Zhang
- Department of Orthopedics, 2nd Affiliated Hospital of Kunming Medical College, Kunming Yunnan, 650101, PR China.
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26
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Pelissier P, Gardet H, Pinsolle V. The palmar intermetacarpal flap in Dupuytren's contracture. J Hand Surg Eur Vol 2007; 32:113. [PMID: 17097781 DOI: 10.1016/j.jhsb.2006.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2006] [Revised: 09/13/2006] [Accepted: 09/15/2006] [Indexed: 02/03/2023]
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Horowitz FB, Wells KL. What is your diagnosis? Dorsomedial avulsion of the right second carpal bone with medial displacement of the proximal portion of the second metacarpal bone. J Am Vet Med Assoc 2007; 230:31-2. [PMID: 17199488 DOI: 10.2460/javma.230.1.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
MESH Headings
- Animals
- Carpal Bones/injuries
- Carpal Bones/surgery
- Carpus, Animal/diagnostic imaging
- Carpus, Animal/injuries
- Carpus, Animal/surgery
- Dogs/injuries
- Dogs/surgery
- Fractures, Bone/diagnosis
- Fractures, Bone/diagnostic imaging
- Fractures, Bone/surgery
- Fractures, Bone/veterinary
- Lameness, Animal/diagnosis
- Lameness, Animal/diagnostic imaging
- Lameness, Animal/surgery
- Male
- Metacarpus/diagnostic imaging
- Metacarpus/injuries
- Metacarpus/surgery
- Pain/etiology
- Pain/veterinary
- Radiography
- Treatment Outcome
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Affiliation(s)
- Farrah B Horowitz
- Dallas Veterinary Surgical Center, 4444 Trinity Mills Rd, Ste 203, Dallas, TX 75287, USA
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Teoh LC, Tan PL, Tan SH, Cheong EC. Cerclage-wiring-assisted fixation of difficult hand fractures. ACTA ACUST UNITED AC 2006; 31:637-42. [PMID: 17011090 DOI: 10.1016/j.jhsb.2006.07.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2005] [Revised: 06/26/2006] [Accepted: 07/03/2006] [Indexed: 11/19/2022]
Abstract
Difficult hand fractures with multiple butterfly fragments, multiple cortical splits or intraarticular extension continue to pose a challenge for optimal stable fixation that allows early postoperative mobilisation. In this study, we describe the use of cerclage-wire-assisted fixation of 17 difficult hand fractures in 16 patients. The cerclage wires helped to maintain the reduction, so providing sufficient initial stability for placement of a plate and screws. Stable fixation of the fracture was then accomplished without losing the reduction. One to three cerclages of stainless-steel wires were used for the preliminary fixation. Stable fixation was then accomplished by a bridging or neutralising plate technique. Postoperatively, the fixation was sufficiently stable to allow immediate mobilisation. With an average follow up of 44.5 months, all 17 fractures united without loss of reduction. At final follow-up, the average total active range of motion was 247 degrees (range 220-260 degrees ).
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Affiliation(s)
- L C Teoh
- Department of Hand Surgery, Singapore General Hospital, Singapore
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Abstract
PURPOSE To determine factors that affect healing index and consolidation time following lengthening of congenitally short metacarpals (brachymetacarpia). METHODS 18 metacarpals of 8 young women (mean age, 18.6 years) were lengthened using the callus distraction technique. The results, including healing index and consolidation time, were analysed and compared with those in the literature. RESULTS The mean length increase was 16.5 mm (55% of the original length of 30 mm). Age was positively correlated with healing index and consolidation time: younger patients healed faster than older patients. Healing index differed significantly between patients aged 0 to 18 years and those aged 19 to 30 years (p=0.002). Comparison of our results with 9 previous studies confirmed that increased age was associated with a greater healing index and consolidation time. Conversely, the faster the distraction rate, the less the healing index and consolidation time. CONCLUSION Age has the most effect on healing index and consolidation time. Metacarpal lengthening using callus distraction is recommended. Adolescence is the most appropriate time to perform distraction lengthening of a congenitally short metacarpal. This will avoid additional lengthening of normal metacarpals prior to epiphyseal closure.
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Affiliation(s)
- M E Bozan
- Department of Orthopaedics, Medical School of Afyon Kocatepe University, Afyon, Turkey
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Koff MF, Shrivastava N, Gardner TR, Rosenwasser MP, Mow VC, Strauch RJ. An in vitro analysis of ligament reconstruction or extension osteotomy on trapeziometacarpal joint stability and contact area. J Hand Surg Am 2006; 31:429-39. [PMID: 16516738 DOI: 10.1016/j.jhsa.2005.11.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2005] [Revised: 11/14/2005] [Accepted: 11/14/2005] [Indexed: 02/02/2023]
Abstract
PURPOSE Painful instability of the minimally osteoarthritic thumb carpometacarpal (CMC) joint can be treated successfully by either ligament reconstruction or metacarpal extension osteotomy. The purpose of this study was to measure the laxity of cadaveric thumb CMC joints and to determine the influence of ligament reconstruction and metacarpal osteotomy on joint laxity and contact area. METHODS The baseline laxity of CMC joints from 25 fresh-frozen human cadaveric specimens (average age, 42 y; range, 18-55 y) was measured in the position of lateral pinch on a custom-designed CMC joint laxity tester. Joint laxity was measured again after 2 surgical simulations consisting of either a metacarpal extension osteotomy (at 10 degrees and 15 degrees) or a simulated Eaton-Littler ligament reconstruction (including total, volar, and dorsal ligament reconstructions relative to the plane of the thumbnail). Contact area between the thumb metacarpal and trapezium during testing was determined using stereophotogrammetry. RESULTS The 15 degrees extension osteotomy significantly reduced CMC joint laxity in the radial-ulnar, dorsal-volar, pronation-supination, and distraction directions in the position of lateral pinch. The 10 degrees osteotomy reduced laxity only in the dorsal-volar direction. The total ligament reconstruction significantly reduced joint laxity in the radial-ulnar, dorsal-volar, and pronation-supination directions. The dorsal ligament reconstruction reduced laxity in the dorsal-volar direction only; the volar ligament reconstruction reduced laxity in both dorsovolar and radioulnar directions. The 10 degrees and 15 degrees osteotomies produced a dorsal shift of the weighted centroid of contact on the metacarpal and trapezium, whereas the ligament reconstruction did not produce such an effect. CONCLUSIONS In the position of lateral pinch the 15 degrees osteotomy and total ligament reconstruction significantly reduced laxity of the thumb CMC joint in all directions tested. The isolated dorsal or volar ligament reconstructions both reduced dorsal-volar laxity. Metacarpal extension osteotomy may stabilize the thumb CMC joint in lateral pinch to a degree similar to that of a standard ligament reconstruction.
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Affiliation(s)
- Matthew F Koff
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
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31
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Soejima O, Hanamura T, Kikuta T, Iida H, Naito M. Suspensionplasty with the abductor pollicis longus tendon for osteoarthritis in the carpometacarpal joint of the thumb. J Hand Surg Am 2006; 31:425-8. [PMID: 16516737 DOI: 10.1016/j.jhsa.2005.12.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2005] [Revised: 12/01/2005] [Accepted: 12/01/2005] [Indexed: 02/02/2023]
Abstract
PURPOSE Many surgical procedures have been described for treating painful osteoarthritis at the carpometacarpal joint of the thumb. This article reports our clinical and radiographic results in performing suspensionplasty using the abductor pollicis longus (APL) tendon without tendon interposition after a complete trapeziectomy for patients with painful osteoarthritis in the carpometacarpal joint of the thumb. METHODS Eighteen patients (2 men, 16 women), including 21 thumbs with advanced arthritis of the first carpometacarpal joint, who were treated by suspensionplasty using the APL tendon after a complete trapeziectomy were evaluated both clinically and radiographically. Ten thumbs were classified as stage III and 11 were classified as stage IV (Eaton's classification). The average follow-up period was 33.3 months. RESULTS All patients (18 patients, 21 thumbs) reported pain with daily use before surgery; after surgery 13 of the 21 thumbs had no pain, 5 thumbs had mild pain with strenuous activity, and the remaining 3 thumbs had mild pain with light work. At the final follow-up evaluation the radial and palmar abductions each were 56 degrees +/- 9 degrees and 56 degrees +/- 6 degrees. The grip and key-pinch strengths were 16 +/- 6 kg and 4 +/- 1 kg, respectively. The first metacarpal subsidence at rest was 15% and the additional subsidence when performing a 2-kg key pinch was 6% in the final follow-up radiographic findings. CONCLUSIONS This study showed that the APL suspensionplasty has a favorable outcome for painful osteoarthritis in the carpometacarpal joint of the thumb and that the APL tendon can be removed as a deforming force without any abduction weakness. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic, Level IV.
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Affiliation(s)
- Osamu Soejima
- Hand and Wrist Surgery Service, Department of Orthopaedic Surgery, Fukuoka University School of Medicine, Nanakuma, Fukuoka, Japan.
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Abstract
There are numerous surgical treatment options for instability and painful trapeziometacarpal arthrosis. The available surgical treatments are arthrodesis and trapeziectomy alone or with synthetic/biologic interpositions, osteotomy, and total joint replacement. However, there is no clear consensus regarding the appropriate surgical procedure, and a unique situation exists in which the surgeon can develop a successful hybrid technique based on his own philosophy and experience. Traditionally, ligament reconstruction and tendon interposition have been used for elderly patients with lower demands whereas arthrodesis has been reserved for the treatment of posttraumatic arthritis in high-demand, younger patients. Regarding the second case, when thumb carpometacarpal arthrodesis is indicated, the procedure provides a reliable and lasting treatment with satisfactory results. However, it is important to know the indications and contraindications, as well as benefits and risks of this procedure. Therefore, the surgical technique is straightforward, and fusion may be performed with either a plate-and-screw construct, power staples, tension band wiring with or without Kirschner wires, or alone with multiple Kirschner wires. However, in all the techniques, it is necessary to remove the articular surfaces of the metacarpal and trapezium apart from the need of autogenous bone graft to fill the defect between those bones from either the distal radius or iliac crest. In addition, later in almost all the cases, it is necessary to remove the metal work because of protrusion or skin intolerance. The technique described in this article is a modification of a sliding inlay metacarpal bone graft technique originally described by Müller in 1949 and, 52 years after, perfected by Doyle. However, and as opposed to these, with the extra-articular arthrodesis technique, it is not necessary to remove the articular surfaces, and the graft fixation is performed by 2 Herbert screws which, when buried into the bone, avoid the need to remove the metal work because of the protrusion under the skin. Therefore, this intervention easily permits to convert the arthrodesis to another method of treatment (implant arthroplasty or tendon interposition arthroplasty) by means of the resection of the bone bridge between the metacarpal and trapezium and proceed to the chosen surgical intervention.
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Lu LJ, Gong X, Liu ZG, Zhang ZX. Retrospective study of reverse dorsal metacarpal flap and compound flap: a review of 122 cases. Chin J Traumatol 2006; 9:21-4. [PMID: 16393511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To evaluate the clinical application and discuss the operative indication of the reverse dorsal metacarpal flap and its compound flap on the skin defects of hand. METHODS From 1990 to 2003, we applied the reverse dorsal metacarpal flap and its compound flap to repair soft tissue defects of fingers in 122 cases, which included 90 cases of the reverse metacarpal flap and 32 cases of its compound flaps with tendon grafts, nerve grafts or bone grafts. Based on the follow-up observations, we analyzed the indications of the reverse metacarpal flap and its compound flaps, the postoperative contours, flap colors and textures in comparison to contralateral fingers retrospectively. RESULTS In the series of 122 cases, flaps survived and the donor site defects were closed directly. The follow-up period ranged from 1-12 years. The postoperative contours, colors and textures of the flaps and its compound flaps were similar to those of normal fingers, although linear scar remained. According to standards of sense recovery (British Medical Research Council, BMRC), the sense function of the flaps resumed S3 after operation for 1 year. In 10 cases with the tendon defects treated by the flap with tendon grafts, function of flexion-extension of fingers resumed 50%-75% in comparison to the contralateral fingers using the method of measurement of total active motion. In 7 cases with the phalangeal nonunion or bone defects treated by the flap with bone grafts, union occurred after operation for 3 months. CONCLUSIONS To soft tissue defects on fingers with bone or tendon exposure, the reverse metacarpal flap and its compound flap are a better choice for repairing. The range of repairing is up to the distal interphalangeal joint of fingers. The second dorsal metacarpal artery is more consistent and larger as the choice of vascular pedicle, in comparison with other dorsal metacarpal arteries. Postoperative flap color and texture are similar to normal fingers.
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Affiliation(s)
- Lai-jin Lu
- Department of Hand Surgery, The First Clinical College Affiliated to Jilin University, Changchun 130021, China.
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Abstract
Injuries to the bases of the index finger and long finger metacarpals are unusual because of the stability of the carpometacarpal joints. Such stability is provided by the strong capsuloligamentous attachments and the unique bony architecture. Given the rare nature of these injuries, there is no consensus regarding the optimal management of avulsion fractures of the bases of the index finger and long finger metacarpals. Open reduction and internal fixation of the fracture, with anatomic repair of the extensor carpi radialis brevis or extensor carpi radialis longus, offers several advantages over closed treatment. A case report and a review of the literature are presented.
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Affiliation(s)
- Anthony E Johnson
- Orthopedic Surgery Service, McDonald Army Hospital, Fort Eustis, VA 23604, USA
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Takehana K, Kawaguchi Y, Kuroda K, Yamazaki M, Kimura T. Transient talipes equinus deformity of bilateral lower limbs following malignant hyperthermia: a case report and review of literature. J Orthop Sci 2005; 9:657-61. [PMID: 16228690 DOI: 10.1007/s00776-004-0843-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2004] [Accepted: 08/20/2004] [Indexed: 10/26/2022]
Abstract
Malignant hyperthermia (MH) is a potentially fatal disease triggered by general anaesthesia. Four cases of compartment syndrome complicating MH have been reported. We report here a case of transient talipes equinus deformity of bilateral lower limbs, a condition similar to compartment syndrome, following MH in a previously healthy pediatric patient. MRI revealed high intensity in the bilateral soleus muscles but not in the gastrocnemius muscles. We discuss the possible mechanisms of the deformity of the lower limbs after the MH crisis.
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Abstract
AIM Because of the low prevalence, there is poor evidence on the effective management of bone and joint infections of the carpus and metacarpus. We therefore studied the outcomes of patients undergoing surgical treatment at our department. METHOD We conducted a retrospective study on all patients operated on because of osteomyelitis of the carpus and metacarpus between January 1998 and June 2004. Main study endpoint were the infection control rate at end of treatment and at time of follow-up. RESULTS Of eleven subjects (nine men, two women) with a median age of 43 years (range, 19 to 79 years) serial débridement with temporary wound closure and surgical fixation proved successful in ten cases. We identified causative pathogens in ten cases (S. aureus: n = 3, P. aeruginosa: n = 3, mixed: n = 4) by intraoperative biopsy. Eight subjects received local or free tissue flaps. A 73 year old man died in hospital. Follow-up information was available for eight patients after a median of 19.5 months (range: 3 to 61 months). Seven of them did not show signs of recurrent infection. CONCLUSION Adhering to accepted standards of treating osteomyelitis, satisfactory control rates in carpal and metacarpal infection can be achieved while salvaging the hand.
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Affiliation(s)
- A Eisenschenk
- Unfallkrankenhaus Berlin, Abteilung für Hand-, Replantations- und Mikrochirurgie
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Muir L. Condone or condemn? J Hand Surg Am 2005; 30:867; author reply 867. [PMID: 16039391 DOI: 10.1016/j.jhsa.2005.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2005] [Accepted: 02/23/2005] [Indexed: 02/02/2023]
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Abstract
Twelve patients (eleven males, one female; mean age 36 years) with Bennett's fracture having a gap or a step-off of more than 2 mm and in whom maintenance of the reduced position was difficult were treated by percutaneous leverage pinning. Bone union was obtained in all patients, and the wire was removed 37 days on average after the initial treatment. On the final follow-up examination, mild pain with motion was noted in two patients, and moderate to severe pain was noted in one patient. The reduction of the articular surface of the carpometacarpal joint of the thumb was confirmed by radiography; it was less than 1 mm in nine patients, less than 2 mm in two, and more than 2 mm in one. Because reduction and fixation are performed utilizing the leverage force of the wire inserted into the trapezium, percutaneous pinning has advantages, such as technical simplicity and the ability to apply tension to the fractured site.
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Affiliation(s)
- Takuya Sawaizumi
- Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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Meyer J, Kretschmer F, Brocks M, Wannske M. [Resection arthroplasty of the carpometacarpal joint of the thumb - results of 132 cases]. HANDCHIR MIKROCHIR P 2005; 37:137-44. [PMID: 15877276 DOI: 10.1055/s-2004-821280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Resection arthroplasty of the carpometacarpal joint of the thumb is considered to be the most frequently used surgical treatment for arthrosis of the trapeziometacarpal joint. To avoid proximalisation and to improve stability of the first metacarpal, tendon-sling resectional arthroplasties have gained general approvement. To further simplify surgery, we have used a surgical technique since 1995, that consists in a fixation of the first metacarpal with local capsular tissue. METHOD AND CLINICAL MATERIAL From 2000 to 2001, 152 resections of the trapezium were performed in 147 patients with arthrosis of the first carpometacarpal joint. 48 surgical procedures included a tendon-sling arthroplasty; in 104 cases stabilisations of the first metacarpal were achieved by fixing local radiopalmar capsular tissue to the flexor-carpi-radialis tendon. After a mean follow-up of 30 months (18 to 41 months), patients were asked to complete a questionnaire concerning pain, physical strength, practical skills, maximal physical capacity and aesthetic result. The general surgical result had to be scored and the recovery time until the thumb could be used for activities of daily living had to be recorded. RESULTS 132 of 152 questionnaires, 43 of the patients with tendon-sling arthroplasty and 89 of the patients with arthroplasty with local radiopalmar capsular tissue, were returned. After tendon-sling arthroplasty, 69.8 % of the patients judged their results to be good or very good, after stabilisation with radiopalmar capsular tissue 69.7 % of the patients valued their surgical results good or very good. Unsatisfactory results were found in 18.6 % of the patients after tendon-sling arthroplasty and in 19.1 % of the patients after stabilisation with radiopalmar capsular tissue. The thumb could be used for every-day life after a mean time of 6.7 months. There was no significant difference between the operative procedures. CONCLUSION The collected data implies that resection-arthroplasty of the carpometacarpal joint of the thumb with stabilisation by radiopalmar capsular tissue yields similar results compared to tendon-sling arthroplasty.
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Affiliation(s)
- J Meyer
- Abteilung für Plastische und Handchirurgie (Ltd. Arzt: Prof. Dr. M. Wannske), Klinikum Lippe-Lemgo, Lemgo.
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Taleisnik J. Excision of the trapezium for osteoarthritis of the trapeziometacarpal joint. J Hand Surg Am 2005; 30:625; author reply 625. [PMID: 15925180 DOI: 10.1016/j.jhsa.2005.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2004] [Accepted: 01/18/2005] [Indexed: 02/02/2023]
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Clark CB. Complications after the usual excision of the trapezium, tendon interposition, and stabilization of the base of the thumb metacarpal and dorsal displacement. J Hand Surg Am 2005; 30:626; author reply 626. [PMID: 15925181 DOI: 10.1016/j.jhsa.2005.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2004] [Accepted: 01/18/2005] [Indexed: 02/02/2023]
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Unglaub F, Christopoulos G, Hahn P. [Palmar carpal-metacarpal dislocation with hamulus fracture]. ROFO-FORTSCHR RONTG 2005; 177:576-7. [PMID: 15838765 DOI: 10.1055/s-2005-858036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- F Unglaub
- Vulpiusklinik, Handchirurgie, Bad Rappenau
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Chong AKS, Chew WYC. An isolated ring finger metacarpal shaft fracture?--beware an associated little finger carpometacarpal joint dislocation. ACTA ACUST UNITED AC 2005; 29:629-31. [PMID: 15542229 DOI: 10.1016/j.jhsb.2004.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2003] [Accepted: 05/05/2004] [Indexed: 10/26/2022]
Abstract
Dislocations of the ulnar carpometacarpal joint are easily missed because of a low index of suspicion as well as their subtle clinical and radiological features. Often, the presence of a more obvious adjacent injury also draws attention away from the carpometacarpal joint. Two cases of ring finger metacarpal shaft fractures with associated little finger carpometacarpal joint dislocations are presented. In both cases, the metacarpal fractures were diagnosed but the carpometacarpal joint dislocations were initially overlooked. The presence of an apparently isolated ring finger metacarpal fracture due to an indirect force should raise the possibility of an associated carpometacarpal joint injury.
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Affiliation(s)
- Alphonsus K S Chong
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Republic of Singapore
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Manfrini M, Stagni C, Ceruso M, Mercuri M. Fibular autograft and silicone implant arthroplasty after resection of giant cell tumor of the metacarpal--a case report with 9-year follow-up. ACTA ACUST UNITED AC 2005; 75:779-81. [PMID: 15762273 DOI: 10.1080/00016470410004201] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Marco Manfrini
- Orthopaedic Clinic of the University of Bologna, Istituto Ortopedico Rizzoli, Bologna, Italy
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Nilsson A, Liljensten E, Bergström C, Sollerman C. Results from a degradable TMC joint Spacer (Artelon) compared with tendon arthroplasty. J Hand Surg Am 2005; 30:380-9. [PMID: 15781363 DOI: 10.1016/j.jhsa.2004.12.001] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2003] [Accepted: 12/01/2004] [Indexed: 02/02/2023]
Abstract
PURPOSE A new spacer for the trapeziometacarpal joint (TMC) based on a biological and tissue-preserving concept for the treatment of TMC osteoarthritis (OA) has been evaluated. The purpose was to combine a spacing effect with stabilization of the TMC joint. METHODS Artelon (Artimplant AB, Sweden) TMC Spacer is synthesized of a degradable polyurethaneurea (Artelon), which has been shown to be biocompatible over time and currently is used in ligament augmentation procedures. Fibers of the polymer were woven into a T-shaped device in which the vertical portion separates the bone edges of the TMC joint and the horizontal portion stabilizes the joint. Fifteen patients with disabling pain and isolated TMC OA were included in the study. Ten patients received the spacer device and the remaining 5 (control group) were treated with a trapezium resection arthroplasty with abductor pollicis longus (APL) stabilization. The median ages of the 2 groups were 60 and 59 years, respectively. Pain, strength, stability, and range of motion were measured before and after surgery. Radiographic examination was performed in all patients before and after surgery. At follow-up evaluation 3 years after surgery an unbiased observer evaluated all patients. Biopsy specimens were obtained from 1 patient 6 months after surgery. RESULTS All patients were stable clinically without signs of synovitis. In both groups all patients were pain free. The median values for both key pinch and tripod pinch increased compared with before surgery in the spacer group but not in the APL group. The biopsy examinations showed incorporation of the device in the surface of the adjacent bone and the surrounding connective tissue. No signs of foreign-body reaction were seen. CONCLUSIONS This study showed significantly better pinch strength after Artelon TMC Spacer implantation into the TMC joint compared with APL arthroplasty.
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Abstract
OBJECTIVE To evaluate the use of carbon dioxide (CO(2)) gas for joint distention during arthroscopy for removal of osteochondral (OC) fragments of the palmar/plantar aspect of the metacarpo (MCP)/metatarsophalangeal (MTP) joints in horses. STUDY DESIGN Clinical study. ANIMALS Horses (26) with OC fragment(s) of palmar/plantar aspect of 1 or 2 MCP/MTP joint(s). METHODS OC fragments were removed using arthroscopic technique. Joint distention was maintained by isotonic Ringer's acetate at the beginning and at the end of the procedure but during fragment removal, CO(2) was used for joint distention. After surgery, fragment removal was confirmed by radiography. Horses were discharged the day after surgery, and outcome was determined by telephone contact 3-24 months later. RESULTS CO(2) joint distention resulted in a sharp image without villi obscuring the operative field. Fragments were identified and completely removed in all horses except one where a 1 mm x 3 mm radiodense body was seen on postoperative radiographs. In 5 horses, bleeding from the arthroscopic or instrument portal precluded optimal visualization when the joint was distended by gas; however, repeatedly rinsing the tip of the arthroscope with Ringer's acetate solution delivered from the fluid ingress line easily restored joint visualization. No specific complications were observed postoperatively. CONCLUSIONS Joint distention by CO(2) permitted optimal visualization of the palmar/plantar aspect of the MCP/MTP joints, which facilitated fragment removal. CLINICAL RELEVANCE Gas arthroscopy is a useful technique for removal of OC fragments of the palmar/plantar aspect of the MCP/MTP joints in horses.
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Affiliation(s)
- Nicolai Jansson
- Skara Equine Hospital, Gråbrödragatan 6, 532 31 Skara, Sweden.
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Walsh EF, Akelman E, Fleming BC, DaSilva MF. Thumb carpometacarpal arthroscopy: a topographic, anatomic study of the thenar portal. J Hand Surg Am 2005; 30:373-9. [PMID: 15781362 DOI: 10.1016/j.jhsa.2004.11.011] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2004] [Accepted: 11/16/2004] [Indexed: 02/02/2023]
Abstract
Arthroscopic treatment of osteoarthritis of the thumb carpometacarpal joint has been well described; however, the current site of the 2 working portals, especially the 1-R portal, may be complicated by neurovascular morbidity. This is owing to the close proximity of these portals to important nerves and vessels surrounding the carpometacarpal joint. We studied 7 cadaveric wrists to map out the topographic, anatomic, and arthroscopic position of a new thenar portal. We hypothesized that it would increase considerably the safe zone distances of the portal from vital structures of the joint compared with the traditional portals. This study showed that the thenar portal increases considerably the safe zone of the portal from the sensory branches of the radial nerve and the radial artery and does not put the motor branch of the median nerve at risk. In addition the thenar portal allows for better visualization of the carpometacarpal joint, which leads to improved ability to perform arthroscopic trapeziectomy.
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Affiliation(s)
- Eric F Walsh
- Department of Orthopaedics and Division of Hand and Upper Extremity and Microvascular Surgery, Brown Medical School, and Rhode Island Hospital, Providence, RI 02818, USA
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Abstract
Giant cell tumours are aggressive lesions, albeit benign. Lesions in the hand, especially those arising from metacarpals require resection with adequate margins and definitive structural reconstructions to ensure preservation of hand architecture, function and cosmesis. Almost all the described reconstructive procedures require a stump of tumour free metacarpal base after resection, for reconstruction of the metacarpal. This report describes replacement of the entire metacarpal with a silastic prosthesis, in a case of giant cell tumour involving the entire metacarpal head and shaft to within 7 mm of the base.
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Affiliation(s)
- A Chatterjee
- Department of Orthopaedics, King Edward VII Memorial Hospital, Mumbai, India.
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Trevisan C, Morganti A, Casiraghi A, Marinoni EC. Low-severity metacarpal and phalangeal fractures treated with miniature plates and screws. Arch Orthop Trauma Surg 2004; 124:675-80. [PMID: 15602676 DOI: 10.1007/s00402-004-0745-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2003] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The results reported in the literature of metacarpal and phalangeal fractures treated with miniature plates and screws are scarce and contradictory. The aim of our study was to evaluate the functional results after low-severity metacarpal and phalangeal fractures treated by miniature plates and screws. MATERIALS AND METHODS We retrospectively reviewed 44 patients of a consecutive series with 56 low-severity metacarpal and/or phalangeal fractures stabilized with miniature plates and screws with a mean follow-up of 24 months to assess objective and subjective outcomes and complications. The objective assessment included measurement of the range of motion (ROM) of the involved finger, prehension, sensory function and strength. The subjective evaluation assessed the impairment and pain felt by the patient. RESULTS At the final check-up, average total active movement of the involved digit was 256 degrees (range 175 degrees -260 degrees ), and average score for prehension was 49.3 (range 30-50), with 41 patients with a full score. The Jamar test pointed to a significant reduction in grip strength (-5.2%) of the injured hand compared with the other hand. Average subjective impairment score for all the fractures was 15.5 (range 10-16), with 39 patients having a score between 16 and 14 (no impairment). Fracture reduction was anatomic in 42 fractures (75%), satisfactory in 11 (19.6%) and unsatisfactory in 3 (5.4%). There were no contractures, non-unions, infections or tendon ruptures. Twenty patients (45%) presented with one or more complications in 23 fractures (41.1%). CONCLUSION These very favourable results suggest that miniature plates and screws are a possible choice in the treatment of these fractures.
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Affiliation(s)
- Carlo Trevisan
- Clinica Ortopedica Università degli Studi Milano Bicocca, Azienda Ospedale S.Gerardo, Via Donizetti, 106-20052 Monza, Italy.
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