Trapeziometacarpal arthrodesis Amadei, F.
Hand surgery and rehabilitation,
September 2021, 2021-09-00, 20210901, Volume:
40
Journal Article
Peer reviewed
Arthrodesis of the trapeziometacarpal (TMC) joint is one of the first surgical procedures used to treat thumb basal joint arthritis. From 1970 to 1990, we performed 254 TMC arthrodeses with crossed ...K-wires. From 2015 to 2016, we performed 12 TMC arthrodesis procedures with shape-memory staples. The results were evaluated with De La Caffinière’s classification and took into account patient satisfaction and any complications. The results were satisfactory overall, without any significant difference between the two fixation methods but with a rather high complication rate. The indication for arthrodesis in surgical treatment of thumb basal joint arthritis is based on the patient’s age and occupation. The best indication is a young active patient.
L’arthrodèse trapézo-métacarpienne (TMC) est une des premières techniques chirurgicales utilisées dans le traitement de la rhizarthrose. De 1970 à 1990, nous avons pratiqué 254 arthrodèses TMC fixées par broches de Kirschner en croix. De 2015 à 2016, nous avons pratiqué 12 arthrodèses TMC fixées par agrafes à mémoire de forme. Les résultats ont été évalués en utilisant la classification de De la Caffinière prenant en compte la satisfaction du patient et les éventuelles complications. Les résultats sont dans l’ensemble satisfaisants, ne montrent pas de différences significatives entre les deux moyens de fixation, mais un taux de complications élevé. L’indication d’arthrodèse TMC dans le traitement de la rhizarthrose est déterminée essentiellement par l’âge et le niveau d’activité professionnelle du patient, la meilleure indication étant un sujet jeune et actif.
Orthopedic care often calls for the treatment of different trauma-affected tissues, such as nerve, skin, skeletal and soft tissues. Orthoplasty is designed to meet such a need, hence not only does it ...constitutes a therapeutic method but a real "therapeutic attitude" as well, for the ultimate purpose of dealing with highly complex and multifaceted injuries; by virtue of such features, orthoplasty needs to rely on a truly multidisciplinary and concerted effort, in order to effectively treat highly complex traumatic lesions while prioritizing both anatomical and functional restoration, while avoiding as much as possible demolition surgery, e.g. amputation. Ultimately, the authors point out the extent to which such a technique is valuable in terms of optimizing healthcare resources allocation as well, given that no specific costs to apply orthoplastic surgical interventions, and in light of shorter hospitalization times and operating room occupation.
Purpose
Unicompartmental knee arthroplasty (UKA) has shown a higher rate of revision compared with total knee arthroplasty. The success of UKA depends on prosthesis component alignment, fixation and ...soft tissue integrity. The tibial cut is the crucial surgical step. The hypothesis of the present study is that tibial component malalignment is correlated with its risk of loosening in UKA.
Methods
This study was performed in twenty-three patients undergoing primary cemented unicompartmental knee arthroplasties. Translations and rotations of the tibial component and the maximum total point motion (MTPM) were measured using radiostereometric analysis at 3, 6, 12 and 24 months. Standard radiological evaluations were also performed immediately before and after surgery. Varus/valgus and posterior slope of the tibial component and tibial–femoral axes were correlated with radiostereometric micro-motion. A survival analysis was also performed at an average of 5.9 years by contacting patients by phone.
Results
Varus alignment of the tibial component was significantly correlated with MTPM, anterior tibial sinking, varus rotation and anterior and medial translations from radiostereometry. The posterior slope of the tibial component was correlated with external rotation. The survival rate at an average of 5.9 years was 89 %. The two patients who underwent revision presented a tibial component varus angle of 10° for both.
Conclusions
There is correlation between varus orientation of the tibial component and MTPM from radiostereometry in unicompartmental knee arthroplasties. Particularly, a misalignment in varus larger than 5° could lead to risk of loosening the tibial component.
Level of evidence
Prognostic studies—retrospective study, Level II.
Background and aimThe fascio-cutaneous posterior interosseus artery flap (PIAF) is used in hand reconstruction, especially to repair skin or tissue defects such as burn injuries, open fractures, ...gunshot wounds or traumatic amputations. The aim of this study is to examine the anatomical features of this flap, to describe the surgical harvesting technique and the difficulties associated with the dissection.MethodsFrom January 2016 to January 2022, we performed PIAF in 10 patients (3 women and 7 men) with a mean age of 28 years (range 22-44). This flap is taken from the back of the forearm, between the extensor carpi ulnaris (ECU) muscle and the extensor digitorum common (EDC) muscle.ResultsWe analyzed retrospectively our patients indicating the failures of this reconstructive surgery, the complications that have arisen and the results using DASH score with the related clinical and medico-legal implications.ConclusionsDue to its location and structure, PIAF is one of the most versatile fascio-cutaneous flaps in upper limb reconstructive surgery and can be used to reconstruct parts of the hand, wrist, or elbow, allowing to restore limb function and improve the quality of life of patients even if there could be some medico-legal implications.
The authors aimed to elaborate on an interesting clinical case of a subject that came to our attention following a low-energy traumatic event, producing a bilateral femur fracture. During the ...instrumental investigations, findings pointing to multiple myeloma were described, in fact later confirmed by the histological and biochemical investigations. In this specific case, unlike manifestations in most patients with MM, the classic correlated pathognomonic symptoms, such as lower back pain, weight loss, recurrent infections, asthenia, were not present. Furthermore, the inflammatory indices, the values of serum calcium, renal function and hemoglobin were completely normal, although numerous bone localizations of disease already coexisted, and these were all unknown to the patient.
AbstractThe authors aimed to elaborate on an interesting clinical case of a subject that came to our attention following a low-energy traumatic event, producing a bilateral femur fracture. During the ...instrumental investigations, findings pointing to multiple myeloma were described, in fact later confirmed by the histological and biochemical investigations. In this specific case, unlike manifestations in most patients with MM, the classic correlated pathognomonic symptoms, such as lower back pain, weight loss, recurrent infections, asthenia, were not present. Furthermore, the inflammatory indices, the values of serum calcium, renal function and hemoglobin were completely normal, although numerous bone localizations of disease already coexisted, and these were all unknown to the patient.
The authors describe a case of tumoral calcinosis of the hand in a three-year-old child, involving the digits and carpus, and associated with ectrodactyly. The clinical features, diagnostic imaging ...procedures, particularly radiography and MRI, and therapeutic approach, in most cases radical excision, of this rare soft tissue tumour are discussed.
Les auteurs rapportent un cas de calcinose tumorale de la main chez un enfant de trois ans, localisée aux doigts et au niveau du carpe, et associée à une ectrodactylie. Les tableaux cliniques, les procédures diagnostiques, particulièrement la radiographie et l'imagerie par résonance magnétique, et les approches thérapeutiques, le plus souvent l'ablation radicale, de cette tumeur rare sont analysés.
Los autores presentan un caso de calcinosis tumoral de la mano en un niño de tres años, localizada en la mano y en el carpo y asociada a una ectrodactilia. Se analizan la formas de presentación clínica de este raro tumor, los procedimientos diagnósticos, en particular la radiografía y la resonancia magnética, el enfoque terapéutico que frecuentemente consiste en la ablación radical.
This paper proposes a new regulatory framework for continuity of supply provides indices, measurement rules, and a bonus/penalty system based on specific targets in Italy. ENEL Distribuzione has ...planned important investments to improve the quality of service according to decisions made by AEEG. (5 pages)
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