Chd4 choreographs self-antigen expression for central immune tolerance.

Autoreactive T cells are eliminated in the thymus to prevent autoimmunity by promiscuous expression of tissue-restricted self-antigens in medullary thymic epithelial cells. This expression is dependent on the transcription factor Fezf2, as well as the transcriptional regulator Aire, but the entire picture of the transcriptional program has been obscure. Here, we found that the chromatin remodeler Chd4, also called Mi-2ß, plays a key role in the self-antigen expression in medullary thymic epithelial cells. To maximize the diversity of self-antigen expression, Fezf2 and Aire utilized completely distinct transcriptional mechanisms, both of which were under the control of Chd4. Chd4 organized the promoter regions of Fezf2-dependent genes, while contributing to the Aire-mediated induction of self-antigens via super-enhancers. Mice deficient in Chd4 specifically in thymic epithelial cells exhibited autoimmune phenotypes, including T cell infiltration. Thus, Chd4 plays a critical role in integrating Fezf2- and Aire-mediated gene induction to establish central immune tolerance.

Deuterium labelling to extract local stereochemical information by VCD spectroscopy in the C-D stretching region: a case study of sugars.

Stereochemical elucidation of molecules with multiple chiral centers is difficult. Even with VCD spectroscopy, excluding all but one diastereomeric structural candidate is challenging because the stereochemical inversion of one chiral center among many centers does not always result in noticeable differences in their VCD spectra. This work demonstrates that the introduction of a suitable VCD chromophore with absorption in the 2300-1900 cm-1 region can be used for extracting local stereochemical information and for the stereochemical assignment of the C-1 position of various sugars as a case study. Through studies on a series of epimeric pairs of monosaccharides and their derivatives, we found that the introduction of one -OCD3 group to each C-1 position produced almost mirror-image VCD patterns in the 2300-1900 cm-1 region depending on the C-1 stereochemistry irrespective of the other molecular moieties. This work also shows that comparison of the observed VCD signals and the calculated ones enables the stereochemical assignment of a chiral center in the vicinity of the chromophore. This study provides a proof of concept that the use of a VCD chromophore in the 2300-1900 cm-1 region enables the analysis of selected stereochemistry of suitable molecular systems. Further studies on this concept should lead to the development of a method useful for the structural elucidation of other types of complex molecules.

Outer Membrane Protein of Gut Commensal Microorganism Induces Autoantibody Production and Extra-Intestinal Gland Inflammation in Mice.

Gut commensal microorganisms have been linked with chronic inflammation at the extra-intestinal niche of the body. The object of the study was to investigate on the chronic effects of a gut commensal Escherichia coli on extra-intestinal glands. The presence of autoimmune response was diagnosed by autoantibody levels and histological methods. Repeated injection of E. coli induced mononuclear cell inflammation in the Harderian and submandibular salivary glands of female C57BL/6 mice. Inflammation was reproduced by adoptive transfer of splenocytes to immune-deficient Rag2 knockout mice and CD4⁺ T cells to mature T cell-deficient TCRß-TCRδ knockout mice. MALDI TOF mass spectrometry of the protein to which sera of E. coli-treated mice reacted was determined as the outer membrane protein A (OmpA) of E. coli. Multiple genera of the Enterobacteriaceae possessed OmpA with high amino-acid sequence similarities. Repeated injection of recombinant OmpA reproduced mononuclear cell inflammation of the Harderian and salivary glands in mice and elevation of autoantibodies against Sjögren's-syndrome-related antigens SSA/Ro and SSB/La. The results indicated the possibility of chronic stimuli from commensal bacteria-originated components as a pathogenic factor to elicit extra-intestinal autoimmunity.

[Survey report on magnetic resonance equipment damage in areas in Miyagi Prefecture affected by the Great East Japan Earthquake].

A questionnaire comprising 14 items, inquiring about the state of damage, whether safety could be ensured, and progress of repair and restoration was distributed to 984 facilities in seven prefectures on the Pacific coast as part of a fact-finding survey of damage caused to magnetic resonance (MR) devices by the Great East Japan Earthquake. In all, 458 responses (46.6%) were collected. In Miyagi Prefecture alone, 65 responses from 105 questionnaires were collected (response rate: 61.9%). The overall incidence of damage was 19.2%, with 57 facilities (12.4%) reporting that displacement of the magnets was the most common problem. The damage event rate in Miyagi Prefecture was 51.3%, with displacement of the magnet being highest at 17 cases (26.2%). There was a high rate of 13 cases (26.5%) of chiller and air conditioning failures and a rapid loss of He in ten MR scanners (20.4%). Notably, 87.8% of facilities in Miyagi Prefecture (24.5% of the total) were affected by earthquakes exceeding 6 on the Japanese Seismic Intensity Scale. Flood damage caused by the tsunami was also seen along the Sanriku coast to Sendai City (six MR scanners, 50% of the total), and was typical of the damage seen in Miyagi Prefecture.

Bone temperature elevation by drilling friction and neurological outcome in the cervical spino-laminoplasty.

BACKGROUND: Drill-induced heat has been suspected as a cause of tissue injury, and there are ample experimental data to substantiate the implication. However, no clinical results have been presented with measurement of temperature in the vicinity of neural structures during the actual spinal procedures. METHODS: Using a thermocouple, temperature in the gutters drilled in the midline and the lateral margins of the lamina was monitored closely in 61 patients, who underwent the French-door style of cervical spino-laminoplasty. The drilling was performed intermittently for a duration of 5 or 10 seconds, using 3- or 5-mm diamond burrs with sufficient continuous cooling irrigation. The correlations between bone temperature elevation and postoperative sensorimotor symptoms were then analyzed. RESULTS: In the lateral gutters at the most cephalad level (typically C3), where the drilling was performed underneath an overlying bundle of muscle attached to C2's spinous process, the temperature rose significantly. This occurred even with 5-second drilling sessions. The average peak temperature was 44 °C at this level. At all other sites, the temperature was maintained below 40 °C. In three patients, transient neurological deficit developed postoperatively, which did not correlate with the incidence of bone temperature elevation. CONCLUSIONS: Intermittent drilling with sufficient irrigation can prevent thermal neuronal damage generated by high-speed drills. Drilling with small diamond burrs in deep and narrow spaces covered by overlying muscles predisposes to inadequate irrigation and thermal elevation. Continuous, protracted drilling without frequent irrigation may result in excessive heat generation and nerve injury.

Effect of Oral Prednisolone after Collagenase Injection for Dupuytren's Contracture: A Randomized, Controlled Trial with a 1-Year Follow-Up.

Introduction This study verified the effectiveness of oral prednisolone after collagenase clostridium histolyticum (CCH) (10 mg/day for 2 weeks) for Dupuytren's contracture with a 1-year follow-up. Materials and Methods This study included 31 patients with a contracture of the metacarpophalangeal joint of ≥ 30 degrees. A total of 16 patients were allocated randomly to treatment with prednisolone and 15 patients were treated without prednisolone (control group). Results At day 7, mean total active motion (TAM) was 235 degrees in the prednisolone group and 228 degrees in the control group. Mean Visual Analog Scale was 3.3 in the prednisolone group and 4.6 in the control group. There was significant difference between two groups. At day 30, mean TAM was 241 degrees in the prednisolone group and 233 degrees in the control group. There were significant difference between two groups The mean QuickDASH score was significantly higher in the control group (5.8 vs. 3.4). Recurrence was observed in 2/16 patients (13%) in the prednisolone group and 5/15 patients (33%) in the control group; there was no significant difference. Conclusion The administration of prednisolone decreased the likelihood of adverse effects, and also improved finger flexion range of motion and reduced pain after CCH.

Comparison of Treatment Outcomes after Collagenase Injection and Percutaneous Needle Fasciotomy for Dupuytren's Contracture: Objective and Subjective Comparisons with a 3-Year Follow-Up.

BACKGROUND: This study compared the effectiveness of injectable collagenase clostridium histolyticum and percutaneous needle fasciotomy in the treatment of Dupuytren's contracture. METHODS: Patients with a total passive extension deficit of 30 degrees or more in a single digital ray were enrolled and assigned randomly to receive either collagenase clostridium histolyticum injections or percutaneous needle fasciotomy. Preoperative severity of proximal interphalangeal joint contracture for Dupuytren's disease was classified according to the British Society for Surgery of the Hand as less than 30 degrees (stage I) or 30 degrees or more (stage II). RESULTS: Of the 70 patients enrolled, 36 patients with 46 joints received collagenase clostridium histolyticum injections and 34 patients with 48 joints received percutaneous needle fasciotomy. At day 30, successful corrections were obtained in only 50 percent of the injection group and 67 percent of the fasciotomy group for stage II proximal interphalangeal joints. Recurrences were frequent among patients with stage II joint contractures. The mean Quick Disabilities of the Arm, Shoulder and Hand questionnaire score at day 30 was significantly higher in the injection group compared with the fasciotomy group (7.5 versus 4.2, respectively). In the injection group, adverse events were reported for all patients. In the fasciotomy group, complications were reported for 15 percent of patients. CONCLUSIONS: The collagenase clostridium histolyticum and percutaneous needle fasciotomy groups had similar outcomes for Dupuytren's contracture with 3 years' follow-up. Recurrences were frequent among patients with stage II proximal interphalangeal joint contractures. The Unité Rhumatologique des Affections de la Main scale and Quick Disabilities of the Arm, Shoulder and Hand questionnaire score decreased significantly for both groups at final follow-up. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

On-line liquid chromatography and circular dichroism detection of stereo-isomers of alpha-tocopherol derivatives generated by an electrochemical reaction.

The electrochemical oxidation of (+/-)-alpha-tocopherol on a porous graphite electrode was performed in the presence of methanol, and successive separation and detection of the products were performed by an on-line liquid chromatography/mass spectrometry system. Three products were identified, one of which was determined to be alpha-tocopheryl quinone, because its m/z was 469 [M+Na](+). The other two products showed identical mass and UV spectra, and were suspected to be diastereomers of 9-methoxy-alpha-tocopheron, because their molecular weights were m/z 483 [M+Na](+), and also because it is known that the chemical oxidation of alpha-tocopherol by benzoyl peroxide or N-bromosuccinimide in the presence of methanol should provide 9-methoxy-alpha-tocopheron. To confirm that these two compounds were diastereomers, a circular dichroism detector was used. The signs of both peaks detected by the circular dichroism detector at 230 nm were opposite. In addition to observations of identical mass and ultraviolet spectra, these results indicated that the two products were diastereomers of 9-methoxy-alpha-tocopheron, whose stereochemistry is different at the newly generated chiral center of the 9-position. The on-line use of a circular dichroism detector with an electrochemical cell/liquid chromatography system may expand the utility of the system to study the metabolism of a chiral drug.

Radial head dislocation with ulnar plastic deformation in children: an osteotomy within the middle third of the ulna.

This retrospective study includes 6 patients (average age, 8.7 years) with a dislocation of the radial head and ulnar plastic deformation. All were Monteggia fractures, Bado type I equivalents. The maximum ulnar bow was near the midulna. Five patients underwent an ulnar osteotomy, with elongation and reduction of the angulation within the middle third of the ulna, and open reduction of the radial head. One patient underwent an ulnar osteotomy with only elongation. The osteotomy sites were stabilized by a plate and screws or Kirschner wires. Mean follow-up was 3.4 years. Postoperatively, the average elbow range of motion was extension to 0 degrees, flexion to 138 degrees, forearm supination to 90 degrees, and forearm pronation to 88 degrees. Results in all patients were rated as excellent. One nonunion occurred. An osteotomy performed within the middle third of the ulna, combined with open reduction of the radial head, resulted in excellent clinical outcomes.

DMPO-OH radical formation from 5,5-dimethyl-1-pyrroline N-oxide (DMPO) in hot water.

When an aqueous solution of 5,5-dimethyl-1-pyrroline N-oxide (DMPO) was heated at 70 degrees C for 30 min, formation of DMPO-OH was observed by ESR. This DMPO-OH radical formation was suppressed under an argon atmosphere. When water was replaced with ultra-pure water for ICP-MS experiments, DMPO-OH radical formation was also diminished. Under an argon atmosphere in ultra-pure water, the intensity of the DMPO-OH signal decreased to about 1/20 of that observed under aerobic conditions with regular purified water. The addition of hydroxyl radical scavengers such as mannitol did not affect the formation of DMPO-OH, but the signal turned faint in the presence of EDTA. We suggest that DMPO reacted with dissolved oxygen to form DMPO-OH.

Asymptomatic Flexor Tendon Damages after Volar Locking Plate Fixation of Distal Radius Fractures.

BACKGROUND: To investigate asymptomatic flexor tendon damages after volar locking plate fixation of distal radius fractures in 32 wrists of 32 patients with distal radius fractures fixed using two plate types. Sixteen patients received the Acu-Loc volar distal radius plate, and the remaining 16 patients received the Aptus distal radius correction plate. METHODS: The flexor pollicis longus (FPL) tendon and flexor digitorum profundus were evaluated according to intraoperative findings at plate removal. Ultrasonography was used to measure the distance between the FPL tendon and distal edge of the plates (FPL plate distance) before plate removal, the distance between the FPL tendon and distal edge of the radius (FPL radius distance) after plate removal, in the contralateral wrist, and the angle between an extension line of a volar surface line on the proximal FPL tendon and a second volar surface line on the distal FPL tendon (FPL angles). RESULTS: Erosion of the FPL tendon was identified in four wrists, and erosion of the flexor digitorum profundus of the index finger was identified in one wrist. All five cases of wrists with flexor tendon damage had Acu-Loc plates installed. The average FPL angle before plate removal was 15.4° in the wrists with tendon damage, which was statistically significantly larger than the average FPL angle in the wrists without erosion. CONCLUSIONS: The type of plate and larger FPL angle on ultrasonography may be the risk factors for flexor tendon damage.

Management of Intra-Articular Distal Radius Fractures: Volar or Dorsal Locking Plate-Which Has Fewer Complications?

BACKGROUND: The aim of this study was to compare the functional outcomes and complications of volar and dorsal plating for the management of intra-articular distal radius fractures, with special regard to indications for dorsal plating. Furthermore, we examine the rationale for choosing dorsal plating and its frequency of use. METHODS: Clinical assessments included range of motion measurements at the wrist; grip strength; the Quick Disabilities of the Arm, Shoulder, and Hand score; and the Gartland and Werley score. Clinical results were compared with those achieved using a volarly placed locking plate system. According to Lutsky's plate theory, the rationale for choosing dorsal plating was based on 4 types of pathologic fractures. RESULTS: Of 112 patients, 38 patients were treated with open reduction internal fixation via a dorsal approach and 68 patients were treated using a volar approach. Except for wrist flexion, there were no other statistical differences in the clinical results between groups for both subjective and objective parameters. There were no statistically significant differences in the complication rates between the volar and dorsal plated groups. One serious complication occurred after volar plating. The most common reason for choosing dorsal plating was irreducible dorsal die-punch fractures. CONCLUSIONS: The treatment of displaced intra-articular distal radius fractures with a dorsally versus a volarly placed interlocking plate system demonstrated similar clinical results. Postoperative complications were not readily observed in the patients treated with a dorsal locking plate. Certain fracture patterns are more appropriately stabilized using a dorsal plate fixation.

Dual Plating Technique for Volar Rim Fracture of the Distal Radius Using DePuy-Synthes 2.0 m and 2.4 mm Locking Plates.

BACKGROUND: To assess the surgical results of distal radius fractures with the involvement of a volar rim fragment using the DePuy-Synthes 2.0 mm and 2.4 mm locking plates. METHODS: Subjects were six women and one man of average age 57 years (range, 31-83 y) and a mean follow-up period of 9 months (range, 5-19 mo) with AO B3 (volar shearing) distal radius fractures. Time of the procedure, physical examination of wrist range of motion, grip strength compared with the contralateral healthy wrist, and radiographic evaluation (volar tilt, radial inclination, and ulnar variance) were evaluated. The Visual Analog Scale (VAS: 0 points represents no pain, 100 points represents the worst pain possible) and the Quick Disability of the Arm, Shoulder, and Hand questionnaire (QuickDASH, 0 = no disability, 100 = extreme disability) were completed by patients at the final follow-up. RESULTS: The average time of the procedure was 74 min. There were no perioperative complications. Average radiographic measures were: volar tilt, 8°; radial inclination, 23°, and ulnar variance, 0 mm. Wrist range of motion averaged 63° in wrist extension (range, 55-80°) and 55° in wrist flexion (range, 45-65°). Grip strength averaged 81% of the contralateral side at final evaluation (range, 67-100%). The mean QuickDASH score was 3.0 points (range, 0-9.1 points) and the mean VAS for pain was 9.3 at final follow-up. CONCLUSIONS: Open reduction internal fixation with the DePuy-Synthes 2.0 mm and 2.4 mm locking plates is an effective means of fixing a distal radius fracture that includes a volar rim fragment without interfering with flexor tendon gliding.

Development and evaluation of an overseas clinical rotation program for undergraduate pharmacy students in Japan.

BACKGROUND AND PURPOSE: Internationalization of pharmacists, as well as pharmacy students, in terms of both the knowledge to care for international patients and to have medical information literacy, is a current concern in Japan. EDUCATIONAL ACTIVITY AND SETTING: Keio University Faculty of Pharmacy has developed an elective course for pharmacy students, based on written agreements with the United States and Thailand that establish a student clinical rotation exchange program. The exchange program lasts for four to six weeks and involves clinical rotations in hospitals abroad during the students' sixth year. Rotations follow a four-week didactic preparatory course. The course objectives are to acquire the knowledge, skills, and attitude needed to function as leading pharmacists with an international perspective. METHODS: We asked students to complete a feedback survey inquiring about the usefulness of preparatory courses, self-evaluation pre- and post-rotation satisfaction with the program, and overall self-assessment. FINDINGS: Twenty-four out of 41, i.e., 58.5% of the students replied with feedback. All respondents replied that the preparatory course was useful. They also replied that, based on their self-evaluation, they were satisfied with their level of English language skill improvement after the rotation. Pharmaceutical knowledge satisfaction, however, was slightly decreased. All respondents replied that this program was of a satisfactory nature, with 71%, 63%, and 92% of the respondents replying that they could acquire the knowledge, skills, and attitude program objectives respectively. SUMMARY: It is possible to successfully develop an overseas clinical rotation program. Students were quite satisfied upon completion and achieved the expected objectives.

Clinical results of a percutaneous technique for trigger digit release using a 25-gauge hypodermic needle with corticosteroid infiltration.

Clinical results of a percutaneous needle trigger digit release (PNTDR) technique using a 25-gauge needle with corticosteroid infiltration are reported. This prospective study assessed 52 digits that underwent PNTDR. Experimental results were compared with those of a control group with only steroid injection. Patients who underwent PNTDR were divided into diabetic and nondiabetic groups, and assessed after 1 week, and 1, 2, 3, and 6 months post surgery. The quick disability of the arm, shoulder, and hand (QuickDASH) questionnaire and visual analog scale (VAS) score for pain were completed both before and after surgery. PNTDR showed better statistical results than the control group. At final follow-up, 94% of patients were rated as excellent or good, recurrence was observed in 3 digits, and QuickDASH and VAS score significantly decreased. This technique was equally effective in patients with moderate or well-controlled diabetes with favorable results.

Novel Suture Anchor Technique with Continuous Locking Stitch for Collateral Ligament Repair.

Collateral ligaments are difficult to repair due to large amount of fraying in detached ligaments and attenuated stumps that may not provide enough strength after the repair. Although strong locking sutures are used to repair the ligament with proper tension, these damages can cause pull-out failure or relaxation of the repaired ligaments even from undersized load that may extend postoperative splinting or casting time. Furthermore, current suture techniques can repair varus or valgus instability of the elbow and radial or ulnar instability of the fingers, but these techniques do not offer rotatory stability of these areas. We have developed a novel suture anchor technique that has overcome this problem of current suture techniques, and this can be used to correct rotatory instability in the elbow and fingers. We used this procedure in seven cases with injury of collateral ligament in the elbow and eight cases with detached collateral ligaments of finger joint. No patient experienced rerupture or any kind of residual instability. We believe that the proposed method can produce much stronger repair and may shorten the postoperative immobilization period.

Closed mallet thumb injury: Our experience of 10 patients treated with surgery and a systematic review.

OBJECTIVE: This retrospective study reports 10 patients with closed mallet thumb injury treated with surgery and compares the clinical outcomes achieved with those of previously described patients who were treated with either conservative therapy or surgery. METHODS: We report the outcomes of a series of 10 patients who received surgical treatment at our institutions. Due to the rarity of closed mallet thumb, a systematic review was conducted, and the results of a literature search were compared with our case series to strengthen our conclusions. The previously described patients were categorized into two groups: the surgically treated group (16 patients) and the conservatively treated group (10 patients). The following patient and injury characteristics were documented: age, gender, injured side, time from injury to treatment, mechanism of injury, extension lag at first visit, postoperative range of motion (ROM) of the interphalangeal joint, immobilization period, and follow-up period. RESULTS: Statistical analyses showed no significant differences in the clinical results, except for shorter immobilization periods between our series and the previously described patients involving conservative treatment (4.9 ± 0.9 vs. 9.5 ± 2.3 weeks, respectively; P = 0.0053). CONCLUSIONS: This study suggests that surgery may result in more rapid recovery.

A Simple, Easy, and Reliable Technique of Phalangeal Corrective Osteotomy for Overlapping Fingers.

BACKGROUND: The theory that malrotation is best assessed by making a fist and looking for digital overlap was the basis for devising a simple, easy, and reliable technique for phalangeal corrective osteotomy. METHODS: This study assessed the phalangeal corrective osteotomy technique in 7 digits, involving 7 cases in 6 patients; 1 patient required treatment bilaterally. This technique required the use of a small hologram 2-row plate and screws to maintain stable fixation during aggressive postoperative therapy. Evaluation of the clinical results was based on the total range of active motion (%TAM), the grading of results according to Büchler, and the severity of pain reported by patients using the visual analog scale. The disability of the arm, shoulder, and hand questionnaire was completed preoperatively and at final follow-up by patients. RESULTS: Corrective osteotomy corrected the overlapping of digits in all of the patients. There were no perioperative complications. Bone union was obtained in all cases, on average 13.4 weeks after surgery. Two osteotomies required secondary tenocapsulolysis concomitant with implant removal surgery. In light of total range of active motion and Büchler's grade, all the patients had excellent to good results for both criteria at final follow-up. No patient complained about pain. Mean disability of the arm, shoulder, and hand scores significantly decreased from 16.9 (range, 11.3-26.5) preoperatively to 3.9 (range, 0-7.6) postoperatively. CONCLUSIONS: Phalangeal corrective osteotomy was performed using a simple, easy, and reliable technique.

Clinical Results of Percutaneous Needle Fasciotomy for Dupuytren's Disease in Japanese Patients.

BACKGROUND: Clinical results of percutaneous needle fasciotomy (PNF) in Japanese patients with Dupuytren's disease are reported. METHODS: In this prospective study, 51 patients (103 fingers: 1 index, 9 middle, 47 ring, and 46 small) underwent PNF at 99 metacarpophalangeal (MCP) and 68 proximal interphalangeal (PIP) joints. Patients were assessed postoperatively after 1 day, at 1, 2, 4, 6, and 8 weeks, and at 3, 6, 9, and 12 months. Correction of contracture was measured in degrees, and an improvement index (% improvement) was described previously by Tonkin et al. A correction of the contracture to 5° or less at each joint and at each digital ray represented a successful correction. The recurrence rates in MCP and PIP joints were also evaluated. Correlations between the Tubiana classification stage and successful correction, % improvement, and recurrence rate were evaluated. The relationships between recurrence rate and the diathesis score (more/less than 5 points) and between recurrence rate and age at surgery (<50/≥50 years) were also examined. RESULTS: In MCP and PIP joints, the improvement maintained at final follow-up was 89% and 57%, respectively, with successful corrections in 89% and 76%, respectively. PNF corrected digital rays at various Tubiana stages: stage 1 = 100%, stage 2 = 82%, stage 3 = 46%, and stage 4 = 0%. Improvements were preserved in stage 1 = 83%; stage 2 = 62%; stage 3 = 58%, and stage 4 = 60%. Recurrence of Dupuytren's disease was significant for the PIP joint, severe Tubiana stage, and younger patients. CONCLUSIONS: Clinical results of PNF in Japanese patients with Dupuytren's contractures were similar to those of whites.

Surgical Technique and Clinical Results for Trapeziometacarpal Arthrodesis Using Locking Plate Fixation in Women Aged 50 Years or Older.

BACKGROUND: The authors hypothesized that locking plates have the potential to decrease the risk of nonunion for trapeziometacarpal joint arthrodesis and eliminate the period of postoperative immobilization. The surgical technique is described and the clinical results are reported for Eaton stage III trapeziometacarpal joint arthrodesis using locking plate fixation in elderly women. METHODS: The outcomes of 18 fusion operations with a 2-year follow-up were assessed during this prospective study. Patients were evaluated for bone union, grip strength, tip and key pinch strength, and Kapandji opposition scores. The Disabilities of the Arm, Shoulder and Hand questionnaire and visual analogue scale pain scores were obtained from the patients and evaluated. In addition, complications were assessed. RESULTS: Bone unions were obtained for 16 of 18 fusions. Grip strength was 18.3 kg (range, 12.5 to 26.0 kg), tip pinch strength was 5.6 kg (range, 3.5 to 7.5 kg), and key pinch strength was 6.4 kg (range, 4.0 to 7.5 kg). The Kapandji opposition score was 8.3 points (range, 8 to 10). Disabilities of the Arm, Shoulder and Hand questionnaire score decreased from 54.2 (range, 68.8 to 39.4) to 8.8 (range, 3.9 to 22.0), and visual analogue scale pain scores decreased from 8.3 (range, 8 to 10) preoperatively to 0.9 (range, 0 to 4) postoperatively. Malpositioned devices were removed from two patients. One symptomatic patient required removal of the fixation device as a result of hardware loosening. CONCLUSION: The results for arthrodesis with a locking plate are comparable to results with a nonlocking plate and are quite satisfactory in the appropriate hands. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.