Surgical Fixation of Metacarpophalangeal Collateral Ligament Rupture of the Fingers.

BACKGROUND: Collateral ligament injury of the metacarpophalangeal joint of the fingers is underreported in the literature and widely underestimated by the medical community. Here, the authors present results from a large series of patients and review factors influencing success of surgery. METHODS: The authors performed a retrospective study of 46 patients who underwent surgical fixation of the metacarpophalangeal collateral ligament using bone anchor in an acute or chronic setting. The diagnosis was predominantly clinical, based on laxity testing of the joint. The authors collected demographic data and intraoperative findings and postoperative results. RESULTS: Following surgery, with a median follow-up of 17 months, all patients presented with a stable joint and complete resolution of pain. The mean flexion of the metacarpophalangeal joint was 77.11 degrees, and mean extension was 0.84 degrees. The authors measured the injured grip strength at a mean of 88.52 percent of the opposite hand, and the mean Quick Disabilities of the Arm, Shoulder and Hand questionnaire score used to evaluate disability was 9.56 on a scale of 100 (with 100 being complete disability). CONCLUSIONS: Surgical treatment of metacarpophalangeal collateral ligament rupture of the fingers is a safe technique that gives reproducible positive results in terms of mobility, strength, and disability scale score. The authors' results show that anchoring of the ligament should be performed even with prolonged time from injury to surgery.

Slotted intramedullary hip screw nails reduce proximal mechanical unloading.

The current prospective and randomized study was done to determine whether fixation of intertrochanteric femoral fractures that lack a medial buttress with a dynamically locked intramedullary hip screw prevents proximal stress shielding. Stress shielding was evident by the presence of cortical hypertrophy at the level of the tip of the nail and often was associated with midthigh pain. Of the 80 patients enrolled in this trial, 64 still were alive after 1 year. Among these patients, 30 had the nail classically locked with two screws transfixing the nail in two separate holes (Group A), and 34 had the nail locked with one screw passing through a slot (Group B). The average duration of followup was 37 months (range, 12-49 months). Tolerance to dynamically locked nails was significantly better, with only one patient in Group B having cortical hypertrophy of the femur at the level of the tip of the nail, compared with six patients in Group A. Other outcomes were equal in both groups. Late tolerance to this new dynamically locked intramedullary hip screw is good, while retaining the known advantages of nailing of these fractures.