Endosteal strut using a hydroxyapatite/poly-L-lactide mesh tube with a proximal humeral locking plate for the treatment of proximal humeral fractures.

PURPOSE: Proximal humeral fractures cause large intramedullary bone defects after humeral-head reduction. Hydroxyapatite/poly-L-lactide (HA/PLLA) materials are widely used for various fractures. However, the efficacy of endosteal strut using a HA/PLLA mesh tube (ES-HA/PLLA) with a locking plate for treating proximal humeral fractures was not reported. The purpose of this study is to examine the efficacy of ES-HA/PLLA with a proximal humeral locking plate in proximal humeral fractures. METHODS: Seventeen patients with proximal humeral fractures treated using ES-HA/PLLA with a locking plate from November 2017 to November 2021 were evaluated. The range of motion of the shoulder and postoperative complications were assessed at the final follow-up. Radiographs were evaluated to assess bone union and loss of reduction by measuring humeral-head height (HHH) and humeral neck-shaft angle (NSA). RESULTS: The average flexion and external rotation of the shoulder at the final follow-up were 137° (range, 90-180°) and 39° (range, - 10 to 60°), respectively. All fractures were united. The average HHH and NSA just after the surgery and final follow-up were 12.5 mm and 11.6 mm and 129.9° and 127.4°, respectively. Two patients presented screw perforation of the humeral head. One patient underwent implant removal due to infection. Avascular necrosis of the humeral head was observed in one patient with arthritis mutilans. CONCLUSIONS: The use of ES-HA/PLLA with a proximal humeral locking plate resulted in bone union in all patients and prevented postoperative loss of reduction. ES-HA/PLLA is one of the treatment options for proximal humeral fractures.

A biomechanical analysis of the effect of hydroxyapatite augmentation for trochanteric femoral fractures.

Hydroxyapatite (HA) augments are used to treat trochanteric femoral fractures. However, the efficacy of HA augmentation has not been fully described in trochanteric femoral fracture surgery. In total, 85 patients were enrolled in the present study; all had trochanteric femoral fractures between January 2016 and October 2020, 45 with HA (HA group) and 40 without HA (N group). The intraoperative lag screw insertion torque was directly measured and the amount of lag screw telescoping with and without HA augmentation after surgery was analyzed. Maximum lag screw insertion torque (max-torque), bone mineral density in the opposite femoral neck (n-BMD), tip apex distance (TAD) of the lag screw, radiographic findings including fracture union, the amounts of lag screw telescoping and occurrence of complications were evaluated. A total of 12 patients were excluded if they were aged under 60 years old, had ipsilateral surgery and disorders in the hip joint, TAD of the lag screw ≥26 mm on postoperative radiographs and had measurement errors. A total of 73 fractures could be analyzed: HA group (n=36) and N group (n=37). Max-torque/n-BMD ratios were higher in the HA group compared with in the N group (7.23±2.71 vs. 5.93±1.91 g/cm2·N·m; P=0.04). The amounts of lag screw telescoping in the HA group were smaller compared with the N group (1.41±2.00 vs. 2.58±2.34; P=0.05). Evaluation of screw insertion torque showed maximum screw insertion torque correlated well with n-BMD in both groups, HA (R=0.57; P<0.01) and N group (R=0.64; P<0.01). No correlation was found between maximum screw insertion torque and TAD in both groups, HA (R=-0.10; P=0.62) and N group (R=0.02; P=0.93). All fractures were radiographically united without any complications. These results support the effectiveness of HA augmentation, indicating higher resistance against rotational instability and reduced lag screw telescoping in trochanteric femoral fracture treatment.

Fixation of intra-articular calcaneal fractures: A comparative study of the postoperative outcome between HA/PPLA screws and locking plates.

Background: Forged unsintered hydroxyapatite and poly l-lactic acid (F-u-HA/PLLA) screw is bioactivite, bioabsorbable, and radiopaque with high mechanical strength. Its efficacy has been previously demonstrated in the treatment of lateral humeral condylar, lateral tibial condylar, ankle, and patellar fractures. However, studies on its efficacy in treatment of calcaneal fractures is lacking. This study aimed to compare the postoperative results of F-u-HA/PLLA screw fixation and locking plate fixation for intra-articular calcaneal fractures. Methods: From January 2013 to December 2019, 47 closed intra-articular fractures treated with either F-u-HA/PLLA screws (group S, 18 feet in 17 patients) or locking plates (group P, 29 feet in 28 patients) in a single trauma center were retrospectively reviewed. The sinus tarsi approach was used in both groups. The time to bone union, step-off, varus deformity, Bohler's angle, and width and height of the calcaneus were assessed after surgery. Ankle joint range of motion (ROM) and postoperative complications were also assessed. Results: All fractures were successfully treated. The Kaplan-Meier curves of the two groups showed similar trends. The log-rank test showed no significant difference in the time to bone union between the two groups (p = 0.48). In the Cox proportional hazards model adjusted for preoperative width and Bohler's angle, the hazard ratio for bone union was not statistically significant (HR: 1.13, 95%CI: 0.50-2.56, p = 0.78). Other variables included step-off (group S: 2.0 vs group P: 2.2 mm, p = 0.84), varus deformity (2.0° vs. 3.0°, p = 0.7), Gissane's angle (103.5° vs 104.0°, p = 0.84), width (38.0 vs 34.8 mm, p = 0.12), height (42.1 vs 44.0 mm, p = 0.07), and ankle ROM degrees (dorsal flexion, 20.0° vs. 20.0°, p = 0.13; plantar flexion 40.0° vs 40.0°, p = 0.56), which were not significantly different between groups P and S. The Bohler's angle was smaller in group S than in group P (20.5° vs 27.0°, p < 0.01). No skin necrosis or infection was observed in either group. Conclusion: Postoperative results of F-u-HA/PLLA screw fixation using the sinus tarsi approach for intra-articular calcaneal fractures were as good as those of locking plate fixation.

Pin and Wire System Fixation for the Treatment of Comminuted Patella Fractures.

We describe the wiring technique and evaluate the radiographic and clinical outcomes of treatment with a pin and wire system (PWS) for comminuted patella fractures. From June 2013 to October 2018, 33 patients with comminuted patella fractures were treated using a PWS. Open reduction and internal fixation was performed with multiple pins and a wire. All patients were allowed full weight bearing without a brace. Radiographs were obtained to evaluate bone union, implant breakage, back-out of pins, and intra-articular gaps and step-off. Clinical outcomes and postoperative complications were assessed at final follow-up examination. All fractures were united. Thirteen cable wires in 13 patients were partially broken without displacement of fracture at an average of 7.4 months (range, 1-19 months) postoperatively. The average preoperative, postoperative, and final follow-up intra-articular gap and step-off were 11.7 mm, 0.5 mm, and 0.03 mm and 6.6 mm, 0.4 mm, and 0.2 mm, respectively. The average postoperative pin displacement was 0.1 mm (range, 0-0.8 mm). Deep infection was not observed after the surgery. The implant removal rate was 21% (7 of 33). Among these, the symptomatic implant removal rate was 9% (3 of 33). Additionally, 3 of 7 patients with implant removal had broken wires. The average flexion and extension of knee joints were 139.7° (range, 120°-150°) and -0.9° (range, -10° to 0°), respectively. A PWS prevents back-out of the pins and reduces intra-articular gaps and step-off distances to acceptable levels, even if the cable wire is partially broken. Therefore, a PWS is a good treatment option for comminuted patella fractures. [Orthopedics. 2023;46(5):291-296.].

Effect of hydroxyapatite tubes on the lag screw intraoperative insertion torque for the treatment of intertrochanteric femoral fractures.

BACKGROUND: Hydroxyapatite (HA) augments are frequently used in orthopedic surgery. However, the effectiveness of HA augments on the treatment of intertrochanteric femoral fractures remains unknown. This study aimed to investigate whether the use of HA tubes affects the intraoperative insertion torque of the lag screw during intertrochanteric femoral fracture surgery. METHODS: From January 2016 to October 2020, 58 patients with intertrochanteric femoral fractures were included and divided into the HA treatment group (HA group, n = 29) and non-HA treatment group (N group, n = 29). Patients with intertrochanteric femoral fractures were treated using the Gamma3 nail system® with or without two HA tubes. HA tubes were inserted into the femoral head through the lag screw hole before the insertion of the lag screw. The mean and maximum intraoperative insertion torques of the lag screw, bone mineral density (BMD) of the uninjured opposite side femoral neck, and tip apex distance (TAD) of the lag screw on postoperative radiographs were assessed. To assess the loss of reduction after the surgery, we investigated the amounts of telescoping of the lag screw and the changes in the neck shaft angle. RESULTS: The mean and maximum insertion torques were correlated with BMD in the HA and N groups, respectively. The mean and maximum insertion torques were not correlated with TAD in the HA and N groups, respectively. The mean torque/BMD ratio was significantly higher in the HA group than in the N group (p = 0.03). There were no significant differences in the maximum torque/BMD ratio between HA and N groups (p = 0.06), while the maximum torque/BMD ratio tended to be higher in the HA group than in the N group. The amounts of telescoping of the lag screw in the HA group were significantly lower than that in the N group (p = 0.04), while there were no significant differences in the changes in the neck shaft angle between two groups (p = 0.32). CONCLUSION: Our results strongly suggest that the use of HA tubes increases the intraoperative lag screw insertion torque/BMD ratio and may improve the lag screw fixation by strengthening the bone/metal thread interface in the treatment of intertrochanteric femoral fractures.

Banding with lesser trochanter fragment using nonabsorbable tape in trochanteric femoral fractures.

INTRODUCTION: Trochanteric femoral fracture is one of the most common fractures in the elderly. Trochanteric femoral fracture with involvement of the lesser trochanter is considered unstable and recognized as having a poor prognosis. However, fixation of lesser trochanter fragment is scarce because of technical difficulties. In this study, we reported the simple surgical procedure and the effect of using nonabsorbable tape in lesser trochanter fixation. METHODS: From January 2014 to December 2017, 114 patients treated with proximal intramedullary nailing for trochanteric fractures with the lesser trochanter fragment were reviewed. Among patients enrolled in this study, 73 were followed up until radiographic bone union, of which 26 were treated with lesser trochanter fragment banding (group B) and 47 without banding (group N). Radiographs and/or computed tomography images were used to evaluate bone union of the lesser trochanter fragment at three months postoperatively. RESULTS: The bone union of the lesser trochanter fragment was achieved in 24 cases (92%) in group B and 30 cases (64%) in group N. Compared with group N, group B showed a significantly increased number of mild and moderate deformities but decreased number of severe deformity and nonunion (P < 0.001). Postoperative complications were not observed in both groups. CONCLUSIONS: From the viewpoint of increasing lesser trochanteric bone union ratio, fixation of the lesser trochanter fragment using nonabsorbable tape in the treatment of trochanteric fractures could be an effective procedure.

Treatment of patellar fractures using bioresorbable forged composites of raw particulate unsintered hydroxyapatite/poly-L-lactide cannulated screws and nonabsorbable sutures.

BACKGROUND: Forged composites of raw particulate unsintered hydroxyapatite/poly-L-lactide (F-u-HA/PLLA) implants are widely used in surgeries because they possess high mechanical strength, bioactivity, and radio-opacity. We previously reported that F-u-HA/PLLA implants were useful for treating lateral tibial condylar, lateral humeral condylar, and ankle fractures. The study aim was to investigate the efficacy of F-u-HA/PLLA cannulated screws and FiberLoop® for treating transverse patellar fractures. METHODS: From April 2013 to February 2019, 15 patients with transverse patellar fractures were treated with F-u-HA/PLLA cannulated screws and FiberLoop® as follows: Open reduction and internal fixation (ORIF) were performed with two F-u-HA/PLLA cannulated screws and a temporary fixation Kirshner wire (K-wire). Three No. 2 FiberLoops® were inserted into these two screw holes and the K-wire hole for temporary fixation. All patients were allowed to full weight-bearing gaits using a knee brace. Knee range of motion exercise was initiated on postoperative day 1. Knee flexion was restricted to ≤90° for 1 month postoperatively. Radiograph was performed to evaluate fracture healing, screw breakage, reduction loss, and screw radio-opacity. Clinical outcomes and postoperative complications were assessed. RESULTS: The average follow-up was 16.0 months. All fractures were successfully united. Screw breakage, reduction loss, osteolysis, and radiolucent zones around the screws were not observed at the final radiographic follow-up. All F-u-HA/PLLA screw shadows were observed during the follow-up. The average range of flexion and extension were 132.0° and -2.7°, respectively. No patients experienced deep infection episodes, late aseptic tissue reactions, or foreign body reactions postoperatively. No patients complained of pain at the final follow-up. All patients returned to their pre-injury work level and activities of daily living. CONCLUSION: Our results strongly suggest that ORIF with F-u-HA/PLLA screws and FiberLoop® could be an alternative treatment option for transverse patellar fractures.

Distribution of Solitary and Multiple Enchondromas of the Hand.

BACKGROUND/AIM: Although some patients with enchondroma have multiple lesions, no study has investigated the distribution of lesions in patients with multiple enchondromas. PATIENTS AND METHODS: This retrospective study included 118 patients with enchondroma of the hand. The incidence and characteristic feature of multiple enchondromas of the hand were investigated. RESULTS: Four patients (3.4%) had multiple enchondromas. In all the patients with multiple enchondromas, the lesions occurred in the middle phalanx, proximal phalanx, and metacarpal bone in the same digital ray. CONCLUSION: The development of the hand rapidly progresses from intrauterine day 33 to day 54. The digital rays are evident on intrauterine day 41, and separation of the distal phalanx, middle phalanx, proximal phalanx, and metacarpal bone is completed until intrauterine day 54. The successive occurrence of multiple enchondroma lesions in the same digital ray in all four cases suggests that the occurrence of lesions preceded the separation of the hand bones and the lesions were divided during the development of these bones.

Continuous Peripheral Nerve Blocks for Early Active Mobilization after Hand Surgery: Four Case Reports.

Early active mobilization after hand surgery is extremely important for preventing scar tissue and adhesion. We examined four patients for whom continuous peripheral nerve blocks (CPNB) were used during and after hand surgery. This method was used for three median nerves and one ulnar nerve. A 2-cm incision was made at distal one-third of the forearm with local analgesia. The catheter tip was placed in the distal one-fourth of the forearm, and the hand surgery was begun. Early active mobilization and the self-rehabilitation exercise started immediately after the operation. The VAS scores during exercise were 0-2 (mean: 1.3); pain was controlled sufficiently. Regarding ROM, excellent results were obtained for tenolysis, with good results for arthrolysis. No infection or postoperative nerve compression was found. This method, using CPNB with a portable infusion pump, is effective and safe for use at home for postoperative pain control.

Anatomical Basis for Arthroscopy of the Proximal Interphalangeal Joints.

BACKGROUND: Arthroscopy is a widely used minimally invasive technique. Nevertheless, no report describes the arthroscopic anatomy of the proximal interphalangeal (PIP) joint for portal creation. To facilitate arthroscopy, this study elucidated the anatomy of the lateral bands of the extensor mechanism and collateral ligaments of PIP joints. METHODS: A total of 39 fingers from the right hands of 10 cadavers (4 males, 6 females) were evaluated in this study. We defined the extension line from the proximal interphalangeal volar crease as the C-line. We also defined an imaginary line along the distal edge of the proximal phalanx, which is parallel to the C-line, as the J-line. The distance between J-line and C-line was measured. On the C-line and J-line, we measured the following: from the dorsal skin to the lateral edge of the lateral band (LB), the dorsal edge of the collateral ligament (CL) and from the lateral band and the collateral ligament (D), the width of the finger (W). The finger half-width (M) was measured on the J-line. Comparison between the digits and comparison between radial and ulnar distance were measured and statistical analysis was performed. RESULTS: All PIP joint spaces were distal from the C-line, except for one ring finger. The average distances between the J-line and C-line were 1.8-3.2 mm. On the C-line, only 11 cases (14.1%) showed an interval between the lateral bands and the collateral ligaments, but, on the J-line 72, cases (92.3%) had such an interval. The interval was located 1.6-2.9 mm in a dorsal direction from the midlateral on the J-line. CONCLUSIONS: Portal creation at the J-line is safer than at the C-line. This study revealed that safe portals for arthroscopy of the PIP joint are 2 mm dorsal to the midlateral line of the finger on the J-line.

Progress and Role of Finger Joint Arthroscopy.

This article describes the authors' experience with, and recent advancement in, the techniques that have allowed the development of many new arthroscopic procedures in the finger joints. It also describes the role and techniques of arthroscopy in small finger joints. Because the intra-articular anatomy of the first to the fifth metacarpophalangeal (MCP) joints is similar, this article discusses the hand MCP joints without distinguishing thumb from fingers.

Morphometric analysis of the peroneal tubercle using a three-dimensional computed tomography model.

BACKGROUND: The peroneal tubercle is a small bony ridge located on the lateral wall on the calcaneus immediately inferior to the lateral malleolus and separates the peroneus brevis and peroneus longus tendons. The size and configuration of the peroneal tubercle has been implicated in the pathogenesis of peroneal tendon tears and tenosynovitis and is the increasing object of clinical interest. However, the morphology of the tubercle is difficult to assess with precision. METHODS: We utilized a new method to evaluate the three-dimensional (3D) geometry of 46 calcanei from 34 consecutive patients; average patient age was 48.0 years who underwent lower extremity computed tomography (CT) for clinical treatment of non-peroneal tubercle-related conditions. The 3D geometries of calcanei were reconstructed by using the computer software to calculate the surface 3D models. To measure the size of the peroneal tubercle, we virtually excised it from the 3D calcaneus model and made a precise measurement of the height. RESULTS: Peroneal tubercles with measured heights of 1mm or more were detected in 65% of the feet, with an average tubercle height of 2.59mm. Peroneal tubercles were larger and more frequent in middle-aged or older than younger patients.

Anatomical basis of distally based anterolateral thigh flap.

Soft tissue coverage around the knee has persisted as a challenge for plastic and reconstructive surgeons. The distally-based anterolateral thigh flap is often used for coverage. Nevertheless, few anatomical studies have investigated the retrograde vascular pedicle. This report clarifies the anatomy of the connection between the descending branch of the lateral circumflex femoral artery and the lateral superior genicular artery. This study examined 38 lower limbs from cadavers and recorded the numbers and locations of perforating vessels. Proximal and distal pivot points were also recorded. The proximal pivot point was 1.0-12.1 cm (average = 6.0 cm) from the inguinal ligament. The distal pivot point, found under the vastus lateralis muscle in all 38 specimens, was 4.0-13.6 cm (average = 9.8 cm) from the lateral superior edge of the patella. The most distal perforator was 8.2-28.0 cm (average = 18.9 cm) from the proximal pivot point. The most proximal perforator was 3.0-19.5 cm (average = 8.7 cm) from the distal pivot point. Details of the anastomosis of the descending branch and the superior lateral genicular artery were clarified. The distally-based anterolateral thigh flap presents one option for reconstruction around the knee.

Recovery process of sciatic nerve defect with novel bioabsorbable collagen tubes packed with collagen filaments in dogs.

Autologous nerve graft is the most commonly applied treatment for the patients with peripheral nerve defect, while application is limited because of tissue availability and unfavorable donor site morbidity. To overcome this problem, peripheral nerve regeneration using a nerve conduit has been studied. Especially, nerve conduit using biodegradable materials has been considered promising. In this study, a potential of collagen nerve conduit has been studied with special reference to the regenerating process of a peripheral nerve. Twelve adult female Beagle dogs weighting 10-12 kg were used. The peroneal nerve was cut to make a 30-mm defect. The nerve defect was bridged by the collagen artificial nerve conduit. Comprehensive functional, electrophysiological, morphometrical, and histological analyses were performed until one year after operation. The wet weight of tibialis anterior muscles was only 32.4% of the healthy side at 24 weeks, which was recovered to 77.4% at 52 weeks after denervation. Electrophysiological evaluation of tibialis anterior muscle belly showed polyphasic wave at 52 weeks after implantation, which was almost half amplitude as compared with that of control. The diameters of myelinated nerve fibers thickened day by day, and the average diameter was 5.16 microm at PFN, 3.91 microm at CG, and 3.75 microm at DFN, and average thickness of myelin sheath was 0.94 microm at PFN, 0.46 microm at CG, and 0.55 microm at DFN after 52 weeks. The distribution of myelinated nerve fiber size in the 52 weeks group was distinctly bimodal with the major peak at approximately 2-4 microm and the minor peak at 10-12 microm. These findings were consistent with the distribution of the normal nerve fiber. This study proves the feasibility of the collagen artificial nerve conduit for promoting nerve regeneration, raises new possibilities of seeking alternatives to autograft for nerve repair. The results from this study showed detailed process of morphological, electrophysiological, and functional recovery of the regenerated nerve, which would provide scientific background for this novel therapy.

Arthroscopic synovectomy of the metacarpophalangeal and proximal interphalangeal joints.

Few reports about clinical experience in arthroscopy of finger joints exist. Furthermore, little attention has been given to arthroscopic synovectomy of rheumatoid fingers. Herein, we describe our experience with arthroscopic synovectomy of metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints in patients with rheumatoid arthritis.Arthroscopic synovectomy was performed in 45 finger joints (18 MCP joints, 26 PIP joints, and 1 interphalangeal thumb joint) of 23 patients with rheumatoid arthritis. All procedures were performed on an outpatient basis under regional anesthesia. The diameter of the arthroscope for small joints was 1.5 mm, and a mini shaver system with a 2.5-mm cutter was used for synovectomy. We developed new portals for PIP joints that were established on the dorsolateral aspect at a position more lateral than previously reported portals.Intraarticular structures of finger joints were well visualized, and magnified observation of the articular cartilage and synovial membrane was possible. Because insertion of the instruments into the palmar cavity was not possible without causing damage to the articular surfaces, synovectomy of the palmar capsule could not be performed. However, arthroscopic synovectomy of the dorsal capsule under visual control could be safely performed using the 2-portal technique. None of the patients experienced postprocedural complications. Swelling of each joint disappeared after the procedure and did not return in many cases for a long period. Furthermore, no joints required reoperation.We conclude that arthroscopy of MCP and PIP joints is useful not only for the assessment of articular cartilage and synovium but also for synovectomy in rheumatoid arthritis.

Relationship between screw trajectory of C1 lateral mass screw and internal carotid artery.

STUDY DESIGN: Evaluation of diagnostic imaging. OBJECTIVE: To comprehend anatomic relationships between the internal carotid artery (ICA) and bicortical purchase of C1 lateral mass screws from the perspective of avoiding ICA injury. SUMMARY OF BACKGROUND DATA: No studies have evaluated safety trajectory of atlantal lateral mass screw that would avoid the ICA injury in relation to its location, although previous studies have indicated concern about ICA injury by the screw tip at the anterior surface of the lateral mass of the atlas. METHODS: From 149 of 177 human 3-dimensional computed tomography reconstruction images, 6 distance and 2 angle parameters related to both atlas and ICA were measured on the plane 15 degrees cephalad to the transverse plane. In addition, angle of error during screw insertion from intended trajectory was checked. RESULTS: The ICA was located in front of the C1 lateral mass in 64.4% of cases and faced the lateral one third of the C1 lateral mass in 54.6% of cases. None were located in front of the medial one third of the C1 lateral mass. The maximum inward screw trajectory that would violate the ICA was 8.6 degrees . Mean angle of preoperative C1/2 rotation and angle of error from intended trajectory was about 5 degrees , respectively. CONCLUSION: The possibility of ICA injury can be excluded by correct insertion of the screw 10 degrees inward. Although bicortical purchase with adequately medially angulated trajectory might be safe enough, we must remember the possibility to violate the ICA in bicortical purchase, because the intended screw trajectory never be assured.

Anatomical basis of the medial sural artery perforator flap in Asians.

Forty-four lower limbs preserved in formaldehyde from cadavers of adult Asians were used. In all specimens 1-5 perforating branches from the medial sural artery were found. No perforators were found higher than 5 cm or lower than 17.5 cm from the popliteal crease. In the most common place (16/44, 36%) in which 2 perforators were found, the proximal one was a mean of 9.6 cm away from the popliteal crease, and the distant one 12.8 cm. All perforators were in an area between 0.5 cm and 4.5 cm from the midline of the gastrocnemius muscles. Because of the differences in the length of the muscle belly, the distribution of perforators may differ between white people and Asians. It should be safe to raise this flap in Asians, because the anatomical comparison of the perforators of the medial sural artery between Asians and white people is now clear.

Treatment of an aneurysmal bone cyst of the second metatarsal using an endoscopic approach.

An aneurysmal bone cyst is a benign solitary lesion of unknown etiology. A case report is presented of recurrence of an aneurysmal bone cyst in the foot that was treated with endoscopic curettage without bone grafting. Bone remodeling and bone formation were completed in the early stages postsurgically. At 2-year follow-up, the patient is asymptomatic with no radiographic evidence of recurrence.

Arthroscopy of the proximal interphalangeal and metacarpophalangeal joints in rheumatoid hands.

PURPOSE: To describe our experience with arthroscopy of the proximal interphalangeal (PIP) and metacarpophalangeal (MP) joints and to assess the value of this technique. TYPE OF STUDY: Case series. METHODS: Arthroscopy was performed on 27 PIP joints and 16 MP joints of 21 patients with rheumatoid arthritis (mean age, 47.2 years; range, 26 to 62 years). After arthroscopic examination, 24 joints were treated with joint irrigation only and 19 were treated with arthroscopic synovectomy. All procedures were performed on an outpatient basis. The diameter of the arthroscope was 1.5 mm, and mini-forceps and a mini-shaver system with a 2.5-mm cutter were used for biopsy and synovectomy. We developed new portals for the PIP joints on the dorsal-lateral aspect, more lateral than previously reported portals. RESULTS: The articular cartilage and synovial membrane of the PIP and MP joints were well visualized, and arthroscopy revealed cartilage changes and synovial proliferation. Because the PIP joint space was not wide enough to insert the arthroscope into the palmar cavity, the palmar part of the articular surfaces and the volar synovium could not be inspected. Synovial biopsy of the dorsal joint capsule was easily performed under arthroscopic visualization. Synovectomy of the dorsal joint capsule and both the radial and ulnar recesses was also possible using the 2-portal technique with a mini-shaver system. No intraoperative or postoperative complications were encountered. CONCLUSIONS: Arthroscopy of the PIP and MP joints is useful in assessing articular cartilage and synovium and for synovial biopsy. Arthroscopic synovectomy can be performed safely with the 2-portal technique.