First Carpometacarpal Joint Motion and Proximal Migration of the First Metacarpal After Tensioning of a Suture Device Suspensionplasty Compared With Trapeziectomy: A Biomechanical Cadaver Study.

PURPOSE: The purpose of this cadaveric biomechanical experiment was to evaluate the effects of suture button suspensionplasty of the first carpometacarpal joint on thumb biomechanics and thumb position compared with an intact, arthritic specimen. METHODS: Six tendons in 8 cadaver hands were loaded to simulate 6 activities of daily living and passively moved through a circumduction motion. Proximal migration of the base of the first metacarpal was measured using optical motion sensors in the intact hand, after trapeziectomy, and following insertion of a suture button suspensionplasty with nominal tightening (approximately 4.5 N) and with firm tightening (approximately 44.5 N). RESULTS: Removal of the trapezium caused a significant increase in the proximal migration of the first metacarpal during a simulated jar grasp, opposition, flexion, extension, and abduction (average, 9.5 mm) compared with its location with the thumb in the intact, neutral position (average, 3.8 mm). Firm tightening of the tightrope caused a near elimination of the proximal migration of the first metacarpal (average, 0.7 mm). In all 6 static loading cases with the trapezium removed, firm tightening caused a significantly smaller migration than in the absence of tightening. CONCLUSIONS: This biomechanical cadaver study supports the hypothesis that trapeziectomy results in proximal migration of the first metacarpal. Suture suspensionplasty mitigates against this migration while maintaining normal motion of the first metacarpal compared with the intact state. Firm tightening of the suture does not adversely affect the first metacarpal's mobility and further decreases proximal migration. However, firm tightening may cause impingement between the first and second metacarpals. CLINICAL RELEVANCE: Suture button suspensionplasty can be used in addition to trapeziectomy in the treatment of basal joint arthritis, and may diminish the need for ligament reconstruction or temporary K-wire insertion.

A Comparison of Complications and Union Rates in Intramedullary Nailing of Femoral Shaft Fractures Treated With Open Versus Closed Reduction.

Intramedullary rod fixation is a common technique for treatment of femoral shaft fractures, with both open and closed reduction techniques described. The purpose of this study was to assess union and complication rates among patients treated with open vs closed reduction and intramedullary nailing of closed femoral shaft fractures. A total of 107 patients undergoing intramedullary fixation of nonpathologic femoral shaft fractures (AO/OTA type 32) between January 2012 and June 2017 were retrospectively studied. Those undergoing open reduction prior to intramedullary nailing were compared with those undergoing closed reduction. The primary outcome analyzed was union rate. Secondary outcomes were time to union, complications necessitating return to the operating room, and operative times. Mean follow-up was 14 months in both groups (range, 6-48 months). Of the 107 patients, 34.6% (n=37) underwent open reduction and 65.4% (n=70) underwent closed reduction. Patients in the open reduction group had rates of union (89.1%, 33 of 37) similar to those of patients in the closed reduction group (92.9%, 65 of 70; P=.378). Patients in the open reduction group who had union did so in a mean of 6.2 months (range, 3-12 months) vs a mean of 5.4 months (range, 2-11 months) in the closed reduction group (P=.13). Six patients (16.2%) in the open reduction group and 6 patients (8.6%) in the closed reduction group had a postoperative complication requiring return to the operating room (P=.18). Open reduction and intramedullary nailing results in rates of union, time to union, and rates of significant complications similar to those of closed reduction and intramedullary nailing. [Orthopedics. 2020; 43(2): 103-107.].