Thumb interphalangeal joint arthrodesis angles in patients with carpometacarpal osteoarthritis.

PURPOSE: Previous studies have shown that thumb interphalangeal (IP) joint arthrodesis is typically performed between 0 and 30° of flexion, with a recent study in healthy subjects having recommended a range of 15-30° to be an ideal functional IP joint fusion angle for various activities of daily living. The current study aimed to evaluate the ideal thumb IP fusion angle in patients with thumb carpometacarpal (CMC) osteoarthritis (OA). METHODS: Twenty-seven patients with thumb CMC OA were evaluated; five patients had bilateral pathology, for a total of thirty-two thumbs included. Hand dominance was noted and baseline unsplinted measurements were obtained for power tasks, precision tasks, pinch, and grip strength testing. Patients' thumbs were then splinted at 0, 15, 30, and 45° with repeat measurements taken and compared to baseline. Outcomes were measured by use of a 10-point Visual Analogue Scale, timing of tasks, and a dynamometer. Outcomes were analyzed by Wilcoxon sign ranked tests for each category of trials. RESULTS: For significant outcomes, the most favorable simulated thumb fusion angles were 15° in the dominant hand and 0°, 15° in the nondominant hand (precision tasks); the least favorable position was found to be 45° in the dominant hand (precision tasks, pinch strength). When combining all outcomes that both reached and approached significance, the most favorable position was found to be 15° and least favorable position, 45°. CONCLUSIONS: In patients with thumb CMC OA, an IP fusion angle of 15° is preferable, while a fusion angle of 45° is to be avoided. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic Study, Level III.

Are CT Scans Overutilized in the Workup of Vertebral Compression Fractures?

STUDY DESIGN: This was a retrospective chart review. OBJECTIVES: Computed tomography (CT) does not aid in determination of compression fracture chronicity and contributes to higher cost and radiation exposure. An examination of extraneous imaging will help to guide appropriate workup. SUMMARY OF BACKGROUND DATA: Cost for osteoporotic fracture treatment has been estimated at $17 billion annually; future costs are anticipated to increase by at least 50%. MATERIALS AND METHODS: A chart review evaluated patients who received kyphoplasty or vertebroplasty as part of compression fracture treatment. The primary end point of the study was analysis of unnecessary imaging obtained during workup. The secondary outcome was excess radiation exposure incurred from unneeded imaging studies. RESULTS: There were 104 instances (40.2% of n=259 workups) where patients underwent only magnetic resonance imaging (MRI) or bone scan after radiographs. There were 28 instances (10.8%) where patients underwent only radiographs with a comparison study. There were a total of 76 instances (29.3%) where patients underwent extraneous CT scans and 13 instances (5%) where patients underwent both MRI and bone scan, causing an average of 979.4 mGy cm additional radiation exposure. CONCLUSIONS: We recommend an algorithm that favors radiographs with comparison study or acquiring either MRI or bone scan to determine acuity. If these are available, CT scan becomes unnecessary and incurs increased costs and radiation exposure.

Patient Reported Outcomes from Sacroiliac Joint Fusion.

STUDY DESIGN: Retrospective, case series. PURPOSE: The purpose of this study is to determine morbidity, complications, and patient reported outcomes from minimally invasive sacroiliac joint (SIJ) fusion. OVERVIEW OF LITERATURE: Lumbar back pain emanating from the SIJ can be surgically treated via a percutaneous approach in the appropriately selected patient with minimal morbidity and acceptable functional outcomes. METHODS: Patients diagnosed by >2 physical examination maneuvers and subjective relief from a computed tomography-guided lidocaine-bupivacaine-steroid injection underwent SIJ fusion after failing conservative management with a combination of oral anti-inflammatory medications, physical therapy, and pelvic belt stabilization. Perioperative data collected include estimated blood loss (EBL) and operative time. Oswestry disability index, 12-item short form health survey (SF-12), visual analogue score, and functional status were analyzed. All complications were noted. RESULTS: The study cohort of 45 cases (69% female) achieved postoperative survey follow-up at 9.9 and 32.3 months. SF-12 physical component summary statistically improved while all other scores were equivalent. Mean EBL and operative time were 22 mL and 36 minutes, respectively. Initial survey showed that 64% of patients discontinued narcotics (29/45), 71% do not use an assistive device (32/45), and 15.6% do not work due to pain (7/45). 73% of patients stated they would have the surgery again (33/45). For the second survey, 65% of patients discontinued narcotics (26/40), 70% did not use an assistive device (28/40), and 17.5% did not work due to pain (7/40). A history of thoracolumbar instrumentation (16/45) did not significantly affect outcomes. Three complications described by screw malposition with neurologic deficit (6.7%) were treated with screw repositioning (1 case) and removal of a single superior implant (2 cases) with time to revision of 2.2 months. All three ultimately had resolution of radicular pain. CONCLUSIONS: Percutaneous SIJ fusion offers minimal morbidity and acceptable functional outcomes. While women and those with a prior history of lumbar instrumentation may be at increased risk of having SIJ dysfunction requiring surgical intervention, it was not found to affect postoperative functional outcomes when compared to the non-instrumented group.