Steinmann pin arthrodesis for salvage of failed small joint arthroplasty.

Proximal interphalangeal joint arthroplasty has been performed since the 1960s, with good short-term and medium-term results. However, despite improvements in pain, there is a considerable failure rate. Often, there is a delicate soft tissue envelope and substantial bone loss after removal of these prostheses, making salvage procedures difficult. We present an intramedullary technique of proximal interphalangeal joint arthrodesis following failed implant arthroplasty. This technique has provided reliable results in a small cohort of patients.

Effect of corticosteroids on the biomechanical strength of rat rotator cuff tendon.

BACKGROUND: The effect of corticosteroids on tendon properties is poorly understood, and current data are contradictory and diverse. The biomechanical effect of steroids on rotator cuff tendon has not been studied, to our knowledge. The current study was undertaken to characterize the biomechanical effects of corticosteroid exposure on both uninjured and injured rat rotator cuff tendon. METHODS: One hundred and twenty-three male Sprague-Dawley rats were randomly assigned to four groups: control (C), tendon injury (I), steroid exposure (S), and tendon injury plus steroid exposure (I+S). Unilateral tendon injuries consisting of a full-thickness defect across 50% of the total width of the infraspinatus tendon were created. Steroid treatment consisted of a single dose of methylprednisolone placed into the subacromial space. At one, three, and five weeks postoperatively, the shoulders were harvested and the infraspinatus tendon was subjected to biomechanical testing. Two specimens from each group were used for histological analysis. RESULTS: At one week, maximum load, maximum stress, and stiffness were all significantly decreased in Group S compared with the values in Group C. Mean maximum load decreased from 37.9 N in Group C to 27.5 N in Group S (p < 0.0005). Mean maximum stress decreased from 18.1 MPa in Group C to 13.6 MPa in Group S (p < 0.0005). Mean stiffness decreased from 26.3 N/mm in Group C to 17.8 N/mm in Group S (p < 0.0005). At one week, mean maximum stress in Group I+S (17.0 MPa) was significantly decreased compared with the value in Group I (19.5 MPa) (p < 0.0005). At both the three-week and the five-week time point, there were no significant differences between Group C and Group S or between Group I and Group I+S with regard to mean maximum load, maximum stress, or stiffness. Histological analysis showed fat cells and collagen attenuation in Groups S and I+S. These changes appeared to be transient. CONCLUSIONS: A single dose of corticosteroids significantly weakens both intact and injured rat rotator cuff tendons at one week. This effect is transient as the biomechanical properties of the steroid-exposed groups returned to control levels by three weeks.

Merkel cell tumor of the hand: report of two cases.

Merkel cell carcinoma is a rare cutaneous neuroendocrine neoplasm. Often located on the head and neck, reports of Merkel cell carcinoma in the hand are extremely limited. In this article, we review 2 cases of Merkel cell carcinoma of a digit treated with ray resection and sentinel lymph node dissection with greater than 5 years of follow-up.