Arthrodesis of the thumb carpometacarpal joint using a quadrangular plate: surgical technique and long-term results of 70 patients.

PURPOSE: To assess the long-term results of trapeziometacarpal arthrodesis using a quadrangular plate, regarding clinical, radiological and functional outcomes, as well as development of complications. MATERIAL AND METHOD: From 2005 to 2015, 70 patients were treated at our institution for primary osteoarthrosis of thumb carpometacarpal joint performing a trapeziometacarpal arthrodesis. A total of 85 arthrodesis were carried out using a titanium quadrangular plate (Proflyle plate, Stryker®, Kalamazoo MI, USA), without grafting in any case. Pre- and postoperative functional data were assessed at the outpatient clinics using DASH, MWS and VAS. All patients were asked for their ability to perform basic daily activities before and after surgery. All patients were also asked about satisfaction and their return to their jobs after surgery. Pre- and postoperative radiological data were also assessed. RESULTS: There were 59 females and 11 males with an average age of 55 years (range 44-60). In 66 cases arthrodesis was carried out in the dominant hand, in 45 cases the right thumb was involved, and in 40 the left thumb was involved; in 15 cases arthrodesis was carried out bilaterally. Preoperative average DASH score was 64 (range 50-85), postoperative average score was 25 (range 5-61). Regarding MWS, 51 patients obtained excellent results, 15 patients obtained good results and 4 patients referred poor results. The preoperative average score of VAS was 6 (range 5-10), which decrease to an average of 2 (range 0-3) after surgery; all those differences were statistically significant. All patients reported a mild loss of motion; however, all of them reported improvement to carry out daily activities. There were four cases of nonunion because of failure of fixation and two cases with dysesthetic scar. There was no development of osteoarthritis in adjacent joints. The average follow-up was 60 months. CONCLUSIONS: The use of quadrangular plates for arthrodesis of the trapeziometacarpal joint is a safety and reproducible technique with a low rate of complications. Arthrodesis decreases pain and improves function in patients with primary osteoarthritis of the thumb carpometacarpal joint; in spite of a mild loss of motion, patients are satisfied with this procedure.

Secondary Patellar Resurfacing as a Rescue Procedure for Persistent Anterior Knee Pain After Primary Total Knee Arthroplasty: Do Our Patients Really Improve?

BACKGROUND: Secondary patellar resurfacing (SPR) is a procedure that can be used in patients with persistent anterior knee pain (AKP) after a primary total knee arthroplasty. The aim of our study was to analyze the clinical and functional outcomes as well as the complications of this procedure and identify predictive factors for a favorable outcome. METHODS: Forty-six patients who underwent SPR for persistent AKP after primary total knee arthroplasty were retrospectively studied. The patient's mean age was 68 years (range, 36-86 years). The average follow-up time after SPR was 74 months (range, 24-197 months). Demographic data, Knee Society Score scale, range of motion, pain improvement (Visual Analogue Scale), overall satisfaction, and complications were recorded. The statistical analysis was performed using STATA tm/SE v10. RESULTS: There was an improvement of the Knee Society scale (from 54 ± 11 to 64 ± 16 points; P < .05). However, in 59% of the cases, there was no pain improvement, and 65% of patients were not satisfied. Four patients showed complications, and in 2 cases, reoperation was necessary. We did not find any preoperative predictive factor for a favorable outcome after SPR. CONCLUSION: Despite improvement of the Knee Society scale, many patients continue with AKP and are dissatisfied with this procedure; therefore, we do not recommend it in this clinical scenario.

Early results with the new internal fixator systems LCP and LISS: a prospective study.

The Locking Compression Plate (LCP) and the Less Invasive Stabilisation System (LISS) are new implants with angular stability developed by the AO/ASIF. They offer an alternative for internal fixation in complex intra-articular fractures and high-energy diaphyseal fractures of the long bones. The new system was used in a prospective study to treat 113 patients (76 women, 37 men; average age: 53.1 years) with 122 injuries (multifragment shaft fractures or complex intra-articular, delayed/ non-union, malunion) from October 2002. Of these, 13 affected the humerus, 20 the radius, 2 the ulna, 21 the femur, 42 the tibia, 10 the fibula, 2 the acetabulum and 12 the calcaneus. Because of severe concomitant injuries, 18 fractures were first treated with an external fixator and definitively stabilised more than two weeks after the injury. Thirty-one patients were operated on after failure of other implants and non-union. Clinical and radiographic findings as well as complications were followed prospectively over a mean period of 20 months (range: 13 to 30). One patient was lost to follow-up. A total of 112 patients underwent a standardised follow-up examination. The outcome correlated with the severity of the fracture, anatomic reduction, adequate positioning of the plate and concomitant injuries. Despite the large number of open and comminuted fractures, no serious complications such as deep infections, vascular lesions, deep venous thrombosis or non-unions were noted. We found the new internal fixator system to be a safe and reliable procedure. It offers numerous fixation possibilities and has proven its value in complex fracture situations and in revision operations. A good knowledge of biomechanics is essential as well as precise preoperative planning.