Patient-Experience of Trapeziectomy for Trapeziometacarpal Osteoarthritis in Wide-Awake Local Anesthesia no Tourniquet, 2-Year Follow-up.

PURPOSE OF THE STUDY: The purpose of this study was to assess the patient experience of trapeziectomy under WALANT for trapeziometacarpal joint (TMJ) osteoarthritis (OA) in a prospective study with 2-year follow-up. MATERIAL AND METHODS: The study included 23 patients with TMJ OA undergoing trapeziectomy with WALANT. All patients were seen by a hand therapist preoperatively and at 3, 12, and 24 months postoperatively. At each visit, VAS pain scores, thumb range of motion, grip strength, and Disabilities of the Arm, Shoulder and Hand (DASH) score were assessed. The Picker Patient Experience (PPE-15) questionnaire was administered within 2 weeks of surgery. RESULTS: All 23 patients completed the PPE-15 questionnaire. Their mean age was 64 years. The 21 patients who remained at the 24-month follow-up all said they would choose the same anaesthesia method again. At this follow-up, VAS pain scores, thumb range of motion, key pinch grip and DASH scores had improved significantly, while thumb opposition and hand grip strength remained largely unchanged. The majority of patients felt well informed before and during the procedure, and all patients rated pain relief as good or satisfactory. Nearly 40% of patients reported receiving inadequate information about the postoperative medications. DISCUSSION: Patients have a positive attitude to trapeziectomy with WALANT, and seem to prefer WALANT over other methods of anaesthesia. Trapeziectomy with WALANT for TMJ OA is a safe procedure and appears to give a functional outcome similar to trapeziectomy under general anaesthesia. CONCLUSIONS: Trapeziectomy with WALANT for TMJ OA is safe, preferred by patients and has similar clinical outcome as trapeziectomy in general anesthesia. KEY WORDS: trapeziectomy, osteoarthritis, WALANT.

Three-dimensional motion analysis of pre- and postoperative thumb movement in trapeziometacarpal joint osteoarthritis-Comparison of arthrodesis and trapeziectomy with suspensionplasty.

Trapeziometacarpal osteoarthritis (TMC-OA) reduces the range of motion (ROM) of the thumb. However, the kinematic change achieved through surgical treatment remains unclear. Therefore, to quantify the kinematic change following TMC-OA surgery, we performed a three-dimensional motion analysis of the thumb using an optical motion capture system preoperatively and 1 year postoperatively in 23 patients with TMC-OA scheduled for arthrodesis (AD) or trapeziectomy with suspensionplasty (TS). Eighteen hands of nine healthy volunteers were also included as controls. Both procedures improved postoperative pain and Disability of the Arm, Shoulder and Hand scores, and AD increased pinch strength. The ROM of the base of the thumb was preserved in AD, which was thought to be due to the appearance of compensatory movements of adjacent joints even if the ROM of the TMC joint was lost. TS did not improve ROM. Quantifying thumb kinematic changes following TMC-OA surgery can improve our understanding of TMC-OA treatment and help select surgical procedures and postoperative assessment.

De Quervain tendinitis after total trapeziometacarpal joint arthroplasty: Biomechanical evaluation of tendon excursion in the first extensor tendon compartment.

De Quervain's tenosynovitis is the most common complication after total trapeziometacarpal joint replacement. Etiology is unclear. Implantation of a ball-in-socket implant changes the biomechanics of the normal trapeziometacarpal saddle joint and increases its range of motion. The present study demonstrates that this procedure also significantly increases excursion of the abductor pollicis longus and extensor pollicis brevis tendons during thumb flexion-extension, and not during thumb abduction-adduction. Increased tendon gliding under the retinaculum of the first extensor tendon compartment could predispose to the development frictional tenosynovitis and play a role in the development of de Quervain's syndrome after total trapeziometacarpal joint replacement. LEVEL OF EVIDENCE: Not applicable (laboratory study).

Internal brace augmentation improves the biomechanical properties of trapeziometacarpal joint dorsoradial ligament repair.

This study investigated whether dorsoradial ligament repair with internal brace augmentation provided more immediate stability in the trapeziometacarpal joint than dorsoradial ligament repair alone. Seven matched pairs of cadaveric hands were used. One specimen from each pair was assigned to the repair-only group and the other to the repair + internal brace augmentation group. Trapeziometacarpal joint range of motion and translation were quantified under different conditions for both groups: (1) intact, (2) transected dorsoradial ligament, and (3) repaired dorsoradial ligament or repaired dorsoradial ligament plus internal brace augmentation. Load-to-failure tests were performed after repair. Range of motion and translation were increased by dorsoradial ligament transection and were decreased by dorsoradial ligament repair; however, compared to the intact condition, the repair-only group demonstrated greater flexion/extension range, while the repair + internal brace group showed no significant difference in range of motion. Mean loads at 2- and 3-mm displacements were greater in the repair + internal brace group than in the repair-only group (18.0 ± 1.8 N vs. 10.8 ± 1.3 N for 2 mm displacement and 35.3 ± 3.7 N vs. 23.1 ± 2.9 N for 3 mm displacement, respectively). Internal brace augmentation improved the load-to-failure characteristics of dorsoradial ligament repair without compromising range of motion. LEVEL OF EVIDENCE: IV.

Update on Thumb Basal Joint Arthritis Surgery.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Comprehend anatomy and biomechanics of the normal and arthritic trapeziometacarpal joint. 2. Evaluate best evidence for diagnosis and for operative and nonoperative treatment of thumb osteoarthritis. 3. Understand treatment pitfalls of basilar joint arthritis and complication avoidance. SUMMARY: Articular and ligamentous anatomy of the trapeziometacarpal joint enables complex motions. Disability from arthritis, common at the trapeziometacarpal joint, is debilitating. Furthering the understanding of how trapeziometacarpal arthritis develops can improve treatment. The authors provide current best evidence for diagnosis and treatment of basilar joint arthritis. Pitfalls in treatment are discussed.

Thumb Carpometacarpal Arthritis Surgery: The Patient Experience.

BACKGROUND: Patients with symptomatic recalcitrant thumb carpometacarpal arthritis often undergo surgery. Although most surgical patients do well, the authors anticipated that a substantial portion of their thumb carpometacarpal surgery patients would have unsatisfactory experiences and express unmet expectations, dissatisfaction, and regret, regardless of surgical procedure performed. The authors hypothesized those experiences would correlate with patient-reported outcomes scores. METHODS: The authors identified patients who had undergone trapeziectomy alone or with ligament reconstruction 1 to 4 years previously for primary thumb carpometacarpal arthritis. One hundred twelve patients completed Quick Disabilities of the Arm, Shoulder and Hand and visual analogue scale pain, expectations, satisfaction, and regret questionnaires. RESULTS: More than 40 percent of patients expected to "return to normal" after surgery for pain, strength, and/or function. Including all patients, 7, 19, and 11 percent had unmet expectations for improvement in pain, strength, and function, respectively. Twelve percent expressed dissatisfaction with their outcome. Although just 4 percent regretted undergoing surgery, 13 percent would likely not recommend the procedure to someone they care about. There were no statistically significant differences for any patient-reported outcomes between trapeziectomy-alone (n = 20) and trapeziectomy with ligament reconstruction (n = 92). Visual analogue scale and Quick Disabilities of the Arm, Shoulder and Hand questionnaire scores were both moderately correlated with expectations being met for pain, strength, and function and for satisfaction with surgical outcome. CONCLUSIONS: Patients' thumb carpometacarpal surgical experiences vary considerably. Many express dissatisfaction or a lack of expectations met with the two most common procedures. A thorough understanding and review of expectations preoperatively may be uniquely pertinent for these patients. Further research should determine predictors and potentially modifiable factors for unsatisfactory outcomes.

Clinical efficacy of closed reduction and percutaneous parallel K-wire interlocking fixation of first metacarpal base fracture.

BACKGROUND: This study aimed to explore the clinical efficacy of treating a first metacarpal base fracture by closed reduction and percutaneous parallel K-wire interlocking fixation between the first and second metacarpals. METHODS: Twenty patients treated by the abovementioned modified technique (modified technique group) and ten patients treated by the traditional percutaneous K-wire fixation technique (traditional technique group) from October 2015 to November 2019 at our institution were retrospectively reviewed. The patients' average age was 38 years (range, 16-61 years). The mean follow-up period was 13 months (range, 10-18 months). At the final follow-up, the functional recovery of the injured hand was assessed and compared between the modified and traditional technique groups. In addition, the functional recovery of the injured hand was compared with that of the uninjured hand within the modified technique group. RESULTS: All patients recovered well, with no cases of infection or nonunion. Compared with the traditional technique group, the modified technique group had a shorter operative time, lower postoperative visual analogue scale pain score, better effective range of motion score of the first carpometacarpal joint (Kapandji score), and had almost no need for auxiliary plaster fixation, enabling functional exercise to be started earlier. Within the modified technique group, the mean hand grip strength, pinch strength, and Kapandji score on the injured side did not significantly differ to the values on the uninjured side in both the extra-articular and intra-articular fracture subgroups. While the abduction and flexion-extension arcs of the thumb on the injured hand were significantly smaller than those on the uninjured hand in both the extra-articular and intra-articular fracture subgroups, the patients felt clinically well with respect to daily activities and strength. CONCLUSION: The percutaneous parallel K-wire and interlocking fixation technique is simple, effective, and economical for first metacarpal base fractures.

Patients With Higher Treatment Outcome Expectations Are More Satisfied With the Results of Nonoperative Treatment for Thumb Base Osteoarthritis: A Cohort Study.

OBJECTIVE: To investigate how satisfaction with treatment outcome is associated with patient mindset and Michigan Hand Outcome Questionnaire (MHQ) scores at baseline and 3 months in patients receiving nonoperative treatment for first carpometacarpal joint (CMC-1) osteoarthritis (OA). DESIGN: Cohort study SETTING: A total of 20 outpatient locations of a clinic for hand surgery and hand therapy in the Netherlands. PARTICIPANTS: Patients (N=308) receiving nonoperative treatment for CMC-1 OA, including exercise therapy, an orthosis, or both, between September 2017 and February 2019. INTERVENTIONS: Nonoperative treatment (ie, exercise therapy, an orthosis, or both) MAIN OUTCOME MEASURES: Satisfaction with treatment outcomes was measured after 3 months of treatment. We measured total MHQ score at baseline and at 3 months. As baseline mindset factors, patients completed questionnaires on treatment outcome expectations, illness perceptions, pain catastrophizing, and psychological distress. We used multivariable logistic regression analysis and mediation analysis to identify factors associated with satisfaction with treatment outcomes. RESULTS: More positive pretreatment outcome expectations were associated with a higher probability of being satisfied with treatment outcomes at 3 months (odds ratio, 1.15; 95% confidence interval, 1.07-1.25). Only a relatively small part (33%) of this association was because of a higher total MHQ score at 3 months. None of the other mindset and hand function variables at baseline were associated with satisfaction with treatment outcomes. CONCLUSIONS: This study demonstrates that patients with higher pretreatment outcome expectations are more likely to be satisfied with treatment outcomes after 3 months of nonoperative treatment for CMC-1 OA. This association could only partially be explained by a better functional outcome at 3 months for patients who were satisfied. Health care providers treating patients nonoperatively for CMC-1 OA should be aware of the importance of expectations and may take this into account in pretreatment counseling.

Surgery for trapeziometacarpal osteoarthritis in relation to cumulative occupational hand force requirements: a Danish nationwide cohort study.

OBJECTIVES: To evaluate if higher cumulative occupational hand force requirements are associated with higher risks of surgery for trapeziometacarpal osteoarthritis and with surgery earlier in life. METHODS: The study was based on Danish national registers. Among all persons born in Denmark 1931 to 1990, we included those who had been employed for at least 5 years since 1991 by the end of 2000, or later when this employment criterion was reached, up until the end of 2016. Cumulative exposure estimates for 10-year time windows (force-years) were assessed by combining individual year-by-year information on occupational codes with an expert based hand-arm job exposure matrix. First-time events of surgery for trapeziometacarpal osteoarthritis 2001 to 2017 constituted the outcome. Surgery rates were analysed by a logistic regression technique equivalent to discrete survival analysis using a 1-year lag. We also calculated rate advancement periods. RESULTS: A total of 2 860 448 persons contributed with around 48 million person-years of follow-up, during which 3977 cases appeared (821 among men and 3156 among women). Compared with <5 force-years, the adjusted OR (ORadj) for ≥5 to <10 force-years was 1.39 (95% CI 1.14 to 1.68) and for ≥10 to 30 force-years 1.47 (95% CI 1.26 to 1.71) among men and 1.64 (95% CI 1.50 to 1.78) and 1.29 (95% CI 1.16 to 1.43) among women. The sex combined ORadj were 1.59 (95% CI 1.47 to 1.72) and 1.36 (95% CI 1.25 to 1.48). Among the exposed, surgery was advanced by 3 to 7 years. CONCLUSION: Medium/high cumulative hand force requirements were associated with elevated hazard rates of surgery for trapeziometacarpal osteoarthritis and advanced the time of surgery by several years.

Painful Snapping of Thumb Caused by a Displaced Non-Union Fragment from the Trapezium: A Case Report.

There are only a few reports regarding snapping thumb caused by the pathology of the extensor tendon. We report a rare case of snapping thumb caused by a displaced non-union fragment from the trapezium in a 54-year-old man treated with the surgical resection. The intraoperative findings and the outcome are described.

Pin Insertion to the Interosseous Hood Minimize the Finger Motion Restriction for the Proximal Phalangeal Percutaneous Fixation: A Cadaveric Study.

Background: The purpose of this study was to identify the optimal pin insertion point to minimize finger motion restriction for proximal phalangeal fixation in cadaver models. Methods: We used 16 fingers from three fresh-frozen cadavers (age, 82-86 years). Each finger was dissected at the level of the carpometacarpal joint and fixated to a custom-built range of motion (ROM)-measuring apparatus after skin removal. The pin was inserted into the bone through four gliding soft tissues: the interosseous hood, dorsal capsule, lateral band, and sagittal band. Then, each tendon was pulled by a prescribed weight in three finger positions (flexion, extension, and intrinsic plus position). Changes in the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) angles were measured before and after pinning. We compared the differences between the insertion points using the Tukey-Kramer post hoc test. Results: Placement of pins into the sagittal band significantly restricted MCP joint flexion, while placement into the dorsal capsule and lateral band significantly restricted PIP joint flexion. Only placement into the interosseous hood showed no significant difference in joint angles between the three finger positions compared to pre-pin insertion. There were no significant effects on MCP, PIP, and DIP joint extension. Conclusions: The ROM of the MCP joint was obstructed due to pinning in most areas of insertion. However, pin insertion to the interosseous hood did not obstruct the finger flexion ROM compared to that of other gliding soft tissues; therefore, we believe that the interosseous hood may be a suitable pin insertion point for proximal phalangeal fixation.

APL Lasso Suspensionplasty for Trapeziectomy.

Base of thumb arthritis is a common pathology, with late-stage disease often treated by trapeziectomy and a form of ligament reconstruction or suspension. No therapeutic option for suspension or ligament reconstruction has proven to be superior to others, with risks inherent to all. Here, the authors describe a novel technique utilizing an accessory slip of abductor pollicis longus looped around the second metacarpal base to suspend the metacarpal and prevent subsidence after trapeziectomy. This technique aims to mitigate some of the risks seen in other methods, while providing similar biomechanical strength. Early clinical results are also presented.

Fifth metacarpal instability and its effect on hamatometacarpal arthritis patterns-a cadaver study.

Osteoarthritis (OA) of the fifth carpometacarpal joint is a rare diagnosis with most cases occurring post-traumatically. The joint's ligamentous supports have not been described extensively; however we know that the volar and intermetacarpal ligaments acts as the primary stabilizers. The major deforming forces on this joint are the extensor carpi ulnaris (ECU) dorsally and the flexor carpi ulnaris volarly, via the pisimetacarpal ligament. The aim of this study was to determine how the different joint stabilizers contribute to fifth carpometacarpal joint stability and biomechanics. We also sought to describe the OA patterns affecting the fifth carpometacarpal joint. A study was performed on 10 embalmed cadavers. The fifth carpometacarpal joint was evaluated biomechanically through ECU traction and sequential transection of the joint stabilizers. Gross macroscopic evaluation of degenerative changes in the articular surface was conducted and graded on a scale of 0-3 (with 0 representing normal cartilage with no visible lesions). Biomechanical data were available from 18 specimens (10 right; 8 left) and arthritic patterns were available from all 20 specimens (10 right; 10 left). Based on the biomechanical data, the proximal and distal intermetacarpal ligaments were found to be major contributors to stability. The volar stabilizer was a minor contributor to stability and the dorsal stabilizer was a minimal contributor to stability. OA was present in 16/20 specimens (80%) with an average arthritis grade of 1.6 on the right hand and 1.0 on the left hand. The most common site of OA was the dorso-ulnar quadrant.

The use of the RegJoint™ implant for base of thumb osteoarthritis: Results with a minimum follow-up of 2 years.

The RegJoint™ (Scaffdex Oy, Finland) implant is a bio-absorbable poly-L/D-lactide implant which acts as a temporary support in resected joint spaces. It can be used in base of thumb surgery as a spacer to prevent first metacarpal subsidence. However, high rates of adverse tissue reactions and bone osteolysis have been reported recently by one group. The objective of this study was to investigate the outcome of patients treated in our institution with this implant. Patients underwent a postoperative clinical and radiological assessment. The QuickDASH questionnaire, Patient Evaluation Measure (PEM) and a visual analogue scale for pain assessment were used. Grip strength, key pinch, pinch strength, thumb palmar and radial abduction and opposition were measured. Trapeziometacarpal height was used to evaluate thumb shortening compared with the preoperative value. Periprosthetic bone-erosion of the trapezium and metacarpal were measured. Subluxation of the joint was evaluated by measuring the step-off between the radial edge of the trapezium and the base of the first metacarpal bone. Twenty-two patients from 2013-2016 were included. There were no postoperative wound complications. There was no significant difference in grip strength, key pinch or pinch between the operated and the contralateral hand. There was no significant difference in the trapeziometacarpal height, trapezial height or the degree of subluxation pre-or post-operatively. Contrary to recent reports, we did not find any adverse soft tissue reactions or significant bone erosion. There was no significant change in hand function. We consider the RegJoint™ a useful adjunct in the management of a select cohort of patients with base of thumb arthritis.

Beneficial Effects of Nonsurgical Treatment for Symptomatic Thumb Carpometacarpal Instability in Clinical Practice: A Cohort Study.

OBJECTIVE: To describe outcomes of nonsurgical treatment for symptomatic thumb carpometacarpal joint (CMC-1) instability. Secondary, to evaluate the conversion rate to surgical treatment. DESIGN: Prospective cohort study. SETTING: A total of 20 outpatient clinics for hand surgery and hand therapy in the Netherlands. PARTICIPANTS: A consecutive sample of patients with symptomatic CMC-1 instability (N=431). INTERVENTION: Nonsurgical treatment including exercise therapy and an orthosis. MAIN OUTCOME MEASURES: Pain (visual analog scale [VAS], 0-100) and hand function (Michigan Hand Outcomes Questionnaire [MHQ], 0-100) at baseline, 6 weeks, and 3 months. Conversion to surgery was recorded for all patients with a median follow-up of 2.8 years (range, 0.8-6.7y). RESULTS: VAS scores for pain during the last week, at rest, and during physical load improved with a mean difference at 3 months of 17 (97.5% CI, 9-25), 13 (97.5% CI, 9-18), and 19 (97.5% CI, 12-27), respectively (P<.001). No difference was present at 3 months for MHQ total score, but the subscales activities of daily living, work, pain, and satisfaction improved by 7 (97.5% CI, 1-14), 10 (97.5% CI, 4-16), 5 (97.5% CI, 2-9), and 12 (97.5% CI, 2-22) points, respectively (P<.001-.007). After median follow-up of 2.8 years, only 59 participants (14%) were surgically treated. Both in the subgroups that did and did not convert to surgery, VAS pain scores decreased at 3 months compared with baseline (P<.001-.010), whereas MHQ total score did not improve in both subgroups. However, VAS and MHQ scores remained worse for patients who eventually converted to surgery (P<.001). CONCLUSIONS: In this large sample of patients with symptomatic CMC-1 instability, nonsurgical treatment demonstrated clinically relevant improvements in pain and aspects of hand function. Furthermore, after 2.8 years, only 14% of all patients were surgically treated, indicating that nonsurgical treatment is a successful treatment of choice.

Suture Suspension Arthroplasty With Trapeziectomy for Thumb Carpometacarpal Arthritis Using a Wide-awake Approach.

Despite the introduction of various techniques for ligament reconstruction in the treatment of thumb carpometacarpal (CMC) arthritis, complications, including proximal migration, dorsal subluxation of the first metacarpal base, hyperextension of the thumb metacarpophalangeal joint, and impingement between the first and second metacarpal bases, have been reported. Even suture button suspensionplasty with Arthrex Mini TightRope may be unable to correct the adduction contracture deformity and does not effectively tether the trapeziometacarpal toward the base of the index metacarpal, thus potentially leaving patients with persistent decreased first web space angle, proximal migration, and collapse deformity. Hence, suture suspension arthroplasty with abductor pollicis longus (APL)-flexor carpi radialis (FCR) tendon suture after trapeziectomy, a simpler technique, was applied. This simple surgical reconstruction abducts the first metacarpal bone. Abduction of the CMC joint improves metacarpophalangeal joint hyperextension. However, strong tension of the APL-FCR causes abduction contracture of the first CMC joint and difficulty of pinch motion of the thumb to the other fingers. Therefore, we have modified the arthroplasty with a wide-awake approach. The procedure is performed with the patient fully awake under local anesthesia, without a tourniquet to allow the patient to actively move and pinch the thumb, which allows the surgeon to confirm the tension of the APL-FCR suture. A fiber wire is connected to the APL-FCR with proper tension. The patient and surgeon can ensure pinch motion and thumb opposition with satisfaction during surgery.

Suture Suspensionplasty Using Abductor Pollicis Longus and Flexor Carpi Radialis for Advanced Thumb Carpometacarpal Joint Arthritis.

PURPOSE: Current operative treatment for advanced thumb carpometacarpal (CMC) joint arthritis mainly constitutes complete trapeziectomy with or without additional stabilizing procedures. However, it is unclear whether the additional procedures influence overall clinical outcomes. Therefore, the purpose of this study was to evaluate the effectiveness of our posttrapeziectomy suture suspensionplasty technique, performed using the abductor pollicis longus and flexor carpi radialis tendons, in patients with advanced thumb CMC arthritis. MATERIALS AND METHODS: We evaluated 36 thumbs of 35 patients with advanced thumb CMC arthritis treated with combined operative excision of trapezium followed by a suture suspensionplasty using flexor carpi radialis and abductor pollicis longus tendons. We used a minimal volar approach to create a sling construct with a nonabsorbable suture material, which could support the thumb metacarpal base without pin fixation or tendon transfer. For radiographic evaluation, we used the ratio of the radial metacarpal subluxation to metacarpal articular width, estimated from the bilateral stress-view radiographic images of the thumb, and calculated the trapezial space ratio by dividing the trapezial space height by the proximal phalangeal length. The clinical outcomes were evaluated using the visual analog scale and disabilities of the arm, shoulder, and hand scores, along with evaluation of the improvement in both postoperative range of motion and strength recovery. RESULTS: The mean duration of follow-up was 26 months (range, 18-60 months). The average visual analog scale and disabilities of the arm, shoulder, and hand scores decreased from 5.9 to 0.4 and from 51.6 to 27.0, respectively. The range of motion during palmar abduction and opposition of the metacarpophalangeal joint improved with an increase in mean value from 49.1 degrees to 54.1 degrees, and from 7.8 to 9.3 Kapandji score, respectively. The grip and key pinch strengths showed no significant changes from mean preoperative values of 13.3 kg and 3.8 kg to 13.2 kg and 3.2 kg, respectively, as measured at the 18-month follow-up. CONCLUSIONS: Our suture suspensionplasty technique has several advantages including minimal invasive approach, short operative time, cost-effectiveness, and early mobilization. We suggest that it can be used as an effective, alternative stabilization method after a complete trapeziectomy.

Does occupational therapy delay or reduce the proportion of patients that receives thumb carpometacarpal joint surgery? A multicentre randomised controlled trial.

Objectives: To evaluate whether occupational therapy, provided in the period between referral and surgical consultation, might delay or reduce the need of surgery in thumb carpometacarpal joint (CMCJ) osteoarthritis and to explore predictors for CMCJ surgery. Methods: This multicentre randomised controlled trial included patients referred for surgical consultation due to CMCJ osteoarthritis. An occupational therapy group received hand osteoarthritis education, assistive devices, CMCJ orthoses and exercises. A control group received only hand osteoarthritis information. Primary outcome was the proportion of patients that had received CMCJ surgery after 2 years. We examined the primary outcome and predictors for surgery with regression models, and time to surgery with the log-rank test and cox regression analyses. Results: Of 221 patients screened for eligibility, 180 were randomised. Information on the primary outcome was collected from medical records for all included patients. Surgery was performed on 22 patients (24%) that had received occupational therapy and 29 (32%) control patients (OR 0.56, 95% CI 0.26 to 1.21; p=0.14). Median time to surgery was 350 days (IQR 210-540) in the occupational therapy group and 296 days (IQR 188-428) in the control group (p=0.13). Previous non-pharmacological treatment (OR 2.72, 95% CI 1.14 to 6.50) and higher motivation for surgery (OR 1.25, 95% CI 1.09 to 1.43) were significant predictors for CMCJ surgery. Conclusions: Occupational therapy showed a small non-significant tendency to delay and reduce the need for surgery in CMCJ osteoarthritis. Previous non-pharmacological treatment and higher motivation for surgery were significant predictors for surgery.

Functional and radiological outcomes of multiple dorsal carpometacarpal fracture dislocations treated with open reduction and internal fixation.

OBJECTIVES: This study aims to evaluate the clinical and radiological results of patients with multiple dorsal carpometacarpal (CMC) joint fracture dislocations treated with open reduction and internal fixation (ORIF). PATIENTS AND METHODS: We evaluated 14 patients (12 males, 2 females; mean age 35.1 years; range, 22 to 64 years) between January 2013 and December 2017. Our main outcome measurements were the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, loss of grip strength, limitation of range of motion (ROM), and Kellgren-Lawrence osteoarthritis classification identified with radiographs and computed tomography images. RESULTS: The mean QuickDASH scores at seventh week and third month were 73.57 (range, 65-90) and 29.11 (range, 25-42.5), respectively. The mean QuickDASH score at seventh, ninth, and 12th month, and final follow-up was 4.64 (range, 0-30) and the QuickDASH score at these follow-up points was not 0 for only three patients. The mean loss of grip strength was 32.14% and two patients (14.29%) had limitation of ROM in third proximal interphalangeal joint at final follow-up. Four patients had grade I, nine patients had grade II, and one patient had grade III osteoarthritis according to Kellgren-Lawrence classification at final follow-up. CONCLUSION: Although functional results demonstrated that multiple CMC joint fracture dislocations can be treated with ORIF, the high rate of osteoarthritis is a disadvantage.