Complications in phalangeal and metacarpal fracture management. Results of extensor tenolysis.

Extensor tendon adherence and joint contracture after phalangeal and metacarpal fracture are common complications that affect finger motion and hand function. The results obtained by extensor tenolysis and dorsal capsulotomy are discussed in this article. Surgical outcome was evaluated as it related to extensor tenolysis and capsulotomy relative to the final total active motion, total passive motion, and active extensor lag. This information will be useful in discussing the expected results of surgery with the patient and in guiding postoperative rehabilitation.

Long-term evaluation of Silastic trapezial arthroplasty in patients with osteoarthritis.

This study of 151 Silastic trapezial arthroplasties evaluates the long-term radiographic and clinical results in patients with osteoarthritis. A radiographic grading system was developed to objectively evaluate and quantify changes seen at the implant-bone contact areas, within the metacarpal medullary canal and distal pole of the scaphoid. Trapezial arthroplasties studied on average of 51 months after implantation revealed that in 56% (85 of 151) of scaphoids cysts had developed, and 74% (111 of 151) of the metacarpals had intramedullary radiolucency and/or cysts. Histopathologic evaluation of the areas of radiographic changes demonstrated silicone synovitis. Statistical analysis revealed that the radiographic changes in the scaphoid and medullary canal of the metacarpal were not directly related to time. Patient satisfaction, found to be 84% (127 of 151) of the study population, did not correlate with the grade of scaphoid or metacarpal radiographic change. This systematic radiographic grading system has been found useful in the long-term durability evaluation of Silastic trapezial arthroplasties.

Primary malignant tumors of the upper extremity: retrospective analysis of one hundred twenty-six cases.

We retrospectively evaluated 126 patients with primary sarcomas of bone (45) and soft tissue (61) in the upper extremity principally to evaluate the effectiveness of the Musculoskeletal Tumor Society staging system in predicting treatment outcome and to note differences between bone and soft tissue sarcomas. Patients were followed 2 to 11 years from diagnosis. The mean survival from treatment onset was 49 months (4 to 144 months). A strong statistical relationship (p less than 0.05) between anatomic location (above/below elbow) and surgical stage (stage I/II, A/B) was demonstrated. The type of primary operation and subsequent incidence in local tumor recurrence were found to be statistically different. Seventy percent of soft tissue tumors that metastasized first recurred locally, but such a strong association was not evident for bone. Development of metastases significantly shortened survival. Radical primary excision of soft tissue malignancies sharply reduced local recurrence and thereby diminished metastatic risk; similar findings were not present for bone malignancies. This study suggests that the Musculoskeletal Tumor Society staging system is valid and should be applied to these infrequent malignancies, permitting future statistical comparisons.