The Mitek bone anchor: application to the hand, wrist and elbow.

Mitek (Norwood, MA) bone anchors were used to attach soft tissue to the bones of the hand, wrist, and elbow in 66 procedures (166 anchors). The technical difficulties, initial fixation, long-term stability, and postoperative complications were retrospectively reviewed. The technique was easy to learn and to use. Intraoperatively, secure fixation of soft tissue to bone was accomplished in every case, and follow-up x-ray films showed that 65 of the implants remained securely anchored in bone. The far cortex was penetrated six times, resulting in two complications. The Mitek bone anchor is an excellent technique for achieving soft-tissue fixation in the hand and upper extremity, but penetration of the far cortex should be avoided.

Ulnar subluxation of the extensor digitorum communis tendon: a case report and review of the literature.

Ulnar subluxation of the extensor digitorum communis tendon at the MCP joint occurs infrequently in the nonrheumatoid patient and is secondary to one of four reported etiologies: traumatic, spontaneous, congenital, or epileptic. If symptomatic, patients may present with pain, swelling, a sensation of the tendon "snapping", "catching", "locking", or the inability to fully extend the MCP joint. Conservative and operative interventions have been recommended as treatment options. In the acute traumatic dislocation (less than ten days post injury), satisfactory results may be obtained with simple splinting with the MCP joint in extension. Patients who have failed conservative management or have a more chronic or degenerative dislocation may require surgical correction. The successful surgical repair must meet two requirements: (1) the tendon must be accurately aligned over the MCP joint to diminish the forces causing the dislocation to occur, and (2) the repair must be able to withstand the ulnar forces incurred during flexion of the joint. Realignment of the extensor tendon and direct repair of the radial sagittal band may be sufficient in acute traumatic, congenital, or spontaneous cases if the tissue is sufficient. In chronic dislocations or in cases with atrophic or degenerative tissue, reconstruction with augmentation of the radial restraints to the extensor hood is advised.

Groin and hip pain due to fractures at or near the pubic symphysis.

Three patients with fractures at or near the pubic symphysis presented with groin pain simulating hip fracture or arthritis. A 71-year-old osteoarthritic woman was treated with a nonsteroidal antiinflammatory drug (NSAID) and exercises for right-sided sciatic pain after a minor fall, but developed left groin pain and tenderness over the pubic symphysis after two days of exercise. She had an impacted fracture of the left pubic symphysis which responded to use of a cane. The second patient was a 90-year-old woman with rheumatoid arthritis (on steroids) who complained of right hip pain after a series of falls in her home. Initially treated with Buck traction for a presumed hip fracture, she was later treated with heat and exercises after negative hip x-rays were obtained. Retrospective analysis of pelvic films and bone scan revealed a right pubic symphysis fracture. The third patient was an 83-year-old rheumatoid arthritic woman with inability to walk secondary to left groin pain. Pubic tomograms revealed disruption of the superior aspect, and bone scan showed increased uptake of the left pubic bone. She was treated with moist heat, rest, and NSAID. Twenty-four cases of os pubis fractures without major trauma or symphysis disruption have been reported. All patients had osteoporosis, and six had rheumatoid arthritis. Our three cases are presented to increase awareness of pubic symphysis fractures as a cause for groin pain, especially in patients with osteoporosis and rheumatoid arthritis.