Delayed, Atraumatic Index Metacarpal Fracture After Trapeziectomy and Suture-Button Suspensionplasty for Thumb Carpometacarpal Osteoarthritis: A Report of Three Cases.

Trapeziectomy with suture-button suspensionplasty is a surgical treatment option for thumb carpometacarpal osteoarthritis refractory to nonsurgical management. We describe the cases of 3 patients who presented with index metacarpal fracture, in the absence of traumatic injury, over 4 months after trapeziectomy with suture-button suspensionplasty. All 3 fractures demonstrated the same pattern: short oblique/spiral, oriented proximal radial to distal ulnar with the distal end in the vicinity of the index metacarpal button, presumably after the orientation of the metacarpal drill hole. Two of the fractures were treated with surgical fixation. Fracture healing was obtained in all cases. Two of the 3 patients remained symptomatic with thumb pain, but decided against revision treatment for the carpometacarpal osteoarthritis. The third underwent restabilization of the suture button at the time of fracture fixation. Although uncommon, index metacarpal fracture after trapeziectomy with suture-button suspensionplasty can present without trauma several months after surgery.

Safe Return to Driving After Volar Plating of Distal Radius Fractures.

PURPOSE: A major concern for patients following distal radius fracture fixation is when they can resume driving. This decision has medical, legal, and safety considerations, but there are no evidence-based guidelines to assist the surgeon. The goal of this study was to observe when patients are capable of safely resuming driving following surgical fixation of the distal radius. METHODS: Patients undergoing volar plating of a distal radius fracture were prospectively enrolled. At approximately 2 and 4 weeks after surgery, patients were administered a driving examination on a closed course and given a subjective questionnaire including visual analog scale scores. All basic functions of vehicle operation were evaluated. Successful completion indicated they would pass a driving evaluation. RESULTS: Twenty-three patients were enrolled. Sixteen (69.5%) passed their first attempt (average of 18.4 days from surgery), another 4 (17.4%) passed their second attempt (31.3 days from surgery), and 3 did not complete the second examination. Patients who failed relied too much on their nonsurgical hand, were not able to control the steering wheel with 2 hands, and reported pain and insecurity when using the operative hand. Of those who passed the second attempt, the first failure was universally attributed to pain. Fifteen patients reported a return to independent driving prior to the first examination (average, 11.3 days). Of the 7 who failed, 6 reported they could control the car in an emergency, and 2 reported they would not feel safe with daily driving. Maximum pain while driving on the visual analog scale was 2.4 of 10 among those who failed compared with 1.3 among those who passed. CONCLUSIONS: Most patients could safely return to driving within 3 weeks of surgery. Pain was the primary limiting factor affecting driving ability. Safe return to driving may be warranted within 3 weeks of distal radius volar plate fixation in some patients. Persistent pain is likely the most important obstacle to a safe return to driving. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.

Fingertip Amputation Treatment: A Survey Study.

Distal fingertip amputations are common injuries in work- and non-work-related accidents. There is a paucity of evidence to support use of any one treatment. We conducted a study to better understand how surgeon and patient factors influence the treatment preferences for distal fingertip amputations among a cross section of US and international hand surgeons. We sent a 16-question survey to the American Association for Hand Surgery and reciprocal international hand societies and analyzed the response data using a logistic regression model. We hypothesized that hand surgeons' treatment preferences would be varied and influenced by surgeon and patient demographics. One hundred ninety-eight hand surgeons (62% US, 38% international) responded to the survey. For each clinical scenario (Allen levels 2, 3, and 4 and volar oblique amputations), there were wide variations in treatment preferences. Wound care was less likely performed by surgeons with more than 30 years of experience or plastic surgery backgrounds. Replantation was less likely performed by US surgeons and private practice surgeons. Pedicle and homodigital flaps were more commonly performed internationally. Surgeons in practice for less than 5 years were more likely to perform skeletal shortening. For all levels and orientations of fingertip amputation queried, there is a wide range of treatment preferences. Our survey results highlight the need for a prospective randomized trial to elucidate the most effective treatments for fingertip amputations.