Palmar plate capsulodesis for thumb metacarpophalangeal joint hyperextension in association with trapeziometacarpal osteoarthritis.

Hyperextension of the thumb metacarpophalangeal (MCP) joint is frequently seen with trapeziometacarpal osteoarthritis, but there is no consensus on the indication for, or type of, treatment. We re-examined 12 thumbs at a mean of 9 (range 6-13) years following MCP capsulodesis using a suture anchor performed with trapeziectomy. Mean MCP hyperextension improved from 45° pre-operatively to 19° at 1 year post-operatively. At 9 years follow-up, it had increased to 30° but was still significantly better than pre-operatively (p = 0.007). Mean MCP flexion was 37° and near normal opposition was retained. The median pain score had improved from 5.5 to 1 (p = 0.002). Thumb key and tip pinch and hand grip strength showed no significant change from pre-operative values. No thumb MCP had symptomatic radiological degeneration. Our results suggest that MCP capsulodesis preserves a useful range of MCP flexion but stretches out over time. However, this did not result in increased pain or thumb weakness.

The conservative management of primary pyomyositis abscess in children: case series and review of the literature.

Pyomyositis is a primary pyogenic infection in skeletal muscle, often progressing to abscess formation. It is rare in temperate climates and generally deep-seated within the pelvis with non-specific clinical features, making diagnosis difficult. Magnetic resonance imaging (MRI) is highly sensitive for muscle inflammation and fluid collection, and with its increasing availability is now the investigation of choice. Treatment of pyomyositis abscess has traditionally been with incision and drainage or guided aspiration followed by a prolonged course of antibiotics, although there are sporadic reports of cases treated successfully with antibiotics alone. Our aim was to describe our own experience with the treatment of pyomyositis abscess in children. From our 20-year database of over 16,000 paediatric orthopaedic admissions, we identified only three cases with MRI-confirmed pyomyositis abscess. These were all in boys (aged 2-12 years) and affected the gluteal, piriformis and adductor muscles. Despite the organisms not being identified, each patient was treated successfully with a short (4-7 days) course of intravenous antibiotics followed by 2-6 weeks of oral therapy. There were no recurrences or complications and all made a full recovery. In conclusion, we propose that uncomplicated pyomyositis abscess in children may usually be managed conservatively without the need for open or percutaneous drainage.