Partial Trapezoid Excision in Thumb CMC Arthroplasty for STT Arthritis: A Cadaveric Study.

PURPOSE: Thumb carpometacarpal (CMC) joint arthroplasty is one of the most commonly performed surgeries by hand surgeons. A large portion of these patients also have scaphotrapezoidal (ST) arthritis in addition to CMC arthritis. The purposes of this study were to quantify the amount of transverse trapezoid resection necessary to prevent ST impingement and to compare an oblique with a transverse osteotomy of the trapezoid. METHODS: A total of 9 cadaveric specimens were used and were randomly placed into 2 groups. Group 1 had sequential transverse osteotomies and the space between the scaphoid and trapezoid was measured in various wrist positions. Group 2 had oblique osteotomies and the ST distance was measured in multiple wrist positions. RESULTS: In group 1, there was no contact between the scaphoid and trapezoid in neutral wrist position after any resection. The half and two-thirds transverse osteotomies did not have contact at 20° radial deviation (RD) and 30° wrist flexion (WF). In 1 of the 5 specimens, there was contact at one-third resection in either isolated RD or WF. In 3 specimens, there was contact at one-third resection with 20° of radial deviation combined with 30° WF. In group 2, there was no contact in any specimen in any wrist position tested. At neutral, there was 3.7 mm of space between the scaphoid and trapezoid measured at the radial side. In 20° RD and 0° WF, an average space remaining was 2.8 mm. In 0° RD and 30° WF, there was an average space of 2.3 mm remaining. At 20° RD and 30° WF, there was an average space remaining of 1.8 mm. At the extreme of RD and WF, there was an average space remaining of 1.4 mm. CONCLUSIONS: An oblique osteotomy of the trapezoid did not have any ST contact in 20° RD and 30° WF. The transverse osteotomies had contact with only one-third resection. Therefore, if a transverse osteotomy of the trapezoid is performed, more than one-third of the bone should be resected to minimize the risk for bony impingement in positions of WF, RD, or both. CLINICAL RELEVANCE: In ST arthritis, an oblique osteotomy of the trapezoid may prevent impingement while allowing for less overall bony resection compared with a transverse osteotomy.

A review of mallet finger and jersey finger injuries in the athlete.

PURPOSE OF REVIEW: The purposes of this review are to discuss the diagnosis and management of mallet and jersey finger injuries in athletes and to highlight how treatment impacts return to play. RECENT FINDINGS: Mallet finger: although numerous non-operative and operative techniques have been described, there continues to be little consensus regarding the optimal procedure. Jersey finger: ultrasound appears to be a cost-effective imaging modality that may be useful for preoperative planning. Wide-awake surgery offers optimal intraoperative assessment of the tendon repair. Tendon repair with volar plate augmentation has been shown to improve the strength of the repair in the laboratory, and early clinical results are encouraging. Most mallet finger injuries will heal with non-operative treatment over a period of 8-12 weeks, even when treatment is delayed up to 3-4 months. An acute diagnosis of jersey finger requires surgical treatment and generally means 8-12 weeks of inability to compete in most contact sports.

Hand Surgeon Reporting of Tendon Rupture Following Distal Radius Volar Plating.

Background: Volar plate fixation with locked screws has become the preferred treatment of displaced distal radius fractures that cannot be managed nonoperatively. This treatment, however, is not without complication. The purpose of this study was to determine what percentage of hand surgeons, over a 12-month period, have experienced a tendon complication when using volar plates for the treatment of distal radius fractures. Methods: A total of 3022 hand surgeons were e-mailed a link to an online questionnaire regarding their observation and treatment of tendon injuries associated with volar plating of distal radius fractures. Responses were reported using descriptive statistics. Results: Of the 596 (20%) respondents, 199 (33%) surgeons reported encountering at least one flexor tendon injury after distal radius volar plating over the past year of practice. The flexor pollicis longus was the most commonly reported tendon injury (254, 75%). Palmaris longus grafting (118, 37%) and tendon transfer (114, 36%) were the most often reported treatments following this complication. A total of 216 respondents (36%) also encountered 324 cases of extensor tendon rupture after volar plating of distal radius fractures, with tendon transfer (88%) being the preferred treatment option. Conclusions: Both flexor and extensor tendon ruptures can be seen after volar plating of distal radius fractures. Surgeons should be aware of these complications. Critical assessment of hardware position at the time of index procedure is recommended to avoid complications. Long-term studies are needed to standardize approaches to managing tendon rupture following volar plating of distal radius fractures.