Thumb basal joint arthritis in 2023.

Thumb carpometacarpal or basal joint arthritis is the second most common location for osteoarthritis in the hand. It mainly affects women over 50years of age. Basal joint arthritis causes pain, loss of strength during pinch grips, and eventually stiffness and progressive deformity of the thumb column. Conservative treatment must be implemented first. It aims to spare the joint by using standardized methods. It must be initiated as soon as pain starts, not once the deformity has settled in. There is broad agreement that surgery is indicated when pain relief is not achieved after at least 6months of conservative treatment. The available surgical techniques can be classified as joint-sparing (extra-articular) and joint-sacrificing (intra-articular). The former consists of trapeziometacarpal stabilizing ligament reconstruction, subtraction osteotomy of the first metacarpal and thumb carpometacarpal denervation. The latter consists of trapeziometacarpal fusion, trapeziectomy (and its variants) and implant arthroplasty. Except in very specific cases, trapeziectomy and trapeziometacarpal implant arthroplasty with a total joint prosthesis or an interposition implant are the two main surgical techniques for treating basal joint arthritis. After reviewing the pathophysiology and the diagnosis of thumb basal joint arthritis, we will provide an overview of the available treatment options, with emphasis on the accepted surgical strategies in 2023. LEVEL OF EVIDENCE: III.

A Cadaveric Study Examining the Accuracy of Wireless Hand-Held Guided Ultrasound Injections Versus Blind Injections in the Flexor Tendon Sheath.

Purpose: Hand-held ultrasound (HHUS) is gaining popularity among clinicians. Although its use for procedural guidance could have several advantages in hand surgery, other surgeons may wonder about its added benefits. This cadaveric study aimed to examine the hypothesis of increased accuracy of wireless HHUS-guided injections versus that of blind injections into the flexor sheath. Methods: Our series included 20 fresh cadaveric hands with 80 fingers randomly assigned to 2 groups. In group A, 10 hands were randomly assigned to receive a landmark injection and then received a blinded injection to the flexor tendon sheath (FTS). In group B, 10 hands were blinded in the same manner and received an ultrasound-guided injection with HHUS. Methylene blue was injected, and anatomic dissection was performed to evaluate the injection accuracy based on the dye's filling pattern in the FTS as stage I (no filling), stage II (<50% filling), and stage III (>50% filling). Statistical analysis was performed, and P <.05 indicated a significant difference. Results: One finger was excluded because of severe Dupuytren contracture. In group A, 39 blind injections of the FTS were performed, with 82% (32/39) fingers achieving stage III filling. In group B, 40 ultrasound-guided FTS injections were performed, with 90% (36/40) of fingers achieving stage III filing. Our study did not reveal any superiority in accuracy when ultrasound guidance was used (P = .35). Conclusions: Hand-held ultrasound-guided FTS injections were not more accurate than blind injections performed by an experienced hand surgeon. These findings suggest that blind injections can be used as routine practice when performed by experienced operators to treat trigger finger. However, the use of HHUS may offer other advantages in hand surgery practice. Clinical relevance: Ultimately, choosing to perform HHUS-guided injection versus blind injection to treat trigger finger depends on the surgeon's experience and preference for a particular technique.

Accuracy of Wireless Hand-Held Guided Ultrasound Injections in the Trapeziometacarpal Joint: A Cadaveric Study.

Background Symptomatic trapeziometacarpal osteoarthrosis can be treated with an ultrasound-guided injection in the early stages. This cadaveric study aimed to assess the hypothesis suggesting enhanced accuracy and reliability of hand-held ultrasound (HHUS) injections compared to blind injections into the trapeziometacarpal joint (TMC). Materials and method Our series included 20 fresh cadaveric hands, with a total of 20 TMC randomly assigned to two groups. In group A, 10 TMC received a blinded injection, and in group B, 10 TMC received an ultrasound-guided injection with HHUS. Methylene blue was injected, and anatomical dissection was performed to assess the intra-articular location of the dye. The injection was considered accurate if the intra-articular synovial fluid was stained after opening the articular capsule on the dorsal approach. If there was no injection, it was inaccurate. A statistical analysis was performed, and p <.05 indicated a significant difference. Results Two thumbs were excluded during the study due to an existing trapeziectomy. In group A, 10 blind injections of TMC were performed, with 70% (7/10) of injections graded as accurate. In group B, eight ultrasound-guided injections were performed, with 75% (6/8) achieving accuracy. A Fisher's exact test was performed, and the results indicated no statistically significant difference in injection accuracy between the two groups (P = 1, odds ratio = 0.788). Conclusion Hand-held ultrasound guided TMC injections were not more accurate than blind injections performed by an experienced hand surgeon. Nonetheless, additional studies with a larger sample and comparative studies with conventional cart-based machines are necessary to evaluate the potential of this newly accessible device.

Preliminary stage in the development of an artificial intelligence algorithm: Variations between 100 surgeons in phase annotation in a video of internal fixation of distal radius fracture.

INTRODUCTION: In order to be used naturally and widely, an artificial intelligence algorithm of phase detection in surgical videos presupposes an expert consensus defining phases. OBJECTIVES: The aim of the present study was to seek consensus in defining the various phases of a surgical technique in wrist traumatology. METHODS: Three thousand two hundred and twenty-nine surgeons were sent a video showing anterior plate fixation of the distal radius and a questionnaire on the number of phases they distinguished and the visual cues signaling the beginning of each phase. Three experimenters predefined the number of phases (5: installation, approach, fixation, verification, closure) and sub-phases (3a: introduction of plate; 3b: positioning distal screws; 3c: positioning proximal screws) and the cues signaling the beginning of each. The numbers of the responses per item were collected. RESULTS: Only 216 (6.7%) surgeons opened the questionnaire, and 100 answered all questions (3.1%). Most respondents claimed 5/5 expertise. Number of phases identified ranged between 3 and 10. More than two-thirds of respondents identified the same phase cue as defined by the 3 experimenters in most cases, except for "verification" and "positioning proximal screws". DISCUSSION: Surgical procedures comprise a succession of phases, the beginning or end of which can be defined by a precise visual cue on video, either beginning with the appearance of the cue or the disappearance of the cue defining the preceding phase. CONCLUSION: These cues need to be defined very precisely before attempting manual annotation of surgical videos in order to develop an artificial intelligence algorithm. LEVEL OF EVIDENCE: II.

Radiologic, clinical, and functional evaluation of children with lateral humeral condyle fractures using the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire.

This study investigated the clinical and radiologic outcomes of lateral humeral condyle (LHC) fractures in children and evaluated the functional outcome of these injuries according to the type of treatment using the Quick DASH questionnaire. Data on consecutive children admitted to the Emergency Department for LHC fracture (01/11-12/18) were collected from their charts. Anterior-posterior and lateral radiographs of the injured elbow were used to classify each fracture according to Jakob's classification, and to detect any other concomitant bone lesions. Data on pain, stiffness, impact on daily activities, skin lesions, surgical-site infection, and range of motion were retrieved. The Quick DASH questionnaire was used to evaluate functional outcome. Forty-eight children with a mean age at trauma of 6.06 ± 2.22 years (32 males; mean follow-up: 75 ± 25 months) were reviewed. The overall Quick DASH score was 4 (0-15.9); it was 2.69 ± 0.31 in Jakob-1 ( n = 12; 25%), 3 ± 1.06 in Jakob-2 ( n = 19; 39.6%), and 3.06 ± 1.56 in Jakob-3 fractures ( n = 17; 35.4%). Functional outcomes were similar irrespective of the severity of displacement, type of treatment, length of postoperative immobilization, and presence of associated fracture ( P > 0.05). Quick DASH scores in children less than 8 years (2.77 ± 0.44) and in those more than 8 years (3.47 ± 2.13) were similar ( P > 0.05). Five out of 48 patients developed one complication (10.5%). Good functional and radiologic outcomes can be expected in children with LHC fractures irrespective of the amount of initial displacement, type of treatment, length of postoperative immobilization, and age at surgery. Families should be warned about potential complications although these are most often minor. Level of evidence: III.

Malignant transformation of a phalangeal enchondroma into a recurrent grade II chondrosarcoma requiring successive transcarpal amputations: a case report.

We report a case of malignant transformation of a phalangeal enchondroma into a grade II chondrosarcoma requiring two successive transcarpal amputations owing to recurrence. Soft tissue defects were repaired using single-stage reconstruction with a posterior interosseous artery flap. The 2-year follow-up assessment was satisfactory and no recurrence was observed.

Bipedicle strap flaps for reconstruction of longitudinal dorsal finger defects: a review of 42 cases.

We report our experience with 42 bipedicle strap flaps in 42 fingers of 37 patients for the reconstruction of long longitudinal dorsal finger defects. Twelve cases were compound lesions with tendon lacerations. All flaps healed without infection, congestion or necrosis. At follow-up, mean total active interphalangeal joint mobility was 150° and 108° in patients without and with tendon lacerations, respectively. The median scores of the short version of the Disability of Arm, Shoulder and Hand questionnaire were 5 and 7, respectively. Patients were able to return to work or to their daily activities after a mean of 6 weeks. The patients were satisfied with the appearance in 34 of the 42 flaps. We conclude that the flap is a useful option for reconstructing dorsal digital lesions. It has a texture similar to the normal dorsal digital skin, and it is easy to perform without needing microsurgery.Level of evidence: IV.

Isoelastic resurfacing prosthesis for distal radius fractures: Outcomes in 24 cases with at least 2 years' follow-up.

BACKGROUND: Unicompartmental resurfacing prostheses have been reported to be useful for treating comminuted fractures involving the distal radial joint surface in elderly patients with osteoporosis. However, the data on this method remain scarce and further evaluations are needed. The objective of this study was to evaluate the clinical and radiological outcomes after unicompartmental resurfacing prosthesis implantation in patients with distal radius fractures and at least 2 years' follow-up. HYPOTHESIS: Outcomes with Prosthelast® are as good in the mid-term as in the short term. MATERIALS AND METHODS: We studied 24 patients with type C fractures in the AO classification. The Prosthelast® prosthesis was implanted in each. Mean age was 78 years (60 to 91). There were 22 females. Three of the fractures were open. The patients were evaluated clinically using a visual analogue scale (VAS) for pain, ranges of motion at the wrist, and grip strength. In addition, functional scores were determined, and radiographs obtained. RESULTS: Mean follow-up was 55.2 months (24-97). Mean tourniquet time was 61.9minutes (37-126). Mean motion ranges were 39° in flexion, 49° in extension, 74° in pronation, and 68° in supination. The mean VAS pain score was 2.1 (0-7). The mean Quick DASH was 39.8 (9.09-77), the mean PRWE was 42.7 (5-95), and mean grip strength was 38 (25-150). Painful motion limitation of the elbow was noted in a patient treated with total elbow prosthesis. Complex regional pain syndrome developed in 6 patients, and 5 patients required revision surgery. Asymptomatic perforation of the radial head occurred in 8 patients. No cases of peri-prosthetic osteolysis or osteoarthritis were noted. The prosthesis impinged on the lunate bone in 2 patients and on the scaphoid bone in one patient. Mean ulnar variance was +0.17mm (-1 to 7.5). Bone remodelling about the prosthesis was noted in all the patients, but 2. DISCUSSION: Our data obtained after a mean follow-up of 55 months indicate that resurfacing prostheses have a role to play in the treatment of comminuted articular fractures in patients with osteoporosis. A long-term study is needed to further evaluate these results. LEVEL OF EVIDENCE: IV; therapeutic.

Use of allograft to reconstruct anterior bony glenoid defect in chronic glenohumeral instability: a systematic review.

INTRODUCTION: Bone-block procedures are well-established in anterior chronic shoulder instability treatment. Autograft with the coracoid process (Bristow-Latarjet procedures) and iliac crest (Eden-Hybbinette) are the most frequent source of bone but the use of allograft is also possible. The objective of this review is to assess clinical and radiographic outcomes after bony allograft reconstruction in anterior glenohumeral instability. MATERIAL AND METHODS: Medline, Cochrane, Embase databases were searched for studies reporting on bone allograft reconstruction in anterior glenohumeral instability with glenoid defect. We conducted a systematic review of studies with all levels of evidence reporting on clinical or radiological outcomes or both. LEVEL OF EVIDENCE: IV. RESULTS: Ten studies met the inclusion criteria for the review; 283 shoulders were included with a mean age of 26 years (17-63) and mean follow-up of 34 months (4-168). Glenoid reconstruction was performed using bone from different source: femoral head (1 study), distal tibia allograft (5 studies), and iliac crest (4 studies). Allografts were fresh in 4 studies, demineralized in 2 studies, and freeze-dried after sterilization in 1 study. All scores performed in the different studies increased between pre-operative and post-operative evaluations (mean + 36.8 points for the ASES). Global rate of recurrence was 3.9% (11 patients) (0-11%), comprising 6 cases of dislocation (2.1%) and 5 subluxations (1.8%). Allograft healing occurred in 93.5% of cases. CONCLUSIONS: This systematic review data suggest that allograft reconstructions in anterior glenohumeral instability could be a viable alternative to similar reconstructions with autografts and provide close clinical/radiological outcomes, at short and mid-term follow-up. Prospective randomized studies are needed to confirm these results.

The Moovis® implant for trapeziometacarpal osteoarthritis: results after 2 to 6 years.

In this retrospective study we reviewed the outcomes of 46 trapeziometacarpal joint replacements with the Moovis® prosthesis in 46 patients with painful osteoarthritis. The dual mobility design of this prosthesis aims to reduce prosthetic dislocation and subsidence. At follow-up 2 to 6 years (mean 5 years) after operation, pain was reduced from 6 to 0 on a visual analogue scale from 0 to 10. The scores of the Quick Disabilities of the Arm, Shoulder and Hand questionnaire improved significantly. Thumb motion and grip and pinch strength did not differ significantly from the contralateral hand. There were no radiographical signs of implant subsidence or loosening. No implant required revision. Forty-five patients rated the result as excellent or good. We conclude the Moovis® is a reliable and effective implant at short- to mid-term follow-up. Level of evidence: IV.

The Eden-Hybbinette procedure is one hundred years old! A historical view of the concept and its evolutions.

INTRODUCTION: One hundred years ago, before Bankart, Latarjet or Bristow, Eden and Hybbinette developed a procedure to treat anterior shoulder instability and currently, this eponymous term is known by every shoulder surgeon. The purpose of this review is to summarise the historical "Eden-Hybbinette" procedure and its evolutions during the last century and discuss results. METHOD: On the centenary of the first publication on the "Eden-Hybbinette procedure", a search was conducted on Medline, Google Scholar and in the grey literature, to find its initial concept and description, and the evolutions. RESULTS: The initial procedure was based on the concepts of glenoid bony augmentation (anatomic reconstruction with an autograft from the tibia) and capsulorrhaphy. The main evolutionary themes identified were the origin of the graft (autograft with iliac crest, allograft), graft positioning and fixation (no fixation device, screws), and the surgical approach (split of the subscapularis tendon in open surgery, arthroscopy). Studies with long-term follow-up exhibited good results, considered similar as those with other classic bone-block procedures. Development of osteoarthritis during the following years after the procedure is not usual and not related to the graft unless if there is articular protrusion. CONCLUSION: The Eden-Hybbinette procedure is one of the oldest surgical interventions still commonly used for chronic anterior shoulder instability. The changes to the procedure over the last 100 years allow it to remain a contemporary solution for both primary surgery and revision cases.

Functional outcome of displaced radial head fractures in children treated by elastic stable intramedullary nailing.

The objectives of this study were to retrospectively investigate the clinical and radiological outcomes of displaced radial head fractures in children treated by elastic stable intramedullary nailing (ESIN) and evaluate the functional outcome of these injuries using the short version of the Disabilities of the Arm, Shoulder and Hand outcome questionnaire (Quick DASH). A total of 24 patients (nine males and 15 females) fulfilled the inclusion criteria. The mean age at the time of injury was 10.7±2.8 years (range: 9.5-16.33 years). Before surgery, the mean angulation was 53.8°±18.4° (range: 28°-82°) differentiating fractures on the basis of Judet's classification. The mean Quick DASH score was a good 4 (range: 0-15.9). Functional outcomes were similar irrespective of the severity of fracture displacement (P>0.05), presence or absence of associated fracture (P>0.05), and time immobilized (P>0.05). The Quick DASH score was better in children younger than 9 years of age (1.62) than children older than 9 years of age (4.95), but without a statistically significant difference (P=0.058). Children with displaced radial head fractures treated with ESIN showed good functional outcomes. Associated fracture injuries were not a predictive factor of functional outcome. Open reduction must be avoided as it carries an increased risk of complications.