Complications of standard versus long cephalomedullary nails in the treatment of unstable extracapsular proximal femoral fractures: A randomized controlled trial.

AIMS: To compare in a prospective randomized trial the mechanical complications in patients with unstable extracapsular proximal femur fractures without subtrochanteric extension (AO/OTA 31-A2 and 31-A3) METHODS: We prospectively studied 182 patients with unstable extracapsular proximal femur fractures without fractures lines extending more than 3 cm below the lesser trochanter, randomized to receive either a 'standard' (240 mm) nail or a long nail and followed them up for 1 year. RESULTS: We found no difference in the incidence of mechanical or general complications between the two groups, no cut-outs, no fractures of the tip the implant, 1 cut-through and 2 malrotations in the LN group, 2 non-unions that were reoperated, one on each group. The commonest complication was blade lateral migration, 13 (14%) patients in SN and 6 (9%) in the LN. The operating time was shorter in the SN group 51 minutes compared to 67 minutes in the LN group (p=0.000075). The mortality at 1,3 and 12 months in the SN group was of 2%, 6%, 12% while in the LN group was 12%, 18% and 22%. These differences where significative at 1 (p=0.007) and 3 months (p=0.013), but not at 12 months (p=0.075). CONCLUSIONS: We recommend the use of standard nails (240 mm) for this group of fractures, since it does not produce more mechanical complications, and it is faster, cheaper and easier to interlock distally.

3D printing innovation: New insights into upper extremity surgery planning.

INTRODUCTION: Surgical planning relies on the use of images to develop an action plan prior to the actual surgical intervention. Imaging technology improvement together with the development of specific software to treat three dimensional images has increased the accuracy and capabilities of pre-surgical planning. In addition to this, 3D printing allows us to manufacture customized surgical tools to implement and aid in the success of surgeries. MATERIAL AND METHODS: 3D virtual planning together with 3D printing has been implemented through different approaches in 8 different upper extremity trauma cases. We describe these 8 cases (2 women and 6 men with ages ranging from 16 to 67 years), their specific challenges and management. RESULTS: We show how 3D technology changes the conception, planning and execution of surgery in 8 different cases. In addition, we describe what challenges were faced as well as the various utilities of 3D technology beyond that of anatomical model printing. CONCLUSIONS: The use of 3D technology has improved and enhanced surgical planning. It allows us to view and virtually manipulate fracture fragments prior to surgery. It also enables us to develop customized surgical tools and guides that can increase the accuracy of certain procedures, and help in the management of orthopaedic and trauma lesions. We believe that the use of this technology is beneficial to both the patient and surgeon, since it reduces surgical time and complications giving a better understanding of the injury and its treatment.

Partial Versus Total Trapeziectomy With Interposition Arthroplasty for Trapeziometacarpal Osteoarthritis Grade II to III Eaton-Littler: A Clinical Trial.

Purpose: Total trapeziectomy is the most widely used technique to treat isolated thumb trapeziometacarpal joint osteoarthritis. However, this technique has been associated with proximal migration of the thumb metacarpal, which has led some physicians to consider partial trapeziectomy as a valid alternative. The purpose of this study was to assess whether partial trapeziectomy improves final key pinch strength compared with total trapeziectomy. Methods: We randomized 34 patients with basal thumb osteoarthritis into 2 groups to undergo partial or total trapeziectomy with interposition arthroplasty. Key pinch strength at 12 months was the primary outcome measure. Other variables measured included trapezial space height, range of motion, grip strength, change in key pinch strength, patient-reported outcome measures, and pain. Results: No difference between groups was detected regarding final pinch strength, trapezial space height, grip strength, range of motion, change in pinch strength, patient-reported outcomes (Quick-Disabilities of the Arm, Shoulder, or Hand), or pain. Conclusions: We cannot conclude that partial trapeziectomy provides an advantage over total trapeziectomy at 1 year after surgery. Although trapeziometacarpal space was substantially preserved in the partial trapeziectomy group at 12 months, this difference was not statistically or clinically significant. Type of study/level of evidence: Diagnostic III.

Long-Term Evaluation Following Partial Trapeziectomy and Suspension Arthroplasty for Trapeziometacarpal Osteoarthritis: An Observational Study.

Purpose: Partial trapeziectomy is performed to decrease the risk for first ray collapse. However, the incidence of scaphotrapezoidal (ST) joint osteoarthritis (OA) in the presence of advanced trapeziometacarpal joint OA is around 40%. The purposes of this study were to analyze the progression of the ST joint after partial trapeziectomy and to establish the potential link between radiographic findings and patient outcomes. Methods: We reviewed a series of 22 patients (26 thumbs) with base of the thumb OA who underwent partial trapeziectomy and interposition arthroplasty. Standardized radiographs of the ST joint were classified by 2 independent observers. Measured outcomes were pain, mobility (degrees of abduction, Kapandji score, and anteversion [in centimeters]), force (in kilograms]) and the short version of the Disabilities of the Arm, Shoulder, and Hand questionnaire score. Results: Median follow-up was 8 years. The modified Eaton-Glickel scale was used to rate the degree of ST joint arthritis: 2 thumbs were classified as grade 1, 11 as grade 2, 12 as grade 3, and 1 as grade 4. No parameters analyzed demonstrated a statistically significant correlation between patients' outcomes and joint radiographic arthritis. Conclusions: Our study cannot demonstrate that the radiographic presence of ST arthritis correlates with the patient's main symptoms after partial trapeziectomy. Type of study/level of evidence: Therapeutic IV.