What's new in hand surgery

Complications with the use of Artelon in thumb CMC joint arthritis

BACKGROUND

Complications with the use of the Artelon spacer in thumb carpometacarpal (CMC) joint arthritis include inflammation, osteolysis, and persistent pain. We evaluated our short-term results and complications.

METHODS

A retrospective review of 29 patients was performed. Pre- and postoperative radiographs, operative techniques, complications, and subsequent surgeries were analyzed. Pearson's and chi-squared testing was used to identify associations between complications and surgical technique or preoperative radiographic criteria. The average age was age 51 ± 7.7 (34-66), average follow-up was 8 months (1-26).

RESULTS

Twelve patients sustained complications. Nine patients displayed postoperative osteolysis. Four patients underwent conversion to CMC suspensionplasty due to persistent pain. The rate of revision surgery and radiographic postoperative osteolysis were not significantly associated with preoperative arthritis grade, metacarpal subluxation, or surgical techniques: fixation method, the bony surface(s) involved in the osteotomy, or spacer modifications.

CONCLUSIONS

Our study found a significant short-term complication rate following Artelon spacer arthroplasty of the CMC joint. This is higher than previously described. We could not identify any factors that were significantly associated with the complications. It is possible that the inherent instability of the joint or the material of the spacer is involved in implant failure. Further study is necessary to better define the indications for use and specific techniques for the use of the implant.

No Higher Risk of CRPS After External Fixation of Distal Radial Fractures - Subgroup Analysis Under Randomised Vitamin C Prophylaxis

Operative and conservative treatment of wrist fractures might lead to complex regional pain syndrome (CRPS) type I.In our multicenter dose response study in which patients with distal radial fractures were randomly allocated to placebo or vitamin C in a daily dose of 200mg, 500mg or 1500mg during 50 days, an operated subgroup was analyzed.48 (of 427) fractures) were operated (11.2%). Twenty-nine patients (60%) were treated with external fixation, 14 patients (29%) with K-wiring according to Kapandji and five patients (10%) with internal plate fixation. The 379 remaining patients were treated with a plaster.In the operated group of patients who received vitamin C no CRPS (0/37) was seen in comparison with one case of CRPS (Kapandji technique) in the operated group who received placebo (1/11 = 9%, p=.23). There was no CRPS after external fixation.In the conservatively treated group 17 cases of CRPS (17/379 = 4.5%) occurred in comparison with one in case of CRPS in the operated group (1/48 = 2.1%, p=.71).External fixation doesn't necessarily lead to a higher incidence of CRPS in distal radial fractures. Vitamin C may also play a role in this. This subgroup analysis in operated distal radial fractures showed no CRPS occurrence with vitamin C prophylaxis.

Finding evidence: evidence-based practice

Best practice treatment decisions require the integration of external information, internal information, and patient factors. This article provides a tested methodology for formulating a structured question from a clinical dilemma and then transforming that question into a query appropriate for searching online evidence-based resources. Listed are some of the preeminent online databases for searching for evidence pertinent to clinicians specializing in hand surgery. Also discussed are various online methods for continuously delivering pertinent evidence to the clinician as it becomes available. The conclusion is a practical example of a literature search as it applies to a problem commonly encountered in surgical care of the upper extremity.