Functional survival of cementless trapeziometacarpal total joint arthroplasty after upper extremity trauma

INTRODUCTION

Our purpose with this publication is to document the survival of uncemented and unconstrained total trapeziometacarpal arthroplasty after energy trauma to the upper extremity.

MATERIAL AND METHODS

From 1999 to the present, ten patients carrying total TMC arthroplasty suffered major traumatic injuries on the hand. Eight patients had fractures of the distal radius, one patient had scapho-lunate dissociation and one patient had a dorsal pullout of the triquetrum. A clinical and radiological examination of the patients after the trauma was carried out and compared with the pre-traumatic prosthesis status.

RESULTS

Three patients required surgical intervention for the associated traumatic injury. The postraumatic clinical and functional follow-up of the patients was good, and no differences were documented with respect to mobility, strength and pain at the level of the thumb with respect to the prior to the trauma. No signs of loosening, instability or alteration in the alignment of the components of the protheses were observed in the radiological examinations following the trauma.

CONCLUSIONS

There is a high survival rate of uncemented total trapeziometacarpal arthroplasty in the long term, even in the face of energy trauma. It is then a safe implant. Despite of being non-constrained, a good alignment of the prosthetic components is the key to avoid dislocation of the prosthesis.

Technical aspects and complications in the surgical treatment of poliomyelitis-affected lower limb fractures

OBJECTIVE

Post-polio patients present problems such as small and deformed bones, with narrow intramedullary canal and osteoporosis, affecting surgical treatment. The aim of this article is to describe the main preoperative and intraoperative complications of the surgical treatment of fractures in this population.

MATERIAL AND METHODS

A retrospective analysis was conducted between 1995 and 2014. Data obtained from the medical records included patient age, fracture pattern (AO/OTA), device used, technical aspects of the surgery that changed compared to a standard procedure, and the presence of intraoperative skeletal complications.

RESULTS

Sixty-four patients with 78 fractures were included in the study. Forty-seven percent of the fractures were at the proximal femur. The main complications of hip arthroplasty (14 patients) were absent hip abductors and intraoperative instability (3), bad cup fixation (3) and intraoperative periprosthetic fracture (2). The main problems of intramedullary nailing were due to a narrow canal and previous bone deformity. Main problems reported when plating included difficulty to fit a precontoured plate, and oversized hardware.

CONCLUSION

Given the large number of intraoperative complications, in preoperative planning we must include nails of small diameter and length, locking plates and external fixators, and, in the case of hip arthroplasty, long and thin stems and restrictive or dual mobility acetabular systems.

Proximal Femoral Nail Antirotation versus Gamma3 nail for intramedullary nailing of unstable trochanteric fractures. A randomised comparative study

The purpose of this study was to compare the clinical results and the complication rates of a new generation of two intramedullary fixation devices: Proximal Femoral Nail Antirotation® (PFNA) and Gamma3®. We conducted a prospective randomised multicentre trial of 61 patients who underwent a PFNA fixation treatment (31 patients) or a Gamma3 nail (30 patients). We documented the fixation failure complications as well as data of the surgical procedure, the clinical and functional outcomes (the EuroQoL5 questionnaire, the Katz index score, the Short Form 36 (SF-36), and the Harris Hip Score) and the plain radiographic parameters at 3,6 and 12 months follow up. The PFNA and Gamma3 fixation devices were similar in terms of complication rates. The risk for experiencing a postoperative complication after Gamma3 nailing was 40% versus 45% after PFNA fixation. At the 6-month and 1-year follow-up evaluations, there were no significant differences in terms of range of motion, clinical scores and radiological outcomes.