Background: Acute dislocation of the thumb carpometacarpal (CMC) joint is a rare and challenging injury, and its treatment remains controversial. The purpose of the study was to evaluate the clinical outcome after sur...Background: Acute dislocation of the thumb carpometacarpal (CMC) joint is a rare and challenging injury, and its treatment remains controversial. The purpose of the study was to evaluate the clinical outcome after surgical repair of the dorsal capsulo-ligamentous complex. Materials and methods: Eight patients with a mean age of 39.8 years (range, 23 - 56 years) treated for the thumb CMC joint were treated in our hospital between 2008 and 2018. The ruptured dorsal capsulo-ligamentous complex was repaired using suture anchors in all patients, and the joint was immobilized with a Kirschner wire pinning and splint for 3 weeks. The clinical outcome was assessed by measuring the range of motion of the thumb CMC joint and the Japanese Society for Surgery of the Hand version of the Quick Disability of the Arm, Shoulder, and Hand (Q-DASH-JSSH) score. Results: The mean radial abduction of the thumb CMC joint was 66°, and the volar abduction was 63°. The mean Q-DASH-JSSH score was 4.8 (range, 0 - 15.6). There were no cases of infection, nerve disturbance, or osteoarthritis. Anatomical reduction was observed in seven patients at the final follow-up and in a rugby football player at 6 months of follow-up;however, subluxation of the thumb CMC joint at 12 months of follow-up due to reinjury was observed. Conclusion: Surgical repair of the dorsal capsulo-ligamentous complex with suture anchors is a reliable and simple treatment for acute unstable dislocation of the thumb CMC joint.展开更多
The effect of through-thickness reinforcement by composite pins （Z-pins） on the static tensile strength and failure mechanisms of the joints made from ceramic matrix composite （CMC） is investigated. Overlap length...The effect of through-thickness reinforcement by composite pins （Z-pins） on the static tensile strength and failure mechanisms of the joints made from ceramic matrix composite （CMC） is investigated. Overlap length of the single lap joint is 15 mm, 20 mm, 23 mm, 37 mm, and 60 mm, respectively. The experimental results indicate that the final failure modes of the joints can be divided into two groups, （a） the bond-line stops debonding until crack encounters Z-pins; and then the adherends break at the location of Z-pins, when overlap length is more than 20 mm; （b） the bond-line detaches entirely and Z-pins are drawn from adherends, when overlap length is equal to 15 mm. A simple efficient computational approach is presented for analyzing the benefit of through-thickness pins for restricting failure in the single lap joints. Here, the mechanics problem is simplified by representing the effect of the pins by tractions acting on the fracture surfaces of the cracked bond-line. The tractions are prescribed as functions of the crack displacement, which are available in simple forms that summarize the complex deformations to a reasonable accuracy. The resulting model can be used to track the evolution of complete failure mechanisms, for example, bond-line initial delamination and ultimate failure associated with Z-pin pullout, ultimate failure of the adherends. The paper simulates connecting performance of the single lap joints with different Z-pins＇ diameter, spacing and overlap length; the numerical results agree with the experimental results; the numerical results indicate enlarging diameter and decreasing spacing of Z-pins are in favor of improving the connecting performance of the joints. By numerical analysis method, the critical overlap length that lies between two final failure modes is between 18 mm and 19 mm, when Z-pins＇ diameter and spacing are 0.4 mm, 5 mm, respectively.展开更多
BACKGROUND Basal joint arthritis is a common disease which is especially present in postmenopausal women. A variety of procedures have been described once conservative treatment has failed. The purpose of our study is...BACKGROUND Basal joint arthritis is a common disease which is especially present in postmenopausal women. A variety of procedures have been described once conservative treatment has failed. The purpose of our study is to present a novel surgical technique based on a clinical case with three-year follow-up which is highly effective, even after failure of previous procedures. CASE SUMMARY We present a case of a 39 year-old-woman who suffered from recurring, persistent, sharp left thumb pain for several years After two operative procedures, she presented again with intolerable, sharp pain over the trapeziometacarpal joint, and wished to proceed with a pain relieving procedure or arthroplasty. Intraoperatively, the articular surfaces appeared well, without any bare areas of bone or eburnation, resulting in the decision to perform a “subtraction hemiarthroplasty”. A shortening osteotomy of the os trapezium was performed by removing a slice of 8-9 mm bone, without damaging the joint cartilages. The osteotomy was stabilized using two screws, the ligament and capsular tissue was suture imbricated, and a cut down on the translation and a dorsal radial ligament reconstruction were performed. Three years after the final procedure, a long-term follow-up demonstrates excellent results, pain free with full range-of-motion. CONCLUSION Subtraction hemiarthroplasty with ligament tightening imbrication and reconstruction of the radial ligament led to excellent results in motion and pain.展开更多
BACKGROUND We report a case with the displacement of an articular fracture fragment of the base of the second metacarpal from the ulnar to the volar side,treated via the dorsal approach.The dorsal approach can be a go...BACKGROUND We report a case with the displacement of an articular fracture fragment of the base of the second metacarpal from the ulnar to the volar side,treated via the dorsal approach.The dorsal approach can be a good option not only because it allows direct observation of ligament damage and fixation of bone fragments but also because the thin subcutaneous tissue makes the approach easier.CASE SUMMARY A 45-year-old man with a right hand injury visited the hospital.A small bone fragment was identified using plain radiography.Lateral radiography revealed the fragment as lying over the volar aspect of the carpometacarpal(CMC)joint.Computed tomography revealed that approximately one-third of the CMC joint surface of the second metacarpal was damaged.We provisionally diagnosed an intra-articular fracture with significant CMC joint instability and performed open reduction and internal fixation.We made a dorsal longitudinal incision over the CMC joint between the second and third metacarpals.The dorsal ligament of the third CMC joint was torn.We thought it had been dislocated to the volar side and spontaneously reduced to that position.There are only few reports of volar dislocation of CMC joint fractures,particularly of the second and third metacarpals;our report is unique as our patient had an intact interosseous ligament between the second and third metacarpals.CONCLUSION Although past reports have used a palmar approach,the dorsal approach is a good option for these cases.展开更多
Multiple pometacarpal （CMC） joints volar dislocations of car- are uncommon and have been reported rarely. A 25 years old male presented with injury to his left hand 6 days following a road traffic accident. Clini- c...Multiple pometacarpal （CMC） joints volar dislocations of car- are uncommon and have been reported rarely. A 25 years old male presented with injury to his left hand 6 days following a road traffic accident. Clini- cal examination revealed gross swelling of the hand and diffuse tenderness over the carpometacarpal area. His ra- diographs of the hand showed volar dislocation of the second, third and fourth CMC joints in association with anextra-articular fracture of the base of thumb metacarpal. He was treated by open reduction and percutaneous fixation using Kirschner wires. The functional results were excellent at one year follow-up.展开更多
文摘Background: Acute dislocation of the thumb carpometacarpal (CMC) joint is a rare and challenging injury, and its treatment remains controversial. The purpose of the study was to evaluate the clinical outcome after surgical repair of the dorsal capsulo-ligamentous complex. Materials and methods: Eight patients with a mean age of 39.8 years (range, 23 - 56 years) treated for the thumb CMC joint were treated in our hospital between 2008 and 2018. The ruptured dorsal capsulo-ligamentous complex was repaired using suture anchors in all patients, and the joint was immobilized with a Kirschner wire pinning and splint for 3 weeks. The clinical outcome was assessed by measuring the range of motion of the thumb CMC joint and the Japanese Society for Surgery of the Hand version of the Quick Disability of the Arm, Shoulder, and Hand (Q-DASH-JSSH) score. Results: The mean radial abduction of the thumb CMC joint was 66°, and the volar abduction was 63°. The mean Q-DASH-JSSH score was 4.8 (range, 0 - 15.6). There were no cases of infection, nerve disturbance, or osteoarthritis. Anatomical reduction was observed in seven patients at the final follow-up and in a rugby football player at 6 months of follow-up;however, subluxation of the thumb CMC joint at 12 months of follow-up due to reinjury was observed. Conclusion: Surgical repair of the dorsal capsulo-ligamentous complex with suture anchors is a reliable and simple treatment for acute unstable dislocation of the thumb CMC joint.
基金supported by the National Natural Science Foundation of China (No. 90405015)the Research Fund forthe Doctoral Program of Higher Education (No. 20030699040).
文摘The effect of through-thickness reinforcement by composite pins （Z-pins） on the static tensile strength and failure mechanisms of the joints made from ceramic matrix composite （CMC） is investigated. Overlap length of the single lap joint is 15 mm, 20 mm, 23 mm, 37 mm, and 60 mm, respectively. The experimental results indicate that the final failure modes of the joints can be divided into two groups, （a） the bond-line stops debonding until crack encounters Z-pins; and then the adherends break at the location of Z-pins, when overlap length is more than 20 mm; （b） the bond-line detaches entirely and Z-pins are drawn from adherends, when overlap length is equal to 15 mm. A simple efficient computational approach is presented for analyzing the benefit of through-thickness pins for restricting failure in the single lap joints. Here, the mechanics problem is simplified by representing the effect of the pins by tractions acting on the fracture surfaces of the cracked bond-line. The tractions are prescribed as functions of the crack displacement, which are available in simple forms that summarize the complex deformations to a reasonable accuracy. The resulting model can be used to track the evolution of complete failure mechanisms, for example, bond-line initial delamination and ultimate failure associated with Z-pin pullout, ultimate failure of the adherends. The paper simulates connecting performance of the single lap joints with different Z-pins＇ diameter, spacing and overlap length; the numerical results agree with the experimental results; the numerical results indicate enlarging diameter and decreasing spacing of Z-pins are in favor of improving the connecting performance of the joints. By numerical analysis method, the critical overlap length that lies between two final failure modes is between 18 mm and 19 mm, when Z-pins＇ diameter and spacing are 0.4 mm, 5 mm, respectively.
文摘BACKGROUND Basal joint arthritis is a common disease which is especially present in postmenopausal women. A variety of procedures have been described once conservative treatment has failed. The purpose of our study is to present a novel surgical technique based on a clinical case with three-year follow-up which is highly effective, even after failure of previous procedures. CASE SUMMARY We present a case of a 39 year-old-woman who suffered from recurring, persistent, sharp left thumb pain for several years After two operative procedures, she presented again with intolerable, sharp pain over the trapeziometacarpal joint, and wished to proceed with a pain relieving procedure or arthroplasty. Intraoperatively, the articular surfaces appeared well, without any bare areas of bone or eburnation, resulting in the decision to perform a “subtraction hemiarthroplasty”. A shortening osteotomy of the os trapezium was performed by removing a slice of 8-9 mm bone, without damaging the joint cartilages. The osteotomy was stabilized using two screws, the ligament and capsular tissue was suture imbricated, and a cut down on the translation and a dorsal radial ligament reconstruction were performed. Three years after the final procedure, a long-term follow-up demonstrates excellent results, pain free with full range-of-motion. CONCLUSION Subtraction hemiarthroplasty with ligament tightening imbrication and reconstruction of the radial ligament led to excellent results in motion and pain.
文摘BACKGROUND We report a case with the displacement of an articular fracture fragment of the base of the second metacarpal from the ulnar to the volar side,treated via the dorsal approach.The dorsal approach can be a good option not only because it allows direct observation of ligament damage and fixation of bone fragments but also because the thin subcutaneous tissue makes the approach easier.CASE SUMMARY A 45-year-old man with a right hand injury visited the hospital.A small bone fragment was identified using plain radiography.Lateral radiography revealed the fragment as lying over the volar aspect of the carpometacarpal(CMC)joint.Computed tomography revealed that approximately one-third of the CMC joint surface of the second metacarpal was damaged.We provisionally diagnosed an intra-articular fracture with significant CMC joint instability and performed open reduction and internal fixation.We made a dorsal longitudinal incision over the CMC joint between the second and third metacarpals.The dorsal ligament of the third CMC joint was torn.We thought it had been dislocated to the volar side and spontaneously reduced to that position.There are only few reports of volar dislocation of CMC joint fractures,particularly of the second and third metacarpals;our report is unique as our patient had an intact interosseous ligament between the second and third metacarpals.CONCLUSION Although past reports have used a palmar approach,the dorsal approach is a good option for these cases.
文摘Multiple pometacarpal （CMC） joints volar dislocations of car- are uncommon and have been reported rarely. A 25 years old male presented with injury to his left hand 6 days following a road traffic accident. Clini- cal examination revealed gross swelling of the hand and diffuse tenderness over the carpometacarpal area. His ra- diographs of the hand showed volar dislocation of the second, third and fourth CMC joints in association with anextra-articular fracture of the base of thumb metacarpal. He was treated by open reduction and percutaneous fixation using Kirschner wires. The functional results were excellent at one year follow-up.
