Ligament reconstruction with tendon interposition arthroplasty for first carpometacarpal joint osteoarthritis

Background Ligament reconstruction tendon interposition （LRTI） is the most commonly performed surgical procedure for first carpometacarpal joint osteoarthdtis.The purpose of this study was to examine the radiographic and clinical outcomes of LRTI arthroplasty and document the clinical results based on metacarpal subsidence.Methods From January 2008 to January 2011,19 patients （21 thumbs） underwent surgery for thumb carpometacarpal arthritis using ligament reconstruction tendon interposition arthroplasty with flexor carpi radialis （FCR） in Kleinert Kutz Hand Care Center of Louisville University,USA.The follow-up period was an average of 13.9 months.Pain,grip strength,tip pinch strength,range of motion,and radiographic measurements were recorded.Based on first metacarpal subsidence,the cases were classified in to mild,moderate,and severe.Clinical outcomes of the groups were evaluated and compared.Results Grip strength improved from 18.6 kg to 20.5 kg,and tip pinch strength increased from 4.4 kg to 4.5 kg after the surgery.Radial abduction and palmar abduction improved after surgery.Radial abduction increased from 55.7° to 60.6° and palmar abduction improved from 56.7° to 63.5° after the procedure.Visual analogue scores （VAS） were significantly reduced,from 6.6 to 0.5.Compared with the preoperative radiographs the first metacarpal had subsided about 54.6％ of the arthroplasty space.The height of arthroplasty space and index of the arthroplasty space significantly decreased from 12.4 mm to 5.6 mm and from 0.27 to 0.12 respectively.Between the various groups （mild,moderate and severe metacarpal subsidence）,there was no difference in grip strength,tip pinch strength,thumb range of motion,and VAS.Conclusions Ligament reconstruction tendon interposition arthroplasty resulted in excellent relief of pain and increase in range of motion.However,LRTI cannot maintain the arthroplasty space.Compared with the preoperative radiographs,the metacarpal subsided more than 50％.The amount of first metacarpal subsidence has no bearing on the results.

Degree and location of metacarpal angulations

Aim: Fractures of metacarpals are commonly encountered in hand surgery. For adequate fixation, a thorough knowledge about the anatomy is essential. While fixing the metacarpals with plates and screws, plates are bent to contour the dorsal surface. However, there are no reference values in literature for the location and degree of angulation. The authors studied the dorsal surface of metacarpals in cadavers to gather data regarding the location and degree of angulation of the dorsal cortex. Methods: Cadaveric dissections of 118 metacarpals from 30 hands were performed. A true lateral view of each metacarpal was taken using fluoroscopy.These pictures were analyzed using Image J software. The dorsal cortex angle was measured in each image, and the center of rotation of angulation (CORA) was identified. The distance from the CORA to the base of metacarpal was measured and calculated as a percentage of the metacarpal length. Results: The average dorsal angle of the metacarpals was 11.5°. The average angles for each metacarpal were as follows: 2nd metacarpal = 13° (range, 6-26°;SD, 4.73), 3rd = 10° (range, 1-25°;SD, 5.28), 4th = 11° (range, 1-20°;SD, 4.45), 5th = 12°(range, 2-24°;SD, 5.11). The average location of the CORA from the base of the metacarpal as a percentage of the metacarpal length was identified as follows: 53.5% for the index finger,52.1% for the long finger, 48.3% for the ring finger and 50.3% for the small finger. Conclusion:These measurements are able to serve as reference values for plate bending while operating on a metacarpal fracture or metacarpal corrective osteotomy.

Non-vascularized fibular graft for distal radial reconstruction：42 years follow-up

The distal radius is the third most common site for giant cell tumors of bone This tumor is known to be very locally aggressive and recurs in situ quite frequently after excision. En bloc resection, removing a wide margin through normal tissue planes, ensures the lowest rate of recurrence.