The Journal of hand surgery
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Comparative Study
Porous polyurethaneurea (Artelon) joint spacer compared to trapezium resection and ligament reconstruction.
To examine outcomes and complications of the porous polyurethaneurea (Artelon; Small Bone Innovations, Morrisville, PA) spacer compared to traditional surgical treatment of trapeziectomy with ligament reconstruction and tendon interposition (LRTI). ⋯ In our practice, use of the Artelon joint spacer resulted in an explantation rate of 37%. Due to these findings, we have abandoned its use for treatment of basilar thumb osteoarthritis. In contrast to previous studies, pain and satisfaction are worse in patients with intact Artelon spacers than those who had received LRTI.
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In practice, the surgeon must rely on screw position (insertion depth) and tactile feedback from the screwdriver (insertion torque) to gauge compression. In this study, we identified the relationship between interfragmentary compression and these 2 factors. ⋯ Knowledge of the insertion profile may improve our understanding of the implants, provide a better basis for comparing screws, and enable the surgeon to optimize compression.
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An elbow dislocation associated with radial head and coronoid process fractures, the terrible triad injury, has an unpredictable outcome in adults and is rare in children. We present 2 such injuries in children, 1 combined with an olecranon fracture, and both with good early clinical outcomes. However, in 1 of the 2 cases, avascular necrosis of the proximal radius was evident on radiographs.
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To evaluate the clinical and radiographic outcomes of tension band wiring of displaced olecranon fractures treated using Kirschner wires with eyelets to assess their clinical performance with respect to complications such as backing out of the K-wires, restriction of forearm rotation, and neurovascular injury. ⋯ Tension band wiring using the pin studied produced excellent clinical and radiologic outcomes for the treatment of isolated, displaced Mayo type IIA and some type IIB olecranon fractures. The pin was effective in preventing the backing out of Kirschner wires and avoiding the complications associated with anterior cortical engagement of Kirschner wires, such as neurovascular injury or restriction of forearm rotation.
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To report the presentation, treatment, and outcomes of a series of simple medial elbow dislocations and to identify features distinguishing this injury from the more common dislocation patterns. ⋯ Simple medial elbow dislocations may be at risk for early instability and may represent a more noteworthy soft tissue injury than typical dislocation patterns. Surgical treatment of early instability in these injuries led to acceptable patient outcomes.