Many different surgical procedures have been used to alleviate the pain of first carpometacarpal joint osteoarthritis. The most common procedure involves removal of the trapezium with, or without, suspension of the base of the first metacarpal. This operation may also include a soft tissue interposition. A novel technique using the whole of FCR as a soft tissue arthroplasty after trapezectomy is described. Fifty-two trapezectomies with suspension arthroplasty using the whole of FCR were performed on 48 patients by one surgeon over a six year period. Average follow-up was 1.8 years. Grip and pinch strengths were measured and compared with the contralateral hand and with pre-operative measurements. A Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was completed. Of 48 patients, 42 responded to the follow-up request (87.5%) for a total of 43 operations. There were 32 females and 10 males with an average age of 54 years. There was no significant difference between the pre and post-operative pinch and grip strengths (pinch pre-op 5.4 kilogram, post-op 4.9 kilogram; grip pre-op 24 kilogram, post-op 21 kilogram). The average DASH sc ore was 41.8 (range 35–60.8), which is comparable to the other trapezectomy studies. When the patients were asked whether they would undergo the surgery again, 95% answered “yes”. Our results using this novel technique demonstrated a DASH score comparable to other techniques using half of the FCR tendon, or no soft tissue interposition at all. Interestingly a significant fall in pinch strength (noted in other trapezectomy studies) was not a finding in this study.
The aim was to compare the efficacy and outcomes of reduction of closed forearm fractures in a paediatric population using Ketamine in the Emergency Department (ED) setting versus reduction under general anaesthesia (GA) in the operating theatre (OT). A prospective audit of children presenting to our institution with closed fractures of the radius and/or ulna was conducted. Patients presenting to ED were offered manipulation under GA or Ketamine, and then grouped accordingly. Children were followed up until full range of motion had recovered. Outcomes measured at follow up were 1) need for remanipulation, 2) position at union, 3) total hospital stay and 4) functional outcome. Forearm fractures account for 22% of acute paediatric orthopaedic admissions to our institution. 70% require manipulation and splintage. 221 forearm fractures required manipulation during the study period. 90 patients (41%) were manipulated under Ketamine in the ED, 131 patients (59%) were manipulated in the OT. There was no significant difference in mean angulation of fractures treated by either method (p=0.20). There was no significant difference between the two methods with respect to rates of remanipulation (p=0.73) or poor position at union (p=0.55). There was a significantly shorter hospital stay for those treated in the ED. Treatment of paediatric forearm fractures in the ED under Ketamine sedation offers an effective alternative for selected fractures. It also offers considerable financial savings and is less of a drain on valuable theatre and staff resources.
