Ostoearthritis of the trapeziometacarpal (TMC) joint, the key joint in thumb opposition, is one of the most common diseases involving the hand, especially among middle-aged and elderly women, and can seriously impair overall hand function.

Material and Methods: The purpose of this study was to analyze our experience in the treatment of trapezio-metacarpal (TMC) osteoarthritis with a cemented surface replacement arthroplasty (SR Avantis prosthesis). We did a retrospective study of 34 patients with 43 hands operated on with this technique, with a follow-up evaluation of 36 months. We analyzed the preoperative stage, the postoperative clinical results, measured the radiographic changes found at the end of the study. For outcome, Quick-DASH (Disabilies of the Arm, Shoulder and Hand Score) scores was used.

A Jamar dynamometer was used to assess the grip and pinch strengths which showed a 63% of recovering of the grip strength. Overall survival after a mean follow up of 36 months was 93%. At final follow up mean Quick DASH score was 27.4 Radiological review of the surviving joints showed subsidence of trapezial component in 4 joints and further lucencies in 3 joints. However, these patients had good hand function and grip strength. No sign of osteolysis was seen in any of the cases. We found that the radiological findings did not correlate with clinical findings. Satisfaction rate was 26 good to excellent, with 5 fair and 3 poor.

Conclusion: The three years results of the SR joint replacement are promising with satisfactory functional outcome despite some radiological findings.

This study investigates the efficacy of the AO Pi-plate in the treatment of complex, unstable, intra-articular fractures of the distal radius.

A retrospective study of 17 patients was carried out who underwent open reduction and internal fixation for dorsally displaced, intra-articular fractures of the distal radius using the AO Pi-plate. All patients were assessed clinically and radiologically post-operatively. The final functional outcome was assessed using the Gartland & Werley scoring system.

The average follow-up period was 34.3 months. 94% (16 patients) of the fractures were classified as AO type C fractures. The wrist movement was restored to a near normal range in all cases. The mean grip strength was 67% of the uninjured hand. The functional outcome as measured by the Gartland & Werley scoring system showed excellent and good results in 88% of the patients. Radiographic assessment revealed an average articular step-off of 0mm post-operatively. The implant removal rate was 29% (5 patients) and the main reason for that was extensor tenosynovitis.

Conclusion: Our study demonstrates that although the functional outcome after using the Pi-plate for complex distal radius fractures is good, there is a significant incidence of extensor tenosynovitis. We recommend that the implant is best used for Type C fractures and be removed electively after fracture union.

Introduction and Aims: The purpose of our study was to assess the efficacy of double osteotomy of the radius and ulna for correction of Madelung’s deformity. Made-lung’s deformity is a congenital alteration of the growth of the ulnar portion of the distal radius resulting in pain, decreased function of the wrist and hand and serious aesthetic disturbances.

Method: Four wrists in four patients with a mean age of 18.3 years were treated for symptomatic increased ulnar and volar inclination of the distal articular surface of the radius. All patients complained of wrist pain. In addition, two of them were dissatisfied with the aesthetic appearance of their wrist and the restricted range of movement. A double osteotomy of the radius and ulna was performed. The ulna was stabilised with a six-hole semi-tubular plate and the radius with a titanium T-plate.

Results: At one-year follow-up: pain relief and cosmetic appearance were satisfactory in all patients. Grip strength improved by 5.3 pounds. Average flexion improved from 63 to 67 degrees and pronation from 59 to 66 degrees. Abduction increased from three to six degrees and adduction from 16 to 21 degrees. Realignment of the wrist was shown radiographically by a change of ulnar inclination and volar inclination of the radius from 35.5 to 24 degrees and 15.5 to 10.5 degrees respectively. There was no evidence of recurrence of the deformity in any of the four wrists.

Conclusion: The initial results with the double osteotomy of the radius and ulna for Madelung’s deformity are promising but need longer follow-up.