This retrospective study evaluated 69 Swanson trapezium replacements performed between 1990 and 2009 for trapeziometacarpal osteoarthritis in 58 patients. Pain and function were assessed using the Michigan Hand Questionnaire (MHQ) and the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Patients had a mean age of 62 years at the time of surgery, with a mean time of 7.7 years from time of surgery to completion of the follow-up interview. The results showed good relief of pain and function with no significant deterioration with time from surgery. There were no gender differences or differences by age. The only differences observed were that those patients following surgery on a dominant hand indicated higher activities of daily living and work related activities. The authors conclude silicone trapezium replacement remains a good option for patients with painful trapeziometacarpal osteoarthritis that has not responded to non-operative treatment.
Antegrade K wiring of the fifth metacarpal for treatment of displaced metacarpal neck fractures is a well recognized surgical procedure. However it is not without complication and injury to the dorsal cutaneous branch of the ulnar nerve has been reported in up to 15% of cases. We performed a cadaver study to determine the proximity of this nerve to the K wire insertion point at the base of the fifth metacarpal. K wires were percutaneously inserted under image intensification in sixteen cadaver hands and advanced into the head of the metacarpal. Wires were then cut and bent outside the skin. This was then followed by meticulous dissection of the ulnar nerve from proximal to distal. A number of measurements were taken to identify the distance from the insertion point of the K wire to each branch of this nerve.Introduction
Methods
The aim of operative treatment for ankle fractures is to allow early movement after internal fixation. The hypothesis of this study was that early mobilisation facilitated by a removable cast after internal fixation of ankle fractures would improve functional recovery of patients compared with that after conventional immobilisation in a cast. Sixty-two patients between the age of seventeen and sixty-five with ankle fractures that required operative treatment were randomly allocated to two groups: immobilisation in a non weight bearing below knee cast for six weeks or early movement in a removable cast (at two weeks after removal of sutures) for the following four weeks. The follow-up examinations which consisted of subjective (clinical, Olerud-Molander score, AOFAS score, SF 36) and objective (swelling measurement, x-ray) evaluations were performed at two, six, nine, twelve and twenty four weeks post-operatively. Time of return to work was recorded. There were two post-operative complications in the group treated with immobilisation in cast; two patients had deep vein thrombosis (DVT). There was one superficial wound infection treated with oral antibiotics and two deep wound infections requiring removal of metal in the group treated with early movement in a removable cast. Patients in group two (early movement) had higher functional scores at nine and twelve weeks follow-up. They also returned to work earlier (63.7 days) compared with the ones treated in cast (94.9 days). There was no statistical difference in Quality of Life (SF-36 Questionnaire) at six months between the two groups. Early movement with the use of removable cast after removal of sutures in operated ankle fractures decreases swelling, prevents calf muscle wasting, improves functional outcome and facilitates early return to work of patients. Our findings support the use of a removable cast and early exercises in selected, compliant patients after surgery of the ankle.
