Trapeziometacarpal arthritis is a common condition, causing symptoms in up to ten percent of women and one percent of men¹. LRTI is the most commonly used surgical technique for this condition however, long-term studies have shown persistent weakness of pinch strength² after surgery. The Ascension® PyroDisk is a pyrocarbon disk shaped implant designed to articulate against the trapezium and metacarpal, preserving the height of the articulation. The objective of this study was to determine whether treatment with a pyrocarbon implant resulted in comparable pain relief and range of motion, whilst providing superior gains in pinch strength when compared to LRTI.

This is a prospective randomized control trial comparing pyrocarbon implant to LRTI. Surgeries were accomplished by a single surgeon in a standardized fashion. Patients were evaluated at six weeks, three, six and 12 months following surgery. Data on pain (VAS), function (Patient Rated Wrist Evaluation (PRWE)), mobility and strength (grip, key and lateral pinch) were obtained as well as radiographic assessment of the height of the arthroplasty space.

A total of 80 patients had surgery between July 2008 and November 2016. Forty patients were allocated to the PyroDisk group and 40 to the LRTI group. Seventy-four patients (92,5%) completed the one year follow-up. Mean age was slightly older in the PyroDisk group (64 vs 60,8 y.o., p=0,03). Surgical and tourniquet times were longer in the PyroDisk group. There was no difference between the groups in strength, pain or functional outcome at one year. However, VAS was significantly higher in the PyroDisk group at three and six months (4,5 vs 2,4, p < 0,001, 2,6 vs 1,7, p=0,02) and PRWE was also significantly better at three months in the LRTI group (53,7 vs 71,2, p=0,02). The overall complication rate was three times higher in the PyroDisk group (10% vs 30%).

Treatment of trapeziometacarpal arthritis with PyroDisk does not provide superior functional gains when compared to LRTI. On the contrary, it seems to result in more pain in the first few months following surgery. This difference in pain is not seen at 1 year after surgery. This may suggest that there is a period of adaptation to the Pyrodisk after its insertion. We also found a higher risk of complications with the use of the PyroDisk.

Purpose: To compare failure rates, and patient functional outcomes, using the Dynamic Hip Screw (DHS) and Medoff Sliding Plate (MSP) for unstable intertrochanteric hip fractures.

Method: One hundred and sixty three consecutive patients with unstable intertrochanteric hip fractures, from three hospitals, were prospectively randomized to DHS or MSP. Inclusion and exclusion criteria were designed to focus on isolated unstable intertrochanteric hip fractures in ambulatory patients over age 60, without previous hip fractures or significant subtrochanteric extension. Patients were stratified by mental status and treating hospital. Randomization was performed intra operatively, after placement of a 135 degree guide wire. Follow up assessments were performed at regular intervals for a minimum of six months. The primary outcome was re-operation rate. The secondary outcome was patient function, using a validated outcome measure, the Hip Fracture Functional Recovery Score. Tertiary outcomes included: mortality, hospital stay, quality of reduction and mal union rate.

Results: 86 patients were randomized to DHS and 76 to MSP. The groups had similar patient demographics and pre fracture status (medical and functional). The patients had similar hospital course except there were more transfusions in the MSP group (2 vs. 1 unit). The quality of reduction was the same for each group but the operative time was longer in the MSP group (61 vs. 50 min). The rate of re-operation was low (3/86 in DHS and 2/76 in MSP) with no statistically significant difference. The indication for re-operation differed for the two groups as all three failures in the DHS group were related to screw cut out and both failures in the MSP arm were because of non union. The functional outcomes were the same for both groups with functional recovery scores at six months of 51% in the DHS arm and 49% in the MSP arm.

Conclusion: The two techniques produced similar results for the clinically important outcomes of the need for further surgery and functional status of the patients. For this challenging sub group of hip fractures, based on the equivalent results in this study either implant is a reasonable choice.