scholarly journals Autologous Fat Transplantation for Thumb Carpometacarpal Joint Osteoarthritis (Liparthroplasty): A Case Series with Two Years of Follow-UP

2020 ◽  
Vol 10 (1) ◽  
pp. 113
Author(s):  
Stefan M. Froschauer ◽  
Matthias Holzbauer ◽  
Raphael Wenny ◽  
Manfred Schmidt ◽  
Georg M. Huemer ◽  
...  
Keyword(s):  
Remission Rate ◽  
Surgical Techniques ◽  
Case Series ◽  
Thumb Carpometacarpal Joint ◽  
A Value ◽  
Autologous Fat Transplantation ◽  
Thumb Carpometacarpal ◽  
Satisfaction Rates ◽  
Carpometacarpal Osteoarthritis

Adipose-derived mesenchymal stem cell (ASC) therapy is currently a focus of regenerative medicine. Lipoaspirate is rich in ASCs and is evolving into a promising, less-invasive tool to treat thumb carpometacarpal osteoarthritis as compared with common surgical techniques, for example, trapeziectomy or prosthesis implantation. The present study aimed to examine the effect of 1 mL intraarticular lipoaspirate injection (liparthroplasty) in 31 thumb carpometacarpal osteoarthritis patients (27 woman and four men) with a median age of 58 (interquartile range (IQR) of 10) years and Eaton–Littler Stage 2 or 3. Median pain levels assessed via visual analogue scale significantly decreased from 7 (IQR 2) to 4 (IQR 6) after six months (p < 0.0001) and 2 (IQR 5) after two years (p < 0.0001). Median pre-interventional Disabilities of the Arm, Shoulder and Hand (DASH) scores of 59 (IQR 26) significantly reduced to a value of 40 (IQR 43) after six months (p = 0.004) and to 35 (IQR 34) after two years (p < 0.0001). Subjective grip strength showed no significant improvement. However, the time until recurrence of symptoms was measured and a cumulative remission rate of 58% was detected after two years. Satisfaction rates were 68% after six months and 51% after two years. In conclusion, liparthroplasty represents a promising option to reduce pain and functional impairment and to postpone surgery for a certain period of time.

scholarly journals TOUCH® Prosthesis for Thumb Carpometacarpal Joint Osteoarthritis: A Prospective Case Series

2021 ◽  
Vol 10 (18) ◽  
pp. 4090
Author(s):  
Stefan M. Froschauer ◽  
Matthias Holzbauer ◽  
Julian A. Mihalic ◽  
Oskar Kwasny
Keyword(s):  
Case Series ◽  
Pinch Strength ◽  
Dual Mobility ◽  
Neck Size ◽  
Thumb Carpometacarpal Joint ◽  
Preoperative Status ◽  
Prospective Case Series ◽  
Thumb Carpometacarpal ◽  
Inappropriate Choice

The dual mobility concept currently represents the newest generation of thumb carpometacarpal prostheses. The aim of this study was to evaluate the short-term outcomes of TOUCH® prosthesis. From September 2019 to July 2020, 40 prosthesis were implanted in 37 patients suffering from symptomatic stage III osteoarthritis. All included patients with a median age of 57.7 (IQR: 13.6) finished the systematic follow-up regimen (4, 8, 16 weeks, 6, and 12 months postoperatively). All parameters significantly improved (p < 0.0001) compared to the preoperative status. At 1 year follow-up, median DASH Scores decreased from 54 (IQR 22) to 12 (IQR 28) and pain levels improved from 8 (IQR 2) to 1 (IQR 2). Moreover, key-pinch strength increased from 3.8 (2.0) to 5.8 (2.5), while palmar abduction, radial abduction, and opposition also significantly improved. 35/37 patients were satisfied with the functional outcomes. We observed 10 complications, of which 6 were tendon-related issues, and 2 were due to an inappropriate choice of neck size. We could detect one dislocation but no evidence of cup loosening, tilting or subsidence in any patient. Despite the occurrence of some complications, we recommend implantation of this prosthesis type due to favorable clinical and radiological performance.

scholarly journals Modified Eaton-Littler's Reconstruction for Traumatic Thumb Carpometacarpal Joint Instability: Operative Technique and Clinical Outcomes

2017 ◽  
Vol 07 (03) ◽  
pp. 191-198 ◽  
Author(s):  
Karthikeyan Iyengar ◽  
William Loh ◽  
Hosam Matar
Keyword(s):  
Clinical Outcomes ◽  
Outcome Measures ◽  
Joint Instability ◽  
Case Series ◽  
Strength Analysis ◽  
Carpometacarpal Joint ◽  
Thumb Carpometacarpal Joint ◽  
Thumb Carpometacarpal ◽  
Cmc Joint

Background Injuries to thumb carpometacarpal joint ligaments lead to instability. Eaton-Littler's ligament reconstruction traditionally uses a strip of flexor carpi radialis to stabilize the CMC joint. Study Description We have modified this technique to reproduce the direction of active action of the anterior oblique ligament by reconstructing both the volar and dorsoradial ligaments. In this prospective study, we evaluated patients with confirmed traumatic thumb CMC joint instability who underwent modified Eaton-Littler's reconstruction. Strength analysis, Michigan Hand Outcome Questionnaire, QuickDASH, and subjective outcome measures were collected pre- and postoperatively with minimum 3 years of follow-up. Eleven patients were included in the final analysis, with mean age of 29 years (range: 16–52) and average follow-up of 6.2 years (range: 3–11). There was a statistically significant improvement in all outcome measures. Clinical Relevance Our modified technique helps to simultaneously address both volar and dorsal ligaments and yields satisfactory clinical outcomes at medium term follow-up. Level of Evidence Level IV, case series.

THE EFFECT OF ULTRASOUND GUIDED STEROID INJECTION ON PROGRESSION TO SURGERY IN THUMB CMC ARTHRITIS

Hand Surgery ◽  
2014 ◽  
Vol 19 (01) ◽  
pp. 49-52 ◽  
Author(s):  
P. A. McCann ◽  
C. J. Wakeley ◽  
R. Amirfeyz
Keyword(s):  
Disease Progression ◽  
Positive Likelihood Ratio ◽  
First Year ◽  
Patient Counseling ◽  
Carpometacarpal Joint ◽  
Ultrasound Guided ◽  
Thumb Carpometacarpal Joint ◽  
Thumb Carpometacarpal ◽  
Carpometacarpal Osteoarthritis

Thumb carpometacarpal joint (CMCJ) osteoarthritis is a common complaint that produces pain and disability within the hand. This study aims to ascertain whether joint injection with local anaesthetic and steroid is of predicative value in disease progression in thumb carpometacarpal osteoarthritis. Forty-three patients were assessed at an average follow up of 24 months following ultrasound-guided injection. Fourteen patients (32%) progressed to surgery, at a mean interval of 8.6 months (range 4–14 months). There was a statistically significant correlation between those patients who had on-going pain following injection at one week and progression to surgery (p = 0.025) with an odds ratio of 3.14 and positive likelihood ratio of 2.1. Patients with thumb CMCJ osteoarthritis that does not respond favourably to injection at one week are likely to progress to surgery in the first year after the injection. This work offers a useful tool in predicting disease progression and patient counseling.

Trapeziometacarpal narrow pseudarthrosis: a new surgical technique to treat thumb carpometacarpal joint arthritis

2012 ◽  
Vol 38 (8) ◽  
pp. 844-850 ◽  
Author(s):  
M. Rubino ◽  
A. Civani ◽  
D. Pagani ◽  
V. Sansone
Keyword(s):  
Clinical Outcome ◽  
Surgical Techniques ◽  
Pinch Strength ◽  
Dash Score ◽  
Carpometacarpal Joint ◽  
Thumb Carpometacarpal Joint ◽  
Thumb Carpometacarpal ◽  
Excision Arthroplasty ◽  
Joint Arthritis

We describe a technique that arose from the observation of the clinical outcome of failed arthrodeses of the thumb carpometacarpal joint. In these cases a pseudoarthrosis developed which, surprisingly, rarely lead to a poor clinical outcome. Thus we developed a simple technique which deliberately caused the formation of a narrow pseudoarthrosis in the carpometacarpal joint. We present a retrospective review of 248 consecutive patients treated for Eaton stages II and III osteoarthritis. We observed a statistically significant improvement in mean appositional and oppositional pinch strength, mean DASH score (63.8 pre-operatively to 10.5 at final follow-up), and the mean pain score (8.3 to 0.2). We conclude that trapeziometacarpal limited excision arthroplasty is a simple and reliable alternative to existing surgical techniques for treating Stage II or III thumb carpometacarpal joint arthritis.

Outcomes of denervation, joint lavage and capsular imbrication for painful thumb carpometacarpal joint osteoarthritis

2016 ◽  
Vol 41 (9) ◽  
pp. 904-909 ◽  
Author(s):  
D. Ehrl ◽  
H. C. Erne ◽  
P. N. Broer ◽  
C. Metz ◽  
E. Falter
Keyword(s):  
Case Series ◽  
Good Alternative ◽  
Carpometacarpal Joint ◽  
Level Of Evidence ◽  
Thumb Carpometacarpal Joint ◽  
Recovery Times ◽  
Surgical Options ◽  
Thumb Carpometacarpal ◽  
Joint Lavage

Pain reduction remains the main aim in the treatment of thumb carpometacarpal joint osteoarthritis. We performed a retrospective analysis of a case series of patients with symptomatic thumb carpometacarpal joint arthritis treated with denervation, joint lavage and capsular imbrication. A total of 60 patients participated in this study. Follow-up, including a clinical examination, was performed on 37 patients at a mean of 46 months (range 12 to 81); an additional 23 patients were followed-up by telephone at a mean of 52 months (range 14 to 93) post-operatively. The patients assessed in person showed a significant decrease in pain and a significant improvement in thumb function. The information gathered by telephone gave similar results. The findings of our study indicate that the presented treatment approach could be a good alternative to more invasive surgical options in patients with earlier stages of thumb carpometacarpal joint osteoarthritis. Advantages include the low rate of complications and invasiveness, as well as short recovery times. Level of evidence: IV

scholarly journals Least possible fixation techniques of 4-part valgus impacted fractures of the proximal humerus: a systematic review

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Andreas Panagopoulos ◽  
Irini Tatani ◽  
Dimitrios Ntourantonis ◽  
Ioannis Seferlis ◽  
Antonis Kouzelis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Avascular Necrosis ◽  
Proximal Humerus ◽  
Constant Score ◽  
Surgical Techniques ◽  
Case Series ◽  
Cochrane Library ◽  
Operation Rate ◽  
Fixation Techniques

The valgus-impacted (VI) 4-part fractures are a subset of fractures of the proximal humerus with a unique anatomic configuration characterized by a relatively lower incidence of avascular necrosis after operative intervention. We systematically reviewed clinical studies assessing the benefits and harms of least possible fixation techniques (LPFT) for this unique fracture type. Such information would be potentially helpful in developing an evidence-based approach in the management of these complex injuries. We performed analytic searches of PubMed, Embase, Web of Science, Google Scholar and the Cochrane Library, restricting it to the years 1991-2014. Included studies had to describe outcomes and complications after primary osteosynthesis with any type of LPFT apart from plate-screws and intramedullary nailing. Eligibility criteria were also included English language, more than 5 cases, minimum follow up of one year and report of clinical outcome using at least one relevant score (Constant, Neer or ASES). Based on 292 database hits we identified 12 eligible studies including 190 four-part valgus impacted fractures in 188 patients. All eligible studies were case series composed of min 8 to max 45 patients per study. The gender distribution was 60% (112) female and 40% (76) male. The average age of the patients at the time of injury was 54.5 years. In 8/12 studies an open reduction was used for fracture fixation using different surgical techniques including KW, cerclage wires, cannulated screws and osteosutures. Closed reduction and percutaneous fixation was used in 4 studies. Mean follow-up time ranged from 24 to 69 months. A good functional outcome (constant score &gt;80) was reported in 9/12 studies. The most common complication was avascular necrosis of the humeral head with an overall incidence of 11% (range, 0-26.3%). Total avascular necrosis (AVN) was found in 15/188 patients (7.9%) and was more common in percutaneous techniques and partial AVN in 6/188 (3.1%) being more common in open techniques. The overall re-operation rate was very low (3.7%). Insufficient study designs cannot provide definite treatment recommendations and quantitative data synthesis of outcome. In general, LPFT for 4-part VI fractures leads to satisfactory outcomes with low incidence of complications. A considerable risk of biases can be attributed to fracture classification, proper radiological control, mean age of patients, mixed types of fixation methods, nonage adjusted clinical scoring and small follow up periods. These factors are discussed in detail. Level of evidence: systematic review of literature (level IV) as most of the studies were level IV.

Description and Clinical Assessment of the Bone Block Tendon Interposition Technique for the Management of Thumb Carpometacarpal Joint Osteoarthritis

2018 ◽  
Vol 23 (04) ◽  
pp. 515-519
Author(s):  
Diego F. Rincon Cardozo ◽  
Wynston J. Alvarez Martinez ◽  
Jhon F. Castañeda Lopez ◽  
Fredy A. Angarita Maldonado ◽  
Juliana A. Rojas Neira ◽  
...  
Keyword(s):  
Case Series ◽  
Functional Results ◽  
Interference Screw ◽  
Pinch Strength ◽  
Bone Block ◽  
Dash Score ◽  
Carpometacarpal Joint ◽  
Thumb Carpometacarpal Joint ◽  
Thumb Carpometacarpal ◽  
And Function

Background: Pellegrini’s surgical technique is the most useful for thumb carpometacarpal joint osteoarthritis. The purpose of this paper is to describe the technique of a modified version using a bone block in the tunnel through which the flexor carpi radialis tendon is passed (BBTI). Methods: Case series of patients diagnosed with osteoarthritis of the thumb carpometacarpal joint, in stage II or higher based on Eaton’s classification, that were intervened using the BBTI technique for a 2-year period. Grip and pinch strength, range of motion, and 1–2 metacarpal angle were evaluated. Pain and function were measured using the visual analogue scale and the Disabilities of the Arm, Shoulder and Hand (DASH) scale. Results: The study included 16 cases in 14 patients (11 women and 3 men), with an average age of 55.7 ± 7.1 years. Encouraging results were obtained, with an average DASH score of 24.3 ± 17.9 and a minimum VAS pain score. A total of 58% showed a grip strength of over 80% and the postoperative movement was equivalent to the contralateral limb. No cases of infection were reported, and only two minor complications were observed. Conclusions: The BBTI technique is a surgical option that incorporates an interference screw, offering good functional results for managing osteoarthritis of the thumb carpometacarpal joint, with a similar complication rate to that of the original technique.

scholarly journals Surgical Correction of Penoscrotal Web: A Case Series With Literature Review

2020 ◽  
Author(s):  
Volkan Sarper Erikçi
Keyword(s):  
Surgical Treatment ◽  
Clinical Characteristics ◽  
Surgical Techniques ◽  
Case Series ◽  
Scrotal Skin ◽  
Penile Skin ◽  
Surgical Experience ◽  
Postoperative Results ◽  
Pediatric Urologist

INTRODUCTION: Penoscrotal webbing (PSW) is an anomaly of penis and it includes penile and scrotal skin aberration. There are various surgical techniques for repairing PSW with different terminologies. Herein we present our surgical experience of Z-plasty procedure in these cases. METHODS: In this retrospective study, 5 patients with an average age of 46 months who were diagnosed and under follow-up for PSW, between June 2017 and May 2019 were included. Along with demographic and clinical characteristics, treatment and follow-up records were collected. RESULTS: Isolated PSW was observed in 4 patients and one patient had an associated megameatus intact prepuce (MMIP) of a hypospadias variant in addition to PSW. Circumcision and ventral prepuce reconstruction of the penis with the aid of "Z-plasty" solved problem and acceptable postoperative results were obtained. DISCUSSION AND CONCLUSION: PSW is a condition that warrants surgical treatment. During the management of these children, in the case of suspicion of penile skin abnormality at the time of circumcision, it should be deferred and should be consulted to a pediatric surgeon or a pediatric urologist. Gentle surgical treatment is recommended for a favourable surgical and psychological result

Early Results of the ARPE Arthroplasty Versus Trapeziectomy for the Treatment of Thumb Carpometacarpal Joint Osteoarthritis

2017 ◽  
Vol 22 (04) ◽  
pp. 472-478 ◽  
Author(s):  
Johnathan D. Craik ◽  
Simon Glasgow ◽  
James Andren ◽  
Mark Sims ◽  
Reza Mansouri ◽  
...  
Keyword(s):  
Treatment Options ◽  
Complication Rates ◽  
Implant Survival ◽  
Carpometacarpal Joint ◽  
Thumb Carpometacarpal Joint ◽  
Early Results ◽  
Functional Scores ◽  
Thumb Carpometacarpal ◽  
Quick Dash

Background: Thumb carpometacarpal joint arthroplasty for osteoarthritis may hold advantages over trapeziectomy by preserving range of motion, whilst providing stability and preventing thumb shortening. Methods: We compare functional and satisfaction outcomes scores, radiological shortening and complication rates between patients treated with trapeziectomy and those receiving the ARPE thumb CMCJ arthroplasty. Results: Seventy-five trapeziectomies and one hundred and ten ARPE arthroplasties were performed over the study period. Both treatments resulted in significant improvements in functional scores. When matching patients according to pre-operative function, patients receiving the ARPE arthroplasty had better post-operative function (Quick DASH: trapeziectomy = 25.1, ARPE = 16.8). More patients receiving the ARPE arthroplasty were satisfied with their treatment (trapeziectomy = 7.8/10, ARPE = 8.7/10) and would have the same treatment again (trapeziectomy = 76%, ARPE = 89%). The ARPE also resulted in less thumb shortening. However the ARPE arthroplasty is associated with a higher complication rate, with 14% of patients requiring further surgery at a mean of 2 years follow up (95% implant survival). Conclusions: Both trapeziectomy and the ARPE CMCJ arthroplasty are effective treatment options for thumb CMCJ osteoarthritis. Arthroplasty may offer potential advantages in terms of post-operative function and patient satisfaction. However the risk of complications and requirement for further surgery is greater and must be carefully considered during patient selection and pre-operative counselling.

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