Background: The purpose of this study was to evaluate the demographics and early radiographic treatment outcome of patients with carpometacarpal (CMC) injuries at our institution over a 10-year period. Methods: We conducted a retrospective review of all patients who sustained CMC injuries of the second to fifth digits between 2005 and 2015. We recorded demographic data, mechanisms of and associated injuries, treatment methods, and complications. Injury and intraoperative and postoperative radiographs were evaluated, and the adequacy of reduction was determined on lateral radiographs of the hand using a grading system that we developed. Results: Eighty patients were included in this study. Delivering a blow with a closed fist was the most common mechanism of injury; however, high-energy mechanisms also made up a large percentage of those included. Injuries to the fourth and fifth CMC joints were most common, and these were frequently associated with fractures of the metacarpal bases and distal carpal row. Closed reduction and percutaneous pinning offered a higher percentage of patients with concentric reduction at the time of pin removal. Time to surgery was significantly different between those with concentric reduction and those with residual subluxation. Conclusion: The most common mechanism of CMC injuries was blow with a closed fist; however, these injuries can be associated with high-energy mechanisms. Fractures of the metacarpal base and distal carpal row are commonly seen with these injuries. With early diagnosis, closed reduction and percutaneous pinning achieved concentric radiographic reduction. Delayed diagnosis makes closed reduction difficult and was associated with less favorable radiographic outcome.
Background: Tranexamic acid (TXA) is a medication that has been shown to decrease blood loss and risk of blood transfusion in total knee and total hip arthroplasty. The purpose of this study was to evaluate the use of TXA in patients undergoing total ankle arthroplasty (TAA). We hypothesized there would be less blood loss and wound complications in patients receiving TXA. Methods: A retrospective review of 2 patient cohorts operated on by 2 surgeons was performed from 2010 to 2018. We compared a group of TAA patients that did not receive TXA vs a subsequent group that received TXA. Patients received 1g intravenous TXA before the tourniquet was inflated followed by another 1 g after release of the tourniquet. Intraoperative blood loss was recorded and preoperative hemoglobin and hematocrit levels were compared to postoperative levels. Intraoperative and postoperative complications were compared between the 2 groups. A total of 119 patients were included in the study, of whom 55 received TXA. No significant difference existed between the 2 groups in gender, age, body mass index, or Charlson comorbidity index. Results: There was no difference in estimated blood loss, postoperative hemoglobin/hematocrit values or preoperative to postoperative change in hemoglobin/hematocrit values. Additionally, there was no difference in wound complications or overall complication rate between the groups. Conclusion: TXA has been shown to be effective in total knee and total hip arthroplasty in decreasing blood loss and transfusion risk. We did not find it to be effective in reducing intraoperative blood loss, perioperative blood loss, or wound complications in TAA. Level of Evidence: Level III, comparative study.
Injuries to the medial meniscus meniscocapsular junction, also known as ramp lesions, are common in the setting of anterior cruciate ligament injuries with a prevalence of 9% to 42%. Anatomically, ramp lesions involve disruption of the posterior meniscocapsular junction and meniscotibial ligaments. Biomechanically, ramp lesions are associated with an increase in anterior tibial translation and internal and external tibial rotation in anterior cruciate ligament-deficient cadaveric knees. Magnetic resonance imaging is useful in evaluating the meniscocapsular junction. Irregularity or increased signal near the posterior meniscocapsular junction and/or signal change indicative of posterior medial tibial plateau edema can suggest these injuries are present before surgical intervention. The current benchmark for diagnosis is arthroscopic visualization of the posterior medial meniscocapsular junction viewed through the intercondylar notch. Once a ramp lesion is identified, stability should be assessed by arthroscopic probing to determine the degree of anterior displacement. Optimal treatment has been debated in the literature, especially for stable ramp lesions, although good outcomes have been shown with and without repair. Repair is warranted for those lesions that are unstable to probing. Unfortunately, only limited literature available to guide clinicians on the optimal rehabilitation for ramp lesions. Meniscal tears are common in the setting of anterior cruciate ligament (ACL) tears, with a prevalence as high as 55% to 65%. 1 Meniscal ramp lesions were initially described as a type of meniscal injury involving the peripheral meniscosynovial attachment of the posterior horn of the medial meniscus seen in conjunction with an ACL tear. 2 Strobel et al coined the term ramp lesion to distinguish this injury from other types of posterior longitudinal meniscal tears because ramp lesions occur at the posterior periphery of the meniscal ramp on a sagittal MRI. 2 More recently, in addition to the peripheral meniscocapsular junction, disruption of the meniscotibial ligaments is also noted. 3 Injuries to this area are biomechanically relevant because they increase not only anterior tibial translation but also internal and external tibial rotation in ACL-deficient cadaveric knees. [4][5][6]
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