Complex regional pain syndrome (CRPS) type I may occur as complication after any type of surgery for basal joint arthritis of the thumb. We investigated prospectively in an ongoing study our results after a fully standardized treatment with a total joint prosthesis under vitamin C prophylaxis.Patients with trapeziometacarpal arthritis stage II or III according to Dell, and no benefit from conservative treatment, were selected to undergo joint replacement with a semi-constrained hydroxyapatite coated prosthesis.First web opening and visual analogue scale (VAS) scores for pain, activities of daily living (ADL) and satisfaction were taken pre and postoperatively. Vitamin C 500 mg daily was started two days prior to surgery during 50 days as prevention for CRPS. Post-operative treatment was functional.We performed 40 implantations for trapeziometacarpal arthritis in 34 patients (mean age 60.8 years; 27 females, 7 males) with a mean follow-up of 44 months. Operations were performed in day care under regional (or general) anesthesia.First web opening increased with 15.4 degrees and there was a significant improvement for pain, ADL and satisfaction as well (p = 0.000). Patient satisfaction was strongly associated with the amount of pain reduction. According to the Veldman and IASP criteria, there were no cases of CRPS.The overall complication rate for this procedure is high. Literature reports 5 cases of CRPS after 38 operations with the same implant (13%). We advise vitamin C as prophylaxis against CRPS in trapeziometacarpal joint replacement.
Complex regional pain syndrome (CRPS) type I may occur as complication after any type of surgery for basal joint arthritis of the thumb. We investigated prospectively in an ongoing study our results after a fully standardized treatment with a total joint prosthesis under vitamin C prophylaxis.Patients with trapeziometacarpal arthritis stage II or III according to Dell, and no benefit from conservative treatment, were selected to undergo joint replacement with a semi-constrained hydroxyapatite coated prosthesis.First web opening and visual analogue scale (VAS) scores for pain, activities of daily living (ADL) and satisfaction were taken pre and postoperatively. Vitamin C 500 mg daily was started two days prior to surgery during 50 days as prevention for CRPS. Post-operative treatment was functional.We performed 40 implantations for trapeziometacarpal arthritis in 34 patients (mean age 60.8 years; 27 females, 7 males) with a mean follow-up of 44 months. Operations were performed in day care under regional (or general) anesthesia.First web opening increased with 15.4 degrees and there was a significant improvement for pain, ADL and satisfaction as well (p = 0.000). Patient satisfaction was strongly associated with the amount of pain reduction. According to the Veldman and IASP criteria, there were no cases of CRPS.The overall complication rate for this procedure is high. Literature reports 5 cases of CRPS after 38 operations with the same implant (13%). We advise vitamin C as prophylaxis against CRPS in trapeziometacarpal joint replacement.
PurposeCases of hepatitis C (HCV) reported to the Centers for Disease Control (CDC) for Fairbanks, AK, are strikingly low compared to the national average. This is, in part, due to a lack of identified cases. Fairbanks population has a very high incidence of IV drug use, a major risk factor for HCV transmission. The population also has a high incidence of tattooing (both homemade and commercial) that may present a transmission risk. Commercial tattoo artists were not required to be licensed before 2001. Testing rates have decreased in recent years. An attempt was made to increase awareness of HCV, risk, and available testing.MethodsCommunity members (including public health nurse, local doctors, patients, and local tattoo artist) were interviewed to gain understanding of local hepatitis C risks and care. Research was completed using PubMed, CDC, State Epidemiology, and various hepatitis C Web sites. An informative flyer was created to share information on HCV as a potentially quiet but worsening disease. Risk factors were listed. Free testing at a public health clinic was advertised. The flyer was circulated at the local needle exchange program and in two local clinics.SummaryIncreased awareness of HCV, risk, and testing should increase the number of Fairbanks residents who identify their need to be tested. Since treatment may be able to stop the progression of liver disease due to HCV, testing may eventually lead to improved outcomes. Community interest and involvement in HCV prevention and treatment should also increase with the flyer.
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