Therapeutic, III.

Fractures of the hamate body and the base of the fourth metacarpal bone in the coronal plane with or without a dislocation of the base of the fifth metacarpal bone are rare. Clenched fist punches are considered to be the main cause. The diagnosis of the fracture dislocation is often missed on routine radiographs. Posterior-anterior, lateral, and oblique views are required for native radiological evaluation. A CT scan can help in the assessment of severity and for preoperative planning. Unless minimal displacement is present, non-surgical treatment does not lead to satisfying outcome. Displaced fractures of the hamate body and the base of the fourth metacarpal bone with or without subluxation of the hamatometacarpal joint should be stabilised by open reduction and internal fixation (ORIF). Controversy exists about the surgical treatment of choice. Screw or K-wire fixation with postoperative cast immobilisation for 6 weeks and consecutive hardware removal has been found to result in excellent clinical and radiological outcomes. This study presents 2 cases of coronal fractures of the body of the hamate and the base of the fourth metacarpal bone with subluxation of the hamatometacarpal V joint. Anatomy, epidemiology, classification, mechanism, clinical symptoms, diagnostic features, and therapy options for these injuries are discussed.

No abstract

Isolated osteoarthritis of the scaphotrapeziotrapezoid joint is rather rare compared with thumb trapeziometacarpal osteoarthritis. The aim of this retrospective study was to evaluate the outcome of 15 consecutive patients treated with trapeziectomy/ligament reconstruction tendon interposition for isolated scaphotrapeziotrapezoid osteoarthritis of the wrist. After a mean follow-up of 54 months, 14 patients (15 wrists) were available for clinical and radiological examination. The median pain intensity was 0 on a 0-10 visual analogue scale, both at rest and with activity, mean grip strength averaged 24 kg, pinch strength 5 kg. The disabilities of the arm, shoulder and hand (DASH) score was 16, and a modified Mayo Wrist Score 84. Correlation between the degree of scaphotrapezoid osteoarthritis and pain at rest, pain with activity, and DASH score was not significant. The findings from our study suggest that trapeziectomy/ligament reconstruction tendon interposition is an effective procedure for treating isolated scaphotrapeziotrapezoid osteoarthritis, and that additional partial trapezoid excision is not necessary.

Femoral avulsion fracture of the anterior cruciate ligament (ACL) in children and adolescents is rare, and its arthroscopic treatment is even more so. A femoral avulsion fracture of the ACL of a 14-year-old girl was arthroscopically reduced and fixed by a Kirschner wire (K-wire) via an inside-out technique. A 1.4-mm K-wire was drilled inside-out into the osseous defect of the lateral femoral condyle under arthroscopic visualization. The avulsed fragment was reduced and then drilled retrograde by the wire. After bending the intra-articular visible end of the K-wire by a knot pusher, the fragment was gently fixed by pulling the wire from outside. At 24 months, both knee stability and range of motion were the same in the operated and the healthy opposite leg. Magnetic resonance imaging evaluation and conventional radiographs showed an intact ACL without detectable disturbance in the growth plate. Only seven cases of a proximal avulsion of the ACL in children and adolescents have been published. Six were treated by open reduction and internal fixation, one by arthroscopic reduction without fixation.