Short report letter: Cortical contact is unnecessary to prevent stem subsidence in cementless trapeziometacarpal arthroplasty

Abstract

swelling might be localized to the snuffbox, but since the patient is unlikely to know which bone is supposed to be broken, there might be other exaggerated signs, such as rigidity of the wrist and a level of subjective pain out of proportion upon range of motion testing. Additionally, the common signs of scaphoid fracture, such as scaphoid tuberosity tenderness on the palmar side, might be absent or poorly localized. Our experience is that the patient's personality and history of injury, given in the bullet points mentioned, play key roles in the diagnosis. Malingering will persist if the malingerer believes it will produce the desired rewards. The feigned symptomswill disappearonce therewards havebeenattained (Sadock et al., 2004). The management of this type of presentation is controversial and additional problems are raised when it occurs in the military setting. Strategies range from tactfully but firmly confronting patients about their behaviour and its consequences to allow the patient to 'save face', as direct confrontation will likely result in the avoidance of contact with medical services. It is not our purpose to discuss treatment, but rather to draw attention to the presentation. In our experience, management of a suspected spurious injury should always include a full workup consisting of past and current medical history and a physical examination. Radiographs are mandatory, especially during the first encounter with the patient for the given injury. The higher occurrence of true scaphoid fractures in the military population compared with the civilian population should also be borne in mind (Wolf et al., 2009).

Aktuelle Trends bei der Implantation der Touch-Prothese am Daumensattelgelenk: Ergebnisse des 1. deutschsprachigen Anwendertreffens

“…Für die Größenbestimmung der Schaftkomponente ist diese Kontrolle eher von untergeordneter Bedeutung. Idealerweise sollte der Prothesenschaft nicht den gesamten Markraum ausfüllen und nicht direkt an die Kortikalis anstoßen, um ein stress shielding zu vermeiden 94 . Vielmehr ist eine Ummantelung mit komprimierter Spongiosa für eine gleichmäßige Druckverteilung optimal.…”