Surgical revision options for failed trapeziometacarpal total joint replacement include implant replacement and trapeziectomy. However, discontinuation of older implants complicates revision with original components, particularly as removing a well-fixed metacarpal stem can be challenging. This study examined the feasibility of pairing discontinued stems (Arpe, Elektra and Ivory) with currently available necks (Maïa, Moovis and Touch). We analysed the metallurgical composition, insertion depth, contact surface area and mechanical stability for all possible combinations of these implants. Our findings show compatibility of both Ivory and Arpe stems with the Touch neck and of the Elektra stem with the Moovis neck. Under strict lateral loading, fixation was stable up to 826.87 N, surpassing in vivo forces. Microscopic evaluation after the biomechanical load-to-failure test showed negligible damage to the connecting surfaces. These results suggest that it is safe to pair discontinued stems with currently available necks in revision trapeziometacarpal total joint arthroplasty.

[This corrects the article DOI: 10.1016/j.jham.2024.100173.].

Introduction Proximal phalanx fractures in children, especially mid-diaphyseal fractures, can result in malunion and significant functional impairment. Early malunions require prompt and effective intervention to prevent long-term complications. This case study highlights the use of intramedullary headless compression screw (IMHCS) fixation in addressing a proximal phalanx malunion. Case presentation A 12-year-old boy presented with a malunion of the mid-diaphyseal proximal phalanx of the fourth finger following conservative treatment of a cycling injury. Initial management involved immobilization followed by buddy taping; however, incomplete radiographic evaluation resulted in an underestimation of the volar angulation. At the four-week follow-up, the patient exhibited 50° volar angulation, clinodactyly, and marked stiffness. The malunion was treated surgically with retrograde IMHCS fixation after osteoclasis. Radiographic evaluation confirmed proper reduction and alignment. The patient began physical therapy immediately, achieved full range of motion within four weeks and maintained excellent functional outcomes at one year postoperatively. Discussion Retrograde IMHCS fixation is an innovative technique for managing phalangeal malunions, providing stable fixation and enabling early mobilization. This method avoids the physis, minimizing the risk of growth disturbances, eliminates the need for hardware removal, and ensures proper alignment. Conclusion IMHCS fixation is a promising solution for early malunions and potentially fresh fractures of the proximal phalanx in pediatric patients. It offers stable fixation, preserves physeal integrity, and supports early rehabilitation, contributing to excellent functional recovery. Further studies are needed to evaluate its long-term outcomes.

Emerging advances in immersive virtual reality incorporating optical hand-tracking present promising potential for application in orthopedic hand therapy. The system is designed to analyze hand movements, enabling users to "use" their hands virtually in any fabricated setting. This article, supplemented with videos, examines practical applications of immersive virtual reality in routine hand therapy and provides a scientific presentation of the interaction of immersive virtual reality with our physiological and neurological systems. Indications for immersive virtual reality use, critical evaluations and recommendations are comprehensively discussed. Immersive virtual reality has the potential to evolve into a standard treatment modality in orthopedic hand therapy.

Background: In patients with symptomatic trapeziometacarpal (TMC) joint arthritis resistant to conservative treatment, surgical treatment can be advised. One of the many surgical treatment options is TMC arthroplasty. The Arpe prosthesis is one example of these TMC arthroplasties.Methods: This retrospective study evaluated patients who underwent TMC arthroplasty with the Arpe prosthesis after a minimum of 15 years of follow-up. Clinical, radiologic, and qualitative outcomes were assessed for 43 Arpe arthroplasties in 41 patients, of whom 2 had bilateral arthroplasties. The female to male ratio was 39:4. The mean follow-up time was 197 months (range = 180-225).Results: The cumulative survival rate after a mean of 16.5 years was 84%. Seven failures (16%) were registered, of which 5 during the first 3 years after primary surgery. All patients were successfully converted to a trapeziectomy. Quick Disabilities of the Arm, Shoulder and Hand score improved with 44.9 points and visual analogue pain score with 97% and 91% at rest and during exercise, respectively.Conclusions: This series demonstrates that thumb arthroplasty is a reliable long-term solution for thumb base arthritis, with significant pain reduction and functional improvement, even after 15 years of follow-up.

Triggering of the thumb is a well-known condition in the current orthopaedic practice.Although most cases of triggering are idiopathic, some are caused by specific anomalies.We present a rare case of atraumatic, bilateral triggering of the thumb caused by a congenital sesamoid bone at the volar aspect of the interphalangeal joint.Sesamoidectomy resulted in immediate and sustained resolution of pain and clicking.In this article, we discuss a step-by-step surgical approach for sesamoidectomy while reviewing the more uncommon causes of triggering.We argue that a broad spectrum of etiologies should be included in the differential diagnosis when opting for surgery in the treatment of trigger thumb.

Introduction: Avascular necrosis of the lunate bone has been extensively researched, although the etiology of the condition remains controversial. Even though many treatments for the disease exist, a better understanding of the pathophysiology can improve our decision-making between preventive and therapeutic measures. Various hematological disorders have been found to predispose for Kienböck’s disease. On the other hand, there has not yet been any reference in literature to a relationship between this condition and hereditary hemochromatosis (HH). Case Report: We present two cases of Kienböck’s disease in two patients who are third-degree relatives and diagnosed with HH. A 61-year-old Caucasian female patient with type 1 HH presented with symptomatic Kienböck’s disease on the left side. The patient is a third-degree relative of a 51-year-old male Caucasian patient with Kienbock’s disease on the right side, known as having the same hereditary hematological condition. Conclusion: Our findings suggest a potential correlation between the aforementioned conditions. The prevalence of these coexisting pathologies should be studied further. Keywords: Kienböck, lunate, osteonecrosis, hemochromatosis.

Carpal tunnel syndrome (CTS) is a common health issue and can be treated with a surgical carpal tunnel release (CTR) providing mainly lasting clinical relieve. However, in some patients, symptoms recur after a variable period. Redo surgery can be considered and different techniques have been propagated. This systematic review aims to investigate whether a hypothenar fat pad flap (HFF) technique provides better clinical outcomes than a second open CTR as revision surgery in these cases.Nine out of 764 articles, included after a systematic search in four databases (PubMed, Embase, Web of Science and Scopus), met our in- and exclusion criteria. We reported following outcomes: Tinel sign, pain score, sensibility, grip- and pinch strength, (q)DASH (Disabilities of the Arm, Shoulder and Hand) score, BCTQ (Boston Carpal Tunnel Questionnaire) and/or satisfaction.Both open CTR as HFF are likely to improve post-surgical pain and sensibility, moreover patients score better on the (q)DASH and BCTQ after the intervention. A HFF provides a significant post-surgical amelioration on both grip- and pinch strength tests and shows a clear trend towards decreased post-interventional present Tinel sign. However, for these outcomes, no data considering open CTR was available.When interpreting the results, it is important to keep in mind the limitations of this resume. Most importantly, there were no directly comparative studies available for the selected outcomes. Meaning data from different studies reporting outcomes after either HFF or CTR were compared. Furthermore, the included studies have all quite small populations and some of them did not even do statistical analysis on their data. Although we have been very strict in selecting only patients with recurrent symptoms, there is a wide variety of definitions used to describe recurrence.In our knowledge, this is the first systematic review with a single focus on these two procedures in a well-defined population with recurrent carpal tunnel symptoms reporting this extensive amount of outcomes. As reported outcome studies on revision carpal tunnel surgery are very heterogeneous and data are difficult to compare, no superiority of either one technique can be concluded.We believe this review is important to highlight the lack of comparative studies in this orthopedic area and may serve as a matrix for a qualitative (randomised) controlled trial to further investigate superiority of one of both revision techniques.

Broader adoption of ultrasound (US) imaging in carpal tunnel syndrome management enhances patient care and outcome. This case underscores the importance in diagnosing carpal tunnel syndrome, highlighting its capability to uncover hidden anomalies and assist in surgical planning.

Objective: Management of recurrent Dupuytren's disease of the little finger is challenging. Various treatment modalities have been proposed: external fixation, local skin flap, dermofasciectomy, or even amputation. An alternative surgical technique was introduced by Honecker et al. in 2016 and refined by Raimbeau et al. in 2019, consisting in resection of the middle phalanx and shortening arthrodesis. We modified the technique by combining arthrodesis with a limited fasciectomy of the abductor and/or pretendinous cord in the fifth ray to improve cosmetic and functional outcomes. Methods: Patients with severe recurrent Dupuytren's disease of the little finger (Tubiana stage III/IV) were treated with proximodistal interphalangeal arthrodesis, combined with limited fasciectomy. Range of motion was assessed preoperatively and postoperatively. QuickDASH and a VAS were assessed to determine overall function and pain respectively. Radiographic evaluation was made at 6 and 12 weeks postoperatively.Results: Thirteen patients were eligible for inclusion. Mean age was 69 years (range 49-87). Radiographic consolidation was obtained at a mean 58 days (range 27-97). Full extension of the metacarpophalangeal joint was achieved in 11 patients and full adduction in 12. Mean active flexion was 948 (range 90-100). QuickDASH scores decreased from 18 to 12 after surgery. Pain scores were low and unchanged.Conclusion: By combining proximodistal interphalangeal arthrodesis with limited fasciectomy through a volar approach, finger extension improved, and fixed abduction was also treated. The combined volar and dorsal approach did not induce vascular impairment or other complications.⠂C 2023 SFCM. Published by Elsevier Masson SAS. All rights reserved.

Management of recurrent Dupuytren's disease of the little finger is challenging. Multiple treatment modalities have been proposed, such as external fixation, local skin flaps, dermofasciectomy and even amputation. An alternative surgical technique was introduced by Honecker et al. in 2016 and refined by Raimbeau et al. in 2019, consisting of resection of the middle phalanx and fusion of the shortened finger by proximodistal interphalangeal arthrodesis. We modified the technique by combining arthrodesis with a limited fasciectomy in the fifth ray to improve outcome, cosmesis and function. Patients with severe recurrent Dupuytren's disease of the little finger (Tubiana stage III/IV) were treated with proximodistal interphalangeal arthrodesis, combined with limited fasciectomy of the pretendinous and/or abductor cord. The latter was performed through a palmar incision and closed with one or more Z-plasties. Range of motion was assessed preoperatively and postoperatively. QuickDASH score was obtained to determine overall function. Radiographic evaluation was done at six and twelve weeks postoperatively. Thirteen patients were found eligible for inclusion. Mean patient age was 69 years (range: 49–87). Radiographic consolidation was obtained after a mean of 58 days (range: 27–97). Full extension of the MP joint could be obtained in eleven patients, full adduction in twelve patients. Mean active flexion of 94 degrees was measured (range: 90–100). QuickDASH scores decreased from 18 to 12 after surgery. Recurrence after surgery for severe DD is common and more frequent when the diathesis is strong. The little finger has a poorer prognosis, and recurrence rates range from 16.6%–39%. Furthermore, the risk of wound-healing complications is higher in repeated surgery. As in the case report by Ito et al., the described technique provides additional reduction of the flexion contracture and correction of the residual abduction contracture of the fifth finger. The main interest of proximodistal arthrodesis as a salvage procedure lies in the conservation of a sensitive digital pulp and a nail, which is both functional and esthetic. Associating a volar approach has the advantage of improving little-finger motion, but incurs inherent risk of damage to neurovascular structures and possible postoperative complications. Combining proximodistal interphalangeal arthrodesis with limited fasciectomy through a volar approach, is a valuable alternative to the existing techniques in advanced recurrent DD of the little finger (especially in Tubiana st IV). The combined volar and dorsal approach caused no vascular compromise or other complications.

Digital mucous cysts are common, benign and highly recurrent tumors of the distal interphalangeal joints of the fingers and often associated with osteoarthritis. Multiple treatment modalities have been described, but still no consensus is stated. In the absence of degenerative changes, we promote a novel non-surgical approach. The aim of this study was to examine all patients with digital mucous cysts without underlying osteoarthritis, undergoing this injection technique and to assess outcome and complications of this procedure. This was a single center study (2018-2019) of 17 patients who received a long needle trajectory aspiration and injection for treatment of digital mucous cysts. Exclusion criteria were prior surgical treatment, post-traumatic cyst formation and the presence of radiographic distal interphalangeal joint osteophytosis. A total of 15 patients were found eligible for inclusion. The patient reports were retrospectively analyzed with a follow-up of 6 months. The primary study outcome was resolution of the cyst; secondary outcomes were complications of the procedure. Twelve (80%) resolved completely and three (20%) had limited local recurrence at 6 months. No complications were reported. None of the patients with limited recurrence desired further treatment. We believe that this technique offers a non-invasive, low-cost treatment option for digital mucous cysts, particularly in the subset of patients with ample evidence of degenerative articular changes in the distal interphalangeal joint. The described technique can be performed in an office-based setting and avoids typical surgical as well as aspiration-associated complications.

We report the case of a 14-year-old boy with an isolated Salter-Harris type IV physeal fracture of the distal ulna. Following failed closed reduction, transition to open reduction and pin fixation was required. Six-month follow-up showed a favourable clinical evolution. Evidence suggests that long-term follow-up is needed because of the increased risk of premature physeal closure and subsequent growth disturbances associated with this type of injury.

BackgroundAlthough carpal tunnel syndrome (CTS) is the most common form of peripheral entrapment neuropathy, its pathogenesis remains largely unknown. An estimated heritability index of 0.46 and an increased familial occurrence indicate that genetic factors must play a role in the pathogenesis.Methods and resultsWe report on a family in which CTS occurred in subsequent generations at an unusually young age. Additional clinical features included brachydactyly and short Achilles tendons resulting in toe walking in childhood. Using exome sequencing, we identified a heterozygous variant (c.5009T>G; p.Phe1670Cys) in the fibrillin-2 (FBN2) gene that co‐segregated with the phenotype in the family. Functional assays showed that the missense variant impaired integrin-mediated cell adhesion and migration. Moreover, we observed an increased transforming growth factor-β signalling and fibrosis in the carpal tissues of affected individuals. A variant burden test in a large cohort of patients with CTS revealed a significantly increased frequency of rare (6.7% vs 2.5%–3.4%, p<0.001) and high-impact (6.9% vs 2.7%, p<0.001) FBN2 variants in patient alleles compared with controls.ConclusionThe identification of a novel FBN2 variant (p.Phe1670Cys) in a unique family with early onset CTS, together with the observed increased frequency of rare and high-impact FBN2 variants in patients with sporadic CTS, strongly suggest a role of FBN2 in the pathogenesis of CTS.

Primary bone and soft tissue tumours are rare in a non-referral teaching department. The incidence varies greatly among the different subtypes and every Orthopaedic surgeon will encounter one or more benign or malignant lesions during their careers. History, clinical examination and technical investigations are of great importance, but basic knowledge and basic principles are necessary for a correct clinical practice. It was the purpose of this study to raise awareness towards such pathology by exemplifying our cases from a two-year period in our community-based hospital and if necessary, to refer patients to specialised sarcoma centres.

The purpose of this study was to evaluate the safety and the effectiveness of a new modified anconeus transfer technique in revision surgery for refractory lateral epicondylitis of the elbow. A modified anconeus muscle transfer was performed in nine patients with persistent symptoms after previous surgical release of the common extensor origin. The original technique was modified by using only half of the anconeus muscle. Patients were clinically evaluated, including quickDASH score and grip strength measurement. At a mean follow up period of 36 months, 4 patients had an excellent result, 3 a good result and 1 a poor result. All patients rated their clinical situation as better than before surgery. All but one patient said to be happy with the result and they would undergo the procedure again. The mean quickDash score at the follow up was 10.6 (SD 14.4). No complications were observed. The modified Anconeus muscle transfer is a safe and effective procedure in patients with persistent lateral epicondylitis complaints after a previous surgical release.

Dupuytren's disease is a connective tissue disorder leading to contractures. It can be treated surgically or through injections of collagenase Clostridium histolyticum (CCH). Patients with Dupuytren's contracture (> 20°) and a palpable cord were included in this observational study, aiming to characterise the Belgian patient population and to assess the effectiveness and safety of CCH. Overall, 108 patients (114 joints) received at least one injection of CCH, and 104 patients completed the study. The percentages of joints achieving a degree of contracture of 5° or less, or a relative contracture reduction of at least 50% after the extension procedure were 64.9% and 90.1%, respectively. The mean number of injections per cord was 1.0. The Unité Rhumatologique des Affections de la Main score decreased from 29.4 ± 11.0 to 12.9 ± 6.3 (mean ± SD ; p < 0.0001). CCH was demonstrated to be effective, safe and able to increase quality of life.

The clinical history and technical investigations for diagnosing an osteoid osteoma are well described in the literature, although the presentation is not always typical. An osteoid osteoma of the coronoid process with diminished forearm rotation is unusual. This in contradistinction to the more common flexion-extension deficit.