Near-miss Injury of Multiple Carpometacarpal Joint Dislocations: A Report of Two Cases

Multiple carpometacarpal joint (CMCJ) dislocations are rare and are easily missed. The anatomical configuration renders stability to the joints. As a result, a high-velocity impact is required to dislocate the joint. We present two cases of multiple carpometacarpal joint dislocations with different mechanisms of injury and their subsequent management at our centre. In case 1, a 29-year-old gentleman presented with acute dislocations of the CMCJs involving the right middle, ring, and little fingers. An open reduction and fixation with Kirschner wires were done to stabilize the dislocated CMCJs and he subsequently recovered. In case 2, a 25-year-old gentleman had the CMCJ dislocations detected late due to other more profound injuries. Partial arthrodesis was performed to address the instability of the CMCJs of the right index, middle and ring fingers. He subsequently recovered and returned to work 6-months postoperatively. The diagnosis of carpometacarpal joint dislocation can be easily missed especially when there is a concurrent distracting injury. It is crucial to maintain a high index of suspicion as early diagnosis and prompt treatment is paramount to yield a better outcome.

Adequate return to sports and sports activities after treatment of Lisfranc injury: a meta-analysis

ImportanceAlthough a large number of Lisfranc injuries occur during sports, data on sports outcomes, such as return to sport (RTS) rates and times as well as level of sports activities after treatment of this injury remain limited.ObjectiveThe aim is to assess the RTS rates, times and the sports activity levels after different treatments of Lisfranc injuries.Evidence reviewThe electronic databases PubMed (MEDLINE), EMBASE, CDSR, DARE and CENTRAL were searched to identify relevant articles from January 1985 to July 2020. The mean RTS rates (to any level and preinjury level of sports) and times were extracted per study, and pooled wherever methodologically possible. Methodological quality of the included studies was assessed using the Methodological Index for Non-Randomized Studies criteria (MINORS).FindingsFifteen studies were included in this review. Methodological quality of the studies was poor. The treatments reported in the studies were conservative treatment, surgical fixation and primary partial arthrodesis. For conservative treatment, the RTS rate regardless of sports level was 93% (95% CI 81% to 98%; n=42) and for return to preinjury level of sports was 88% (95% CI 75% to 95%; n=42). The fixation group showed a RTS percentage of 94% (95% CI 91% to 97%; n=270) to each level of sports and for return to the level before injury was 86% (95% CI 80% to 90%; n=188). In the primary partial arthrodesis group, the return to any level of sports was 94% (95% CI 85% to 98%; n=65) and for return to preinjury level was 74% (95% CI 62% to 83%; n=65). Mean time to RTS ranged from 7 to 33 weeks across all treatment groups. No data pooling was possible for this outcome measure. From the different studies, a total of 43 different sports and 440 physical activities were reported before treatment. After treatment, patients participated in 37 different sports (88%) and 391 different physical activities (89%).Conclusions and relevanceThe different treatment options for Lisfranc injuries allow for good sport-specific outcomes with 93% to 94% of athletes returning to any level of sports, and 74% to 88% of athletes returning to their preinjury level of sport. These sport-specific outcomes can be used to inform patients about their expected sport-specific outcomes after different treatments of Lisfranc injuries.Level of evidenceSystematic review and meta-analysis.

Reproducibility of tomographic evaluation of posterolateral lumbar arthrodesis consolidation

<sec><title>OBJECTIVE:</title><p> To evaluate interobserver agreement of Glassman classification for posterolateral lumbar spine arthrodesis.</p></sec><sec><title>METHODS:</title><p> One hundred and thirty-four CT scans from patients who underwent posterolateral arthrodesis of the lumbar and lumbosacral spine were evaluated by four observers, namely two orthopedic surgeons experienced in spine surgery and two in training in this area. Using the reconstructed tomographic images at oblique coronal plane, 299 operated levels were systematically analyzed looking for arthrodesis signals. The appearance of bone healing in each operated level was classified in five categories as proposed by Glassman to the posterolateral arthrodesis: 1) bilateral solid arthrodesis; 2) unilateral solid arthrodesis; 3) bilateral partial arthrodesis; 4) unilateral partial arthrodesis; 5) absence of arthrodesis. In a second step, the evaluation of each operated level was divided into two categories: fusion (including type 1, 2, 3, and 4) and non fusion (type 5). Statistical analysis was performed by calculating the Kappa coefficient considering the paired analysis between the two experienced observers and between the two observers in training.</p></sec><sec><title>RESULTS:</title><p> The interobserver reproducibility by the kappa coefficient for arthrodesis consolidation analysis for the classification proposed, divided into 5 types, was 0.729 for both experienced surgeons and training surgeons. Considering only two categories kappa coefficient was 0.745 between experienced surgeons and 0.795 between training surgeons. In all analyzes, we obtained high concordance power.</p></sec><sec><title>CONCLUSION:</title><p> Interobserver reproducibility was observed with high concordance in the classification proposed by Glassman for posterolateral arthrodesis of the lumbar and lumbosacral spine.</p></sec>

Load transfer through the radiocarpal joint and the effects of partial wrist arthrodesis on carpal bone behaviour: a finite element study

A finite element model of the wrist was developed to simulate mechanical changes that occur after surgery of the wrist. After partial arthrodesis, the wrist will experience altered force transmission during loading. Three different types of partial arthrodesis were investigated — radiolunate, radioscaphoid, and radioscapholunate — and compared with the healthy untreated wrist. The results showed that the compressive forces on the radiocarpal joint decreased compared with the untreated wrist with both radiolunate and radioscaphoid fusions. The load transmission through the midcarpal joints varied depending on arthrodesis type. The forces in the extrinsic ligaments decreased with the fusion, most noticeably in the dorsal radiotriquetral ligament, but increased in the dorsal scaphotriquetral ligament. From the results of the study it can be concluded that the radioscapholunate fusion shows the most biomechanically similar behaviour out of the three fusion types compared with the healthy wrist. The modelling described in this paper may be a useful approach to pre-operative planning in wrist surgery.

Treatment of Lisfranc Fracture-Dislocations with Primary Partial Arthrodesis

Background: The optimal method of treatment for Lisfranc fracture-dislocations remains controversial, and the role of primary partial arthrodesis for combined osseous-ligamentous Lisfranc injuries is unclear. This study reviewed the outcomes of Lisfranc injuries treated by primary partial arthrodesis. Methods: Patients who underwent primary partial arthrodesis for a primarily ligamentous or combined osseous and ligamentous Lisfranc fracture-dislocation were reviewed retrospectively and assessed at followup according to radiographic, clinical and standardized patient-based outcomes. Twenty-five patients (12 ligamentous, 13 combined), median age of 46 (range, 20 to 73) years, were followed for an average of 42 (range, 24 to 96) months. Results: The average American Orthopedic Foot and Ankle Society (AOFAS) score was 81 points (scale 0 to 100), with patients in general losing points for mild pain, limitations of recreational activities, and fashionable footwear requirements. There was no statistical difference between ligamentous and combined injuries with regard to the physical or mental component scores on the SF-36. At latest followup, patients reported an average return to 85% of their preinjury activity level (range, 50% to 100%). Twenty-one patients (84%) expressed satisfaction with their outcome and at latest followup, the mean visual analog pain scale (VAS) score was 1.8 out of 10 (range, 0 to 8). Three patients showed radiographic signs of posttraumatic arthritis of adjacent joints. Conclusion: Treatment of both primarily ligamentous and combined osseous and ligamentous lisfranc injuries with primary partial arthrodesis produced good clinical and patient-based outcomes. Level of Evidence: III, Retrospective Comparative Study

Arthrodesis of the tarsometatarsal joints in a cat with a two hole advanced locking plate system

SummaryThis report describes the successful use of the novel fixed-angle locking plating system ALPS (advanced locking plate system) in the case of dorsal tarsometatarsal instability in a cat. Partial arthrodesis of the tarsometatarsal joint was performed with a two hole ALPS 5 and two 2.4 mm selftapping locking screws through a small dorsal approach. Five days after the surgery the cat was walking without lameness. Radiographs made after six weeks showed uneventful healing. ALPS offers an alternative to existing plating systems when selecting an implant for the stabilisation of dorsal tarsometatarsal instabilities in cats.