Radiographic Prevalence of Osteoarthritis of the Scaphotrapeziotrapezoid Joint in Patients With Carpometacarpal Osteoarthritis of the Thumb: A Retrospective Case Series

Background: In planning operative treatment of thumb carpometacarpal (CMC) joint osteoarthritis, surgeons should consider the presence of an arthritic scaphotrapeziotrapezoid (STT) joint. We aimed to determine the radiographic prevalence of concomitant (STT) osteoarthritis with thumb CMC osteoarthritis in patients who underwent surgical treatment at our institution. We hypothesized that the prevalence of concomitant arthritis at these 2 joints (STT and CMC) would be lower than previously reported. Methods: Between September 2005 and July 2012, a total of 417 patients were identified from our institution using the Current Procedural Terminology code for thumb CMC joint arthroplasty (25447). After applying exclusion criteria and identifying patients who underwent treatment, a total of 194 patients were included and 218 preoperative radiographs were available for review. Each radiograph was categorized according to the Eaton classification of thumb CMC osteoarthritis, with stage 4 involving the (STT) joint. Evaluation was performed by four reviewers independently. Results: A total of 47 (21.6%) patients had varying degrees of concomitant (STT) joint osteoarthritis with the thumb CMC joint osteoarthritis. Stage 4 was reported in 6.4% (14) of the radiographs. Conclusions: The radiographic prevalence of concomitant (STT) osteoarthritis with thumb CMC osteoarthritis may be lower than previously reported. Further studies that include a similarly large sample size and additional radiographic views can help evaluate the likelihood of these conditions in patients who elect to undergo surgical treatment of thumb CMC osteoarthritis

Elbow Injuries in the Throwing Athlete: A Review

Overhand-throwing motions can create supraphysiologic stresses on the elbow. Repeated stresses often result in overuse injuries affecting the elbow, which are commonly seen in throwing athletes. Noted problems include medial epicondylitis, valgus extension overload, olecranon stress fractures, ulnar neuritis, and damage to the ulnar collateral ligament. Symptoms of pain or numbness at presentation vary in location depending on the injury. Successful diagnosis is typically made using results of physical examinations of elbow, wrist, and arm extensions; results of tests for valgus instability; and findings radiographs can all help indicate the problem. However, pathological features of these injuries are not always clear, which can complete effective treatment. Baseball pitchers are often discussed when investigating overhand-throwing athletes; yet the current review examines players of various overhandthrowing sports to help assess causes, diagnosis, and treatment of related elbow injuries

Comparison of Blood Loss Between Short-Stem and Conventional Femoral Implants in Total Hip Arthroplasty

Background: Although the postoperative results of total hip arthroplasty (THA) are generally successful, the standard technique and implant design have many proposed modifications. The purpose of the current study was to determine if using short-stem femoral implants minimized the intraoperative blood loss during THA when compared with conventional THA. Methods: The medical records of patients who underwent THA using short-stem and conventional femoral implants between 2009 and 2013 were reviewed. Patients with previous surgical procedures for treating the acetabulum or proximal femur and patients without reported hematocrit levels were excluded; subsequently, a total of 53 patients for each group (short-stem or conventional implants) were included. Demographic and outcome variables were collected and analyzed for statistical significance using the Fisher exact test. Results: No significant difference was noted in the patient mass index, preoperative hematocrit level, postoperative decrease in hematocrit level, and mean operating time between the groups. On unadjusted analysis, age, sex, transfusion rates, and blood loss were significant between the groups (P \u3c 0.001, P = \u3c 0.001, P = 0.04, and P = 0.01, respectively). On adjusted analysis for age and sex, no significant difference in transfusion rate was noted (P = 0.12 and P = 0.01, respectively). Conclusions: The use of short-stem implants may not be significantly related to a reduced blood loss compared with conventional implants. However, further studies are needed to analyze the clinical significance between blood loss and implant use

Third Extensor Compartment Disruption and the Biomechanics of Thumb Extension

Background: Procedures involving release of the third dorsal wrist compartment have been thought to transpose the extensor pollicis longus (EPL) tendon from its anatomical position. Few studies, however, have reported on the effects this might have on function and mechanics of the thumb. We analyzed the impacts of intact extensor retinaculum, release of the third dorsal compartment, and removal of Lister’s tubercle on thumb extension. Methods: A total of 15 fresh-frozen cadaveric upper extremities (eight male, seven female; mean age, 52 years; range, 38-59 years) were used. For each specimen, three phases of testing were analyzed: the extensor retinaculum was intact, third dorsal compartment was released, and Lister’s tubercle was released. Force-displacement measurements were obtained to determine maximum extension and stiffness of the thumb by applying 1 N increments on the EPL until full extension of the thumb occurred. A one-way analysis of variance was used for statistical comparison. Results: In 14 of 15 specimens, the EPL tendon transposed during the first trial after release of the extensor retinaculum. No significant difference in mean maximum extension or stiffness of the thumb was found (P = 0.45 and P = 0.74, respectively). Conclusion: Functional loss of thumb extension may not occur with EPL transposition after release of the third dorsal compartment or removal of Lister’s tubercle. In patients with weakness in thumb extension, repairing the third dorsal compartment or creating a new pulley may not be effective