Sacroiliac arthrodesis using a posterior midline fascial splitting approach and pedicle screw instrumentation: a new technique

Many techniques for sacroiliac arthrodesis have been described. No single technique is universally accepted as the standard. The current report describes a new technique using a midline fascial-splitting approach and pedicle screw instrumentation. Four consecutive patients with nontraumatic disorders of the sacroiliac joint who have undergone successful arthrodesis by the described technique are presented. One patient had a spontaneous sacroiliac disruption secondary to rheumatoid arthritis, and was returned to her previous ambulatory status after fusion of the disrupted joint. Her fusion remained stable for 9 years postoperatively. The others had degeneration of the sacroiliac joint that was symptomatically improved by arthrodesis. The described method of sacroiliac arthrodesis may be an attractive option for surgeons who are familiar with pedicle screw instrumentation techniques.     

Clinical biomechanics of the peritalar joint

The peritalar joint includes the articulations between the talus and calcaneus and the talus and navicular. Motion between the talus and calcaneus is described most often as rotation about an axis that points medially, anteriorly, and superiorly. This motion is considered to be triplanar, with inversion, plantar flexion, and adduction occurring together, whereas eversion, dorsiflexion, and abduction are associated. Similar motions have been described between the talus and navicular. Foot deformity, such as a pes planus or a pes cavus foot type, and hindfoot or midfoot joint fusion can alter the biomechanics of the peritalar joint.     

Immediate free vascularized joint transfer from second toe to index finger proximal interphalangeal joint: a case report

The results of treatment of severe injuries to the proximal interphalangeal joint are unsatisfactory. The methods of joint reconstruction are discussed, including fusion, implant arthroplasty, perichondrial grafting and vascularized joint transfer. A patient is presented with a severe crush injury to the dorsum of the index finger with loss of skin and extensor tendon and proximal interphalangeal joint disruption. Immediate reconstruction of the finger is described using a composite free flap of skin, extensor tendon and proximal interphalangeal joint from the second toe. Follow-up at two years is described, demonstrating proximal interphalangeal motion and finger function.     

Hallux tenotomy-capsulotomy

The deformity of the hallux that is described in this article is most probably more common than we realize and is often seen in patients with mycotic nails and subungual exostosis. This pathology is easily corrected with a tenotomy-capsulotomy at the level of the distal interphalangeal joint. This procedure, when accomplished as described, does not affect the function of the hallux at the level of the metatarsophalangeal joint.     

Late presentation of a complete complex thumb metacarpophalangeal joint dislocation: A case report

Metacarpophalangeal (MP) joint injuries and dislocations of the fingers and thumb are not uncommon. They can be classified directionally as either being volar or dorsal, and are further categorized as incomplete, simple complete or complex complete. Complex dislocations are described as dislocations that are irreducible and often require surgical intervention. This is often because tissue has become entrapped within the MP joint, precluding its anatomical reduction. For the thumb MP joint, anatomical structures that may become trapped include the volar plate, sesamoid bones, bony fracture fragments or the flexor pollicis longus tendon. Both dorsal and volar surgical approaches have been described, and their relative merits will be discussed. The unusual case of a late presentation (two months postinjury) of a complex complete dorsal dislocation of the thumb MP joint approached from a dorsal incision is presented.     

Surgical approach to the ulnar wrist

A dorsal surgical approach that allows safe exposure of the distal radioulnar joint and the ulnar aspect of the wrist joint and carpus is described.     

Role of passive structures in the mobility and stability of the human subtalar joint: a literature review

The subtalar joint plays a fundamental role in the transmission of loads between the leg and the foot. Although anatomical structures of this joint have been described extensively, much ambiguity about their location, shape, and function still persists. There is also disagreement regarding mobility, for example, whether the joint can be considered a hinge, screw-like, or a multiaxial joint. The most relevant studies from the literature are reported and the main experimental observations discussed. Recent studies have described the subtalar joint as a structure with no degrees of unresisted freedom, i.e., motion from the single neutral position is attained only by deformation of the ligaments and of the articular surfaces.     

Recurrent dislocation of the sternoclavicular joint]

Author reports on three cases of recurrent non-traumatic dislocation of the sternoclavicular joint. The operation performed by them and the indication of the operation are described. He thinks it probable that this phenomenon develops frequently as a part of a general joint laxity.     

Tibial hemimelia of a different class

A variant of tibial hemimelia, previously undescribed in the literature and not classifiable by either of the established classification systems, is described. The features of this condition include a short, deformed tibia; proximal subluxation of the fibula at the knee; a normal knee joint and an ankle joint that may look abnormal but falls short of true diastasis of the joint. Treatment of two cases by differential lengthening of the tibia and fibula using the Ilizarov device is described. This form of tibial hemimelia should be recognised as a separate variant as preservation of the foot and ankle with expected excellent function should be possible, unlike the more severe forms of this condition.     

Osteoarthritis at the Base of the Thumb The Concept of Monoarticular Reconstruction

Osteoarthritic affection of the base of the thumb involving 148 hands has been studied. Isolated osteoarthritis of the trapezio-metacarpal joint was found to be the largest group including a total of 111 hands. Reconstruction of this particular joint by a new technique is described and long-term results reported. a small series of isolated osteoarthritis of the trapezio-scaphoid joint is presented and reconstruction by replacing the affected articular surface of the carpal scaphoid is described. Osteoarthritic involvement of more than one of the articular surfaces of the trapezium was found in a group of 31 hands. in all of them the trapezio-metacarpal joint was predominantly affected. The rationale for monoarticular reconstruction of the trapezio-metacarpal joint, regardless of the extent of involvement, is discussed in detail.     

Distraction arthrolysis with humero-ulnar motion fixator

Distraction arthroplasty in the treatment of elbow stiffness with an external fixator and subsequent fixator assisted mobilization is described. Joint distraction is employed to correct the shortened ligaments and capsule and permits the separation of articular surfaces. After intraoperative joint distraction, a phase of relaxation followed by fixator assisted mobilization is carried out. The use of the motion fixator is described and additional measures discussed. This technique is particularly valuable in joint subluxation or persistent joint dislocation and allows for reduction after distraction in order to secure joint congruity. Postoperative management is a key factor for the success of the management protocol.     

The Effect of Motor Denervation on Muscle and Bone in the Rabbit's Hind Limb

Osteoarthritic affection of the base of the thumb involving 148 hands has been studied. Isolated osteoarthritis of the trapezio-metacarpal joint was found to be the largest group including a total of 111 hands. Reconstruction of this particular joint by a new technique is described and long-term results reported. a small series of isolated osteoarthritis of the trapezio-scaphoid joint is presented and reconstruction by replacing the affected articular surface of the carpal scaphoid is described. Osteoarthritic involvement of more than one of the articular surfaces of the trapezium was found in a group of 31 hands. in all of them the trapezio-metacarpal joint was predominantly affected. The rationale for monoarticular reconstruction of the trapezio-metacarpal joint, regardless of the extent of involvement, is discussed in detail.     

The modified oblique Keller procedure: a technique for dorsal approach interposition arthroplasty sparing the flexor tendons

A first metatarsophalangeal joint resection arthroplasty that combines a modest metatarsal cheilectomy with an oblique resection of the phalanx base (preserving the flexor hallucis brevis attachment) combined with interposition arthroplasty of the dorsal joint capsule sewn to the plantar soft tissues is presented. Numerous surgical procedures have been described for the treatment of hallux rigidus, including dorsal cheilectomy, resection arthroplasty, joint replacement, and arthrodesis. The Keller procedure has been abandoned by many because of shortening of the great toe and loss of push-off power. The modified oblique Keller technique described here allows for intraoperative transition from cheilectomy to resection arthroplasty with what appears to be a satisfactory outcome, maintaining plantarflexion power and hallux length.     

Motion of the first metatarsophalangeal joint

The analysis of motion of the first metatarsophalangeal joint in this study demonstrates the character of motion about this joint. Four instantaneous centers of rotation were calculated in the first metatarsal head that formed an arc encircling an area of increased stress patterns. The joint motion is made up of rolling, sliding, and compression. The fact that there is more than one center of motion contradicts the theory of a simple hinge joint. The joint is a dynamic acetabulum or "hammock," as described by Kelikian. That is, the first metatarsal head moves within a stable support comprised of the base of the proximal phalanx, the sesamoids, soft tissue, and muscle tendons. The nature of first metatarsophalangeal joint motion must be considered when contemplating surgical procedures of the first metatarsophalangeal joint.     

The range of motion of the metacarpo-phalangeal joint of the thumb and its relationship to injury.

A wide variation in the range of flexion of the metacarpo-phalangeal joint of the thumb in normal individuals is described. Patients with a poor range of flexion at this joint have a significantly higher incidence of indirect soft-tissue injury to the joint.     

The biomechanics of a thumb carpometacarpal immobilization splint: design and fitting.

Splinting for the common osteoarthritis of the carpometacarpal (CMC) joint of the thumb is infrequently described in the literature, but the few splints that are described include one or both adjacent joints. This paper describes the design and biomechanics of a custom-molded thumb CMC immobilization splint that excludes the thumb metacarpophalangeal and wrist joints. The problem of the imbalance of extrinsic extensor/abductor forces against the intrinsic flexor/adductor forces is described. The accompanying weakening of the thumb CMC capsule allows dorsal shifting of the proximal end of the metacarpal, producing pain. The splint described in this paper 1) prevents motion of the first metacarpal in relation to the other metacarpals, 2) prevents tilting (flexion) of the first metacarpal during pinch, and 3) allows unrestricted thumb metacarpal and wrist joint motion. Attention to detail during construction is required for an accurate pattern, precise positioning of the CMC joint during molding, accurate molding around the first metacarpal, and well-distributed pressure. This design may also be used for protection following thumb CMC arthroplasty or thumb CMC sprain or strain and as a base for thumb metacarpophalangeal and/or interphalangeal mobilization splinting.     

Tomography in the Diagnosis of Posterior Dislocation of the Sterno-Clavicular Joint

A case of posterior dislocation of the sterno-clavicular joint is described in which tomography was helpful in confirming the diagnosis. It is suggested that this investigation may be useful where doubt exists in dislocations of this joint.     

Arthroscopic technique for replacing the anterior cruciate ligament using a free patellar tendon transplant]

The replacement of the anterior cruciate ligament (ACL) by a free patellar tendon graft is a well-known procedure. The disadvantage is that the necessary arthrotomy destroys the nerve supply of the joint capsule. Therefore, we developed a procedure of ACL replacement that can be done by arthroscopy without opening the joint except for a small incision needed for the arthroscopy and working canal. The surgical technique is described.     

Tuberculosis as a Late Complication of Total Hip Replacement

A case of tuberculosis developing in a hip joint which had undergone total prosthetic replacement arthroplasty 7 years previously is described. The patient had no manifestation of active systemic tuberculosis although calcified mesenteric nodes were noted on abdominal X-ray. It is assumed that hip joint infection occurred during a bacteraemia following activation of a latent tuberculous focus in the mesenteric lymph nodes.     

Tuberculosis as a late complication of total hip replacement

A case of tuberculosis developing in a hip joint which had undergone total prosthetic replacement arthroplasty 7 years previously is described. The patient had no manifestation of active systemic tuberculosis although calcified mesenteric nodes were noted on abdominal X-ray. It is assumed that hip joint infection occurred during a bacteraemia following activation of a latent tuberculous focus in the mesenteric lymph nodes.