Background Isolated trapezium fractures are rare and account for only 1 to 5% of all carpal fractures but are still the third most common carpal fracture. Trapezium fractures are hard to detect and easily missed on standard radiographs. Trapezium fractures can be treated conservatively, as well as operatively, the best treatment is still debatable. Damage of the joint surface between the trapezium and the base of the first metacarpal or scaphoid could cause pain and restriction of movements. Therefore, it is important to diagnose and treat the fracture at early stage, so that articular congruence is guaranteed. Case description We present four cases of the uncommon trapezium fracture. All four cases are conservatively treated with good results, there was no need for operative treatment in all the cases. Literature review The literature describes the possibility to use fixation techniques, only when it is not possible to reduce the displaced fracture or the residual articular step-off is too high a fixation technique should be used. Clinical relevance Primarily, we would recommend navicular cast immobilization for 4 to 6 weeks as initial treatment.

Purpose Long-term failure of total knee arthroplasty (TKA) is mostly due to loosening of the prosthesis. In this study, the short-and mid-term revision rates of cemented vs cementless TKAs were investigated. Comparable short-and mid-term survival rates of both ixation methods were expected. Methods Data on all cemented and cementless TKAs performed between 2007 and 2017 were retrieved from the Dutch Arthroplasty Register. The cumulative crude incidence of revision of cemented and cementless TKA was calculated. Death was considered a competing risk. Revision rates were compared using multivariable Cox proportional hazard regression analysis. The associations between ixation method and type of revision or reason for revision were tested using logistic regression analyses. Results In total, 190,651 (94.8%) cemented and 10,560 (5.3%) cementless TKAs were evaluated. Both groups had comparable case characteristics. Cemented TKAs were inserted more often in cases with previous knee surgery compared to cementless TKAs (32% vs 27%). The cumulative incidence of revision after 9 years was 5.5% (CI 5.3-5.6%) for cemented and 5.8% (CI 5.2-6.4%) for cementless TKAs (p = 0.2). Cementless TKAs were more often revised due to loosening of the tibial (27% vs 18%; p < 0.001) or the femoral component (7% vs 5%; p = 0.005) than cemented TKAs. Cemented TKAs were more often revised due to infection (17% vs 9%; p = 0.004) than cementless TKAs. Conclusion In conclusion, cemented and cementless TKAs have comparable short-and mid-term revision rates based on a nationwide register study. Level of evidence III.

Purpose Postoperative mortality is commonly reported as outcome measurement after total knee arthroplasty (TKA). Mortality might be inluenced by multiple factors including cementation of the prosthesis. Until now, the inluence of cementation on early and late mortality after TKA is unknown. The aim of the present study was to determine the efect of ixation on early and late mortality after primary TKA. Methods All patients in the Dutch Arthroplasty Register (LROI) with a primary TKA for osteoarthritis were eligible for inclusion. Data collected from 2007 to 2014 with follow-up until January 2020 were used. Survival analysis was performed by using Kaplan-Meier and Cox survival analysis to determine the mortality rate according to ixation. Adjustments were made for age at time of surgery, gender, American Society of Anaesthesiologists class, and year of surgery. Results In total 108,687 TKA were included for analysis, which comprised 95,857 cemented, 6,140 cementless and 6,690 hybrid TKA. The early and late mortality rate in cemented TKA was statistically not diferent compared to cementless or hybrid TKA at 30 days, 31-90 days, 91 days-1 year and 1-5 years. The hazard ratio at 30 days was 1.05 (CI 0.49-2.25) for hybrid ixation, and 1.46 (CI 0.74-2.90) for cementless ixation compared to cemented ixation. The 1-5 years hazard ratio was 1.06 (CI 0.96-1.17) and 0.97 (CI 0.87-1.08), respectively. Conclusion Based on register data, method of ixation does not inluence early mortality after primary TKA. This suggests that there is no preferred ixation technique for primary TKA based on the mortality rates. Level of evidence IV.