No abstract

Background: Venous thromboembolism is a devastating complication representing one of the major causes of postoperative death in plastic surgery. Within the scope of plastic surgery, body-contouring procedures are often considered to carry a higher risk of venous thromboembolism. Hereditary thrombophilias comprise a group of conditions defined by a genetic predisposition to thrombosis development. Collectively, hereditary thrombophilias are present in at least 15 percent of Western populations and underlie approximately half of thromboembolic events. Although the topic of venous thromboembolism is discussed widely throughout the literature, there is little published on the diagnosis and management of hereditary thrombophilias in the plastic surgery literature. The goals of this study were to present a review of the major inherited thrombophilias, to delineate the risk of these disorders, and to recommend a practical algorithm for patient screening and management before major plastic surgery. Methods: A MEDLINE search was performed from 1965 to the present to review the literature on inherited thrombophilia disorders. Results: Based on the English language literature and clinical experience, the authors suggest practical guidelines for screening and management of hereditary thrombophilias. A thorough medical history and preoperative evaluation are key to reducing venous thromboembolism complications. Conclusions: Hereditary thrombophilias are present in a significant number of thromboembolic events. Preoperative vigilance on the part of the plastic surgeon may help to identify patients with undiagnosed hereditary thrombophilias and thereby decrease the incidence of venous thromboembolism. (Plast. Reconstr. Surg. 125: 1544, 2010

We have developed a classification system for osteoarthritis (OA) of the scaphotrapeziotrapezoidal (STT) joint that can be used on posteroanterior, lateral, and oblique wrist radiographs. It can be used to communicate the degree of severity of arthritis, and to study arthritis in the wrist further. Currently we know of no classification system for OA of the STT. We devised a classification system and made an initial study to assess the reproducibility of the system. It was compared with a classification system similar to the Eaton classification of carpometacarpal OA of the thumb. Cohen's kappa test and the sign test were used for comparison. Thirty-seven of the 46 wrists evaluated (80%) showed radiographic evidence of osteoarthritis of the scaphotrapeziotrapezoidal joint. Most kappa values for intrarater and inter-rater reliability lay between 0.87 and 0.95. There was absolute agreement between both systems about the existence of osteoarthritis. When we compared the two classification systems, ours tended to underestimate the arthritic stage. This classification may be helpful for communication, comparison, and evaluation of osteoarthritis of the STT joint among surgeons. Further study is needed to define the clinical and mechanical relevance of osteoarthritis in this joint.

Our understanding of wrist osteoarthritis (OA) lags behind that of other joints, possibly due to the complexity of wrist biomechanics and the importance of ligamentous forces in the function of the wrist. Scaphotrapeziotrapezoidal (STT) OA is common, but its role in wrist clinical pathology and biomechanics is unclear. We identified the prevalence of radiographic STT joint OA in our hand clinic population and defined the relationship between STT and radiocarpal OA in wrist radiographs. One hundred consecutive wrist clinical and radiographic exams were retrospectively reviewed. Radiographs were evaluated for the presence and stage of OA. The mean age was 61.3 (±14.5) years. The radiographic occurrence of STT joint OA was 59% and of radiocarpal (RC) OA was 29%. Radiographic STT and RC joint OA were inversely related. Tenderness over the STT joint in physical exam was not associated with OA in the STT or other joints. STT OA in our series was not related to wrist pain. These findings support the discrepancy between radiographic and cadaver findings and clinically significant OA in this joint. The inverse relationship between STT and RC OA, as seen in scapholunate advanced collapse (SLAC) wrist, requires further biomechanical study.

No abstract