We evaluated the outcomes of the Re-motion total wrist arthroplasty in 39 non-rheumatoid patients. The mean follow-up was 7 years (range 3–12). Postoperative wrist flexion-extension and radial-ulnar deviation as well as the scores of the Disability of Arm Shoulder and Hand questionnaire and the visual analogue scale pain scores improved significantly. Complications occurred in 13 wrists, five of which required further surgery. The most frequent complication was impingement between the scaphoid and the radial implant (n = 5), which can be avoided by complete or almost complete scaphoid resection. Periprosthetic radiolucency developed around the radial component in three cases and three radial screws loosened. Despite the incidence of high implant survival in 38 of 39 wrists over 7 years (97%), the complication rate is not satisfying. Knowledge of the risk of complications and patient selection are essential when making the decision to choose wrist arthroplasty over arthrodesis. Level of evidence: IV

Background: To elucidate the performance of carpometacarpal-I joint prostheses in comparison with the current gold standard treatment, resection-suspension arthroplasty (RA), we conducted a study comparing outcomes of the Ivory prosthesis to those of a cohort of patients receiving RA.Methods: Initially, we had enrolled 34 prosthesis patients and 48 RA patients, of which 5 and 11 were lost to followup. We defined Eaton/Littler stage 3 osteoarthritis, no previous surgery, no concomitant arthrosis, no rheumatic arthritis, no history of trauma and a minimum follow-up period of 2 years as inclusion criteria. We assessed patient demographics, disability of the arm, shoulder, and hand score, pain via visual analogue scale, subjective strength of the thumb, range of motion (radial and palmar abduction and opposition), and patient satisfaction. All occurring complications were recorded.Results: Follow-up included a mean period of 4.5 years (2-7.4) in the prosthesis cohort and 4.1 years (2-6.8) in the RA group. Disability of the arm, shoulder, and hand scores, pain scores, palmar abduction and opposition, and subjective satisfaction showed no significant differences between the two cohorts. Postoperative loss of strength was significantly less in the prosthesis group (p = 0.01). Moreover, we were able to demonstrate better range of motion in terms of radial abduction in the prosthesis group (p = 0.001). The overall complication rate was significantly higher in the prosthesis cohort (41.4% vs. 10.8%) (p = 0.008). Nevertheless, the Ivory prosthesis group showed a survival rate of 93.1%. Conclusion:As the high complication rate is compensated by a better functional outcome (enhanced range of motion and strength), we believe that prosthesis implantation can be a reasonable treatment option for carpometacarpal-I osteoarthritis in a particular patient group. Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

We report a 56-year-old patient with acute wrist trauma. He presented with painful swelling in the area of the anatomical snuff box of the right hand. Plain radiograms revealed a scaphoid fracture ( Figure 1).However, the patient reported a history of repeat wrist trauma in the past years. Concerning the appearance of the fracture in the plain radiogram it was not definitely clear, whether this is a recent or an old fracture. Therefore, an MR examination was done to differentiate between old or recent fracture.The presence of significant bone marrow edema allowed the definite diagnosis of a recent scaphoid fracture (Figure 2 Cinematic and volume rendering of a scaphoid fracture Cinematic Rendering is a novel innovative post-processing technique to create photo-realistic three-dimensional images [1,2]. In comparison to conventional volume rendering techniques the 3D images appear more natural with Cinematic Rendering [1][2][3][4][5]. This new method is not primarily intended for radiologic diagnostic image reading. Possible applications in primary radiologic image diagnosis have to be evaluated in future studies. However, in a routine setting we use it already for demonstrating and teaching anatomy on the basis of CT and MR data sets (virtual anatomy) [6].