No abstract

Introduction Closed reduction and cast immobilization is a common practice as initial treatment for distal radius fractures. This study examines the pain perception that accompanies this approach. Materials and Methods Thirty dorsally displaced distal radius fractures were reduced and casted under finger-trap traction with intravenous analgesics. Patients rated their pain perception on visual analog scale prior to presentation, during reduction, during casting, and for every day until surgery. Closed reduction improved palmar tilt from −26.3 to −10.8 degrees. Surgery improved palmar tilt from −10.8 to +6.1 degrees. Closed reduction improved radial inclination from 15.5 to 19.1 degrees. Surgery improved radial inclination from 19.1 to 21.6 degrees. Mean pain perception was 5.8 at presentation. Reduction increased pain to 7.5 (p < 0.001), whereas casting was less painful (3.7; p < 0.001). At the evening following casting and the following days until surgery, mean pain was still as high as 4.1, 4.2, 4.1, 3.6, 3.9, 2.8, 3.0, and 3.0, with some patients experiencing more pain than initially. Conclusion Reduction generates significant pain with only minor relief during cast immobilization. The indication for closed reduction prior to cast application is therefore questionable.

Injuries to the thumb collateral ligament are common whose acute surgery gives good functional results. But they are often unrecognized and surgical procedures for chronic instability are still being discussed. The aim of this study was to compare retrospectively the clinical and radiological results of the 3 main treatments for chronic instability of the metacarpophalangeal (MCP) joint of the thumb to identify trends and optimize outcome. Materials and Methods: In this retrospective and monocentric study, we included all the patients operated between 2000 and 2012 from a chronic posttraumatic instability of the MCP joint of the thumb by 1 of 3 techniques: primary repair (37 cases), ligament reconstruction (14 cases), and arthrodesis (43 cases). Patients with hyperextension instability, degenerative instability, and a follow-up less than 2 years were excluded from this study. Subjective and objective results and rates of complications and recurrence were compared at end of the follow-up. Results: Sixty-seven patients were included, 55 followed up for a mean 84 months (range, 24-164 months). Whichever the procedure, all patients considered themselves improved or healed. Forty-eight patients (87.3%) were satisfied or very satisfied. The relief of pain was significantly better in the arthrodesis group. The mean Quick Disabilities of Arm, Shoulder and Hand (QuickDASH) for primary repair group were 17.4 (0-89.5), for ligament reconstruction group 25.7 (0-58.3), and for the arthrodesis group 17.8 (0-50). Pinch strength, on average of the value on the unoperated side, was 89% for primary repair group, 84% for ligament reconstruction group, and 94% for the arthrodesis group. Six of 10 ligament reconstructions had MCP joint laxity at end of follow-up. There were significantly fewer patients who considered themselves cured in the ligament reconstruction group. There were 4 failures by end of follow-up: 1 associated with primary repair, 1 with arthrodesis, and 2 with ligament reconstruction. Discussion and Conclusion: Surgery in treating chronic instability of the MCP joint of the thumb gives generally good results. Primary repair should be considered as much as possible. In contrast to literature report, ligament reconstruction does not give better results than arthrodesis.