100 thumbs with primary osteoarthrosis of the joints of the trapezium were treated by trapeziectomy and a FCR sling arthroplasty to reconstruct a first intermetacarpal ligament by the method described by Burton and Pellegrini (1986). Pain at rest remained in five. Some pain at or after exertion persisted in 46, and 49 became completely pain-free. 88 were satisfied with the procedure and there was a significant increase in pinch strength and in the ability to perform activities of daily life. It has become our preferred procedure for treating osteoarthrosis of the basal joint of the thumb.

Primary osteoarthritis of the trapezial joints has been treated by an interposition tendoplasty according to Weilby in eighty-nine cases. After excision of the trapezium, a strip from the flexor carpi radialis was wound around the main portion of the flexor carpi radialis tendon and the abductor pollicis longus. The abductor tendon was then duplicated over the tendoplasty and reinserted to the first metacarpal base. In 40% of cases, osteoarthritis was present in more than one trapezial joint. 57% had an adduction contracture of the first metacarpal, half of which were relieved postoperatively. 73% of patients were satisfied at follow-up. Complications included four cases with loss of active metacarpal abduction which was regained after reinsertion of the abductor pollicis longus. It is concluded that the Weilby tendoplasty is a useful alternative to Silastic implants, especially in cases of adduction contracture. The risks of implant dislocation and silicone synovitis are eliminated.

In a prospective study for 108 surgically treated hand wounds the infection rate was significantly lower in tidy than in untidy injuries (6 and 32%). Infection was significantly more frequent when slough developed than in wounds without slough (54 and 11%). Only seven patients received antibiotic prophylaxis. Quantitative analysis of bacteria in the wound margins was performed in 89 cases. No significant difference in the frequency of infection was found when the cultures yielded greater than 10(5) or less than 10(5) bacteria/gram tissue. Prolongation of the interval between injury and operation (up to 18 hours) was not associated with increased rate of infection. Cases with longer intervals than 18 hours were too few for statistical analysis. The duration of the operation or of tourniquet application did not influence the infection rate. The importance of adequate wound care, gentle technique and staged treatment are discussed, and also the question of prophylactic antibiotic medication.

No abstract

Sixty rheumatoid wrists operated with Swanson implant arthroplasty were evaluated after a mean observation time of thirty-three months. Grip function in daily living improved in 60%, pain decreased in 88%, range of motion increased in 83% and grip strength increased in 69% of operated wrists. Significantly impaired function was found in wrists with implant fracture (12%) and in cases with pronounced bone resorption around the implant (23%). Ulnar deviation and carpal collapse were commonly found but did not impair the function significantly. In seven patients the contralateral wrist had been fused and was compared to the arthroplasty. The merits and indications of arthroplasty are discussed.