Helsper, Elizabeth

Abstract Background Hemiarthroplasty may be indicated for patients with distal radioulnar joint (DRUJ) arthritis. Recently, the use of the pyrocarbon metacarpophalangeal implant has been proposed as a novel means of treating DRUJ arthritis due to the materials improved mechanical properties and wear characteristics. Purpose This study compares midterm outcomes of metallic and pyrocarbon hemiarthroplasties for the treatment of symptomatic DRUJ arthritis. Questions of interest included outcomes and complications. Materials and Methods In total, 32 hemiarthroplasties, 10 metallic and 22 pyrocarbon, were performed between 2010 and 2020 by three surgeons at one tertiary medical center. Patients' retrospective outcomes were extracted from the electronic medical record. Results Postoperatively, the metallic implant group (mean follow-up: 38 months) demonstrated decreased pain but no changes in range of motion. Comparatively, the pyrocarbon group experienced an improved range of motion and postoperative pain (p < 0.05). Radiographic analysis demonstrated 10% of metallic implants and 9% of pyrocarbon implants to have resulted in thinning of the lateral cortex of the radius at the final follow-up. Minor complications in metallic and pyrocarbon implant groups warranting reoperation occurred at rates of 10 and 13.5% while implant failure occurred at a rate of 30 and 18%, respectively. Discussion Within this study, pyrocarbon implants resulted in significant functional improvement with comparable complication and failure rates to the metallic implant. Long-term stability demonstrated efficacy for both techniques in symptomatic DRUJ treatment. Type of Study/Level of Evidence Observational Case Series IV.

Introduction: Swan neck deformity develops as a sequela of chronic mallet finger. Surgical management can include soft tissue reconstruction or distal interphalangeal joint (DIPJ) fusion. Studies examining the incidence and management of posttraumatic swan neck deformity following mallet fracture are limited. Methods: A retrospective, single-institution review of patients undergoing surgical management of swan neck deformity following a traumatic mallet finger from 2000 to 2021 was performed. Patients with preexisting rheumatoid arthritis were excluded. Injury, preoperative clinical, and surgical characteristics were recorded along with postoperative outcomes and complications. Results: Twenty-five patients were identified who had surgical intervention for swan neck deformity. Sixty-four percent of mallet fingers were chronic. Median time to development of mallet finger was 2 months. Twelve (48%) mallet fingers were Doyle class I, 6 (24%) were class III, and 7 (28%) were class IVB. Forty percent of injuries failed nonoperative splinting trials. Sixteen (64%) underwent primary DIPJ arthrodesis, 8 (32%) underwent DIPJ pinning, and 1 underwent open reduction and internal fixation of mallet fracture. The complication rate was 50% overall, and 33% of surgeries experienced major complications. The overall reoperation rate was 33%. Proximal interphalangeal joint hyperextension improved by 11° on average. Median follow-up was 61.2 months. Conclusions: The development of symptomatic swan neck deformity following traumatic mallet finger injury is rare. All patients warrant an attempt at nonsurgical management. Attempts at surgical correction had a high rate of complications, and DIPJ fusion appeared to provide the most reliable solution.