Cushing, Melissa M.

Intramedullary screw fixation (ISF) of metacarpal fractures is a well-established technique. Prior techniques either involve placement of the intramedullary screw in a retrograde fashion or placement of the guidewire in a retrograde fashion before placing the screw in an antegrade fashion. While effective, previously described techniques have risks of extensor tendon irritation, articular cartilage disruption, and limited access to multiple metacarpals from a single incision. We present a novel antegrade intramedullary screw placement and antegrade guidewire technique for ISF that avoids disruption of the metacarpal head and allows for access to multiple metacarpals through a single incision. Cadaveric evaluation confirmed consistent sparing of the distal carpal row and demonstrated the feasibility of this technique across the index through small finger metacarpals. Compared with previously described methods, this technique offers improved soft tissue preservation, reduced risk of tendon scarring, and enhanced surgical efficiency. Level of Evidence: Level IV—case report; cadaveric study.

Introduction: The use of modular components provides several advantages in total knee arthroplasty (TKA), including exchange of the polyethylene insert while retaining the stable components in the revision TKA. Compared to full, non-modular component revision TKA, isolated polyethylene exchange (IPE) has the advantage of decreased morbidity, faster rehabilitation, and acceptable outcomes. Methods: A review of published literature on revision TKA was conducted, with a specific focus on studies evaluating the use of IPE for managing complications such as stiffness, instability, and periprosthetic joint infection (PJI). Results: IPE with downsizing may be considered for patients with mild stiffness and stable, well-positioned implants that have increased polyethylene thickness, though expectations for motion gain should be cautious. There is no clear consensus on IPE for instability. Some studies report high re-revision rates, while others show clinical and functional improvement when the TKA is well-aligned, well-fixed, and intraoperative gap balance is achieved. Additionally, irrigation and debridement with polyethylene exchange (IDPE) may be effective for acute TKA PJI management, particularly within the first two weeks of symptom onset. Conclusions: Based on current literature, IPE in aseptic TKA revisions may be effective for stiffness or instability when implants are well-fixed and well-aligned—particularly if polyethylene constraint can be adjusted for instability or downsized for stiffness. The role of IDPE in acute TKA PJI is better defined in the literature, with strong emphasis on its time-sensitive effectiveness—most notably within the first two weeks of symptom onset.