Thumb Arthritis

History: 51 year old female with right thumb pain that had been present for over a year.  Although it began after a fall, x-rays showed arthritis at the base of the thumb (CMC joint arthritis).  After trying splinting, a steroid injection, and anti-inflammatory medication, she elected for surgery to alleviate her pain. 

Diagnosis: Right thumb CMC arthritis

Treatment: Right thumb trapezium excision with ligament reconstruction and tendon interposition (LRTI)

Outcome: Her recovery proceeded smoothly and by 5 months after surgery she had regained full motion, had returned to all her activities, and no longer had any pain.  She was very happy. 

4th/5th MC Dislocation

History: 20 year-old male punched a wall with his right fist and had immediate pain and swelling over the the dorsal and ulnar aspect of the hand and wrist. X-rays demonstrated a fracture of the hamate bone with the 4th and 5th metacarpal bones dislocated dorsally. Live flouroscopic imaging in the office demonstrated that they could be reduced manually but were unstable.

Diagnosis: Right 4th and 5th carpal-metacarpal joint fracture dislocation

Treatment: Right 4th and 5th CMC Closed Reduction and Pinning

 

Outcome: He remained in a cast after surgery for 4 weeks. After 1 month he was transitioned to a removable splint and started on exercises for motion. 

By 2 months after surgery he had near-anatomic alignment of the joint, full motion, and no pain.

 

Scaphoid ORIF

History: 23 year-old male who came to my office with pain in his wrist about 3 months after a fall. At the time he thought he only sprained his wrist. X-rays in the office showed a scaphoid non-union (not healed) causing his pain. Due to concern about long-term development of arthritis and pain, he elected to have surgery for treatment.

Diagnosis: Left scaphoid non-union, 3 months

Treatment: Scaphoid open reduction internal fixation with bone graft for non-union

Outcome: By 4 months he was fully healed with minimal pain and near full motion. He was very happy with the result.

Scaphoid Non-Displaced

History: 52 year-old male who fell directly onto his right hand with pain and swelling. An initial X-ray was negative for fracture in the Emergency Department. He was evaluated by Dr. Franko who recognized a subtle scaphoid fracture and recommended either non-operative (cast) or operative (surgery) treatment. Because the patient desired a faster return to work, activities, and strengthening while avoiding a long-term cast treatment, he elected for surgery.

Diagnosis: Right scaphoid waist fracture

 

Treatment: Right scaphoid mini-open internal fixation

Outcome: By 6 weeks the fracture was healing and he was aggressively working on motion with therapy. He had minimal pain and had returned to full work. At 3 months a CT scan showed the fracture was fully healed and by 5 months he had fully regained motion without any pain or discomfort.