Ligament injuries of the hand and wrist.

Treatment of some complex disorders of the hand and wrist joints continues to challenge even the most experienced clinician. Dr. Maupin discusses both these injuries and the simpler ligament disorders that commonly result from everyday activities.

The use of a grommet bone liner for flexible hinge implant arthroplasty of the great toe.

Press-fit titanium grommets were developed to shield flexible hinged silicone implants used for arthroplasty of the radiocarpal, metacarpophalangeal, and metatarsophalangeal joints. Since 1985, 179 titanium circumferential grommets were used in 90 first metatarsophalangeal joints with excellent, pain-free, functional results and favorable bone response around the implant stems and at the bone-grommet interface. There were no complications due to particulate reactivity, implant fracture, or grommet fracture.

Bipolar implant shoulder arthroplasty.

A bipolar implant was designed by the author in 1975 for reconstruction of the severely arthritic shoulder. It has the advantage of not requiring glenoidal component fixation, but still provides an artificial joint interface. The ball of the humeral intramedullary stemmed component articulates with a polyethylene bearing within the glenoid cup component.

Scaphoid implant resection arthroplasty. Long-term results.

A silicone scaphoid implant was developed in 1967 to help improve the results of simple resection arthroplasty in the treatment of arthritic changes associated with advanced scaphoid disease. Patients who had scaphoid implant surgery since 1967 were studied. Preoperative and postoperative roentgenograms, charts, surgical pathology, and clinical evaluations were reviewed.

Flexible implant arthroplasty in the proximal interphalangeal joint of the hand.

Between 1966 and 1981, 812 proximal interphalangeal joints were reconstructed by the senior author using the flexible silicone rubber implant resection arthroplasty method. Within this series, a group of 182 patients with 424 proximal interphalangeal joint implants were available for a detailed clinical and roentgenographic review. Increased motion in a more functional arc with good pain relief and a favorable bone response pattern were noted in most cases after surgery.

Unicompartmental and bicompartmental arthroplasty of the knee with a finned metal tibial-plateau implant.

We followed a series of ten patients (ten knees) who had a unicompartmental and twenty patients (twenty-two knees) who had a bicompartmental arthroplasty of the knee, in which a finned metal tibial-plateau implant had been used, for two to fourteen years (average, five years) postoperatively. According to the modified criteria of MacIntosh and Hunter, thirty knees (94 per cent) had a good result and two (6 per cent), a fair result. There were two complications: one intraoperative and one postoperative fracture of the tibial plateau.

Flexible implant arthroplasty of the radiocarpal joint. Surgical technique and long-term study.

The wrist joint is frequently impaired in rheumatoid, post-traumatic, and degenerative arthritis. Stable radiocarpal motion, even limited, can improve functional hand adaptations, especially if the proximal or distal joints are disabled. A flexible silicone intramedullary stemmed hinged implant was developed in 1967 to be used as an adjunct to resection arthroplasty of the radiocarpal joint while at the same time maintaining the radiocarpal relation and allowing wrist motion in all planes.

Silicone implants in dogs. A ten-year histopathologic study.

The biocompatibility of implanted materials is important to the successful long-term results obtained in reconstructive surgery with these materials. Recently, interest has emerged regarding host response to the wear debris of implanted material. Since 1962 flexible implant materials have been studied in the Orthopaedic Research Department at Blodgett Memorial Medical Center.

Long-term silicone implant arthroplasty. Implications of animal and human autopsy findings.

An examination of host tissue response to implanted material has been conducted as part of a comprehensive research program to study low-modulus of elasticity silicone implants for small-joint arthroplasty. This was performed on animals and in a long-term human clinical evaluation. Autopsy material on three dogs was obtained more than ten years after silicone implants were placed in their limbs, and in one human arthritic patient it was obtained 12 years after hand reconstruction with implants.