2005 JOINT ASSH/ ASHT MEETING ABSTRACTS This booklet contains the abstracts for the Scientific/General Session papers as submitted by the authors. All abstracts are in presentation order by day and time. These abstracts are also available on the ASSH website at www.assh.org ii The Joint Annual ASSH/ASHT Meeting Financial Disclosure and FDA Status Symbol Key ●Something of Value—The authors of those presentations preceded by a ● have indicated that they have received something of value in the form of: research or institutional support, stock or stock options, equipment or services, paid travel, royalties or as a consultant or employee of a commercial company or institution related directly or indirectly to the subject of the presentation. ◆Nothing of Value—The authors of those presentations preceded by a ◆ have indicated that they have not received anything of value in the form of: research or institutional support, stock or stock options, equipment or services, paid travel, royalties or as a consultant or employee of a commercial company or institution related directly or indirectly to the subject of the presentation. ▲Documentation of FDA Status—The authors of those presentations preceded by a ▲ have indicated that the FDA has not cleared the listed pharmaceuticals and/or medical devices for the use described in this presentation or that the listed pharmaceuticals and/or medical devices are being discussed for an off-label use. *AFSH Grant Research Acknowledgement—The authors of those presentations preceded by a * have indicated that research related to their presentation was supported by an AFSH Research Grant. The ASSH does not view the existence of these interests or commitments as necessarily implying bias or decreasing the value of the presentations. Disclaimer The material presented in this continuing medical education program is being made available by the American Society for Surgery of the Hand and the American Society of Hand Therapists for educational purposes only. This material is not intended to represent the only, or neces- sarily the best, methods or procedures appropriate for the medical situation discussed, but rather is intended to present an approach, view, statement, or opinion of the authors or presenters, which may be helpful or of interest to other practitioners. The attendees agree to participate in this medical education program sponsored by ASSH and ASHT with full knowledge and awareness that they waive any claim they may have against ASSH and ASHT for reliance on any information presented in this educational program. In addition, the attendees also waive any claim they have against ASSH and ASHT for any injury or other damage, which may result in any way from their participation in the program. ASSH and ASHT are not responsible for expenses incurred by an individual who is not confirmed and for whom space is not available at the meeting. Costs incurred by the registrant, such as airline or hotel fees or penalties, are the responsibility of the registrant. All of the proceedings of this joint ASSH/ASHT meeting, including the presentation of scientific papers, are intended for limited publication only, and all property rights in the material presented, including common law copyright, are expressly reserved to the speaker, ASSH and ASHT. No statement of presentation made is to be regarded as dedicated to the public domain. Any sound reproduction, transcript, or other use of the material presented at this course without the permission of the speaker, ASSH or ASHT is prohibited to the full extent of common law copyright in such material. The approval of U.S. Food and Drug Administration is required for procedures and drugs that are considered experimental. Instrumentation systems discussed and/or demonstrated in ASSH and ASHT educational programs may not yet have received FDA approval. Meeting Abstracts 1 PAPER PAS01 Thursday, September 22, 3:00 p.m. PAS01 Ulna Head Replacement for Trauma and Arthiris of the Distal Radioulnar Joint ●▲ William P. Cooney, MD, Rochester, MN Richard A. Berger, MD, Rochester, MN PURPOSE Resection of the ulnar head has been an was no pain in 80%, mild pain in 15% and unimproved pain accepted procedure for treatment of the painful distal in one patient (5%). Pronation averaged 75* and supination radioulnar joint (DRUJ). However, recent studies have 70*. Grip strength improved 10% as compared with the demonstrated significant resultant instability. The purpose of contralateral limb. Eighteen prostheses were press-fit and this study is to report our experience with a metallic ulnar ten were cemented. There were two acute complications; head endoprosthesis that was designed to restore the normal a nondisplaced ulnar shaft fracture secondary to press-fit anatomic relationships and kinematics at the DRUJ. impaction of the prosthesis and a sensory cutaneous nerve dysesthesia. There were four chronic complications; one METHODS A review of twenty-eight consecutive ulnar neuroma, two revision soft tissue stabilization, and four head arthroplasties was performed in twenty-six patients revision prostheses related to loosening between 7 and 16 (age 51 years, 32–75) with an average follow-up of 30 months months postoperatively. Mild “collar” resorption was noted (range 15–40 months). Pain was significant in all patients and in 8 cases without progression. A Mayo wrist score was used was characterized by DRUJ tenderness to palpation (65%), to assess objective outcomes. There were four excellent, instability (45%), positive lateral compression test (45%), and eighteen good and six poor results. The latter were related to crepitance with forearm rotation (35%). Pronation-supination reoperation for instability or loosening. range of motion averaged 138 degrees and grip strength was 66% of the opposite side. Twenty patients (70%) had CONCLUSIONS Ulnar head endoprosthetic arthroplasty an average of two (1–5) previous procedures. Indications is an effective means of providing pain relief, stability, and for surgery included DRUJ arthritis (40%), failed Darrach improvement in strength in patients with chronic instability procedure (25%), pain with instability (20%), and Rheumatoid and arthritis of the DRUJ. A high rate of patient satisfaction arthritis (15%). can be expected. Soft tissues repair or reconstruction (Adams procedure) are important components of the procedure to RESULTS Based on clinical assessment of pain relief, provide stability and strength. Bone cement is recommended stability and strength, 80% of patients were satisfied with in patients with previous fusion of the wrist. their procedure and 100% felt that they were improved. There ● Royalties, non-cash support, honoraria, or other funding received from AVANTA ORTHOPEDICS for William Cooney, MD. ▲ Presentation includes discussion of off-label or other non-FDA approved, investigational use of SIGMOID FOSS REPLACEMENT manufactured by AVANTA ORTHOPEDICS. 2 The Joint Annual ASSH/ASHT Meeting PAPER PAS02 Thursday, September 22, 3:07 p.m. PAS02 Outcome of Spherical Ceramic TMC Arthroplasty ◆ Brian D. Adams, MD, Iowa City, IA ◆ Jay Pomerance, MD, Arlington Heights, IL PURPOSE Spherical, ceramic implant arthroplasty There were no early perioperative complications, including (Orthosphere, Wright Medical, Inc.) for the treatment of fractures, infections or prosthetic dislocations. Radiographs TMC osteoarthritis was retrospectively reviewed to assess showed implant subsidence in nearly all patients after two both clinical and radiographic outcomes. We were particularly years follow-up, which occurred in either the metacarpal or interested in skeletal response to the implant over time and trapezium but not both. Subsidence typically progressed over the correlation between clinical results and radiographic the first two years, then stabilized in some and continued to findings. progress in others. Early formation of a sclerotic line about the implant was associated with less subsidence. Osteopenia METHODS 50 arthroplasties were performed in 49 patients was associated with greater subsidence. Trapezium fractures by 2 surgeons between 1997 and 2003. Follow up averaged developed in 15 and complete trapezium resorption was seen 3.3 years (range, 1–7 years). Average patient age at surgery in one. Trapezial-metacarpal impingement due to subsidence was 59 years. 35 females and 15 males. Patient satisfaction occurred in two. Patient satisfaction and function did not (pain and function surgery), range of motion, pinch strength, correlate with radiographic findings, including subsidence and and grip strength were assessed. Radiographs were trapezium fractures. evaluated for preoperative arthritis, implant and metacarpal subluxation, implant subsidence, fractures, and adjacent CONCLUSIONS Spherical, ceramic implant TMC skeletal reactions. arthroplasty was found to have a substantial incidence of subsidence and eventual trapezium fracture. However, most RESULTS 47 of 50 thumbs achieved full opposition to the patients achieve a high level of satisfaction and function. base of the small finger and none lost MP or IP motion. 46 Clinical outcome did not correlate with adverse radiographic patients reported high satisfaction for pain relief and improved findings, suggesting that changes are slowly progressive function. Persistent unexplained pain was the cause for a poor and tolerated. Longer follow up is needed to determine if result in 4. Despite pinch strength measuring less than the further implant subsidence will occur and if it will be clinically opposite side,