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Comminuted intra-articular fractures of the metacarpophalangeal joint (MCPJ) of the thumb are difficult to treat because of challenges with anatomical fixation. The pins and rubbers traction system (PRTS), described by Suzuki et al., is a minimally invasive technique that enables early range-of-motion training while maintaining joint congruency. PRTS exhibits advantages relative to other dynamic external fixation techniques due to its simplicity, low cost and compact design. It has been used mainly in treating primarily proximal interphalangeal joint (IPJ) fractures. We present two patients where we used a PRTS for comminuted intra-articular fractures of the thumb MCPJ with good outcomes. We temporarily pinned the carpometacarpal joint (CMCJ) in maximum abduction to avoid skin irritation from the ulnar aspect of the axial traction wire in thumb adduction.

Level of Evidence: Level V (Therapeutic)

Background: Arthroscopic debridement is increasingly being utilised in patients with early-stage first carpometacarpal joint (FCMCJ) arthritis but has limited supportive evidence. This systematic review evaluates the literature, and reports on outcomes and adverse events following this procedure.

Methods: An electronic literature search of PubMed, Embase, Medline and Cochrane Central, looking for studies describing outcomes following arthroscopic debridement in FCMCJ arthritis, was performed in November 2022. Studies where bony resection or interposition was performed as adjuncts were excluded. Reported outcomes included visual analogue scores (VAS) for pain; Disabilities of Arm, Shoulder and Hand (DASH) scores; pinch and grip strength; complications and re-operations.

Results: Out of a total of 90 studies revealed from the search, only two studies were eligible for inclusion, with a cohort of 34 patients. Following arthroscopic debridement for FCMCJ osteoarthritis, the mean VAS improved by four units, mean DASH by 22 points, grip strength by 4.5 kg and pinch strength by 2 kg at mean follow-up of 18 months. The pooled complication and re-operation rates were 8.8% and 23.5%, respectively.

Conclusions: There is a lack of evidence supporting the utility of FCMCJ arthroscopy and debridement in the management of patients with early arthritis. Although the limited evidence suggests that there may be some therapeutic benefit, further large-scale prospective studies need to be performed before making conclusive recommendations.

Level of Evidence: Level III (Therapeutic)

The wrist and thumb postures adopted during the use of three different types of computer mouse (mini mouse; standard mouse; MouseMan) to perform eight standardized tasks were evaluated. Thirty elementary students between seven to twelve years of age were studied using a magnetic tracking system. The peak value and angular range of motion of the wrist and thumb extension/flexion and radial/ulnar deviation were measured during performing 8 standard tasks. There were statistically significant larger values in the standard mice with regard to extreme wrist extension. Angular range of wrist extension observed for the standard mice were also much higher than the mini mouse and MouseMan. There were statistically significant larger values in the MouseMan with regard to extreme wrist ulnar deviation, and an average decrease in extreme thumb flexion and angular range of thumb flexion. The results from the questionnaire showed that most elementary students preferred to use the standard mouse (40%) next was the MouseMan (37%); and the last the mini mouse (23%). The recommendation of mouse types based on the hand length for elementary students was not statistically significant in our study.