Trapeziectomy for trapeziometacarpal osteoarthritis.

AIMS: The objective of this systematic review was to describe trapeziectomy outcomes and complications in the context of osteoarthritis of the base of the thumb after a five-year minimum follow-up. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to guide study design, and 267 full-text articles were assessed for eligibility. After exclusion criteria application, 22 studies were included, involving 728 patients and 823 trapeziectomies. Outcomes included pre- and postoperative clinical and radiological characteristics. Complications and revisions were recorded. RESULTS: All the studies reported good results regarding pain and range of motion at the last follow-up of 8.3 years (5 to 22); the mean satisfaction rate was 91% (84% to 100%). It was difficult to assess the impact on metacarpophalangeal joint motion in extension with contrary results. The key pinch returned to its preoperative values, whereas tip pinch showed a modest improvement (+14%), with a mild improvement found in grip strength (+25%) at the last follow-up. The mean progressive trapezial collapse was 48% (0% to 85%) and was not correlated with pain, grip strength, or satisfaction. The most represented complications were linked to tendons or nerves affected during additional procedures to stabilize the joint (11.6%; n = 56). Mechanical complications included symptomatic scapho-M1 impingement (3.1%; n = 15/580), leading to nine surgical revisions out of 581 trapeziectomies. Meta-analysis was not possible due to study heterogeneity and limited data. CONCLUSION: After a minimum five-year follow-up, trapeziectomy achieved high patient satisfaction and pain relief. However, strength seemed to be deteriorating with detrimental consequences, but this did not correlate with trapezial collapse. The issues related to underestimating mechanical complications and varying degrees of success should be highlighted in the information given to patients. Evidence-based analyses should help the surgeon in their decision-making. Cite this article: Bone Jt Open 2021;2(3):141-149.

Clinical and radiological characteristics of 82 solitary benign peripheral nerve tumours.

Benign peripheral nerve tumours are rare lesions. The surgical treatment and clinical outcomes depend on the resectability. The aim of this retrospective study was to identify clinical or radiological features that may predict the surgical technique that should be used to improve clinical outcome. Eighty-two patients were diagnosed with solitary benign peripheral nerve tumours. Fifty-five tumours were surgically resectable, and 27 were nonresectable. Pre-operative magnetic resonance imaging and ultrasound were used, which were predictive of the neural origin of the tumours in 87% (39/45) of cases imaged. In 78% (50/64) of cases imaged, an origin from the nerve sheath (peripheral nerve sheath tumour), or from non-neural elements was possible. However, no imaging or clinical criteria were identified that could determine tumour resectability preoperatively. The diagnosis of solitary peripheral nerve tumour still relies on the macroscopic appearance and definitive histology after epineurotomy.

Sporadic Schwannomatosis: A Systematic Review Following the 2005 Consensus Statement.

AIMS: To identify the frequency of reports of sporadic schwannomatosis, the types of patients affected, and the nerves affected. PATIENTS AND METHODS: We identified all case reports and case series that reported on patients with sporadic schwannomatosis according to established criteria. RESULTS: The initial search yielded 1,597 studies, of which 15 were included. A total of 38 of 55 individuals met the inclusion criteria. The mean age of the patients was 48 years; 41% were male. Thirty-three patients had peripheral nerve tumors, and 17 had spinal tumors. Twelve had tumors in both locations. Tumor distribution was unilateral in 25 of 30 cases (83.3%) and segmental (limited to one limb or five or fewer contiguous segments of the spine) in 28 of 38 cases (73.7%). CONCLUSION: This systematic review quantified the number of individuals who meet the criteria for sporadic schwannomatosis and better described this population to facilitate the classification of neurofibromatosis in regard to the 2005 consensus statement. Unilateral or segmental distribution of nerve tumors are key aspects when dealing with multiple noncutaneous schwannomas without involvement of the vestibular nerve.

[Sprain of the thumb metacarpal-phalangeal with lesion of the ulnar collateral ligament]. / Entorse de l'articulation métacarpo-phalangienne du pouce avec lésion du ligament collatéral ulnaire.

The sprain of the thumb metacarpal-phalangeal joint must be treated in an adapted way in order to avoid chronic laxity. The comparative and bilateral clinical exam is the main element that will allow to detect laxity. In the case of non laxity, a conservative treatment with a splint makes sense. In the case of laxity with Stener effect, a surgical procedure is recommended in order to reintegrate the collateral ligament. In the case of laxity without Stener effect, the choice of treatment is contentious. A US or MRI would be useful if the Stener effect could be underlying. For whichever treatment opted, rehabilitation is to be started as soon as at week 4, in order to reduce risks of stiffness. The return to any sport or training will depend on the sprain stage and on the possibility to wear a rigid splint or not.

L'entorse de l'articulation métacarpo-phalangienne du pouce doit être traitée de manière adaptée pour éviter une laxité chronique. L'examen clinique bilatéral et comparatif est l'élément central pour dépister une laxité. Il doit être précédé d'une radiographie. En cas d'absence de laxité, un traitement conservateur par attelle se justifie. En cas de laxité avec effet Stener, un traitement chirurgical est indispensable pour réinsérer le ligament collatéral. En cas de laxité sans effet Stener, le traitement est controversé. Un US ou une IRM sont utiles en cas de suspicion d'effet Stener pour statuer sur l'état du ligament. Quel que soit le traitement, la rééducation est débutée dès la 4e semaine pour limiter l'enraidissement. Le retour à la pratique sportive dépend du stade de l'entorse et de la possibilité de porter une attelle rigide.