Partial trapeziectomy for Eaton stage III thumb carpometacarpal arthritis: ligament reconstruction with tendon interposition using the entire flexor carpi radialis and interference screw fixation.

BACKGROUND: Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) is currently the most popular technique for treating primary osteoarthritis of the thumb carpometacarpal joint. However, reduced trapezial height has sometimes been reported after LRTI. Longer immobilization and delayed rehabilitation times are also problematic. In this study, we evaluated the clinical and radiological outcomes of patients who underwent our modified LRTI procedure. METHODS: Retrospective study included 26 thumbs in 24 cases with advanced stages. Our modified Burton's procedure was as follows: (1) trapeziectomy was limited to distal-half, (2) the entire flexor carpi radialis (FCR) was harvested from the forearm, and (3) half-slip of the FCR tendon was stabilized by interference screw in the first metacarpal bone tunnel. RESULTS: Pain on the visual analogue scale (VAS), the quick Disabilities of the Arm Shoulder and Hand score, tip pinch strength significantly improved postoperatively. The preoperative height of the trapezial space was well-maintained at final follow-up. Magnetic resonance imaging at the one-year follow-up showed the existence of FCR tendon ball in 15 cases. Eighteen housewives resumed their daily activities after a mean period of 10 days postoperative, while another 6 patients returned to their original jobs after 3 weeks. CONCLUSIONS: Our modified LRTI method involves distal-half trapeziectomy and entire FCR interposition. A sewn FCR tendon ball always provide enough volume to fill the trapeziectomy space, which helps to prevent sinking of the metacarpal bone. Our technique produced sufficient ligamentoplasty and allowed early mobilization after surgery.

A Comparison of Blinded versus Ultrasound-Guided Limited-Open Trigger Finger Release Using the Yasunaga Knife.

Background: An open approach is the gold standard for trigger finger (TF) release. However, this may be associated with infection and scar tenderness. Percutaneous trigger release is an alternative, but this can sometimes result in incomplete release and digital nerve injury, even with ultrasound (US) guidance. Limited-open TF release is an intermediate technique that uses a specially designed knife via a 2-3 mm incision. The aim of this study is to compare the outcomes of blinded versus US-guided limited-open TF release using the Yasunaga knife (Medical U&A, Inc., Japan). Methods: About 138 fingers in 111 patients underwent limited-open TF release using the Yasunaga knife. Green classification was used to grade the severity of TF. Thirty-one patients had grade 3 TF and 80 patients had grade 4 TF. The TF was released in a blinded fashion in 60 patients and using US guidance in 51 patients. Outcome measures included residual triggering, contracture of the proximal interphalangeal joint, visual analog scale (VAS) for assessment of pain, Quick Disability of the Arm, Shoulder, and Hand (DASH) score, and the Patel and Moradia grading of patient satisfaction. Complications were also recorded. Results: Six patients had residual triggering in the blinded group, whereas it resolved in all patients in the US-guided group. This difference was statistically significant (p = 0.03). Patients in both groups showed significant improvement in VAS and Quick DASH score postoperatively. There were no significant differences between the two groups for these two outcomes. Patient satisfaction was graded as excellent by 20 patients and good by 30 patients in the US-guided group compared to eight excellent and 45 good in the blinded group. Conclusion: The incidence of residual triggering was lower and overall satisfaction higher in patients who underwent US-guided limited-open TF release using the Yasunaga knife. Level of Evidence: Level III (Therapeutic).