T2 mapping of the trapeziometacarpal joint and triangular fibrocartilage complex: a feasibility and reproducibility study at 1.5 T.

PURPOSE: To assess the feasibility and reproducibility of T2 relaxation time measurements of the trapeziometacarpal joint (TM) and triangular fibrocartilage complex (TFCC) on healthy subjects at 1.5 T MR. MATERIALS AND METHODS: Thirty-four healthy volunteers underwent an axial oblique multislice multiecho spin-echo sequence of the wrist at 1.5 T, with 10 of them having performed another MR scan on a different 1.5 T scanner. Regions of interest were independently manually drawn by two musculoskeletal radiologists to include the cartilaginous part of the TM and TFCC. Intra-observer, inter-observer and inter-scanner reproducibility of T2 relaxation time measurements was tested using the Bland-Altman method. RESULTS: The mean T2 values obtained by the two radiologists were 29.9 ± 6.5 ms and 30.0 ± 6.1 ms in the TM and 24.5 ± 2.3 ms and 24.6 ± 2.8 ms in the TFCC, respectively. The mean values of the second series of T2 measurements obtained by the senior radiologist were 29.9 ± 6.5 ms and 30.0 ± 6.3 ms in the TM and 24.3 ± 2.9 ms in the TFCC. Inter-observer reproducibility in the TM and in the TFCC was 76% and 82%, respectively. Intra-observer reproducibility in the TM and TFCC was 71% and 76%, respectively. Inter-scanner reproducibility of T2 measurements was 36% in the TM and 85% in the TFCC, respectively. CONCLUSION: The assessment of T2 relaxation time measurements of the cartilage of the TM and the TFCC seems to be feasible and reproducible, although the inter-scanner reproducibility of T2 measurements of the TM is suboptimal. Further studies including patients are warranted to prove the utility of this tool.

Capitate-trapezoid synostosis: analysis of an Early Bronze Age case and review of the literature.

BACKGROUND: Carpal synostoses are congenital defects characterised by complete or incomplete coalition of two or more carpal bones. Although most of these defects are discovered only incidentally, sometimes they become clinically manifest. Among the different types of carpal coalition, the synostosis between capitate and trapezoid bones is quite rare, with only sparse data available in the literature. The aim of this report was to describe a case of capitate-trapezoid synostosis (CTS) observed in an ancient human skeleton, as well as to scrutinise the pertinent literature in order to assess for the characteristics of this type of defect, including its potential relevance to clinical practice. MATERIALS AND METHODS: We studied the skeletal remains of an Early Bronze Age male warrior affected by incomplete CTS. Macroscopic and radiological examination of the defect was carried out. We also performed a comprehensive PubMed search in the Medline and other specialty literature databases to retrieve and analyse data relevant to the subject under consideration. RESULTS AND CONCLUSIONS: The present case is the most ancient CTS ever found. In those literature-reported cases accompanied by careful anatomical description, such as the present one, incomplete coalition invariably occurs between the dorsal surfaces of the two bones, this characteristic emerging as a distinctive morphological trait. Literature analysis further suggests that the true prevalence of CTS is likely to be higher than estimates based on data gathered from radiology series, and that this defect may be associated with pain and carpal bossing more frequently than generally thought.

Trapezoid fractures: report of 11 cases.

PURPOSE: Trapezoid fractures are rare. Mostly single cases reports appear in the literature. The purpose of this study was to review 11 patients treated for trapezoid fractures at our center. METHODS: We reviewed all trapezoid fractures that presented over the past 10 years at our institution. We reviewed case notes regarding mechanism of injury, fracture pattern, mode of diagnosis, and time to diagnosis and treatment. RESULTS: We treated 11 patients for trapezoid fractures over the 10-year period. A correct diagnosis was made in 5 cases on initial evaluation. Most trapezoid fractures were diagnosed on computed tomographic scan. The fracture plane was predominantly sagittal. Coronal fractures could not be diagnosed on plain radiographs. CONCLUSIONS: Fractures of the trapezoid should be suspected from the mechanism of injury, in particular, axial force, and from local tenderness. These fractures may be underdiagnosed. We recommend computed tomography rather than plain radiography alone in case of clinical suspicion. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic IV.

Volar Dislocation of Trapezoid with Coronal Fracture - A Case Report and Review of Literature.

Volar dislocation of the trapezoid is a rare injury and is easily missed. It is more common to have a dorsal dislocation of trapezoid or multiple carpometacarpal joint dislocations. The rare nature of the injury also means that there is little guidance in literature regarding optimal treatment. We are reporting the presentation, management and a 3-year follow-up of this rare injury in a 19-year-old male. Level of Evidence: Level V (Therapeutic).

Bilateral avascular necrosis of the trapezoid.

We present a 5-year follow-up of a patient with bilateral necrosis of the trapezoid that improved clinically and radiographically with nonoperative treatment.

Carpometacarpal and scaphotrapeziotrapezoid arthritis: arthroscopy, arthroplasty, and arthrodesis.

Osteoarthritis of the first carpometacarpal joint is the second most common site of osteoarthritis in humans. Symptomatic isolated scaphotrapeziotrapezoid joint arthritis, though less common overall, is also frequently observed by the hand surgeon. Investigations on the etiology, pathophysiology, natural history, outcomes of traditional treatments, and new forms of surgical techniques have been attracting more interest in the field of hand surgery. The goal of this article is to sort through the current prevailing ideas using recently available literature and to offer a concise, updated guide to further enhance the understanding of thumb carpometacarpal and scaphotrapeziotrapezoid arthritis.

Arthroscopic Distal Scaphoid Resection for Scapho-Trapezium-Trapezoid Arthritis.

Background: The purpose of this study was to describe the technique of arthroscopic resection of the scaphoid head and evaluate both the clinical and radiographic results of scapho-trapezium-trapezoid osteoarthritis cases. Methods: Seventeen cases (13 men and 4 women) with a mean age of 57 years (24-74 years) were operated on from 2002 to 2015. Inclusion criteria were nontraumatic radial-sided wrist pain without improvement after 4 months of conservative treatment and positive radiographic images demonstrating the presence of osteoarthritis. All cases were evaluated preoperatively and postoperatively using visual analog scale, wrist range of motion (ROM), grip strength, and patient's work status (Mayo Wrist Score). Disabilities of the Arm, Shoulder, and Hand (DASH) and Patient-Rated Wrist/Hand Evaluation (PRWHE) questionnaires were also administered. The technique consisted of performing a 3- to 4-mm round-shaped scaphoid head resection via arthroscopy while preserving the scaphotrapezial and scaphocapitate ligament insertions. Results: At an average follow-up of 24 months, all the patients were satisfied. The results showed statistically significant improvement in pain at rest (P = .001), under maximal load (P = .0001), and in Mayo Wrist Score (MWS) (P = .0001). Wrist ROM, grip strength, DASH, and PRWHE showed an improvement without reaching statistical significance. The mean preoperative radiolunate (RL) X-ray measurement angle was 17° (-10° to 35°). The postoperative mean value was 25° (0°-45°). In the preoperative radiographic evaluation, 11 cases exceeded the "critical" 15° RL angle. At follow-up, the RL angle increased in 10 cases and remained unchanged in 7 cases. None of these cases became symptomatic. Transitory neurapraxia of the dorsal superficial branch of the radial nerve was observed in 1 case. Damage of the dorsal branch of the radial artery was immediately fixed. Conclusions: Arthroscopic resection of the distal portion of the scaphoid due to scapho-trapezium-trapezoid osteoarthritis demonstrated an effective and safe technique with less complications than open surgery.

Trapezoidal fractures: Overview and introduction of a novel diagnostic classification system.

INTRODUCTION: Trapezoidal fractures account for only 0.4% of all carpal bone fractures. Owing to their rarity, there is paucity in the literature regarding the clinical findings and treatment. This paper aims to summarize the current understanding of trapezoidal fractures and present a novel classification algorithm. METHODS: A diagnostic classification algorithm was created based on the known blood supply and ligamentous attachment of the trapezoid. The proposed treatment algorithm was then applied to trapezoidal fractures in the literature to validate the algorithm and determine whether patients received treatment that was in accordance. RESULTS: A total of 19 articles, representing 22 trapezoidal fractures were included, with two additional cases presented by the authors. Presenting symptoms were pain (n = 21) and swelling (n = 12). Diagnosis was made on CT in a majority of the time, 79.2% (n = 18). All outcomes were favorable with symptomatic resolution and full range of motion after treatment, except in four patients that had co-existing wrist injuries. When the algorithm was applied, 89.5% (n = 17) of the patients received treatment in accordance with the proposed algorithm and demonstrated good outcomes. In the remaining patients (n = 2) whose treatment differed, one had diminished grip strength and the other was lost to follow-up. CONCLUSIONS: Given a degree of clinical suspicion including a history of blunt trauma to the hand and persisting pain, trapezoidal fractures should remain on the differential when plain radiographs fail to identify any fracture. Operative treatment is suggested if there is any significant displacement, compromise of the dorsal surface, or breech of the trapezoidal ligaments causing possible dislocation. LEVEL OF EVIDENCE: IV - Diagnostic.

A New Technique for Radiographic Visualization of the Scaphotrapeziotrapezoid Joint.

Standard radiographs of the wrist do not provide adequate visualization of the scaphotrapeziotrapezoid joint. A radiographic technique that provides an improved and more complete visualization of the joint compared with routine views is described. [Orthopedics. 2020; 43(2):e123-e124.].

Scaphoid Motion of the Wrist with Scapho-trapezio-trapezoidal Osteoarthritis-A Pilot Study.

BACKGROUND: The purpose of this study was to investigate scaphoid motion within the scapho-trapezio-trapezoidal (STT) joint during wrist motion in the presence of STT joint osteoarthritis (OA). METHODS: We studied 11 wrists with STT OA and 5 normal wrists. Computed tomography (CT) images were acquired in five wrist positions (maximum active flexion, extension, radial deviation, ulnar deviation, and neutral position). The 3-dimensional surface models of the radius and scaphoid were constructed and the motion of scaphoid relative to the radius was calculated. RESULTS AND CONCLUSIONS: During wrist flexion/extension motion, the scaphoid rotated mostly in the flexion/extension plane. The angle tended to be smaller in STT OA than in normal. During wrist radioulnar deviation, the scaphoid was in an extended position in neutral wrist in STT OA. The motion of scaphoid in STT OA was divided into two types: a rigid type and mobile type. The mobile type rotated closer to the flexion/extension plane than the rigid type. Taking into account scaphoid motion during wrist movement before surgery may provide better results in the treatment of STT OA.

The carpometacarpal stress view radiograph in the evaluation of trapeziometacarpal joint laxity.

PURPOSE: Hypermobility at the thumb carpometacarpal (CMC) joint has been proposed as an explanation for abnormal loading and subsequent development of osteoarthritis. Radiographic evaluation of this joint is difficult owing to the obliquity of the articulation. We modified a previously described technique to obtain a bilateral stress radiograph of the thumbs to measure CMC joint laxity. The purpose of this study was to present the details of this modified technique and evaluate its reproducibility in a group of volunteer subjects. We hypothesized that this technique would be reliable and reproducible. METHODS: A posteroanterior radiograph was obtained after asking volunteer subjects to press their thumbs together using a foam hand support. Three measurements were performed: radial subluxation of the first metacarpal base, first metacarpal articular width, and the distance between the ulnar articular facet of the trapezium and the ulnar metacarpal edge (uncovered edge). Using digital calibration on a picture archiving and communication system radiology server, a radiologist, radiology resident, orthopedic surgeon, and orthopedic resident performed measurements at 2 time points. To evaluate consistency among the raters, intraclass correlation coefficients were calculated. Test-retest bivariate analyses were performed to assess intra-rater reliability. RESULTS: A total of 69 volunteers (39 women and 30 men) were imaged. Women showed significantly greater radial subluxation compared to men (p < .01). Inter-rater reliability coefficients for radial subluxation and articular width initially and at 2 weeks showed high agreement, as did test-retest reliability coefficients. For the uncovered edge measurement, inter-rater reliability coefficients were low, with wide variation in reliability. CONCLUSIONS: The modified thumb CMC stress view radiograph evaluates laxity and joint abnormalities of the trapeziometacarpal articulation. The details of the radiographic technique are straightforward, and the inter- and intra-observer reliability of radial subluxation and first metacarpal width are high. The ratio of the 2 measurements provides an accurate measure of the radiographic subluxation of the first metacarpal from the trapezium. This measurement is most specific to radial subluxation under simulated active loading, in the plane of the hand. The medial uncovered edge of trapezium measurement does not have high inter-observer reliability and varies widely, and it should not be included in laxity measurements.

Isolated Trapezoid Fracture in a Boxer.

BACKGROUND Trapezoid fractures are very uncommon, accounting for less than 1% of all wrist fractures. Isolated fractures of this bone are even more rare, with just a few reports in the literature. The trapezoid bone has a very stable position within the wrist, forming a relatively immobile joint with the second metacarpal base distally. It is also connected by very strong ligaments to the trapezium, capitate and, scaphoid. Trapezoid fractures occur when a strong bending or axial force is applied to the second metacarpal base. CASE REPORT We present a clinical case of an isolated, non-displaced, trapezoid fracture in a young white male, which was treated with cast immobilization for 4 weeks and physical therapy. Complete functional recovery was achieved 3 months after the injury, without any pain or tenderness. CONCLUSIONS Fractures of the trapezoid bone usually have a good clinical outcome. Nonetheless, we need to be very suspicious about this diagnosis since radiography is apparently normal in almost all such cases and clinical examination results may not be entirely clear.

Incidental Flexor Carpi Radialis Tendinopathy on Magnetic Resonance Imaging.

Background: Wrist pain is often nonspecific. Magnetic resonance imaging (MRI) is regularly obtained to evaluate wrist pain. Variations and pathophysiology identified on MRI may not account for patient's clinical symptoms. This study aims to quantify the prevalence of flexor carpi radialis (FCR) tendinopathy on MRI and the coexistence of trapeziometacarpal (TMC) or scaphotrapeziotrapezoid (STT) osteoarthritis. Methods: Using an institutional research database, we identified 3631 adult patients who obtained an MRI of the wrist during a 15-year period. Text search in the radiology reports identified 302 patients with possible FCR signal abnormalities. After reviewing the medical records, 98 patients were identified with FCR tendinopathy. Furthermore, medical records were used to identify pain located on the volar radial part of the wrist. In the absence of a documented examination consistent with FCR tendinopathy, we considered any signal change in the FCR incidental. Results: We identified 55 patients (55%) with incidental FCR tendinopathy. In a bivariate analysis, we found FCR signal changes on the MRI were associated with older age, white race, clinically suspected FCR tendinopathy, volar-radial sided wrist pain, and TMC and STT arthritis. Using multivariable logistic regression to account for confounding, older age and volar-radial sided wrist pain were independently associated with FCR signal changes on MRI. Conclusions: Signal changes in the FCR are infrequent and often incidental (asymptomatic) or associated with peritrapezial osteoarthritis.

Evaluation and Management of Scaphoid-Trapezium-Trapezoid Joint Arthritis.

Degenerative arthritis at the articulation of the scaphoid, trapezium, and trapezoid (STT or triscaphe joint) is a common degenerative disease of the wrist. Pain and weakness with grip strength reduction and functional limitations when performing routine daily tasks are common complaints of patients with STT arthritis. Initial conservative treatments for STT arthritis include splinting, bracing, activity modification, anti-inflammatory medication, and steroid injections for pain relief. Failure of conservative treatment is the main indication for surgery, which may include distal scaphoid excision, with or without filling of the void after excision, trapeziectomy, STT arthrodesis, or STT implant arthroplasty.

Comparison of Radiographic and Intraoperative Visual Assessment of Scaphotrapezoid Joint Arthritis in Patients With End-Stage Carpometacarpal Arthritis of the Thumb Base.

Background: The purpose of this investigation is to compare the radiographic and intraoperative assessment of scaphotrapezoid (ST) joint arthritis in patients with end-stage carpometacarpal (CMC) arthritis of the thumb base. We aim to define the incidence of ST arthritis in this population and determine whether radiographic features such as lunate morphology, dorsal intercalated segment instability (DISI), and scapholunate (SL) diastasis are associated with the incidence of ST arthritis. Methods: We retrospectively reviewed consecutive patients with end-stage CMC arthritis of the thumb treated operatively with trapeziectomy. Preoperative wrist radiographs were reviewed, and the presence of ST arthritis was determined using the Sodha classification. Lunate morphology, DISI, and SL diastasis were noted. Intraoperative grading of ST arthritis was assessed using a modified Brown classification. The specificity and sensitivity of radiographic assessment was compared with the gold standard of intraoperative direct visualization. Results: In total, 302 thumbs met inclusion criteria. End-stage ST joint arthritis determined by intraoperative visual inspection was noted in 31% of cases. No radiographic or demographic variables were found to be risk factors for ST arthritis. Plain radiographs were 47% sensitive and 94% specific in their ability to detect end-stage ST joint arthritis. Conclusions: We report a 31% incidence of end-stage ST joint arthritis in surgically treated patients with CMC arthritis based on visual inspection which is lower than previous literature. Wrist radiographs demonstrate a 47% sensitivity and 94% specificity in predicting end-stage ST joint arthritis. It is imperative to directly visualize the ST joint after trapeziectomy, as radiographs demonstrate poor sensitivity.

Palmar dislocation of the trapezoid with coronal shearing fracture: case report.

We report an unusual variant of a palmar trapezoid dislocation with a shearing fracture of the dorsal cortex treated with mini-fragment screw fixation. This patient's treatment is compared to the few previously published reports of palmarly dislocated trapezoids to assist hand surgeons facing this uncommon injury.

Congenital fusion of the trapezium and trapezoid.

We report an unusual case of carpal coalition between trapezium and trapezoid in a 54-year-old man who was diagnosed after a pain in left wrist following a night's sleep. The patient was otherwise asymptomatic.

Obtaining a Reliable Scaphotrapeziotrapezoid Radiograph: Pronation, Ulnar Deviation, and Thumb Abduction.

A simple, reproducible technique for assessing the scaphotrapeziotrapezoid joint radiographically is described. In addition to its diagnostic value, the technique is simple to perform with a minifluoroscopy unit, allowing for image-guided injections of the scaphotrapeziotrapezoid joint.

A CT-based approach with 3D modeling to determine optimal radiographic views of the scaphotrapezial and scaphotrapezoid joints.

PURPOSE: To use a CT-based approach with 3D modeling to determine novel radiographic views of the scaphotrapezial (STl) and scaphotrapezoid (STd) joints. MATERIALS AND METHODS: Consecutive wrist CT scans excluding those with pathology of the distal radius, scaphoid, trapezium, or trapezoid of subjects between ages 18 and 60 years were retrospectively reviewed. Three-dimensional reconstructions of CT scans were created and best-fit planes of the STl and STd joints were generated. Angles of these planes relative to a distal radial coordinate system were calculated to determine tilt of the wrist and the X-ray beam for novel radiographic views of these joints. RESULTS: Fifty eligible wrist CT scans were identified. The mean age was 38 years (range, 18 to 59). For the novel STl PA view, the wrist is supinated 17° from the standard PA view and the X-ray beam is canted 6° caudad. In the STl lateral view, the wrist is pronated 17° from the standard lateral view, and the X-ray beam is canted 20° caudad. In the STd PA tilt view, the wrist is supinated 28° from the standard PA view, and the X-ray beam is canted 13° caudad. In the STd joint lateral tilt view, the wrist is pronated 28° from the standard lateral view, and the X-ray beam is canted 29° caudad. CONCLUSION: We describe novel radiographic views of the STl and STd joints based on 3D modeling of wrist CT scans. Further studies are required to assess the efficacy of these views in detecting joint pathology.

Anatomical ligament reconstruction for trapeziometacarpal osteroarthritis.

Ostoearthritis of the trapeziometacarpal (TMC) joint, the key joint in thumb opposition, is one of the most common diseases involving the hand, especially among middle-aged and elderly women, and can seriously impair overall hand function. Previous studies have indicated that joint instability from ligament insufficiency is the pathological mechanism underlying the disease. Therefore, various ligament reconstruction techniques have been developed to improve both the stability and kinematics of the joint. However, none of them involve anatomical ligament reconstruction and are almost always used in combination with trapeziectomy. In order to restore joint stability as well as to save the trapezium, we developed a new technique for reconstructing the anterior oblique ligament of the TMC joint anatomically using the distal part of the transverse carpal ligament. In this article, we describe the technique in detail and report the clinical outcome of 9 patients. 6 of whom were treated by ligament reconstruction alone while the other 3 underwnet ligament reconstruction combined with surface joint replacement. All 9 patients maintained good stability and ROM of the joint at their final follow-up (3 years or longer). Although that follow-up period is admittedly short, we think anatomical ligament reconstruction with or without surface joint replacement is a rational alternative to ligament reconstruction tendon interposition (LITI) prodecures.