Stability of the Basal Joints of the New Thumb After Pollicization for Thumb Hypoplasia.

PURPOSE: To investigate the presence or absence of union of the new trapezium to the retained metacarpal base after pollicization and to relate this to stability of the new trapezium and the new carpometacarpal joint. METHODS: Thirty-six patients (46 pollicizations) were assessed at clinical review. Mean time from surgery to review was 96 months (range, 9-260 mo). Clinical assessment measured range of motion (ROM) at the carpometacarpal joint, stability of the carpometacarpal joint, and extrinsic and intrinsic strength of both hands. Radiological review evaluated 3 parameters: bony union between the new trapezium and retained metacarpal base, stability of the new trapezium in relationship to the metacarpal base, and carpometacarpal joint stability. RESULTS: There was radiographic nonunion between the new trapezium and the retained metacarpal base in 8 (1 treated) of 46 pollicizations. Relative risk of instability of the new trapezium was 39 times more likely if nonunion was present. Nine pollicizations were unstable at the carpometacarpal joint, 8 in those with union and 1 with nonunion. Relative risk of instability was 1.4 times more likely for those with union. For patients with nonunion, ROM and grip strength variables were reduced but only grip strength reached statistical significance. In patients with carpometacarpal joint instability, ROM and grip strength variables were reduced but none of the variables reached statistical significance. CONCLUSIONS: This study suggests that when the surgeon is attempting to obtain union of the new trapezium to the retained metacarpal base, failure to do so results in a poorer thumb with a significantly increased risk of trapezial instability and decreased grip strength. There is a mildly increased risk of carpometacarpal joint instability with union, but significantly poorer function as a consequence of this has not been demonstrated. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

[Congenital scaphotrapezial synostosis associated with a carpal tunnel syndrome: a case report]. / Synostose scaphotrapézienne associée à un syndrome du canal carpien chez une enfant de neuf ans : à propos d'un cas.

This report describes a case of congenital synostosis between two bones of the wrist scaphoid and trapezium in a nine-year-old girl who presented a severe tunnel carpal syndrome treated two years ago by open surgery. This association has not previously been described.

[Bilateral congenital fusion of the scaphoid and the trapezium. A case report]. / Synostose scaphotrapézienne congénitale bilatérale.

Congenital synostosis has been described between nearly all of the carpal bones. It can occur in an isolated form or most commonly in relation between the lunatum and the triquetrum. It can also occur in a multiple form and be associated with other malformations. We report a rare case of scaphoid-trapezium fusion observed bilaterally in a nearly asymptomatic 63-year-old patient.

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.

Scaphoid-trapezium hereditary coalition. A case report. / Coalición carpiana escafotrapezoidea hereditaria. A propósito de un caso.

Carpal coalitions are relatively frequent between bones in the same carpal row. Coalitions between bones of different rows, however, are very uncommon. We present a case of bilateral intercarpal coalition between the trapezium and scaphoid as an incidental finding, confirming its hereditary origin since a parent has the same bilateral coalition.

Unilateral fusion of the scaphoid and the trapezium.

Fusion of the carpal bones is a rare anatomical abnormality, caused by a defect in the separation and cavitation during embryonic development. It has a prevalence of about 0.1% and most of the time, patients do not present with symptoms. Symptoms are usually caused by wear and tear of the ligaments attached to the fused carpal fragments. We present a case in which a woman aged 36 years experiences pain caused by a lunato-triquetral instability which in turn is caused by a unilateral complete fusion of the scaphoid and the trapezium. A unilateral complete fusion of the scaphoid and trapezium has not been reported before.

Treatment of a symptomatic trapezial dysplasia with metacarpal instability following thumb metacarpal lengthening with an addition-subtraction osteotomy.

The most important problem of trapezial dysplasia with thumb metacarpal instability is of bony origin. Together with the progressive capsuloligamentous decompensation it evolves in a progressive adduction deformity of the thumb metacarpal secondary to the dysplasia of the trapezium with its increased articular slope. The addition-subtraction osteotomy restores the anatomy combining two techniques: an abduction-extension osteotomy of the first metacarpal to correct the axis of the first metacarpal and an opening wedge osteotomy of the trapezium to reorientate the trapezial saddle. We present a case of an addition-subtraction osteotomy in a case of symptomatic trapezial dysplasia with metacarpal instability following a thumb metacarpal lengthening in a severely mutilated hand. This technique was especially effective in reducing the instability and pain but mainly in maintaining mobile the only remaining joint of the thumb.