[Clinical and radiologic evaluation of a polylactic acid interposition arthroplasty after trapezectomy]. / Évaluation clinique et radiologique d'un implant d'interposition en acide polylactique après trapézectomie.

Surgical management of trapeziometacarpal osteoarthritis does not obey to strict rules. The use of interposition implants made of different materials leads to enrichment of surgeon's resources. This prospective study reports the radiological and clinical results of 45 patients treated by total trapeziectomy with polylactic acid interposition implant, with an average follow-up of 31 months. Thirty-seven surgical treatments were carried out after ineffective medical treatment. According to Dell classification, there were five stages II, 30 stages III and two stages IV. Mean age was 66 years. Dominant side was involved in 60%. Thumbs were pain free at 5 months in average and 81% of the patients reported good results (Alnot stages 0 and 1). The average opposition was 9.1/10, the average M1M2 angle was 40°, and the average key pinch strength was 4.4 kg. Six patients suffered from sympathetic dystrophy but neither infection nor local inflammatory reaction was observed. Collapse of the trapezium space was constant and the trapezium space ratio was 76% at the follow-up. Seventy-five per cent of patients returned back to their occupation. The satisfaction rate was 89%. The radioclinical results were very good in our series. The interposition of polylactic acid implant permits to avoid the presumed complications of tendon harvesting, and those of other types of material used in the same indication. Its safety seems excellent.

[Weil's cervicocapital osteotomy for median metatarsalgia. Report of 70 cases]. / L'ostéotomie cervico-capitale de Weil dans les métatarsalgies médianes. Etude de 70 cas.

The authors report a series of Weil's cervicocapital metatarsal osteotomies which were performed to treat central metatarsalgias. The series included 70 central metatarsalgias treated by osteotomy of one to four metatarsals. There was an excess of length of one or several metatarsals in all cases; there were 30 metatarsophalangeal dislocations. The results were evaluated according to Kitaoka's criteria: 20 were quoted very good, 26 good, 9 fair and 3 poor. The osteotomy gave an overall improvement regarding pain and shoe fitting but the mobility of the MP joint was reduced in all cases. The results were satisfactory in cavus feet and in cases where the osteotomy was combined with correction of a hallux valgus. Weil's osteotomy allows accurate adjustment of the shortening and early weight-bearing. This is indicated in cases with excessive length of the central metatarsals and also in cases with metatarsophalangeal dislocations.

[Rubis 2 trapezometacarpal prosthesis: concept, operative technique]. / Prothèse trapézométacarpienne Rubis 2: concept, technique opératoire.

INTRODUCTION: We have implanted 49 uncemented reversed trapeziometacarpal prostheses since 1997. OPERATIVE TECHNIQUE: We used a classical dorsal approach. A good preparation of the base of the first metacarpal will give excellent exposure of the trapezium, the most important stage of the operation. Instrumentation allows easy insertion of the two components and also their adjustment. RESULTS: A follow-up of three years is too short and we intend to give our full results at five years. At the present time the patients are well and seem satisfied. DISCUSSION: The reversed design of this prosthesis is useful because it spares the scarce bone stock of the trapezium. The shape of the trapezial implant prevents not only its sinkage but also any lateral movement.