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2.
Saudi Med J ; 45(9): 919-928, 2024 Aug.
Article in English | MEDLINE | ID: mdl-39218469

ABSTRACT

OBJECTIVES: To investigate the referral practices across different medical specialties and identify possible barriers to hand surgery referral. Rheumatoid hand deformities (RHDs) and thumb carpometacarpal (CMC) arthritis may require surgery once deformities occur. However, in Saudi Arabia, the rate of referrals to hand surgeons remains low. METHODS: This was a cross-sectional study that included 102 consultants of family medicine, rheumatology, and orthopedics across various regions of Saudi Arabia. A total of 30 institutions were contacted and requested to distribute a survey questionnaire to their physicians; these institutions included 8 private hospitals, 16 government hospitals, and 6 primary healthcare centers. The survey included questions on the incidence, rate, management, knowledge, and referral of patients with RHD and CMC arthritis using a 5-point Likert scale. The Kruskal-Wallis H test was utilized in our analysis to evaluate the differences in responses among the 3 specialties. RESULTS: For RHD and thumb CMC arthritis, the referral rate was higher among orthopedic surgeons compared to rheumatologists and family medicine physicians. The main barriers to referral were patient refusal, medical treatment alone being deemed adequate, and a lack of awareness of surgical options for management. CONCLUSION: Our findings highlight discrepancies in patterns of physician referral of RHD and thumb CMC arthritis cases to hand surgeons, indicating the need for targeted interventions to improve referral rates and enhance patient outcomes.


Subject(s)
Arthritis, Rheumatoid , Carpometacarpal Joints , Practice Patterns, Physicians' , Referral and Consultation , Thumb , Humans , Referral and Consultation/statistics & numerical data , Cross-Sectional Studies , Carpometacarpal Joints/surgery , Practice Patterns, Physicians'/statistics & numerical data , Thumb/surgery , Saudi Arabia , Arthritis, Rheumatoid/surgery , Orthopedic Surgeons/statistics & numerical data , Surveys and Questionnaires , Male , Female , Surgeons/statistics & numerical data
3.
Jt Dis Relat Surg ; 35(3): 699-705, 2024 Aug 14.
Article in English | MEDLINE | ID: mdl-39189581

ABSTRACT

Dislocations of the fourth and fifth carpometacarpal joints (CMCJs) are rare and often misdiagnosed via radiography. Moreover, treatment strategies have not yet been standardized. Herein, we report a case of chronic dislocations of the fourth and fifth CMCJs with delayed diagnosis and successful treatment via ligament repair. A 29-year-old male patient who was initially diagnosed with contusion at another center following a fall on the stairs was referred to our hospital one month later due to persistent pain and swelling. Fourth and fifth CMCJ dislocations were diagnosed using radiography and computed tomography. Closed reduction attempts were unsuccessful, prompting open reduction. The operative findings included rupture of the dorsal carpometacarpal ligament and hamate cartilage injury. Using two mini anchors, the fourth and fifth dorsal carpometacarpal ligaments were repaired, and Kirschner-wire (K-wire) pinning was performed. The K-wire was extracted after four weeks. At the eight-month follow-up, the only remaining symptom was mild discomfort, and the range of motion and grip strength was fully recovered. Our findings highlight the difficulties in diagnosing CMCJ dislocation and suggest ligament repair as a treatment option for chronic cases of CMCJ dislocation.


Subject(s)
Carpometacarpal Joints , Joint Dislocations , Ligaments, Articular , Humans , Male , Carpometacarpal Joints/injuries , Carpometacarpal Joints/surgery , Carpometacarpal Joints/diagnostic imaging , Adult , Joint Dislocations/surgery , Joint Dislocations/diagnostic imaging , Ligaments, Articular/surgery , Ligaments, Articular/injuries , Chronic Disease , Bone Wires , Treatment Outcome , Range of Motion, Articular , Recovery of Function
4.
Microsurgery ; 44(6): e31221, 2024 Sep.
Article in English | MEDLINE | ID: mdl-39212497

ABSTRACT

BACKROUND: Trapeziometacarpal osteoarthritis has been treated with interposition of autologous fascia into the trapezial resection cavity to prevent scaphometacarpal impingement with suboptimal results. Autologous fascia may undergo necrosis and gradual shrinkage due to avascularity. We propose vascularization of the interposed fascia using microvascular techniques as a new alternative to achieve a durable graft with sufficient soft tissue volume. PATIENTS AND METHODS: In this retrospective study, 11 surgeries for 8 patients (6 women, 2 men) (5 primary and 6 revision cases) were performed using vascularized fascial grafts from the anterolateral thigh for interposition in the trapezial resection cavity with microvascular anastomosis for revascularization. Subjective assessment included the short version of the Quick Disabilities of the Hand, Shoulder and Arm and patient related hand wrist evaluation scores. Objective assessment included strength and range of motion measurements. Radiographs were obtained preoperatively and at each follow-up visit. An MRI was done at a mean of 19 months postoperatively. RESULTS: The size of the harvested fascial grafts was 2 × 2-3 cm with a thickness of 1.5-2 cm. There were no postoperative complications apart from one seroma in the graft harvest site. The mean clinical and radiologic follow-up was 2 years and 8 months. The procedure provided pain relief PRWHE pain 32 (SD 13)-9 (SD 12), p < 0.0001, increased tip pinch strength 4 kg (SD3)-6 kg (SD2), p < 0.05, and improved overall function PRWHE 60 (SD28)-16 (SD21), p < 0.0001 and QuickDash 50 (SD21)-13 (SD17), p < 0.0001. Radiographs demonstrated maintenance of the scaphometacarpal space, while MRI scans showed the presence of mildly edematous interposed tissue within the resection cavity. CONCLUSIONS: Although technically demanding, vascularized fascia presents an attractive alternative for the treatment of trapeziometacarpal osteoarthritis. It may be particularly advantageous in complex cases requiring revision surgery and in young patients with high functional demands.


Subject(s)
Osteoarthritis , Trapezium Bone , Humans , Female , Male , Retrospective Studies , Osteoarthritis/surgery , Osteoarthritis/diagnostic imaging , Middle Aged , Trapezium Bone/surgery , Aged , Fascia/transplantation , Fascia/blood supply , Treatment Outcome , Metacarpal Bones/surgery , Metacarpal Bones/blood supply , Free Tissue Flaps/blood supply , Free Tissue Flaps/transplantation , Carpometacarpal Joints/surgery , Range of Motion, Articular , Adult , Follow-Up Studies
5.
Hand Surg Rehabil ; 43(4): 101751, 2024 Sep.
Article in English | MEDLINE | ID: mdl-39002781

ABSTRACT

Metal hypersensitivity is a rare and often underestimated complication, as shown by the small number of published studies, particularly concerning the upper limbs and the hand. However, the increase in the annual number of trapeziometacarpal arthroplasties underlines the importance of better understanding of this problem. We performed a study based on data from the revision of trapeziometacarpal prostheses to assess the incidence of this complication and to define a sequence of radiological changes to detect metal hypersensitivity. This single-center retrospective study included 37 patients operated on between January 2014 and November 2023 for revision of trapeziometacarpal prosthesis. Ten (27%) had no clearly identified cause of failure. For these 10 patients, we analyzed clinical data and postoperative X-rays. In the 11 revision arthroplasties, 2 patients had no symptoms or radiographic signs suggestive of allergy. Six patients had a-posteriori diagnosis established by allergy testing, which also identified 2 additional patients, for a total of 8 patients (21% of the initial cohort). In these cases, there was systematic metaphyseal osteolysis of the first metacarpal between 15 days and 1 month after implantation. Clinically, most patients had an asymptomatic period of 2 weeks to 1 month before onset of symptoms and osteolysis, often accompanied by local inflammation. This study found a reproducible pattern of progression, characterized by the appearance of radiographic signs of osteolysis in the first month, followed by clinical deterioration. Although this course is strongly suggestive of a metal hypersensitivity, it is crucial not to exclude the possibility of an infectious cause, which should always be considered.


Subject(s)
Carpometacarpal Joints , Humans , Retrospective Studies , Male , Female , Middle Aged , Aged , Carpometacarpal Joints/surgery , Carpometacarpal Joints/diagnostic imaging , Reoperation , Hypersensitivity/etiology , Osteolysis/diagnostic imaging , Osteolysis/etiology , Joint Prosthesis/adverse effects , Arthroplasty, Replacement/adverse effects , Metals/adverse effects , Trapezium Bone/surgery , Trapezium Bone/diagnostic imaging , Disease Progression , Metal-on-Metal Joint Prostheses/adverse effects , Prosthesis Failure , Metacarpal Bones/surgery , Metacarpal Bones/diagnostic imaging
6.
Acta Chir Orthop Traumatol Cech ; 91(3): 175-181, 2024.
Article in English | MEDLINE | ID: mdl-38963897

ABSTRACT

PURPOSE OF THE STUDY: The purpose of this study was to assess the patient experience of trapeziectomy under WALANT for trapeziometacarpal joint (TMJ) osteoarthritis (OA) in a prospective study with 2-year follow-up. MATERIAL AND METHODS: The study included 23 patients with TMJ OA undergoing trapeziectomy with WALANT. All patients were seen by a hand therapist preoperatively and at 3, 12, and 24 months postoperatively. At each visit, VAS pain scores, thumb range of motion, grip strength, and Disabilities of the Arm, Shoulder and Hand (DASH) score were assessed. The Picker Patient Experience (PPE-15) questionnaire was administered within 2 weeks of surgery. RESULTS: All 23 patients completed the PPE-15 questionnaire. Their mean age was 64 years. The 21 patients who remained at the 24-month follow-up all said they would choose the same anaesthesia method again. At this follow-up, VAS pain scores, thumb range of motion, key pinch grip and DASH scores had improved significantly, while thumb opposition and hand grip strength remained largely unchanged. The majority of patients felt well informed before and during the procedure, and all patients rated pain relief as good or satisfactory. Nearly 40% of patients reported receiving inadequate information about the postoperative medications. DISCUSSION: Patients have a positive attitude to trapeziectomy with WALANT, and seem to prefer WALANT over other methods of anaesthesia. Trapeziectomy with WALANT for TMJ OA is a safe procedure and appears to give a functional outcome similar to trapeziectomy under general anaesthesia. CONCLUSIONS: Trapeziectomy with WALANT for TMJ OA is safe, preferred by patients and has similar clinical outcome as trapeziectomy in general anesthesia. KEY WORDS: trapeziectomy, osteoarthritis, WALANT.


Subject(s)
Anesthesia, Local , Osteoarthritis , Range of Motion, Articular , Trapezium Bone , Humans , Osteoarthritis/surgery , Osteoarthritis/physiopathology , Middle Aged , Trapezium Bone/surgery , Female , Male , Anesthesia, Local/methods , Prospective Studies , Follow-Up Studies , Carpometacarpal Joints/surgery , Carpometacarpal Joints/physiopathology , Hand Strength , Aged , Pain Measurement , Patient Satisfaction , Treatment Outcome , Surveys and Questionnaires , Thumb/surgery , Thumb/physiopathology , Metacarpal Bones/surgery
7.
J Hand Surg Asian Pac Vol ; 29(4): 281-285, 2024 Aug.
Article in English | MEDLINE | ID: mdl-39005181

ABSTRACT

Background: Arthroscopic debridement is increasingly being utilised in patients with early-stage first carpometacarpal joint (FCMCJ) arthritis but has limited supportive evidence. This systematic review evaluates the literature, and reports on outcomes and adverse events following this procedure. Methods: An electronic literature search of PubMed, Embase, Medline and Cochrane Central, looking for studies describing outcomes following arthroscopic debridement in FCMCJ arthritis, was performed in November 2022. Studies where bony resection or interposition was performed as adjuncts were excluded. Reported outcomes included visual analogue scores (VAS) for pain; Disabilities of Arm, Shoulder and Hand (DASH) scores; pinch and grip strength; complications and re-operations. Results: Out of a total of 90 studies revealed from the search, only two studies were eligible for inclusion, with a cohort of 34 patients. Following arthroscopic debridement for FCMCJ osteoarthritis, the mean VAS improved by four units, mean DASH by 22 points, grip strength by 4.5 kg and pinch strength by 2 kg at mean follow-up of 18 months. The pooled complication and re-operation rates were 8.8% and 23.5%, respectively. Conclusions: There is a lack of evidence supporting the utility of FCMCJ arthroscopy and debridement in the management of patients with early arthritis. Although the limited evidence suggests that there may be some therapeutic benefit, further large-scale prospective studies need to be performed before making conclusive recommendations. Level of Evidence: Level III (Therapeutic).


Subject(s)
Arthroscopy , Carpometacarpal Joints , Debridement , Osteoarthritis , Carpometacarpal Joints/surgery , Humans , Arthroscopy/methods , Arthroscopy/adverse effects , Debridement/methods , Osteoarthritis/surgery , Hand Strength , Disability Evaluation , Pain Measurement
8.
BMC Musculoskelet Disord ; 25(1): 607, 2024 Aug 01.
Article in English | MEDLINE | ID: mdl-39085859

ABSTRACT

PURPOSE: Total joint arthroplasty (TJA) has often been used to treat thumb carpometacarpal (CMC) osteoarthritis (OA). However, guidelines for the CMC prosthesis shape remain unclear. This study aimed to identify the effective shape of a ball-and-socket prosthesis in restoring the range of thumb motion after TJA. METHODS: The participants were 10 healthy young adult men (22-32 years; 26.8 ± 3.57 [mean ± SD]). CT scans were performed in eight static limb positions during abduction and flexion. We defined three design variables (offset R, height H, and neck rotation angle Φ) as the variables that determine the basic shape of the ball-and-socket prosthesis. The ideal values of these design variables were examined based on the results of a 3D motion analysis, which evaluated the change in the posture of the first metacarpal (r, h, and φ corresponding to R, H, and Φ, respectively) relative to the center of rotation (COR) during abduction and flexion. We also simulated the effect of these design variables on the range of thumb motion after TJA using 3D CAD. RESULTS: We found that the values of r and h averaged over all limb positions were 6.92 ± 1.60 mm and 51.02 ± 1.67 mm, respectively, showing that these values remained constant regardless of limb position. In contrast, φ changed significantly. The simulation results indicated that Φ affected the range of thumb motion after TJA, and Φ = 0° relatively reproduced all limb positions compared to other values. CONCLUSION: Our results suggested that the desirable values of R and H were the average of r and h over several limb positions and that Φ = 0° was effective in restoring the range of thumb motion after TJA. Our results will provide surgeons with new guidelines for selecting a prosthesis.


Subject(s)
Carpometacarpal Joints , Joint Prosthesis , Prosthesis Design , Range of Motion, Articular , Thumb , Humans , Male , Thumb/surgery , Thumb/physiology , Thumb/diagnostic imaging , Carpometacarpal Joints/surgery , Carpometacarpal Joints/diagnostic imaging , Carpometacarpal Joints/physiopathology , Adult , Young Adult , Imaging, Three-Dimensional , Tomography, X-Ray Computed , Osteoarthritis/surgery , Osteoarthritis/physiopathology , Osteoarthritis/diagnostic imaging , Arthroplasty, Replacement/instrumentation , Arthroplasty, Replacement/methods
9.
Hand Surg Rehabil ; 43(4): 101737, 2024 Sep.
Article in English | MEDLINE | ID: mdl-38851633

ABSTRACT

OBJECTIVES: De Quervain's tendinitis is frequently observed after placement of a trapeziometacarpal prosthesis. The aim of this study was to investigate the relationship between De Quervain's tendinitis, osteoarthritis of the thumb and placement of a trapeziometacarpal prosthesis. The second aim was a critical analysis of the literature in search of a cause for this postoperative event after arthroplasty or trapeziectomy. METHODS: We reviewed a series of 331 trapeziometacarpal prostheses. RESULTS: There were no differences in thumb column length, gender, type of neck (straight or angled), or surgical approach between patients who developed De Quervain's tendinitis and those who did not. However, the frequency of De Quervain's tendinitis was much higher after arthroplasty than trapeziectomy. CONCLUSIONS: We believe that the preoperative frequency of De Quervain's tendinitis in trapeziometacarpal osteoarthritis is underestimated, being part of a more general pain symptomatology. More precise and specific examination is needed for a better preoperative diagnosis. Trapeziometacarpal osteoarthritis should be considered within a more global framework of peri-trapeziometacarpal pathology, including the trapeziometacarpal and triscaphoid levels, the articular ligaments and the abductor pollicis longus, extensor pollicis brevis, flexor pollicis longus, and flexor carpi radialis tendons.


Subject(s)
De Quervain Disease , Osteoarthritis , Tendinopathy , Thumb , Trapezium Bone , Humans , Osteoarthritis/surgery , Trapezium Bone/surgery , Thumb/surgery , Tendinopathy/surgery , Tendinopathy/etiology , De Quervain Disease/surgery , Female , Male , Carpometacarpal Joints/surgery , Middle Aged , Joint Prosthesis , Postoperative Complications , Arthroplasty, Replacement , Metacarpal Bones/surgery , Aged , Retrospective Studies
10.
Acta Orthop ; 95: 325-332, 2024 06 18.
Article in English | MEDLINE | ID: mdl-38887076

ABSTRACT

BACKGROUND AND PURPOSE: Thumb carpometacarpal (CMC) joint osteoarthritis (OA) is increasingly treated with total joint arthroplasty (TJA). We aimed to perform a systematic review and meta-analysis of the benefits and harms of the TJA for thumb CMC OA compared with other treatment strategies. PATIENTS AND METHODS: We performed a systematic search on MEDLINE and CENTRAL databases on August 2, 2023. We included randomized controlled trials investigating the effect of TJA in people with thumb CMC joint OA regardless of the stage or etiology of the disease or comparator. The outcomes were pooled with a random effect meta-analysis. RESULTS: We identified 4 studies randomizing 420 participants to TJA or trapeziectomy. At 3 months, TJA's benefits for pain may exceed the clinically important difference. However, after 1-year follow-up TJA does not improve pain compared with trapeziectomy (mean difference 0.53 points on a 0 to 10 scale; 95% confidence interval [CI] 0.26-0.81). Furthermore, it provides a transient benefit in hand function at 3 months (measured with Disabilities of Arm, Shoulder, and Hand questionnaire, scale 0-100, lower is better) compared with trapeziectomy with or without ligament reconstruction tendon interposition. The benefit in function diminished to a clinically unimportant level at 1-year follow-up (4.4 points better; CI 0.42-8.4). CONCLUSION: Transient benefit in hand function for TJA implies that it could be a preferable option over trapeziectomy for people who consider fast postoperative recovery important. However, current evidence fails to inform us if TJA carries long-term higher risks of revisions compared with trapeziectomy.


Subject(s)
Carpometacarpal Joints , Osteoarthritis , Randomized Controlled Trials as Topic , Thumb , Humans , Carpometacarpal Joints/surgery , Carpometacarpal Joints/physiopathology , Osteoarthritis/surgery , Thumb/surgery , Thumb/physiopathology , Arthroplasty, Replacement/methods , Arthroplasty, Replacement/adverse effects , Trapezium Bone/surgery
11.
Handchir Mikrochir Plast Chir ; 56(3): 201-211, 2024 Jun.
Article in German | MEDLINE | ID: mdl-38861975

ABSTRACT

The introduction of the new generation of thumb carpometacarpal (CMC I) joint implants for the treatment of CMC I osteoarthritis has significantly broadened the scope of hand surgery in recent years. However, the technical demands of the procedure and the many details that need to be considered require appropriate training and a learning curve. To share experiences with the Touch CMC I prosthesis, we held the first German-speaking CMC I joint prosthetics user meeting in Zurich. After some basic introductory lectures on biomechanics and the principles of prosthetic fitting of the CMC I joint, the various challenges associated with CMC I joint prosthetics were discussed in interactive expert panels. Subsequently, cases were discussed in small groups under expert guidance and the respective conclusions were discussed in plenary. The main results of this symposium are summarised in this manuscript.


Subject(s)
Carpometacarpal Joints , Joint Prosthesis , Osteoarthritis , Prosthesis Design , Thumb , Humans , Male , Biomechanical Phenomena , Carpometacarpal Joints/surgery , Osteoarthritis/surgery , Prosthesis Fitting , Thumb/surgery
12.
J Hand Surg Am ; 49(9): 817-826, 2024 Sep.
Article in English | MEDLINE | ID: mdl-38934999

ABSTRACT

PURPOSE: The purpose of this study was to assess the content, construct, and discriminative validity and responsiveness of the Patient-Specific Functional Scale (PSFS) in patients with thumb carpometacarpal arthritis. METHODS: Data were collected at Xpert Clinics, comprising 34 outpatient hand surgery and hand therapy clinics in the Netherlands. We included 267 patients for content validity and 323 patients for construct validity and responsiveness. The PSFS items were classified into the International Classification of Function Core Set for Hand Conditions to assess content validity. We used hypothesis testing to investigate the construct validity and responsiveness. The Michigan Hand Outcomes Questionnaire was used as a comparator instrument. The standardized response mean was calculated to evaluate the magnitude of change. For discriminative validity, we used independent t tests to discriminate between satisfied and dissatisfied patients. RESULTS: We classified 98% of the PSFS items in the International Classification of Function "activities" and "participation" domains, indicating good content validity. Two of six hypotheses for construct validity and three of six hypotheses for responsiveness were confirmed. The standardized response mean for the PSFS was 0.57 (0.46-0.68) and 0.47 (0.35-0.58) for the Michigan Hand Outcomes Questionnaire total score. The mean PSFS score showed good discriminative validity because it could distinguish between satisfied and dissatisfied patients at the 3-month follow-up. CONCLUSIONS: The PSFS scores showed good content and discriminative validity in patients with first carpometacarpal arthritis. Hypothesis testing for responsiveness and construct validity indicates that the PSFS measures a unique construct different from the Michigan Hand Outcomes Questionnaire. CLINICAL RELEVANCE: The PSFS may be a useful scale for measuring the patient-specific status of individuals with thumb carpometacarpal arthritis.


Subject(s)
Carpometacarpal Joints , Osteoarthritis , Thumb , Humans , Carpometacarpal Joints/physiopathology , Carpometacarpal Joints/surgery , Osteoarthritis/physiopathology , Osteoarthritis/surgery , Male , Female , Middle Aged , Thumb/physiopathology , Aged , Reproducibility of Results , Patient Satisfaction , Surveys and Questionnaires , Disability Evaluation , Netherlands
13.
J Hand Surg Am ; 49(9): 846-856, 2024 Sep.
Article in English | MEDLINE | ID: mdl-38935000

ABSTRACT

PURPOSE: Trapeziometacarpal (TMC) joint replacement has become a valid option in the therapeutic arsenal of TMC joint osteoarthritis in Europe. Good mid-term results of the MAÏA TMC joint prosthesis suggested that it is a reliable procedure. This study aimed to assess the long-term results of this modular uncemented ball-and-socket hydroxyapatite-coated implant. METHODS: This single-center retrospective study evaluated 92 MAÏA TMC joint prostheses in 76 patients with a minimum of 10 years of follow-up. Indications for the procedure were painful TMC joint osteoarthritis both at rest and during activity, despite nonsurgical treatment for more than six months. Pre- and postoperative clinical and radiographic outcomes were compared. RESULTS: Mean follow-up was 134 months (range: 120-158 months). Mean age at the time of surgery was 67 years (range: 53-84 years). The cohort comprised 86.8% of women (n = 66). The mean Quick Disabilities of the Arm, Shoulder, and Hand score improved from 61.3 ± 17.1 to 19.6 ± 16. Range of motion was restored, and postoperative mobility was comparable with that of the contralateral side. Final Kapandji opposition score was almost normal (9.2 ± 0.7). Final key pinch and grip strength improved by 26% and 39%, respectively. Eight implants were surgically revised, six for trapezium cup loosening and two for instability because of polyethylene wear. Three cases of traumatic fracture of the trapezium in older patients were successfully treated with a cast for eight weeks. Five of 26 (20.8%) cases of preoperative-reducible z-deformity were not totally corrected after surgery. The Kaplan-Meier survival over 10 years was 88% (95% confidence interval: 84-93) versus 93% (95% confidence interval: 87-98) over 5 years. CONCLUSIONS: MAÏA TMC joint prosthesis is a reliable long-term surgical procedure for TMC joint osteoarthritis, improving overall function beyond 10 years. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.


Subject(s)
Arthroplasty, Replacement , Carpometacarpal Joints , Joint Prosthesis , Osteoarthritis , Range of Motion, Articular , Trapezium Bone , Humans , Female , Middle Aged , Male , Aged , Osteoarthritis/surgery , Osteoarthritis/diagnostic imaging , Retrospective Studies , Follow-Up Studies , Aged, 80 and over , Trapezium Bone/surgery , Trapezium Bone/diagnostic imaging , Carpometacarpal Joints/surgery , Carpometacarpal Joints/diagnostic imaging , Radiography , Prosthesis Design , Treatment Outcome , Metacarpal Bones/surgery , Metacarpal Bones/diagnostic imaging , Disability Evaluation
14.
Eur J Radiol ; 177: 111561, 2024 Aug.
Article in English | MEDLINE | ID: mdl-38897054

ABSTRACT

INTRODUCTION: The trapeziometacarpal (TMC) joint is a complex joint, whose anatomy and function are different from the metacarpophalangeal joints of the long fingers. The stability of this joint is ensured at three levels by multiple structures: osteochondral, capsulo-ligamentous, and musculo-tendinous. The anatomical and biomechanical structures ensuring the stability of the TMC joint are perfectly evaluated on magnetic resonance imaging (MRI), with a high degree of confidence. All described ligaments are anatomically visible and perfectly assessed on MRI and ultrasound (US): the dorsoradial ligament, the posterior oblique ligament, the intermetacarpal ligament, the ulnar collateral ligament, the two bundles of the anterior oblique ligament (break ligament), as well as the superficial anterior oblique and deep anterior oblique ligaments. METHODOLOGY: This educational review assesses the TMC joint anatomy using high-field MRI and US compared with cadaveric specimens as well the biomechanics of this joint. In addition, it highlights pathological patterns of traumatic (sprain, dislocation, and fractures) and degenerative diseases. RESULTS AND CONCLUSION: Knowledge of TMC joint anatomy is crucial to the radiologists' understanding and assessment of various traumatic and degenerative pathologies, and thus helps clinicians and surgeons choose the appropriate treatment.


Subject(s)
Cadaver , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Ultrasonography , Humans , Magnetic Resonance Imaging/methods , Ultrasonography/methods , Tomography, X-Ray Computed/methods , Carpometacarpal Joints/diagnostic imaging
15.
Handchir Mikrochir Plast Chir ; 56(3): 192-200, 2024 Jun.
Article in German | MEDLINE | ID: mdl-38861974

ABSTRACT

Base-of-thumb osteoarthritis is the most frequent osteoarthritis of the hand requiring surgical treatment, although conservative treatment options should be exhausted before surgery. If the wear process progresses with continuing pain-related loss of thumb function, thus leading to a loss of function of the whole hand, surgical treatment is indicated. In 1947, Gervis published results after trapeziectomy and heralded the development of a multitude of different surgical procedures. The long time needed for rehabilitation is a major problem of trapeziectomy with or without tendon interposition and/or suspension. After the implementation of the first CMC I prosthesis by De la Caffiniere 50 years ago, a rapid development took place, leading to the current modular bipolar implants. Especially in the German-speaking world, there is still some scepticism regarding these prostheses, which is why this review aims to illuminate both surgical procedures with a special focus placed on the aspects of indication.


Subject(s)
Carpometacarpal Joints , Joint Prosthesis , Osteoarthritis , Prosthesis Design , Thumb , Trapezium Bone , Osteoarthritis/surgery , Humans , Trapezium Bone/surgery , Thumb/surgery , Carpometacarpal Joints/surgery , Postoperative Complications/surgery , Postoperative Complications/etiology
16.
Handchir Mikrochir Plast Chir ; 56(3): 212-218, 2024 Jun.
Article in German | MEDLINE | ID: mdl-38861976

ABSTRACT

BACKGROUND: The increasing use of thumb carpometacarpal joint prostheses for advanced CMC 1 (carpometacarpal) joint arthritis reflects the success of the latest prosthesis generations, which has been achieved through their improved functional outcomes and lower complication rates. Precise alignment of the prosthesis cup parallel to the proximal joint surface of the trapezium is essential for stability and the prevention of dislocation. This is a challenging surgical step, particularly for surgeons new to this technique. Despite adequate positioning of the guidewire, misplacements of the cup may occur, necessitating intraoperative revision. MATERIAL AND METHODS: This study examined the deviations in cup and guidewire positioning in thumb carpometacarpal joint prosthesis implantations by inexperienced and experienced surgeons through radiological analysis of 65 prostheses. RESULTS: Both inexperienced and experienced surgeons achieved precise guidewire positioning with mean deviations of<2.2°. Inexperienced surgeons showed significantly larger cup deviations in the dorsopalmar and lateral view (7.6±6.1° and 7.3±5.9°) compared with experienced surgeons (3.6±2.7° and 3.6±2.5°; p=0.012, p=0.017). The deviation of the cup position exhibited by inexperienced surgeons tends to be in the direction opposite to the initial guidewire position (p<0.0038). CONCLUSION: The results highlight the current challenges in cup positioning depending on a surgeon's level of experience, questioning the reliability of the current guidewire placement.


Subject(s)
Carpometacarpal Joints , Thumb , Carpometacarpal Joints/surgery , Humans , Thumb/surgery , Male , Female , Joint Prosthesis , Bone Wires , Clinical Competence , Middle Aged , Aged , Prosthesis Design , Postoperative Complications/prevention & control , Postoperative Complications/etiology , Reoperation , Osteoarthritis/surgery
17.
Hand Surg Rehabil ; 43(4): 101725, 2024 Sep.
Article in English | MEDLINE | ID: mdl-38796060

ABSTRACT

PURPOSE: The aim of this study was to determine whether the shape of the first metacarpal head influences metacarpophalangeal hyperextension, and to evaluate the influence of metacarpophalangeal hyperextension on hand pain and function in patients with trapeziometacarpal osteoarthritis. METHODS: 362 patients with painful basal thumb osteoarthritis were evaluated over a 2-year period. Pain rating on a visual analog scale, trapeziometacarpal and metacarpophalangeal motion, and grip and pinch strength were evaluated. The shape of the metacarpal head was assessed on strict lateral radiographs using the "A/r" ratio. RESULTS: Round metacarpal heads had significantly greater and more frequent metacarpophalangeal hyperextension than flat heads (28° vs. 8°, and 78% vs. 29%). Metacarpophalangeal hyperextension adversely impacted trapeziometacarpal motion in antepulsion (27° vs. 32°), abduction (25° vs. 30°) and pinch strength (3.6 vs. 4.6 KgF). CONCLUSION: Our findings indicate that the shape of the metacarpal head influences metacarpophalangeal hyperextension in trapeziometacarpal osteoarthritis. Metacarpophalangeal hyperextension adversely impacted pinch strength and trapeziometacarpal motion. LEVEL OF EVIDENCE: Level IV, Retrospective case series.


Subject(s)
Carpometacarpal Joints , Hand Strength , Metacarpal Bones , Metacarpophalangeal Joint , Osteoarthritis , Range of Motion, Articular , Humans , Osteoarthritis/physiopathology , Osteoarthritis/diagnostic imaging , Female , Male , Middle Aged , Metacarpophalangeal Joint/physiopathology , Metacarpophalangeal Joint/diagnostic imaging , Metacarpal Bones/diagnostic imaging , Metacarpal Bones/physiopathology , Hand Strength/physiology , Carpometacarpal Joints/physiopathology , Carpometacarpal Joints/diagnostic imaging , Aged , Radiography , Retrospective Studies , Trapezium Bone/diagnostic imaging , Trapezium Bone/physiopathology , Pain Measurement , Thumb/physiopathology , Thumb/diagnostic imaging , Pinch Strength/physiology
19.
Hand Surg Rehabil ; 43(3): 101712, 2024 06.
Article in English | MEDLINE | ID: mdl-38701947

ABSTRACT

INTRODUCTION: Total joint replacement has become significantly more common as a treatment for advanced trapeziometacarpal joint osteoarthritis in recent years. The latest generation of prostheses with dual-mobility designs leads to very good functional results and low rates of loosening and dislocation in the short and medium term. Biomechanical studies showed that central placement and parallel alignment of the cup with respect to the proximal articular surface of the trapezium are crucial for both cup stability and prevention of dislocation. Despite correct positioning of the guidewire, incorrect placement or tilting of the inserted cup may occur, requiring immediate intraoperative revision. METHODS: The existing spherical and conical cup models in sizes 9 mm and 10 mm were transferred to a computer-aided design dataset. Depending on the intraoperative complication (tilting or incorrect placement), the revision options resulting from the various combinations of cup type and size were simulated and analyzed according to the resulting defect area and bony contact area. RESULTS: In well centered cups, a size 9 conical cup could be replaced by a size 9 spherical cup and still be fixed by press-fit. Conversely, a size 9 spherical cup could not be replaced by a size 9 conical cup, but only by a size 10 cup, of whatever shape. When a size 9 conical cup was tilted up to 20°, the best revision option was to resect the sclerotic margin and insert a size 10 conical cup deeper into the cancellous bone, to achieve the largest contact area with the surrounding bone. When a size 9 cup of whatever shape was poorly centered (misplaced with respect to the dorsopalmar or radioulnar line of the trapezium), placement should be corrected using a size 10 cup, combined with autologous bone grafting of the defect. Again, the size 10 conical cup showed the largest bony contact area. CONCLUSION: Our computer-based measurements suggested options for intraoperative cup revision depending on cup shape and size and on type of misalignment with resulting bone defects. These suggestions, however, need to be confirmed in anatomic specimens before introducing them into clinical practice.


Subject(s)
Joint Prosthesis , Prosthesis Design , Reoperation , Humans , Computer Simulation , Computer-Aided Design , Carpometacarpal Joints/surgery , Arthroplasty, Replacement/instrumentation , Prosthesis Failure , Osteoarthritis/surgery , Trapezium Bone/surgery
20.
J Biomech ; 168: 112129, 2024 May.
Article in English | MEDLINE | ID: mdl-38703515

ABSTRACT

The thumb carpometacarpal (CMC) joint facilitates multidirectional motion of the thumb and affords prehensile power and precision. Traditional methods of quantifying thumb CMC kinematics have been largely limited to range-of-motion (ROM) measurements in 4 orthogonal primary directions (flexion, extension, abduction, adduction) due to difficulties in capturing multidirectional thumb motion. However, important functional motions (e.g., opposition) consist of combinations of these primary directions, as well as coupled rotations (internal and external rotation) and translations. Our goal was to present a method of quantifying the multidirectional in vitro biomechanics of the thumb CMC joint in 6 degrees-of-freedom. A robotic musculoskeletal simulation system was used to manipulate CMC joints of 10 healthy specimens according to specimen-specific joint coordinate systems calculated from computed tomography bone models. To determine ROM and stiffness (K), the first metacarpal (MC1) was rotated with respect to the trapezium (TPM) to a terminal torque of 1 Nm in the four primary directions and in 20 combinations of these primary directions. ROM and K were also determined in internal and external rotation. We found multidirectional ROM was greatest and K least in directions oblique to the primary directions. We also found external rotation coupling with adduction-flexion and abduction-extension and internal rotation coupling with abduction-flexion and adduction-extension. Additionally, the translation of the proximal MC1 was predominantly radial during adduction and predominantly ulnar during abduction. The findings of this study aid in understanding thumb CMC joint mechanics and contextualize pathological changes for future treatment improvement.


Subject(s)
Carpometacarpal Joints , Range of Motion, Articular , Thumb , Humans , Carpometacarpal Joints/physiology , Thumb/physiology , Range of Motion, Articular/physiology , Biomechanical Phenomena , Male , Female , Rotation , Models, Biological , Aged , Middle Aged
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