[Total trapeziectomy and suspension ligamentoplasty: is there any interest to interpose a pyrocarbon Pi2® implant?]. / Trapézectomie totale et ligamentoplastie de suspension : une interposition par un implant Pi2® en pyrocarbone a-t-elle un intérêt ?

Total trapeziectomy with suspensioplasty remains one of the most widely used techniques in thumb osteoarthritis. Nevertheless, such a technique does not completely prevent collapse of the trapezial space. We wanted to know whether adding a pyrocarbon spacer allowed better keeping trapezial space and increasing strength. We compared two groups of patients matched on sex, age, manual labor and dominant side. In each group, they were 23 patients suffering from CMC1 osteoarthrosis, mean age was 62 years. Surgical technique consisted in a total trapeziectomy and suspensioplasty with a Gore-Tex(®) slip without spacer (group A) or associated with spacer Pi2(®) (group B). The follow-up was 25 months for group A and 15 months for group B. Height of the scaphometacarpal space represented 81.5% of trapezium height in group B versus 61.6% in group A. Better correction of hyperextension of the metacarpophalengeal joint was noted in group B. Between group A and group B, no difference was found according to pain (VAS 1.6 versus 1/10), mobility (opposition 9.44 versus 9.31; commissural opening 35.2° versus 37.2°) or strength (Jamar 19.1kg/F versus 16.8kg/F, pinch 4.35kg/F versus 4.67kg/F). DASH score was 16.9 and 25.1/100 respectively. We deplore three symapthetic reflex dystrophies in group A and seven radiological subluxations of the implant in group B. The total trapeziectomy with suspensioplasty gave satisfactory results for both series. The implant Pi2(®) seems to contribute keeping trapezial height, without functional advantages and with a risk of dislocation.

Total talar fracture - inter- and intra-observer reproducibility of two classification systems (Hawkins and AO) for central talar fractures.

INTRODUCTION: We evaluated the inter- and intra-observer reproducibility of two classification systems for central talar fractures (Hawkins, as modified by Canal and Kelly and then by us; AO/AOT). HYPOTHESIS: The analysis and classification of these fractures will be better with CT scans than with X-rays. MATERIAL AND METHODS: Four observers evaluated 39 X-ray and CT scan files twice in the span of six weeks; each evaluation entailed classifying the fractures and describing their main features. Cohen's Kappa coefficient for inter-rater agreement was calculated and analysed. RESULTS: The inter- and intra-observer reproducibility with CT scans was better with X-rays for most of the parameters evaluated. The modified Hawkins classification provided better reproducibility than the AO/AOT one. However, this classification system was not perfect, even after modifications and use of CT scans. DISCUSSION: CT scans are an essential tool for the analysis of all talar fractures. We modified the Hawkins classification (as modified by Canal and Kelly) to include a Type 0 (no displacement or less than 2mm), include frontal body fractures that are displaced like neck fractures and take into account comminuted fractures and other trauma in the area. LEVEL OF PROOF: IV - retrospective clinical study.