Influence of the anatomy of the proximal articular surface of the trapezium (PAST) and the trapezoidal articular surface of the trapezium (TRAST) in cup placement during trapeziometacarpal arthroplasty.

The influence of the anatomy of the proximal articular surface of the trapezium (PAST) and the trapezoidal articular surface of the trapezium (TRAST) on cup placement during trapeziometacarpal arthroplasty was retrospectively evaluated on 56 preoperative anteroposterior radiographs of patients who underwent surgery for trapeziometacarpal osteoarthritis. The percentage coverage of the prosthetic cup by the PAST and the available height of the trapezium were calculated. In 39% of cases, there was a significant difference (up to a mean 4.5 mm, p < 0.001) between the radial height of the trapezium (which is usually considered) and the available height of the trapezium. The anatomy of the PAST and the TRAST has an impact on the placement of the prosthetic cup when trapezium height is low. The results of the present study suggest that these considerations must be known by all operators performing trapeziometacarpal arthroplasty; that lateralization, implant suspension, or surgical alternatives should be considered to prevent several intra- and postoperative surgical complications. Level of evidence: IV.

Time to return to work after total trapeziometacarpal prosthesis.

OBJECTIVES: This study assessed return to work and prosthesis survival after trapeziometacarpal prosthesis surgery. MATERIAL AND METHODS: A multicenter retrospective study was carried out on patients operated on between 2002 and 2020. All working patients who had undergone trapeziometacarpal prosthesis surgery were included. Return to work was defined as resuming the same full-time position. Postoperative events and their specific treatment and failure to return to work were reported. RESULTS: 240 prostheses in 211 patients were included. The complications rate was 7.5%, with 97% prosthesis survival. 94.3% of patients returned to work, at a mean 48 days (range, 29-210 days; SD, 22.7 days), with no significant difference according to age. Twelve patients did not return to work, half of whom because of prosthetic complications. CONCLUSION: Trapeziometacarpal arthroplasty enables most patients to return to work within 6 weeks. In this series, the prosthetic survival rate was 97%.

Outcomes of Double-Mobility Prosthesis in Trapeziometacarpal Joint Arthritis With a Minimal 3 Years of Follow-Up: An Advantage for Implant Stability.

Background: New generation of total trapeziometacarpal joint prosthesis using double mobility concept has been used for several years. The aim of this study was to evaluate the dislocation rate with this implant after a minimal 3 years of follow-up. Methods: From September 2013 to August 2015, 200 trapeziometacarpal prostheses were implanted in 179 patients. Clinico-radiological follow-up was performed with an average of 48.2 months (36-60 months). Survival rate and dislocation rate were analyzed. Loosening of the implants and other intercurrent events were noticed. Results: Visual analog scale, Quick-DASH, strengths and range of motion improved significantly. We report a survival rate of 97% with only 0.5% of dislocation of prosthesis at 48 months of follow-up. Intercurrent events rate were similar to the ones found in literature or other studies. Conclusions: After a minimal of 3 years of follow-up, prosthesis with double mobility seemed to bring better stability in implant for thumb prosthetic replacement.

Results of 110 IVORY® prostheses for trapeziometacarpal osteoarthritis with a minimum follow-up of 10 years.

The IVORY® prosthesis is a total trapeziometacarpal joint prosthesis used for the treatment of symptomatic trapeziometacarpal osteoarthritis. The aim of this prospective study was to evaluate its long-term outcomes with a minimum follow-up of 10 years. From 2004 to 2007, 110 trapeziometacarpal prostheses (95 patients) were implanted. The implant survival curve was constructed using the Kaplan-Meier method. Five patients were lost from follow-up and two died. Six prosthesis (5.5%) were removed after dislocation or fracture of the trapezium. The survival rate of the prosthesis was 95%. After 10 years, the mean visual analogue pain score was 0.24/10 and the key-pinch force was similar to the other hand. Dislocations occurred for eight implants (7.3%). No radiological loosening was noted. In conclusion, the long-term results with the IVORY® prosthesis are very satisfactory in terms of pain relief, function and survival. Level of evidence: II.

Assessment of Somatosensory Reorganization by Functional Magnetic Resonance Imaging After Hand Replantation.

INTRODUCTION: Amputation of the hand is a rare and extremely intense trauma. Replanting and allografting after this type of injury require a major reorganization of the brain. Brain plasticity, though better known in the context of disorders of the central nervous system, is just as indispensable when the extremities are damaged. MATERIALS AND METHODS: A 17-year-old patient underwent replantation of the nondominant hand after transmetaphyseal amputation after traumatic injury. After 18 days in hospital and subsequent treatment in a physical rehabilitation center, the patient attended clinical and radiology follow-up sessions over the next 2 years. RESULTS: The management of this patient led to an excellent functional outcome in conjunction with successful social and professional reintegration. Electromyography at 18 months confirmed nerve regrowth. Functional magnetic resonance imaging was done at 2 years to evaluate cerebral plasticity. Motor function, largely dependent on the primary motor area, is aided by the addition of secondary and accessory motor areas for both simple and complex movements. A change in sensory information is stimulation in its own right hemisphere and increases solicitation of the contralateral precentral and postcentral gyrus. CONCLUSIONS: There seems to be a real reversible dynamic plasticity under the balance of inhibitory and excitatory influences exerted on the cortical neurons. Any disruption of this balance requires the brain to adapt to the new circumstances to reestablish the hand as a functioning part of the body.

Complex reconstruction of the dorsal hand using the induced membrane technique associated with bone substitute: A case report.

INTRODUCTION: High-energy trauma of the hand often causes tissue loss involving bone, tendon and skin and is sometimes accompanied by devascularization of digits. Bone stabilization is the first step in the management of such injuries. MATERIALS AND METHODS: A young patient presented composite tissue loss of the dorsum of his right (dominant) hand following an accident with a surface planer. Tissue loss involved the diaphyses of the first 4 metacarpals, tendons and skin with almost complete amputation of the 3rd finger. Bone stabilization comprised osteosynthesis using pins associated with cement to fill the bone defect. Hunter tendon rods were used for tendon repair and a pedicle groin flap (McGregor) was used to achieve skin coverage. The cement was replaced with autologous cortico-cancellous bone graft combined with bone paste (Nanostim) 3 months after the cement stabilization. RESULTS: Eleven months after the accident, the patient was able to return to work as a carpenter. Pinch and Grasp strength in the injured hand were half that in the contralateral hand, but there was no loss of sensitivity. Mobility was very satisfactory with a Kapandji score of 9 and a mean TAM of 280°. The patient can write, open a bottle and does not feel limited for everyday activities. Radiographically, the bone of the 3 reconstructed metacarpals appears consolidated. CONCLUSION: The induced membrane technique allowed the reconstruction of small bone deficits in the long bones of the hand in a two-step procedure, the first step taking place in an emergency context of composite tissue trauma.

Posterior perilunate carpal dislocation associated with a multifragmentary distal radius fracture.

Dorsal perilunate wrist dislocations are rare. Associated carpal bones or radial styloid process fractures can occur and be included in the current classifications. The authors report an unusual association of dorsal perilunate wrist dislocation with a multifragmentary distal radius fracture. Such traumatic entity has never been previously described. Poor functional outcome may justify the inclusion of associated complex forearm bone fractures in wrist dislocation classifications.