Arthroscopically Assisted Treatment of Isolated Comminuted Trapezium Fracture: A Report of Two Cases.

CASES: Two competitive athletes with isolated comminuted trapezium fractures, sustained during American football and rugby, presented with pain and swelling of the first metacarpal base. Computed tomography confirmed isolated comminuted trapezium fractures. Arthroscopic reduction of displacement with screw fixation below the articular surface was performed through a small incision. Both patients returned to their preinjury sports levels within 2 months postoperatively. CONCLUSION: Arthroscopic treatment of isolated comminuted trapezium fractures achieved accurate reduction of articular surface displacement and preserved trapeziometacarpal joint stability with minimal soft-tissue invasion. This facilitated an early return to contact sports for the affected athletes.

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.

Does trapezium remodeling correlate with cup shape?

We investigated whether trapezium bone reaction was different following implantation of a trapeziometacarpal total joint replacement with a hemispheric or a conical cup. Fifty-three Keri Medical Touch implants with hemispheric cup and 53 with conical cup were prospectively followed up radiographically. We compared radiographs taken immediately and one year after surgery for cup subsidence, tilt, heterotopic ossification and loosening. Cup subsidence of at least 1 mm was detected in 4% of cases for both cup types. Additive bone reaction around the cup of more than 1 mm was present in 62% of conical cups and 47% of hemispheric cups. These were minor and there were no large ossifications with risk of impingement. Minor radiolucency was seen superficially at the implant-bone interface of 13% of the hemispheric cups and 9% of the conical cups. None of these bone reactions differed significantly according to cup design.

Thumb basal joint arthritis in 2023.

Thumb carpometacarpal or basal joint arthritis is the second most common location for osteoarthritis in the hand. It mainly affects women over 50years of age. Basal joint arthritis causes pain, loss of strength during pinch grips, and eventually stiffness and progressive deformity of the thumb column. Conservative treatment must be implemented first. It aims to spare the joint by using standardized methods. It must be initiated as soon as pain starts, not once the deformity has settled in. There is broad agreement that surgery is indicated when pain relief is not achieved after at least 6months of conservative treatment. The available surgical techniques can be classified as joint-sparing (extra-articular) and joint-sacrificing (intra-articular). The former consists of trapeziometacarpal stabilizing ligament reconstruction, subtraction osteotomy of the first metacarpal and thumb carpometacarpal denervation. The latter consists of trapeziometacarpal fusion, trapeziectomy (and its variants) and implant arthroplasty. Except in very specific cases, trapeziectomy and trapeziometacarpal implant arthroplasty with a total joint prosthesis or an interposition implant are the two main surgical techniques for treating basal joint arthritis. After reviewing the pathophysiology and the diagnosis of thumb basal joint arthritis, we will provide an overview of the available treatment options, with emphasis on the accepted surgical strategies in 2023. LEVEL OF EVIDENCE: III.

Primary trapeziectomy with Regjoint(TM), a poly-L/D-lactide spacer, a two-year follow-up study with new radiological assessment tool.

The aim of this retrospective study was to evaluate the potential bony erosion and the clinical and radiological results of primary trapeziectomy with RegjointTM interposition, in patients with peritrapezial arthritis. Data were recorded on twenty patients over a period of two years (January 2015-December 2016). On average 24 months, patients were reconvened for a post-operative evaluation (subjective evaluation of pain, function and patient satisfaction; clinical evaluation with strength and mobility measures; post-operative X-rays). On X-rays, 2 criteria were evaluated: the bony erosion and the shortening of the thumb column (trapezium+metacarpal height measure, ratio between first and second metacarpal bones, a new radiological assessment tool based on a trapezoid relationship gradation). In most patients, surgery relieved pain and offered good functional results, according to the Quick Disabilities of the Arm, Shoulder and Hand scale. Following surgery, our patients showed a subjective improvement, both in terms of pain and functional results. For plain X-ray, only 3 patients showed an osteolytic lesion (maximum of 2.8 millimeters) on the first metacarpal base. A statistically significant reduction in the thumb column height was generally observed on follow-up X-rays. However, all of these radiologic changes were present without any clinical impact. We show that the RegjointTM spacer is an available alternative in the surgical treatment of peritrapezial arthritis. We did not highlight any significant associated complications, no important adverse tissue reaction or bone erosion, no pain or functional disorder. Type of study/level of evidence Therapeutic IV.

Is increased trapezial slope a cause of early trapeziometacarpal osteoarthritis?

OBJECTIVES: Thumb carpometacarpal joint osteoarthritis is one of the most common forms of osteoarthritis in the hand. The underlying causes are multifactorial. We investigated whether increased trapezial slope could be a causal factor. MATERIAL AND METHODS: We measured trapezial slope and 1st metacarpal slope in 37 patients with early thumb carpometacarpal joint osteoarthritis and compared results with 41 patients without osteoarthritis, using computer-supported 3D-analysis based on CT scans. RESULTS: There was a significant intergroup difference in trapezial slope (111° in patients with osteoarthritis, and 107° in patients without) and in 1st metacarpal slope (17° versus 14°). CONCLUSION: Steeper trapezial slope seemed to be a risk factor for thumb carpometacarpal joint osteoarthritis. Therefore, correction of trapezial slope by trapezium osteotomy could be a valuable surgical approach in early thumb carpometacarpal joint osteoarthritis.

Relationship between trapeziometacarpal joint morphological parameters and joint contact pressure: a possible factor of osteoarthritis development.

The trapeziometacarpal (TMC) joint is the one of the hand joints that is most affected by osteoarthritis (OA). The objective of this study was to determine if specific morphological parameters could be related to the amount of pressure endured by the joint which is one of the factors contributing to the development of this pathology. We developed 15 individualized 3D computer aided design (CAD) models of the TMC joint, each generated from the CT scan of a different participant. For each participant, we measured several crucial morphological parameters: the width and length of the trapezium bone and dorso-volar and ulno-radial curvature, of the trapezium and the metacarpal bone. Each CAD model was converted into a finite element model, of both bones and the cartilage located in between. The joint forces applied during pinch grip and power grip tasks were then applied in order to estimate the contact pressures on joint cartilage for each model. Correlations between joint contact pressures and morphology of the trapezium and the metacarpal bone were then analysed. Important variations of TMC joint pressures were observed. For both pinch and power grip tasks, the strongest correlation with joint contact pressure was with the dorso-volar curvature of the trapezium bone. Our findings indicate that dorso-volar curvature of the trapezium bone has a significant impact on mechanical loadings on the TMC joint. This contributes to understanding the prevalence of OA in certain patients.

Osteonecrosis of Trapezium Occurring in Patient with History of Recurrent Carpometacarpal Corticosteroid Injection.

Osteonecrosis affecting the carpal bones is rare and is mostly seen in the lunate (Kienböck's disease). Osteonecrosis of the scaphoid (Preiser disease) is even rarer. There are only four individual case reports published on patients presenting with trapezium necrosis, none with previous history of corticosteroid injection. This case report is the first presentation of isolated trapezial necrosis in the setting of prior corticosteroid injection for thumb basilar arthritis. Level of Evidence: Level V (Therapeutic).

Characterization of Trapezial Pommel in Relation to Radiographic and Wear Patterns in Carpometacarpal Osteoarthritis.

BACKGROUND: Trapezial pommel, or ulnar osteophyte positioned at the vertex of the saddle-shaped facet, is a consistent structural appearance in osteoarthritis (OA) of the first carpometacarpal. This study investigates its relation to radiographic measures (modified Eaton staging and thumb OA [ThOA] index) and wear patterns (trapezial surface morphology and cartilaginous eburnation). METHODS: In all, 137 whole trapezia were explanted from 116 patients and evaluated for Eaton staging, morphology (saddle, cirque, or dish), and eburnation (degree of cartilaginous effacement) of the articular surface of the trapezium. In total, 131 Robert's views and 126 stress views were reviewed by 2 blinded senior surgeons for ThOA index and pommel size. Statistical analyses included Spearman correlation and linear regression. RESULTS: Standardized pommel size achieved good intrarater reliability (correlation coefficient: 0.80-0.98) and moderate interrater reliability (correlation coefficient: 0.60-0.67). The ThOA index and pommel size were significantly correlated across Robert's (rs = 0.51) and stress views (rs = 0.64). The ThOA index better distinguished between stages compared with pommel size. All the radiographic measures inversely correlated with preserved cartilage and varied across morphologies. Pommel size differed significantly between dish and saddle, and the ThOA index was significantly different between all morphologies when using stress views. CONCLUSIONS: We reliably quantified the pommel feature and demonstrated significant correlations with other radiographic and topologic measures of arthritic disease. If future studies can demonstrate that the pommel is a pathogenic process in ThOA and its correction can curb disease progression, the identification of the pommel feature may help guide targeted intervention.

Anatomical study for elucidating the stabilization mechanism in the trapeziometacarpal joint.

To determine the pathogenesis of trapeziometacarpal (TMC) joint instability, which leads to osteoarthritis, we investigated the anatomical relationships among the surrounding ligaments, muscles (first dorsal interosseous [FDI] and opponens pollicis [OPP]), and joint capsule. We examined the bone morphology and cortical bone thickening in 25 cadaveric thumbs using micro-computed tomography and performed macroscopic and histological analyses. The dorsal trapezium had a tubercle with cortical bone thickening, corresponding to the attachment of the FDI aponeurosis intermingled with the joint capsule. Radially, the thin joint capsule was observed to underlie the muscular part of the OPP. Therefore, the dorsal ligaments, which have been previously considered static stabilizers, could be interpreted as parts of the capsuloaponeurotic complex consisting of the FDI aponeurosis and joint capsule. In the radial aspect, muscular OPP activation may be essential for TMC joint stabilization. Our findings may contribute to the appropriate management of TMC osteoarthritis.

Validation of dynamic biplane radiography and three-dimensional model-based tracking for evaluation of dynamic thumb kinematics.

Dynamic biplane radiography (DBR) in conjunction with model-based tracking (MBT) has provided a suitable mechanism for biomechanical assessment of many joints but has not yet achieved widespread use at the thumb and wrist. The purpose of this work is to determine the accuracy of DBR with markerless MBT for the evaluation of thumb and wrist joint kinematics. Three 0.6 mm stainless steel beads were implanted into each trapezium, scaphoid, first metacarpal, and radius of three cadaveric upper extremities. Each specimen was manipulated in thumb abduction/adduction, thumb flexion/extension, wrist radioulnar deviation, and wrist flexion/extension while synchronized biplane radiographs were collected at 100 Hz. Specimen-specific 3D bone models were created from CT scans. MBT was performed by optimizing the correlation between digitally reconstructed radiographs, created from the volumetric CT-based bone models, and the biplane radiographs. Joint kinematics and joint space were calculated and compared between the "gold standard" bead-based tracking and markerless MBT. The MBT system accuracy (RMS error) in measuring bone position for the static and dynamic trials was 0.25 mm and 0.58 mm, respectively. The overall MBT system accuracy in measuring dynamic joint kinematics was 1.3 mm in translation and 5.0° in rotation. The MBT system accuracy in measuring dynamic joint space was 0.4 mm. DBR with MBT is a non-invasive and accurate method that can be utilized for kinematic analysis of the thumb and wrist.

Influence of differences in bone morphology on the distribution patterns of subchondral bone density across the trapeziometacarpal joint.

We aimed to clarify the effects of morphological patterns of the trapezium and first metacarpal on the distribution of subchondral bone density across the articular surface of the trapeziometacarpal (TMC) joint using computed tomography osteoabsorptiometry. Thirty-three patients with normal TMC joints were evaluated. The percentages of the high-density areas in the radial-dorsal and ulnar-volar regions of the trapezium were significantly higher than that in the ulnar-dorsal region, and that of the ulnar-dorsal region of the first metacarpal was significantly lower than in the other three regions. The percentage of the high-density area of the radial-dorsal region of the trapezium and trapezial inclination (TI) showed a significant positive correlation, and the percentages of the high-density areas in the ulnar-dorsal and ulnar-volar regions had significant negative correlations with TI at the articular surface of the first metacarpal. These results indicate that bony morphologic differences in the trapezium affect the distribution pattern of subchondral bone density through the TMC joint.

Osteonecrosis of the trapezium: a case report and review of the literature.

We describe the case of a 58-year-old woman with AVN of the left trapezium which was treated surgically. This paper aims to review the etiologies leading to the pathology and the different therapeutic options. Avascular necrosis (AVN) of the carpal bones most commonly involves the lunate and the scaphoid . AVN of the trapezium is extremely rare. To our knowledge only 3 cases have been published in the literature so far and they were all treated differently.

Defining trapezial dysplasia - analysis of trapezial inclination in a normal population.

We assess the distribution of trapezial inclination in a young population in order to propose a threshold for trapezial dysplasia. One hundred peritrapezial views were reconstructed from wrist computed tomography scan datasets to measure trapezial inclination. Seventy peritrapezial views were constructed from 10 datasets to assess the influence of radiograph rotation. Mean trapezial inclination in our population was 8° (range 0.2-17.9). Fifteen degrees of radiographic pronation or supination did not alter trapezial inclination significantly. Intra-rater consistency and absolute agreement had an interclass correlation (ICC) of 0.95. Inter-rater consistency and absolute agreement had an ICC of 0.88. Trapezial inclination is a reliable measurement for trapezial dysplasia with an excellent intra-rater and good inter-rater reliability and does not change significantly with 15° of radiographic pronation or supination. These normal values can be used to propose a threshold for trapezial dysplasia in the management of trapeziometacarpal joint instability in the younger population.Level of evidence: IV.

[Resection arthroplasty for thumb basal joint arthritis]. / Die Resektionsarthroplastik bei Rhizarthrose.

Due to the crucial role of the thumb for gripping, osteoarthritis of the first carpometacarpal joint leads to a substantial impairment of hand function. There are effective nonoperative and joint-preserving surgical treatment options for early stages of the disease. In advanced cases, after exploiting conservative treatment, carpometacarpal thumb arthrodesis or arthroplasty may be indicated in selected cases but trapeziectomy with or without interposition or suspension constitutes the gold standard surgical procedure. This reliably provides favorable results, irrespective of the technique, with pain relief, good physical function, excellent patient global assessment and low complication rates.

Technical trick in suture-button suspensionplasty for the treatment of thumb carpometacarpal arthritis.

Suture-button suspensionplasty has been popularized in the treatment of thumb carpometacarpal (CMC) arthritis in recent years. The surgical technique of this method was well defined previously. The most challenging and important part of this technique is the tensioning of the suture-button system to preserve first metacarpal height after trapeziectomy. In present study, we would like to present a technical trick about adjusting the tension while performing suspensionplasty using suture-button device in thumb CMC joint osteoarthritis. In the original technique, trapeziectomy is performed prior to fixation and tensioning of suture-button system. However, it is quite difficult to recreate the original trapezial space, since first metacarpal subsides after trapeziectomy. The trick in our technique is that trapezium remains in its anatomic position up to the end of the operation. Thus, we do not need to make effort to adjust the thumb ray height and use fluoroscopic imaging to ensure its position. In conclusion, we believe that our technique simplifies the most challenging part of the operation, shortens the operation time, preserves the original first ray height and diminishes the exposure of ionizing radiation as it reduces the need for fluoroscopy.

An Anatomical Evaluation of the Trapezium and Its Relationship to Basilar Joint Osteophytic Change.

BACKGROUND: To perform a comprehensive osteologic investigation into trapezium anatomy and investigate the relationship between anatomical factors and osteophyte formation, focusing on sex-specific differences. METHODS: This was a cadaveric study involving 1233 trapezia and first metacarpals. Two subgroups ("Control" and "Main Study") were established. The "Control" cohort was used to identify features of the trapezium in specimens devoid of osteophytic change. The prevalence and severity of osteophytic change were investigated in the "Main Study" cohort. Sex differences were specifically assessed. Regression analyses were used to identify factors associated with osteophyte formation. RESULTS: Three discrete surface morphologies exist at the trapezium trapeziometacarpal (TM) facet: heart, quadrilateral, and bean. Controlling for height, men have a larger trapezium TM facet surface area. However, the trapezium assumes the same off-center saddle shape in both sexes. The presence of osteophytes at the basilar joint is a common finding; no differences in osteologic prevalence exist between sexes. The progression of osteophytic change complements the radiographic Eaton-Littler classification system. The trapezium TM facet increases the surface area with incremental osteophyte involvement, with the degree of surface area expansion correlated with increases in the severity of osteophytic change. Increased age, increased surface area, bean morphology, and decreased volar joint depth are associated with more severe osteophyte formation. CONCLUSIONS: Anatomical features of the trapezium may contribute to osteophyte development. Although the prevalence of osteophytic disease appears equal between sexes, sex differences exist in some anatomical parameters. These differences may help explain the increased prevalence of symptomatic basilar joint disease in women.

Does proximal migration of the first metacarpal correlate with remaining pain after trapeziectomy?

Proximal migration of the thumb metacarpal has been suggested as a possible cause of remaining pain after trapeziectomy for trapeziometacarpal joint osteoarthritis. The aim of this study was to investigate if proximal migration after trapeziectomy is associated with a poorer long-term outcome in terms of pain and objective physical variables. We retrospectively examined 91 thumbs in 65 patients after a mean of 10 years following trapeziectomy with or without ligament reconstruction and tendon interposition. Proximal migration of the thumb metacarpal was measured on plain lateral radiographs of the thumb and correlated to visual analogue pain scale (VAS), thumb range of motion and strength. Most thumbs had a severe proximal migration of the first metacarpal, the mean scaphoid metacarpal distance was 2.7 mm. Most patients reported no or little pain, median VAS was 0 at rest and 1 after load. There were no differences in reported VAS pain at rest or after load between patients with severe (<2 mm scaphoid metacarpal joint space) or less severe (≥2 mm metacarpal joint space) proximal migration. Patients that reported more pain (VAS >2) did not exhibit more migration than patients reporting less or no pain. Thumbs with severe migration had weaker key pinch (3.4 vs. 4.6 kg, p = 0.008) and grip strength (15 vs. 21 kg p = 0.002). We conclude that proximal migration most likely does not cause residual or recurrent pain after trapeziectomy.

[Hemitrapeziectomy of the carpometacarpal joint of the thumb]. / Hemiresektionsarthroplastik am Daumensattelgelenk.

BACKGROUND: Hemiresection arthoplasty or partial trapeziectomy of the carpometacarpal joint of the thumb is a surgical option in stages 1-3 according to Eaton-Littler classification. Preservation of the intact scaphotrapeziotrapezoidal (STT) joint and maintenance of the length of the thumb is the advantage of this technique. TECHNIQUE: Technically, partial trapeziectomy is only slightly more complex compared to trapeziectomy with or without suspension. An interposition of autologous or allogeneic material is recommended; suspension arthroplasty is also possible in almost all common variants. Despite these theoretical advantages, this technique has not proven advantageous in practice, neither in terms of function nor in terms of time, compared to other techniques. The great advantage of partial trapeziectomy, however, is the wide range of options for revision surgery in the case of persistent complaints. RESULTS: The risk of proximalization of the thumb due to an inadequate interposition is generally minor and is usually caused by implant sintering. This can easily be compensated for by implanting a larger graft. Persistent instabilities are the most common cause of persistence of symptoms and can usually be remedied by autologous or allogeneic suspension arthroplasty. In addition, the entire range of endoprosthetics is also possible with a previous spare resection of the trapezium and the possibility of a complete trapeziectomy remains in any case. The obvious theoretical advantages of arthroscopic hemitrapeziectomy need to be confirmed in practice in future.

Trapeziectomy for basal thumb osteoarthritis does not increase the risk of developing wrist osteoarthritis in the long term.

BACKGROUND: Symptomatic osteoarthritis of the basal joint of the thumb (trapeziometacarpal joint) is a common disabling condition mainly affecting women. It is frequently treated with complete removal of the trapezium with or without soft-tissue interposition. There is limited evidence about whether removal of the trapezium affects stability of the wrist joint and increases the risk of developing wrist osteoarthritis. The aim of this study was to evaluate the long-term prevalence of OA in wrists with previous trapeziectomy compared to wrists with intact trapezium. METHODS: Patients treated with surgery for trapeziometacarpal osteoarthritis at one orthopedic department were invited 10-29 (mean 17) years postoperatively for bilateral radiographic examination. We included radiographs from 114 hands with trapeziectomy and 46 hands with intact trapezium; 38 patients had unilateral trapeziectomy and intact contralateral trapezium. The radiographs were blinded so that the intact trapezium or the trapezial space after trapeziectomy was not visible. The radiographs were then evaluated for radiocarpal/midcarpal osteoarthritis independently by two assessors using three different osteoarthritis grading systems, including the Kellgren-Lawrence classification. The patients rated their satisfaction with the function of each of their hands on a visual analog scale (VAS) from 0 to 100 (higher score better). RESULTS: The prevalence of osteoarthritis ranged from 20 to 26%, mostly mild (Kellgren-Lawrence grade 1). The prevalence of osteoarthritis did not differ between wrists with previous trapeziectomy and those with intact trapezium, both in the whole cohort and in the subgroup of patients with unilateral trapeziectomy and intact contralateral trapezium. There was no significant difference in hand function VAS scores between hands with previous trapeziectomy and hands with intact trapezium in the whole cohort or in the subgroup. CONCLUSIONS: Removal of the trapezium as treatment for basal thumb osteoarthritis does not increase the risk of developing wrist osteoarthritis in the long term.