Metacarpophalangeal hyperextension in trapeziometacarpal osteoarthritis: Relationship to first metacarpal head shape, and clinical impact.

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.

Three-dimensional motion analysis of pre- and postoperative thumb movement in trapeziometacarpal joint osteoarthritis-Comparison of arthrodesis and trapeziectomy with suspensionplasty.

Trapeziometacarpal osteoarthritis (TMC-OA) reduces the range of motion (ROM) of the thumb. However, the kinematic change achieved through surgical treatment remains unclear. Therefore, to quantify the kinematic change following TMC-OA surgery, we performed a three-dimensional motion analysis of the thumb using an optical motion capture system preoperatively and 1 year postoperatively in 23 patients with TMC-OA scheduled for arthrodesis (AD) or trapeziectomy with suspensionplasty (TS). Eighteen hands of nine healthy volunteers were also included as controls. Both procedures improved postoperative pain and Disability of the Arm, Shoulder and Hand scores, and AD increased pinch strength. The ROM of the base of the thumb was preserved in AD, which was thought to be due to the appearance of compensatory movements of adjacent joints even if the ROM of the TMC joint was lost. TS did not improve ROM. Quantifying thumb kinematic changes following TMC-OA surgery can improve our understanding of TMC-OA treatment and help select surgical procedures and postoperative assessment.

De Quervain tendinitis after total trapeziometacarpal joint arthroplasty: Biomechanical evaluation of tendon excursion in the first extensor tendon compartment.

De Quervain's tenosynovitis is the most common complication after total trapeziometacarpal joint replacement. Etiology is unclear. Implantation of a ball-in-socket implant changes the biomechanics of the normal trapeziometacarpal saddle joint and increases its range of motion. The present study demonstrates that this procedure also significantly increases excursion of the abductor pollicis longus and extensor pollicis brevis tendons during thumb flexion-extension, and not during thumb abduction-adduction. Increased tendon gliding under the retinaculum of the first extensor tendon compartment could predispose to the development frictional tenosynovitis and play a role in the development of de Quervain's syndrome after total trapeziometacarpal joint replacement. LEVEL OF EVIDENCE: Not applicable (laboratory study).

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.

Functional outcomes after surgical treatment of isolated scaphotrapeziotrapezoid osteoarthritis: Retrospective single-center 24-case series.

Isolated scaphotrapeziotrapezoid (STT) osteoarthritis has functional consequences on the wrist. The main objective of our study was to evaluate the functional outcomes of patients managed surgically during the last 12 years at the Toulouse University Hospital, regardless of the surgical technique used, for isolated STT osteoarthritis. We performed a single-center retrospective observational study using the CCAM database. The inclusion criteria were patients treated surgically for isolated STT osteoarthritis who did not respond to conservative treatment, with at least 6 months of clinical and radiological follow-up. Twenty-four patients were treated between 2006 and 2018. Partial arthroplasty of the distal pole of the scaphoid with or without interposition and total trapeziectomy had been performed on these patients. The mean follow-up was 79±46.8 months. The wrist range of motion (ROM) and the Kapandji score were not significantly reduced postoperatively. The mean postoperative QuickDASH score was 29.15±8.46. The mean pain assessed using a visual analog scale was 6.6±1.17 preoperatively versus 1.25±1.51 postoperatively (P=0.003). Statistical subgroup analysis found no predictive factor for a better postoperative QuickDASH score, and no surgical technique was superior at halting the progression of intracarpal misalignment and postoperative ROM. Surgical treatment of isolated STT osteoarthritis resistant to conservative treatment leads to significant functional improvement, particularly in terms of pain, without altering the wrist's overall mobility.

Tendon versus Pyrocarbon Interpositional Arthroplasty in the Treatment of Trapeziometacarpal Osteoarthritis.

BACKGROUND: Trapeziometacarpal (TMC) arthritis is treated with surgery when nonsurgical treatment fails. The best surgical option for improving pain relief, functional outcomes, and postoperative complications remains controversial. The purpose of this study was to compare clinical and radiological outcomes and complications between trapezium excision with ligament reconstruction and tendon interposition (LRTI) and pyrolytic carbon interpositional arthroplasty. METHODS: From March 2009 to August 2014, 37 patients (39 wrists) with Eaton-Littler stage II or III TMC arthritis underwent complete trapezium excision with LRTI (Group L, n=19) or pyrolytic interpositional arthroplasty (Group P, n=20). Visual analog scale (VAS) pain scores; grip and pinch strength; Kapandji scores to quantify thumb opposition; and Disabilities of Arm, Shoulder, and Hand (DASH) scores were used to compare clinical outcomes between the two groups. Radiographic changes (metacarpal shortening, subluxation, and radiolucency) were evaluated on the radiographs of thumb basal joints. RESULTS: There were no differences in patient demographics, Eaton-Littler stage, preoperative outcome measures, or the duration of follow-up between the two groups. At the last follow-up, VAS pain scores, pinch and grip strengths, Kapandji scores, and DASH scores were significantly improved in both groups compared with preoperative scores. All follow-up measurements were similar between the two groups except pinch strength, which was 1.8 kg higher in Group P (p<0.001). Proximal metacarpal migration did not differ significantly between the groups. Periprosthetic lucency more than 1 mm was observed in 7 of 20 (35%) thumbs. Complication rates were similar between the two groups. CONCLUSIONS: All subjective and objective outcomes were similar following LRTI and pyrolytic interpositional arthroplasty in patients with TMC arthritis, except pinch strength, which was more improved following pyrolytic interpositional arthroplasty. Longer follow-up is required to test adverse effects of high rates of periprosthetic lucency and prosthetic subluxation on clinical outcomes after PyroDisk interpositional arthroplasty.

Influence of the trapeziometacarpal joint fusion on thumb muscles and thumb-tip movement: A cadaveric study.

BACKGROUND: Trapeziometacarpal (TMC) arthrodesis provides stability and strength of the thumb, whereas fixation of the TMC joint restricts motion of the thumb, which may consequently impair the activity of daily living. The objective of our study was to investigate how length and area of the thumb-tip trajectory were reduced after the TMC joint fusion. METHODS: Six fresh, frozen cadavers were used for this study. Tension was applied to the distal tendons of 4 extrinsic thumb muscles (extensor pollicis longus, flexor pollicis longus, abductor pollicis longus, and extensor pollicis brevis) by servomotor, whereas tension was applied to 4 intrinsic muscles (abductor pollicis brevis, opponens pollicis, flexor pollicis brevis, and adductor pollicis) using static weights. The thumb-tip trajectory was examined using a motion capture system without tension and with 5 different weights to induce intrinsic muscle tension before and after the TMC joint fusion. FINDINGS: When tension was applied to the intrinsic muscles, the length of the thumb-tip trajectory decreased in all conditions compared with that before the TMC joint fusion, whereas the trajectory decreased only when the abductor pollicis longus was pulled. The overall thumb-tip trajectory area was reduced to approximately 30% compared with that before the TMC joint fusion. INTERPRETATION: Thumb-tip trajectory was restricted by the TMC joint fusion to approximately 30%. However, the reduced area was found tolerable for performing daily activities. Thus, arthrodesis can be the first-line treatment in patients who wish to engage in activities of daily living without difficulties.

Maïa® trapeziometacarpal joint arthroplasty: Survival and clinical outcomes at 5 years' follow-up.

We sought to report the clinical and radiological outcomes and the survival of Maïa® trapeziometacarpal joint arthroplasty retrospectively at a mean 5 years' follow-up. We evaluated the implant survival and the clinical outcomes of 93 patients (113 prostheses). Patients were examined during a consultation and their mobility, key pinch strength and satisfaction were recorded. Patients also completed a QuickDASH evaluation. The 5-year survival rate was 92.2%. The mean QuickDASH Score was 26.7. The complication rate was 31% and the revision rate was 12.4%. The most common complication was dislocation and the most frequent cause of surgical revision was periprosthetic ossification. We identified two cases of aseptic loosening. This study shows the Maïa® prosthesis provides satisfactory medium-term results and has an excellent 5-year survival. However, the high complication and revision rates are still a major concern.

Outcomes of Surgical Management for Thumb Basilar Arthritis in Patients 55 Years of Age and Younger.

Background: Trapeziectomy with ligament reconstruction tendon interposition (LRTI) or suspensionplasty is an effective treatment in older patients with end-stage thumb basilar arthritis. However, the survivability of this procedure is unknown in younger patients who may impart more stress on their thumbs. Methods: A retrospective review was performed on all patients who underwent trapeziectomy and LRTI or suspensionplasty at 55 years of age or younger from 1992 to 2008. Objective clinical outcome measures included preoperative to postoperative changes in thumb range of motion, grip and pinch strength, a study-specific thumb function score, and the Buck-Gramcko subjective outcome score. Progressive metacarpal subsidence was evaluated on radiographs. Survivorship free from revision surgery was calculated with a Kaplan-Meier analysis. Results: A total of 57 wrists underwent trapeziectomy and LRTI (n = 18) or suspensionplasty (n = 39). The mean patient age at the time of surgery was 49.6 years (range: 38-55 years). Mean clinical and radiographic follow-up were 10.2 and 6.4 years, respectively. Overall, there were significant improvements in pain and grip strength despite progressive and metacarpal subsidence. Survivorship was 100% and 86% free from revision surgery at 10 and 15 years, respectively (n = 2 failures). Conclusions: Trapeziectomy and LRTI or suspensionplasty in patients less than or equal to 55 years of age can result in considerable improvements in pain and grip strength with a 10-year survivorship free from revision.

Decision Aid for Trapeziometacarpal Arthritis: A Randomized Controlled Trial.

PURPOSE: Decision aids increase patient participation in decision making and reduce decision conflict. The goal of this study was to evaluate the effect of a decision aid prior to the appointment, upon decisional conflict measured immediately after the visit relative to usual care. We also evaluated other effects of the decision aid over time. METHODS: In this randomized controlled trial, we included 90 patients seeking the care of a hand surgeon for trapeziometacarpal (TMC) arthritis for the first time. Patients were randomly assigned to receive either usual care (an informational brochure) or an interactive Web-based decision aid. At enrollment, consult duration was recorded, and patients completed the following measures: (1) Decisional Conflict Scale; (2) Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH); (3) pain intensity; (4) Physical Health Questionnaire (PHQ-2); (5) satisfaction with the visit; and (6) Consultation And Relational Empathy (CARE) scale. At 6 weeks and 6 months, patients completed: (1) pain intensity measure; (2) Decision Regret Scale; and (3) satisfaction with treatment. We also recorded changes in treatment and provider. RESULTS: Patients who reviewed the interactive decision aid prior to visiting their hand surgeon had less decisional conflict at the end of the visit. Other outcomes were not affected. CONCLUSIONS: Use of a decision aid prior to a first-time visit for TMC led to a measurable reduction in decision conflict. Decision aids make people seeking care for TMC arthritis more comfortable with their decision making. Future research might address the ability of decision aids to reduce surgeon-to-surgeon variation, resource utilization, and dissatisfaction with care CLINICAL RELEVANCE: Surgeons should consider the routine use of decision aids to reduce decision conflict.

El nervio espinal y el trapecio superior en la cervicalgia / No disponible

INTRODUCCIÓN: La cervicalgia es un transtorno muscoloesquelético muy frecuente en las consultas de Osteopeatía, afectando al 45-54% de la población a lo largo de su vida. Se define como un dolor localizado entre occipucio y la tercera vértebra dorsal. La mayoría de pacientes con cervicalgia no solucionan completamente sus síntomas y su discapacidad, evolucionando con periodos de remisión y exarcerbación. El músculo trapecio es un importante estabilizador escapular e interviene mediante contracción mantenida en la posición de la cabeza. La neuropatía del nervio espinalpodría degenerar la fibra muscular (atrofia o fibrosis) presentando el trapecio las bandas tensas típicas del dolor miosfacial cervical. OBJETIVO: Exponer la relación existente entre la cervicalgia mecánica, el trapecio superior y su inervación a través del nervio espinal (XI). MATERIAL Y MÉTODOS: Se ha realizado una revisión bibliográfica y posterior comentario de una serie de artículos que relacionan la neuropatía del XI par craneal y consecuente afectación del trapecio, en los pacientes con disfunciones miosfaciales cervicales. RESULTADOS: Existe cierta evidencia científica que relaciona las disfunciones del nervio espinal y sus repercusiones en el trapecio superior en los individuos con dolor cervical. CONCLUSIONES: El osteópata debe realizar una correcta evaluación del agujero rasgado posterior y su contenido vasculonervioso para tratar y prevenir las implicaciones del trapecio superior en las cervicalgias

No disponible

Thumb Basal Joint Arthritis.

The thumb basal joint is the second most common site of osteoarthritis in the hand, and osteoarthritis of this joint can contribute to painful movement and debilitating function. To achieve a high degree of prehensile and manipulative function, this highly mobile joint is constrained by both the saddle morphology of the trapezium and a stout complement of ligamentous constraints. The disease proceeds progressively with several wear patterns. Substantial new biomechanical and longitudinal clinical studies have changed some of the prevailing opinions on the process of serial degenerative changes. Diagnosis is made with a thorough clinical examination and radiographic staging, as described by Eaton and Littler. Thumb basal joint arthritis can be initially managed with medications, orthoses, and steroid injections; however, it frequently progresses despite these interventions. Surgical management commonly consists of trapeziectomy with or without interposition or suspension, arthroplasty with implant, volar ligament reconstruction, osteotomy, or arthrodesis; none of these techniques has been proved to be superior to the others.

The effectiveness of physical therapies for patients with base of thumb osteoarthritis: Systematic review and meta-analysis.

BACKGROUND: Trapeziometacarpal osteoarthritis (known as base of thumb OA) is a common condition causing pain and disability worldwide. OBJECTIVE: The purpose of this review was to evaluate the effectiveness of multimodal and unimodal physical therapies for base of thumb osteoarthritis (OA) compared with usual care, placebo or sham interventions. DESIGN: Systematic review and meta-analysis. METHOD: We searched MEDLINE (PubMed), CINAHL, Embase, AMED, PEDro, Cochrane Database of Systematic Review, Cochrane Register of Controlled Trials (CENTRAL) from inception to May 2017. Randomized controlled trials involving adults comparing physical therapy treatment for base of thumb OA with an inactive control (placebo or sham treatment) and reported pain, strength or functional outcomes were included. Meta-analyses were performed where possible. Methodological risk of bias was assessed with the Cochrane Risk of Bias tool. RESULTS: Five papers with low risk of bias were included. Meta-analyses of mean differences (MD) with 95% confidence intervals (95% CI), were calculated for between-group differences in point estimates at 4 weeks post-intervention. Multimodal and unimodal physical therapies resulted in clinically worthwhile improvements in pain intensity (MD 2.9 [95% CI 2.8 to 3.0]; MD 3.1 [95% CI 2.5 to 3.8] on a 0-10 scale, respectively). Hand function improved following unimodal treatments (MD 6.8 points [95% CI 1.7 to 11.9)] on a 0-100 scale) and after a multimodal treatment (MD 20.5 (95%CI -0.7 to 41.7). CONCLUSIONS: High quality evidence shows unimodal and multimodal physical therapy treatments can result in clinically worthwhile improvements in pain and function for patients with base of thumb OA.

Changes in Local Bone Density in Early Thumb Carpometacarpal Joint Osteoarthritis.

PURPOSE: Thumb carpometacarpal (CMC) osteoarthritis (OA) represents a major source of functional morbidity. The effects of early CMC OA on loading and use patterns potentially lead to changes in local bone density and microarchitecture. Hounsfield units (HU), a quantitative attenuation coefficient obtained from computed tomography (CT) scans, have been shown to be a reliable marker of bone density. We hypothesized that early CMC OA is associated with lower local bone density about the CMC joint as assessed by HU. METHODS: We examined HU units from CT scans in 23 asymptomatic subjects and 91 patients with early CMC OA. The HU measurements were obtained within cancellous portions of the trapezium, capitate, first and third metacarpal bases, and distal radius. Linear regression models, with age and sex included as covariates, were used to assess the relationship between CMC OA and HU values at each anatomical site. RESULTS: Early OA patients had significantly lower HU than asymptomatic subjects within the trapezium (mean, 377 HU vs 436 HU) and first metacarpal bases (265 HU vs 324 HU). No significant group differences were noted at the capitate, third metacarpal, or distal radius. Male sex and younger age were associated with significantly higher HU at all the anatomical sites, except the first metacarpal base, where age had no significant effect. CONCLUSIONS: Subjects presenting with early CMC OA had significantly lower bone density as assessed with HU at the thumb CMC joint (trapezium and first metacarpal base). Early thumb CMC OA and discomfort may lead to diminished loading across the basal joint, producing focal disuse osteopenia. These findings in symptomatic early arthritis suggest a relationship between symptoms, functional use of the CMC joint, and local bone density. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic II.

Biomechanical causes of trapeziometacarpal arthroplasty failure.

Trapeziometacarpal joint prosthesis revision has been widely reported, mainly due to loosening of the trapezium cup. Our hypothesis is that current prostheses do not sufficiently respect the kinematics of this joint. CT scan acquisitions enabled us to determine the position of the first metacarpal relative to the trapezium in three different characteristic postures, in subjects in different stages of arthrosis. A CAD model of a current prosthesis was inserted into the numerical 3D model of the joint under the different postures. In the numerical model, we observe penetration of the cup by the head of the prosthesis. This virtual penetration could, in vivo, amount to overstressing the prosthetic elements, which would lead to loosening of the cup or of the metacarpal stem and luxation of the prosthesis.

Interposition Arthroplasty Versus Hematoma and Distraction for the Treatment of Osteoarthritis of the Trapeziometacarpal Joint.

BACKGROUND: Various surgical techniques were reported with excellent result for the treatment of trapeziometacarpal joint arthritis. However, the best treatment option was not defined yet. METHODS: This randomized prospective study compared the result of two surgical techniques: tendon interposition arthroplasty (64 patients) and K. wire distraction (56 patients) after trapeziectomy for stage 3 or 4 osteoarthritis of the trapeziometacarpal joint. RESULTS: After a mean follow-up period of 6.8 (range, 3-10) years it was possible to observe a higher rate of pain relief following trapeziectomy with K. wire suspension, but no significant differences in strength, range of motion and DASH score between the two groups. On lateral unloaded radiographs the height of the space between the base of the thumb metacarpal and the scaphoid showed a mean value of 6.5 mm for both groups; the average distance between the metacarpal base and the trapezium was not statistically significant in the two groups. Complications were observed only in patients treated with trapeziectomy and interposition arthroplasty and were represented by tendinitis of the FCR in 15% of cases. CONCLUSIONS: We demonstrate that the trapezium excision and bone space distraction technique requires a smaller incision, a shorter surgical time, an easier surgical technique, and a less painful recovery, maintaining overlapping levels of functional restore.

Contribución de la fuerza y el dolor en la función del paciente con artrosis trapecio metacarpiana. Estudio transversal / Effect of muscle strength and pain on hand function in patients with trapeziometacarpal osteoarthritis. A cross-sectional study

Objetivo. Establecer una posible relación entre la fuerza (Jamar), el dolor (EVA) y la capacidad funcional referida por el paciente (DASH) determinando en qué grado influyen unas en otras. Estudio observacional transversal analítico. Participantes. Muestra de 72 pacientes que presentaban una artrosis trapecio metacarpiana grado 2-3 de Eaton. Los pacientes fueron reclutados cuando acudían a la Unidad de Cirugía de mano. Método. Se realizaron mediciones de fuerza de agarre, pinza, valoración del dolor y funcionalidad, y se establecieron las correlaciones entre cada una de ellas. Resultados. El modelo más significativo para la función (R2 =0.83) incluye la variable dolor y la fuerza. Pero es la fuerza punta contra punta la que presenta una mayor correlación con el cuestionario DASH (B-estandarizado: –57). Respecto al dolor, influye en todas las mediciones de fuerza realizadas con el dinamómetro, siendo también la fuerza de la pinza punta contra punta la que presenta una mayor correlación. Conclusiones. Los hallazgos corroboran que existe una correlación significativa entre la función referida por el paciente y variables que podemos medir en consulta, como la fuerza del puño y la pinza. Pero también esta correlación es significativa entre las variables función y dolor entre sí, pero es la pinza punta contra punta la que presenta una mayor asociación con el cuestionario DASH (AU)

Objective. To assess the relationship between muscle strength (Jama), and pain (VAS) levels with hand function (DASH) in patients with trapeziometarcapal osteoarthritis. Cross-sectional study. Participants. Sample of 72 patients with osteoarthritis stage 2-3 (Eaton) and trapeziometacarpal osteoarthritis. Patients were recruited when they came to the Hand Surgery Unit. Method. Grip strength, pinch, pain and hand function were measured, and correlation and regression coefficients between them were obtained. Results. For function, the most significant model (R2=0.83) included pain and strength. But it is tip to tip pinch force which has a stronger relationship with DASH (Standardized B: –57) questionnaire. Pain also influenced strength measured with the dynamometer but it was tip to tip pinch force that was the most affected. Conclusions. Findings confirm that there is a significant correlation between function referred by the patient and variables that can be measured in the clinic such as grip strength and pinch. The correlation between pain intensity and function was also significant, but tip to tip pinch strength had the greatest impact on the function (AU)

[Results after distraction arthroplasty according to Bufalini and Perugia in early stages of trapeziometacarpal osteoarthritis]. / Ergebnisse der Behandlung der Rhizarthrose im Frühstadium mittels der Distraktionsarthroplastik nach Bufalini und Perugia.

BACKGOUND: A distraction arthroplasty of the trapeziometacarpal joint was introduced by Bufalini and Perugia for the treatment of the early stages of carpometacarpal osteoarthritis. Our retrospective study presents the results of this technique. Thereby, a tendon graft anchored to the distal second metacarpal is fixed at the base of the first metacarpal, keeping it in distraction. MATERIAL AND METHODS: 10 distraction arthroplasties were performed in 9 patients with carpometacarpal osteoarthritis stage I and II of the thumb after unsuccessful conservative therapy. In 2 cases, which were excluded from our study, trapeziectomy had to be performed because of persisting pain. Patient satisfaction, pain measurement, range of motion, and tip, key and grip strength were evaluated at a follow-up of 46.5 (29-63) months in the remaining 7 patients (8 operations overall). Strengh measurement was taken in an absolute value and compared to the opposite side. Thumb range of motion was measured with the combined flexion-opposition of the thumb with the Kapandij index and also the angle of abduction of the metacarpal I to metacarpal II. Assessment included a DASH score evaluation and an X-ray control. RESULTS: All of the 7 evaluated patients were satisfied with the operation results. Compared to the opposite side, patients achieved 80.1% (5.9 kg±1.1 kg) of key pinch strength, 86.3% (4.8 kg±0.9 kg) of oppositional tip pinch strength, and 86.1% (23.1 kg±4.8 kg) of grip strength. In combined flexion and opposition a Kapandij index of 8.5 (94.4%) compared to 9 on the opposite side was achieved. Thumb radial abduction was 48.2°±2.8°, compared to 51.0°±2.9° on the contralateral hand. At follow-up, the mean DASH score was 17.8 (±10.0). Radiological control showed no progression of carpometacarpal osteoarthritis of the thumb. CONCLUSIONS: The collected data after distraction arthroplasty according to Bufalini and Perugia confirm the efficacy of the technique in the early stage of carpometacarpal osteoarthritis of the thumb. Even though a failure rate of 20% occurred, in our opinion the operation is justified in the early stages of carpometacarpal osteoarthritis of the thumb as the patients benefit from a pain-free interval, leaving the option for future trapeziectomy.

The follow-up of trapeziometacarpal arthrodesis using V-shaped osteotomy for osteoarthritis of the first carpometacarpal joint.

INTRODUCTION: Osteoarthritis of the trapeziometacarpal joint, also known as the thumb carpometacarpal joint, is one of the most common anatomic sites of arthritis in the human body. Many surgical techniques to address this problem have been developed; including, trapeziectomy with or without ligament reconstruction tendon interposition, implant arthroplasty, and arthrodesis. No methods have yet proven superior to the others, and each has associated limitations and complications. The primary complication found in the literature after arthrodesis of the trapeziometacarpal joint is nonunion; with a reported incidence in the literature as 13% (8% to 39%). METHODS: In 2010, a new surgical technique for this procedure was published by Wolff and Duerinckx in Techniques in Hand Surgery. In summary, a V-shaped osteotomy is made at the base of the first metacarpal and, together with a matching osteotomy of the trapezium, creates a more stable fusion site. Our current research looks at a minimum of 2-year follow-up of patients treated with this technique between 2004 and 2012. RESULTS: Twenty-one patients, including 3 who had bilateral procedures, have participated in the study. The average age is 62.6 years (range, 51 to 76 y) with an average follow-up of 4.6 years (range, 2 to 8 y). Sixteen are female and 5 are male, with a variety of occupations. In these patients, the Quick DASH score improved 51% (49.8 to 24.2; P=0.0006), and the Quick DASH Work score improved 56% (52.8 to 23.2; P=0.0035). Nineteen of 21 patients said that they wound have the procedure again. Range of motion and strength of the operated versus nonoperated thumbs were compared and showed very similar capabilities. Seventy-five percent (18 of 24) were able to lay their hand flat. There were 4 fibrous unions, resulting in an 83% complete fusion rate. There were no infections or reoperations for nonunion. CONCLUSION: The data suggest that this procedure is a highly successful, pain-relieving, strength-preserving, reproducible arthrodesis with a nonunion rate similar to that of the published literature.

Dual mini TightRope suspensionplasty for thumb basilar joint arthritis: a case series.

PURPOSE: To evaluate the efficacy of the technique of dual Mini TightRope suspensionplasty for treatment of trapeziometacarpal joint arthritis. METHODS: We conducted a retrospective study investigating the use of a dual Mini TightRope suspensionplasty technique from 2010 to 2013 at a single institution. We identified 11 patients (12 thumbs). Grip and pinch strength, thumb range of motion, and complications were reviewed. The trapezial space ratio was measured from the preoperative, postoperative, and follow-up radiographs. All patients completed the Disabilities of Arm, Shoulder, and Hand survey, Patient-Rated Wrist Evaluation, and the Michigan Hand Outcome Questionnaire at the latest follow-up. RESULTS: Dual Mini TightRope suspensionplasty resulted in reduced pain levels, increased grip and pinch strength, and preserved range of motion. Radiographs demonstrated maintenance of trapezial space height at an average of 17 months (range, 10-26 mo). There were no cases of impingement or fracture of the first and second metacarpal bases. CONCLUSIONS: Dual Mini TightRope suspensionplasty for the management of trapeziometacarpal joint arthritis yielded satisfactory results with improvement in strength and function. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.