Volar Dislocation of Trapezoid with Coronal Fracture - A Case Report and Review of Literature.

Volar dislocation of the trapezoid is a rare injury and is easily missed. It is more common to have a dorsal dislocation of trapezoid or multiple carpometacarpal joint dislocations. The rare nature of the injury also means that there is little guidance in literature regarding optimal treatment. We are reporting the presentation, management and a 3-year follow-up of this rare injury in a 19-year-old male. Level of Evidence: Level V (Therapeutic).

Arthroscopic Distal Scaphoid Resection for Scapho-Trapezium-Trapezoid Arthritis.

Background: The purpose of this study was to describe the technique of arthroscopic resection of the scaphoid head and evaluate both the clinical and radiographic results of scapho-trapezium-trapezoid osteoarthritis cases. Methods: Seventeen cases (13 men and 4 women) with a mean age of 57 years (24-74 years) were operated on from 2002 to 2015. Inclusion criteria were nontraumatic radial-sided wrist pain without improvement after 4 months of conservative treatment and positive radiographic images demonstrating the presence of osteoarthritis. All cases were evaluated preoperatively and postoperatively using visual analog scale, wrist range of motion (ROM), grip strength, and patient's work status (Mayo Wrist Score). Disabilities of the Arm, Shoulder, and Hand (DASH) and Patient-Rated Wrist/Hand Evaluation (PRWHE) questionnaires were also administered. The technique consisted of performing a 3- to 4-mm round-shaped scaphoid head resection via arthroscopy while preserving the scaphotrapezial and scaphocapitate ligament insertions. Results: At an average follow-up of 24 months, all the patients were satisfied. The results showed statistically significant improvement in pain at rest (P = .001), under maximal load (P = .0001), and in Mayo Wrist Score (MWS) (P = .0001). Wrist ROM, grip strength, DASH, and PRWHE showed an improvement without reaching statistical significance. The mean preoperative radiolunate (RL) X-ray measurement angle was 17° (-10° to 35°). The postoperative mean value was 25° (0°-45°). In the preoperative radiographic evaluation, 11 cases exceeded the "critical" 15° RL angle. At follow-up, the RL angle increased in 10 cases and remained unchanged in 7 cases. None of these cases became symptomatic. Transitory neurapraxia of the dorsal superficial branch of the radial nerve was observed in 1 case. Damage of the dorsal branch of the radial artery was immediately fixed. Conclusions: Arthroscopic resection of the distal portion of the scaphoid due to scapho-trapezium-trapezoid osteoarthritis demonstrated an effective and safe technique with less complications than open surgery.

Trapezoidal fractures: Overview and introduction of a novel diagnostic classification system.

INTRODUCTION: Trapezoidal fractures account for only 0.4% of all carpal bone fractures. Owing to their rarity, there is paucity in the literature regarding the clinical findings and treatment. This paper aims to summarize the current understanding of trapezoidal fractures and present a novel classification algorithm. METHODS: A diagnostic classification algorithm was created based on the known blood supply and ligamentous attachment of the trapezoid. The proposed treatment algorithm was then applied to trapezoidal fractures in the literature to validate the algorithm and determine whether patients received treatment that was in accordance. RESULTS: A total of 19 articles, representing 22 trapezoidal fractures were included, with two additional cases presented by the authors. Presenting symptoms were pain (n = 21) and swelling (n = 12). Diagnosis was made on CT in a majority of the time, 79.2% (n = 18). All outcomes were favorable with symptomatic resolution and full range of motion after treatment, except in four patients that had co-existing wrist injuries. When the algorithm was applied, 89.5% (n = 17) of the patients received treatment in accordance with the proposed algorithm and demonstrated good outcomes. In the remaining patients (n = 2) whose treatment differed, one had diminished grip strength and the other was lost to follow-up. CONCLUSIONS: Given a degree of clinical suspicion including a history of blunt trauma to the hand and persisting pain, trapezoidal fractures should remain on the differential when plain radiographs fail to identify any fracture. Operative treatment is suggested if there is any significant displacement, compromise of the dorsal surface, or breech of the trapezoidal ligaments causing possible dislocation. LEVEL OF EVIDENCE: IV - Diagnostic.

Scaphoid Motion of the Wrist with Scapho-trapezio-trapezoidal Osteoarthritis-A Pilot Study.

BACKGROUND: The purpose of this study was to investigate scaphoid motion within the scapho-trapezio-trapezoidal (STT) joint during wrist motion in the presence of STT joint osteoarthritis (OA). METHODS: We studied 11 wrists with STT OA and 5 normal wrists. Computed tomography (CT) images were acquired in five wrist positions (maximum active flexion, extension, radial deviation, ulnar deviation, and neutral position). The 3-dimensional surface models of the radius and scaphoid were constructed and the motion of scaphoid relative to the radius was calculated. RESULTS AND CONCLUSIONS: During wrist flexion/extension motion, the scaphoid rotated mostly in the flexion/extension plane. The angle tended to be smaller in STT OA than in normal. During wrist radioulnar deviation, the scaphoid was in an extended position in neutral wrist in STT OA. The motion of scaphoid in STT OA was divided into two types: a rigid type and mobile type. The mobile type rotated closer to the flexion/extension plane than the rigid type. Taking into account scaphoid motion during wrist movement before surgery may provide better results in the treatment of STT OA.

A New Technique for Radiographic Visualization of the Scaphotrapeziotrapezoid Joint.

Standard radiographs of the wrist do not provide adequate visualization of the scaphotrapeziotrapezoid joint. A radiographic technique that provides an improved and more complete visualization of the joint compared with routine views is described. [Orthopedics. 2020; 43(2):e123-e124.].

T2 mapping of the trapeziometacarpal joint and triangular fibrocartilage complex: a feasibility and reproducibility study at 1.5 T.

PURPOSE: To assess the feasibility and reproducibility of T2 relaxation time measurements of the trapeziometacarpal joint (TM) and triangular fibrocartilage complex (TFCC) on healthy subjects at 1.5 T MR. MATERIALS AND METHODS: Thirty-four healthy volunteers underwent an axial oblique multislice multiecho spin-echo sequence of the wrist at 1.5 T, with 10 of them having performed another MR scan on a different 1.5 T scanner. Regions of interest were independently manually drawn by two musculoskeletal radiologists to include the cartilaginous part of the TM and TFCC. Intra-observer, inter-observer and inter-scanner reproducibility of T2 relaxation time measurements was tested using the Bland-Altman method. RESULTS: The mean T2 values obtained by the two radiologists were 29.9 ± 6.5 ms and 30.0 ± 6.1 ms in the TM and 24.5 ± 2.3 ms and 24.6 ± 2.8 ms in the TFCC, respectively. The mean values of the second series of T2 measurements obtained by the senior radiologist were 29.9 ± 6.5 ms and 30.0 ± 6.3 ms in the TM and 24.3 ± 2.9 ms in the TFCC. Inter-observer reproducibility in the TM and in the TFCC was 76% and 82%, respectively. Intra-observer reproducibility in the TM and TFCC was 71% and 76%, respectively. Inter-scanner reproducibility of T2 measurements was 36% in the TM and 85% in the TFCC, respectively. CONCLUSION: The assessment of T2 relaxation time measurements of the cartilage of the TM and the TFCC seems to be feasible and reproducible, although the inter-scanner reproducibility of T2 measurements of the TM is suboptimal. Further studies including patients are warranted to prove the utility of this tool.

Evaluation and Management of Scaphoid-Trapezium-Trapezoid Joint Arthritis.

Degenerative arthritis at the articulation of the scaphoid, trapezium, and trapezoid (STT or triscaphe joint) is a common degenerative disease of the wrist. Pain and weakness with grip strength reduction and functional limitations when performing routine daily tasks are common complaints of patients with STT arthritis. Initial conservative treatments for STT arthritis include splinting, bracing, activity modification, anti-inflammatory medication, and steroid injections for pain relief. Failure of conservative treatment is the main indication for surgery, which may include distal scaphoid excision, with or without filling of the void after excision, trapeziectomy, STT arthrodesis, or STT implant arthroplasty.

Isolated Trapezoid Fracture in a Boxer.

BACKGROUND Trapezoid fractures are very uncommon, accounting for less than 1% of all wrist fractures. Isolated fractures of this bone are even more rare, with just a few reports in the literature. The trapezoid bone has a very stable position within the wrist, forming a relatively immobile joint with the second metacarpal base distally. It is also connected by very strong ligaments to the trapezium, capitate and, scaphoid. Trapezoid fractures occur when a strong bending or axial force is applied to the second metacarpal base. CASE REPORT We present a clinical case of an isolated, non-displaced, trapezoid fracture in a young white male, which was treated with cast immobilization for 4 weeks and physical therapy. Complete functional recovery was achieved 3 months after the injury, without any pain or tenderness. CONCLUSIONS Fractures of the trapezoid bone usually have a good clinical outcome. Nonetheless, we need to be very suspicious about this diagnosis since radiography is apparently normal in almost all such cases and clinical examination results may not be entirely clear.

Incidental Flexor Carpi Radialis Tendinopathy on Magnetic Resonance Imaging.

Background: Wrist pain is often nonspecific. Magnetic resonance imaging (MRI) is regularly obtained to evaluate wrist pain. Variations and pathophysiology identified on MRI may not account for patient's clinical symptoms. This study aims to quantify the prevalence of flexor carpi radialis (FCR) tendinopathy on MRI and the coexistence of trapeziometacarpal (TMC) or scaphotrapeziotrapezoid (STT) osteoarthritis. Methods: Using an institutional research database, we identified 3631 adult patients who obtained an MRI of the wrist during a 15-year period. Text search in the radiology reports identified 302 patients with possible FCR signal abnormalities. After reviewing the medical records, 98 patients were identified with FCR tendinopathy. Furthermore, medical records were used to identify pain located on the volar radial part of the wrist. In the absence of a documented examination consistent with FCR tendinopathy, we considered any signal change in the FCR incidental. Results: We identified 55 patients (55%) with incidental FCR tendinopathy. In a bivariate analysis, we found FCR signal changes on the MRI were associated with older age, white race, clinically suspected FCR tendinopathy, volar-radial sided wrist pain, and TMC and STT arthritis. Using multivariable logistic regression to account for confounding, older age and volar-radial sided wrist pain were independently associated with FCR signal changes on MRI. Conclusions: Signal changes in the FCR are infrequent and often incidental (asymptomatic) or associated with peritrapezial osteoarthritis.

Comparison of Radiographic and Intraoperative Visual Assessment of Scaphotrapezoid Joint Arthritis in Patients With End-Stage Carpometacarpal Arthritis of the Thumb Base.

Background: The purpose of this investigation is to compare the radiographic and intraoperative assessment of scaphotrapezoid (ST) joint arthritis in patients with end-stage carpometacarpal (CMC) arthritis of the thumb base. We aim to define the incidence of ST arthritis in this population and determine whether radiographic features such as lunate morphology, dorsal intercalated segment instability (DISI), and scapholunate (SL) diastasis are associated with the incidence of ST arthritis. Methods: We retrospectively reviewed consecutive patients with end-stage CMC arthritis of the thumb treated operatively with trapeziectomy. Preoperative wrist radiographs were reviewed, and the presence of ST arthritis was determined using the Sodha classification. Lunate morphology, DISI, and SL diastasis were noted. Intraoperative grading of ST arthritis was assessed using a modified Brown classification. The specificity and sensitivity of radiographic assessment was compared with the gold standard of intraoperative direct visualization. Results: In total, 302 thumbs met inclusion criteria. End-stage ST joint arthritis determined by intraoperative visual inspection was noted in 31% of cases. No radiographic or demographic variables were found to be risk factors for ST arthritis. Plain radiographs were 47% sensitive and 94% specific in their ability to detect end-stage ST joint arthritis. Conclusions: We report a 31% incidence of end-stage ST joint arthritis in surgically treated patients with CMC arthritis based on visual inspection which is lower than previous literature. Wrist radiographs demonstrate a 47% sensitivity and 94% specificity in predicting end-stage ST joint arthritis. It is imperative to directly visualize the ST joint after trapeziectomy, as radiographs demonstrate poor sensitivity.

Obtaining a Reliable Scaphotrapeziotrapezoid Radiograph: Pronation, Ulnar Deviation, and Thumb Abduction.

A simple, reproducible technique for assessing the scaphotrapeziotrapezoid joint radiographically is described. In addition to its diagnostic value, the technique is simple to perform with a minifluoroscopy unit, allowing for image-guided injections of the scaphotrapeziotrapezoid joint.

A CT-based approach with 3D modeling to determine optimal radiographic views of the scaphotrapezial and scaphotrapezoid joints.

PURPOSE: To use a CT-based approach with 3D modeling to determine novel radiographic views of the scaphotrapezial (STl) and scaphotrapezoid (STd) joints. MATERIALS AND METHODS: Consecutive wrist CT scans excluding those with pathology of the distal radius, scaphoid, trapezium, or trapezoid of subjects between ages 18 and 60 years were retrospectively reviewed. Three-dimensional reconstructions of CT scans were created and best-fit planes of the STl and STd joints were generated. Angles of these planes relative to a distal radial coordinate system were calculated to determine tilt of the wrist and the X-ray beam for novel radiographic views of these joints. RESULTS: Fifty eligible wrist CT scans were identified. The mean age was 38 years (range, 18 to 59). For the novel STl PA view, the wrist is supinated 17° from the standard PA view and the X-ray beam is canted 6° caudad. In the STl lateral view, the wrist is pronated 17° from the standard lateral view, and the X-ray beam is canted 20° caudad. In the STd PA tilt view, the wrist is supinated 28° from the standard PA view, and the X-ray beam is canted 13° caudad. In the STd joint lateral tilt view, the wrist is pronated 28° from the standard lateral view, and the X-ray beam is canted 29° caudad. CONCLUSION: We describe novel radiographic views of the STl and STd joints based on 3D modeling of wrist CT scans. Further studies are required to assess the efficacy of these views in detecting joint pathology.

Isolated scaphotrapeziotrapezoid osteoarthritis treatment using resurfacing arthroplasty with scaphoid anchorage. / Tratamiento de la artrosis escafotrapeciotrapezoidea aislada con artroplastia de recubrimiento con anclaje escafoideo.

OBJECTIVE: The aim of this study is to show the results of scaphotrapeziotrapezoid (STT) joint osteoarthritis treatment performing resurfacing arthroplasty with scaphoid anchorage. MATERIAL AND METHOD: An observational, descriptive and retrospective study was performed. Ten patients with isolated STT joint osteoarthritis were studied between 2013 and 2015. The mean follow-up time was 26months. Clinical results, functional and subjective scores were reviewed. RESULTS: The patients were satisfied, achieving an average of 2.1 (0-3) on the VAS score and 16 (2 to 28) in the DASH questionnaire, and returning to work in the first three months post-surgery. Recovery of range of motion compared to the contralateral wrist was 96% in extension, 95% in flexion, 87% in ulnar deviation and 91% in radial deviation. The average handgrip strength of the wrist was 95% and pinch strength was 95% compared to the contralateral side. There were no intraoperative complications or alterations in postoperative carpal alignment. CONCLUSION: Resurfacing arthroplasty is proposed as a good and novel alternative in treating isolated SST joint arthritis. Achieving the correct balance between the strength and mobility of the wrist, without causing carpal destabilisation, is important to obtain satisfactory clinical and functional results.

QuickDASH Score Is Associated With Treatment Choice in Patients With Trapeziometacarpal Arthrosis.

BACKGROUND: Trapeziometacarpal (TMC) arthrosis has a variety of treatment options, including nonoperative (eg, education, splint, injection) and operative management. Symptoms and limitations vary greatly among patients. The purpose of this study was to determine an association of symptoms and limitations, quantified using the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, with treatment choice in patients newly diagnosed with TMC arthrosis. We also addressed the association of the QuickDASH score with radiographic severity and sought factors associated with higher QuickDASH scores. METHODS: As part of the routine new patient intake paperwork, all new patients completed a QuickDASH form. We included 81 new patients with newly diagnosed TMC arthrosis visiting the office of 1 of 5 orthopedic hand surgeons between March 1, 2015, and November 30, 2015. Eight patients were excluded because of incomplete QuickDASH forms. RESULTS: Based on QuickDASH tertiles, patients with a low QuickDASH score were more likely to choose education alone than patients with intermediate and high QuickDASH scores; no patients in the lowest QuickDASH tertile chose injection or surgery. Patients who chose education alone also had a lower mean QuickDASH score than patients who chose splint or surgery. Radiographic severity and other patient-related factors were not associated with greater symptoms and limitations. CONCLUSIONS: More adaptive patients (lower QuickDASH) are less likely to choose injection or surgery, irrespective of disease severity. The psychosocial factors known to correlate with greater symptoms and limitations might lead patients to feel they have fewer options or to choose more interventional options than they would if they were more at ease. In other words, inadequate attention to psychosocial factors may increase the risk of misdiagnosis of patient preferences.

[Transtrapezoid carpal dislocation: a case report]. / Transtrapezoidale Luxation: Ein Fallbericht.

Fracture dislocations of the STT joint are extremely rare. We present the case of a 50-year-old worker, who sustained a crush injury of his left hand with a dorsal fracture dislocation of the trapezoid bone and the associated second metacarpal bone at the STT, and a concomitant compartment syndrome of the hand. The fracture was reduced immediately and compartment release was performed, followed by percutaneous stabilisation using three K-wires. Material removal after six weeks was followed by intensive physical therapy. At the final follow-up examination after three months, we observed a good recovery of hand function compared to the unaffected right side with 75 % grip strength, 90 % ROM in extension/flexion and full thumb opposition (Kapandji score 9/10). Immediate surgical treatment of this rare injury can lead to a good functional result of the hand.

Pulse-dose radiofrequency can reduce chronic pain in trapezio-metacarpal osteoarthritis: A mini-invasive therapeutic approach.

AIM: To assess the efficiency of pulse-dose radiofrequency (PDRF) in the management of chronic pain in patients with trapezio-metacarpal osteoarthritis (OA). METHODS: Seventy-five patients with trapezio-metacarpal OA were treated with the PDRF between October 2011 and September 2013. A 22-gauge cannula with a 5-cm length was introduced with percutaneous access in the lateral region of the affected trapezio-metacarpal joint. The PDRF procedure was performed with 1200 pulses at 45 V and 20 msec duration, followed by a 480 msec silent phase. The follow-up visits were performed at 1 month, 3 and 6 months after the PDRF procedure. All patients underwent a second treatment between 7 and 9 months after the first PDRF procedure with a new follow-up scheme at 1, 3, 6 and 9 months. RESULTS: Mean visual analogue scale (VAS) scores before the procedures was 8.5 ± 1.1. A great reduction in pain intensity was reported at 3 months after the PDRF procedure (mean VAS scores 3.1 ± 0.9, P < 0.05). Pain intensity began to increase back to pre-procedural values after 4 months (mean VAS scores at 6 months was 7.9 ± 1.3, P < 0.05). After the second PDRF treatment the mean VAS scores decreased to 3.3 ± 0.8 at 3 months, but increased to 8.1 ± 1.6 at 9 months. (P < 0.05). No complications after the procedures were observed. CONCLUSIONS: The PDRF may be a safe, repeatable and effective short-term pain management technique in patients with trapezio-metacarpal OA. Larger, randomized controlled studies are indicated to better clarify the efficacy and utility of the PDRF.

Capitate-trapezoid synostosis: analysis of an Early Bronze Age case and review of the literature.

BACKGROUND: Carpal synostoses are congenital defects characterised by complete or incomplete coalition of two or more carpal bones. Although most of these defects are discovered only incidentally, sometimes they become clinically manifest. Among the different types of carpal coalition, the synostosis between capitate and trapezoid bones is quite rare, with only sparse data available in the literature. The aim of this report was to describe a case of capitate-trapezoid synostosis (CTS) observed in an ancient human skeleton, as well as to scrutinise the pertinent literature in order to assess for the characteristics of this type of defect, including its potential relevance to clinical practice. MATERIALS AND METHODS: We studied the skeletal remains of an Early Bronze Age male warrior affected by incomplete CTS. Macroscopic and radiological examination of the defect was carried out. We also performed a comprehensive PubMed search in the Medline and other specialty literature databases to retrieve and analyse data relevant to the subject under consideration. RESULTS AND CONCLUSIONS: The present case is the most ancient CTS ever found. In those literature-reported cases accompanied by careful anatomical description, such as the present one, incomplete coalition invariably occurs between the dorsal surfaces of the two bones, this characteristic emerging as a distinctive morphological trait. Literature analysis further suggests that the true prevalence of CTS is likely to be higher than estimates based on data gathered from radiology series, and that this defect may be associated with pain and carpal bossing more frequently than generally thought.

Trapeziometacarpal joint dislocation complicated by a trapezium fracture: A case report and literature review.

The authors report and discuss the management of a 25-year-old male patient with a trapeziometacarpal joint dislocation complicated by a trapezium fracture. This injury combination is rare with only reported 15 cases. After closed reduction resulted in dorsal instability, anatomical reduction of the trapezium fracture and internal screw fixation were performed using an open approach. This fixation stabilized the joint but was fragile due to the small fragment size. For this reason, ligament reconstruction using half of the flexor carpi radialis tendon was added. At the last follow-up, 16 months later, the trapeziometacarpal joint was stable with a normal range of motion, but the patient had slight pain during physical effort and decreased pinch strength.