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.

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.

Solitary osteochondroma of the trapezoid disguised as a tooth fragment.

Fight bite injuries of the hand are common presentations in A&E departments and usually result from a fist blow to the mouth. The authors report a case of a 24-year-old man who presented 6 weeks after an injury to his right wrist following an altercation. Radiographic examination and CT scans were in keeping with a tooth fragment embedded in the trapezoid. However, post excision histology subsequently revealed the lesion to be a solitary osteochondroma of the trapezoid. Osteochondromas are benign lesions of bony or cartilaginous origin and are usually found in the metaphyseal region of long bones. They represent by far the most common primary bone tumours. However, osteochondromas arising from the carpal bones are extremely rare with very few cases reported in the literature. This case illustrates the need to include 'tumour' as a differential diagnosis in every unusual appearing bony lesion, even if there is a history of trauma.

Six new examples of the bipartite trapezoid bone: morphology, significant population variation, and an examination of pre-existing criteria to identify bipartition of individual carpal bones.

Carpal bone bipartition is a developmental variant resulting in the division of a normally singular carpal into two distinct segments. Cases involving the scaphoid are best known, though many other carpals can be affected, including the trapezoid. Six new examples of bipartite trapezoids, identified in African and Asian anatomical and archeological samples, are reported here and compared with the eight previously known. While the site of bipartition is consistent, the resulting segments exhibit variability in their articulations with neighboring carpals. Five of the six affected trapezoids were identified in African or African-derived samples, yielding a significantly higher frequency (0.323%) of bipartite trapezoid than seen in anatomical or archeological series of European origin. Bilateral bipartite trapezoids in archeological remains from the Mid Holocene site of Gobero (Niger) are potentially the oldest bipartite carpals yet identified in humans. Their discovery may indicate that trapezoid bipartition is a condition that has been present in African populations since prehistoric times, though more data are needed. Because bipartite carpals may be symptomatic and can occur as part of syndromes, the significant population variation in frequency identified here has potential utility in both anatomical and clinical contexts. However, a comparison of the morphological appearance of bipartite trapezoids with the suggested criteria for bipartite scaphoid diagnosis indicates that these criteria are not equally applicable to other carpals. Fortunately, due to the rarity of fracture, identification of the bipartite trapezoid and separating it from pathological conditions is considerably easier than diagnosing a bipartite scaphoid.

[Trapeziometacarpal arthroscopy]. / Die Arthroskopie des Daumensattelgelenks.

OBJECTIVE: Trapeziometacarpal arthroscopy improves diagnostic and therapeutic options in pathologies of the carpometacarpal (CMC) I joint. INDICATIONS: Pathologic conditions of the CMC I joint which are not sufficiently diagnosed by X-rays or MRI. CONTRAINDICATIONS: Pathologic conditions of the CMC I joint in which trapeziometacarpal arthroscopy is not expected to make a contribution to diagnosis or therapy. SURGICAL TECHNIQUE: Trapeziometacarpal arthroscopy using a 1.9 mm arthroscope after instillation of physiological solution. POSTOPERATIVE MANAGEMENT: Thumb cast sparing the interphalangeal joint for 1 week, then functional therapy. RESULTS: Trapeziometacarpal arthroscopy improves diagnosis of CMC I pathologies and gives new therapeutic options, a field which is still rapidly expanding.

Avascular necrosis of the trapezoid bone following carpometacarpal arthroplasty.

A 58-year-old female developed avascular necrosis of her trapezoid approximately 3 months after undergoing carpometacarpal arthroplasty. The patient was treated conservatively with immobilization and had complete resolution of her clinical symptoms during her year of follow-up. Additionally, radiographic examination showed complete restoration of the height of her trapezoid approximately 1 year after the index procedure. Avascular necrosis of the trapezoid is extremely rare with very few cases described in the literature. This is the first description of avascular necrosis following carpometacarpal arthroplasty.

Osteoid osteoma of the trapezoid bone.

Osteoid osteoma is a benign, bone-forming tumor that rarely involves the carpal bones. We report a case of osteoid osteoma of the trapezoid carpal bone with extension to the adjacent second metacarpal bone. Chronic wrist pain and local tenderness were the major clinical signs and symptoms. In chronic wrist pain osteoid osteoma and the possibility of extension to the adjacent bones should be considered.

Bilateral avascular necrosis of the trapezoid.

We present a 5-year follow-up of a patient with bilateral necrosis of the trapezoid that improved clinically and radiographically with nonoperative treatment.

[Roseland® prosthesis: quality of life's studies about 68 patients with a mean followed-up of 43.8 months]. / Prothèse Roseland®: étude de qualité de vie de 68 patients avec un recul moyen de 43,8 mois.

OBJECTIVES: Roseland® prosthesis is a ball and socket prosthesis, physiological and not anatomical. This study wants to demonstrate by a quality life questionnaire (quick DASH described by Dubert et al., 2001) that Roseland® prosthesis gives to patients a trapeziometacarpal joint native capacities. PATIENTS AND METHODS: An exterior examinator reviewed prospectively 68 patients having a mean age of 61.1 years at surgery with 11 bilateral cases that is 79 prothesis. With a mean follow-up of 43.8 months, we value by Kapandji's opposition, first comisssural openning, quality of life and patient's satisfaction. RESULTS: Three patients have been excuded: two of them had got post-traumatic dislocation: one trapezium fracture, one unknown reason. The third patient had got osteophytis with "came" effects. We keep 65 patients with 84,6% satisfying and very satisfaying. 75,4% of patients have a capacity of 80% and more of their joint, 40% of them had got 100%. DISCUSSION: Roseland® prosthesis has good results because it agrees with already known principles as on its own concept: rotula prothesis gives three axes mobility, as on its own conception: metarcarpal stem with a palmar "T" shaped against rotation and bone saving, a cup with equatorial ring to prevent burying of the spongy bone. Componenents are recovered by hydroxyapatite to favour osteo-integration with less loosening than ciment. An accurate technique avoids dislocations traps: trapezium implant centring, internal osteophytis removal. An accurate indication: trapeziometarpal joint osteoarthritis only (second degree's Dell classification). CONCLUSION: Roseland® prosthesis reproduces a satisfactory and functional joint for 84,6% of cases. These good results can be obtained by accurate indication (Dell II) and contra-indication (osteoarthritis around trapezium except trapeziometacarpal of course).

Foreign body reaction to artelon spacer: case report.

Anecdotal reports of painful synovitis after implantation of the Artelon spacer (Small Bone Innovations, Inc., Morrisville, PA) have emerged. The manufacturer claims that this type of reaction is related to the method of fixation and/or to suture material. This report illustrates one case in which a patient exhibited sustained painful synovitis after implantation of the Artelon spacer in the scaphotrapezio-trapezoidal joint, which clinically resolved on removal of the implant. Furthermore, pathology specimens of the soft tissue, synovium, and bone demonstrated an exuberant granulomatous foreign body giant cell reaction to the implant material. Patients should be made aware of the potential of the Artelon spacer to cause a foreign body reaction that may necessitate reoperation for removal of the implant.

Temporary scaphotrapezoidal joint fixation for adolescent Kienböck's disease.

PURPOSE: There are few therapeutic guidelines for adolescent Kienböck's disease. The purpose of our study was to investigate the clinical and radiographic outcomes of temporary scaphotrapezoidal (ST) joint fixation for adolescent Kienböck's disease. METHODS: This was a retrospective review of 6 adolescent patients with Kienböck's disease treated by temporary ST joint fixation. All patients had pain with rest and activity before surgery. The mean patient age at the time of surgery was 14 years, and final follow-up examination was at a mean of 23 months. Under general anesthesia, 2 or 3 K-wires were inserted from the dorsal trapezoid to the scaphoid. The wires were removed at 3 to 6 months. RESULTS: Mean postoperative wrist extension and flexion were increased from 46 degrees and 48 degrees to 68 degrees and 77 degrees , respectively. These improvements were statistically significant compared with preoperative wrist extension and flexion. Grip strength significantly increased from 52% to 86% of the unaffected side. None of the 6 patients had postoperative pain either at rest or with activity. On final follow-up wrist x-ray films, none of the patients had sclerotic change or fragmentation of the lunate, although decreased lunate height remained in all patients. Magnetic resonance imaging revealed improvement to nearly normal intensity of the lunate on T1- and T2-weighted images in all patients. CONCLUSIONS: Both clinical and radiographic outcomes of temporary ST joint fixation for adolescent Kienböck's disease were excellent. We therefore recommend this procedure for the surgical treatment of adolescent Kienböck's disease. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Anatomical ligament reconstruction for trapeziometacarpal osteroarthritis.

Ostoearthritis of the trapeziometacarpal (TMC) joint, the key joint in thumb opposition, is one of the most common diseases involving the hand, especially among middle-aged and elderly women, and can seriously impair overall hand function. Previous studies have indicated that joint instability from ligament insufficiency is the pathological mechanism underlying the disease. Therefore, various ligament reconstruction techniques have been developed to improve both the stability and kinematics of the joint. However, none of them involve anatomical ligament reconstruction and are almost always used in combination with trapeziectomy. In order to restore joint stability as well as to save the trapezium, we developed a new technique for reconstructing the anterior oblique ligament of the TMC joint anatomically using the distal part of the transverse carpal ligament. In this article, we describe the technique in detail and report the clinical outcome of 9 patients. 6 of whom were treated by ligament reconstruction alone while the other 3 underwnet ligament reconstruction combined with surface joint replacement. All 9 patients maintained good stability and ROM of the joint at their final follow-up (3 years or longer). Although that follow-up period is admittedly short, we think anatomical ligament reconstruction with or without surface joint replacement is a rational alternative to ligament reconstruction tendon interposition (LITI) prodecures.