Le traitement de la rhizarthrose évoluée par transposition rotatoire vascularisée du complexe bi-articulaire trapézoïde-trapézométacarpien

Abstract

A new surgical technique to reconstruct the basal joint of the thumb, to treat persistent pain, restore stability and function, due to severe degenerative osteo-arthritis, is here presented. Our research on the anatomo-topographical and bio-mechanical aspect of the Trapezium–Trapezoid-Metacarpal bi-articular complex (TM-TZM) has led us to observe that trapezoid-metacarpal joint (TZM) is a working joint, which has remained inactive for many years, a true joint bank for the TM joint. When it is transposed at the base of the thumb column, it is obliged to move according to the active movements of the intrinsic and the extrinsic muscles. Since January 1998, 34 patients have been operated on, replacing the trapezio-metacarpal (TM) joint with trapezoid-metacarpal (TZM) joint and vice-versa. Rotatory transfer of trapezoid-metacarpal pro-trapezio-metacarpal joint was achieved preserving entirely the intrinsic ligaments and the dorsal branch of the radial artery, which rotates palmarly with the biarticular complex thus ensuring vascular supply. Procedure consists in a wrist dorso-radial approach, metaphyseal osteotomy of first and second metacarpal bases, capsulotomy all around and rotatory transfer of the bi-articular complex, stbilization with K wires of osteotomies and capsulo-ligamentous reconstruction. Follow-up evaluation of the patients ranged between 3 months and 10 years (mean 4 years). Results have been excellent in 24 cases and good in 10. Painless motion, stability due to the first metacarpal ray length reconstruction with a subsequent redistribution of forces along the entire axis, restored thumb opposition, pinch and grip strength of the hand have been obtained. In conclusion, this technique represents now a new surgical opportunity for a surgeon to choose a straightforward and reliable treatment in a wider range of care for degenerative arthritis or severe and destructive trauma of the TMC joint. A greater number of cases and a longer follow-up are necessary for a wider evaluation of the procedure.