Rhizarthrose débutante et rotation du bloc articulaire trapézométacarpien en îlot sur le pédicule radial. DOOR procedure

Abstract

Introduction Trapezium dysplasia and trapezo-metacarpal joint instability induce TMC-joint arthritis. To correct these two factors, we propose a surgical technique associating a double oblique osteotomy of the trapezium and of the first metacarpal basis, and an island rotator transfer of the TMC-joint harvested in block on the radial pedicle. The articular block is rotated at 180° on the longitudinal axis of the thumb. Method Since 2000, 41 cases were performed on 38 patients (35 women, three men). Mean age was 47 (from 17 to 63). All the patients complained of a painful thumb and sometimes of instability. The mobility was preserved (Kapandji 9/3). The grasp was 43% of the opposite side. X-rays showed a TMC-joint instability in all the cases. Results DOOR procedure was possible 41 times. With a mean follow-up of 65 months (from three months to ten years), 28 thumbs are pain-free, nine patients complain of barometric pain or pain after heavy works. Four thumbs were reoperated after failure of the procedure. Mobility decreased (Kapandji 8/2), the grasp increased to 100% of the opposite side. The joint was stabilized in all the cases. X-rays showed an osteolysis in three cases. The cartilage was worse in 19 cases, improved in five cases, stable in 14 cases. Discussion DOOR procedure is a very demanding procedure but reliable. The correction of the dysplasia is constant. Denervation could explain the good clinical results in cases of joint narrowing. Conclusion DOOR procedure is a solution in cases of trapezium dysplasia associated with instability and early stages of osteoarthritis in young women.