Vascularized surgical rotation of a bi-articular trapezoid-trapeziometacarpal complex for the treatment of severe rhizarthrosis of the thumb

Abstract

A new surgical procedure has been conceived to avoid persistent pain and to restore the functionality and pinch strength of the basal joint of the thumb destroyed by degenerative osteoarthritis. Since January 1998 a double total joint transposition was performed on eight patients, switching the trapezoid-metacarpal joint and the trapezio-metacarpal joint. A 180 degrees rotation of the bi-articular complex (trapezoid-trapezio-metacarpal joints) in its entirety was achieved, while preserving the intrinsic ligaments and vascular supply insured by the dorsal branch of the radial artery; the Cardan conformation in Physics of the trapezoid-metacarpal joint provided complete thumb motion. skin dorso-radial approach of the wrist; arteriolysis of the dorsal branch of the radial artery at the anatomic snuff box and at its entrance into the first intermetacarpal space; metaphyseal osteotomy of the first and second metacarpal; capsulotomy all around the bi-articular complex; transfer and rotation of the trapezoid-trapezio-metacarpal bi-articular complex together with the dorsal branch of radial artery; osteotomy stabilisation by Kirschner wires; capsulo-ligamentous reconstruction; plaster slab immobilisation. Four weeks later the thumb moves actively; hand therapy starts six weeks post-operatively. Clinical and radiological controls were performed at two, four and six weeks, tomography at three months post-operation. Clinical assessment for three patients showed three good results and for the other five showed excellent outcomes, resulting in complete motion, stability of the first metacarpal and restored painless pinch strength of the thumb. Today the trapezoid-metacarpal joint seems to ensure pain relief, mobility and to solve the instability due to the collapse of the thumb column by restoring the bone chain of the first metacarpal ray.