Excision Of Trapezium Research Articles

D6. Significance and Implications of Partial Trapezoidectomy in Management of Scapho-Trapezio-Trapezoid (STT) Osteoarthritis

PURPOSE: Trapeziectomy with partial trapezoid excision is a common surgical approach for scapho-trapezio-trapezoidal osteoarthritis (STTOA). This study seeks to determine the efficacy of partial trapezoidectomy for the treatment of STTOA. METHODS: All patients within the Cleveland Clinic Healthcare System who received a trapeziectomy with or without partial trapezoidectomy for isolated STTOA between 2003 and 2022 were reviewed. Demographic information, pain scores, and physical findings were recorded. Second metacarpal subsidence was calculated as a ratio of the change in scaphotrapezoid space (base of second metacarpal to scaphoid) preoperatively and postoperatively over the preoperative scaphotrapezoid space. Differences in subsidence and correlation between subsidence and pain scores were assessed between the two groups. RESULTS: Sixty-seven patients who underwent 76 trapeziectomies were included. Of these, 37 underwent a partial trapezoidectomy. The average age at the time of surgery was 64 years (48-86), and 58 patients were female. Median follow-up time was 3 months (IQR=3). 81% of patients with partial trapezoidectomy had second metacarpal subsidence with a median subsidence of 14%(IQR=18), compared to 72% of patients in the trapeziectomy only group who had a median subsidence of 15%(IQR=30) (p=0.34). Pain scores decreased from 6 to 2 in the partial trapezoidectomy group (p<0.001) and from 7 to 3 in the trapeziectomy only group (p<0.001). There was no significant correlation between subsidence and pain in either group (p=0.301, p=0.729). CONCLUSION: Trapeziectomy with and without partial trapezoidectomy reduced pain, but neither procedure was more effective than the other. Subsidence was not found to be a significant indicator of postoperative pain.

Surgical treatment of carpometacarpal thumb arthritis with trapeziectomy and intra-tendon (FCR) suspension with one-loop APL: comparative cohort study

BackgroundOne of the current choices of treatment for Trapeziometacarpal (TMC) joint arthritis is trapeziectomy with ligament reconstruction and tendon interposition arthroplasty. The Ceruso’s technique consists of complete trapezial excision and abductor pollicis longus (APL) tendon suspension. The APL tendon is tied to the flexor carpi radialis (FCR) tendon with two loops, one around it and one inside, and then used as interposition tissue. The purpose of the present study was to compare two different techniques of a trapeziectomy with ligament reconstruction and tendon interposition arthroplasty using the Abductor Pollicis Longus (APL) tendon, which is only Once Looped Around (OLA) versus Once Looped Inside (OLI) the Flexor Carpi Radialis (FCR) tendon.MethodsA single-center, retrospective study (Level of evidence: III) has been conducted on sixty-seven patients older than 55 years (33 OLI, 35 OLA), assessing clinical outcomes for at least 2 years of post-surgery follow-up. The outcomes were to assess and compare surgical outcomes comparing the two groups, in terms of subjective and objective evaluation for both groups at the last follow-up (primary outcome), and at the intermediate follow-ups (three and six months). Complications were also assessed.ResultsThe authors found an improvement in pain, range of motion, and function, with equivalent results for both techniques. No subsidence was observed. FCR tendinitis was significantly reduced with OLI, as well as the need of post-operative physiotherapy.ConclusionsThe one-loop technique allows for reduced surgical exposure, providing excellent suspension and clinical outcomes. Intra FCR loop should be preferred to improve post-surgical recovery.Level of evidenceLevel III study. This is a retrospective cohort study (written according to STROBE guidelines).

The Trapezium is Not Necessary: Logical Implications in Treating Basal Joint Arthritis and Pollicization.

It has long been thought that the surgical treatment of osteoarthritis of the first carpometacarpal joint must replicate the normal anatomy. Common sense argues that biomechanical stability can be achieved by a simple ball-and-socket joint obviating complicated ligament reconstructions and trapezium replacements. Our argument is presented and the conclusions are based on the results of a very large series over a long period. A simple trapezium excision arthroplasty of the base of the thumb without ligamentous reconstructions is all that needs to be done to surgically solve painful osteoarthritis of the first carpometacarpal joint. Anything more is overoperating.

Proximal Trapezoidectomy and Scaphotrapezoid Joint Tendon Interposition at the Time of Ligament Reconstruction and Tendon Interposition for Pan Trapezial Osteoarthritis Does Not Increase Proximal Carpal Row Malalignment.

Background Surgical options for osteoarthritis (OA) of the first carpometacarpal include excision, replacement arthroplasty, and arthrodesis. However, in pan trapezial OA, optimal management of residual scaphotrapezoidal articulation has remained unclear. Purpose The purpose of this study was to evaluate whether removing the proximal trapezoid from the scaphotrapezoid joint (STJ) and interposing tendon when performing a ligament reconstruction and tendon interposition (LRTI) for pan trapezial arthritis resulted in any clinical or radiographic compromise compared with LRTI alone in isolated carpometacarpal joint arthritis. Methods In a prospective consecutive cohort, 122 thumbs were selected to generate two matched cohorts and a cross-sectional review was completed at an average of 24 months (range: 5-203 months). Fifty-six thumbs had LRTI alone and 66 thumbs also had resection of the proximal portion of the trapezoid with tendon interposition in the residual gap. Results The cohorts showed no significant differences in subjective and objective outcome measures and imaging. Excision of the STJ was not associated with poorer clinical outcomes or the development of a dorsal intercalated segment instability deformity. Conclusions The management of pan trapezial arthritis with LRTI and proximal trapezoid excision and STJ interposition appears satisfactory on short- to medium-term clinical and radiographic follow-up. Level of Evidence: This is a Level III, consecutive cross-sectional cohort study.

A 15-Year Review of Clinical Practice Patterns and Evidence-Based Medicine in Carpometacarpal Joint Arthroplasty.

The purpose of this study was to help understand national practice patterns in carpometacarpal (CMC) arthroplasty and how they have evolved with evidence-based recommendations over the past 15 years. The American Board of Plastic Surgery (ABPS) started collecting practice data on primary CMC joint arthroplasty in 2006 as a portion of its continuous certification (CC) process. Data on primary CMC arthroplasty from May 2006 through December 2013 were reviewed and compared to those from January 2014 to March 2020. National practice trends observed in these data were evaluated. Comprehensive evidence-based medicine reviews published in 2008, 2011, 2013, and 2017 were reviewed alongside the CC data. In all, 570 primary CMC joint arthroplasty cases were included from May 2006 to March 2020. The average age at the time of repair was 62 years and the patient population was predominantly female (79%). Most cases were done under general anesthesia (69%), and there was an increase in the use of regional anesthesia with nerve block when our 2 cohorts were compared (27% vs 37%; P = .020). A trapezium excision with flexor carpi radialis tendon ligament reconstruction was the most popular technique (72%) and an increase in the use of simple trapeziectomy was observed (6% vs 14%; P = .001). One-third of patients did not receive any form of deep vein thrombosis prophylaxis. The ABPS CC data provide a databank that allows for direct observation of national practice trends and sheds light on potential avenues for improvement in patient care.

What’s New in Hand and Wrist Surgery

What’s New in Hand and Wrist Surgery

Effect of Trapeziectomy on Carpal Stability.

Background: The scaphoid-trapezoid-trapezium (STT) articulation stabilizes the scaphoid and links the proximal and distal carpal rows. The purpose of the study was to determine whether trapezium excision in the treatment of trapeziometacarpal (TM) arthritis affects carpal stability. Methods: A retrospective chart and radiographic review was performed on all wrists that underwent trapeziectomy with suspensionplasty or ligament reconstruction, and tendon interposition for TM arthritis between 2004 and 2016. Radiographic outcome measures included the modified carpal height ratio (MCHR) and radioscaphoid (RS), radiolunate (RL), and scapholunate (SL) angles. Degenerative change at the TM and STT joints was classified according to the Eaton-Littler, and Knirk and Jupiter classification systems. Radiographic parameters were compared between preoperative and final follow-up time points. Results: A total of 122 wrists were included in the study with a mean follow-up of 3.5 years (range: 1.0-13.0 years). The mean RL (range: -2.2° ± 11.8° to -10.7° ± 16.5°) and RS angles (range: 52.6° ± 13.8° to 44.4° ± 17.8°) decreased significantly (<.001) without significant change in SL angle, indicating progressive lunate and scaphoid extension after trapeziectomy. The mean MCHR decreased significantly (range: 1.6 ± 0.1 to 1.5 ± 0.1) following trapeziectomy, indicating progressive carpal collapse. Progressive scaphoid-trapezoid arthrosis was observed following trapeziectomy. No other preoperative radiographic factors investigated were associated with significant differences in preoperative and postoperative values for radiographic outcome measures. Conclusions: Trapeziectomy can lead to loss of carpal height, coordinated extension of both the lunate and scaphoid, and progressive scaphotrapezoid arthrosis. As such, in wrists with dynamic or static carpal instability, trapeziectomy should be performed with caution due to the risk of carpal collapse with a nondissociative pattern of dorsal intercalated segment instability.

Surgical Management of Scaphotrapeziotrapezoid Arthritis.

Scaphotrapeziotrapezoid (STT) arthritis occurs commonly with basal joint arthritis, but can also occur in isolation or in conjunction with other patterns of wrist arthritis, such as scapholunate advanced collapse. Surgical options depend on the specific clinical scenario encountered. Isolated STT arthritis was classically managed with arthrodesis, but is now often addressed with distal scaphoid resection (open or arthroscopic), trapeziectomy (partial or complete) and partial trapezoid resection, or implant arthroplasty. Development of postoperative dorsal intercalary segment instability is a notable concern with any of these techniques. STT arthritis in conjunction with basal joint arthritis can be managed effectively with trapeziectomy and either partial trapezoid excision or distal scaphoid excision. STT arthritis with scapholunate advanced collapse is uncommon, but can be managed with proximal row carpectomy or scaphoidectomy and four-corner fusion. If basal joint arthritis is also present, trapeziectomy can additionally be performed, but grip strength is likely to be substantially diminished.

Managing severe flexion deformity of the lower femur in a young child

A severe flexion deformity of the knee that prevented a 2-year-old-child from walking caused by a 90° flexion of the lower right femur is presented. It was managed surgically by a large closed-trapezoid wedge extension-shortening osteotomy resulting in gaining the ability to walk. This case report represents a dilemma of diagnosis and management and discusses a well-planned trapezoid excision shortening osteotomy to save the neurovascular structures.

Comparison of arthrodesis and arthroplasty in patients with thumb carpometacarpal osteoarthritis

Objective To compare the effect of arthrodesis and arthroplasty in patients with thumb carpometacarpal osteoarthritis, and to compare the advantages and disadvantages of the two methods. Methods From February 2012 to September 2017, 39 patients with phases Ⅱ and Ⅲ thumb carpometacarpal osteoarthritis underwent surgical treatment. 22 cases were performed with trapeziometacarpal arthrodesis and 17 cases were performed with trapezial excision arthroplasty with ligament reconstruction and tendon interposition (LRTI). Postoperatively, objective and subjective evaluation were performed on the two groups, respectively. The objective evaluation included grip strength, pinch strength, thumb abduction degree (palmer and radial), Kapandji opposition score. The subjective evaluation included visual analogue scale (VAS), Disabilities of the Arm, Shoulder and Hand (DASH) score. The data of the two methods were compared and their differences were observed. Results In the comparison between arthrodesis and arthroplasty group, the differences of pinch strength, thumb abduction degree (palmer and radial), Kapandji opposition score were obvious, but there was no significant difference in grip strength, VAS and DASH score. Conclusion For patients with progressive thumb carpometacarpal osteoarthritis, carpometacarpal arthroplasty or arthroplasty can significantly relieve joint pain and improve grip strength. Arthrodesis can improve thumb pinch strength better, while arthroplasty can improve thumb mobility better. The patients are consciously satisfied with the effects of the two surgical methods. Key words: Thumb; Carpometacarpal joints; Arthrodesis; Arthroplasty

Effect of Partial and Complete Trapezoid Excision on Radiographic and Functional Results After Abductor Pollicis Longus Suspensionplasty

We hypothesized that adding complete or partial trapezoid excision is associated with greater radiographic carpal collapse and worse functional outcomes compared with a simple trapeziectomy and abductor pollicis longus suspensionplasty. A total of 69 patients had abductor pollicis longus suspensionplasty (79 hands), 87% of whom were female, mean age 64 years. Scaphotrapezium-trapezoid arthritis noted at surgery was treated with an additional proximal trapezoid excision (PT) in 21 (27%) or complete trapezoid resection (CT) in 22 hands (28%). No trapezoid was excised in 36 hands. The primary outcome was final radiolunate (RL) extension of 15° or greater on lateral radiographs. Logistic regression (for change in RL angle) and linear regression (for continuous variables) with robust variance estimate to account for within-subject correlation (generalized estimating equation method) were used to investigate whether the trapezoid excision groups had an effect on the outcomes of interest. Models were adjusted for age and sex. Median follow-up was 92 months. Complete trapezoid resection had the most increase in RL angle, but PT had a higher incidence (29% vs 26%) of final RL angle of 15° or greater compared with CT. When stratified into groups with a final RL greater than or less than 15°, the former group had worse total function (Patient-Rated Wrist Evaluation) and Quick-Disabilities of the Arm, Shoulder, and Hand scores. Symptomatic index metacarpal migration was seen in 4 CT and 2 PT wrists (18% and 10%, respectively) and was considered to indicate failure. Compared with no trapezoid excised, both PT and CT had a greater incidence of lunate extension of 15° or greater, consistent with radiographic nondissociative-dorsal intercalated carpal instability, which was associated with inferior functional scores. Symptomatic proximal collapse of the index metacarpal was seen in both CT and PT. Further studies should evaluate whether routine excision of the proximal trapezoid is necessary for scaphotrapezoid arthritis, because any disruption of the scaphotrapezoid ligament complex appears to increase risk for developing carpal instability nondissociative-dorsal intercalated carpal instability over time and may be associated with inferior functional results. Complete trapezoid excision is not recommended. Therapeutic IV.

Comparison of arthrodesis and arthroplasty of Chinese thumb carpometacarpal osteoarthritis

BackgroundThe thumb carpometacarpal (CMC) osteoarthritis is very common. Multiple methods are used to treat progressive thumb CMC osteoarthritis, among which trapeziometacarpal arthrodesis and trapezial excision with ligament reconstruction and tendon interposition (LRTI) are the most common. These two surgical treatment methods have received mixed reviews in previous studies in the west patients. This retrospective study studied the effects, advantages, and disadvantages of arthrodesis and arthroplasty for treating thumb carpometacarpal osteoarthritis in Chinese patients.MethodsBetween February 2012 and September 2017, 39 Chinese patients with stage II or III thumb carpometacarpal osteoarthritis underwent surgery (trapeziometacarpal arthrodesis in 22, trapezial excision with ligament reconstruction and tendon interposition in 17). Postoperative objective and subjective evaluations were performed. The objective evaluation involved grip strength, pinch strength, thumb abduction degree (palmar and radial), and Kapandji opposition scores. The subjective evaluation involved visual analog scale (VAS) and Disabilities of the Arm, Shoulder, and Hand (DASH) scores.ResultsIntergroup differences in pinch strength, thumb abduction degrees (palmar and radial), and Kapandji opposition scores were obvious, whereas those in grip strength, VAS score, and DASH score were not.ConclusionIn Chinese patients, both techniques relieved pain and improve grip strength. Arthrodesis displayed better pinch strength, while arthroplasty displayed better motor function. Patients were satisfied with the effects of both techniques.

Suture Suspensionplasty Using Abductor Pollicis Longus and Flexor Carpi Radialis for Advanced Thumb Carpometacarpal Joint Arthritis.

Current operative treatment for advanced thumb carpometacarpal (CMC) joint arthritis mainly constitutes complete trapeziectomy with or without additional stabilizing procedures. However, it is unclear whether the additional procedures influence overall clinical outcomes. Therefore, the purpose of this study was to evaluate the effectiveness of our posttrapeziectomy suture suspensionplasty technique, performed using the abductor pollicis longus and flexor carpi radialis tendons, in patients with advanced thumb CMC arthritis. We evaluated 36 thumbs of 35 patients with advanced thumb CMC arthritis treated with combined operative excision of trapezium followed by a suture suspensionplasty using flexor carpi radialis and abductor pollicis longus tendons. We used a minimal volar approach to create a sling construct with a nonabsorbable suture material, which could support the thumb metacarpal base without pin fixation or tendon transfer. For radiographic evaluation, we used the ratio of the radial metacarpal subluxation to metacarpal articular width, estimated from the bilateral stress-view radiographic images of the thumb, and calculated the trapezial space ratio by dividing the trapezial space height by the proximal phalangeal length. The clinical outcomes were evaluated using the visual analog scale and disabilities of the arm, shoulder, and hand scores, along with evaluation of the improvement in both postoperative range of motion and strength recovery. The mean duration of follow-up was 26 months (range, 18-60 months). The average visual analog scale and disabilities of the arm, shoulder, and hand scores decreased from 5.9 to 0.4 and from 51.6 to 27.0, respectively. The range of motion during palmar abduction and opposition of the metacarpophalangeal joint improved with an increase in mean value from 49.1 degrees to 54.1 degrees, and from 7.8 to 9.3 Kapandji score, respectively. The grip and key pinch strengths showed no significant changes from mean preoperative values of 13.3 kg and 3.8 kg to 13.2 kg and 3.2 kg, respectively, as measured at the 18-month follow-up. Our suture suspensionplasty technique has several advantages including minimal invasive approach, short operative time, cost-effectiveness, and early mobilization. We suggest that it can be used as an effective, alternative stabilization method after a complete trapeziectomy.

Suture Suspension Arthroplasty for the Treatment of Thumb Carpometacarpal Arthritis

Most studies have demonstrated little difference in the outcome of the various techniques proposed for the surgical treatment of thumb carpometacarpal (CMC) arthritis. However, the difficulty and time required to perform each technique vary widely. In addition, the introduction of recent implants has increased the cost of the overall procedure. We hypothesize that using a simple, yet stable, suture suspension technique without tendon interposition or ligament reconstruction yields similar results to conventional approaches with less operative time. Three hundred twenty consecutive patients underwent thumb CMC arthroplasty by trapezial excision and metacarpal suspension using #2 high-strength orthopedic suture locked weave alone passed from the distal most abductor pollicis longus and flexor carpi radialis insertions without K-wire fixation or tendon transfer. Average duration of preoperative symptoms was 17.8 months. Patient radiographs were graded for arthritis severity and a visual analog scale (VAS) pain score (scale 0-10) obtained. Postoperative clinical and radiological follow-up averaged 5.4 years (minimum, 24 months). The average age at surgery was 57.3 years and there were 221 women (243 procedures) and 65 men (77 procedures). Average total operative time was 23.4 minutes. The dominant hand was involved in 52% of patients. All had prior treatment including orthoses and nonsteroidal anti-inflammatory drugs with 312 having had at least 1 steroid injection. Five patients had stage 1, 134 had stage 2, 164 had stage 3, and 17 had stage 4 disease on radiographs. Average trapezial space height on final follow-up radiographs was 0.8 cm. Two patients had complete trapezial space collapse and required a revision procedure. The average VAS score was 0.6 with pain eliminated in 269 thumbs, minimal in 49, and unchanged/worse in 2. All patients that were employed at the time of surgery returned to work at an average of 2.3 months (range, 3-16 weeks). Suture suspension thumb CMC arthroplasty provides comparable clinical results and several advantages over many current techniques that are described in the literature. The advantages include shortened operative time, inherent stability of the thumb metacarpal height, and no necessity for K-wire fixation, tendon transfers, or implants. Therapeutic IV.

Scaphoïdectomie distale pour arthrose STT, résultats à court terme — la valeur du DISI mise en question

Isolated symptomatic scaphotrapezio-trapezoid arthritis forms an important differential diagnosis in basal thumb pain. Due to the relatively high complication ratio of the conventional STT-arthrodesis and the weakness of thumb strength reported after trapezial excision, emphasis in research has swung towards distal scaphoid resection with or without interposition. In 2009, Decramer and Le Viet described a proper reproducible technique, using Flexor Carpi Radialis tendon as a spacer. Currently, discussion regarding outcomes and complications of this type of interposition procedure needs the most attention. Dorsal Intercalated Segment Instability deformity described after STT-excision doesn’t always seem to correlate with the patients functional ability after surgery and we could ask ourselves whether DISI really matters. All patients with isolated symptomatic STT arthritis that have undergone the above-mentioned technique, between 2012 and 2018, were included. Clinical, radiographical and patient-based written outcome measures were obtained during postoperative visits. We used the operative technique as described in a poster presentation at the FESSH in Poznan in 2009 by Decramer and Le Viet (Institut de la Main, Paris). It involves a distal scaphoid resection, followed by the harvesting of half of the split FCR, which is then accordion like, seated into the freed-up space. The clinical evaluation comprises of range of motion as well as strength measurements. Different relevant carpal angles and the scaphoid length are measured on front and lateral radiographs and compared to the contralateral wrist. Written scores entailed a qDASH, a PRWE score, a VAS pain and a VAS daily functionality of the hand. Twenty-one cases have been evaluated. One patient had wound infection. Three patients suffered from persistent wrist extension deficit, for which 1 patient had revision surgery. Six patients developed CTS complaints. A mild DISI deformity was seen in the majority of the patients. No evolution to gross midcarpal instability was observed. Our results are comparable to earlier studies and report a global satisfactory outcome. Although a mild DISI deformity was seen in the majority of the cases, there was no correlation with the functional scores. This should be interpreted with caution given the relatively short follow-up period. Given the encouraging results of this type of intervention, this operative technique is considered successful in the short term. This study set-up could be used to develop a prospective protocol in order to offer a higher level of evidence with larger series and a longer follow-up period.

Five-Year Results of Suture Suspension Thumb CMC Arthroplasty

Ownership Interest: IlluminOss Medical (Weiss) Receipt of Intellectual Property: IlluminOss Medical (Weiss) Royalty: Medartis, Extremity Medical, Arthrosurface (Weiss) Most studies have demonstrated little difference in the outcome of the various techniques proposed for the treatment of thumb CMC arthritis. However, the difficulty and time required to perform each technique vary widely. In addition, the introduction of recent implants has increased the cost of the overall procedure. We hypothesize that using a simple, yet stable, suture suspension technique without tendon interposition or ligament reconstruction yields similar results to conventional approaches with far less operative time and economic cost. 320 consecutive patients underwent thumb CMC arthroplasty by trapezial excision and metacarpal suspension using number 2 high-strength orthopedic suture locked weave alone passed from the distal most APL and FCR insertions without K-wire fixation or tendon transfer by the senior surgeon. Average duration of preoperative symptoms was 17.8 months. Patient radiographs were graded for arthritis severity and a VAS pain score (scale 0–10) obtained. Average preoperative Eaton score was 2.6 with a VAS pain score of 7.9 (range of 5–10 on a 0–10 scale). Postoperative clinical and radiological follow-up averaged 5.4 years (minimum of 24 months). The average age at surgery was 57.3 years with 221 females (243 procedures) and 65 males (77 procedures). Average total operative time was 23.4 minutes. The dominant hand was involved in 52% of patients. All had prior treatment including orthoses and NSAIDs, with 312 having at least one steroid injection. Five patients had stage 1, 134 had stage 2, 164 had stage 3, and 17 had stage 4 disease on radiographs. Average trapezial space height on final follow-up radiographs was 0.8 cm. Two patients had complete trapezial space collapse and required a revision procedure (Figure 58-1). The average VAS score was 0.6 with pain eliminated in 269 thumbs, minimal in 49, and unchanged/worse in 2. All patients who were employed at the time of surgery returned to work at an average of 2.3 months (range 3–16 weeks). Suture suspension thumb CMC arthroplasty appears to provide equal clinical results and several advantages over many current techniques:•Shortened operative time•Inherent stability of the thumb metacarpal height•No requirement for K-wire fixation•No requirement for tendon transfer•No requirement for implants•Simple technique with minimal cost

Abductor Pollicis Longus Suspensionplasty for Treatment of Carpometacarpal Arthritis of the Thumb

Arthritis of the thumb carpometacarpal joint is a common cause of pain, weakness and significant dysfunction in the hand. Surgical options to treat the condition are many, with no one technique showing clear superiority. This article focuses on a technique of trapezial excision and suspensionplasty of the thumb metacarpal using the abductor pollicis longus tendon. A brief history of the procedure is discussed followed by a detailed description of the procedure. The procedure has proven to be a simple and cost-effective option performed through a single incision. We review the advantages and disadvantages along with reported outcomes and complications.

Biomechanical comparison of anterior oblique ligament versus dorsal radial ligament reconstruction of the trapeziometacarpal joint

Objective To compare the axial shortening resistance of anterior oblique ligament and dorsal radial ligament reconstruction of trapeziometacarpal joint after trapezium excision for the patients with osteoarthritis of trapeziometacarpal joint, and to determine which method was more stable. Methods Twenty cases of male adult fresh cadaver hand specimens were dissected. After the trapezium excision, ten cases of anterior oblique ligament and ten cases of dorsal radial ligament were reconstructed using half bundle of flexor carpi radialis tendon. Biomechanical testing was performed to obtain maximum load when the first metacarpal sinking 10 mm and to determine which ligament reconstruction method yielded larger axial shortening resistance. Results After the trapezium excision, the maximum load of the dorsal radial ligament reconstruction when the first metacarpal sinking 10 mm was (67.67±7.98) N and that of the anterior oblique ligament reconstruction was (77.11±8.25) N. The difference between two groups was significant (P<0.05). Conclusion After the trapezium excision, anterior oblique ligament reconstruction using flexor carpi radialis tendon can achieve more stable trapeziometacarpal joint. We should reconstruct the anterior oblique ligament firstly. Key words: Thumb; Carpometacarpal joints; Ligaments; Biomechanics

Long-term Outcomes of APL Suspensionplasty with No, Partial, or Complete Trapezoid Excision

There is no financial information to disclose. Partial or complete trapezoid excision, combined with trapeziectomy and abductor pollicis longus (APL) suspensionplasty, impacts long term radiographic and clinical results. Sixty-nine patients (79 hands) underwent surgery for basal joint arthritis. Eighty-seven percent were female with a mean age 64. The dominant hand was involved in 57%. Advanced scaphotrapezial-trapezoid arthritis was noted intraoperatively in 55%, and treated with resection of the proximal 50% of the trapezoid (PT) in 21 hands (27%), and complete trapezoid (CT) resection in 22 (28%). No trapezoid excision was required (NT) in 36 hands. Fisher’s exact tests compared categorical outcomes and linear regression investigated whether predictors of interest (PT, CT or NT) had any effect on continuous variables such as Patient Rated Wrist Evaluation (PRWE), or DASH. Mean follow up was 95 months. There was no significant difference in satisfaction or the desire to have the procedure again. Mean total pain score was significantly lower with CT (4.89) and PT (4.94) when compared to NT (11.37). CT had significantly lower (better) mean total functional and usual activity scores on the PRWE, and four sub-scores on the quickDASH when compared to NT, but not to PT. Significant decreases in mean carpal height ratio (CHR) were seen in NT and CT. There was no significant difference between PT and CT; NT and PT had significantly more proximal collapse of the thumb metacarpal relative to the scaphoid compared to CT. Only NT had a significant change in the scapholunate angle. Both PT and CT had significant proximal migration of the index metacarpal. Complication rates trended higher in CT (27.3%) when compared to PT (23.8%)and NT (16.7%) but was insignificant. Secondary procedures were highest in CT (18%) and involved arthrodesis of the index and long finger carpometacarpal joints. •Complete trapezoidectomy had the greatest decrease in CHR and radiographic collapse of the index metacarpal, but without significant change in the scapholunate angle. It had the lowest (best) total pain and functional scores on the PRWE.•While CT also led to the greatest improvement in total functional scores (PRWE), the authors now only do PT for two reasons: (1) No significant differences in radiographic or clinical outcomes between PT and CT. (2) Higher complication rate with CT, notably an 18% incidence of symptomatic index CMCJ collapse and arthritis requiring arthrodesis.•NT patients had the highest total pain score and this may be due to impingement between the thumb metacarpal and trapezoid.

Functional Outcomes of Thumb Trapeziometacarpal Arthrodesis With a Locked Plate Versus Ligament Reconstruction and Tendon Interposition

To compare standardized functional and patient-reported early outcomes following trapeziometacarpal arthrodesis (TMA) using a locking cage plate construct with trapezial excision, ligament reconstruction, and tendon interposition (LRTI). This prospective cohort enrolled 50 consecutive patients with trapeziometacarpal osteoarthritis undergoing TMA or LRTI. Demographic data, objective measurements, Sollerman function testing, and patient-reported outcomes were collected before surgery and at various time intervals up to 12 months after surgery. The study was powered to detect a minimally clinically important difference on the Michigan Hand Questionnaire between groups at 12 months. To account for selection bias, we performed between-group statistical analysis of the magnitude of change from preoperative to postoperative data. All complications were recorded. There were no significant differences in the amount of change in grip or pinch strength, patient-reported outcomes, or functional hand testing between TMA and LRTI. The TMA group had significantly increased thumb tip opposition distance. The TMA group was complicated by a 26% overall nonunion rate of which 8% were symptomatic. The LRTI group (Wagner incision) had a significantly increased incidence of superficial branch of the radial nerve paresthesia. The incidence of complications was similar between operative groups, but revision surgery was more common after TMA. Compared with LRTI, TMA failed to demonstrate superior improvement in strength, standardized functional performance, or patient-reported function and is associated with an increased likelihood of revision surgery in the first 12 months. Trapeziometacarpal arthrodesis with a locking plate and screw construct does not ensure union, although most radiographic nonunions were asymptomatic. Wagner incisions are associated with a significantly increased incidence of superficial branch of the radial nerve paresthesia compared with dorsal trapeziometacarpal exposure. Therapeutic II.