Scaphotrapezial Joint Research Articles

Simulated Radioscapholunate Fusion Alters Carpal Kinematics While Preserving Dart-Thrower's Motion

Midcarpal degeneration is well documented after radioscapholunate fusion. This study tested the hypothesis that radioscapholunate fusion alters the kinematic behavior of the remaining lunotriquetral and midcarpal joints, with specific focus on the dart-thrower's motion. Simulated radioscapholunate fusions were performed on 6 cadaveric wrists in an anatomically neutral posture. Two 0.060-in. carbon fiber pins were placed from proximal to distal across the radiolunate and radioscaphoid joints, respectively. The wrists were passively positioned in a custom jig toward a full range of motion along the orthogonal axes as well as oblique motions, with additional intermediate positions along the dart-thrower's path. Using a computed tomography-based markerless bone registration technique, each carpal bone's three-dimensional rotation was defined as a function of wrist flexion/extension from the pinned neutral position. Kinematic data was analyzed against data collected on the same wrist prior to fixation using hierarchical linear regression analysis and paired Student's t-tests. After simulated fusion, wrist motion was restricted to an average flexion-extension arc of 48 degrees , reduced from 77 degrees , and radial-ulnar deviation arc of 19 degrees , reduced from 33 degrees . The remaining motion was maximally preserved along the dart-thrower's path from radial-extension toward ulnar-flexion. The simulated fusion significantly increased rotation through the scaphotrapezial joint, scaphocapitate joint, triquetrohamate joint, and lunotriquetral joint. For example, in the pinned wrist, the rotation of the hamate relative to the triquetrum increased 85%. Therefore, during every 10 degrees of total wrist motion, the hamate rotated an average of nearly 8 degrees relative to the triquetrum after pinning versus 4 degrees in the normal state. Simulated radioscapholunate fusion altered midcarpal and lunotriquetral kinematics. The increased rotations across these remaining joints provide one potential explanation for midcarpal degeneration after radioscapholunate fusion. Additionally, this fusion model confirms the dart-thrower's hypothesis, as wrist motion after simulated radioscapholunate fusion was primarily preserved from radial-extension toward ulnar-flexion.

Nonoperative Compared with Operative Treatment of Acute Scaphoid Fractures

Traditionally, acute nondisplaced scaphoid fractures have been treated nonoperatively in a cast, and the expected union rate approaches 90%. Internal fixation of nondisplaced scaphoid fractures has increased in popularity, and a union rate of 100% has been reported. The growing trend is to recommend internal fixation for the majority of acute scaphoid fractures. The true long-term benefits of this more complicated treatment modality have not yet been determined in randomized controlled trials. The purpose of this study was to compare the long-term results of operative fixation of acute scaphoid fractures with those of nonoperative treatment. During the period between 1992 and 1997, eighty-three patients with an acute nondisplaced or minimally displaced scaphoid fracture were randomly allocated to, and received, either nonoperative treatment with a cast or internal fixation with a Herbert screw. At a median of ten years after the injury, seventy-five (93%) of the eighty-one patients who were still alive were assessed clinically and radiographically. All fractures united. A significant increase in the prevalence of osteoarthritis in the scaphotrapezial joint was found in the operatively treated group. No differences in subjective symptoms, as measured with limb-specific outcome scores, were found between the two groups. The range of motion and grip strength were greater, but not significantly greater, in the nonoperatively treated group. This study did not demonstrate a true long-term benefit of internal fixation, compared with nonoperative treatment, for acute nondisplaced or minimally displaced scaphoid fractures. The long-term risks of surgery should be considered when recommending operative treatment.

Complete Open Dorsoradıal Dıslocatıon Of Trapezıum

Dislocation or subluxation of scaphotrapezial joint is occasionally seen in patients with degenerative osteoarthritis or the other forms of arthritis. However, traumatic dislocation or subluxation of this joint is extremely rare because of strong ligamenteous complex. Complete dislocation of greater multangular (trapezoid bone) is especially observed via a harsh trauma. Here, a complete dislocation of multangular occurred with self-mutilating trauma is presented as well. The study was performed at the 1 st Orthopaedics and Traumatology Clinics of Ankara Training and Education Hospital .

Interposition Arthroplasty Using Trapezium Tendon Ball for Osteoarthritis of the Carpometacarpal Joint of the Thumb

Carpometacarpal (CM) joint arthroplasty of the thumb using a trapezium tendon ball was performed in 11 hands of 9 patients with osteoarthritis. After a total dissection of the trapezium, the palmaris longus was wrapped around the trapezium, with the surfaces of both the CM joint and the scaphotrapezial joint tightly covered. Grafted trapezium was repositioned, and a congruency of the CM joint was confirmed. All patients were relieved from pain, with the radial abduction angle, grip strength, and the pinch strength increased 5 years after surgery. Radiographically, the mean width of the CM joint space increased, and a central migration of the first metacarpal bone was not found. This procedure would be available for the osteoarthritis in both the CM joint and the scaphotrapezial joint.

Uses and abuses of wrist arthroscopy

PURPOSE OF REVIEW The use of wrist arthroscopy in the diagnosis and treatment of carpal pathology continues to expand. The purpose of this paper is to summarize recent advances in the utility of this diagnostic, therapeutic, and research tool. RECENT FINDINGS The indications for wrist arthroscopy are growing with the description of volar portals for the radiocarpal and scaphotrapezial trapezoid joint. Arthroscopic assistance in the treatment of distal radius and scaphoid fractures is also becoming more feasible. Arthroscopic excision of dorsal carpal ganglions has met with considerable success. In addition, the application of electrothermal collagen shrinkage is an exciting new frontier in arthroscopic wrist procedures. SUMMARY Wrist arthroscopy has evolved to be an essential diagnostic and therapeutic tool in the armamentarium of every surgeon treating disorders of the wrist.

The late consequences of scaphoid fractures.

Fractures which unite Nearly 90% of scaphoid fractures unite with conservative treatment2,3 and the overall clinical impression is that patients continue to progress well and remain free of symptoms. However, they are rarely followed up after the fracture has united. Dias, Brenkel and Finlay4 followed up patients for between 1.7 and 2.6 years and found that 20% had some pain and 19% tenderness, but grip strength and wrist movement were nearly normal. They suggested that the persistent symptoms could reflect damage to the articular cartilage at the time of the injury. Secondary osteoarthritis may develop after the fracture has united. Lindstrom and Nystrom5 showed in 1990 that after seven years or more osteoarthritis occurred in 5% of wrists in which a fracture of the scaphoid had healed normally and suggested that it would probably progress. In 2001 Saeden et al6 described a study of acute fractures, some treated in a cast and some by a Herbert screw. The patients were reviewed after 10 to 12 years, when CT scans and plain radiographs were carried out on both wrists. Of the 16 patients treated conservatively, seven had osteoarthritis in the radiocarpal joint and seven in the scaphotrapezial joint. The higher incidence of osteoarthritis reported in this series was probably because it was revealed by the CT scans. Why should osteoarthritis develop after a fracture has united? It may be because of damage to the articular cartilage sustained at the time of the fracture or, as Lindstrom and Nystrom5 suggest, to some degree of malunion. It would be likely to occur if the fracture had healed with a step in the articular surface. Such displacement is seldom seen on ordinary scaphoid radiographs. It cannot be detected reliably on such films and may only be demonstrable by MRI or CT scans.7

Incidence of osteoarthritis in the scapho-trapezial joint after herbert screw fixation of the scaphoid

Twenty patients treated with a Herbert screw for scaphoid fractures (acute or non-union) were reviewed and X-rayed 5–10 years later to assess whether there were degenerative changes in the scapho-trapezial joint due to insertion of the screw. Six had some irregularity in the lateral part of that joint, three of which followed backing-out of the screw. Two others were described as showing irregularity all round the scaphoid but, apart from these, no radiological abnormalities were seen in the central or ulnar part of the scapho-trapezial joint, or on the proximal tip of the scaphoid.

Flexor carpi radialis tendinitis caused by malunited trapezial ridge fracture in a professional baseball player

Flexor carpi radialis tendinitis is an uncommon cause of pain experienced over the flexor aspect of the wrist. It may be a primary condition caused by overuse syndrome, or it may be a secondary condition associated with osteoarthritis of the carpometacarpal joint of the thumb, osteoarthritis of the scaphotrapezial joint, scaphoid fracture, or scaphoid cyst. We present a case report of flexor carpi radialis tendinitis caused by a malunited trapezial ridge fracture, in a professional baseball player who was treated successfully by excision of the malunited trapezial ridge fragment.

Fracture of the carpal scaphoid

We compared the long-term outcome in 61 patients (62 fractures) treated operatively or conservatively for an acute fracture of the carpal scaphoid. A total of 30 fractures was randomised to conservative treatment using a cast and 32 to operative treatment using a Herbert bone screw. The duration of sick leave was shorter for patients treated by operation, but this was only significant in patients with blue-collar occupations. There were no differences between the groups in respect of function, radiological healing of the fracture, or carpal arthritis after follow-up at 12 years. Those managed by operation showed radiological signs of arthritis of the scaphotrapezial joint more often, but this finding did not correlate with subjective symptoms. Operative treatment of an acute fracture of the scaphoid allows early return of function and should be regarded as an alternative to conservative treatment in patients in whom immobilisation in a cast for three months is not acceptable for reasons related to sports, social life or work.

Fracture of the carpal scaphoid

We compared the long-term outcome in 61 patients (62 fractures) treated operatively or conservatively for an acute fracture of the carpal scaphoid. A total of 30 fractures was randomised to conservative treatment using a cast and 32 to operative treatment using a Herbert bone screw. The duration of sick leave was shorter for patients treated by operation, but this was only significant in patients with blue-collar occupations. There were no differences between the groups in respect of function, radiological healing of the fracture, or carpal arthritis after follow-up at 12 years. Those managed by operation showed radiological signs of arthritis of the scaphotrapezial joint more often, but this finding did not correlate with subjective symptoms. Operative treatment of an acute fracture of the scaphoid allows early return of function and should be regarded as an alternative to conservative treatment in patients in whom immobilisation in a cast for three months is not acceptable for reasons related to sports, social life or work.

Long-term results of arthrodesis of the carpometacarpal joint of the thumb.

We reviewed 48 arthrodeses of the carpometacarpal joint of the thumb in 39 patients being treated for osteoarthritis. The mean follow-up period was 90 months (range 14 months-17 years). In 28 (58%) hands pain relief was excellent and in 6 (12%) good. Morbility was significantly reduced (p < 0.002). Mean key pinch (52.9 N) and grip strength (219.5 N) were comparable with the unoperated hand (51.0 and 239.1 N, respectively). Hand function was near normal. In 29 hands an additional operation was needed to remove the osteosynthesis material; 14 hands failed to unite. Osteoarthritis of the scaphotrapezial joint increased significantly faster in the operated hands than in the unoperated ones (p < 0.0001). A soft tissue procedure (such as flexor carpi radialis interposition arthroplasty) is advised instead of arthrodesis, because of the large number of reoperations, based on non-union and removal of the osteosynthesis material. From a survey of published papers we conclude that arthrodesis of the carpometacarpal joint of the thumb can best be done by stapling and bone grafting.

Surgery for root arthrosis: retrospective study and search for an algorithm

Several treatments, conservative or surgical, have been proposed for painful arthritis of the base of the thumb with various outcomes. Swanson trapezium implant, arthrodesis of the trapezio-metacarpal (T.M.) joint and suspension arthroplasty are three of the most used techniques for treatment of this condition. Two hundred patients operated on using one of the three techniques were reviewed for a retrospective study to assess the advantages and disadvantages of each method of treatment and their indications. Patient satisfaction rate is high whatever the technique used. Complete pain relief was obtained more often with the Swanson implant (Alnot 0) but differences between the three methods decrease when patients with pain only for particular strains (Alnot 1) are included. Swanson implants (patient satisfaction Alnot 0 and 1: 85.5%) provide excellent subjective and objective results for patients with light activity of daily living causing little stress to the implant. Complication rate with reoperation is equal to other techniques. Surgical treatment is well come through and recovery is fast and not painful. Suspensioplasty (patient satisfaction Alnot 0 and 1: 78.2%) have a low complication and reoperation rate when the technique is well applied. Patient satisfaction rate is high but duration of recovery is long (strength, nimbleness). T.M. arthrodesis is the only type of surgery providing a good strength identical to the opposite side at the price of a limited decrease of range of motion. In conclusion, we propose the following algorithm: for patients over years of age: Swanson trapezium implant; for young and active patients presenting a radiological stage less than Dell III and an intact Scaphotrapezial joint: T.M. arthrodesis; for other patients: suspensioplasty using the A.P.L.

Degenerative changes at the scaphotrapezial joint following herbert screw insertion: A radiographic study comparing patients with scaphoid fracture and primary hand arthritis

One method of Herbert screw insertion is to mobilize the scaphotrapezial joint and insert the screw through the articular surface of the distal scaphoid. Because of concern that this might predispose to osteoarthritis in the scaphotrapezial joint, we have investigated joint space width and the presence of osteophytes adjacent to the scaphotrapezial joint using high definition macroradiography.Twenty-eight patients with symptomatic primary osteoarthritis of their hands, 23 with a scaphoid fracture successfully treated conservatively and 18 treated with a Herbert screw were studied. The patients with primary osteoarthritis of their hands had more narrowing of the scaphotrapezial joint compared with the other two groups, but patients treated with a Herbert screw had a significantly higher incidence of osteophytosis on the distal scaphoid than the other two groups. With Herbert screw fixation, osteophytosis on the distal scaphoid may cause impingement and pain, and be a predictor of further degenerative joint changes.

Degenerative Changes at the Scaphotrapezial Joint Following Herbert Screw Insertion: A Radiographic Study Comparing Patients with Scaphoid Fracture and Primary Hand Arthritis

One method of Herbert screw insertion is to mobilize the scaphotrapezial joint and insert the screw through the articular surface of the distal scaphoid. Because of concern that this might predispose to osteoarthritis in the scaphotrapezial joint, we have investigated joint space width and the presence of osteophytes adjacent to the scaphotrapezial joint using high definition macroradiography. Twenty-eight patients with symptomatic primary osteoarthritis of their hands, 23 with a scaphoid fracture successfully treated conservatively and 18 treated with a Herbert screw were studied. The patients with primary osteoarthritis of their hands had more narrowing of the scaphotrapezial joint compared with the other two groups, but patients treated with a Herbert screw had a significantly higher incidence of osteophytosis on the distal scaphoid than the other two groups. With Herbert screw fixation, osteophytosis on the distal scaphoid may cause impingement and pain, and be a predictor of further degenerative joint changes.

Percutaneous fixation of scaphoid fractures An anatomical study

Percutaneous scaphoid fracture fixation has many advantages over the open method of fixation. We describe the anatomical basis for a safe percutaneous approach. Cannulated screws were inserted into 32 cadaveric scaphoids through 1 cm palmar incisions under fluoroscopic control. We then measured the distance between the entry point in the scaphoid and important local neurovascular structures. We also measured the angle of entry of the guide wire in two planes. The mean distance of the entry point from the main radial artery was 14 mm (range, 7–24 mm); from the radial nerve 19 mm (range, 7–35 mm); from the recurrent branch of the median nerve 29 mm (range, 14–45 mm); and from the superficial branch of the radial artery 5 mm (range, 0–8 mm) The mean radial angle of insertion was 34° and the mean palmar angle of insertion was 58°. Percutaneous fixation of scaphoid fractures puts the superficial palmar branch of the radial artery at risk. We recommend a 1 cm incision centred over the scaphotrapezial joint and dissection under direct vision to the entry point in the scaphoid rather than a completely percutaneous approach.

Save the trapezium: Double interposition arthroplasty for the treatment of stage IV disease of the basal joint

Twenty patients with symptomatic stage IV basal joint (pantrapezial) arthritis were treated with double interposition arthroplasty, a new technique that resurfaces the degenerative trapeziometacarpal and scaphotrapezial joints after minimal distal trapezial resection. The results of the 21 procedures were reviewed clinically and radiographically after a mean follow-up period of 34 months (minimum, 1 year). Ninety-one percent of the patients were completely satisfied. Seventy-one percent were entirely free of pain, and an additional 24% noted only occasional, mild, high-stress pain that did not limit their activities. One case was a clinical failure. Objectively, all 21 basal joints were stable, with active range of motion to within 90% of normal. Mean grip strength increased 32%, from a force of 26.1 kg to 33.9 kg (p < .01). Key pinch strength increased from a force of 5.3 kg to 6.0 kg (an 11% increase; p = .05). A new method of determining changes in basal joint height indicated a mean decrease in height of 5.3% (range, 0%-12%) at rest and 8.1% (range, 0%-20%) under axial compression. This difference was statistically but not functionally significant. Overall, there were 95% good or excellent results and 1 poor result. We believe this technique is simple and preserves the osseous foundation of the basal joints. These results compare favorably with arthroplasties that include trapezium excision for the treatment of stage IV basal joint arthritis.

Acute percutaneous scaphoid fixation

Fractures of the scaphoid are most common in young men; immobilisation in a cast usually means a long period away from work and athletic activities. Early rigid fixation has been shown to promote a rapid functional recovery, but open reduction and internal fixation is technically demanding with the dangers of damage to the radiocarpal ligaments, the scaphotrapezial joint, and the blood supply of the scaphoid. For minimally displaced or undisplaced B1 or B2 fractures, these problems can be overcome by percutaneous fixation. We report our technique and the results of a pilot study in 15 patients. There was no immobilisation; patients were allowed movement soon after operation, but union was obtained in all at a mean of 57 days (38 to 71). The range of movement after union was equal to that of the contralateral limb and grip strength was 98% of the contralateral side at three months. Patients were able to return to sedentary work within four days and to manual work within five weeks. Our initial results show that percutaneous scaphoid fixation for acute fractures is satisfactory and gives rapid functional recovery.

Acute percutaneous scaphoid fixation. A pilot study.

Fractures of the scaphoid are most common in young men; immobilisation in a cast usually means a long period away from work and athletic activities. Early rigid fixation has been shown to promote a rapid functional recovery, but open reduction and internal fixation is technically demanding with the dangers of damage to the radiocarpal ligaments, the scaphotrapezial joint, and the blood supply of the scaphoid. For minimally displaced or undisplaced B1 or B2 fractures, these problems can be overcome by percutaneous fixation. We report our technique and the results of a pilot study in 15 patients. There was no immobilisation; patients were allowed movement soon after operation, but union was obtained in all at a mean of 57 days (38 to 71). The range of movement after union was equal to that of the contralateral limb and grip strength was 98% of the contralateral side at three months. Patients were able to return to sedentary work within four days and to manual work within five weeks. Our initial results show that percutaneous scaphoid fixation for acute fractures is satisfactory and gives rapid functional recovery.

Acute percutaneous scaphoid fixation using a cannulated screw

Fractures of the scaphoid are most commonly seen in young males where immobilisation in a cast will lead to a prolonged period away from work and from athletic activities. Early rigid fixation has recently been advocated to promote a rapid functional recovery. Open reduction and internal fixation of the scaphoid is however technically demanding, damages the anterior radiocarpal ligaments, violates the scapho trapezial joint, further endangers the already compromised blood supply of the scaphoid and not infrequently leads to troublesome hypertrophic scars. These problems can be overcome in minimally displaced or undisplaced fractures by percutaneous fixation. We present the first 50 cases from our ongoing study of patients treated acutely in this way. No cast immobilisation was used and the patients were allowed to mobilise immediately postoperatively. Union was obtained in all cases after an average of 55 days (37-79). Range of movement at the time of fracture union was equal to that of the contralateral limb at three months and grip strength was 98% of the contralateral side at three months. Patients returned to sedentary work within 4 days and to manual work/sports within 5 weeks. We have found percutaneous scaphoid fixation for acute fractures a rapid and very satisfactory intervention which leads to a rapid functional recovery.

Herbert screw insertion in the scaphotrapezial joint: A cause of degenerative change?

The method of insertion of the Herbert screw for scaphoid fractures and its long-term presence in the scaphotrapezial joint may predispose to degeneration in that joint. We examined a group of patients with long-term follow-up to assess this risk and found it to be insignificant.