RESUMEN
Several methods of resection arthroplasty for the thumb basal joint exist, yet one commonality of these procedures is the removal of the trapezium. My preference is to achieve total trapeziectomy through a less invasive approach and encourage immediate mobilization in order to expedite return to function. Herein I present a step by step method of arthroscopic total trapeziectomy without suspensionplasty.
Asunto(s)
Articulaciones Carpometacarpianas , Osteoartritis , Hueso Trapecio , Humanos , Articulaciones Carpometacarpianas/cirugía , Osteoartritis/cirugía , Hueso Trapecio/cirugía , Pulgar/cirugía , Artroplastia/métodosRESUMEN
Trapeziectomy with suture-button suspensionplasty is a surgical treatment option for thumb carpometacarpal osteoarthritis refractory to nonsurgical management. We describe the cases of 3 patients who presented with index metacarpal fracture, in the absence of traumatic injury, over 4 months after trapeziectomy with suture-button suspensionplasty. All 3 fractures demonstrated the same pattern: short oblique/spiral, oriented proximal radial to distal ulnar with the distal end in the vicinity of the index metacarpal button, presumably after the orientation of the metacarpal drill hole. Two of the fractures were treated with surgical fixation. Fracture healing was obtained in all cases. Two of the 3 patients remained symptomatic with thumb pain, but decided against revision treatment for the carpometacarpal osteoarthritis. The third underwent restabilization of the suture button at the time of fracture fixation. Although uncommon, index metacarpal fracture after trapeziectomy with suture-button suspensionplasty can present without trauma several months after surgery.
Asunto(s)
Articulaciones Carpometacarpianas/cirugía , Fracturas Espontáneas/etiología , Huesos del Metacarpo/lesiones , Procedimientos Ortopédicos/efectos adversos , Osteoartritis/cirugía , Hueso Trapecio/cirugía , Femenino , Fijación Interna de Fracturas , Curación de Fractura , Fracturas Espontáneas/terapia , Humanos , Inmovilización , Masculino , Persona de Mediana Edad , Dispositivos de Fijación Ortopédica , Complicaciones Posoperatorias , Pulgar/cirugíaRESUMEN
BACKGROUND: Pellegrini's surgical technique is the most useful for thumb carpometacarpal joint osteoarthritis. The purpose of this paper is to describe the technique of a modified version using a bone block in the tunnel through which the flexor carpi radialis tendon is passed (BBTI). METHODS: Case series of patients diagnosed with osteoarthritis of the thumb carpometacarpal joint, in stage II or higher based on Eaton's classification, that were intervened using the BBTI technique for a 2-year period. Grip and pinch strength, range of motion, and 1-2 metacarpal angle were evaluated. Pain and function were measured using the visual analogue scale and the Disabilities of the Arm, Shoulder and Hand (DASH) scale. RESULTS: The study included 16 cases in 14 patients (11 women and 3 men), with an average age of 55.7 ± 7.1 years. Encouraging results were obtained, with an average DASH score of 24.3 ± 17.9 and a minimum VAS pain score. A total of 58% showed a grip strength of over 80% and the postoperative movement was equivalent to the contralateral limb. No cases of infection were reported, and only two minor complications were observed. CONCLUSIONS: The BBTI technique is a surgical option that incorporates an interference screw, offering good functional results for managing osteoarthritis of the thumb carpometacarpal joint, with a similar complication rate to that of the original technique.
Asunto(s)
Tornillos Óseos , Articulaciones Carpometacarpianas/cirugía , Osteoartritis/cirugía , Transferencia Tendinosa/métodos , Tendones/cirugía , Pulgar/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis/diagnóstico , Osteoartritis/fisiopatología , Fuerza de Pellizco , Rango del Movimiento Articular , Pulgar/fisiopatologíaRESUMEN
BACKGROUND: Carpometacarpal joints can be affected by traumatic or degenerative pathology. Although different techniques have been described to treat these conditions, most authors agree that arthrodesis is an effective treatment modality. Vascularized bone grafts of the distal radius have been used to treat carpal conditions, such as scaphoid nonunion or Kiënbock disease, and they have been shown to have several advantages over nonvascularized bone grafts. METHODS: We report a case of a carpal boss in a female patient treated with an arthrodesis of the second and third carpometacarpal joints by using the fourth extensor compartment artery vascularized bone graft. RESULTS: At 6 weeks postoperative bone union was achieved. At 2 years follow-up the patient was able to perform daily life activities without pain. CONCLUSIONS: The fourth ECA VBG with reverse blood flow from the dorsal intercarpal arch allowed the graft to reach the CMC. A solid fusion was obtained at 6 weeks due to the biological advantage of the VBG.
Asunto(s)
Artrodesis/métodos , Articulaciones Carpometacarpianas/cirugía , Radio (Anatomía)/irrigación sanguínea , Radio (Anatomía)/trasplante , Esclerosis/cirugía , Artralgia/fisiopatología , Artralgia/cirugía , Articulaciones Carpometacarpianas/patología , Articulaciones Carpometacarpianas/fisiopatología , Femenino , Humanos , Persona de Mediana Edad , Osteoartritis/fisiopatología , Osteoartritis/cirugía , Esclerosis/fisiopatología , Articulación de la Muñeca/fisiopatología , Articulación de la Muñeca/cirugíaRESUMEN
BACKGROUND: Carpometacarpal arthroplasty provides well-documented pain relief with preservation of thenar function in basal joint arthritis treatment. Nevertheless, some patients continue to have pain following surgery. The authors hypothesize that unrecognized midcarpal (capitolunate) arthritis is a contributor to persistent pain after carpometacarpal arthroplasty. The prevalence of midcarpal arthritis in patients with basal joint arthritis is unknown. This article establishes the radiographic prevalence of midcarpal arthritis in patients with carpometacarpal arthritis. METHODS: Patients with basal joint arthritis were identified from a search using International Classification of Diseases, Ninth Revision code 716.94. Hand radiographs were reviewed and graded using the Eaton classification and Sodha classification for carpometacarpal arthritis. Scaphotrapeziotrapezoid arthritis and midcarpal arthritis were graded using the Sodha classification for arthritis as follows: grade 1, no or nearly no arthrosis; grade 2, definite arthrosis but not severe; and grade 3, severe arthrosis. RESULTS: Eight hundred ninety-six radiographs were reviewed. The prevalence of scaphotrapeziotrapezoid arthritis in this population was 64 percent. The prevalence of midcarpal arthritis in this population was 23.5 percent. The prevalence of midcarpal arthritis in patients with radiologic evidence of carpometacarpal arthritis was 25.4 percent. The prevalence of severe midcarpal arthritis was 7 percent. CONCLUSIONS: The prevalence of midcarpal arthritis in patients with basal joint arthritis is 24 percent. The presence of two locations of arthritis may explain persistent hand and wrist pain in this population despite carpometacarpal arthroplasty. Clinically, these data will allow hand surgeons to better educate patients with basal joint arthritis regarding the possibility of incomplete pain relief following carpometacarpal arthroplasty.
Asunto(s)
Artroplastia/métodos , Huesos del Carpo/cirugía , Articulaciones Carpometacarpianas/cirugía , Osteoartritis/cirugía , Hueso Escafoides/cirugía , Anciano , Huesos del Carpo/diagnóstico por imagen , Articulaciones Carpometacarpianas/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis/diagnóstico , Radiografía , Estudios Retrospectivos , Hueso Escafoides/diagnóstico por imagenRESUMEN
Trapeziometacarpal arthrosis is a degenerative condition described by Fostier in 1937. Osteoarthrosis of the trapeziometacarpal joint is a common condition among postmenopausal women; mean age of individuals affected by this disease is 64 years. The male:female ratio is 1:10; 33% of patients have a bilateral component. This study was conducted at Lomas Verdes Traumatology and Orthopedics UMAE hospital, hand surgery module, between March and December 2006. Descriptive, cross-sectional, retrospective study including a total of 18 patients, 12 females (66.6%) and 6 males (33.3%). Mean age is 49.3 years. Patients were clinically and radiographically diagnosed and classified by stages according to the Eaton classification. Surgery was performed more frequently in right hands, which were a total of 10 (55.6%), than left hands, which were 8 (44.4%). Surgery of the dominant hand was performed in 8 patients, 7 of them right handed, and one left handed. Arthrodesis with nails was performed in 12 patients (66.7%) and with a 2.0 condylar plate in 6 (33.3%). Mean operative time was 52.8 minutes. Eleven patients were found to have primary arthrosis, and 7 had posttraumatic arthrosis: 2 due to untreated Benett fractures, one due to a healed trapezius fracture and 4 patients had recurrent dislocation. As regards their occupation, 12 were employees, 5 were housewives and one was unemployed. The concomitant conditions found included: 9 without disease, 7 with hypertension, 7 diabetes mellitus, and one had rheumatoid arthritis. Two patients were reoperated (11.1%) due to pseudoarthrosis. In one of them a new arthrodesis was performed 18 months later, which failed and 8 months later triscaphoid arthrodesis was performed with a 10-week healing time. Trapeziometacarpal arthrodesis is a procedure involving a certain difficulty due to the anatomic conformation of the joint, which results in the various complications that have already been described. It provides pain relief; it is a good option for people who need to resume a type of work requiring the use of force; a longer follow-up is required to determine the course of these patients.