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Proximal row carpectomy with a partial trapeziectomy. The treatment proposed for trapeziometacarpal arthritis and SCAC wrist with radioscaphoid and scaphotrapeziotrapezoid involvement.
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Although the simultaneous occurrence of arthritis of the wrist and the base of the thumb is rare, it is nonetheless imperative to carry out a preoperative clinical and radiological assessment of the wrist when managing trapeziometacarpal osteoarthritis. The presence of pre-arthritic lesions or established wrist arthritis, even if treated, must be t...
Context in source publication
Context 1
... arthritis and SCAC wrist (chondrocalcinosis) (Fig. 4) This corresponds to wrist arthritis with an atraumatic origin [17]. Although it can affect each joint or ligament of the carpus, radioscaphoid and STT locations are the most frequent [45]. It can be associated with scapholunate dissociation, although this is not common ...
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This paper describes the design of a prosthetic hand for wrist amputations. The mechanism considers the use of three actuators: one each for the movement of the little finger, annular finger, and middle finger. The second actuator controls the index finger, and the third controls the thumb. The prototype is considered relevant as it is able to move...
Citations
... After thumb trapeziometacarpal arthrodesis surgery, the surrounding joints will compensate for its movement,thereby increasing the rates of osteoarthritis in these joints 53 . But in a longterm follow-up of patients treated with LRTI showed no increased risk of developing radiographic OA in adjacent carpal joints 54 . ...
The optimal management of trapeziometacarpal (TMC) osteoarthritis remains controversial. This meta-analysis assessed the subjective and objective outcomes of trapeziometacarpal arthrodesis (TMA) versus trapeziec-tomy with ligament reconstruction (LRTI). The PubMed, Cochrane Library, Embase, Web of science data-bases were searched from inception to June 30, 2022. Keywords included “trapeziometacarpal osteoarthrosis”, “trapeziometacarpal arthrodesis” and “trapeziectomy with ligament reconstruction”. Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) including patients treated for TMC osteoarthritis were included. The subjective outcomes visual analogue scale (VAS) , Patient-Rated Wrist and Hand Evaluation (PRWHE), Disabilities of arm, shoulder and hand (DASH) scores, Kapanji scores, objective outcomes total interphalangeal (IP) and metacarpophalangeal (MCP) joint motion, palmar abduction, grip strength, tip, key pinch strength and complications were extracted. The methodological quality of each was assessed in- dependently. Meta-analysis was performed for comparative trials. From the 5 included studies (2 RCTs, 3 CCTs), 208 cases were divided into TMA group (n = 107) and LRTI group (n =101) groups. Compared with the TMA group, PRWHE, tip pinch strength and palmar abduction was better in the LRTI group. There was no statistical difference in DASH score, VAS, kapandji score, grip strength, key pinch strength, total IP joint motion, total MCP joint motion and complications. The LRTI group had more obvious advantages in term of PRWHE, tip pinch strength and palmar abduction. Moreover, there was no statistical difference in DASH score, VAS, kapandji score, grip strength, key pinch strength, total IP joint and total MCP joint motion and complications. Therefore, we concluded LRTI was more recommendable for more management of TMC osteoarthritis. Certainly, high-quality studies are required in long-term follow-up.
... However, the use of a primary implant in complex fractures of the first metacarpal base has been successfully advocated and described in a case report. 2 The rationale behind the choice of a prosthetic implant for severely comminuted or articular fractures is the challenging restoration of the joint line congruency in joints with a native predisposition to develop severe osteoarthritis, especially in hand workers. 3 As metacarpal fractures are more common in young adults with a mean age of 40.1 years, 4 failure to restore the native joint biomechanics leads to impaired function, pain, and significant disability, especially in young, active workers. However, all results available in the literature concern devices implanted in patients with TMC osteoarthritis and data on implant survival are scarce, with studies with medium-to longterm follow-ups only focusing on interposition arthroplasty. ...
This report describes the case of a 61-year-old man reporting a painful subluxation and instability of the first metacarpal of the right hand after surgery for a multifragment fracture-subluxation of the thumb base. The fracture (considered irreducible) had been previously treated with K-wire stabilization of the trapeziometacarpal joint and subsequent removal of the K-wires at another clinical center. We advocate the use of trapeziometacarpal arthroplasty after the failure of open reduction internal fixation of the previous articular fracture, with successful results at follow-up.
The assessment of thumb basal joint arthritis requires a radiographic evaluation and a classification of the lesions to guide the treatment choice. Arthritis of the thumb basal joint is not limited to trapeziometacarpal arthritis. The radiographic assessment must consider the scaphotrapeziotrapezoid joint, the entire carpus and the rest of the thumb column, in particular the metacarpophalangeal joint. There is currently no classification that captures all these items. This article reviews the existing classifications, proposes a new classification system that takes into account the entire thumb column and sets out the therapeutic options.
