Treatment of advanced carpometacarpal joint disease: trapeziectomy and hematoma arthroplasty.
ABSTRACT Some surgical treatment options of painful basal joint arthritis do not require complex arthroplasty or suspensionplasty techniques. Simple trapeziectomy with temporary pinning of a slightly overdistracted thumb metacarpal can provide reliable pain relief, good motion, and functional stability. Recent literature supports alternative options when compared with formal ligament reconstruction or suspensionplasty procedures. Simple trapeziectomy is associated with less morbidity due to shorter operative times and the lack of need for graft harvest and ligament reconstruction.
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ABSTRACT: A clinical review of patients treated by excision of the trapezium for carpometacarpal arthritis of the thumb is presented. Excision of the trapezium gave good results, particularly with respect to relief of pain. Hand function was good following excision of the trapezium, though there was some reduction in the power of opposition grip and pinch in three-quarters of the patients. This weakness may be due the the carpal instability that exists following the operative procedure.The Hand 11/1981; 13(3):246-50.
Article: Trapeziectomy.[show abstract] [hide abstract]
ABSTRACT: Primary osteoarthritis of the carpometacarpal joint of the thumb is common, especially in women aged 60 or older. Patients usually present with activity-related pain at the thumb base. First treatment may include activity modification, pain relieving medications, splinting, and possibly corticosteroid injections. When these measures fail to pre-serve or restore the patient's quality of life, surgical intervention may be appropriate. Many surgical alternatives are described for the treatment of thumb carpometacarpal joint arthritis, and most begin with at least partial trapeziectomy. Hematoma-distraction arthroplasty results in improved outcomes as compared with historical results following trapeziectomy alone. Temporary distraction allows the body's healing response to fill in the trapezial void with scar tissue, obviating the need for ligament reconstruction or tissue interposition.Hand Clinics 06/2006; 22(2):165-9. · 0.95 Impact Factor
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ABSTRACT: To investigate whether palmaris longus interposition or flexor carpi radialis ligament reconstruction and tendon interposition improved the outcome of excision of the trapezium for the treatment of painful osteoarthritis of the trapeziometacarpal joint. 183 thumbs with trapeziometacarpal osteoarthritis were randomized for treatment by either simple trapeziectomy, trapeziectomy with palmaris longus interposition, or trapeziectomy with ligament reconstruction and tendon interposition using 50% of the flexor carpi radialis tendon. A K-wire was passed across the trapezial void during each of the 183 surgeries to hold the base of the thumb metacarpal at the level of the index carpometacarpal joint and was retained for 4 weeks in every case. All patients wore a thumb splint for 6 weeks. Each patient had subjective and objective assessments of thumb pain, stiffness, and strength before surgery and at 3 months and 1 year after surgery. The 3 treatment groups were well matched for age, dominance, and presence of associated conditions. Complications were distributed evenly among the 3 groups and no cases of subluxation/dislocation of the pseudarthrosis were observed. Of the 183 thumbs 82% achieved good pain relief and 68% regained sufficient strength to allow normal activities of daily living at the 1-year follow-up evaluation. Neither of these subjective outcomes nor the range of thumb movement was influenced by the type of surgery performed. Thumb key-pinch strength improved significantly from 3.5 kg before surgery to 4.6 kg at 1 year but the improvement in strength was not influenced by the type of surgery performed. The outcomes of these 3 variations of trapeziectomy were very similar at 1-year follow-up evaluation. In the short term at least there appears to be no benefit to tendon interposition or ligament reconstruction.The Journal Of Hand Surgery 12/2004; 29(6):1069-77. · 1.57 Impact Factor