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PubMed1976

[Arthrosis of the first ray of the hand in geriatric patients (author's transl)].

The frequency of arthrosis in the first ray of the hand increases with the age of the patient, particularly in the saddle joint of the thumb and in the joint between the trapezoid bone and the navicular bone of the hand. The finding is frequently bilateral and is accompanied by kinesalgia, periarticular swelling and restricted movement. A relationship between arthrosis of the first ray of the hand and certain occupations can be assumed. While the arthrosis in the saddle joint of the thumb demonstrates the usual radiological symptoms of arthrosis, the sclerosing of the joint surfaces between the os naviculare and the ossa multangula is the most pronounced.

Age Factors↗
PubMed1991

[The combined luxation of the trapezoid and 2nd metacarpal bones. Apropos of a case].

The authors report a case of posterior dislocation of the trapezoid bone together with the second metacarpal. Among the 25 cases of trapezoid dislocations reported in the literature, no similar case has been found. The patient was seen 4 months after the injury and there was also a scaphoid instability. Open reduction and a scapho-trapezio-trapezoid arthrodesis were performed. The diagnosis, the mechanism and the treatment of this very unusual injury are discussed.

Adult↗
PubMed2005

Trapeziometacarpal joint instability after Bennett's fracture-dislocation.

BACKGROUND: Investigation of trapeziometacarpal joint instability was undertaken following Bennett's fracture-dislocation. METHODS: We treated six patients who were experiencing trapeziometacarpal joint instability following Bennett's fracture-dislocation. The average age of the patients at the initial visit was 22.2 years. There were four men and two women. All six patients complained of trapeziometacarpal joint pain and instability preoperatively. Fluoroscopy confirmed that the beak fragment moved with the shaft fragment. The length of time from injury to surgery ranged from 1 to 29 months (average 10.7 months). Ligament reconstruction based on Eaton's method was performed on five patients, and in one patient the fracture site was osteotomized and reduced and the dorsoradial ligament repaired. RESULTS: Over an average follow-up observation period of 20 months, none of the patients complained of severe joint pain or instability. CONCLUSIONS: When treating Bennett's fracture-dislocation, it is necessary to pay careful attention not only to accurate anatomic reduction of the joint surface but also to joint instability.

Adolescent↗
PubMed2006

Time course of magnetic resonance images in an adolescent patient with Kienböck's disease treated by temporary scaphotrapezoidal joint fixation: a case report.

UNLABELLED: Kienböck's disease in a 15-year-old girl was treated successfully by temporary scaphotrapezoidal joint fixation using longitudinal K-wires. Repeated magnetic resonance imaging begun 3 months after surgery showed progressive increases in signal intensity on T1-weighted sequences of the lunate and was almost normal 6 months after surgery. The K-wires used for the temporary joint fixation were removed 6 months after surgery. The signal intensity of the lunate on magnetic resonance images remained normal 2 years after surgery. At that time plain x-ray showed no sign of lunate sclerosis and there was no cystic shadow or sign of advanced collapse. At 2 years after surgery the patient does not complain of wrist pain, can lead a normal daily life, and plays sports without difficulty. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Adolescent↗
PubMed2002

Osteotomy for malunited fractures of the distal radius: a comparison of structural and nonstructural autogenous bone grafts.

Two cohorts of 10 patients who had a corrective osteotomy for a malunited fracture of the distal radius with a pi-shaped plate and screw fixation were compared retrospectively to see whether the outcome was affected by using a nonstructural cancellous bone graft compared with a trapezoidal corticocancellous bone graft. The indications for the osteotomy, surgical techniques, and postoperative rehabilitation were consistent and all surgical procedures were done by the same surgeon. All osteotomies healed without loss of the surgical correction. Follow-up radiographic and functional results were comparable between groups. Use of a nonstructural, cancellous only bone graft-appealing in its relative simplicity-seems safe and efficacious.

Adult↗
PubMed2006

Loading of the index metacarpal after trapezial and partial versus complete trapezoid resection.

PURPOSE: To examine the effects of partial or complete trapezoidectomy in conjunction with trapezium resection on proximal migration of the index metacarpal during axial loading. METHODS: Five specimens from below the elbow were obtained from fresh-frozen cadavers. A customized vise was used to position the wrist in 20 degrees extension and 5 degrees ulnar deviation, simulating a power grip. The index metacarpal was instrumented to allow axial loading at 125 N and 250 N. Specimens were tested under 4 experimental conditions: (1) in the intact state, (2) after trapezial resection, (3) after partial trapezoid resection, and (4) after complete trapezoid resection. Specimens were tested 5 times under each experimental condition, displacement was measured with a linear variable differential transformer, and stiffness was calculated. RESULTS: There was no difference in stiffness between the different treatments at either 125 N or 250 N. Displacement was not significantly different between treatments for loads of 125 N. For loads of 250 N the displacement was approximately 1 mm greater with complete trapezoid resection than with any of the other treatment conditions. Displacement did not differ significantly between the other 3 treatments. CONCLUSIONS: The addition of a partial trapezoid resection performed at the time of trapezial resection does not affect proximal migration of the second metacarpal. When a complete trapezoidectomy is performed at the time of trapezial excision, however, the loading characteristics of the index metacarpal do change statistically significantly, although the magnitude of that change is only approximately 1 mm. Further testing will be necessary to elucidate the biomechanical effects of a partial trapezoid resection in conjunction with a trapezial resection on the second metacarpal in other planes.

Cadaver↗
PubMed2006

[Scapho-trapezio-trapezoidal arthrodesis for scapho-trapezio-trapezoidal osteoarthritis].

Scapho-trapezio-trapezoid arthrodesis was originally performed for the treatment of scapho-lunate instability. However, only a few publications have described this technique for treatment of osteoarthritis of the scapho-trapezio-trapezoid (STT) joint. The purpose of this paper is to analyze the results of triscaphoid arthrodesis for STT osteoarthritis with a long-term follow-up. Thirteen cases of osteoarthritis of the STT joint in twelve patients, all treated by STT arthrodesis, were reviewed with an average follow-up of 60 months. Pain was classified according to Alnot's classification: eight patients were classified as grade III, two as grade IV and two as grade II. The average preoperative range of motion of the wrist was 51 degrees for flexion, 39 degrees for extension, 9 degrees for radial deviation and 28 degrees for ulnar deviation. Grip strength was compared to the contralateral side. Radiographic changes were classified according to Crosby's classification, including sublevels for carpal instability. Four wrists were classified 2a and nine wrists were classified 2b. The average radio-lunate and scapho-lunate angles were 14 and 45 degrees respectively. Pain was improved in all patients (P = 0.05) all of whom were subjectively satisfied. Strength and range-of-motion did not statistically decrease after STT arthrodesis except for wrist extension (P = 0.03). Radio-lunate and scapho-lunate angles were unchanged in five patients and improved in five patients. There were four non-unions of whom two patients without pain were not re-operated. The other two were re-operated with the same technique leading to fusion. Scapho-trapezio-trapezoid arthrodesis is an efficient procedure for STT osteoarthritis with regard to pain reduction. Strength and global range-of-motion are not modified by this procedure. Moreover, as it limits carpal instability, this procedure is preferable in active patients.

Adult↗
PubMed2005

Trapezium fracture associated with occult fracture of the proximal pole of the scaphoid.

There has been no case of simultaneous fracture of the trapezium and the proximal pole of the scaphoid. We have treated a case with this combination. The fracture of the proximal pole of the scaphoid was only found on computed tomography imaging. We performed accurate reduction and fixation of both fractures with cannulated headless compression screws in a minimally invasive technique. We obtained rigid initial fixation and good clinical and radiographical results.

Adult↗
PubMed2006

A new surgical technique for the ligament reconstruction of the trapeziometacarpal joint.

Isolated traumatic dislocation of the trapeziometacarpal joint is rare compared with fracture-dislocation of the joint. The mechanism of injury is usually axial loading on a flexed thumb metacarpal, leading to dorsal dislocation of the joint. Closed reduction with immobilization is an acceptable method of treatment if the joint is stable after the reduction. Otherwise, early ligamentous reconstruction is recommended to reduce the likelihood of secondary arthritis. Various surgical techniques have been used to reestablish the ligamentous integrity of the joint; however, these techniques usually reconstruct only 1 or 2 ligaments around the joint. The current technique is aimed to reconstruct all 4 ligaments of the trapeziometacarpal joint using a half strip of extensor carpi radialis brevis tendon.

Adult↗
PubMed1985

The origin and innervation of the adductor pollicis muscle.

A gross dissection of twenty human adductor pollicis muscles indicated an extensive origin of both the transverse and oblique heads. The origins included the second, third, and fourth metacarpal bones and the capitate, trapezoid, and trapezium bones. Soft tissue origins included intermetacarpal ligaments and the anterior fascia of palmar interosseous muscles. An interfascicular dissection of the deep branch of the ulnar nerve within the substance of the adductor pollicis muscle revealed three distinct patterns of terminal branching to the transverse and oblique heads, and to the first dorsal interosseous muscle.

Hand↗
PubMed1992

A comparison of scaphoid-trapezium-trapezoid fusion and four-bone tendon weave for scapholunate dissociation.

The contact characteristics of the radiocarpal joint (area, pressure, and ratios of scapholunate area, pressure and force transmitted) were determined with the use of pressure-sensitive film in seven normal wrists after ligament sectioning to create scapholunate instability, with reconstruction involving a scaphoid-trapezium-trapezoid fusion, and with reconstruction involving a four-bone tendon weave procedure. The results demonstrated that the scaphoid-trapezium-trapezoid fusion significantly altered the contact characteristics of the wrist, transferring load, pressure, and area to the radioscaphoid joint, thereby unloading the lunate. In contrast, the tendon weave reconstruction produced characteristics similar to those of the normal joint.

Arthrodesis↗
PubMed1998

[Mid-term results of scapho-trapezio-trapezoid arthrodesis in aseptic semilunar bone necrosis stage IIIa/b].

The mid-term results of 20 cases of Kienböck's disease treated with scaphotrapezio-trapezoid arthrodesis with an average follow-up period of 25 months between 1993 and 1997 are presented. Clinical results were good with regard to pain, grip strength and range of motion; the results with regard to the DASH questionnaire were very good. It can be concluded from this study that STT arthrodesis is a useful procedure for the treatment of Kienböck's disease in stage III.

Adult↗
PubMed2006

[The trapezio-metacarpal joint: the strain of the ligaments as a function of the thumb position. Study on an enlarged model].

INTRODUCTION: The aim of this paper was to develop an enlarged anatomical model of the trapezio-metacarpal joint in order to measure the strains on the ligaments when this joint was passively moved in several directions under constant loading. MATERIAL AND METHOD: A model of the two first rays of the hand was made in polystyrene, at a X3 enlargement, and the ligaments substituted by rubber bands with well characterized mechanical properties so as to reproduce the actual ratio of stiffness (approximately = 10) of the different tissues (bones and ligaments) found in real life. The first metacarpal was moved in 6 directions as described by Ebskov (1970) and Pieron (1973, 1980) using a small spring exerting a constant force (1.5 N) tilted at 30 degrees with respect to the transverse plane. The strain was measured between two white marks for each model ligament and each direction respectively, and the percentage of lengthening was calculated. A statistical study was performed using the non-parametrical Test of Wilcoxon in order to compare the ligament strains obtained in the different directions of loading. RESULTS: The largest strains were observed in the intermetacarpal ligament and in the anterior oblique ligament reaching 26 to 39% in direction J (posteromedial) and in direction L (posterolateral). Deformations of the two parts of the dorsoradial ligament and of the posterior oblique ligament were equal or inferior to 12% and were observed in the other 4 directions: D, F, K, I (Anterolateral, maximal anteposition, anteromedial, medial) and their combinations. CONCLUSION: . These data may be useful for helping the understanding of the biomechanics of the basal joint of the thumb. Nevertheless, we are dealing here with a simplified model, which must be considered with caution if the results are to be applied to the living joint.

Carpometacarpal Joints↗
PubMedDate not supplied

Effect of bone block removal and patellar prosthesis on stresses in the human patella.

Thermoelastic stress analysis was used to examine stresses on the anterior surface of patellae after patellar bone block excision for autogenous graft anterior cruciate ligament reconstruction. Complications of anterior cruciate ligament injury often lead to degenerative changes in the knee that can require total knee joint replacement. It was hypothesized that stresses in a bone block-compromised patella may be increased even further by insertion of a patellar prosthesis. All patellae were first tested intact and then were retested after a sequence of surgical modifications including patellar prosthesis implantation, tapered bone block excision, square bone block excision, and both shapes of excised bone blocks with a patellar prosthesis in place. Stresses in patellae with bone blocks excised were significantly greater than stresses in intact patellae. The anterior surface stress pattern in the loaded patella was significantly altered by excision of a bone block. There were no significant differences between maximum stress in patellae with tapered and square bone blocks excised. A finite element analysis showed that excision of a larger trapezoid-shaped bone block greatly increased maximum stress levels. Insertion of a patellar prosthesis did not significantly alter stress patterns or maximum stress levels in the patella.

Adult↗
PubMed2005

Prevalence of osteoarthrosis of the trapeziometacarpal joint.

BACKGROUND: The age and gender-related prevalence of arthrosis of the trapeziometacarpal joint has been incompletely defined. METHODS: The radiographs of 615 consecutive patients who had presented with an isolated fracture of the distal part of the radius over a two-year period were evaluated for evidence of trapeziometacarpal arthrosis. We used a simple three-grade rating system suitable for standard wrist radiographs. Grade I indicated no or nearly no arthrosis; grade II, obvious arthrosis; and grade III, a totally destroyed joint. This rating system was demonstrated to have adequate intraobserver reliability (average kappa of 0.72, p < 0.001) and interobserver reliability (average kappa of 0.56, p < 0.001). The number of patients with each grade of arthrosis was analyzed according to age and gender. RESULTS: The overall radiographic prevalence of trapeziometacarpal arthrosis in patients with a distal radial fracture increased steadily from the age of forty-one years onward and reached a prevalence of 91% in patients older than eighty years of age. The prevalence increased more rapidly in women than in men; it reached 94% in women who were older than eighty years of age compared with 85% in men who were older than eighty years of age. The prevalence of grade-III trapeziometacarpal arthrosis (a totally destroyed joint) was much greater in women than in men at all age levels; it reached a prevalence of 66% in women older than eighty years of age compared with 23% in men older than eighty years of age. CONCLUSIONS: The radiographic prevalence of trapeziometacarpal arthrosis in patients presenting for treatment of a distal radial fracture is age-related, and trapeziometacarpal arthrosis is more likely to lead to complete joint destruction in women than it is in men.

Adolescent↗
PubMed2007

Carpal anomalies.

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Carpal Bones↗