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PubMed1988

Trapezoidal osteotomy of the distal radius for unacceptable articular angulation after Colles' fracture.

Loss of radial palmar tilt in malunion of Colles' fractures alters wrist biomechanics, abnormally loading the tenuous dorsal ligament complex. This can result in midcarpal instability with synovitis, pain, weakness, and possible articular degeneration. An osteotomy to correct radius alignment using a trapezoidal corticocancellous bone graft has been devised. The graft is harvested from the dorsal radius adjacent to the osteotomy and malunion site. When turned 90 degrees, a properly designed trapezoidal graft restores radial length, inclination, and palmar tilt in one step. Functional results in 15 patients at 46 months (range, 18 to 116) were comparable with a series using iliac crest graft and plate- and-screw fixation. This simple technique avoids disruption of the extensor retinaculum and reoperation for hardware removal as Kirschner-wire fixation proved adequate.

Adolescent↗
PubMed2006

[Interposition arthroplasty for the treatment of primary osteoarthritis: comparison of results using the technique of Epping and Weilby].

We compare clinically and radiologically two groups of total trapezectomy performed as treatment for the primary osteoarthritis of trapeziometacarpal joint combined in 83 cases (2000 to 2003) with tendon interposition arthroplasty type Weilby, in 51 cases (1987 to 1991) with Epping tendon interposition and ligament reconstruction arthroplasty in a retrospective study. In both groups we used a strip of the flexor carpi radialis tendon. The mean follow-up time in both groups is 33 months. Overall, both methods achieved similar results. The relief of pain and the patient satisfaction are better, stability and grip force are worse in the Weilby group. At least one year (12 to 57 months) after operation with the technique of Weilby, 88 % of the patients would prefer this method for the other side. It appears that there is no clinical and radiological benefit of ligament reconstruction. However, the two procedures studied yield equally good results in most cases, but we prefer the simple technique of Weilby and guess that the (missing) long-term results would be superior to the results after trapezectomy alone. Long-term results need to be evaluated.

Adult↗
PubMed1990

[Transiliac leg lengthening: experiences with a modified Salter osteotomy].

Transiliac limb lengthening osteotomy is a modified Salter innominate osteotomy which uses a trapezoidal interposition bone graft instead of the usual triangular graft to achieve up to 3 cm of intrapelvic lengthening. It allows correction of certain forms of postural imbalance and pelvic obliquity, as well as allowing an optimal and variable amount of acetabular redirection. This review of 105 patients who have undergone the procedure at our institution revealed the following indications: decompensated scoliosis, 26 patients; acetabular dysplasia with ipsilateral femoral shortening, 34 patients; intrapelvic asymmetry, 7 patients; pure limb length inequality, 38 patients. Intrapelvic lengthening averaged 2.5 cm. Correction of decompensated scoliotic curves averaged 7 degrees reduction in Cobb angle. Improvement in center-edge angle in patients with hip dysplasia averaged 17 degrees. Reduction in size of shoe lift required to balance the trunk in all cases was correlated closely with the intrapelvic lengthening achieved. Complications included two transient neurapraxias (one femoral, one femoral and sciatic), two cases of sacroiliac subluxation (one patient with myelodysplasia, and one patient with polio), three cases of partial graft collapse, and six instances of broken fixation pins, and three deep wound infections. No patient had chondrolysis or avascular necrosis of the femoral head. After average follow-up of nearly 5 years (minimum follow-up 2 years), patients who underwent transiliac limb lengthening osteotomy for correction of postural imbalance for various causes retained satisfactory correction.

Adolescent↗
PubMed2007

Collapsed scaphoid non-union with dorsal intercalated segment instability and avascular necrosis treated by vascularised wedge-shaped bone graft and fixation.

Patients with the specific problem of a collapsed Nakamura volar type, scaphoid synovial pseudarthrosis with avascular necrosis on both magnetic resonance imaging and intraoperative inspection were studied to determine the ability of a trapezoidal wedge-shaped structural bone graft vascularised by the 1,2 intercompartmental supraretinacular artery to simultaneously achieve correction of the scaphoid dimension and a high union rate. Fifteen patients with this specific problem were followed for a mean of 32.1 months and achieved union in all cases at a mean of 11.5 weeks. Improvements were seen postoperatively in wrist flexion and extension, grip strength, degree of dorsal intercalated segment instability and degree of scaphoid collapse. Two complications relating to the fixation technique occurred. Although technically difficult, it is possible to achieve a high rate of union for scaphoid pseudarthrosis while correcting substantial collapse deformity by the use of a structural, wedge-shaped, vascularised bone graft.

Adolescent↗
PubMed1986

A longitudinal study of carpal bone development in Perthes' disease: its significance for both radiologic standstill and bilateral disease.

This paper reports a longitudinal study of carpal bone development in 125 children (98 boys, 27 girls) attending a clinic for Perthes' disease. The age at appearance of ossification in each carpal bone was estimated by studying consecutive radiographs obtained at six-months intervals. The results were compared with the findings for normal children published by Stuart et al. Three radiologic groups of carpal bone maturation are defined: not delayed (capitate and hamate); markedly delayed (triquetral and lunate); and slightly delayed (scaphoid, trapezium, and trapezoid). Overall, the bone age delay is severely abnormal at three to five years of chronologic age and indicates the time in development when general abnormalities occur. The mean age at diagnosis (and standard deviation) for 34 boys with skeletal standstill was 4.49 +/- 1.07 years, compared with 7.28 +/- 2.40 years for 51 boys without such standstill; the mean age at appearance of carpal bones was not significantly different between these two groups, suggesting an equally profound delay of carpal maturation in the group of later-diagnosed boys. Boys with bilateral hip disease show a significant delay in age at ossification of the trapezoid compared with boys who have unilateral disease. The immaturity of bone age may be present during a latent period and be of etiologic significance in the onset of the hip disease, but at present the evidence links it only with bilateral disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Carpal Bones↗
PubMed2005

A 3D quantitative comparison of trapezium and trapezoid relative articular and nonarticular surface areas in modern humans and great apes.

The structure and functions of the modern human hand are critical components of what distinguishes Homo sapiens from the great apes (Gorilla, Pan, and Pongo). In this study, attention is focused on the trapezium and trapezoid, the two most lateral bones of the distal carpal row, in the four extant hominid genera, representing the first time they have been quantified and analyzed together as a morphological-functional complex. Our objective is to quantify the relative articular and nonarticular surface areas of these two bones and to test whether modern humans exhibit significant shape differences from the great apes, as predicted by previous qualitative analyses and the functional demands of differing manipulative and locomotor strategies. Modern humans were predicted to show larger relative first metacarpal and scaphoid surfaces on the trapezium because of the regular recruitment of the thumb during manipulative behaviors; alternatively, great apes were predicted to show larger relative second metacarpal and scaphoid surfaces on the trapezoid because of the functional demands on the hands during locomotor behaviors. Modern humans were also expected to exhibit larger relative mutual joint surfaces between the trapezoid and adjacent carpals than do the great apes because of assumed transverse loads generated by the functional demands of the modern human power grip. Using 3D bone models acquired through laser digitizing, the relative articular and nonarticular areas on each bone are quantified and compared. Multivariate analyses of these data clearly distinguish modern humans from the great apes. In total, the observed differences between modern humans and the great apes support morphological predictions based on the fact that this region of the human wrist is no longer involved in weight-bearing during locomotor behavior and is instead recruited solely for manipulative behaviors. The results provide the beginnings of a 3D comparative standard against which further extant and fossil primate wrist bones can be compared within the contexts of manipulative and locomotor behaviors.

Anatomy, Comparative↗
PubMed2001

Metacarpal synostosis: a simple classification and a new treatment technique.

The current classification of metacarpal synostosis is based on the extent of the synostosis. The authors propose a new classification that takes into account the shape of the metacarpal bones, the curvature of the epiphysis, and the discrepancy in length between the two bones. This classification provides better guidelines for the correction of all components of the deformity. The classification is based on the authors' observations of and experience with 36 cases of metacarpal synostosis; 13 of the deformities were surgically corrected. The I-shaped deformity, whether with distinct (type d) or fused (type f) metacarpophalangeal joints, does not require surgical correction. The U-shaped deformity has parallel epiphysis and does not require surgery unless the two metacarpals are asymmetrical in length (type a) or tightly fused (type t); in these cases, simple lengthening or widening of the space with a bone graft is sufficient. Y-shaped synostosis should be separated whether the branches are symmetrical or asymmetrical, the latter having one branch shorter than the other. Because the epiphyses are already divergent, simple separation does not effectively correct Y-shaped synostosis. The authors propose an osteotomy to isolate a trapezoidal segment of bone from the bifurcation. The isolated bone segment is then reversed in the proximal-distal direction to provide a "plateau" upon which the two distal metacarpals can be realigned. Two cases of Ys (symmetrical) synostosis were successfully treated with this technique; one case of Ya (asymmetrical) synostosis also required distraction lengthening of the shorter metacarpal to achieve an excellent result. One of the most difficult types of metacarpal synostosis to treat is k-shaped synostosis, observed only between the fourth and fifth metacarpals; in this type, the head of the short fifth metacarpal abuts the metaphysis of the fourth. Osteotomy and distraction lengthening provide predictable results for correction of this deformity. The authors suggest that k-shaped synostosis might represent a late evolution of untreated Ua synostosis.

Child, Preschool↗
PubMed2002

A Thai mother and son with distal symphalangism, hypoplastic carpal bones, microdontia, dental pulp stones, and narrowing of the zygomatic arch: a new distal symphalangism syndrome?

A Thai mother and son with distal symphalangism and other associated abnormalities are reported. Distal and middle phalanges of fingers and toes 2-5 were either aplastic/hypoplastic or fused between the corresponding digits. The second fingers and fourth fingernails were most severely affected in both patients. The mother's hands were less severely affected; the middle and distal phalanges of her hands were malformed and fused. Besides the absence of fusion lines, the shape of the fused middle and distal phalanges was quite different from that of other types of fusion, i.e., fused bones in both patients did not maintain the normal configuration of bone, referring to as "middle-distal phalangeal complex". Distal symphalangism was observed in toes 2-5 of the mother and in toe 3 of the son. Both patients had additional clinical manifestations such as narrowing of the zygomatic arch, dental pulp stone, microdontia of a mandibular permanent central incisor, cone-shaped epiphyses of middle phalanges of fingers, and absence of scaphoid, trapezium, trapezoid, and pisiform bones. Mutation analysis of NOG and ROR2, the genes responsible for proximal symphalangism and brachydactyly type B, respectively, was negative.

Abnormalities, Multiple↗
PubMed2001

One-incision endoscopic technique for posterior cruciate ligament reconstruction with quadriceps tendon-patellar bone autograft.

Quadriceps tendon-patellar bone autograft is an alternative graft choice for posterior cruciate ligament (PCL) reconstruction. A 2-incision technique with outside-in fixation at the femoral condyle is generally used. In this article, we describe a 1-incision endoscopic technique for PCL reconstruction with quadriceps tendon-patellar bone autograft. The graft consists of a proximal patellar bone plug and central quadriceps tendon. The bone plug is trapezoidal, 20 mm long, 10 mm wide, and 8 mm thick. The tendon portion is 80 mm long, 10 mm wide, and 6 mm thick, including the full-thickness of the rectus femoris and partial thickness of the vastus intermedius. Three arthroscopic portals, including anteromedial, anterolateral, and posteromedial, are used. All procedures are performed in an endoscopic manner with only 1 incision at the proximal tibia. At the femoral side, the bone plug is fixed by an interference screw. At the tibial side, the tendon portion is fixed by a suture to a screw on the anterior cortex and an interference bioscrew in the posterior tibial tunnel opening. Quadriceps tendon autograft has the advantages of being self-available, allowing for easier arthroscopic technique, and providing comparable graft size. The 1-incision technique provides a simple reconstruction method for PCL insufficiency without a second incision at the medial femoral condyle.

Journal Article↗
PubMed1996

Geometrical relationships between bone plug configuration and patellar tendon graft width.

There is a lack of information in the orthopedic literature regarding the optimal shape of the patellar and tibial bone plugs when using the central one third of the patellar tendon graft for reconstruction of the anterior cruciate ligament. Clinically, we have observed that the final bone plug and patellar tendon graft width are narrower than the intended width of the graft secondary to contouring the bone plugs to accommodate the bone tunnel. This study mathematically evaluates the relationship between the bone plug cross-sectional configuration and its influence on osseous area and patellar tendon graft width. This mathematical study was divided into three parts using accepted trigonometric and geometric methods. The first part compares the maximum cross-sectional area of four commonly used bone plug shapes: a triangle, rectangle, trapezoid, and square for 8-, 9-, 10-, and 11-mm wide bone-patellar tendon-bone grafts. Area values were calculated as a function of the radius of a circle (bone tunnel) and were compared to determine which configuration provided maximum fill of the tunnel. In the second part, the minimum tunnel diameter needed to accommodate a graft of a given width (8 to 11 mm) for each of the four bone plug shapes was calculated. In Part 3, the maximum bone plug width that would fit in a tunnel of a given diameter (8 to 11 mm) was calculated for each of the four bone plug shapes. Results from Part 1 showed a 47% increase in the area of each shape from 8- to 11-mm wide grafts. Regardless of the bone plug size or tunnel diameter, a square plug filled 64% of the area of a circle; a trapezoid, 59%; a rectangle, 51%; and a triangle, 41%. In Part 2, the minimum tunnel diameter required to accommodate a square was 4 mm greater than the desired graft width for 8- and 9-mm wide grafts, and 5 mm greater for 10- and 11-mm wide grafts. The minimum tunnel diameter needed to accommodate a trapezoidal, rectangular, or triangular-shaped bone plug was only 2 mm greater than the desired graft width. In Part 3, the maximum graft width of the trapezoid, rectangle, and triangle was 0.8 to 1.5 mm smaller (10% to 14% less) than the corresponding tunnel diameters of 8 to 11 mm. Yet, the maximum width of the square was 2.3 to 3.2 mm smaller (29% less) than the corresponding tunnel diameters of 8 to 11 mm. These results confirm our clinical observation that the actual bone plug that would fit the bone tunnel is much narrower than the intended graft width. It is recommended that a trapezoidal or rectangular bone plug be harvested as these two shapes would provide a satisfactory amount of bone (cross-sectional area) compared with a square or triangle, with less tunnel-bone plug size difference.

Anterior Cruciate Ligament↗
PubMed1979

[Bilateral fusion of the lesser multangulum (trapezoid) and the capitate in Turner's syndrome (author's transl)].

Fusion of the carpal bones, especially the lesser multangulum (trapezoid) and the capitate, are rare. Fusion of the lunate and triquetrum, however, are more common and are more frequent in negroes than in caucasians. The patient presented had Turner's syndrome, retarded bone age and shortening of the fourth metacarpals. Etiology, pathology, symptoms and possible relation to Turner's syndrome are discussed.

Adolescent↗
PubMed1993

Wrist arthrodesis using an embedded iliac crest bone graft.

34 patients treated by the iliac crest bone graft technique for wrist arthrodesis were reviewed. The average age was 45.6 years and the mean follow-up was 45 months. The procedure is performed through a straight ulnar approach and the head of the ulna is removed. A longitudinal trench is created in both distal radius and carpus preserving the anterior, posterior and lateral cortices. A curved trapezoidal monocortical iliac crest bone graft is embedded inside the trench. The position of the arthrodesis automatically follows the curvature of the graft. No fixation device is used. A short-arm cast is applied for 2 to 3 months. All arthrodeses except two fused within 3 months. Pain was completely relieved in 85% of the cases. Pronation and supination returned to normal 5 months post-operatively. Grip strength was increased in 80% of the cases. The carpometacarpal joints remained pain-free even when not fused. Complications were rare: two lesions of the dorsal branch of the ulnar nerve; two cases of delayed union due to errors in technique, and displacement of the graft in one case. Although it is technically demanding, the embedded iliac crest graft wrist arthrodesis improves pronation and supination as a result of resection of the distal radio-ulnar joint, preserves or improves grip strength, and relieves pain.

Arthritis, Rheumatoid↗
PubMed1999

Anterior cervical fusion and trapezoidal plate stabilization for re-do surgery.

BACKGROUND: Pseudarthrosis, graft fracture or dislocation, and kyphotic angulations are highly undesired complications after surgery of the cervical spine. The purpose of this retrospective study was to evaluate the effect of anterior cervical fusion and plating in cases of failed cervical spine surgery. METHODS: From January 1980 to December 1993 41 patients (25 male, 16 female, mean age 46.8 years, range 30-66 years) underwent corrective surgery of the cervical spine in our department. A total of 33 patients had one, 7 patients had two, and one patient had three previous cervical operations. Re-do surgery was most frequently indicated because of intractable head-neck-shoulder-arm-pain corresponding with radiological findings. Corrective surgery consisted of anterior cervical decompression, realignment, autologous iliac crest bone graft fusion, and trapezoidal plate stabilization. Clinical and radiological follow-up examinations were performed, ranging from 20 to 112 months with a mean of 24.7 months, in 37 patients. Epidemiological, clinical, and radiological data were collected and used for this retrospective study. RESULTS: Of 37 patients 21 showed complete alleviation of head-neck-shoulder pain, 10 improved, and six remained unchanged. Of 15 myelopathy patients, one showed further progress, two were unchanged, four were normal, and eight showed only mild signs of medullary irritation, e.g., hyperreflexia or minimal spasticity. Radiological examinations showed a stable bony fusion in optimal alignment in all 37 patients. CONCLUSION: Based on these findings, anterior cervical decompression, fusion, and plating is a rational treatment in cases of failed cervical fusion.

Adult↗
PubMed1999

[Temporary external fixation in the correction of non articular mal-unions of the distal radius].

PURPOSE OF THE STUDY: The authors reviewed 21 cases of extra articular malunions of the distal radius treated by osteotomy, temporary external fixation, then osteosynthesis. Two groups were studied: Group A of 14 patients with dorsal tilt of the distal radius and Group B of 7 patients with palmar tilt of the distal radius. Mean follow-up of this series was 69 months ranged from 12 to 109 months. MATERIAL AND METHODS: In Group A, after exposure of the distal radius through a dorsal approach, the site of osteotomy, proximal to the distal radio-ulnar joint, was determined by fluoroscopy. The angular correction was done by progressive opening using a small external fixator. After checking on the correction, the bone graft was harvested 7 times on the radius as described by Watson et Castle, 7 times on the iliac crest. Bone fixation was done by two K-wires and a cast for 8 to 10 weeks. Three Sauvé-Kapandji procedures was done at the same time. In Group B, the approach was palmar, extended distally to open the carpal tunnel. The distraction was done with a distal T-shaped external fixator. The bone graft was always harvested on the iliac crest. Bone fixation was done with a T-shaped palmar plate. Two Sauvé-Kapandji procedures was done at the same time. RESULTS: Group A: Flexion-extension arc was improved of 15.5 p. 100, pronation-supination of 83.7 p. 100 and grip strength of 80 per cent of the pre-operative values. Radiological evaluation showed good correction except one case of undercorrection of the dorsal tilt (-7 degrees) and one case of undercorrection of the radial inclination (+6 degrees). The distal radio-ulnar index was measured at the mean of 0mm postoperatively compared to +5 mm pre-operatively. One patient developed a postoperative radiocarpal arthritis. Group B: Flexion-extension arc was improved of 96.2 p. 100, pronation-supination of 76.9 p. 100 and grip strength of 108.3 p. 100 of the preoperative values. Radiological evaluation showed good correction except one case of overcorrection of the palmar tilt (-10 degrees) and one case of undercorrection of the radial inclination (+7 degrees). The distal radio-ulnar index was measured at the mean of 0mm postoperatively compared to +7 mm pre-operatively. DISCUSSION: The functional consequences of malunions of the distal radius have been stressed by others for more than sixty years. Since, many authors have contributed to refine and improve their surgical correction. Several displacements should be taked into account for the preoperative planning. They are sagittal tilt, frontal horizontalisation, shortening, sagittal and frontal translation, and axial rotation. Many types of osteotomies could be done; closing wedge, opening wedge or reorientation. In some cases, an operative procedure of the distal radio-ulnar joint should be done at the same time. We chose an opening-wedge osteotomy and the use of a temporary external fixator to ensure progressive distraction and good adjustment in the correction of angular deformities. In the dorsal tilt group we were satisfied in using on 7 patients a trapezoidal cortico-cancellous bone graft harvested on the radius. CONCLUSION: The authors would like to stress two points: The technical interest of using a temporary external fixator to adjust the angular correction of the distal radius. The importance of an adequate treatment of distal radius fractures in emergency situation, considering the functional and cosmetic alterations due to malunions and their need for surgical corrections in main instances.

Colles' Fracture↗
PubMed2005

Corrective osteotomy for symptomatic scaphoid malunion.

A prospective study aimed at assessment of the outcome of management of symptomatic scaphoid malunion (hump-back deformity). The work included 13 scaphoid malunions in 13 patients. All patients complained of weak painful hand grip and limitation of wrist function. All cases were subjected to a corrective opening wedge scaphoid osteotomy with insertion of a trapezoid-shaped tricortical iliac bone graft. At the final assessment, after a mean follow-up period of 42 months, the achieved results were rated excellent in seven cases, good in four and fair in two according to the scoring system used. Objectively, the mean range of wrist motion and hand grip strength improved from 48% and 47% pre-operatively to 82% and 79% at the final assessment. Radiological parameters including height to length ratio, lateral intrascaphoid angle and dorsal cortical angle were also effectively improved. The intra-operative corrected carpal alignment has almost been maintained at the final follow-up. The procedure did not have serious drawbacks such as non-union or avascular necrosis and perhaps might delay the development of degenerative arthritis of the wrist.

Adult↗