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A 26-year-old woman presented with radiologic signs of avascular necrosis of the trapezium bone. Treatment by bone excision and suspension arthroplasty gave an excellent clinical result. Pathology studies confirmed the diagnosis of avascular necrosis of the trapezium.
The luxation of the os trapezium without fracture - a very rare lesion - is reported. This is the first publication in the Hungarian literature of this sort. Proper diagnosis was established after the patient's admission. Covered reduction of the luxation was made, and the luxated bone was fixed by percutaneous wiring and plaster-bandage. The patient recovered without complications.
Due to the functional peculiarities of the thumb, fractures of the trapezium are of importance, though being rather rare. Difficulties are often encountered with radiological demonstration and anatomical correlation of findings in this area. The article gives an anatomical-radiological correlation and points out aspects of traumatology.
Carpal bone is an uncommon location for metastases, and diagnostic problems can occur when a solitary metastasis mimics acute arthritis or osteomyelitis clinically as well as radiologically.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Osteoarthritis (OA) is a progressive disease of the joints and can cause pain, reduced range of motion and strength, and ultimately loss of function at affected joints. Osteoarthritis often occurs at sites where biomechanical stress is acutely severe or moderate but habitual over the course of a lifetime. Skeletal remains from an Umm an-Nar tomb at Tell Abraq, United Arab Emirates (ca. 2300 BC), were recovered and represented over 300 individuals of all ages. The remains were disarticulated, commingled, and mostly fragmented. An analysis of 650 well-preserved adult metacarpal and carpal bones, from the tomb's western chamber, revealed that over 53% of the trapeziometacarpal joint facets showed signs of OA varying from mild to severe. The first and second metacarpals and trapezium bones were sided and evaluated for OA at the trapeziometacarpal joint articulations. Osteoarthritis was detected on 53% of the first metacarpals, 40% of the second metacarpals, and 57% of the trapezium bones. All specimens appeared enlarged, and the first metacarpals were assessed for sexual identification and robusticity. Eighty-five percent of the bones were probable males, and more than 80% of them had a robusticity index of 60 or higher. A strong correlation was found between OA, sex, and robusticity. High levels of OA and robusticity at the thumb suggest that the people of Tell Abraq were habitually involved in biomechanically challenging work with their hands.
In sixteen of twenty adult human cadaveric hands a muscle fascicle was isolated from the adductor pollicis muscle. It had osseous origins from the base of the first metacarpal bone and from the trapezium bone in eleven hands. These origins were connected by a fibrous arch, which was a soft tissue origin itself. In two of the sixteen hands, muscle fibers emerged from the palmar aspect of the first dorsal interosseous muscle near the radial artery. The findings can be explained by the ontogenesis of the human hand. The described muscle is neither a part of the oblique head of the adductor pollicis nor an equivalent to the three palmar interosseous muscles. In our dissections it was a constant muscle. Other studies have to show the exact function of the muscle. We postulate a stabilization of the carpometacarpal joint of the thumb.
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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.
An immunocompromised 29-year-old man presented with a Ralstonia pickettii osteomyelitis affecting the trapezium bone. The patient underwent two surgical debridement stages, including trapezectomy and long-term drainage. The type of the contaminant organism and the trapezium localization make this observation atypical.
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Although erosive silicone synovitis is an unusual complication of implant arthroplasty, its recognition is important. The authors describe three patients in whom this complication occurred after Silastic replacements of the carpal scaphoid and trapezium bones. Intercarpal arthrodesis is suggested as a form of stress shielding for the implants. Regular, long-term follow-up of patients with these Silastic implants is recommended.
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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.
Isolated scaphotrapeziotrapezoid osteoarthritis is rare but can cause weakness and wrist pain. We present the results of a pilot study of interposition arthoplasty with a scaphoid trapezium pyrocarbon implant (STPI) by an open and arthroscopic approach for this problem. We performed this procedure in 10 hands in eight patients, all women, with a mean age of 60.5 (range 51-70) years. The average follow-up was 19 (range 2-24) months. Pre-operative X-rays in all cases identified an isolated degenerative arthritis of the scaphotrapeziotrapezoid joint. Average DASH evaluation pre-operatively of 49 was reduced to 39. All of the patients had functional improvement and returned to daily activities after 3 months. The results of this pilot study suggest that the STPI may prove a useful compromise treatment for this problem.