Search

International audience; Thumb metacarpophalangeal instability is commonly found in conjunction with trapeziometacarpal osteoarthritis. If not corrected, it can have detrimental effects on the outcome. The authors describe the two types of metacarpophalangeal deformities - hyperextension and valgus - their pathophysiology and the surgical repair techniques available to surgeons. An algorithm for treating this instability is presented.

Thumb carpometacarpal osteoarthritis affects many post-menopausal women. If medical treatment fails, the most common options are trapeziectomy and trapezio-metacarpal arthroplasty. The purpose of this study was to evaluate the survival rate of trapezio-metacarpal prostheses in surgical treatment of thumb carpometacarpal osteoarthritis, and to highlight potential risk factors of unfavorable outcome. We performed a retrospective study involving 294 trapezio-metacarpal prostheses in 245 patients, who underwent surgery between 2001 and 2016. Clinical assessment was performed by self-questionnaire including pain, satisfaction, recovery time, QuickDASH Score, and opposition according to Kapandji score. Thumb X-rays were used to evaluate implant loosening sign, periprosthetic remodeling, and arthrosis of over and underlying joints. Implants survival rate at the final follow-up of 17.3 years was 90.8 % (95 % CI [85.8–96.1]). Median pain was 1 on 10 on VAS scale (0–8). Median QuickDASH Score was 20 (0–82), median opposition according to Kapandji was 9 on 10 (3–10). Median return to work time was 2 months (1–12). We identified 7.8 % of major complications, including 3.4 % of dislocations, 3.1 % of implants loosening, and 1 % of fractures. All dislocations involved surgical revision. Only few publications show results with more than 100 trapezio-metacarpal prostheses. Our results are consistent with existing studies. Trapeziectomy represents currently the gold standard in surgical treatment of thumb carpometacarpal osteoarthritis. Long-term superiority has not been proven in recent meta-analysis. Two recent studies found superiority of arthroplasty at short term concerning pain, strength, mobility, satisfaction, and recovery time, with similar complication rates. Trapezio-metacarpal arthroplasty is a long-term reliable solution for surgical treatment of thumb carpometacarpal osteoarthritis, with a limited complication rate.

Trapezio-metacarpal (TM) prosthesis has show good results in the surgical treatment of rhizarthrosis. One of the main causes of failure is tapezium loosening. For the revision of a failed prosthesis, trapeziectomy can be a solution. Another possibility is to implant a cup into the distal extremity of the scaphoid, thus performing a scapho-metacarpal arthroplasty. This scapho-metacarpal arthroplasty can also be used in the event of failed trapeziectomies. The purpose of this study is to present preliminary results of 10 cases of scapho-metacarpal prosthesis. A retrospective multicentric study was carried out on 10 patients, 9 women and 1 man, with an average age of 74 years, who underwent surgery between 2009 and 2015. Four had revision surgery after trapezio-metacarpal arthroplasty, 5 after trapziectomy, one hade a revision of silicon implant. The prosthesis that has been used was MAIA ® Prosthesis, with long or extra-long neck. Assessment covered – Visual Analog Pain Scale, mobility, strength, Quick-DASH, satisfaction score, preoperative, postoperative and the most recent X-rays (Kapandji incidences). Results Nine patients were assessed with a mean follow-up of 34 months, 1 patient was lost during the follow-up. Out of these 9 patients, we had 1 who failed, due to an early scaphoid cup loosening. There are 4 out of 9 patients who underwent surgery on their dominant hand. Four patient said they were very satisfied with the outcome, 4 were satisfied and 1 was not very satisfied. The average pain score was 1.2/10 and the average Quick-DASH was 38.5. The mean mobility of the carpometacarpal joint was – 48° in abduction, 40° in antepulsion, opposition according to Kapandji was 8.6, retropulsion was 1.9. Tumb strength measurements were 3 kg for key pinch, and 13.6 kg for grip strength. Radiographic assessment showed only one scaphoid cup loosening, and measurement of the length of the thumb column showed a shortening of 0.2 cm after surgery. Other surgical procedures has shown good results for revision of failed prosthesis such as secondary trapeziectomy, but only with short follow-up. Surgical procedures for failed trapeziectomy are very limited. Scapho-metacarpal arthroplasty is a reliable medium-term solution for revision of the loosening of a trapezio-metacarpal prosthesis with trapezium damage, as well as for failed trapeziectomy.

Les fractures articulaires du radius distal peuvent s’accompagner de refends dans la fossette lunarienne conduisant a la separation de fragments anteromedial et posteromedial. Si l’osteosynthese par plaque anterieure verrouillee a fait la preuve de son efficacite dans les fractures du radius distal avec fragment anteromedial, la synthese specifique du fragment posteromedial (FPM), et les consequences d’une reduction insuffisante ont ete peu evaluees. L’objectif etait d’evaluer du point de vue tomodensitometrique la qualite de la reduction et de la fixation des fractures articulaires du radius distal avec FPM osteosynthesees par plaque anterieure verrouillee et leur correlation clinique. Dans une etude monocentrique retrospective, les criteres d’inclusion etaient : fracture articulaire du radius distal avec FPM confirme par scanner preoperatoire, osteosynthese par plaque anterieure verrouillee, sans ablation du materiel. La tenue du FPM par les vis de la plaque et la reduction du fragment par mesure des marches d’escalier articulaires etaient evaluees sur scanner apres consolidation. Les patients etaient separes en 4 groupes : FPM fixe et reduit, fixe et non reduit, non fixe reduit, non fixe non reduit. L’evaluation clinique au dernier recul comportait : mesures des amplitudes articulaires, de la force, de la douleur, scores fonctionnels Quick-DASH et Mayo Wrist. Une arthrose post-traumatique etait recherchee sur scanner. Dix patients repondaient a tous les criteres d’inclusion, avec un recul moyen de 18 mois (5–41). Les amplitudes articulaires dans les groupes de patients avec FPM reduit (fixe ou non), etaient superieures a celles des groupes avec FPM non reduit (90 % versus 61 % des amplitudes controlaterales, non significatif). Les scores fonctionnels etaient meilleurs en cas de fragment reduit : score de Quick DASH de 17,3 dans les groupes fragment reduit versus 52,5 (p = 0,083), score de Mayo-Wrist de 85,0 versus 41,7 (p = 0,080). Les FPM reduits et fixes sont caracterises par des vis prenant le fragment et atteignant la corticale posterieure. Des signes d’arthrose n’etaient presents que dans les groupes FPM non reduit, au niveau radiocarpien (p = 0,01), et radio-ulnaire distal (p = 0,32). Apres reduction, la tenue du FPM necessite une vis specifique atteignant sa corticale posterieure. Ce type de fracture necessite une planification par scanner preoperatoire et une analyse precise peroperatoire. L’existence d’un FPM necessite une osteosynthese specifique au risque d’evolution vers une arthrose radiocarpienne et radio-ulnaire distale.