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Save the Trapezium in Thumb CMC Osteoarthritis
Jorge Luis Orbay, Md
The Hand Institute, Miami, FL

Introduction: Motion preserving reconstructive procedures commonly used for osteoarthritis of the trapezio-metacarpal joint involve excision of the trapezium and invariably result in a weak pinch. We present our clinical results with two new motion preserving procedures that do not require excision of the trapezium.

Methods: We performed a retrospective review of all the cases treated between November 1st 2011 and June 31st 2012 with these procedures. The indications were severe pain due to trapezio-metacarpal arthritis that did not respond to conservative treatment. Through a Wagner approach, a constant palmar trapezial osteophyte was removed (trapezioplasty), which allowed reduction of the joint subluxation. The underlying instability was corrected either with a 1st MC osteotomy or a hemiarthroplasty with a stabilized saddle surface. Temporary pinning of the TM joint and splinting for four weeks was used in the case of osteotomy and splinting alone for four weeks for the hemiarthroplasty. Useful thumb function was allowed after four weeks and pin removal and no further support was provided. During the last follow-up visit results were evaluated by assessing pain, ROM and pinch strength.

Results: Twenty-two osteotomy and thirteen hemiarthroplasty patients were followed for an average of 8 months (range: 6-13 months). There were 6 males and 28 females and one patient was lost to follow up. At final follow-up all patients were satisfied with their degree of pain relief; eighteen patients reported no pain, fourteen mild and two moderate pain. All patients could reach the flexion crease at the base of the small finger, adduct their thumb to the 2nd metacarpal, flatten their hand and oppose their thumb to the pulp of their extended index finger. Pinch strength averaged 12lbs. The twelve employed patients were able to return to work in an average period of six weeks. Complications were four neuropathies of a branch of the radial sensory nerve. There were no non-unions, loss of correction or subluxation.

Conclusion: Trapezial preserving procedures provide satisfactory pain relief, useful motion at the TM joint and a strong pinch. They are technically involved and attention to surgical detail is important.

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