Pdf evidence based surgical treatment of trapeziometacarpal. Many of the diagnoses have more than one protocol to choose from to appeal to all physicians. Because of its relative instability, this joint is a frequent site for osteoarthritis. Excellent surgical hemostasis can make much of intraoperative blood conservation moot. The surgery, called a trapeziectomy, involves removing a small bone one of eight which form the wrist called the trapezium. Long term results of surgical intervention for osteoarthritis. Dec 18, 2015 the purpose of this study was to introduce arthroscopic partial trapeziectomy and tendon interposition for the treatment of symptomatic thumb carpometacarpal arthritis of eaton stage ii or iii.
Arthrex internalbrace ligament augmentation repair. Other surgical procedures for osteoarthritis of the trapeziometacarpal joint include fusion 1, 4, 7, 12, 14, 15, 25, 27, 33, trapeziectomy combined with. For the early stages of arthritis options include a ligament reconstruction or a metacarpal extension osteotomy. We publish new techniques across the whole orthopaedic spectrum.
Nonsurgical management includes orthotics, thenar strengthening exercises, nsaids, steroid injections, and hyaluronic acid injections. Generally, several pain relief methods have been exhausted before surgery is suggested. Surgical treatment of primary trapeziometacarpal osteoarthritis by. Fcr tendon suture after trapeziectomy, a simpler technique, was applied. Jul 24, 2017 trapeziectomy with ligament reconstruction and tendon interposition versus a trapeziometacarpal prosthesis for the treatment of thumb basal joint osteoarthritis. Simple trapeziectomy was first described in 1949 by gervis and again in 1960 by murley but was abandoned due to decreased grip strength. Arthroplasty for trapezium excision and tendon interposition in rhizarthrosis cases. This is a very good book on diagnosing injuries and abnormalities in the anatomy and physiology of the hand and particularly the wrist, as well as repairing or replacing the parts thereof. Trapeziectomy associated with interposition of yarn from the. Please also read my page about thumb base arthritis. Physicians do not, however, tend to employ this surgical procedure as a primary measure. As with any surgical procedure there could be complications including.
Trapeziectomy with suspensionplasty patients with advanced disease or who fail nonsurgical treatment may be candidates for surgical reconstruction. We present the surgical techniquepartial trapeziectomy with capsular. Trapeziectomy with interpositional arthroplasty using acellu. Arthroscopicassisted suspensionplasty using the palmaris longus. A randondized, doubleblinded clinical trial benton e. A variety of surgical techniques are available that can successfully reduce or eliminate pain. This operation is usually performed under general anaesthetic, meaning you will not be awake during the procedure. Summary of proposed research basal joint osteoarthritis oa of the thumb is a common, debilitating disease that can have a.
Trapeziectomy mary obrien plastic and hand surgery. This operation is usually performed under general anaesthetic. Two types of graft were used, initially half of a flexor carpi radialis fcr then our surgical technique evolved towards the use of the palmaris longus. Specific complications of a trapeziectomy may include. It can also be used in acute and chronic ankle sprains. Several surgical options are available depending on the severity of the disease.
Suspension arthroplasty is a biologic arthroplasty procedure that is indicated in patients with eatonlittler stage ii to stage v thumb carpometacarpal joint arthritis. In this article, an alternative suspension technique, using 2 osseous tunnels through the first and second metacarpal and a flexor carpi radialis tendon strip, is described. Procedure 31 operative treatment of distal radius fractures. The technique received by each patient was dependent on which surgeon they were referred to. A total of 35 articles fulfilled the inclusion criteria. From august 2001 to april 2009, 23 patients with thumb carpometacarpal arthritis were treated using this technique. Trapeziectomy and lrti ligament reconstruction tendon interposition mr jeremy read. Trapeziectomy is not the only thumb surgery, but it is generally considered to be one of the easiest. This video highlights the technical aspects of trapeziectomy with suture anchor suspensionplasty. However, it is still controversial as to whether one surgical procedure is. A trapeziectomy can relieve the pain and so improve how your thumb works.
This joint is formed by the trapezium bone of the wrist and the first metacarpal bone of the thumb. An alternative suspension technique after trapeziectomy. Osteoarthritis of the first carpometacarpal joint is often treated by partial trapeziectomy and tendon interposition or suspension arthroplasty procedures. Gentle movement of your fingers will prevent them from becoming stiff. Partial trapeziectomy with capsular interposition arthroplasty ptci.
For advanced stages, only salvage procedures exist. Suturebutton suspensionplasty for the treatment of thumb. Learn the trapeziectomy with capsuloperiosteal flap interposition arthroplasty surgical technique with step by step instructions on orthoracle. Trapeziectomy with ligament reconstruction and tendon interp. The bone forms one of the carpal bones and can become affected by arthritis. In many patients we see with thumb pain and restricted motion, they have selfmanaged their thumb problems for as long as they could before pain and loss of mobility, and, especially grip strength and inability to sleep at. Cmc arthritis is treated surgically with one of several techniques. A trapeziectomy not only relieves the pain but also restores the use of the thumb and the hand in general. Surgical technique an overview sciencedirect topics.
To help reduce any swelling it is important to keep your hand raised above your heart using a sling or pillow. The surgical technique had to include total trapeziectomy associated with ligament reconstruction with tendon suspension andor interposition. Learn the trapeziectomy surgical technique with step by step instructions on orthoracle. The purpose of this study was to introduce arthroscopic partial trapeziectomy and tendon interposition for the treatment of symptomatic thumb carpometacarpal arthritis of eaton stage ii or iii.
Partial versus total trapeziectomy thumb arthroplasty. To prospectively evaluate the results from a series of patients who underwent surgical treatment for rhizarthrosis using the technique of trapezium resection associated with interposition of yarn from the long abductor tendon of the thumb. Trapeziectomy with ligament reconstruction and tendon interposition versus a trapeziometacarpal prosthesis for the treatment of thumb basal joint osteoarthritis. Short to mediumterm outcomes from a singlesurgeon experience. Trapeziectomy with suspensionplasty patients with advanced disease or who fail non surgical treatment may be candidates for surgical reconstruction. Pain score, range of motion, and pinch strength were clinically evaluated and compared. Arthroscopic partial trapeziectomy and tendon interposition. Fakhouri performing a trapeziectomy procedure youtube. The trapezium is a small bone in your wrist at the base of your thumb which is commonly affected by arthritis. The influence of evidence in the surgical treatment of. This surgical technique for the treatment of thumb tmc joint arthritis. Our elearning platform contains high resolution images and a certified cme of the trapeziectomy with capsuloperiosteal flap interposition arthroplasty surgical procedure. Ao surgery reference is a resource for the management of fractures, based on current clinical principles, practices and available evidence. Indications, contraindications, technical pearls, and potential pitfalls are discussed.
Mike hayton, hand surgeon from wrightington uk, performs his technique for a trapeziectomy and fcr weilby sling. Trapeziectomy with interpositional arthroplasty using repriza acellular dermal matrix is a novel technique to treat primary and secondary. Thumb cmc trapezial excision and suture suspension. The next chapter is dedicated to the surgical technique. Postoperative guidelines your splintdressing should remain on until your first postoperative visit which will be 814 days after surgery and will be on your. This is a surgical procedure to remove a small bone at the base of the thumb. According to the eaton classification, 1 thumb was grade ii, 81 were grade iii, and 18 were grade iv. The technique involves trapeziectomy and suspension of the first metacarpal bone using a hemiflexor carpi radialis tendon. Pain at the wrist and base of the hand is a common symptom of osteoarthritis. Trapeziectomy is considered a good surgical option to treat stage ii to iv of cmc oa of the thumb.
Original article prognostic factors for the recovery of. Trapeziectomy with capsuloperiosteal flap interposition. Arthrex trapeziectomy tool with handle, sterile ar891901s. Apr 22, 2018 trapeziectomy and lrti ligament reconstruction tendon interposition mr jeremy read. Trapeziectomy and intermetacarpal ligament reconstruction with the extensor carpi radialis longus for osteoarthritis of the trapeziometacarpal joint. Trapeziectomy and lrti ligament reconstruction tendon. Recently the trend has been towards simple trapeziectomy. Different types of scopes are used to look at the structures of the wrist, and various instruments are utilized to perform.
Surgical management of primary thumb carpometacarpal. A threestep technique to correctly identify the trapezium without the. Excision of the incorrect bone during trapeziectomy for basal joint arthritis of the. Suture suspension arthroplasty with trapeziectomy for thumb. Hand elevation is important to prevent swelling and stiffness of the fingers. Trapeziectomy for osteoarthritis claremont private hospital. You will have a bandage or plaster cast on your hand. Trapeziectomy for the treatment of trapeziometacarpal tm osteoarthritis oa disrupts the scaphotrapeziumtrapezoidal ligament complex and may be associated with carpal collapse in a subset of patients in the form of nondissociative dorsal intercalated segment instability disi. Surgical technique is the most important component of blood conservation in pediatric cardiac surgery.
This provides more space for the thumb to move so that the arthritic bone surfaces are not rubbing together causing pain. Your splintdressing should remain on until your first postoperative visit which will be 814 days after surgery and will be on your discharge paperwork. The most simple form out of the four variations is the trapeziectomy alone, also referred as the simple trapeziectomy. Infection of the surgical site wound unsightly scarring. Treatment of thumb basal joint arthritis with hematoma and distraction arthroplasty compared to lrti in a.
Orthoracle the online elearning orthopaedic atlas of. The same can be said of poor surgical hemostasis because surgical bleeding will persist until the cause is found and repaired. These have included simple trapeziectomy, arthrodesis and implant arthroplasty. Our elearning platform contains high resolution images and a certified cme of the trapeziectomy surgical procedure. One method of surgical treatment of this condition is excision. Trapeziectomy or total joint arthroplasty in primary thumb carpometacarpal. Kuhns et al described a technique of trapeziectomy with postoperative kwire immobilization of the cmc joint, known as.
Green berets ultralight bug out bag with gear recommendations duration. The radioclincial evaluation with a followup of at least 5years had to be performed by an independent. What is the technique for surgical treatment of thumb base arthritis trapeziectomy. This manual is in a weekbyweek format that is easy to use.
Partial trapeziectomy and soft tissue interposition. Various surgical techniques are available for the management of thumb carpometacarpal joint arthritis. Each protocol is based on the most current medical evidence and is uniformly outlined with indications, contraindications, recommended weekly therapy visits, and surgical outcome limitations. The longterm efficacy of this newer technique remains to be determined but the main benefit over the other techniques is the ability to begin early mobilization because this device is implanted and does not require any biologic healing prior to stabilization. Incision was made over the dorsal base of thumb extending toward the flexor carpi radialis at the wrist. Orthoracle is an independent, surgeon developed, owned and produced resource full of of practical information validated for both experienced surgeons as well as surgeons in training. A number of surgical procedures have been described for basal joint osteoarthritis, whereby simple excision was first reported in 1949. In many patients we see with thumb pain and restricted motion, they have selfmanaged their thumb problems for as long as they could before pain and loss of mobility, and, especially grip strength and inability to sleep at night makes selfmanagement difficult at best. Professionally taken photographs, detailing every step of the surgical technique from live. Numerous surgical techniques, including ligament reconstruction, partial or complete trapeziectomy, arthrodesis, and arthroplasty have been. When disease severity interferes with function and pain can not be controlled by less invasive. Procedure 43 trapeziectomy and abductor pollicis longus.
The arthrex mini tightrope cmc surgical technique duration. To investigate which surgical technique trapeziectomy, trapeziectomy with lrti, cmc arthrodesis, total. Lrti arthroplasty for surgical treatment of basal joint arthritis of the thumb. Thumb carpometacarpal joint arthritis is a common and debilitating disease that can be managed nonsurgically or surgically. The 8 most commonly used surgical procedures to treat trapeziometacarpal tmc joint. Thumb osteoarthritis and surgery alternatives caring medical. Partial trapeziectomy and soft tissue interposition request pdf. Trapeziometacarpal osteoarthritis, also known as osteoarthritis at the base of the thumb or as rhizarthrosis, is a reparitive joint disease affecting the first carpometacarpal joint cmc1. Preoperative and postoperative imaging studies are presented. Arthrex trapeziectomy tool with handle, sterile ar. Arthroplasty for trapezium excision and tendon interposition.
Postoperative rehabilitation following trapeziectomy and. We present thumb carpometacarpal cmc suture suspensionplasty surgical technique. Mar 04, 2020 trapeziectomy is not the only thumb surgery, but it is generally considered to be one of the easiest. Surgical management of basal joint arthritis of the thumb. Historical results and outcomes of suture buttonanchor suspensionplasty versus ligament reconstruction and tendon interposition trapeziectomies. Treatment of thumb basal joint arthritis with hematoma and.
Two weeks after surgery your plaster can be removed and replaced with a thermoplastic splint. Fakhouri performing a trapeziectomy procedure midamerica orthopaedics. The operation is usually performed as a daycase under regional anaesthetic arm numb andor general anaesthetic asleep. Trapeziectomy usually takes 6090 minutes to complete. Continued numbness or pain severe pain, stiffness and loss of use of your hand complex regional pain syndrome. Your hand will be placed in a bulky dressing which includes a plaster to protect the operation. During this procedure, the trapezium bone is removed without any further surgical adjustments. An alternative suspension technique after trapeziectomy for. The mean patient age at the time of surgery was 62.
Many of the other techniques available are considerably more involved and require a longer operative time as well as. The purpose of this paper is to provide a video detailing this technique for trapeziectomy for trapeziometacarpal joint osteoarthritis. When disease severity interferes with function and pain can not be controlled by less invasive alternatives, one option is removal of the affected bone. Trapeziectomy tool with handle, sterile ar891901s related pages. Cmc mini tightrope alternate two step passing technique. Thumb carpometacarpal joint suspension arthroplasty. A trapeziectomy is the removal of this bone and a small sponge space filler is put in its place. During the same operation, other surgical interventions could be performed on the hand. Sep 22, 2006 a number of surgical procedures have been described for basal joint osteoarthritis, whereby simple excision was first reported in 1949. The original burtonpellegrini technique used to treat trapeziometacarpal joint osteoarthritis suggests the use of half of the flexor carpi radialis fcr width to reconstruct the ligament and perform the tendon interposition arthroplasty. Both procedures are outlined in supplemental digital content 1 and illustrated in figure 1, respectively. Continued numbness or pain severe pain, stiffness and loss of use of your hand complex regional pain syndrome how soon will i recover. The trapeziectomy was always total after minimal resection of the base of the first metacarpal bone while taking care to excise all osteophytes.
In the subsequent section, the author provides a very detailed clinical and etiological description of the operated cases. Trapeziectomy with ligament reconstruction and tendon. In our study, unlike the original technique, we used the full thickness of the fcr and evaluated a sample of 100 thumbs 95 patients preoperatively and. Prognostic factors for the recovery of hand function. For surgical treatment of thumb carpometacarpal joint arthritis, current evidence suggests that simple trapeziectomy is as effective as and may be safer than trapeziectomy and ligament reconstruction with or without tendon interposition.
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