Partial trapeziectomy with ligament reconstruction--tendon interposition in thumb carpo-metacarpal osteoarthritis. A study of 112 cases.

INTRODUCTION: We have performed arthroligamentoplasty with partial trapeziectomy since 1987. We compare the results of this technique with those of arthroligamentoplasty with total trapeziectomy. MATERIAL AND METHODS: We reviewed 112 arthroligamentoplasties performed by the same surgeon, with a minimum follow-up of three years, comparing partial trapeziectomy (93 hands Eaton stage II-III of the disease and one with post-traumatic osteoarthritis), with total trapeziectomy (nine hands stage IV of the disease, eight hands requiring re-operation due to failure of total trapeziectomy and one with post-traumatic osteoarthritis). RESULTS: Pain: all the patients have improved. Slight pain at moderate effort persisted in three cases (17%) of total trapeziectomy and in 14 cases (15%) of partial trapeziectomy but only one of these required revision surgery with arthrodesis. Key-Pinch strength: partial trapeziectomy: strength averaged 93% of preoperative strength. In the 34 bilaterally affected cases, the operated hand had 110% of the strength of the non-operated contralateral hand. Total trapeziectomy: strength averaged 85% of preoperative values. In the seven bilateral affection cases, the operated hand had 105% of the strength of the non-operated contralateral hand. Range of motion: we did not register relevant differences. Radiology: in relation to preoperative period, we registered 18% reduction of the scapho-metacarpal space associated with partial trapeziectomy, and 29% in scapho-metacarpal space associated with total trapeziectomy. COMPLICATIONS: we have registered complications in 12 hands. CONCLUSION: Both techniques resulted in indistinguishable outcomes. Given the goal of preventing the impairment of a healthy joint and a very hazardous surgical alternative in case of failure, the indication for total trapeziectomy should be restricted to the presence of damage in the two major surfaces of the trapezium.

[Metastasis of an adenocarcinoma of the colon to the 1st metacarpal bone]. / Métastases d'un adénocarcinome du côlon au premier métacarpien.

The authors report a clinical case of metastasis to the first metacarpal arising from carcinoma of the colon, treated surgically four years previously. Clinical examination revealed painful swelling over the right thenar eminence. The diagnosis was established by radiology and needle biopsy. No treatment was administered and the patient died one month later. Metastases of the hand are uncommon and, according to the review of the international literature concerning bone metastases in the hand conducted by Kerin (1987), are usually secondary to lung, renal and breast cancers. Only a few cases have been described in the literature of bone metastases of the hand from carcinoma of the colon. The authors feel that some of these cases probably remain undiagnosed, as they are of secondary importance in view to the severity of the disease.

[Pseudoaneurysm of the common digital artery]. / Faux anévrysme de la arteria digitalis communis.

Palmar aneurysms are very rare. The authors report a case of pseudoaneurysm in an 18 year old waiter. The mechanism was puncture by a chip of porcelain. The diagnostic errors, clinical and pathological criteria are recalled and the literature concerning this problem is reviewed.