Slip abductor pollicis longus suspension tendinoplasty for management of trapezio-metacarpal joint osteoarthritis.

PURPOSE: Trapezio-metacarpal (TM) joint arthritis is a common cause of pain and functional disability of the hand. The ideal surgical procedure for TM joint osteoarthritis is still controversial. The aim of the current study is to assess the outcome of complete trapezial excision and abductor pollicis longus tendon interposition arthroplasty in the treatment of TM osteoarthritis. METHODS: Twenty patients (16 women and 4 men) were prospectively enrolled in the current study with average age of 51.5 years (36-64). All patients had complete trapezial excision and abductor pollicis longus tendon interposition arthroplasty with minimum follow-up of 24 months. RESULTS: At final follow-up there was significant improvement as regard pain, range of motion, and functional assessment scores. Pre-operative visual analogue scale (VAS) for pain improved from 6.2 (±1.54) to 1.1 (±0.97), and the average Quick DASH Score improved from 47.6 (±8.81) points pre-operatively to 13.6 (±5.46) points post-operatively. The mean pre-operative Buck-Gramcko score system improved from 21 (±6.2) points to 41.5 (±7). The average post-operative satisfaction score was 9.1(±2.1), with all the patients somewhat satisfied and recommending operation to other patients. CONCLUSIONS: The total trapeziectomy tendinoplasty with suspension and interposition using the abductor pollicis longus is a reliable procedure for the treatment of TMJ osteoarthritis, providing satisfactory functional results.

Distraction lengthening by callotasis of traumatically shortened bones of the hand.

BACKGROUND: Callotasis of the hand has several advantages: it is less invasive than other techniques as bone grafting is unnecessary, gradual distraction is possible, joint mobilization can be performed during treatment, and sensation is maintained. Disadvantages include longer period of treatment and perhaps the need for complicated and bulky instrumentation. METHODS: We reported results of the lengthening of eight traumatically shortened metacarpals or phalanges (in six patients). There were two men and four women, with a mean age of 17.5 years. There were one thumb and seven fingers. There were three proximal phalanges and five metacarpals. Unilateral external fixator was applied to all cases. Osteotomy was performed at the proximal metaphysis in three cases, middle diaphysis in two cases, and the distal metaphysis in three cases. Lengthening was begun after 10 days to 14 days at a rate of 0.25 mm two times or three times daily. We modified the rate of distraction according to the development of pain, sensory disturbance, and contracture of the digit during lengthening. In former cases, the rate was 0.25 mm three times daily. RESULTS: The proposed length was achieved in all digits and no bone graft was required. The mean length increase was 18.9 mm (53.5% of the original length of 35.25 mm). Age was positively correlated with the healing index and consolidation time as younger patients healed faster than older patients. Conversely, the faster the distraction rate, the slower were the healing index and consolidation time. There were few complications which did not affect the final results. We preferred metacarpal lengthening in cases with very short proximal phalangeal traumatic amputation stump (<1 cm). CONCLUSION: Distraction lengthening is a valid option with minor complications rate. LEVEL OF EVIDENCE: Therapeutic study, level V.