Thumb basal joint arthritis in 2023.

Thumb carpometacarpal or basal joint arthritis is the second most common location for osteoarthritis in the hand. It mainly affects women over 50years of age. Basal joint arthritis causes pain, loss of strength during pinch grips, and eventually stiffness and progressive deformity of the thumb column. Conservative treatment must be implemented first. It aims to spare the joint by using standardized methods. It must be initiated as soon as pain starts, not once the deformity has settled in. There is broad agreement that surgery is indicated when pain relief is not achieved after at least 6months of conservative treatment. The available surgical techniques can be classified as joint-sparing (extra-articular) and joint-sacrificing (intra-articular). The former consists of trapeziometacarpal stabilizing ligament reconstruction, subtraction osteotomy of the first metacarpal and thumb carpometacarpal denervation. The latter consists of trapeziometacarpal fusion, trapeziectomy (and its variants) and implant arthroplasty. Except in very specific cases, trapeziectomy and trapeziometacarpal implant arthroplasty with a total joint prosthesis or an interposition implant are the two main surgical techniques for treating basal joint arthritis. After reviewing the pathophysiology and the diagnosis of thumb basal joint arthritis, we will provide an overview of the available treatment options, with emphasis on the accepted surgical strategies in 2023. LEVEL OF EVIDENCE: III.

Is increased trapezial slope a cause of early trapeziometacarpal osteoarthritis?

OBJECTIVES: Thumb carpometacarpal joint osteoarthritis is one of the most common forms of osteoarthritis in the hand. The underlying causes are multifactorial. We investigated whether increased trapezial slope could be a causal factor. MATERIAL AND METHODS: We measured trapezial slope and 1st metacarpal slope in 37 patients with early thumb carpometacarpal joint osteoarthritis and compared results with 41 patients without osteoarthritis, using computer-supported 3D-analysis based on CT scans. RESULTS: There was a significant intergroup difference in trapezial slope (111° in patients with osteoarthritis, and 107° in patients without) and in 1st metacarpal slope (17° versus 14°). CONCLUSION: Steeper trapezial slope seemed to be a risk factor for thumb carpometacarpal joint osteoarthritis. Therefore, correction of trapezial slope by trapezium osteotomy could be a valuable surgical approach in early thumb carpometacarpal joint osteoarthritis.

The floating first metacarpal: A rare case.

A floating metacarpal is defined as the simultaneous dislocation of the metacarpophalangeal (MCP) and carpometacarpal (CMC) joints. Metacarpal dislocations are rare, and floating metacarpals with double dislocations are extremely rare. In this article, we present a very rare case of floating metacarpal in which the first MCP and CMC dislocations were found simultaneously and successfully treated with closed reduction, open reduction, and Kirschner wire fixation methods.

Isolated Second and Third Carpometacarpal Joint Injuries: A Report of 2 Cases.

CASES: Two high-level male athletes with isolated second and third carpometacarpal (2, 3 CMC) joint injuries presented with mid-dorsal wrist pain, decreased grip strength, and painful wrist motion. Both reported inciting trauma-1 acutely and the other months after the original injury. Both exhibited 2, 3 CMC joint tenderness and positive provocative testing on exam. Advanced imaging confirmed 2, 3 CMC joint injuries. Both patients returned to preinjury level of play 3 months after diagnosis and surgical treatment. CONCLUSION: 2, 3 CMC joint injuries should be considered when evaluating radial/mid-dorsal wrist pain. Surgical treatments range from pin stabilization to fusion depending on chronicity and associated degenerative joint changes.

Subluxation of the first carpometacarpal joint and age are important factors in reduced hand strength in patients with hand osteoarthritis.

OBJECTIVE: To investigate the determinants of hand strength in patients with hand osteoarthritis (OA). METHOD: Pinch and cylinder grip strength were measured in 527 patients with hand OA diagnosed by their treating rheumatologist from the Hand OSTeoArthritis in Secondary care (HOSTAS) study. Radiographs of hands (22 joints) were scored 0-3 (scaphotrapeziotrapezoid and first interphalangeal joints 0-1) on osteophytes and joint space narrowing following the Osteoarthritis Research Society International atlas. The first carpometacarpal joint (CMC1) was scored 0-1 for subluxation. Pain was assessed with the Australian/Canadian Hand Osteoarthritis Index pain subscale, and health-related quality of life with the Short Form-36. Regression analysis served to investigate associations of hand strength with patient, disease, and radiographic features. RESULTS: Hand strength was negatively associated with female sex, age, and pain. Reduced hand strength was associated with reduced quality of life, although less after adjusting for pain. Radiographic features of hand OA were associated with reduced grip strength when solely adjusted for sex and body mass index, but only CMC1 subluxation in the dominant hand remained significantly associated with pinch grip adjusted additionally for age (-0.511 kg, 95% confidence interval -0.975; -0.046). Mediation analysis showed low and not significant percentages of mediation of hand OA in the association between age and grip strength. CONCLUSIONS: Subluxation of CMC1 is associated with reduced grip strength, whereas associations with other radiographic features seem to be confounded by age. In the relationship between age and hand strength, radiographic hand OA severity is not an important mediator.

Bennett fracture combined with hamate fracture: carpometacarpal joint 'diagonal' fracture and dislocation: a case report.

BACKGROUND: Multiple carpometacarpal fractures and dislocations are rare. This case report describes a novel multiple carpometacarpal injury, namely, 'diagonal' carpometacarpal joint fracture and dislocation. CASE PRESENTATION: A 39-year-old male general worker sustained a compression injury to his right hand in the dorsiflexion position. Radiography indicated a Bennett fracture, hamate fracture, and fracture at the base of the second metacarpal. Subsequent computed tomography and intraoperative examination confirmed an injury to the first to fourth carpometacarpal joint along a diagonal line. The normal anatomy of the patient's hand was successfully restored via open reduction combined with Kirschner wire and steel plate fixation. CONCLUSION: Our findings highlight the importance of taking the injury mechanism into account to avoid a missed diagnosis and to choose the best treatment approach. This is the first case of 'diagonal' carpometacarpal joint fracture and dislocation to be reported in the literature.

Retrospective interobserver agreement on diagnoses of 4th and 5th carpometacarpal fracture-dislocation and hamate fracture in plain X-ray - Is CT essential after ulnar carpometacarpal pain?

OBJECTIVE: To determine interobserver agreement and reliability of different radiological parameters in the assessment of fracture-dislocation of the 4th and 5th carpometacarpal joints (FD CMC 4-5) and associated hamate fracture on radiographs. MATERIALS AND METHODS: A retrospective, consecutive case series of 53 patients diagnosed with FD CMC 4-5. Emergency room diagnostic radiology images were reviewed by four independent observers. The reviews included assessment of radiological patterns and parameters in relation to CMC fracture-dislocations and associated injuries previously described in the literature, to analyze their diagnostic power (specificity and sensitivity) and reproducibility (interobserver reliability). RESULTS: Among 53 patients, mean age 35.3 years, dislocation of the 5th CMC joint was present in 32/53 (60%) of patients, mostly (11/32 [34%]) associated with 4th CMC dislocation and base of 4th and 5th metacarpal fracture. The most common presentation of hamate fracture, in 4/18 (22%), was associated with combined 4th and 5th CMC dislocation and base of metacarpal fracture. Computed tomography (CT) was performed in 23 patients. Performing CT scan was significantly associated with hamate fracture diagnosis (p < 0.001). Interobserver agreement was slight (0-0.641) for most of the parameters and diagnoses. Sensitivity ranged from 0 to 0.61. Overall, the described parameters had low sensitivity. CONCLUSION: Radiological parameters described for assessment of fracture-dislocation of the 4th and 5th CMC joints and associated hamate fracture have a slight interobserver agreement index in plain X-ray and low sensitivity for diagnostic assessment. These results suggest the need for emergency medicine diagnostic protocols that include CT scan for such injuries. GOV IDENTIFIER: NCT04668794.

Relationship between trapeziometacarpal joint morphological parameters and joint contact pressure: a possible factor of osteoarthritis development.

The trapeziometacarpal (TMC) joint is the one of the hand joints that is most affected by osteoarthritis (OA). The objective of this study was to determine if specific morphological parameters could be related to the amount of pressure endured by the joint which is one of the factors contributing to the development of this pathology. We developed 15 individualized 3D computer aided design (CAD) models of the TMC joint, each generated from the CT scan of a different participant. For each participant, we measured several crucial morphological parameters: the width and length of the trapezium bone and dorso-volar and ulno-radial curvature, of the trapezium and the metacarpal bone. Each CAD model was converted into a finite element model, of both bones and the cartilage located in between. The joint forces applied during pinch grip and power grip tasks were then applied in order to estimate the contact pressures on joint cartilage for each model. Correlations between joint contact pressures and morphology of the trapezium and the metacarpal bone were then analysed. Important variations of TMC joint pressures were observed. For both pinch and power grip tasks, the strongest correlation with joint contact pressure was with the dorso-volar curvature of the trapezium bone. Our findings indicate that dorso-volar curvature of the trapezium bone has a significant impact on mechanical loadings on the TMC joint. This contributes to understanding the prevalence of OA in certain patients.

Dorsal Subluxation of the First Metacarpal During Thumb Flexion is an Indicator of Carpometacarpal Osteoarthritis Progression.

BACKGROUND: Measurable changes in patients with progression of thumb carpometacarpal (CMC) osteoarthritis (OA) include joint space narrowing, osteophyte formation, subluxation, and adjacent-tissue changes. Subluxation, an indication of mechanical instability, is postulated as an early biomechanical indicator of progressing CMC OA. Various radiographic views and hand postures have been proposed to best assess CMC subluxation, but 3D measurements derived from CT images serve as the optimal metric. However, we do not know which thumb pose yields subluxation that most indicates OA progression. QUESTIONS/PURPOSES: Using osteophyte volume as a quantitative measure of OA progression, we asked: (1) Does dorsal subluxation vary by thumb pose, time, and disease severity in patients with thumb CMC OA? (2) In which thumb pose(s) does dorsal subluxation most differentiate patients with stable CMC OA from those with progressing CMC OA? (3) In those poses, what values of dorsal subluxation indicate a high likelihood of CMC OA progression? METHODS: Between 2011 and 2014, 743 patients were seen at our institutions for trapeziometacarpal pain. We considered individuals who were between the ages of 45 and 75 years, had tenderness to palpation or a positive grind test result, and had modified Eaton Stage 0 or 1 radiographic thumb CMC OA as potentially eligible for enrollment. Based on these criteria, 109 patients were eligible. Of the eligible patients, 19 were excluded because of a lack of interest in study participation, and another four were lost before the minimum study follow-up or had incomplete datasets, leaving 86 (43 female patients with a mean age of 53 ± 6 years and 43 male patients with a mean age of 60 ± 7 years) patients for analysis. Twenty-five asymptomatic participants (controls) aged 45 to 75 years were also prospectively recruited to participate in this study. Inclusion criteria for controls included an absence of thumb pain and no evidence of CMC OA during clinical examination. Of the 25 recruited controls, three were lost to follow-up, leaving 22 for analysis (13 female patients with a mean age of 55 ± 7 years and nine male patients with a mean age of 58 ± 9 years). Over the 6-year study period, CT images were acquired of patients and controls in 11 thumb poses: neutral, adduction, abduction, flexion, extension, grasp, jar, pinch, grasp loaded, jar loaded, and pinch loaded. CT images were acquired at enrollment (Year 0) and Years 1.5, 3, 4.5, and 6 for patients and at Years 0 and 6 for controls. From the CT images, bone models of the first metacarpal (MC1) and trapezium were segmented, and coordinate systems were calculated from their CMC articular surfaces. The volar-dorsal location of the MC1 relative to the trapezium was computed and normalized for bone size. Patients were categorized into stable OA and progressing OA subgroups based on trapezial osteophyte volume. MC1 volar-dorsal location was analyzed by thumb pose, time, and disease severity using linear mixed-effects models. Data are reported as the mean and 95% confidence interval. Differences in volar-dorsal location at enrollment and rate of migration during the study were analyzed for each thumb pose by group (control, stable OA, and progressing OA). A receiver operating characteristic curve analysis of MC1 location was used to identify thumb poses that differentiated patients whose OA was stable from those whose OA was progressing. The Youden J statistic was used to determine optimized cutoff values of subluxation from those poses to be tested as indicators of OA progression. Sensitivity, specificity, negative predictive values, and positive predictive values were calculated to assess the performance of pose-specific cutoff values of MC1 locations as indicators of progressing OA. RESULTS: In flexion, the MC1 locations were volar to the joint center in patients with stable OA (mean -6.2% [95% CI -8.8% to -3.6%]) and controls (mean -6.1% [95% CI -8.9% to -3.2%]), while patients with progressing OA exhibited dorsal subluxation (mean 5.0% [95% CI 1.3% to 8.6%]; p < 0.001). The pose associated with the most rapid MC1 dorsal subluxation in the progressing OA group was thumb flexion (mean 3.2% [95% CI 2.5% to 3.9%] increase per year). In contrast, the MC1 migrated dorsally much slower in the stable OA group (p < 0.001), at only a mean of 0.1% (95% CI -0.4% to 0.6%) per year. A cutoff value of 1.5% for the volar MC1 position during flexion at enrollment (C-statistic: 0.70) was a moderate indicator of OA progression, with a high positive predictive value (0.80) but low negative predictive value (0.54). Positive and negative predictive values of subluxation rate in flexion (2.1% per year) were high (0.81 and 0.81, respectively). The metric that most indicated a high likelihood of OA progression (sensitivity 0.96, negative predictive value 0.89) was a dual cutoff that combined the subluxation rate in flexion (2.1% per year) with that of loaded pinch (1.2% per year). CONCLUSION: In the thumb flexion pose, only the progressing OA group exhibited MC1 dorsal subluxation. The MC1 location cutoff value for progression in flexion was 1.5% volar to the trapezium , which suggests that dorsal subluxation of any amount in this pose indicates a high likelihood of thumb CMC OA progression. However, volar MC1 location in flexion alone was not sufficient to rule out progression. The availability of longitudinal data improved our ability to identify patients whose disease will likely remain stable. In patients whose MC1 location during flexion changed < 2.1% per year and whose MC1 location during pinch loading changed < 1.2% per year, the confidence that their disease would remain stable throughout the 6-year study period was very high. These cutoff rates were a lower limit, and any patients whose dorsal subluxation advanced faster than 2% to 1% per year in their respective hand poses, were highly likely to experience progressive disease. CLINICAL RELEVANCE: Our findings suggest that in patients with early signs of CMC OA, nonoperative interventions aimed to reduce further dorsal subluxation or operative treatments that spare the trapezium and limit subluxation may be effective. It remains to be determined whether our subluxation metrics can be rigorously computed from more widely available technologies, such as plain radiography or ultrasound.

Long-term follow-up of patients treated with pyrocarbon disc implant for thumb carpometacarpal osteoarthritis: the effect of disc position on outcomes measures.

Pyrocarbon disc interposition arthroplasty is an effective treatment for thumb base osteoarthritis. However, as with all implant techniques, the disc can (sub)luxate over time. The relationship between disc position, the experienced pain, and the necessity for revision surgery is not known. This study evaluated the effect of radiographic pyrocarbon disc position on the Michigan Hand Questionnaire (MHQ) outcome measurement. In addition, the correlation between disc position and other factors, including pain intensity, thumb strength, and occupation, was assessed. In this retrospective study, we included 136 patients (161 thumbs) with a mean follow-up of 6.7 years (range 3.3-11). Radiographs were scored on disc position and classified as 'well aligned' (Grade 1) up to 'luxated' (Grade 4). A database used for outcome measures included MHQ scores, pain intensity, satisfaction, thumb strength, range of motion, occupation, and hand dominance. In bivariate analyses, we assessed any association between disc position and outcome measurements. Eighty of the 136 implants (59%) were well-positioned (not displaced), 41% were (slightly) displaced (grade 2-3). No relationship existed between the degree of disc displacement and MHQ scores. Manual labor occupation was the only factor that correlated with more severe disc displacement. We could not detect any association between disc position and other outcome variables including pain intensity, thumb strength, or hand dominance. In conclusion, our study suggests that radiographic disc displacement has little clinical consequences. Future studies must assess if there is a causality between heavy mechanical stress to the CMC1 joint and luxation of the pyrocarbon disc over time.Level of evidence: IV Therapeutic-Retrospective case series.

Prognostic factors and clinical features in metacarpophalangeal joint hyperextension after ligament reconstruction with trapeziectomy: A retrospective cohort study.

BACKGROUND: Management of metacarpophalangeal (MCP) hyperextension deformity in thumb carpometacarpal (CMC) joint arthritis is challenging. It remains unclear how the preoperative MCP joint angle affects the outcomes. The present study aimed to clarify the associations between postoperative MCP hyperextension deformity and outcomes, and to determine the preoperative MCP joint angle that can predict poor outcomes. METHODS: We investigated the functional outcomes of patients who underwent surgery for CMC arthritis at two institutions from 2016 to 2020. All patients received a modified Thompson technique, ligament reconstruction suspension arthroplasty, and had no additional treatment for MCP hyperextension. The patients were divided into three groups according to their postoperative MCP joint angles: Group A, <10°; Group B, 10°-20°; Group C, >20°. Evaluations included preoperative and postoperative VAS, Quick DASH, range of motion (ROM), grip power, pinch strength, first web space angle, and postoperative trapezial space ratio (TSR). RESULTS: Overall, 66 eligible patients (72 thumbs) were identified and received follow-up for a mean of 25.2 months. The 72 thumbs were assigned to Group A (n = 38), Group B (n = 16), and Group C (n = 18). Group C had significantly lower preoperative MCP joint angle and postoperative grip power, pinch strength, and TSR compared with the Group A (P < 0.05). However, there were no significant differences in VAS, Quick DASH, ROM, and first web space angle (P > 0.05). The preoperative risk factor for highly residual MCP hyperextension was preoperative MCP joint angle (OR = 1.078; P = 0.001), with a cut-off value of 21.5° (AUC = 0.79; sensitivity = 0.813; specificity = 0.821). CONCLUSIONS: Postoperative MCP hyperextension of >20° after ligament reconstruction with trapeziectomy has adverse effects on functional outcomes. In cases with preoperative MCP joint angle of >21.5°, additional treatment for MCP hyperextension should be considered.

Suspension arthroplasty using the palmaris longus tendon with a suture button for thumb trapeziometacarpal arthritis: a retrospective observational study.

BACKGROUND: This study was performed to assess the clinical and radiographic results at a minimum of 2 years after ligament reconstruction suspension arthroplasty (LRSA) that comprised full trapeziectomy and suspensionplasty using the palmaris longus tendon and the Mini TightRope (Arthrex, Naples, FL) for advanced thumb carpometacarpal arthritis. METHODS: We clinically and radiographically evaluated 26 thumbs in 26 patients who had undergone LRSA at least 2 years previously. The mean follow-up period was 35.9 months. We evaluated the subjective clinical outcomes (visual analogue scale and Quick Disabilities of the Arm, Shoulder, and Hand scores) and objective clinical outcomes (range of motion, pinch strength, grip strength, and trapezial space height ratio). RESULTS: At the final follow-up evaluation, the mean visual analogue scale score was 11.1 (standard deviation (SD) 13.4) and the mean Quick Disabilities of the Arm, Shoulder, and Hand questionnaire score was 9.39 (SD 10.1). The mean palmar and radial abduction were 62.3° (SD 11.8°) and 63.8° (SD 9.09°), respectively. The mean key pinch and grip strength were 3.92 (SD 1.07) kg and 19.7 (SD 7.77) kg, respectively. The mean trapezial space ratio was 0.21 (SD 0.10). The subjective clinical outcomes, range of motion, and pinch strength were significantly improved compared with preoperatively. CONCLUSIONS: LRSA for advanced-stage thumb carpometacarpal osteoarthritis relieves pain, improves range of motion and strength, and obtains favourable subjective patient-reported clinical outcomes.

Carpometacarpal Joint Dislocations as a Rare Cause of Hand Pain.

Carpometacarpal joint dislocations represent not more than 1% of all hand injuries due to stable joint structures and high-energy trauma mechanism. Unfortunately, there are many missed cases suffering from ongoing pain and loss of function because of difficulty in diagnosis. Here we present a case of a healthy 42-year male who presented to the emergency department with hand pain after a punch injury. On physical examination, painful swelling at the dorsal side of his right hand was noted. His radiographic images showed dorsal dislocation of fourth and fifth carpometacarpal joints, and the dislocations were reduced to the anatomical position by the emergency physician without any complication. In the case of carpometacarpal joint fracture or dislocations, early diagnosis and reduction are the most critical steps to avoid severe morbidity, and it is only possible with careful evaluation of physical and radiological findings. In conclusion, as seen in our case, emergency physicians should remain vigilant in the diagnosis and treatment of rare traumatic injuries. Key Words: Carpometacarpal joints, Dislocation, Hand injury, Pain.

In vivo quantification of the 3D kinematics and coupling of the thumb base joints.

Full thumb mobility is required to execute tasks of daily living and results from the combined motions of the thumb joints. In this study, we focus on the coupling between the proximal joints of the thumb, the radioscaphoid (RS), scaphotrapezial (ST) and trapeziometacarpal (TMC) joints. We quantified the 3D kinematics of these joints during maximal thumb extension and abduction in a group of healthy volunteers using an image-based technique. Semi-dynamic CT scans of the dominant hand of 36 healthy subjects with the thumb in different standardized positions were used. The maximal range of motion of each joint in the different planes was calculated using a markerless bone registration method. Inter-joint coupling was assessed by performing a regression analysis between the range of motion of the joints during both thumb movements. Strong inter-joint coupling was found between the RS and ST joints during thumb extension and abduction, whereas coupling between the other joints was moderate to weak. This study provides valuable information on the in vivo 3D kinematics of the RS, ST and TMC joints during thumb movement. This can be used as input for modeling studies, where the coupling between the joints can decrease the degrees of freedom of the model. Moreover, these baseline data of a healthy cohort can be used for comparison with the kinematics of patients with TMC osteoarthritis or other pathologies and aid our understanding of motion deficits resulting from these joint disorders.

Knotless Suture Anchor Suspensionplasty for Basal Joint Arthritis A Prospective Case Series with Short-Term Outcomes.

BACKGROUND: The mainstay of surgical treatment for advanced basal joint arthritis is arthroplasty. Many differ- ent techniques of basal joint arthroplasty exist, but none has been determined to be superior to the others, and most methods used to maintain the post-trapeziectomy space require postoperative immobilization or pin fixation. In this article, we describe a knotless suture anchor suspen- sionplasty (KSAS) technique and present a prospective case series with short-term outcomes. The KSAS technique utilizes a suspension construct to maintain the post-trapeziectomy space, allowing for early mobilization without the need for pin fixation or casting. METHODS: Twenty-five patients underwent trapeziectomy with KSAS. Visual analog scale (VAS) for pain scores and Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) scores were recorded preoperatively and at multiple post- operative points. Grip and pinch strengths were recorded. Maintenance of the post-trapeziectomy space and subsidence were determined by comparing preoperative and postopera- tive radiographs. RESULTS: VAS pain scores were significantly reduced from baseline at all postoperative time points with a reduction from 6.54 to 1.47 at 20 to 24 weeks (p < 0.001). qDASH scores were also significantly decreased from baseline at all time points except for 1 week postoperatively with a re- duction from 57.71 to 12.27 at 20 to 24 weeks (p < 0.001). Grip strength improved from 80.43% compared to the non- operative side preoperatively to 90.36% at 6 months status post KSAS (p < 0.05). Radiographically, subsidence was 35.11% at final follow-up. CONCLUSIONS: Our data suggest that KSAS is a safe, effective, and reproducible basal joint arthroplasty tech- nique that allows for early mobilization while sufficiently maintaining the post-trapeziectomy space enough to prevent impingement of the first metacarpal on the scaphoid. Al- though there are limitations to this prospective case series, the data presented here warrant long-term outcome studies utilizing this technique.

Physical Examination and Radiographic Staging of Thumb Carpometacarpal Arthritis.

This article reviews the key components of a complete history and physical examination for a patient presenting with thumb pain. The history should include the location and severity of pain, alleviating and exacerbating factors, and impact of disability. Physical examination consists of joint palpation; assessment for laxity or stiffness; inspection for swelling, subluxation, or deformity; and provocative maneuvers. Further workup includes plain radiographs with possible dedicated thumb views. Last, we review the Eaton-Littler classification system, a commonly used radiographic grading system, and some of its limitations.

Complete Occlusion of Radial and Ulnar Arteries Following Hand Crush Injury with Multiple Carpometacarpal Joint Fracture-Dislocations.

Multiple dorsal fracture-dislocations of the carpometacarpal joints (CMCJ) occur from very high-energy trauma and are often associated with soft tissue injury or ischaemia. We report a 54-year-old male manual worker and a smoker who presented to the emergency room with history of compression of his right hand in a press machine. Radiographs showed dorsal fracture-dislocations of the scapho-trapezio-trapezoidal and third to fifth CMCJ's. Despite emergent Guyon canal and carpal tunnel release and closed reduction and pinning, skin pallor persisted in all digits. Brachial angiography revealed total occlusion of the radial and ulnar arteries and loss of the palmar arch at the level of the fracture. Heparin and Alprostadil were injected directly. On follow-up angiography three weeks later, the vessels were still occluded and collaterals provided digital circulation. Although digital sensations recovered, cold intolerance and stiffness resulted in a poor functional outcome. Level of Evidence: Level V (Therapeutic).

Dorsal Trans-Scaphoid Perilunate Fracture-Dislocation in Association with Dorsal Dislocation of the Thumb Carpometacarpal Joint: A Rare Injury Pattern.

We report a dorsal trans-scaphoid perilunate fracture-dislocation associated with dorsal dislocation of the thumb carpometacarpal joint in a 25-year-old man. This is a rare injury and we discuss a possible mechanism for the injury. Level of Evidence: Level V (Therapeutic).

Arthroscopic Partial Trapeziectomy for Thumb Carpometacarpal Joint Osteoarthritis: 5-Year Follow-up.

Osteoarthritis of the thumb carpometacarpal (CMC) joint is the most common type of arthritis of the hand. The goal of the study was to evaluate clinical results and radiographic changes after arthroscopic partial trapeziectomy combined with ligament shrinkage and K-wire fixation to treat thumb CMC joint arthritis. From February 2013 to March 2014, 24 patients with thumb CMC joint arthritis received this arthroscopic procedure. We investigated the preoperative and postoperative Modified Mayo Wrist Score (MMWS); Disabilities of the Arm, Shoulder and Hand (DASH) score; radiographic changes; and associated complications. Sixteen patients completed 5 years of functional score and radiographic follow-up. Comparison of preoperative and postoperative MMWS and DASH scores showed significant improvement after the arthroscopic procedure. Pre-operative and postoperative evaluation of radiographic changes showed significant differences in the CMC joint distance, scaphoid-metacarpal distance, trapezium-metacarpal distance, and metacarpal prominence distance. This arthroscopic procedure is an effective and less invasive method for the treatment of CMC joint arthritis. This procedure can improve clinical function, preserve the mechanical height of the trapezium, and increase CMC joint space. We report our surgical technique and some pitfalls that required attention during the arthroscopic procedure. [Orthopedics. 2022;45(3):e140-e147.].