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.

Hypothenar hammer syndrome: outcomes after ulnar artery reconstruction with autologous vein graft.

The most common surgical procedure for the treatment of hypothenar hammer syndrome (HHS) is resection of the pathological segment followed by arterial reconstruction using a venous bypass. Bypass thrombosis occurs in 30% of cases, with various clinical consequences, ranging from no symptoms to reappearance of the preoperative clinical symptoms. We reviewed 19 patients with HHS who underwent bypass graft, to assess clinical outcomes and graft patency, with a minimum follow-up of 12 months. Objective and subjective clinical evaluation and ultrasound exploration of the bypass were carried out. Clinical results were compared according to bypass patency. At a mean follow-up of 7 years, 47% of patients had complete resolution of symptoms; symptoms were improved in 42% of cases, and unchanged in 11%. Mean QuickDASH and CISS scores were 20.45/100 and 28/100, respectively. Bypass patency rate was 63%. Patients with patent bypass had shorter follow-up (5.7 vs 10.4 years; p = 0.037) and a better CISS score (20.3 vs 40.6; p = 0.038). There were no significant differences between groups for age (48.6 and 46.7 years; p = 0.899), bypass length (6.1 and 9.9 cm; p = 0.081) or QuickDASH score (12.1 and 34.7; p = 0.084). Arterial reconstruction gave good clinical results, with the best results in case of patent bypass. Level of evidence: IV.