Comparative study between trapezium resection and tendon interposition with and without ligamentplasty in the management of carpometacarpal arthrosis of the thumb.

PURPOSE: Treating arthrosis in the base of the thumb has been a highly controverted subject. Many surgeries have been described, such as the isolated trapezium resection; resection with interposition with and without ligament plasty; arthrodesis, and arthroplasties. The purpose of this paper is to compare the two techniques which are currently the most used in this treatment. METHODS: A prospective study has been made to compare the surgical results between the trapezium resection with tendon interposition (tenoarthroplasty) - 22 cases - and tenoarthroplasty associated to ligament plasty-24 cases. Objective evaluation was done by measuring opponence, movements of the metacarpophalangeal joint, pinch and grasp strength, radiographic measurement of the distance between the base of first metacarpal and the scaphoid, and measurement of the angle between the first and the second metacarpals. Subjective evaluation was done with a DASH questionnaire, visual analog scale to evaluate pain and patient satisfaction. RESULTS AND CONCLUSION: After application of the criteria described and using Student 't' tests for statistical analysis, the authors concluded that the ligament reconstruction has no advantage over the simple resection and tendon interposition in carpometacarpal arthrosis of the thumb.

Transferências tendinosas para flexäo do cotovelo / Tendinous transfers for elbow flexion

Dentre as várias técnicas descritas para restaurar a flexao do cotovelo, os autores demonstram os resultados obtidos em dez pacientes submetidos a transferência do tríceps para o bíceps (quatro casos) e do epicôndilo medial com o grupo flexor-pronador para o 1/3 distal do úmero (Steindler, seis casos). Houve melhora cosmética e funcional em todos, porém a média de flexao ativa e a força de flexao do cotovelo foi ligeiramente superior na transferência do tríceps. Concluem que esta transferência deverá ser a preferida, exceto nos casos em que o tríceps for fraco. Nesses casos, a indicaçao deverá ser a cirurgia de Steindler se os músculos flexores e pronadores da mao estiverem fortes (M5). Como, na maioria dos casos, o ombro também está seriamente comprometido, a artrodese dessa articulaçao é complemento importante à restauraçao da flexao do cotovelo, na recuperaçao funcional global do membro superior.