Martinel V, Mansat P, Mansat M, Rongières M, Bonnevialle P
Service d'orthopédie-traumatologie, urgences-Main, centre hospitalier universitaire de Toulouse-Purpan, place du Docteur-Baylac, 31059 Toulouse, France.
Chir Main. 2007 Apr;26(2):103-9. doi: 10.1016/j.main.2007.03.004. Epub 2007 Apr 20.
Partial trapezectomy with suspension and interposition tendinoplasty is an alternative to total trapezectomy or trapezometacarpal arthroplasty for the treatment of trapezometacarpal osteoarthritis. This technique preserves the thumb length allowing good motion and satisfactory pollicidigital strength. The purpose of the present study is to report our experience with this procedure reviewing a continuous monocentric series of 41 thumbs with an averaged follow-up of 5 years. Surgical technique, clinical and radiographic results, and indications are discussed.
Thirty-three patients (41 thumbs) of 57.4 years average age underwent this procedure. According to Dell classification there were 23 stage II, 15 stage III, and 3 stage IV. No sign of osteoarthritis of the scapho-trapezo-trapezoidal joint were noted. Clinical and radiographic evaluations were available for all the patients. Pollicidigital strength was measured with a dynamometer.
At 57 months average follow-up, 71% of the patients had no pain. Average opposition was 9.56 out of 10 according to Kapandji, the key pinch was equal to 6.51 kg, and M1M2 space was 34 degrees . Trapezometacarpal space was 2.52 mm on average. There were only 3 complications related to a reflex sympathetic dystrophy.
Partial trapezectomy with tendinoplasty gives satisfactory functional results which is maintained with follow-up. It allows recovery of a functional pollicidigital strength by limiting thumb shortening. It is a reliable procedure with a low rate of complication indicated for isolated thumb trapezometacarpal joint osteoarthritis without scapho-trapezo-trapezoidal joint involvement.
