[Long-term observation and results following trapeziectomy in idiopathic thumb carpometacarpal joint arthrosis].

Numerous, complicated and expensive operative techniques have been described in recent years for the treatment of osteo-arthritis of the thumb. Aetiologically, the idiopathic form of this disability is the most frequent and effects especially women older than 50 years. A longtime follow-up (21/2 to 101/2 years) after trapeziectomy allowed critical assessment of the various operative procedures and a realistic evaluation of the removal of the trapezium. In this group of patients the examination of mobility and pain are the most important aims, followed by strength and appearance. Assessment of pain, mobility strengths of pinch and radiological findings--including the very important functional roentgenograms--showed that trapeziectomy, with or without tendon interposition, represents the method of choice. All patients, in all parameters, showed a significant improvement in comparison with the pre-operative condition. A detailed pre-operative clinical and radiological examination enables us to appreciate correctly the osteo-articular, capsulo-ligamentous and muscular conditions of the first ray in the hand. This allows us to supplement the trapeziectomy with soft tissue procedures (e.g. plication of the capsule, disinsertion of adductor pollicis tendon, etc.) which improve the final results, especially with respect to strength. The assessment of the longterm results after trapeziectomy demonstrated 50% very good, 45% good and 5% fair results.