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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Ligament Reconstruction and Tendon Interposition and Partial Trapezoidectomy for Pantrapezial Arthritis

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  • presenting/speaker Mark Ross - Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
  • David Gilpin - Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
  • Christopher James - Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
  • Susan E. Peters - Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
  • Richard Benson - Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
  • Bradley Gilpin - Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-782

doi: 10.3205/19ifssh1086, urn:nbn:de:0183-19ifssh10863

Published: February 6, 2020

© 2020 Ross et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: The purpose was to evaluate whether removing the scaphotrapezoid joint (STJ) when performing a Ligament Reconstruction and Tendon Interposition (LRTI) for pantrapezial arthritis resulted in any clinical or radiographic compromise compared to LRTI alone.

Methods: In a consecutive cohort of 198 thumbs having surgery for CMCJ +/- pantrapezial arthritis, 78 patients were selected to generate two closely matched cohorts and a cross-sectional review was completed of both clinical and radiological outcomes at an average of 41 months (range: 6 - 203). 43 thumbs with no STTJ arthritis had LRTI alone. 35 with pantrapezial arthritis had LRTI and excision/interposition of STJ.

Results and Conclusions: When comparing LRTI vs LRTI plus partial trapezoidectomy the only significant difference, though small, was in favour of the LRTI for satisfaction VAS (median 99 vs 90.5/100). Grip strength, lateral pinch strength, tip pinch strength, Kapandji score, pain on normal activity, Patient Rated Wrist Evaluation or QuickDASH score showed no significant differences. Radiographic analysis did not demonstrate significant differences (mean degrees: LRTI vs LRTI plus partial trapezoidectomy) for radio-lunate (RL) angle (11 vs 13), capito-lunate angle (12 vs 11), scapholunate angle unloaded (55 vs 54), scapholunate angle loaded (50 vs 49). In both groups 10 patients had a RL angle > 15 degrees. In the LRTI plus partial trapezoidectomy group, 2 had scaphoid and lunate extension; with 3 observed in the LRTI group.

We demonstrated that there was no increased risk of poorer clinical outcome or the development of a DISI deformity following resection of the proximal pole of the trapezoid with tendon interposition in the residual gap. The management of pantrapezial arthritis with LRTI and proximal trapezoid excision and STJ interposition appears satisfactory on short to medium term clinical and radiographic follow-up.