Several techniques for shoulder arthrodesis have been described over the past century. We gratefully thank our respective departments, parent academic institutions, corporate partners, and the national institutes of health, whose generous support have made this meeting possible. The typical causes of such pain are fractures which disrupt the joint, severe sprains, and arthritis. Arthroscopic ankle and subtalar arthrodesis induces less trauma to the soft tisues and this translates in a lower complication rate, a shorter hospital stay, an early mobilization and a higher success rate. No joint destruction, less than onethird subluxation of the joint, joint space may be widened if effusion present. It has recently been performed by arthroscopy using a cannulated screw for fixation. Fatti earned his medical degree with distinction from upstate medical university, followed by a general surgery internship at hartford hos. A functional evaluation over a 10year period, 39 trapeziometacarpal tm joint fusions were performed in 37 patients.
Therefore, we performed a randomized clinical trial comparing trapeziectomy, with ligament reconstruction and tendon. Thumb arthritis diagnosis and treatment mayo clinic. Surgical pathologies of the cervical spine have commonly been addressed through anterior and posterior approaches. Morans phone number, address, insurance information, hospital affiliations and more. Arthroscopic ankle and subtalar arthrodesis indications and. Arthrodesis of the thumb carpometacarpal joint using a. Trapeziometacarpal arthrodesis or trapeziectomy with ligament. Literature supporting the use of trapeziometacarpal tmc arthrodesis in the treatment of osteoarthritis oa of this joint is unclear. The surgery can be performed using a rightsided or a leftsided approach.
A thorough literature search was performed using predetermined criteria. The uniqueness of the human thumbs carpometacarpal cmc joint has long fascinated anatomists and anatomistsurgeons. It is the second most common degenerative disease of the hand, after distal interphalangeal joint oa. Arthrex ankle arthrodesis anterior ankle fusion plate. All these factors have made arthroscopic surgery, our first choice technique for ankle and subtalar arthrodesis. Ruch, md, chief of the hand surgery at duke health in durham, north carolina, says women, especially those older than 50, are 10 to 20 times more likely than men to develop. Long term results of surgical intervention for osteoarthritis. Surgical treatment of trapeziometacarpal joint arthritis. Dozens of different operations have been proposed, including total or subtotal resection of the trapezium or resection and implant arthroplasty. Arthrodesis, also known as artificial ankylosis or syndesis, is the artificial induction of joint ossification between two bones by surgery. Trapeziometacarpal arthrodesis or trapeziectomy with.
May, 2017 the use of quadrangular plates for arthrodesis of the trapeziometacarpal joint is a safety and reproducible technique with a low rate of complications. Patients who have significant ankle deformity associated with their ankle arthritis may not be appropriate for the arthroscopic technique and may best be treated with an open technique. Surgery for thumb trapeziometacarpal joint osteoarthritis. A number of surgical procedures have been described for basal joint osteoarthritis, whereby simple excision was first reported in 1949 20. Jul 24, 2017 trapeziectomy with ligament reconstruction and tendon interposition lrti is widely applied, with good longterm outcomes. John fatti orthopedic doctors syracuse orthopedic specialists. The bones in the affected joint are permanently fused. The design of this plate provides excellent compression options by utilizing the oblong compression hole which accepts a nonlocking screw and the anatomic compression hole which accepts a 5. September 2016 volume 41, issue 9, p873946, e259e329. This book, for the first time, brings together the best evidence for treatments as well as any complications. Surgical technique hindfoot endoscopic technique unlike the technique originally proposed by tasto,1 using anterolateral and posterolateral portals and placing the patient in the lateral decubitus position, we perform arthroscopic subtalar arthrodesis using posterior endoscopic portals following a. Ligament reconstruction beverly hills ghavami plastic.
This book describes the anatomy and biomechanics of the trapeziometacarpal joint and explains the pathogenesis and treatment of trapeziometacarpal joint osteoarthritis, also known as rhizarthrosis. Degenerative arthritis of the thumb trapeziometacar. The cover image shows posteroanterior and lateral radiographs illustrating the sauvekapandji procedure. Tmc arthrodesis was first proposed by muller in 1949, but this is a challenging procedure with a nonunion rate ranging from 0 to 58%. Degenerative arthritis of the thumb trapeziometacarpal. Dupuytrens disease at 48 hours postcollagenase finger manipulation was performed after anesthetic injection. Because of its relative instability, this joint is a frequent site for osteoarthritis. It can be carried out either through an anterior or dorsolateral approach. The discussion of treatment sets out both conservative and surgical approaches, clearly explaining the indications for the various options, as well. The reason for withdrawal and previous versions are archived and accessible within the withdrawn record in the cochrane library. The primary trapeziometacarpal ligament is also known as the anterior oblique ligament. Therefore, we performed a randomized clinical trial comparing trapeziectomy, with ligament reconstruction and tendon interposition lrti using the weilby surgical technique,2, 3 with tmc arthrodesis, 3 and 12 months after surgery.
There are very few textbooks on elective hand surgery and this will be an essential resource for hand surgeons, orthopedic surgeons, plastic surgeons, rheumatologists and physiotherapists. Pin fixation was used in 27 fusions and staple fixation in 12. Trapeziometacarpal joint tmj osteoarthritis oa, or rhizarthrosis, is a disabling condition of the hand that causes pain, stiffness and weakness, resulting in impaired hand function, strength and dexterity fig. Cervical arthrodesis is a surgical procedure that joins selected bones in the cervical spine. There were five delayed unions 3 months and three nonunions. Surgery for trapeziometacarpal osteoarthritis sciencedirect.
Osteoarthritis of the trapeziometacarpal joint is the second most common site of degenerative joint disease in the hand, and mostly affects postmenopausal women. Surgical management of primary thumb carpometacarpal. Fatti, a boardcertified, fellowshiptrained orthopedic surgeon specialized in hand, wrist and elbow injuries. Surgeons create a socket by hollowing out the thumbs metacarpal bone and then shaping the trapezium into a cone that fits inside the socket. Trapeziometacarpal arthrodesis or trapeziectomy with ligament reconstruction in primary trapeziometacarpal osteoarthritis. Welcome to the 1st international thumb osteoarthritis workshop 1st itow which we have the honor of hosting in historic newport, rhode island.
Five surgeries for thumb arthritis arthritis foundation. Clinical study arthrodesis of the trapeziometacarpal joint using a chevron osteotomy and plate fixation g. Surgical orthopedic procedures such as hip replacements, arthroscopy or knee replacements are surrounded by pre and postoperative complications, and there are varying different methods for the procedures themselves. Numerous surgical techniques including trapeziectomy with or without tendon interposition arthrodesis and partial or total joint arthroplasty with cemented and noncemented prosthesis have been. One of the bones in your thumb joint trapezium is removed. Surgical technique hindfoot endoscopic technique unlike the technique originally proposed by tasto,1 using anterolateral and posterolateral portals and placing the patient in the lateral decubitus position, we perform arthroscopic subtalar arthrodesis using posterior endoscopic portals following a similar technique as. See the article by gibersonchen et al, functional outcomes after sauvekapandji arthrodesis on page 408. Background the trapeziometacarpal tmc joints unique anatomy and biomechanics render it susceptible to degeneration. Arthrodesis of the trapeziometacarpal joint using a chevron osteotomy and plate fixation. Anterolateral arthroscopic posterior subtalar arthrodesis. Arthroscopic treatment of trapeziometacarpal disease. The complex skeletal, muscular, and ligamentous anatomy of the trapeziometacarpal tmc joint challenged early investigators who sought to understand how such a joint could, at the same time, be so mobile and yet so stable when performing forceful pinch. Clinical study arthrodesis of the trapeziometacarpal joint.
This is done to relieve intractable pain in a joint which cannot be managed by pain medication, splints, or other normally indicated treatments. Osteoarthritis of the trapeziometacarpal joint produces painful limitation of movement in the capsular pattern the typical pattern of. What is common to all resection arthroplasty procedures is the creation of a sufficiently stable pseudarthrosis. Raven ee, kerkhoffs gm, rutten s, marsman aj, marti rk, albers gh 2007 long term results of surgical intervention for osteoarthritis of the trapeziometacarpal joint. Posterior arthroscopic subtalar arthrodesis youtube. The surgical technique and clinical results for trapeziometacarpal arthrodesis using locking plate fixation in women 50 years or older article pdf available in plastic and reconstructive surgery. Although subtalar joint arthrodesis may be achieved through open or arthroscopic approaches, we have found that posterior arthroscopic subtalar arthrodesis has technical advantages compared with. We have evaluated 18 patients with eaton iii tmj osteoarthritis, who underwent an arthrodesis. Chris coetzee, md, edina, mn demonstrates an ankle arthrodesis using the anterior ankle fusion plate. We describe a technique for treating eaton stage iv osteoarthritis of the first ray, which is a development of our previously published technique for treating trapeziometacarpal arthritis. Kevin chung, shows you how to perform all the latest procedures and get the best results. Many surgical treatments are available trapeziectomy, trapeziectomy and ligament reconstruction, arthrodesis, arthroscopic resection, metacarpal osteotomy, prosthetic implant arthroplasty but there is currently no gold standard.
Visualization is performed through the posterior portal in a, b, and d and through the anterior portal in c. Recent reports in the north american literature 1, 2 of good results following complete trapeziectomy with hematoma arthroplasty have rejuvenated interest in this technique, which has been commonplace in europe for some time. After graduating from the university of notre dame, dr. Trapeziometacarpal osteoarthritis, also known as osteoarthritis at the base of the thumb or as rhizarthrosis, is a reparitive joint disease affecting the first carpometacarpal joint cmc1. Osteoarthritis of the trapeziometacarpal joint of the thumb. Fatti earned his medical degree with distinction from upstate medical university, followed by a general surgery internship at hartford hospital. Arthrodesis eliminates pain by fusing the bones in the joint together. Glickel 2001 reports the most widely used system of littler and eaton which involves a staging system dividing the progression of osteoarthritis into four. The typical patient is a middleaged woman who describes the gradual onset of thumb basilar joint discomfort, pain with gripping or pinching, difficulty opening jars, and diminished strength. It permits the simple and perfect fixation of the implant, with minimal bone resection, but also allows for the replacement of the entire trapezoid bone, if needed. Wrist arthroscopy is a wrist surgery that allows a doctor to see the inside of a joint.
Trapeziometacarpal arthritis is a common condition seen in hand surgery practice. Recently, shoulder arthrodesis has been performed using malleable reconstruction plates, and has been shown to be a reliable and stable. Surgical treatment of trapeziometacarpal joint osteoarthritis. It is performed after a patient sustains an injury such as a fall or a twisting of the. This study aims to determine the union rate and key strength following arthrodesis using a chevron osteotomy and plate fixation. We are committed to sharing findings related to covid19 as quickly and safely as possible. Theoretically, the last of the above options allows preservation of joint anatomy and biomechanics. Trapeziometacarpal joint arthritis 1,699 kb request inspection copy. The management of nerve defects is discussed and techniques for nerve grafting are.
The indications for arthroscopic ankle arthrodesis are for treatment of end stage ankle arthritis in those patients who have failed non operative treatments. About one in four women 30% of postmenopausal women and. Dupuytrens disease this shows injection technique beginning with the ring finger because it was not possible to get to those cords with the ring in the way. We will be providing unlimited waivers of publication charges for accepted articles related to covid19. Arthrodesis of the trapeziometacarpal joint using a. Sep 30, 2014 raven ee, kerkhoffs gm, rutten s, marsman aj, marti rk, albers gh 2007 long term results of surgical intervention for osteoarthritis of the trapeziometacarpal joint.
Exploration and repair of nerves requires specialized equipment, detailed anatomical knowledge, and expertise in microsurgery. The lowprofile mtp plates and screws are a complete system for joint preparation and fixation for the treatment of severe hallux rigidus and other mtp pathologies. This surgical video demonstrates a technique for shoulder arthrodesis that uses modern fixation methods and implants. Not only does it cover the evidence base for orthopedic. Arthrodesis decreases pain and improves function in patients with primary osteoarthritis of the thumb carpometacarpal joint. Figure 1 arthrodesis of the trapeziometacarpal joint. Trapeziectomy with ligament reconstruction and tendon interposition lrti is widely applied, with good longterm outcomes. Total replacement of trapeziometacarpal joint type t. Figure 1 arthrodesis of the trapeziometacarpal joint using. The fused joint can bear weight without pain, but has no flexibility. This medical reference book in the operative techniques series uses stepbystep descriptions, illustrations, and videos to provide all the guidance you need to. This joint is formed by the trapezium bone of the wrist and the first metacarpal bone of the thumb.
Trapeziectomy with ligament reconstruction and tendon. Osteoarthritis of the trapeziometacarpal joint of the. Arthroscopic ankle and subtalar arthrodesis indications. Dec 11, 2018 cervical arthrodesis is a surgical procedure that joins selected bones in the cervical spine. To assess the longterm results of trapeziometacarpal arthrodesis using a quadrangular plate, regarding clinical, radiological and functional outcomes, as well as development of complications. Jarvis 2 birmingham heartlands hospital, bordesley green east, birmingham, west midlands b ss, uk. Shoulder arthrodesis is an uncommon salvage procedure that is most commonly performed in patients with intractable instability or paralytic disorders of the upper extremity. A metal pin holds bones together to maintain proper.
Despite the availability of numerous surgical options, none has been definitively proven to be superior. Rheumatoid arthritis ra and other forms of inflammatory arthritis can also damage the cmc joint in the thumb, also known as the trapeziometacarpal joint tmc. This chapter includes details of a primary and secondary repair of nerves. Apr 20, 2015 the primary trapeziometacarpal ligament is also known as the anterior oblique ligament. Describe the surgical technique for ligament reconstruction tendon interposition arthroplasty and its variants. Pdf the surgical technique and clinical results for. The trapeziometacarpal tmc joints unique anatomy and biomechanics render it susceptible to degeneration. The high prevalence of trapeziometacarpal joint tmj osteoarthritis leads to develop techniques to improve surgical outcomes when conservative treatment has failed.