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Effect of Trapeziectomy on Carpal Stability
Aaron W Paul1, Christian M Athens1, Raahil Patel1
1Mayo Clinic, Rochester, MN, USA.
Hand (New York, N.Y.)
|July 16, 2020
Summary
Trapeziectomy for trapeziometacarpal arthritis can cause carpal collapse and progressive scaphotrapezoid arthrosis. Caution is advised for patients with carpal instability due to risks associated with this procedure.
Area of Science:
- Orthopedic Surgery
- Hand Surgery
- Biomechanics
Background:
- The scaphoid-trapezoid-trapezium (STT) articulation is crucial for scaphoid stability and linking carpal rows.
- Trapeziometacarpal (TM) arthritis commonly affects the base of the thumb.
- Understanding the impact of trapezium excision on carpal stability is essential for treatment planning.
Purpose of the Study:
- To evaluate the effect of trapezium excision on carpal stability in patients with trapeziometacarpal arthritis.
- To assess radiographic changes in carpal alignment and height after trapeziectomy.
- To identify potential risks of carpal instability following trapeziectomy.
Main Methods:
- Retrospective review of 122 wrists undergoing trapeziectomy for TM arthritis (2004-2016).
- Radiographic analysis included modified carpal height ratio (MCHR), radioscaphoid (RS), radiolunate (RL), and scapholunate (SL) angles.
- Degenerative changes were graded using Eaton-Littler and Knirk and Jupiter classifications.
Main Results:
- Significant decrease in RL and RS angles, indicating lunate and scaphoid extension post-trapeziectomy.
- Significant reduction in MCHR, suggesting progressive carpal collapse.
- Development of progressive scaphoid-trapezoid arthrosis observed in multiple cases.
Conclusions:
- Trapeziectomy can result in loss of carpal height and coordinated carpal extension.
- Progressive scaphotrapezoid arthrosis is a potential complication.
- Trapeziectomy should be approached cautiously in wrists with existing carpal instability to mitigate the risk of carpal collapse and dorsal intercalated segment instability.
