Double Oblique Osteotomy and Rotation of the trapeziometacarpal Joint (DOOR procedure)

The double oblique osteotomy with rotation of the trapeziometacarpal (TMC) joint procedure (DOOR procedure) is a surgical technique conceived to treat non-traumatic TMC instability, often responsible for TMC joint osteoarthritis. The main goal of this procedure is to correct the exaggerated slope of the trapezium. It also allows opening of the first web space, transfers pressure to healthy cartilage areas, and reverses the forces exerted on the trapeziometacarpal ligaments. The technique is demanding and should be learned in the anatomy laboratory. Since 2000, we have carried out 96 cases, evidence that this technique is reliable. Our case series consists of 88 patients (71 females, 17 males), with 8 patients operated bilaterally. The average age at the time of the procedure was 48 years. The first 22 operated (24 cases) between 2000 and 2005 were reviewed in 2015 with an average follow-up of 13 years. Pain averaged 0.5 on VAS. The average QuickDASH score was 6. The average mobility according to Kapandji's index was 9 for opposition and 3 for retropulsion. The grip strength compared to that of the contralateral side was 180%, the key pinch strength was 100% of the contralateral side and the tip pinch strength was 98%. This intervention makes up approximately 10% of our surgical indications in thumb basal joint arthritis. It is reserved for young women with early arthritis or unstable thumbs, and for men who perform manual labor. While the results take a long time to achieve (about 3 months), they remain highly satisfactory at the average follow-up of 13 years.