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Thumb Carpometacarpal Joint Pathoanatomy-A Computed Tomography-Based Study.

Karam Al-Tawil1, Madeleine Garner1, Tony Antonios1

  • 1Department of Trauma and Orthopaedics, King's College Hospital, London, United Kingdom.

Journal of Wrist Surgery
|August 12, 2021
PubMed
Summary

Osteoarthritis of the thumb carpometacarpal joint (CMCJ) causes increased space between metacarpals, potentially damaging the stabilizing ligament. Preoperative CT scans may predict ligament damage, guiding surgical stabilization during trapeziectomy.

Keywords:
CMCJ arthritisintermetacarpal ligamentosteophytethumb carpometacarpal jointtrapeziectomy

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Area of Science:

  • Orthopedic Surgery
  • Hand Surgery
  • Radiology

Background:

  • Thumb carpometacarpal joint (CMCJ) osteoarthritis is a prevalent condition causing significant morbidity.
  • Ligamentous structures are crucial for thumb CMCJ stability, especially after trapeziectomy.
  • Understanding CMCJ anatomy is vital for surgical success and avoiding complications.

Purpose of the Study:

  • To analyze normal and arthritic thumb CMCJ anatomy, focusing on osteophytes and intermetacarpal distance.
  • To assess the impact of these anatomical changes on intermetacarpal ligament integrity.
  • To determine if anatomical findings predict the need for surgical stabilization during trapeziectomy.

Main Methods:

  • Retrospective cohort study analyzing computed tomography (CT) scans.
  • Inclusion of 30 normal and 25 arthritic thumb CMCJ patient cohorts.
  • Three-dimensional reconstructions used to examine osteophyte location and intermetacarpal distance.

Main Results:

  • Osteophytes commonly form on the ulnar aspect of the trapezium.
  • Arthritic changes correlate with an average 2.1 mm increase in intermetacarpal distance.
  • Increased intermetacarpal distance suggests ligament lengthening and potential damage.

Conclusions:

  • Increased intermetacarpal distance in thumb CMCJ osteoarthritis may result from osteophyte formation and wear.
  • This widening can lead to intermetacarpal ligament lengthening and damage.
  • Preoperative CT assessment of osteophyte position and intermetacarpal distance may guide surgical stabilization during trapeziectomy.