Thumb carpometacarpal joint (CMCJ) arthritis is a common and debilitating condition. The mainstay of surgical management is Trapeziectomy. Concerns about possible functional implications of collapse of the metacarpal into the arthroplasty space as well as the potential for scaphometacarpal led to the development of techniques to try and prevent this. The purpose of this study was to investigate if there were any significant differences in the long-term outcomes of patients who participated in a randomized trial of trapeziectomy alone compared with trapeziectomy with ligament reconstruction and tendon interposition (LRTI). Sixty-five patients participated in our original trial, the 1 year findings of which were published in 2007. These patients were invited for a follow-up visit at a mean of 17 years (range 15–20) postoperatively. Twenty-eight patients attended, who had 34 operations, 14 trapeziectomy alone and 20 with LRTI. Patients were asked to complete a visual analogue scale (VAS) for satisfaction with the outcome of their procedure, rated on a scale from 0 (most dissatisfied) to 100 (most satisfied). They also completed the short version of the Disabilities of the Arm, Shoulder and Hand Score (QuickDASH) at their appointment. They underwent a functional assessment with a hand therapist and had a radiograph of the thumb. There were no statistically significant differences between the two groups in terms of satisfaction with surgery or functional outcomes, with most measurements showing minimal or no differences in means between the two groups. There was no difference in the space between the metacarpal and scaphoid on radiograph. Radial abduction was the only parameter that was significantly greater in the patients with simple trapeziectomy (median 79°) compared with trapeziectomy with LRTI (median 71°) (p = 0.04). Even at 17 years there is no significant benefit of LRTI over trapeziectomy alone for thumb carpometacarpal joint osteoarthritis

Background: Thumb carpalmetacarpal joint (CMCJ) osteoarthritis has been treated using various combinations of resection, interposition and replacement arthroplasties. The procedure of choice for various stages of CMCJ osteoarthritis remains controversial. This study compares the short term outcomes of trapeziectomy alone and trapeziectomy with PI2 implantation. Methods: A cross-sectional observational study involving 33 patients (36 thumbs). 18 thumbs had trapeziectomy alone and 18 had trapeziectomy and PI2 implantation. Underlying indication was osteoarthritis in 35 thumbs and trauma in one thumb. Preoperative radiological assessment using the Eaton and Glickel grading for CMCJ osteoarthritis and clinical review including DASH and SF-36 score was performed at a mean follow-up of 18 months. Preoperative and postoperative pain level was assessed using Visual Analogue Scale (VAS) and satisfaction of the surgery using the Likert 5-point scale. Results: There were 30 women and 3 men. The average age at follow up was 61 years (range 45 to 75). There was no significant difference between the two groups regarding age, duration of symptoms, and stage of disease, preoperative pain score and handedness. The mean DASH score at follow up was 26.8 for trapeziectomy alone group and 35.4 for the PI2 arthroplasty group. Preoperative to postoperative VAS for pain showed an improvement from fair to excellent in 60% of patients in trapeziectomy alone group and 30% of the patients in the PI2 arthroplasty group. There was no significant difference in the SF-36 scores between the two groups in all health domains. 6 out of 16(38 %) patients in the PI2 group had multiple surgeries mainly due to dislocation or subluxation of the implant. The overall Likert 5-point scale scores were highest for trapeziectomy alone group with 70% very satisfied compared to 40% in the PI2 arthroplasty group. Conclusion: The early results of pyrocarbon PI2 arthroplasty show a high complication rate compared to simple trapeziectomy. The high rates of subluxation and dislocation observed in the early cohort resulting in multiple surgeries may be attributed to steep learning curve of the surgical technique and creation of a shallow groove for the implant. This may have contributed to the low satisfaction levels observed in PI2 arthroplasty group. Simple trapeziectomy provides satisfactory outcome in more than 80% of the patients

Aims. The objective of this systematic review was to describe trapeziectomy outcomes and complications in the context of osteoarthritis of the base of the thumb after a five-year minimum follow-up. Methods. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to guide study design, and 267 full-text articles were assessed for eligibility. After exclusion criteria application, 22 studies were included, involving 728 patients and 823 trapeziectomies. Outcomes included pre- and postoperative clinical and radiological characteristics. Complications and revisions were recorded. Results. All the studies reported good results regarding pain and range of motion at the last follow-up of 8.3 years (5 to 22); the mean satisfaction rate was 91% (84% to 100%). It was difficult to assess the impact on metacarpophalangeal joint motion in extension with contrary results. The key pinch returned to its preoperative values, whereas tip pinch showed a modest improvement (+14%), with a mild improvement found in grip strength (+25%) at the last follow-up. The mean progressive trapezial collapse was 48% (0% to 85%) and was not correlated with pain, grip strength, or satisfaction. The most represented complications were linked to tendons or nerves affected during additional procedures to stabilize the joint (11.6%; n = 56). Mechanical complications included symptomatic scapho-M1 impingement (3.1%; n = 15/580), leading to nine surgical revisions out of 581 trapeziectomies. Meta-analysis was not possible due to study heterogeneity and limited data. Conclusion. After a minimum five-year follow-up, trapeziectomy achieved high patient satisfaction and pain relief. However, strength seemed to be deteriorating with detrimental consequences, but this did not correlate with trapezial collapse. The issues related to underestimating mechanical complications and varying degrees of success should be highlighted in the information given to patients. Evidence-based analyses should help the surgeon in their decision-making. Cite this article: Bone Jt Open 2021;2(3):141–149

Introduction: Osteoarthritis of the thumb is the second most common site of arthritis in humans. There are numerous operations for the condition, but perhaps the commonest is trapeziectomy, which can be supplemented with a suspension procedure generally using FCR. It was the aim of this study to determine whether there is an advantage of one procedure over the other. Materials and methods: 60 patients with either Eaton and Littler grade III or IV arthritis of the CMCJ of their thumbs were randomised into either having a traditional trapeziectomy (with no wiring), or a trapeziectomy with FCR suspension. The surgery was performed by the senior surgeon. All patients were assessed pre- and post operatively (at 3,6 and 12 months) by a physiotherapist measuring pain on visual analogue scores doing various activities, range of movement and grip and pinch strength. X-rays were taken at the same intervals. Results: Patient satisfaction from both operations was similar. There was no significant difference between visual analogue scores. Measurement of the gap left by the trapeziectomy was less when trapeziectomy alone was performed. Discussion: There is no obvious difference in the results of these two surgical techniques for treating OA of thumb CMCJ. It is not necessary to perform the FCR suspension

Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) with the flexor carpi radialis (FCR) tendon is one of the most common procedures for the treatment of thumb carpometacarpal (CMC) arthritis. An alternative method involves trapeziectomy alone (TA). The trapeziectomy with LRTI procedure was developed to theoretically improve biomechanical strength and hand function when compared to TA, which leaves an anatomical void proximal to the first metacarpal. The LRTI procedure takes longer to perform and includes an autologous tendon graft. The goal of this retrospective cohort study was to evaluate the clinical outcomes of trapeziectomy with or without LRTI at a minimum follow-up of 1 year. A total of 43 adult patients who had underwent a total of 58 (TA=36, LRTI=22) surgical procedures for CMC arthritis participated in the study. This single surgeon retrospective cohort study sampled patients who underwent CMC arthroplasty with either TA or LRTI techniques between 2008 and 2020 with a minimum time of 1 year post-operatively. The patients were evaluated subjectively (The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire) and objectively (hand/thumb strength, pre/post-operative hand radiographs). Both the TA and LRTI procedures provided good pain relief, motion, strength, and stability without any severe complications. There was no statistically significant difference in hand or thumb strength between the two groups. Radiography showed that compared to the preoperative status, the trapezial space decreased similarly between the two groups. There was no difference in size of collapse between TA and LRTI post-operatively. The TA procedure had similar outcomes to LRTI and has the advantages of shorter surgical time, less incision length, and lower surgical complexity. TA provided equivalent trapezial space to LRTI after the operation. Future study should investigate these two procedures in a head-to-head comparison rather than longitudinally where both surgeon experience and time since procedure at follow-up may have impacted results

The comparison between surgical outcomes of trapeziectomy versus trapeziectomy with ligament reconstruction (LRTI) is well documented in the literature. We could not find any literature comparing these two procedures from a ‘patient-based outcome scoring’ perspective. The Patient Outcomes Of Surgery (POS) hand/arm questionnaire was used in order to assess the outcomes of 33 patients (23 Trapeziectomy and 10 LRTI). All surgery was carried out by the same hand surgeon. A telephone questionnaire was performed on each patient. The mean time post surgery was 15 months (range 1 to 27) and 20 months (range 7 to 30) for the Trapeziectomy and LRTI group respectively. There was statistically significant improvement in both groups for symptoms, physical activities and psychological functioning/cosmetic appearance. The Trapeziectomy alone group scored higher in all groups though this did not show statistical significance. There were statistically significant higher rates of complications in the LRTI group. LRTI surgery increased the tourniquet time by 28 minutes on average. Patient overall satisfaction was higher (85/100) in the trapeziectomy alone group than that of the LRTI group (75/100). Both trapeziectomy and trapeziectomy with LRTI offer a reliably way of treating arthritis of the carpometacarpal joint. In our study, Trapeziectomy alone resulted in better overall patient satisfaction with lower complication rates and reduced operating time

The December 2023 Wrist & Hand Roundup. 360. looks at: Volar locking plate for distal radius fractures with patient-reported outcomes in older adults; Total joint replacement or trapeziectomy?; Replantation better than revision amputation in traumatic amputation?; What factors are associated with revision cubital tunnel release within three years?; Use of nerve conduction studies in carpal tunnel syndrome; Surgical site infection following surgery for hand trauma: a systematic review and meta-analysis; Association between radiological and clinical outcomes following distal radial fractures; Reducing the carbon footprint in carpal tunnel surgery inside the operating room with a lean and green model: a comparative study

Introduction: Trapeziectomy is a well established surgical procedure for the treatment of osteoarthritis of the carpo-metacarpal joint (CMCJ) o the thumb. The complications have been recognised in the past, but there has been limited literature describing the management and prognosis of long term complications following Trapeziectomy. Aim: The purpose of our study was to describe our experience in management and prognosis of patients with long term complications associated with Trapeziectomy with particular references to residual pain and sensory branch of radial nerve (SBRN) paraesthesia. Methods: 118 trapeziectomy procedures were performed in 103 patients for primary osteoarthritis of the CMCJ of thumb during the period of January 2000 – December 2005 at a single centre performed or supervised by a single surgeon (senior author). The data was obtained from the case notes retrospectively. The average follow up period was 12 months. The short term and long term complications and their management were recorded and analysed in detail. Results: Long term complication rate was 23.7% (28 cases) which included 15 patients (12.7 %) complaining of residual pain at the base of the thumb, 6 patients (5.1%) had symptoms related to superficial branch of radial nerve and 2 patients (1.7%) had FCR rupture. Steroid injection was more successful than physiotherapy or splinting in majority of the patients with residual pain. Superficial branch of radial nerve symptoms resolved with time. However persistent symptoms were treated suceesfully by desensitization therapy. Conclusion: Trapeziectomy is a fairly benign operation, but the complications are more than expected and the patients must be warned to expect long term complications. Most of the postoperative problems can be effectively managed non-operatively and the prognosis remains good in majority of the cases. Patients must be reassured to expect full recovery with time

Numerous procedures have been described for degenerative arthritis of the carpometacarpal joint of the thumb. The sling procedure is technically demanding and involves sacrificing part of a healthy tendon. Silicon arthroplasty is associated with stem fracture and synovitis. We have successfully used external fixation for distraction and correction of adduction deformity following trapeziectomy with S-Quattro (Stockport Serpentine Spring System). Following trapeziectomy specially designed pins are inserted into the base of the 1. st. metacarpal and radial styloid and distracted with 2 serpentine springs. The fixator is removed at six weeks and removable thermoplastic splint applied for further 6 weeks. We reviewed the results of 39 trapeziectomy performed in 32 patients (3 male) with an average follow up of 53 months. ROM, power, pinch, pain score and patient satisfaction were reviewed by an independent hand therapist. Average functional score was 28. 9 post-op (maximum 30) compared to 20. 7 pre operatively. Mean thumb abduction was 48. 9 and extension 49. 2 degrees which increased from 42. 9 and 43. 8 pre-operatively. Span was 19 centimetres and opposition 9. 26 on the Kapandji scale. Average grip strength was 40 lbs, pinch strength of 6 lbs and key lateral of 9. 5 lbs. Pain score improved from 7. 9 pre-op to 0. 9. There was statistically significant improvement of all functions except span. Long term follow up radiograph showed good maintenance of gap between base of 1. st. metacarpal and scaphoid. Three cases had deep penetration of the pins, which required early removal. We now insert padding between the fixator and the spring to avoid deep penetration. One patient had mild RSD and another patient had pain in the distribution of the radial nerve, both of which improved following pin removal. Application of S-Quattro following trapeziectomy is a simple and quick procedure. It is reasonably well tolerated by patients. Long-term follow-up showed improvement in hand function and good maintenance of gap between base of 1. st. metacarpal and scaphoid

Carpometacarpal arthritis of the thumb is a common source of morbidity particularly in post-menopausal women. It is commonly and successfully treated by trapeziectomy with or without ligament reconstruction and tendon interposition. This randomised prospective study compared the results of trapeziectomy alone or combined with tendon interposition and ligament reconstruction in 125 patients. Each patient had subjective and objective assessment of thumb pain, stiffness and strength and were scored using the D.A.S.H. and P.E.M. scoring systems. Patients were assessed pre-operatively and at 3 months and 1 year after surgery. The results of the two procedures revealed statistically improved pain levels but there was no statistically significant difference between the two in terms of pain relief, stiffness, weakness, grip strength, keypinch and thumb key pinch as well as in the D.A.S.H. and P.E.M. scores. The study shows that in the short term soft tissue reconstruction in addition to a simple trapeziectomy provides no improved benefit to the patient

Objectives: Evaluation of patients satisfaction, radiological and functional outcome in patients with trapeziometacarpal osteoarthritis after trapeziectomy with a extensor carpi radialis longus suspension. Material and Methods: Between November 1997 and Dezember 2003, 44 patients (34 female, 10 male, average age 60 years, range 46 to 73 years) underwent trapeziectomy with extensor carpi radialis longus suspension at our institution. In 37 patients clinical and radiological outcome could be assessed after an average follow up of 7 years (range 5 to 10 years). 7 patients were lost to follow up. Preoperative range of motion, pain intensity (VAS) function and radiographs were evaluated. Postoperative patients satisfaction, using the DASH score functional and radiological outcome was determined. Results: The average patients satisfaction was 27.8 points (range 0 – 70). Pain intensity improved from pre-operative VAS 8.5 (range 6.3 – 10) to postoperative 1.9 (range 1.2 to 4). 92 % of patients would again choose this surgical procedure. Duration of pain anamnesis was 24 months or longer in 64% of patients. After 3 months full pain relief and usage property was achieved in 62% of patients. A free opposition was possible in 76%, radial abduction of 40° was possible in 24%, of 30–40° in 38% and of 20–30° in 35% of patients. Palmar abduction of more than 40° was possible in 68% and 30 – 40° in 32% of patients. Grip strength deteriorated in 49%, in 16% there was no difference and improved in 35% compared to the other hand. The average trapezium space lost 18% of its height compared with preoperative values. Conclusion: Trapeziectomy with extensor carpe radialis longus suspension shows good results regarding pain relief but remarkable deterioration of strength

Purpose: To present results of a series of patients treated with Trapeziectomy, Ligament Reconstruction and Tendon Interposition for treatment of 1st CMC joint arthritis. Methods: 59 patients (65 thumbs) from Single surgeons’ practice were prospectively followed by 2 independent observers who did not participate in the study. Patient demographics, occupation, handedness, symptoms and clinical findings were recorded. Objective assessment including pinch and grip strength was carried out by the Occupational therapists. Functional outcome assessment was done using questionnaire designed by senior author. Patients were asked to evaluate the operation using the subjective assessment component of Buck-Gramcko score. Radiographs were studied for Trapezial space and arthroplasty space. Analysis was carried out using SPSS statistical software. Results: A total of 59 patients at an average age of 62 years were followed up for an average of 25 months. Six patients had bilateral procedures. Average follow up was 3.5 years with minimum follow up being 3 years. Osteoarthritis was the commonest diagnosis accounting for 53 (91%) patients and rheumatoid arthritis in 6 (9%) of patients. 48 cases (82%) were Stage IV and 15 cases (18%) Stage V. Mean duration of symptomsbefore the surgical intervention was 36 months. 3 patients developed superficial wound infection and 4 patients developed reflex sympathetic dystrophy. The results suggested pinch strength and grip strength improved to 50% and 22.5% respectively, as compared to pre-operative value. Conclusion: Treatment options for 1st CMC joint arthritis have evolved over time. Many prospective randomized studies have shown lack of advantage of LRTI as compared to trapeziectomy alone, but these studies are not free from limitations. The present study is one of the largest reported single surgeon series and benefits from aprospectively maintained database with minimum 3 years follow up. The study rises above the existing limitations in the literature and reinforces concept of Ligament Reconstruction and Tendon Interposition. Level of Evidence: Level II (Prospective study)

Introduction. “No routine post-operative follow up appointments” policy has been implemented in NHS hospitals in different specialties for uncomplicated surgical procedures. In trauma and orthopaedics few studies to date reviewed this practice and reflected on the patients' opinions. Methods. A total of 121 patients were recruited over 2 years, each patient had post operative follow up by the hand therapist for 3 months. 50 patients post Trapeziectomy and 71 patients post single digit Dupuytren's fasciectomy were prospectively surveyed for their opinion on their post operative care and whether they would have liked to be reviewed by the surgeon in a routine post operative follow up appointment or not. All operations were done by one surgeon in one hospital. All patients were reviewed by a hand therapist within 2 weeks post operatively and treatment protocols were followed with all the patients. During their final appointment with the hand therapist all patients completed a questionnaire. Results. 116 patients completed the study, 5 post Dupuytren's fasciectomy patients were lost for follow up. 106 patients (91%) were satisfied with their post operative management and 99 patients (85%) did not want to be reviewed by the surgeon in a post operative outpatient follow up appointment. Discussion. This study reflects the successful application of “Hand therapy led follow up and discharge” policy with no routine post operative review by the surgeon. We succeeded in reducing the waste in the NHS by avoiding at least 215 un-necessary routine follow up appointments over a 2 year period. By applying this policy we also succeeded in avoiding the inconvenience to patients having multiple trips to the hospital. We advise implementing this practice for other common uncomplicated surgical procedures, with the possibility of giving the patient the option to request an appointment with the surgeon if needed

Purpose of the study: Basal joint osteoarthritis remains one of the most invalidating degenerative diseases of the upper limb. Most patients are women and the main symptom is pain. Several surgical approaches can be used: total trapeziectomy with or without a ligament reconstruction for intermetacarpal stabilization associated or not with tendon interposition (possibly with a synthetic insert); cemented or non-cemented trapezio-metacarpal prosthesis and arthrodesis. The purpose of this work was to report our experience with the modified Eaton-Littler technique and determine the current contribution of total trapeziectomy – ligament reconstruction – tendon interposition. Material and methods: We report a series of 26 patients who underwent surgery between 1994 and 2002 for trapezium resection associated with intercarpal ligamentoplasty and «anchovy» interposition using a flexor carpi radialis hemi-tendon. The series involved 21 patients, 16 women and 5 men, with invalidating basal joint osteoarthritis unresponsive to medical treatment. The Dell classification was stage II and III. Mean age was 58.6 years. Five patients underwent surgery on both wrists. One patient had had a prior operation on one side and a Swanson implant on the other. The mean follow-up was 66.1 months (range 25–131 months). Results: For these 22 cases, outcome at last follow-up was satisfactory with complete resolution of pain, excellent joint mobility with a mean Kapandji score of 9.5/10 (range 8–10). Half of the wrists exhibited deficient pinch and grasp force. Mean postoperative force was 20 kg (range 8–28 kg). Radiographically, scaphometacarpal collapse was nearly complete in all cases. For four cases, outcome was considered poor because of nearly constant pain with reduced mobility and a mean Kapandji score of 5/10. Three patients developed a reflux dystrophy: one of these patients achieved a final satisfactory result. There had been no revisions at last follow-up. Discussion: All the proposed techniques appear to give good results in terms of pain relief. Trapiezectomy with ligamentoplasty appears to provide good results at mean six months follow-up, results which are reliable and sustained over time. Trapezio-metacarpal prostheses give good immediate results in selected patients but the rate of failure at mid-term remains high, mainly due to loosening. Second generation cemented prostheses are promising. Trapezial implants have specific complications. Trapeiometacarpal arthrodesis gives good stability of the thumb column and is particularly indicated for young active patients with less consideration on the esthetic aspect of their hand, keeping in mind the significant rate of nonunions. Conclusion: Despite the significant progress achieved with trapeziometacarpal prosthetic arthroplaasty, we still believe that complete resection of the trapezium with ligament reconstruction associated with tendon interposition remains the gold standard in terms of patient satisfaction and reliable results for the surgical treatment of basal joint osteoarthritis

The August 2023 Wrist & Hand Roundup360 looks at: Complications and patient-reported outcomes after trapeziectomy with a Weilby sling: a cohort study; Swelling, stiffness, and dysfunction following proximal interphalangeal joint sprains; Utility of preoperative MRI for assessing proximal fragment vascularity in scaphoid nonunion; Complications and outcomes of operative treatment for acute perilunate injuries: a systematic review; The position of the median nerve in relation to the palmaris longus tendon at the wrist: a study of 784 MR images; Basal fractures of the ulnar styloid? A randomized controlled trial; Proximal row carpectomy versus four-corner arthrodesis in SLAC and SNAC wrist; Managing cold intolerance after hand injury: a systematic review

The December 2024 Wrist & Hand Roundup. 360. looks at: Variability in thumb ulnar collateral ligament rupture management across the UK: survey insights; Identifying five distinct hand osteoarthritis pain phenotypes highlights the impact of biopsychosocial factors; Long-term outcomes of MAÏA TMC joint prosthesis for osteoarthritis: a possible alternative to trapeziectomy; Diagnostic and management strategies for malignant melanoma of the hand; Early versus delayed surgery for distal radius fractures: comparable outcomes but higher complications in delayed treatment; Perioperative anticoagulant and antiplatelet use does not increase complications in wide-awake hand surgery; Variability in treatment of metacarpal shaft fractures highlights need for standardized care; Low-intensity pulsed ultrasound ineffective in reducing time to union for scaphoid nonunion post-surgery

Aims. Base of thumb osteoarthritis (BTOA) is a common age-related disease which has a significant negative impact upon quality of life. Our aim was to assess current UK practice in secondary care with regard to the nature of non-surgical treatments, the surgical procedures most commonly performed, and factors influencing the surgical decision-making process. Methods. Ten consecutive patients undergoing surgery for BTOA between March 2017 and May 2019 were prospectively identified in 15 UK centres. Demographic details, duration of symptoms, radiological grade, non-surgical management strategies, and surgery conducted were recorded. A supplementary consultant questionnaire consisting of four multiple-choice-questions (MCQ) based on hypothetical clinical scenarios was distributed. Results. A total of 150 patients were identified with a mean age of 64 years (SD 9), comprising 119 females and 31 males. Median duration of symptoms prior to surgery was 24 months (Interquartile range (IQR) 12 to 40). Hand therapy was used in 67 patients (45%), splints in 80 (53%), and 121 patients (81%) received one or more intra-articular injections, of which 81 (67%) were image-guided (14 (12%) ultrasound and 67 (55%) fluoroscopic). Only 48 patients (32%) received all three non-surgical treatments. Simple trapeziectomy (79 patients) and trapeziectomy with ligament reconstruction and/or tendon interposition (69 patients) were the most commonly performed operations. One patient was treated with arthrodesis, and one with arthroplasty. The supplementary questionnaire revealed that no specific patient or disease characteristics significantly influenced the type of surgery undertaken. Conclusion. We found considerable variation in practice of both non-surgical and surgical management of BTOA. The proportion of patients exhausting non-surgical strategies before being offered surgery is low. Surgeons tend to favour a single type of surgery irrespective of patient or disease characteristics. Cite this article: Bone Joint J 2020;102-B(5):600–605

Introduction. Despite the rising popularity of 1st carpometacarpal joint (CMCJ) arthrodesis as one of the surgical options for basilar thumb arthritis, the available literature on this is poor. This study aims to investigate post-operative pinch and grip strength following 1st CMCJ arthrodesis, at a minimum of 1 year follow-up. Complication rates, range of motion and patient reported scores were also evaluated. Methods. A retrospective cohort (2012–2020) was used, which included patients who had arthrodesis performed by the Hands surgeons at Counties Manukau DHB. In a 15 minute visit, we took the measurements using our standard dynamometer and pinch gauge, and collected three questionnaires [QuickDASH, PRWHE, PEM]. For analysis, we compared our results to the preoperative measures, contralateral hand, and to a previous study on a similar cohort looking at thumb strength following trapeziectomy. Results. 42 arthrodesis were performed, and 24 were available for follow-up. The average follow-up time was 77 months and the average age was 51 years old. Overall, we found a statistically significant improvement in thumb strength following surgery. Mean preoperative grip strength was 21.4kg and 32.5kg postoperatively (= +11kg). Preoperative pinch strength was 5.5kg and 7kg postoperatively (= +1.5kg). These results were significantly higher compared to the trapeziectomy cohort. We also found an improvement in 1st CMCJ ROM post-operatively. 7 complications were reported (29.1%). 4 were metalware-related and 3 were non-union. QuickDASH score significantly improved from a median of 42.95 to 12.5 while PRWHE from 67.5 to 14.5. Overall patient satisfaction was 87.4%. Conclusion. 1st CMCJ arthrodesis leads to an improvement in thumb function, pain and range of movement and results in high patient satisfaction, and therefore should be recommended for younger patients who need a pain-free and strong thumb

Tourniquet is a commonly used tool in orthopaedic practice. Incidence of complications is low but if any develops, it is devastating. Transient nerve damage, ischemia or skin burns are the possible tourniquet related complications. There is big variation in practice regarding the limb occlusion pressure. 51 procedures in 50 patients were reviewed retrospectively in our district general hospital. We looked at quality of documentation guided by the BOAST standard (The Safe Use of Intraoperative Tourniquets, published in October 2021). Limb occlusion pressure and ischemic time were analysed. Intra-operative and post-operative notes were reviewed to assess quality of documentation and post-operative complications. Although limb occlusion pressure was above the recommended range in more than 75% of cases, there were no significant complications observed. Two cases only developed transient neuropraxia in common peroneal nerve and median nerve following tibial plateau ORIF and trapeziectomy simultaneously. Tibial ORIF fixation case had prolonged ischemic time (more than 120 minutes) and the limb occlusion pressure for the hand case was above the recommended range. Both have recovered within few days with no long-term consequences. Minimum documentation threshold was not met with regarding tourniquet site condition, method of skin isolation and padding, and exsanguination method. This relatively new standard with no previous similar guidance needs time until it is followed by the health care professionals especially when there is no high incidence of complications related to the use of the tourniquet. However, it is crucial to increase the theatre staff awareness of such standards. This will prevent devastating complications specifically in vulnerable patients. Adjustments to theatre checklist have been suggested to improved documentation. Additionally, local teaching sessions will be delivered to theatre personnel aiming at improving our compliance to this standard

Objectives. Little is known about tissue changes underlying bone marrow lesions (BMLs) in non-weight-bearing joints with osteoarthritis (OA). Our aim was to characterize BMLs in OA of the hand using dynamic histomorphometry. We therefore quantified bone turnover and angiogenesis in subchondral bone at the base of the thumb, and compared the findings with control bone from hip OA. Methods. Patients with OA at the base of the thumb, or the hip, underwent preoperative MRI to assess BMLs, and tetracycline labelling to determine bone turnover. Three groups were compared: trapezium bones removed by trapeziectomy from patients with thumb base OA (n = 20); femoral heads with (n = 24); and those without (n = 9) BMLs obtained from patients with hip OA who underwent total hip arthroplasty. Results. All trapezium bones demonstrated MRI-defined BMLs. Compared with femoral heads without BMLs, the trapezia demonstrated significantly higher bone turnover (mean . sd. 0.2 (0.1) versus 0.01 (0.01) µm. 3. /µm. 2. /day), mineralizing surface (18.5% (13.1) versus 1.4% (1.3)) and vascularity (5.2% (1.1) versus 1.2% (0.6)). Femoral heads with BMLs exhibited higher bone turnover (0.3 (0.2) versus 0.2 (0.1) µm. 3. /µm. 2. /day), a higher mineralization rate (26.6% (10.6) versus 18.6% (11.9)) and greater trabecular thickness (301.3 µm (108) versus 163.6 µm (24.8)) than the trapezia. Conclusion. Bone turnover and angiogenesis were enhanced in BMLs of both the thumb base and hip OA, of which the latter exhibited the highest bone turnover. Thus, the increase in bone turnover in weight-bearing joints like the hip may be more pronounced than less mechanically loaded osteoarthritic joints demonstrating BMLs. The histological changes observed may explain the water signal from BMLs on MRI. Cite this article: M. Shabestari, N. J. Kise, M. A. Landin, S. Sesseng, J. C. Hellund, J. E. Reseland, E. F. Eriksen, I. K. Haugen. Enhanced angiogenesis and increased bone turnover characterize bone marrow lesions in osteoarthritis at the base of the thumb. Bone Joint Res 2018;7:406–413. DOI: 10.1302/2046-3758.76.BJR-2017-0083.R3