Numerous surgical procedures have been described to treat trapeziometacarpal osteoarthritis, but no approach is currently considered superior. Good long-term outcomes have been reported with multiple procedures. No studies have been published comparing outcomes of the Arpe joint replacement (Biomet, Valence, France) with those of ligament reconstruction and tendon interposition (LRTI) using the Burton-Pellegrini technique. The study objective was to compare clinical outcomes between these techniques. Sixty-five patients with Eaton stage III osteoarthritis of the thumb were included in this retrospective follow-up study. Patients were assigned to LRTI (LRTI group) or total joint replacement (Arpe group) and were followed for a mean of 4.8 years. The LRTI group included 34 patients and the Arpe group included 31. Clinical outcome variables were determined preoperatively and every 6 months postoperatively. Pain relief and functional improvement were similar between groups. Pinch strength and range of motion were superior in the Arpe group. Metacarpophalangeal hyperextension appeared to be prevented in the Arpe group but increased over the follow-up period in the LRTI group. However, the complication rate was higher in the Arpe group. Arthroplasty with the Arpe prosthesis can be considered in selected patients who require greater strength and range of motion, although it has been associated with a higher complications rate. [Orthopedics. 2017; 40(4):e681-e686.].

The aim of this study was to evaluate clinical and radiographic outcomes of Elektra® trapeziometacarpal prostheses after 2 years. We present a longitudinal cohort study of 19 prostheses for the treatment of Eaton stage II and III osteoarthritis (mean follow-up of 29 months). QuickDASH score, pinch strength and mobility were determined, and radiographs were analysed. Isotope scans were taken in patients with persistent pain or suspected loosening. Although the QuickDASH score was 69 before and 38 after surgery, nine patients had pain at the trapeziometacarpal joint with radiographic osteolysis around the trapezium component and a positive bone scan uptake at subsequent follow-up. The implant was revised in three of these nine patients and another patient underwent surgery for periprosthetic fracture. Only ten of the 19 implants showed no sign of failure. Most problems derived from the trapezium cup. Because of these poor outcomes after only 2 years, we cannot recommend this implant.

The incidence of fractures of the hamate hook (hamulus) has been reported to be between 2% and 4% of all carpal fractures. Untreated hamulus nonunion can cause attritional rupture of the ulnar digits’ flexor digitorum profundum tendons. Rupture of flexor tendons due to nonunion of the hook of the hamate is an uncommon injury. Most surgeons treat the tendon lesion by a graft, transfer of the superficial flexor of the ring finger, or terminolateral suture of the distal stump of the deep flexor tendon of the little finger to the deep flexor tendon of the ring finger. This article reports a case of a 52-year-old right-handed man who presented with weakness of grip and loss of active flexion of both distal and proximal interphalangeal joints of the right small finger lasting 2 weeks due to grip strength while working. The clinical history and the physical examination were dissonant, and a computed tomography scan revealed a nonunion of the hamulus. Intraoperatively, the nonunion of the hamate hook was identified and the bony ossicle excised. The flexor digitorum profundus and superficialis to the small finger were both ruptured. The flexor digitorum profundus tendon was repaired with a termino-terminal suture. The patient returned to work within 3 months without restriction. Six months postoperatively, the patient had no pain and achieved full active flexion of the small finger.