Prognostic factors for the recovery of hand function following trapeziectomy with ligamentoplasty stabilisation.
BACKGROUND
Numerous procedures are in use to treat trapeziometacarpal osteoarthritis. Most of these techniques impair hand function. In a series of trapeziectomies stabilized by ligament reconstruction with tendon suspension, we investigated whether eventual parameters influenced hand function and dexterity.


OBJECTIVE
Some parameters influence hand function recovery following trapeziectomy combined to ligamento-tendinous stabilization.


METHODS
This is a continuous, retrospective, single surgeon series; 60 cases of thumb trapeziometacarpal osteoarthritis were treated with trapeziectomy and ligament reconstruction (40 palmaris longus, and 20 half flexor carpi radialis) with no additional metacarpophalangeal (MCP) joint surgery. Besides assessing classical clinical outcome criteria (pain, mobility, force), we analyzed hand function: this was obtained with a questionnaire about different everyday movements. Five types of grip were included in this analysis: spherical, pinch grasp, key pinch, power grip, and precision pinch.


RESULTS
Fifty-one trapeziectomies (85%) were evaluated at an average follow-up of 7.5 years (5-11.5). Ninety-four percent of patients had good results for pain. The average Kapandji score for mobility was 9.6 (6-10) with a mean web angle at 36.5 degrees. Hyperextension of the MCP joint occurred in 36 cases and measured an average of 26 degrees (5 degrees-50 degrees). Compared to the contralateral side average strength was 97% with the Jamar dynamometer and 88% for the key pinch. The rate of satisfaction was 96%. Collapse of trapezial height was constant, and at last follow-up, the trapezial index was 50% of its preoperative initial value. The results relative to hand function assessment were good in 58% of patients. The spherical grip was the most difficult to restore. The analysis of the 42% of patients with average or poor hand function showed five prognostic factors for a poor outcome: young age at surgery, persisting postoperative pain, postoperative hyperextension of the MCP joint, reduced postoperative web angle and trapezial space collapse.


METHODS
Level IV. Therapeutic study.
Moineau
G
G
Orthopaedic and Traumatology Department, La Cavale Blanche Teaching Hospital Center, boulevard Tanguy-Prigent, 29200 Brest, France. gregorymoineau@wanadoo.fr
Richou
J
J
Liot
M
M
Le Nen
D
D
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength / Q000502:physiology*; D006801:Humans; D008023:Ligaments, Articular / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D050279:Metacarpal Bones / Q000601:surgery; D008875:Middle Aged; D009048:Motor Skills / Q000502:physiology; D010003:Osteoarthritis / Q000601:surgery*; D010147:Pain Measurement; D052581:Pinch Strength / Q000502:physiology*; D011183:Postoperative Complications / Q000503:physiopathology*; D016059:Range of Motion, Articular / Q000502:physiology*; D012189:Retrospective Studies; D013710:Tendons / Q000601:surgery; D013933:Thumb / Q000601:surgery*; D051222:Trapezium Bone / Q000601:surgery*