title: Treatment of a symptomatic trapezial dysplasia with metacarpal instability following thumb metacarpal lengthening with an addition-subtraction osteotomy.
abstract: The most important problem of trapezial dysplasia with thumb metacarpal instability is of bony origin. Together with the progressive capsuloligamentous decompensation it evolves in a progressive adduction deformity of the thumb metacarpal secondary to the dysplasia of the trapezium with its increased articular slope. The addition-subtraction osteotomy restores the anatomy combining two techniques: an abduction-extension osteotomy of the first metacarpal to correct the axis of the first metacarpal and an opening wedge osteotomy of the trapezium to reorientate the trapezial saddle. We present a case of an addition-subtraction osteotomy in a case of symptomatic trapezial dysplasia with metacarpal instability following a thumb metacarpal lengthening in a severely mutilated hand. This technique was especially effective in reducing the instability and pain but mainly in maintaining mobile the only remaining joint of the thumb.
authors.affiliation: Department of Orthopaedic Surgery, AZ Sint-Jan AV Brugge - Oostende, Campus Brugge, Ruddershove 10, 8000 Brugge, Belgium; Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: C K
authors.initials: CK
authors.lastname: Goorens
authors.affiliation: Department of Orthopaedic Surgery, AZ Sint-Jan AV Brugge - Oostende, Campus Brugge, Ruddershove 10, 8000 Brugge, Belgium; Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium. Electronic address: jean.goubau@azsintjan.be.
authors.forename: J-F
authors.initials: JF
authors.lastname: Goubau
authors.affiliation: Department of Orthopaedic Surgery, AZ Sint-Jan AV Brugge - Oostende, Campus Brugge, Ruddershove 10, 8000 Brugge, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Van Hoonacker
authors.affiliation: Department of Orthopaedic Surgery, AZ Sint-Jan AV Brugge - Oostende, Campus Brugge, Ruddershove 10, 8000 Brugge, Belgium.
authors.forename: D
authors.initials: D
authors.lastname: Kerckhove
authors.affiliation: Department of Orthopaedic Surgery, AZ Sint-Jan AV Brugge - Oostende, Campus Brugge, Ruddershove 10, 8000 Brugge, Belgium.
authors.forename: B
authors.initials: B
authors.lastname: Berghs
mesh_terms: D000328:Adult; D001852:Bone Lengthening; D050823:Hand Joints; D006801:Humans; D007593:Joint Instability / Q000150:complications / Q000601:surgery*; D008297:Male; D050279:Metacarpal Bones / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D013933:Thumb; D051222:Trapezium Bone / Q000002:abnormalities* / Q000601:surgery*
keywords: Addition-soustraction; Addition-subtraction; Allongement métacarpien; Dysplasie trapézienne; Metacarpal lengthening; Osteotomy; Ostéotomie; Trapezial dysplasia