Does thumb metacarpophalangeal arthrodesis increase trapeziometacarpal loading?

IF 0.9 4区医学 Q4 ORTHOPEDICS

Hand Surgery & Rehabilitation Pub Date : 2025-04-01 DOI:10.1016/j.hansur.2025.102110

Pascal Ledoux

{"title":"Does thumb metacarpophalangeal arthrodesis increase trapeziometacarpal loading?","authors":"Pascal Ledoux","doi":"10.1016/j.hansur.2025.102110","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>The combination of a trapeziometacarpal prosthesis and a metacarpophalangeal arthrodesis of the thumb was formally contraindicated by JY de la Caffinière. This is a landmark notion, but no theoretical, experimental or clinical study has confirmed it. Combined indications for arthrodesis and trapeziometacarpal prosthesis are rare. Isolated arthrodesis is more common. In both cases, it is important to avoid overloading the trapeziometacarpal joint.</div></div><div><h3>Aim</h3><div>The aim of this study is to verify whether metacarpophalangeal arthrodesis really does increase the load on the trapeziometacarpal joint, taking into account bone shortening and the angle at which the arthrodesis is performed. The second aim is to review the literature on series of metacarpophalangeal thumb arthrodeses.</div><div>Material & Methods: We used a previously developed 2-dimensional mathematical model to calculate stresses at the trapeziometacarpal joint during a key pinch grip. We calculated stresses at constant thumb column lenght, and after 6 and 8 mm shortening to account for the bone resection required to perform arthrodesis. We also tested several levels of flexion between the metacarpal and the first phalanx in the arthrodesis situation.</div></div><div><h3>Results</h3><div>All other parameters being equal, we found a 118% increase in trapeziometacarpal stress after metacarpophalangeal arthrodesis. When arthrodesis is performed at 25 ° of flexion, the trapeziometacarpal stress level is comparable to the physiological situation.</div></div><div><h3>Conclusions</h3><div>Arthrodesis does not increase trapeziometacarpal stress when performed at 25 ° flexion. Under these conditions, metacarpophalangeal arthrodesis does not increase the risk of trapeziometacarpal osteoarthritis, and is compatible with a trapeziometacarpal prosthesis.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"44 2","pages":"Article 102110"},"PeriodicalIF":0.9000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hand Surgery & Rehabilitation","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2468122925000325","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

The combination of a trapeziometacarpal prosthesis and a metacarpophalangeal arthrodesis of the thumb was formally contraindicated by JY de la Caffinière. This is a landmark notion, but no theoretical, experimental or clinical study has confirmed it. Combined indications for arthrodesis and trapeziometacarpal prosthesis are rare. Isolated arthrodesis is more common. In both cases, it is important to avoid overloading the trapeziometacarpal joint.

Aim

The aim of this study is to verify whether metacarpophalangeal arthrodesis really does increase the load on the trapeziometacarpal joint, taking into account bone shortening and the angle at which the arthrodesis is performed. The second aim is to review the literature on series of metacarpophalangeal thumb arthrodeses.

Material & Methods: We used a previously developed 2-dimensional mathematical model to calculate stresses at the trapeziometacarpal joint during a key pinch grip. We calculated stresses at constant thumb column lenght, and after 6 and 8 mm shortening to account for the bone resection required to perform arthrodesis. We also tested several levels of flexion between the metacarpal and the first phalanx in the arthrodesis situation.

Results

All other parameters being equal, we found a 118% increase in trapeziometacarpal stress after metacarpophalangeal arthrodesis. When arthrodesis is performed at 25 ° of flexion, the trapeziometacarpal stress level is comparable to the physiological situation.

Conclusions

Arthrodesis does not increase trapeziometacarpal stress when performed at 25 ° flexion. Under these conditions, metacarpophalangeal arthrodesis does not increase the risk of trapeziometacarpal osteoarthritis, and is compatible with a trapeziometacarpal prosthesis.

查看原文本刊更多论文

求助全文

约1分钟内获得全文求助全文

来源期刊

Hand Surgery & Rehabilitation Medicine-Surgery

CiteScore

1.70

自引率

27.30%

发文量

审稿时长

49 days

期刊介绍： As the official publication of the French, Belgian and Swiss Societies for Surgery of the Hand, as well as of the French Society of Rehabilitation of the Hand & Upper Limb, ''Hand Surgery and Rehabilitation'' - formerly named "Chirurgie de la Main" - publishes original articles, literature reviews, technical notes, and clinical cases. It is indexed in the main international databases (including Medline). Initially a platform for French-speaking hand surgeons, the journal will now publish its articles in English to disseminate its author''s scientific findings more widely. The journal also includes a biannual supplement in French, the monograph of the French Society for Surgery of the Hand, where comprehensive reviews in the fields of hand, peripheral nerve and upper limb surgery are presented. Organe officiel de la Société française de chirurgie de la main, de la Société française de Rééducation de la main (SFRM-GEMMSOR), de la Société suisse de chirurgie de la main et du Belgian Hand Group, indexée dans les grandes bases de données internationales (Medline, Embase, Pascal, Scopus), Hand Surgery and Rehabilitation - anciennement titrée Chirurgie de la main - publie des articles originaux, des revues de la littérature, des notes techniques, des cas clinique. Initialement plateforme d''expression francophone de la spécialité, la revue s''oriente désormais vers l''anglais pour devenir une référence scientifique et de formation de la spécialité en France et en Europe. Avec 6 publications en anglais par an, la revue comprend également un supplément biannuel, la monographie du GEM, où sont présentées en français, des mises au point complètes dans les domaines de la chirurgie de la main, des nerfs périphériques et du membre supérieur.