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Introduction
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
The hand and wrist have 27 bones. The thumb has the shortest metacarpal articulating with the proximal phalanx to perform various vital functions (Figure 1.8). It has two phalanges and one metacarpal articulating with the trapezium. The trapezium is angled out in front of the carpal plane. The angle made by the first metacarpal to the second is about 45°, and this is the reason for more delicate movements of thumb in the given circumstances (Figure 1.9). The index, middle, ring and little fingers have an unequal length with one metacarpal and three phalanges each (Table 1.2).
Surgery of the Wrist
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Ramon Tahmassebi, Sirat Khan, Kalpesh R Vaghela
The first carpometacarpal joint (CMCJ) is a biconcave saddle joint and can be considered to be composed of several joints forming a complex articulation – the trapezium-metacarpal, trapezium-trapezoid and scapho-trapezium-trapezoid (STT) joints. Basilar thumb arthritis is common and is thought to be caused by a combination of anatomic and biologic factors. Trapeziectomy is a well-described procedure that is essentially an excision arthroplasty. The trapezium in its entirety may be excised leading to an improvement in pain. There is no single best technique, and a multitude of variations have been proposed. The greatest controversy surrounds the use of additional procedures to augment the stability of the first metacarpal. These ‘ligament reconstruction’ procedures aim to restore the subluxed and adducted first metacarpal to a more functional position after the trapezium has been excised. In theory, they also aim to provide a greater restraint to axial loading of the first metacarpal. However, their effectiveness is much debated. The following description is an overview of a simple trapeziectomy undertaken through a dorsal approach. A volar approach has also been described and may be used, again with a multitude of variations.
Hand and Wrist Radiography
Published in Russell L. Wilson, Chiropractic Radiography and Quality Assurance Handbook, 2020
The oblique view of the wrist will project the trapezium and trapezoid carpal bones free of any superimposition. The scaphoid tuberosity and wrist will be clearly visualized. The anterior and posterior articular surfaces of the radius should be superimposed.
Cross-sectional changes of the distal carpal tunnel with simulated carpal bone rotation
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Carpal bone mobilization is a therapeutic technique where the carpal bones are manipulated through multidirectional glide or distraction at the radiocarpal and midcarpal joint. When used in conjunction with wrist splinting, these techniques have shown improvement in carpal tunnel syndrome symptom severity (Huisstede et al. 2010). Previous studies suggest that physical methods which apply forces at or near the carpal bones may serve to decompress the median nerve by increasing the CAA (Marquardt et al. 2015) or total CSA (Bueno-Gracia, Pérez-Bellmunt, et al., 2018; Bueno-Gracia, Ruiz-de-Escudero-Zapico, et al. 2018). The results of this study support these previous findings which show how carpal bone motion can increase the carpal tunnel space near the median nerve. Additionally, the results of this study suggest that carpal bone mobilization techniques which induce inward rotation of the hamate and trapezium may act to increase the CAA, thus relieving the pressure at the median nerve and alleviating the associated carpal tunnel syndrome symptoms.
Displaced isolated coronal shearing fracture of the trapezoid: a case report
Published in Case Reports in Plastic Surgery and Hand Surgery, 2021
Yuya Otake, Koji Sukegawa, Kenji Onuma, Shuhei Machida, Riyo Iida, Masashi Takaso
We scheduled an operation with a dorsal approach, four days after the injury. We made a 3 cm longitudinal incision directly over the trapezoid. The trapezoid was exposed, but the fracture site could not be identified dorsally, and reduction could not be be achieved by traction on the fingers and compression of the dorsal bone fragment. Therefore, we severed the second metacarpal-trapezoid ligament and trapezium-trapezoid ligament, and exposed the proximal surface of the second carpometacarpal (CM) joint. The dorsal fragment was identified and inverted to remove the intraarticular hematoma, small bone fragments, and granulation tissue (Figure 3(A)). Thereafter, reduction could be achieved by pushing the dorsal bone fragment to align with the volar fragment, and guide pins were inserted. We assessed the reduction by direct inspection of the proximal joint surface of the second CM joint and confirmed it under fluoroscopy (Figure 3(B,C)). The correct trajectory of the guide pin was also established under fluoroscopy (Figure 3(C,D)) before insertion of a headless compression screw (DTJ mini screw; Meira Co., Ltd., Nagoya, Japan; width proximal 3.4 mm, distal 2.7 mm, length 20 mm). After satisfactory fixation of the fracture, the dissected second metacarpal-trapezoid ligament and trapezium-trapezoid ligament and capsule were repaired. Kirschner wires were used to reduce the pressure on the trapezoid (Figure 4). Rehabilitation of the fingers was initiated immediately postoperatively. The Kirschner wires were removed after two weeks, and range-of-motion exercises were started.
A voxel-based method for designing a numerical biomechanical model patient-specific with an anatomical functional approach adapted to additive manufacturing
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2019
Augustin Lerebours, Frederic Marin, Salima Bouvier, Christophe Egles, Alain-Charles Masquelet, Alain Rassineux
To test the configurability and the universality of the designed model we used four healthy trapezium bones removed from two diseased patients (males aged 61 and 66, left and right trapeziums). The bones were provided by the Académie Nationale de Chirurgie in Paris, and any evidence of pathology was reported by the surgeon. Specimens were stripped of cartilage and soft tissue, dried by immersion in acetone and underwent a fat-removal procedure. All the specimens were scanned with a clinical computed tomography (CT) (slice thickness of 0.625 mm and pixel size of 0.328 mm × 0.328 mm). Manual segmentation (3D Slicer® (Slicer.4.8)), with a threshold value suitable for extracting cortical bone (CT-AAA2: 129.54), was applied prior to the 3D reconstruction using discrete marching cubes with no iterations of smoothing (Lorensen and Cline 1987). 3D models were exported as STL files. The left trapeziums were mirrored, and all were scaled in order to make the distance between the center of the second metacarpal and the scaphoid contact surfaces correspond to an average value (16.846 mm).