Thumb carpometacarpal (CMC) osteoarthritis is painful and debilitating. Here, we explore outcomes of a modular, press-fit thumb CMC hemiarthroplasty prosthesis (BioPro). This surgical option permits minimal bone resection, sparing the trapezium, hence allowing revision options if necessary. A retrospective review of all cases of the modular thumb CMC implants performed at one community US center between 2018 and 2021 were included and invited for email or telephone review. Electronic records were examined for demographics, patient outcomes, and morbidity. Eleven patients underwent 11 thumb CMC joint hemiarthroplasties, mean age was 64.8 years (SD: 7.68 y), with 6 females. Six received surgery on their dominant extremity. Two were manual workers (both in the medical field), 6 office-based, 2 retired, and 1 homemaker. The preoperative median pain score (Visual Analog Score) was 8/10 (range: 5 to 10), reducing to 1/10 (range: 1 to 10) ( P =0.000033) with a median follow-up of 23 months (range: 13 to 39 mo). In all, 8/11 patients reported they would recommend this surgery to friends and family and opt for the same surgery on their contralateral hand if necessary. One patient reported persistent pain a year postoperatively. On review, the head of the implant was placed too deep into the trapezium. Another center found that this patient had a postoperative trapezium fracture and underwent revision with implant removal and conversion to a suspension arthroplasty. At 12 months, 10/11 thumb CMC hemiarthroplasty showed good pain relief, function, and patient satisfaction. The BioPro has a low risk of subluxation and allows salvage options to remain available should failure occur.

Trapezium fracture is a rare condition that goes undetected and exposes to long-term comorbidities: chronic pain and rhizartrosis. Our work aims to summarize the clinical presentation and improve leading to therapeutic guidelines which are not well established by reporting a case of ORIF with mini-screws for a displaced fracture of the body of the trapezium with a satisfactory outcome.

Thumb carpometacarpal (CMC) arthroplasty with resection of the trapezium and soft tissue interposition, with or without ligament reconstruction, has historically proven to be an efficacious treatment for thumb CMC arthritis. The incidence of failure following primary thumb CMC arthroplasty is low; however, the evaluation and management of a patient experiencing an unsatisfactory outcome following CMC arthroplasty is challenging. If symptoms are refractory to conservative measures, then revision surgical treatment may be indicated. Clinical decision making becomes even more complicated in cases of failure after an initial revision surgery has already been performed. In patients with a failed CMC arthroplasty revision in whom all soft tissue options have been exhausted, the senior author considers arthrodesis of the first metacarpal base to the second metacarpal base as a salvage procedure. The authors describe this surgical technique and present our experience with 4 cases in 3 patients who underwent this surgical intervention. Successful radiographic fusion was achieved in all 4 cases, with satisfactory clinical outcome in 3 out of 4 cases, supporting this surgical technique as a definitive option for patients who have failed multiple CMC arthroplasty revision surgeries.

We describe the case of a 58-year-old woman with AVN of the left trapezium which was treated surgically. This paper aims to review the etiologies leading to the pathology and the different therapeutic options. Avascular necrosis (AVN) of the carpal bones most commonly involves the lunate and the scaphoid . AVN of the trapezium is extremely rare. To our knowledge only 3 cases have been published in the literature so far and they were all treated differently.

Acrometastasis is extremely rare, accounting for 0.1% of all skeletal metastases. Metastases to the carpus are rarer still. This condition can be the first manifestation of an occult malignancy and generally indicates advanced disease. We present the case of a 53-year-old woman with acrometastasis of squamous cell lung cancer to the trapezium as the initial presentation of her malignancy.
The presentation of acrometastasis can mimic infectious or inflammatory processes, leading to an erroneous diagnosis. Although exceptionally uncommon, it is important to consider as a differential diagnosis for a destructive hand lesion.

To report a poorly described etiology for pain after trapeziectomy and soft tissue basal joint arthroplasty, diagnosed with the aid of nuclear imaging.
Five patients (4 women and 1 man), average age 62 years (range, 59-65 years) presented with pain an average of 7 months (range, 2-11 months) after basal joint arthroplasty. The dominant hand was involved in all cases. Advanced imaging including 25 mCi 99mTc methylene diphosphonate bone scintigraphy and single-photon emission computed tomography (CT) showed intense tracer uptake between the base of the thumb metacarpal and residual trapezoid. Computed tomography scans confirmed abutment between these bones. The symptoms were attributed to this finding, and revision surgery consisting of excision of the trapezoid and arthrodesis of the index and middle finger carpometacarpal joints was performed.
Mean follow-up was 40 months (range, 12-60 months). Grip strength improved from a mean of 10.5 to 23 kg, and lateral pinch strength improved from a mean of 3 to 6.75 kg. Radiographic fusion of the index finger metacarpal to capitate was confirmed in 4 of 5 patients; it was indeterminate in one patient who was completely pain-free. Radiographic fusion of long finger carpometacarpal joints was indeterminate in 3 patients. Patient-Rated Wrist Evaluation pain scores improved from 35 to 6, Patient-Rated Wrist Evaluation function scores from 78 to 14, and Quick-Disabilities of the Arm, Shoulder, and Hand scores from 37 to 18.
Impingement between the base of the thumb metacarpal and remaining trapezoid should be considered a potential source of pain after trapeziectomy and soft tissue arthroplasty. Advanced imaging (bone scintigraphy and single-photon emission CT and standard CT) are helpful to confirm the diagnosis.
Therapeutic V.

Trapeziometacarpal joint arthritis is a prevalent condition with a preponderance to women. Most cases are asymptomatic, but typical symptoms are pain, reduced dexterity, and functional decline. Trapeziectomy is the most common surgical treatment in the United Kingdom for patients who remain significantly symptomatic despite nonoperative measures, and this generally produces acceptable outcomes; however, a proportion of patients remain significantly symptomatic. The authors present a case series of 4 patients who underwent successful thumb metacarpal base to index metacarpal base arthrodesis with either distal radial or iliac crest bone grafting. Three of these patients had persisting symptoms after a primary trapeziectomy and 1 patient had gross subluxation of the thumb related to rheumatoid arthritis. Technically, this is a simple procedure to perform. All patients had improved symptoms with satisfactory functional outcomes and an improved cosmetic appearance of the hand.

UNASSIGNED: Trapezium, as a carpal bone positioned at the distal row, is often associated with other wrist injuries such as distal radius fracture. Isolated trapezium fracture, especially in a comminuted form, rarely occurs. There are only six reports of isolated comminuted trapezium fractures in the literature to the best of our knowledge.
METHODS: We present a case with an isolated comminuted trapezium fracture presenting pain in his thenar eminence and thumb motion limitation. He was treated by Open Reduction and Internal Fixation (ORIF) with the K wire pin.
UNASSIGNED: We searched the published related studies and summarized the signs and symptoms of patients presented with trapezium fracture. The most common presentation of trapezial fracture include pain/tenderness at the base of the first metacarpal bone, pain/tenderness at the snuffbox area and 1st digit motion limitation. The treatment options described in the literature for isolated comminuted trapezium fracture are also presented. Open reduction and fixation with pin is the most common treatment mentioned in the literature. The priority is restoring the scaphotrapezial and trapeziometacarpal joint congruency to save the 1st digit range of motion.
CONCLUSIONS: Comminuted trapezial fracture may happen following either low energy (like our patient) or high energy trauma. This paper highlights the fact that even a comminuted trapezium fracture can be easily missed. Regardless of the trauma mechanism (high energy versus low energy trauma), a high index of suspicion and delicate work up would be necessary in order not to miss this type of fracture.

There are only a few reports regarding snapping thumb caused by the pathology of the extensor tendon. We report a rare case of snapping thumb caused by a displaced non-union fragment from the trapezium in a 54-year-old man treated with the surgical resection. The intraoperative findings and the outcome are described.

Isolated scaphotrapeziotrapezoid (STT) osteoarthritis has functional consequences on the wrist. The main objective of our study was to evaluate the functional outcomes of patients managed surgically during the last 12 years at the Toulouse University Hospital, regardless of the surgical technique used, for isolated STT osteoarthritis. We performed a single-center retrospective observational study using the CCAM database. The inclusion criteria were patients treated surgically for isolated STT osteoarthritis who did not respond to conservative treatment, with at least 6 months of clinical and radiological follow-up. Twenty-four patients were treated between 2006 and 2018. Partial arthroplasty of the distal pole of the scaphoid with or without interposition and total trapeziectomy had been performed on these patients. The mean follow-up was 79±46.8 months. The wrist range of motion (ROM) and the Kapandji score were not significantly reduced postoperatively. The mean postoperative QuickDASH score was 29.15±8.46. The mean pain assessed using a visual analog scale was 6.6±1.17 preoperatively versus 1.25±1.51 postoperatively (P=0.003). Statistical subgroup analysis found no predictive factor for a better postoperative QuickDASH score, and no surgical technique was superior at halting the progression of intracarpal misalignment and postoperative ROM. Surgical treatment of isolated STT osteoarthritis resistant to conservative treatment leads to significant functional improvement, particularly in terms of pain, without altering the wrist\'s overall mobility.