BACKGROUND
Simple excision of the trapezium or in combination with soft tissue or silicone interposition, fusion, ligament reconstruction or total joint replacement, remains an effective surgical treatment for trapezio-metacarpal osteoarthritis. Excision of the trapezium is often challenging due to its small dimensions and intimate ligamentous attachments. When removed piece-meal, remnants of trapezium left in situ may cause persistent symptoms. We describe a simple surgical technique to aid single piece trapezial excision.
TECHNIQUE
The trapezium is approached via a volar incision centred over the trapezio-metacarpal joint. The midpoint of the volar aspect of the trapezium is identified and perforated in the antero-posterior plane using a 2.5-mm drill. A standard 3.5-mm partially threaded cortical screw of 18-mm length is inserted into the drill hole utilising the full threaded length (Fig. 1). The screw is held using a pair of Kocker's forceps and sharp dissection is carried out aided by ‘joysticking’ and tractioning manoeuvres via the forceps. The trapezium is thereby delivered as a single piece.
Figure 1.
Cortical screw inserted into the trapezium.
DISCUSSION
Due to inaccessibility of all trapezial ligaments using conventional techniques, often piece-meal trapeziectomy is unavoidable. This may result in risk of injury to surrounding structures, increased operation time and incomplete excision of trapezial fragments. The senior author (SA) has employed this method of trapeziectomy for over 10 years without major complications. We believe this to be a safe and reproducible technique for excising the trapezium as one piece.