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Comminuted intra-articular fractures of the metacarpophalangeal joint (MCPJ) of the thumb are difficult to treat because of challenges with anatomical fixation. The pins and rubbers traction system (PRTS), described by Suzuki et al., is a minimally invasive technique that enables early range-of-motion training while maintaining joint congruency. PRTS exhibits advantages relative to other dynamic external fixation techniques due to its simplicity, low cost and compact design. It has been used mainly in treating primarily proximal interphalangeal joint (IPJ) fractures. We present two patients where we used a PRTS for comminuted intra-articular fractures of the thumb MCPJ with good outcomes. We temporarily pinned the carpometacarpal joint (CMCJ) in maximum abduction to avoid skin irritation from the ulnar aspect of the axial traction wire in thumb adduction.

Level of Evidence: Level V (Therapeutic)

Basal cell carcinoma (BCC) is the most common skin malignancy arising from cells of the basal layer of the epithelium or from the external root sheath of the hair follicle. BCC of the digit is a rare entity. The article presents one such case of bowenoid BCC of the thumb which required amputation at the MP joint.

Giant cell tumours of tendon sheath are common in the hand but multiple lesions are relatively rare. A case report of bilateral symmetrical involvement is presented and discussed.

This prospective study compared the outcome — subjective, objective and radiographic — of two surgical techniques for treating basal joint arthritis of the thumb: a "simple" trapeziectomy (group I) and a ligament reconstruction/tendon (group II) interposition technique. There were respectively 22 patients in group I and 34 in group II, all women with primary osteoarthritis.

Both techniques gave favourable results and there were no significant differences for pain relief, patient satisfaction, mobility, DASH-score, key pinch force and gripping force. However in group II, the trapezial height was better preserved indicating that the proximal migration of the thumb was prevented or limited. There was also a significant correlation between the remaining trapezial space and key pinch force.

Nodular fasciitis is an uncommon, benign, reactive fibroblastic soft tissue tumour. It is infrequently seen in the hand. A case of nodular fasciitis involving the thumb of a 34-year-old male is reviewed, and its clinicopathologic features are presented. Main significance lies in clinical and pathological recognition of the lesion to avoid over-treatment.

Lifetime-standing psychosocial effects of congenital hand anomalies are inevitable in patients who have not received a comprehensive treatment with appropriate timing and approach. Herein, two adult cases of untreated thumb polydactyly are presented. Both of them had hands with striking appearance and late consequent psychosocial problems.

There are several surgical options for osteoarthritis (OA) of the thumb carpometacarpal (CMC) joint. This paper presents our long-term clinical and radiographic review of 12 thumbs in ten patients treated by partial trapezial excision and silicone-rubber interposition arthroplasty. The follow-up period averaged 15; three years with a ten-year minimum. Although the procedure provided early pain relief in most thumbs, all but two had mild to severe pain at follow-up. The average range of post-operative palmar abduction was 23°. The average post-operative grip strength was 9.5 kg. Both tip and key pinch between thumb and index finger averaged about 50% that of normal subjects. Dislocation of the implant occurred in two joints and breakages in five. Bony erosions around the implant, which we attributed silicone synovitis, were found in four thumbs. The indications for silicone-rubber interposition arthroplasty for OA of the thumb CMC joint should be severely restricted as these produced unsatisfactory long-term results.

Locking of the metacarpophalangeal (MP) joint of the fingers, though reported infrequently, is not rare in the literature. We will report two rare cases of the MP joint of the thumb locked in 90° of flexion (vertical locking). The first case is a 21-year-old man, punched on his right thumb by his friend, who arrived with his thumb fixed in a flexed position. The X-ray images of the right thumb showed the proximal phalanx subluxation in the palmer side in a vertical position. The second case is a 35-year-old woman with her right thumb accidentally caught in the chain of a key-holder. The locking was easily reduced without anaesthesia in both cases. We assume the mechanism was that the flexion force on the MP joint led to subluxation and the locking occurred due to the tension of the collateral ligament caused by the volar prominence of the radial condyle.

Five cases with an avulsion fracture of the thumb metacarpophalangeal joint treated by a simple method of internal fixation are described. This method is designed as a form of modified tension band wiring using the combination of a single Kirschner wire and a pull-out wire, and is technically easy.

We report a case with locking of the metacarpophalangeal (MP) joint of the thumb in a 15-year-old high school baseball catcher, which was caused by an intra-articular loose body arising from osteochondritis dissecans. The loose body was removed arthroscopically, enabling early return to full MP joint function.

Basal joint arthritis of the thumb is usually seen in females beginning from the fourth and fifth decades. In the last two decades, arthroscopic techniques have brought new chances of diagnosis and treatment for this condition. In this paper, the authors describe the indications and their experience concerning arthroscopic hemitrapezectomy and tendon interposition using the palmaris longus tendon. A series of 16 patients with a maximum follow-up of 12 months is analysed. All of the 16 patients were followed and assessed with grasp strength, pinch strength, DASH and MAYO evaluation score both pre- and post-operatively at 12 months follow-up. According to the MAYO score, there were six excellent results, six good, three fair and one poor. No complications occurred. According to our preliminary results, this procedure with the proper indications gives a valid option for the treatment of thumb carpometacarpal joint arthritis in stages I and II according to Eaton's classification.

Many modifications to trapeziectomy have been proposed for the treatment of thumb basal joint arthritis. Their final outcomes have been discussed intensively, whereas functional changes in the early post-operative period have not been fully documented. The purpose of the present study is to evaluate an early functional change following our modified ligament reconstruction with tendon interposition (LRTI) arthroplasty. Nine patients (ten thumbs) were included in this study. Pain levels, strength, and mobility were assessed before and after surgery at intervals of two months. Pain level significantly improved at two months after surgery. Grip and pinch strengths had increased gradually after a temporal decrease at two-month follow-up, and were significantly stronger at six months after surgery. Palmar abduction improved significantly at six months after surgery, whereas opposition did not change significantly. A modified LRTI is an effective procedure in terms of early functional improvement of pain, strength, and mobility.

First carpometacarpal joint osteoarthritis (1^st CMCJ OA) is a common condition with variable results reported from local corticosteroid injection. This study aims to explore the medium-term outcome with respect to pain relief, patient satisfaction and the need for subsequent surgical intervention. A prospective review was performed of patients undergoing fluoroscopically guided corticosteroid injection by one surgeon, with postal questionnaires for medium-term follow-up. Forty-one patients were included. Thirty-one were female and ten male, with a mean age of 60 years. In the short term 76% of patients reported pain relief with an average duration of four weeks and 69% of the patients reported benefit from injection. After a median follow-up of 36 months 76% of patients reported continuing pain but 59% reported satisfaction with the outcome. Twenty-eight per cent of the patients had undergone surgery. Local corticosteroid injection of the CMCJ provides only short-term pain relief, but few patients go on to surgical intervention.

Closed flexor pulley rupture of the thumb is extremely rare. We report a case with this condition. The anatomic and biomechanical studies, clinical and operative finding as well as the management of the closed flexor pulley rupture of the thumb are discussed.

Dislocation of the trapeziometacarpal joint is a rare injury. We report an unusual pattern of dorsal dislocation of the trapeziometacarpal joint with an avulsion fracture of the dorsoradial tubercle of the trapezium. Simultaneous ligament rupture with an avulsion fracture of the thumb metacarpophalangeal joint was associated. The trapeziometacarpal joint was reduced and disrupted ligaments with avulsed fragments of both joints were surgically repaired.

The reproducibilities of various measurements of thumb abduction were compared. Two independent observers measured the thumb abduction in 30 volunteers by the following four methods: distance between the thumb tip and the flexion crease of the index finger proximal interphalangeal joint; distance between the flexion crease of the thumb interphalangeal joint and the proximal palmar crease; angle between the thumb and index metacarpals; and angle between the thumb and index proximal phalanxes. Measurements were repeated in three weeks and their reproducibility was assessed by the intraclass correlation coefficient (ICC). Intra-observer reproducibilities by distances were high with ICCs between 0.74 and 0.89, compared with those by angles with ICCs between 0.28 and 0.71. Inter-observer reproducibilities by distances were also high (ICCs = 0.79 and 0.81) compared with those by angles (ICCs = 0.28 and 0.42). Assessment of thumb abduction based on distance in the first web is recommended in terms of reproducibility.

To our knowledge, the combination of a palmar subluxation of the thumb carpometacarpal (CMC) joint with low median nerve deficit followed by the recurrent branch injury is extremely rare. We present a case of the subluxation of the thumb CMC joint with low median nerve deficit.

Purpose: To identify the wrist tendon most effectively maintaining the trapezial space in interpositional arthroplasty in osteoarthritis of the carpometacarpal joint of the thumb.

Methods: The morphometrics of the os trapezium and the tendons of the flexor carpi radialis, extensor carpi radialis longus, and abductor pollicis longus were determined. The stiffness and compressive loading characteristics of the rolled-up tendons were compared to the os trapezium.

Results: No significant morphometric differences between the three tendons were found. The mass and volume of the trapezium was significantly larger when compared to the tendon balls. No significant differences in the compressive loading resistance were found between the tendons, but the mean stiffness was 85% lower when compared to the os trapezium.

Conclusions: Neither tendon material approached the volume nor the stiffness provided by the os trapezium. Any tendon is considered to insufficiently maintain the trapezial space following trapeziectomy.

We report a case in which simultaneous flexion of the thumb, index and middle finger occurred 6 months after the surgical reconstruction of the adductor (AM) and first dorsal interosseous (IO) muscles. An anomalous connection in the form of tendon slip associated to fibrous adhesions between the flexor pollicis longus (FPL) tendon, flexor digitorum profundus indicis (FDPI) and middle finger (FDPM) tendons were found. Either ultrasound (US) examination or magnetic resonance imaging (MRI) were unable to detect the site of adhesion. Excision of the slip and radical tenosynoviectomy led to early functional recovery.

Trapezium components from two uncemented total joint replacements were compared in a three-dimensional finite element model. A 100 N axial and angular load was applied in a normal and an osteoporotic bone model. The axial deformation and maximum periprosthetic stress are greater for the Elektra^TM than the Motec CMC^® cup. The Motec CMC^® design is less sensitive to changing bone quality. The Elektra^TM cup transmits more stress to the cortical bone rim in all load conditions, but under angular loading the proportionate increase in stress is lower. The Motec CMC^® design distributes the stress and contact pressure more evenly, whereas the Elektra^TM transfers most of the load to the cortical bone rim and the screw hole base. The design features that are believed to be of greatest significance for the differences are the raised centre of rotation of the Motec CMC^® cup and the collar acting as a lever arm.