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Minerva Orthopedics 2022 June;73(3):247-52

DOI: 10.23736/S2784-8469.21.04111-0


lingua: Inglese

Bufalini - Perugia distraction arthroplasty of the trapeziometacarpal joint: eight years follow-up

Dario PERUGIA 1, Matteo GUZZINI 1, Guido KOVERECH 1 , Giulia CENCI 1, Marco GUIDI 2, Carlo BUFALINI 3

1 Unit of Orthopedics and Traumatology, Sant’Andrea Hospital, Sapienza University, Rome, Italy; 2 Clinic for Plastic Surgery and Hand Surgery, University Hospital of Zurich, Zurich, Switzerland; 3 M. Bufalini Surgery Center, Florence, Italy

BACKGROUND: Trapeziometacarpal (TM) osteoarthritis (TMO) is a common disease of the thumb that leads to debilitating pain. After failure of conservative treatment, several surgical technique were described. Distraction arthroplasty, described in 2007 by Bufalini and Perugia, does not require trapeziectomy and is indicated in mild TMO.
METHODS: Twenty-two hands (21 patients) were followed to a mean follow-up of 96 months (62-122). Subjective outcomes were evaluated with the DASH questionnaire and the Visual Analogue Scale (VAS) at the preoperatory time and at the end of the follow-up. Objective outcomes were obtained using Kapandji Index and the evaluation of grip and pitch strength measurements were done in a side comparison at the time of follow-up. Radiological evaluation at the preoperative time and at the end of the follow-up to check the anatomy and the position of I and II metacarpal and RMN’s sequences at the end of the follow-up to assess the state of the soft tissues.
RESULTS: The VAS Score dropped from 9.40±0.51 to 0.93±0.88, the DASH Score turned from 75.60±12.69 to 0.89±0.73 at the final follow-up. The grip strength (28.67±10.08 kg) achieved the 108% of functionality and the pinch strength (16.00±1.81 kg) reached the 103%. A Kapandji Index of 10 points in 86.7% of cases and 9 in 13.3% was achieved. No subluxation or loss of reduction was noted during radiographic follow-up.
CONCLUSIONS: The distraction arthroplasty of the TM joint, when performed in patients who meet the correct indications, ensures excellent results in a long term follow-up.

KEY WORDS: Osteogenesis, distraction; Arthroplasty; Osteoarthritis

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