Although several previous reports have indicated that excision arthroplasty has been effective in the treatment of basal joint arthritis of the thumb by relieving pain and preserving motion, 1-7 others have indicated that arthroplasty of the thumb by excision of the trapezium alone causes a substantial loss of thumb strength and stability. 5-7 Luria et al 8 demonstrated that the combination of ligament reconstruction plus an interposition arthroplasty provided optimal thumb stability. Furthermore, in many cases with the arthritis limited to only the trapeziometacarpal (TM) joint, complete excision of the trapezium did not appear to be warranted. In 1984, Littler developed a technique using an interposition material shaped Keywords ► thumb arthritis ► thumb arthroplasty ► CMC OA ► Hemitrapeziectomy ► hand arthritis AbstractBackground Thumb arthritis at the carpometacarpal (CMC) joint is one of the most common sites of arthritis, especially in women. Thumb arthroplasty is an effective method of relieving pain and improving function. Materials and Methods Qualitative and quantitative outcomes were assessed clinically and radiographically in 58 patients (66 thumbs) with thumb basal joint arthritis limited to the trapeziometacarpal joint, treated with hemiresection arthroplasty of the trapezium, flexor carpi radialis (FCR) ligament reconstruction, and allograft costochondral interposition graft. Description of Technique The thumb CMC joint arthroplasty is performed using an FCR tendon for ligament reconstruction combined with removal of the distal half of the trapezium, which is replaced with a life preserver-shaped spacer that is carved out of allograft cartilage. Results Results of the validated Disability of Arm, Shoulder, and Hand (DASH) questionnaire at a mean follow-up time of 56 months (range, 24-103 months) revealed that 90% of the patients had a high level of function with minimal symptoms. Important improvements in web space with increased palmar and radial abduction and grip and pinch strength measurements were observed. The trapeziometacarpal space had decreased 21% after surgery, while trapeziometacarpal subluxation was 14% compared with 21% before surgery. There was an inverse correlation between the loss of trapezial height and subluxation and clinical outcome. Conclusions The results of this study demonstrate that, although the preoperative trapezial height was not maintained, the reconstructed thumbs remained stable, with little subluxation and improved clinical outcomes. Level of Evidence IV, retrospective case series

As the most common fracture, distal radius fractures comprise $15% of all fractures that occur. The principles of treatment of this condition consists of reducing the fracture and maintaining position with cast immobilization, external and/or internal fixation.1,2 Several studies have shown that many of patients have experienced suboptimal results from treatment of their fracture. 3-7 Unreduced fractures or those with unrecognized loss of reduction lead to malunion, eventual arthrosis, and a resultant decrease in function of the forearm, wrist, and digits and may require an osteotomy to realign the radiocarpal and radioulnar joints and regain function. 4,5,8 In many cases, the degree of the deformity does not correlate with the severity of the function loss. ►Fig. 1 demonstrates a case of a patient with pain and a severe deformity but good range of motion of the wrist. As a result of a distal radius fracture, patients can experience considerable disability from loss of motion due to either changes in the alignment in the joint or contracture of the soft tissues following the injury and immobilization. Possible biomechanical explanations for the decreased wrist motion in the setting of a malunion include a decrease in the volume and contact pressures in the distal radioulnar joint (DRUJ). 9Another biomechanical study suggests that the radius Keywords ► allograft ► artilage ► thumb arthritis ► ligament ► stability AbstractBackground Malunions following distal radius fractures are common, with shortening, translation, and rotation occurring. The patients frequently lose forearm rotation, but there is no data to indicate whether this is due to mechanical misalignment between the radius and the ulna or to contracture of the soft tissues. Material and Methods Seven fresh cadaveric specimens were used to determine the loss of forearm rotation with varying simulated distal radius fracture malalignment patterns. Uniplanar malunion patterns consisting of dorsal tilt, radioulnar translation, or radial shortening were simulated by creating an osteotomy at the distal end of the radius. Description of Technique By orienting the distal fragment position using an external fixator and maintaining the position with wedges and a T-plate, varying degrees of malunion of the distal radius could be simulated. Rotation of the forearm was produced by fixing the elbow in a flexed position and applying a constant torque to the forearm using deadweights. Forearm rotation was measured with a protractor. Results Dorsal tilt to 30°and radial translation to 10 mm led to no significant restriction in forearm pronation or supination ranges of motion. A 5-mm ulnar translation deformity resulted in a mean 23% loss of pronation range of motion. Radial shortening of 10 mm reduced forearm pronation by 47% and supination by 29%. Conclusion Because a severe osseous misalignment was required to produce a significant loss in rotation, contracture of the soft tissues is most likely the cause of the loss of rotation in most cases.

SR arthroplasty, when performed through a volar approach, allows for early range of motion and greater improvements in arc of motion, DASH score, and patient satisfaction.

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