Trapezial space height after trapeziectomy: Mechanism of formation and benefits

Abstract Seventy-three thumbs in 67 women with osteoarthritis of the trapeziometacarpal joint were assessed prospectively. The patients were randomly allocated for treatment by either trapeziectomy alone (n = 26) or trapeziectomy with tendon interposition (n = 23) or ligament reconstruction (n = 24). A K-wire was passed through the thumb metacarpal base and across the trapezial space into the distal pole of the scaphoid in all procedures; this held the base of the metacarpal away from the scaphoid for 4 weeks. Standard thumb radiographs were used to calculate the trapezial space ratio before surgery and at 1-year follow-up examination. The trapezial space ratio decreased significantly from a preoperative mean of 0.40 (range, 0.20–0.56) to a mean of 0.18 (range, 0.08–0.30) after trapeziectomy, 0.16 (range, 0.07–0.30) after trapeziectomy with tendon interposition, and 0.20 (range, 0.00–0.33) after trapeziectomy with ligament reconstruction. There was no significant difference between these 1-year follow-up trapezial space ratios, suggesting that the placement of a K-wire across the trapezial void is as effective as tendon interposition or ligament reconstruction in creating a trapezial space in the short term at least. However, the need to create a trapezial space and maintain thumb length is questioned because the trapezial space height did not correlate with thumb strength at 1-year follow-up examination. (J Hand Surg 2001;26A:862–868. Copyright © 2001 by the American Society for Surgery of the Hand.)