Pierre Siret

Anatomical and Radiological Assessment of Trapezial Osteotomy for Trapezial Dysplasia in Early Trapeziometacarpal Joint Arthritis

Opening wedge osteotomy of the trapezial saddle was reported first by Kapandji and Heim (2002) as a possible surgical treatment for early trapeziometacarpal joint arthritis. This study evaluates the feasibility and anatomical risks of the procedure. Ten upper limbs from fresh cadavers were used for this anatomical and radiological study. A dorsolateral opening wedge osteotomy with a 10° correction was performed on each specimen. CT scans and AP radiographs of all the wrists were performed before and after osteotomy to assess the correction of the slope angle, defined as the angle between the longitudinal axis of the second metacarpal and the axis of the trapeziometacarpal articulation. On standard radiographs, mean trapezial slope was 126° preoperatively and 117° postoperatively. On sagittal and coronal CT reconstructions, one case of trapezial translation and two impingements between trapezoid and trapezium bones were identified. Trapezial osteotomy is technically demanding with several possible complications, but merits further study for young patients with Eaton stage 1 or 2 osteoarthritis and an abnormal trapezial slope.

Recurrent primary giant cell tumour of the proximal radius with pulmonary metastases.

Pulmonary metastases secondary to primary bone giant cell tumour (GCT) is extremely rare. Although occurrence has been reported in large case series of recurrent distal radius lesions following surgical treatment, this has not been previously reported following a proximal radius lesion. Treatment of a proximal radius GCT is reported and the risk of pulmonary metastases is highlighted for recurrent surgery. Favourable outcome was achieved at 3 years following three resections despite pulmonary metastases.