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Original article

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A useful surgical landmark for the trapezio-scaphoid joint

By
Camillo Fulchignoni ,
Camillo Fulchignoni

UOC Chirurgia della Mano . Policlinico Universitario A. Gemelli , Rome , Italy

Silvia Pietramala ,
Silvia Pietramala
Contact Silvia Pietramala

Department of Orthopaedics and Traumatology, Fondazione Policlinico A. Gemelli IRCCS-Università Cat-tolica del Sacro Cuore , Rome , Italy

Chiara Muci ,
Chiara Muci

Department of Orthopaedics and Traumatology, Fondazione Policlinico A. Gemelli IRCCS-Università Cat-tolica del Sacro Cuore , Rome , Italy

Alessandro El Motassime ,
Alessandro El Motassime

Department of Orthopaedics and Traumatology, Fondazione Policlinico A. Gemelli IRCCS-Università Cat-tolica del Sacro Cuore , Rome , Italy

Andrea Cruciani ,
Andrea Cruciani

Department of Orthopaedics and Traumatology, Fondazione Policlinico A. Gemelli IRCCS-Università Cattolica del Sacro Cuore , Rome , Italy

Lorenzo Rocchi ,
Lorenzo Rocchi

Catholic University of the Sacred Heart , Milan , Italy

UOC Ortopedia e Chirurgia della Mano - Policlinico A. Gemelli , Roma , Italy

Gianfranco Merendi
Gianfranco Merendi

UOC Chirurgia della Mano . Policlinico Universitario A. Gemelli , Rome , Italy

Editor: SELMA UZUNOVIĆ

Abstract

Aim Unintended scaphoid excision is a rare but serious complication that can occur during surgical procedures involving the trapezium, including but not limited to trapeziectomy. Although prosthetic replacement is increasingly favored in the treatment of rhizarthrosis, trapeziectomy (with or without ligamentoplasty) remains a widely used and effective option. To reduce the risk of inadvertently removing the scaphoid, we rely on the anatomical intersection between the radial artery branch and the first dorsal compartment tendons as a landmark for identifying the scapho-trapezial joint. MethodsIn our Institutitonthe, Policlinico Universitario A. Gemelli IRCSS, we have been using a simple landmark to identify scapho-trapezial joint to teach residents: during surgery, after isolating the radial artery, a 16G needle is inserted at the intersection of the extensor tendons and the radial artery branch, followed by fluoroscopy to confirm needle placement in the scapho-trapezial joint. Patients were classified according to Eaton-Littler classification and the accuracy of the Landmark was then assessed among groups. Results So far we used the landmark on 212 patients. The distribution by Eaton-Littler stage was: 11 stage 1, 63 stage 2, 79 stage 3, and 33 stage 4. The reference point was accurate in 178 cases. No significant differences were found by sexgender or between stages 1, 2 and 3. However, accuracy in stage 4 was significantly lower (p<0.00001). ConclusionOur results confirm the reliability of this reference point, particularly in stages 1–3. While useful in stage 4, additional caution is required due to slightly reduced precision.

Author Contributions

Conceptualization, C.F.; Investigation, C.F., L.R. and G.M.; Data curation, S.P.; Writing – review & editing, S.P. and A.C.; Writing – original draft, C.M. and A.E.M.; Supervision, L.R. and G.M.; Validation, L.R. All authors have read and agreed to the published version of the manuscript.

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Funding Statement

no specific funding was received for this study.

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