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Trapeziectomy with Partial Trapezoidectomy

34 citationsUpdated Oct 2026
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Overview

Trapeziectomy with partial trapezoidectomy is a surgical intervention for basal joint arthritis, specifically indicated for stage IV thumb arthritis and concomitant scaphotrapezial (ST) joint degeneration [12]. Complete trapezoid excision is not recommended; partial excision is preferred because it yields no significant differences in outcomes compared to complete excision while avoiding unnecessary bone loss [1, 2]. This procedure is effective for isolated scaphotrapeziotrapezoid (STT) osteoarthritis, particularly when combined with ligament reconstruction tendon interposition (LRTI), and serves as a viable alternative to other surgical treatments for advanced arthritis [12, 16, 18]. The technique is reliably effective and durable, providing substantial and consistent improvement in thumb stability and strength while alleviating pain [9].

The procedure is associated with low morbidity and complications, although it can lead to weakness of the thumb [3, 4]. Proximal trapezoid excision performed alongside trapezium excision arthroplasty is associated with no morbidity [3]. Performing a trapeziectomy followed by up to 4 mm of proximal trapezoid resection has a negligible effect upon carpal, specifically lunocapitate and scapholunate, stability [5]. Wrist radiographs demonstrate a 47% sensitivity and 94% specificity in predicting end-stage ST joint arthritis [6]. Due to the limited sensitivity of wrist radiographs, direct visualization of the ST joint after trapeziectomy is emphasized [6]. Moderate degenerative changes at the ST joint do not necessitate complete trapezial resection [8].

Partial trapeziectomy for TM joint arthritis provides long-lasting relief of symptoms in patients with radiographically abnormal but clinically insignificant ST joint degeneration [7]. Surgical options for scaphotrapeziotrapezoidal joint osteoarthritis are numerous, but none has clear evidence of superiority [15]. Additional partial trapezoid excision is not necessary for isolated scaphotrapeziotrapezoid osteoarthritis when using trapeziectomy/ligament reconstruction tendon interposition [16]. Cases of STT arthritis with basal joint arthritis are effectively managed with trapeziectomy and partial trapezoid or distal scaphoid excision [17]. Interposition of Flexor carpi radialis autograft maintained in place with a small anchor to the trapezoid is a technique for treating concomitant STT and CMC arthritis [13]. An oblique osteotomy of the trapezoid prevented scaphotrapezial contact in tested wrist positions, whereas transverse osteotomies required more than one-third resection to minimize impingement risk [11].

Anatomy & Pathophysiology

Bony Anatomy & Kinematics

The hand skeleton comprises 27 bones, 19 of which are long bones [30]. The radial ray, or first ray, is the shortest and consists of only three bones: a metacarpal and two phalanges [30]. This ray continues the external column of the carpus formed by the scaphoid and trapezium [30]. The trapezium is angled out in front of the carpal plane, causing the first metacarpal to form an angle of approximately 45 degrees with the second metacarpal in the sagittal plane [30]. The thumb metacarpal is independent and articulates with the trapezium [40]. It is the shortest metacarpal, whereas the index metacarpal is the longest [30]. The trapezoid and trapezium are tightly linked and move together on a single path relative to the scaphoid in all directions of wrist motion [23]. The scaphotrapezial (ST) joint constitutes the radial aspect of the midcarpal joint [23]. The average range of motion of the scaphoid relative to the capitate in the dart-throwing axis is 41 degrees [23]. The T-2MC joint features rigid bone morphology and stable ligamentous support [23].

Ligaments & Soft Tissue Anatomy

The abductor pollicis longus possesses multiple slips that insert at the base of the thumb metacarpal and radially abduct the thumb [29]. The extensor pollicis brevis inserts on the dorsum of the proximal aspect of the proximal phalanx of the thumb, actively extending the metacarpophalangeal joint [29]. The extensor pollicis longus runs longitudinally down the forearm through the third compartment, turning abruptly radialward about Lister tubercle before inserting on the distal phalanx to provide forceful extension of the thumb interphalangeal joint [29]. The flexor pollicis longus originates from two heads: a radial head from the proximal radius and interosseous membrane, and an accessory head from the coronoid process of the ulna and medial epicondyle of the humerus [44]. It inserts into the proximal base of the thumb distal phalanx and is innervated by the anterior interosseous branch of the median nerve [44]. This muscle flexes both the interphalangeal and metacarpophalangeal joints of the thumb [44]. The tenosynovial sheath of the flexor pollicis longus is continuous with the radial bursa [44].

The superficial palmar fascia covers a triangular area of the central palm, with no central band for the thumb [47]. The distal first web space ligament between the thumb and index finger is in continuity with the natatory ligament that spans the remaining web spaces [47].

Vascular Anatomy

The "princeps pollicis" artery, the terminal branch of the radial artery, crosses the first intermetacarpal space and runs along the ulnar side of the first metacarpal bone [41]. It emerges onto the subcutaneous palmar tissue at the level of the cutaneous flexion crease of the metacarpophalangeal joint [41]. The princeps pollicis artery divides into two terminal rami, the collateral palmar arteries of the thumb, which run along the digital tunnel symmetrically [41]. An arcade located deep in the flexor tendon joins together the two palmar arteries at the level of the distal metaphysis of the first phalanx [41]. The dorsal arteries of the thumb originate from palmar arteries (princeps, commissural, or anastomoses) at the level of the first metacarpal [41]. The ulnar dorso-collateral artery generally stems from the "princeps pollicis" onto the medial border of the neck of the first metacarpal [41].

Pathophysiology & Diagnostic Limitations

The prevalence of concomitant trapeziometacarpal and STT OA, combined with the uncertainty of radiographic evaluation of STT OA, indicates the need to visualize the STT joint intraoperatively to determine the true degree of degenerative changes present [21]. The presence of two locations of arthritis may explain persistent hand and wrist pain in this population despite CMC arthroplasty [19]. Simpler classifications that focus on a single anatomical area are reliable, and surgeon and patient factors can bias interpretation of objective pathophysiology such as radiographic findings [32]. The interposition graft provides a soft tissue buffer to avoid ST joint contact and pain that can complicate an otherwise successful CMC arthroplasty [27].

Biomechanical Consequences of Resection

An oblique osteotomy of the trapezoid prevented scaphotrapezial contact in tested wrist positions, whereas transverse osteotomies required more than one-third resection to minimize impingement risk [11]. A 6-mm resection is required to prevent ST impingement under load in different wrist positions [20]. The highest forces occur under load in radial deviation [20]. An oblique osteotomy may be better suited to prevent contact in radial deviation than the transverse osteotomy [20].

Simulated TMC joint fusion resulted in a considerable decrease in the global range of angular motion of the first metacarpal during thumb circumduction [23]. The range of motion decreased by 70% from radial abduction to adduction and by 80% from palmar abduction to adduction following simulated TMC joint fusion [23]. Partial resection of the TT and T-2MC joints increases the range of thumb movement in the TMC-fused thumb [23]. Distal scaphoid excision improves range of motion and addresses the scaphotrapezotrapezoidal joint in patients with pantrapezial arthritis [24]. This procedure maintains the potential benefits of improved strength and decreased risk of subsidence in the younger, high-demand patient [24]. There is an increase in ROM in both the PA and lateral planes after distal scaphoid excision compared with thumb CMC fusion alone [31].

Classification

Radiographic Assessment: Wrist radiographs demonstrate a 47% sensitivity and 94% specificity in predicting end-stage scaphotrapezoid joint arthritis [6]. However, the prevalence of concomitant trapeziometacarpal and scaphotrapeziotrapezoid osteoarthritis, combined with the uncertainty of radiographic evaluation for scaphotrapeziotrapezoid osteoarthritis, indicates the need to visualize the scaphotrapeziotrapezoid joint intraoperatively to determine the true degree of degenerative changes present [21].

Other Considerations: Simpler classifications that focus on a single anatomical area are reliable [32]. Surgeon and patient factors can bias interpretation of objective pathophysiology such as radiographic findings [32].

Clinical Presentation

Diagnostic Assessment and Imaging Limitations

Wrist radiographs demonstrate a 47% sensitivity and 94% specificity in predicting end-stage scaphotrapezoid (ST) joint arthritis [6]. The low sensitivity of these radiographs emphasizes the importance of directly visualizing the ST joint after trapeziectomy [6]. The prevalence of concomitant trapeziometacarpal and scaphotrapeziotrapezoidal (STT) osteoarthritis, combined with the uncertainty of radiographic evaluation, indicates the need to visualize the STT joint intraoperatively to determine the true degree of degenerative changes [21]. Single photon emission computed tomography/computed tomography (SPECT/CT) is able to differentiate between osteoarthritic pain arising from the trapeziometacarpal joint and the scaphotrapeziotrapezoid joint [26].

Clinical Presentation and Symptomatology

The presence of arthritis in two locations may explain persistent hand and wrist pain in patients despite carpometacarpal (CMC) arthroplasty [19]. Trapezial excision and partial trapezoidal excision can lead to weakness of the thumb [4].

Investigations

Imaging and Diagnostic Assessment

Plain radiography: Radiographic evaluation of scaphotrapeziotrapezoid (STT) osteoarthritis carries inherent uncertainty regarding the true degree of degenerative changes present [21]. This limitation necessitates intraoperative visualization of the STT joint to accurately assess pathology and guide surgical planning [21].

Nuclear Medicine: SPECT/CT differentiates osteoarthritic pain arising from the trapeziometacarpal joint versus the scaphotrapeziotrapezoid joint [26]. Identifying arthritis in two locations is critical, as concurrent involvement may explain persistent hand and wrist pain in patients despite prior CMC arthroplasty [19].

Biomechanical and Cadaveric Evidence

Biomechanical Constraints: The highest forces at the ST joint occur under load in radial deviation [20]. To prevent ST impingement under load in different wrist positions, a 6-mm resection is required, which exceeds the 2 mm of resection typically reported as adequate in previous studies [20]. Partial trapezoid excision maintains longitudinal stability of the second ray [20].

Kinematics: The scaphotrapezial (ST) joint possesses a relatively wide range of motion in the dart-throwing axis [23]. The trapezoid and trapezium move together on a single path relative to the scaphoid in all directions of wrist motion [23]. Simulated TMC joint fusion results in a 70% decrease in global range of angular motion of the first metacarpal from radial abduction to adduction and an 80% decrease from palmar abduction to adduction [23].

Treatment

Non-Operative

The provided evidence does not detail specific conservative management protocols such as weight loss, physical therapy, NSAIDs, or injections.

Operative

Indications: Surgical intervention is indicated for isolated scaphotrapeziotrapezoid osteoarthritis and basal joint arthritis. Direct visualization of the scaphotrapezoid (ST) joint following trapeziectomy is emphasized because wrist radiographs have limited sensitivity for detecting end-stage ST joint arthritis [6]. Surgical options for STT arthritis depend on the specific clinical scenario, with cases involving basal joint arthritis effectively managed with trapeziectomy and partial trapezoid or distal scaphoid excision [17].

Surgical Approach / Technique: The procedure involves trapezial excision and partial trapezoidal excision. Previous studies reported that 2 mm of resection is typically adequate for trapezoid excision [20]. However, more recent biomechanics studies recommend resecting at least one-third of the trapezoid to prevent impingement [20]. An oblique osteotomy may be better suited to prevent contact in radial deviation than a transverse osteotomy [20]. Additional partial trapezoid excision is not necessary for treating isolated scaphotrapeziotrapezoid osteoarthritis when using trapeziectomy with ligament reconstruction tendon interposition [16].

Outcomes and Complications: Trapezial excision and partial trapezoidal excision is an effective treatment with low morbidity and complications, although it can lead to weakness of the thumb [4]. Proximal trapezoid excision performed alongside trapezium excision arthroplasty showed no associated morbidity in a comparison of 23 patients versus 14 patients who underwent the former procedure only [3]. The trapezial excisional arthroplasty with partial trapezoidectomy and abductor pollicis longus dual ligament reconstruction leads to substantial and durable improvement in thumb stability and strength while consistently alleviating pain [9]. Limited excision arthroplasty of the trapeziometacarpal and scaphotrapezial joints is evidenced by statistically significant improvements in clinical parameters [12].

Alternative Techniques: Scapho-trapezio-trapezoid arthrodesis combined with “De La Caffinière” arthroplasty cannot be further recommended because of the high rate of re-operation and the risk to the trapezium [10].

Complications

Instability: Trapezial excisional arthroplasty with partial trapezoidectomy and abductor pollicis longus dual ligament reconstruction leads to substantial and durable improvement in thumb stability and strength while consistently alleviating pain [9]. Simultaneous dual prosthetic replacement of trapeziometacarpal and scaphotrapezial-trapezoid joints achieves favorable functional outcomes and a low complication rate [14]. TMC arthrodesis with TIRA at the scaphotrapeziotrapezoid joint achieved satisfactory results with substantial improvement compared with preoperative conditions [25].

Stiffness / Arthrofibrosis: The method of scapho-trapezio-trapezoid arthrodesis combined with “De La Caffinière” arthroplasty is associated with a high rate of re-operation and risk to the trapezium [10]. Distal scaphoid excision increases range of motion in both the PA and lateral planes compared with thumb CMC fusion alone [31].

Other Considerations: No significant differences in outcomes were found between partial and complete trapezoid excision [2]. No morbidity was associated with proximal trapezoid excision in a comparison of 23 patients who underwent both trapezium excision arthroplasty and proximal trapezoid excision with 14 patients who underwent the former procedure only [3]. The interposition of Flexor carpi radialis autograft is maintained in place with a small anchor to the trapezoid [13]. None of the surgical options for scaphotrapeziotrapezoidal joint osteoarthritis has clear evidence of superiority [15]. Additional partial trapezoid excision is not necessary for treating isolated scaphotrapeziotrapezoid osteoarthritis with trapeziectomy/ligament reconstruction tendon interposition [16]. Cases with basal joint arthritis are effectively managed with trapeziectomy and partial trapezoid or distal scaphoid excision [17]. Previous studies have reported that 2 mm of resection is typically adequate to prevent impingement [20]. Trapezoid excision has been found to have some morbidity [20]. Distal scaphoid excision addresses the scaphotrapezotrapezoidal joint in patients with pantrapezial arthritis while maintaining the potential benefits of improved strength and decreased risk of subsidence in the younger, high-demand patient [24].

Recovery

Other Considerations: The provided evidence base does not contain specific data regarding recovery timelines, rehabilitation protocols, or functional milestones for trapeziectomy with partial trapezoidectomy. Consequently, the fields for Light activity, Full activity, Complete recovery / outcome plateau, Rehabilitation protocol, and Functional milestones are omitted due to the absence of supporting evidence.

The surgical approach is defined by the extent of trapezoid resection and concomitant procedures. Complete trapezoid excision is not recommended following abductor pollicis longus suspensionplasty [1]. There are no significant differences in outcomes between partial and complete trapezoid excision, leading to a preference for partial trapezoid excision [2]. When transverse osteotomies of the trapezoid are performed, more than one-third resection is required to minimize impingement risk [11].

Indications for partial trapezoid excision depend on the status of the scaphotrapezoid joint. Partial trapeziectomy for trapeziometacarpal joint arthritis provides long-lasting relief of symptoms in patients with radiographically abnormal but clinically insignificant scaphotrapezoid joint degeneration [7]. Moderate degenerative changes at the scaphotrapezoid joint do not necessitate complete trapezial resection [8]. Conversely, additional partial trapezoid excision is not necessary when performing trapeziectomy/ligament reconstruction tendon interposition for isolated scaphotrapeziotrapezoid osteoarthritis [16].

Several surgical techniques are supported by the evidence for managing concomitant arthritis. Trapezial excisional arthroplasty with partial trapezoidectomy and abductor pollicis longus dual ligament reconstruction leads to substantial and durable improvement in thumb stability and strength while consistently alleviating pain [9]. Limited excision arthroplasty of the trapeziometacarpal and scaphotrapezial joints is a viable alternative to existing surgical treatments for stage IV thumb arthritis, evidenced by statistically significant improvements in clinical parameters [12]. Interposition of Flexor carpi radialis autograft maintained in place with a small anchor to the trapezoid is a technique for treating concomitant scaphotrapeziotrapezoid and carpometacarpal arthritis [13]. Simultaneous dual prosthetic replacement of trapeziometacarpal and scaphotrapezial-trapezoid joints preserves carpal stability and thumb function, achieving favorable functional outcomes and a low complication rate [14].

For cases involving scaphotrapeziotrapezoid arthritis with basal joint arthritis, effective management includes trapeziectomy and partial trapezoid or distal scaphoid excision [17]. Modified total trapezial, partial trapezoidal excision and ligament reconstruction tendon interposition is an effective surgical alternative for isolated scaphotrapeziotrapezoid arthritis [18]. The method of scapho-trapezio-trapezoid arthrodesis combined with “De La Caffinière” arthroplasty is not further recommended due to a high rate of re-operation and the risk to the trapezium [10].

Key Evidence

  • [L4] Complete trapezoid excision is not recommended. [1] (10.1016/j.jhsa.2019.10.006)
  • [L4] Due to no significant differences in outcomes between partial and complete excision, the authors now prefer partial trapezoid excision. [2] (10.1016/j.jhsa.2017.06.062)
  • [L4] Comparison of surgical results in 23 patients who underwent both trapezium excision arthroplasty and proximal trapezoid excision, with 14 patients who underwent the former procedure only, showed that there was no morbidity associated with the latter. [3] (10.1053/jhsu.1999.1220)
  • [L1] Trapezial excision and partial trapezoidal excision is an effective treatment with low morbidity and complications, although can lead to weakness of the thumb. [4] (10.1142/s0218810417300017)
  • [L5] This biomechanical cadaveric study shows that performing a trapeziectomy followed by up to 4 mm of proximal trapezoid resection has a negligible effect upon carpal, specifically lunocapitate and scapholunate, stability. [5] (10.1016/j.jhsa.2019.06.015)
  • [L3] Wrist radiographs demonstrate a 47% sensitivity and 94% specificity in predicting end-stage ST joint arthritis, emphasizing the importance of directly visualizing the ST joint after trapeziectomy. [6] (10.1177/1558944718765246)
  • [L4] Partial trapeziectomy for TM joint arthritis provides long-lasting relief of symptoms in patients with radiographically abnormal but clinically insignificant ST joint degeneration. [7] (10.1016/j.jhsa.2012.02.007)
  • [L4] The authors conclude that moderate degenerative changes at the ST joint do not necessitate complete trapezial resection. [8] (10.1016/0363-5023(92)90303-7)
  • [L4] The technique of trapezial excisional arthroplasty with partial trapezoidectomy and abductor pollicis longus dual ligament reconstruction is a reliably effective and durable surgical option for basal joint arthritis, leading to substantial and durable improvement in thumb stability and strength while consistently alleviating pain. [9] (10.1177/15589447221092060)
  • [L4] This method cannot be further recommended because of the high rate of re-operation and the risk to the trapezium which has to be further evaluated. [10] (10.1016/0266-7681(93)90165-c)
  • [L5] An oblique osteotomy of the trapezoid prevented scaphotrapezial contact in tested wrist positions, whereas transverse osteotomies required more than one-third resection to minimize impingement risk. [11] (10.1016/j.jhsa.2019.12.003)
  • [L4] Limited excision arthroplasty of the trapeziometacarpal and scaphotrapezial joints is a viable alternative to existing surgical treatments for stage IV thumb arthritis, as evidenced by statistically significant improvements in clinical parameters. [12] (10.1177/1753193415609656)
  • [L4] The authors offer a simple novel technique with interposition of Flexor carpi radialis autograft maintained in place with a small anchor to the trapezoid. [13] (10.1097/bth.0000000000000214)
  • [L4] By preserving carpal stability and thumb function, this approach achieves favorable functional outcomes and a low complication rate, making it a potentially superior alternative for patients with high functional demands or those requiring durable long-term results. [14] (10.1016/j.jhsa.2025.12.013)
  • [L5] Surgical options for scaphotrapeziotrapezoidal joint osteoarthritis are numerous, but none has clear evidence of superiority. [15] (10.1177/17531934241295345)
  • [L4] The findings from our study suggest that trapeziectomy/ligament reconstruction tendon interposition is an effective procedure for treating isolated scaphotrapeziotrapezoid osteoarthritis, and that additional partial trapezoid excision is not necessary. [16] (10.1177/1753193413514500)
  • [L5] Surgical options for STT arthritis depend on the specific clinical scenario, with isolated cases often managed by distal scaphoid resection or arthrodesis, while cases with basal joint arthritis are effectively managed with trapeziectomy and partial trapezoid or distal scaphoid excision. [17] (10.5435/jaaos-d-19-00539)
  • [L4] Modified total trapezial, partial trapezoidal excision and LRTI could be an effective surgical alternative in cases of isolated STT arthritis. [18] (10.1177/1753193411434718)
  • [L4] The presence of 2 locations of arthritis may explain persistent hand and wrist pain in this population despite CMC arthroplasty. [19] (10.1177/1558944716660555hw)
  • [L5] [20] (10.1016/j.jhsg.2026.101049)
  • [Paper] The prevalence of concomitant trapeziometacarpal and STT OA, and the uncertainty of radiographic evaluation of STT OA, indicate the need to visualize the STT joint intraoperatively to determine the true degree of degenerative changes present. [21] (10.1016/s0363-5023(03)00258-2)
  • [L5] [23] (10.1016/j.jhsa.2021.03.016)
  • [L4] Distal scaphoid excision improves range of motion and addresses the scaphotrapezotrapezoidal joint in patients with pantrapezial arthritis while maintaining the potential benefits of improved strength and decreased risk of subsidence in the younger, high-demand patient. [24] (10.1016/j.jhsa.2013.08.071)
  • [L4] Compared with preoperative conditions, TMC arthrodesis with TIRA at the scaphotrapeziotrapezoid joint achieved satisfactory results with substantial improvement. [25] (10.1016/j.jhsg.2025.100838)
  • [L4] SPECT/CT is able to differentiate between osteoarthritic pain arising from the trapeziometacarpal joint and the scaphotrapeziotrapezoid joint. [26] (10.1177/1753193415606070)
  • [L4] The interposition graft provides a soft tissue buffer to avoid ST joint contact and pain that can complicate an otherwise successful CMC arthroplasty. [27] (10.1097/bth.0000000000000155)
  • [L5] The study demonstrates an increase in ROM in both the PA and lateral planes after DSE compared with thumb CMC fusion alone. [31] (10.1177/1558944719833707)
  • [L3] Simpler classifications that focus on a single anatomical area are reliable, and surgeon and patient factors can bias interpretation of objective pathophysiology such as radiographic findings. [32] (10.1016/j.jhsa.2015.12.028)

See Also

References

[1] Effect of Partial and Complete Trapezoid Excision on Radiographic and Functional Results After Abductor Pollicis Longus Suspensionplasty. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2019.10.006

[2] Long-term Outcomes of APL Suspensionplasty with No, Partial, or Complete Trapezoid Excision. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.06.062

[3] Scaphotrapezoid arthritis: Prevalence in thumbs undergoing trapezium excision arthroplasty and efficacy of proximal trapezoid excision. The Journal of Hand Surgery. 1999. DOI: 10.1053/jhsu.1999.1220

[4] Scaphotrapeziotrapezoidal Joint Osteoarthritis: A Systematic Review of Surgical Treatment. The Journal of Hand Surgery (Asian-Pacific Volume). 2017. DOI: 10.1142/s0218810417300017

[5] The Biomechanical Consequences of Trapeziectomy and Partial Trapezoidectomy in the Treatment of Thumb Carpometacarpal and Scaphotrapeziotrapezoid Arthritis. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2019.06.015

[6] Comparison of Radiographic and Intraoperative Visual Assessment of Scaphotrapezoid Joint Arthritis in Patients With End-Stage Carpometacarpal Arthritis of the Thumb Base. HAND. 2018. DOI: 10.1177/1558944718765246

[7] The Scaphotrapezial Joint After Partial Trapeziectomy for Trapeziometacarpal Joint Arthritis: Long-term Follow-up. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.02.007

[8] Long-term follow-up of trapeziometacarpal arthroplasty with coexisting scaphotrapezial disease. The Journal of Hand Surgery. 1992. DOI: 10.1016/0363-5023(92)90303-7

[9] Trapeziectomy, Partial Trapezoidectomy, and Abductor Pollicis Longus Dual Loop Ligament Reconstruction for Advanced Basal Joint Arthritis: Long-Term Outcome of 150 Cases. HAND. 2022. DOI: 10.1177/15589447221092060

[10] The Value of Scapho-Trapezio-Trapezoid Arthrodesis Combined with “De La Caffinière” Arthroplasty for the Treatment of Pan-Trapezial Osteoarthritis. Journal of Hand Surgery. 1993. DOI: 10.1016/0266-7681(93)90165-c

[11] Partial Trapezoid Excision in Thumb CMC Arthroplasty for STT Arthritis: A Cadaveric Study. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2019.12.003

[12] A new surgical technique for the treatment of scaphotrapezial arthritis associated with trapeziometacarpal arthritis: the narrow pseudoarthrosis. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193415609656

[13] FCR Interposition Arthroplasty for Concomitant STT and CMC Arthritis. Techniques in Hand & Upper Extremity Surgery. 2019. DOI: 10.1097/bth.0000000000000214

[14] Simultaneous Dual Prosthetic Replacement of Trapeziometacarpal and Scaphotrapezial-Trapezoid Joints in Pantrapezial Osteoarthritis: Midterm Results of a Combined Implant Strategy. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2025.12.013

[15] Surgical options and outcomes for treatment of osteoarthritis of the scaphotrapeziotrapezoidal joint. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934241295345

[16] Trapeziectomy and ligament reconstruction tendon interposition for isolated scaphotrapeziotrapezoid osteoarthritis of the wrist. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193413514500

[17] Surgical Management of Scaphotrapeziotrapezoid Arthritis. Journal of the American Academy of Orthopaedic Surgeons. 2020. DOI: 10.5435/jaaos-d-19-00539

[18] Modified total trapezial and partial trapezoidal excision and ligament reconstruction tendon interposition reduces symptoms in isolated scaphotrapezial-trapezoid arthritis of the wrist. Journal of Hand Surgery (European Volume). 2012. DOI: 10.1177/1753193411434718

[19] Midcarpal and STT Arthritis in Patients With CMC Arthritis. HAND. 2016. DOI: 10.1177/1558944716660555hw

[20] Correlation of Scaphotrapezoid Contact Pressures With Degree of Trapezoid Resection: Does Eliminating Contact Matter?. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2026.101049

[21] Radiography and visual pathology of the osteoarthritic scaphotrapezio-trapezoidal joint, and its relationship to trapeziometacarpal osteoarthritis. The Journal of Hand Surgery. 2003. DOI: 10.1016/s0363-5023(03)00258-2

[23] Partial Trapeziotrapezoid Resection and Thumb Range of Movement After Trapeziometacarpal Joint Fusion—A Biomechanical Study. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2021.03.016

[24] Thumb Carpometacarpal Fusion With Distal Scaphoid Excision: A Novel Procedure for Pantrapezial Arthritis in the High-Demand Hand: A Clinical and Biomechanical Study. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.08.071

[25] Trapeziometacarpal Arthrodesis With Tendon Interposition Resection Arthroplasty at the Scaphotrapeziotrapezoid Joint for Eaton Stage IV Trapeziometacarpal Osteoarthritis. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2025.100838

[26] The use of single photon emission computed tomography/computed tomography to differentiate between pain arising from trapeziometacarpal joint and scaphotrapeziotrapezoid joint osteoarthritis. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193415606070

[27] A Technique for the Management of Concomitant Scaphotrapezoid Arthritis in Patients With Thumb Metacarpotrapezial Arthritis: Interposition Arthroplasty With a Capitate Suture Anchor. Techniques in Hand & Upper Extremity Surgery. 2017. DOI: 10.1097/bth.0000000000000155

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[31] Trapeziometacarpal Fusion With and Without Distal Scaphoid Excision: A Cadaveric Model Comparing Thumb Range of Motion. HAND. 2019. DOI: 10.1177/1558944719833707

[32] Interobserver Agreement of the Eaton–Glickel Classification for Trapeziometacarpal and Scaphotrapezial Arthrosis. The Journal of Hand Surgery. 2016. DOI: 10.1016/j.jhsa.2015.12.028

[40] Exam Of The Hand Wrist 2Ed. The arches of the hand > The metacarpal arch.

[41] Exam Of The Hand Wrist 2Ed. Techniques of investigation of the arterial supply by J P Melki > Vascularization of the thumb > Palmar aspect.

[44] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 9Hand Surgery > FLEXOR TENDON INJURY.

[47] Green S Operative Hand Surgery. PERTINENT ANATOMY.

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Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.