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Scientific Articles   |    
Prevalence of Osteoarthrosis of the Trapeziometacarpal Joint
Samir Sodha, MD1; David Ring, MD2; David Zurakowski, PhD3; Jesse B. Jupiter, MD2
1 Hand and Upper Extremity Surgery, Crystal Run Healthcare, 155 Crystal Run Road, Middletown, NY 10941
2 Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114. E-mail address for D. Ring: dring@partners.org
3 Department of Biostatistics, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115
View Disclosures and Other Information
In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the AO Foundation. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at Massachusetts General Hospital, Boston, Massachusetts

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Dec 01;87(12):2614-2618. doi: 10.2106/JBJS.E.00104
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Abstract

Background: The age and gender-related prevalence of arthrosis of the trapeziometacarpal joint has been incompletely defined.

Methods: The radiographs of 615 consecutive patients who had presented with an isolated fracture of the distal part of the radius over a two-year period were evaluated for evidence of trapeziometacarpal arthrosis. We used a simple three-grade rating system suitable for standard wrist radiographs. Grade I indicated no or nearly no arthrosis; grade II, obvious arthrosis; and grade III, a totally destroyed joint. This rating system was demonstrated to have adequate intraobserver reliability (average kappa of 0.72, p < 0.001) and interobserver reliability (average kappa of 0.56, p < 0.001). The number of patients with each grade of arthrosis was analyzed according to age and gender.

Results: The overall radiographic prevalence of trapeziometacarpal arthrosis in patients with a distal radial fracture increased steadily from the age of forty-one years onward and reached a prevalence of 91% in patients older than eighty years of age. The prevalence increased more rapidly in women than in men; it reached 94% in women who were older than eighty years of age compared with 85% in men who were older than eighty years of age. The prevalence of grade-III trapeziometacarpal arthrosis (a totally destroyed joint) was much greater in women than in men at all age levels; it reached a prevalence of 66% in women older than eighty years of age compared with 23% in men older than eighty years of age.

Conclusions: The radiographic prevalence of trapeziometacarpal arthrosis in patients presenting for treatment of a distal radial fracture is age-related, and trapeziometacarpal arthrosis is more likely to lead to complete joint destruction in women than it is in men.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    David Ring, M.D.
    Posted on February 14, 2006
    Dr. Ring responds to Dr. Field
    Massachusetts General Hospital, Boston, MA

    Surgeons frequently classify things with non-absolutes such as "nearly normal" in clinical practice. We found that this classification was reliable. We couldn't claim to be more accurate than a three grade system when we were using radiographs of the wrist.

    Radiographs of the wrist taken for distal radius fracture were available, convenient, practical, and representative of the general population.

    Jeremy Field, BSc, MB,BS, ChM, FRCS(Edin), FRCS(Eng), FRCS(Orth)
    Posted on February 01, 2006
    RE: "Prevalence of Osteoarthrosis of the Trapeziometacarpal Joint"
    The Cotswold Nuffield Hospital, Cheltenham, Glos, GL51 6QA, UK

    To The Editor:

    I find this article confusing because of the arbitrary designation of a "Grade I" that allows an interpretation of "nearly" or "no arthrosis". Such a vague category allows an interpretation that 75 patients had arthritis despite the fact they were between the ages of 0 and 10! I also find it remarkable that such a centre of excellence should be attempting to grade the presence of osteoarthrosis of a trapeziometacarpal joint by using X-rays of the distal radius.

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