Hand Surgery and Rehabilitation 36 (2017) 146–147

Letter to the editor

M1/M2 ratio for radiological follow-up of trapezio-
metacarpal surgery
Rapport M1/M2 pour le suivi radiologique après
chirurgie trapézo-métacarpienne
The Welch’s t-test in the SPSS statistical software was used
to compare the groups statistically. Differences were conside-
red significant for P < 0.05, highly significant for P < 0.01 and
very highly significant for P < 0.001.

1. Introduction
Restoration of normal thumb length is one of the factors that
contributes to restoring normal muscle tension. Simply
restoring the length of the thumb corrects moderate metacar-
pophalangeal hyperextension. Various radiological measure-
ments have been proposed [1–3] for the follow-up of
trapeziometacarpal surgery. We wanted to develop a standar-
dized follow-up method based on criteria that are relatively
insensitive to radiographic positioning errors and to the
concomitant presence of other diseases in the hand and wrist.
This method can be used to monitor the outcomes of
trapeziometacarpal surgery over time and should be indepen-
dent of the imaging support and the radiological magnification
factor.
3. Results
The mean M1/M2 ratio was 0.732 (s 0.025) for the control
group, 0.687 (s 0.032) for the trapeziometacarpal osteoarthritis
group and 0.741 (s 0.031) for the prosthesis group. Differences
between the control group and the trapeziometacarpal
osteoarthritis group, and between the trapeziometacarpal
osteoarthritis group and the prosthesis group were very highly
significant (P < 0.001). In contrast, the difference between the
control group and the prosthesis group was not significant
(P = 0.14).

2. Materials and methods

By using the ratio between two lengths measured on the

same X-ray view, the impact of the radiological magnification
factor is eliminated. We calculated the ratio of the length from
the head of the first metacarpal to the trapezium/head of the
second metacarpal to the trapezoid (M1/M2) on posterior-
anterior (PA) radiographs (Fig. 1). Measurements were made
with GIMP open-source software. Thumb length was measured
from the most distal point of the metacarpal head, along the axis
of the metacarpal to its intersection with the proximal trapezial
joint surface.
Three groups were studied. The reference group consisted of
43 consecutive radiographs performed in patients with
traumatic hand or wrist disease (excluding the thumb) who
did have any thumb pain. The second group consisted of 51
radiographs performed consecutively in patients who had
radiological signs of trapeziometacarpal osteoarthritis. The
third group consisted of the first postoperative radiographs
performed in 40 consecutive patients reviewed postoperatively
after placement of a trapeziometacarpal prosthesis. The three
groups were compared to each other. Fig. 1. M1/M2 ratio on X-rays.

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 / Hand Surgery and Rehabilitation 36 (2017) 146–147 147

4. Discussion can be used to compare various groups of patients, regardless

Goffin and Saffar [1] measured the height of the trapezial
socket in patients undergoing trapeziectomy with ligament
reconstruction or interposition of a silicone implant; this
allowed them to compare the degree of postoperative collapse
observed with the two techniques. Kadiyala et al. [2] defined a
trapezial index (height of the trapezium/P1) in a normal
population and used this index to monitor the outcomes of
trapeziectomy procedures in patients with trapeziometacarpal
osteoarthritis. The difference between the normal population
and the trapeziometacarpal osteoarthritis population was highly
significant. Similarly, the difference before and after trape-
ziectomy was also highly significant.
The M1/M2 ratio avoids possible bias related to the presence
of STT osteoarthritis or SLAC/SNAC wrist. This ratio is
superior to the index proposed by De La Caffinière [2], which
compares the length from the head of the first metacarpal to the
distal pole of the scaphoid to the length from the head of the
second metacarpal to the distal pole of the scaphoid, but still has
this bias.
The difference in the M1/M2 ratio between the normal
population and patients with trapeziometacarpal osteoarthritis
is very highly significant. The lack of significant differences
between the reference group and the trapeziometacarpal
prosthesis group indicates that this surgery restores the thumb’s
anatomical length and consequently restores physiological
muscle tension.
of the surgical technique performed. This measurement
could use the distal pole of the scaphoid as reference for
the follow-up of trapeziectomy procedures with or without
interposition.
Disclosure of interest
The author declares that he has no competing interest.
Acknowledgements
The author thanks Maxime Rousié for his assistance with the
statistical analysis.
References
[1] Goffin D, Saffar P. A radiological technique for measurement of the height
of the trapezial cavity. Applications in pre- and post-operative assessment in
osteoarthritis of the base of the thumb. Ann Chir Main Memb Super
1990;9:364–8.
[2] De La Caffinière JY. Facteurs de longévité des prothèses totales trapézo
métacarpiennes. Chir Main 2001;20:63–7.
[3] Kadiyala RK, Gelberman RH, Kwon B. Basal joint arthrosis. Radiographic
assessment of the trapezial space before and after ligament reconstruction
and tendon interposition arthroplasty. J Hand Surg Br 1996;21:177–81.
P. Ledoux
Polyclinique du Parc, 48 bis, rue Henri-Barbusse, 59880 Saint-
Saulve, France

5. Conclusion E-mail address: pascal.ledoux@skynet.be

We propose that the M1/M2 ratio be used to evaluate and Received 15 August 2016
monitor the outcomes of trapeziometacarpal surgery. The Received in revised form 11 January 2017
normal value is 0.73  0.05 (2s). This ratio can be easily Accepted 19 January 2017
measured and is independent of radiographic conditions. It Available online 21 February 2017