Jaccoud's arthropathy

Jaccoud's arthropathy, which was first described in 1869, is a rare syndrome that is characterized by a painless or relatively painless deformity of the digits II, II, IV and V with a dislocation of the extensor tendons in the metacarpal fossae. When the thumb is affected, a Z-deformity is observed. The present analysis was based on 21 patients (30 hands, 24 of which were operated on over the period 1989 to 1996). A distinction should be made between Jaccoud's disease following a known inflammatory arthropathy (15 hands; average patient age 55 years) and the idiopathic form of the disease (9 hands; average patient age 70 years). From a clinical point of view, a classification of the deformities is needed so that appropriate surgical treatment can be determined. In the present study, four groups were therefore proposed: in groups I and II, the realignment to centre of the extensor tendons over the metacarpophalangeal joint and joint stabilization yielded 87% positive results. In groups III and IV, the results were not as satisfactory either for the Swanson implant or for metacarpal shortening osteotomy. The pathogenesis of Jaccoud's disease has not yet been determined, but now that more information has become available and a better analysis can be made of its various clinical and anatomopathological characteristics, these should assist in defining precise surgical indications.