Arthrodesis of the thumb metacarpophalangeal joint: Conventional open technique with a locking plate or compression pins versus minimally invasive technique with compression pins or screws

Complications and Unplanned Reoperation After Thumb Metacarpophalangeal Arthrodesis

PURPOSE

Arthrodesis of the metacarpophalangeal (MCP) joint of the thumb is a common procedure to treat arthritis or instability. Studies reporting hardware complications and nonunion rates after thumb MCP joint arthrodesis report on small sample sizes. We aimed to describe the hardware complication rate, the nonunion rate, and the number of thumbs that achieve union among patients undergoing thumb MCP joint arthrodesis.

METHODS

A database spanning 5 urban hospitals in a single metropolitan region in the United States was searched for patients who underwent thumb MCP joint arthrodesis between January 1, 2004 and January 1, 2020. After reviewing patient records, we identified 122 thumbs that underwent MCP joint arthrodesis and had a minimum follow-up of 90 days. The primary outcome was unplanned reoperation after hardware complications and nonunion. Second, the number of thumbs that achieved radiographic union was reported for the tension band and screw fixation arthrodesis group.

RESULTS

Twenty-two (18%) out of 122 thumbs had hardware complications after thumb MCP joint arthrodesis, and 11 (9%) out of 122 thumbs developed a nonunion. Patients who underwent screw fixation arthrodesis had no events of hardware complications and subsequent hardware removal. The nonunion rate was 9/65 (14%) in the tension band arthrodesis group and 2 (4%) of 45 in the screw fixation arthrodesis group. Of the thumbs that had available radiographs to assess the healing of the arthrodesis, 34 (81%) of 42 were radiographically united in the tension band arthrodesis group and 29 (91%) of 32 in the screw fixation group.

CONCLUSIONS

Our data suggest that screw fixation has fewer hardware complications and a lower reoperation rate than tension band arthrodesis.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognosis IV.

Long-Term Outcomes in Female Patients With Carpometacarpal Arthroplasty and Metacarpophalangeal Fusion Compared With the Unoperated Side or Carpometacarpal Arthroplasty

PURPOSE

Patients with carpometacarpal (CMC) osteoarthritis (OA) often present with metacarpophalangeal (MP) hyperextension and/or thenar atrophy. This study hypothesizes that MP fusion (MPF) performed at the time of CMC arthroplasty (CMCA) for patients who have moderate-to-severe thenar atrophy, MP hyperextension >30°, or MP arthritis will have greater long-term pinch strength and improvements in the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score from preoperative values when compared with the unoperated side or those who had CMCA only.

METHODS

This study involved a retrospective review of long-term results from patients who underwent either CMCA or CMCA/MPF. The QuickDASH score, the pain visual analog scale (VAS), and an average of three pinch readings from each thumb were measured on the Baseline pinch gauge and recorded with a correction for hand dominance in right-handed patients.

RESULTS

Fifty-three female patients with 70 operated thumbs were included in the study. The mean age was 67.2 years. There were 29 CMCAs and 41CMCA/MPFs. The mean follow-up was 6.3 years (range 2-16.9 years). At the latest follow-up, the mean CMCA/MPF pinch strength (11.3 lbs) was significantly stronger than that of CMCA (8.0 lbs) and carpometacarpal osteoarthritis thumbs (8.9 lbs). There was no significant difference in pinch strength between patients who underwent a CMCA and CMCOA thumbs (8.0 lbs vs 8.9 lbs, respectively). Preoperative QuickDASH demonstrated worse function in the CMCA/MPF group (55.8 vs 36.5). At the latest follow-up, QuickDASH and VAS revealed similar values in both the CMCA/MPF (10.5 and 0.66) and CMCA (18.5 and 0.52) groups.

CONCLUSION

Long-term results demonstrate stronger pinch and greater improvement in QuickDASH scores in patients who underwent CMCA/MPF compared with those who underwent a CMCA or untreated carpometacarpal osteoarthritis thumbs.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Arthroscopic arthrodesis of the thumb metacarpophalangeal joint: An anatomical feasibility study

Conventional open arthrodesis for the thumb metacarpophalangeal joint provides excellent results but can incur complications. The aim of this study was to evaluate the feasibility and safety of resecting the thumb metacarpophalangeal articular surfaces via an arthroscopic approach or a percutaneous approach under fluoroscopic control. This cadaver study was carried out on 14 thumbs. Ten were operated on arthroscopically, and four percutaneously under fluoroscopic control. The efficacy and safety of the respective procedures were evaluated after dissecting soft tissue and opening the joint. Following 2 insufficient resections using the arthroscopic technique, the procedure was modified, providing satisfactory resection in 80% of cases overall and no tendinous or neurovascular lesions. Percutaneous resection under fluoroscopy did not yield satisfactory results, especially on the volar part of the metacarpal articular surface. We believe these results would justify comparative clinical studies to evaluate fusion of the thumb metacarpophalangeal joint with arthroscopic joint surface resection followed by percutaneous fixation. LEVEL OF EVIDENCE: IV.

Management of Thumb Metacarpophalangeal Hyperextension in the Setting of Thumb Basal Joint Arthritis

Thumb metacarpophalangeal (MCP) joint hyperextension is a well-established sequela of advanced carpometacarpal (CMC) joint arthritis. This deformity results in poor patient function because the ability to perform key pinch is negatively affected. For this reason, surgeons must consider the presence of an MCP deformity when addressing CMC arthritis. A variety of nonsurgical and surgical interventions have emerged. Surgical treatments can be grouped into four main categories: (1) volar plate advancement/capsulodesis, (2) tendon transfer and tenodesis, (3) sesamoidesis, and (4) arthrodesis. Surgical intervention is based on both the degree of deformity present and the surgeon preference. This review aims to clarify indications for various treatments of MCP joint hyperextension, outline commonly performed procedures, and report the published outcomes and potential complications of these interventions.