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Vanpoulle G, Ducharne L, Ivan I, Corcella D, Forli A. Outcomes of Arthrodesis of the Metacarpophalangeal Joint of the Thumb for Sequelae of Collateral Ligament Injuries: A Series of 18 Cases with 6-Year Follow-Up. J Hand Surg Asian Pac Vol 2024; 29:184-190. [PMID: 38726488 DOI: 10.1142/s242483552450019x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Background: Untreated or insufficiently treated collateral ligament injuries of the thumb metacarpophalangeal (MP) joint can lead to instability or even osteoarthritis. Arthrodesis is one of the treatment options available for the treatment of the sequelae of collateral ligament injuries. The objective of our study was to evaluate the radiological, clinical and functional outcomes of MP joint arthrodesis performed for sequelae of collateral ligament injuries. Methods: We conducted a retrospective, single-centre study and reviewed the files of patients who had a thumb MP joint arthrodesis following a collateral ligament injury between 2011 and 2019. We collected patient's demographic data and the results of the radiological and clinical examinations. Results: Eighteen patients were included in the study. The average age was of 53.6 years and the time between injury to arthrodesis averaged 7 years. Four patients (22%) had nonunion. In the remaining 14 patients with solid union at an average of 72 months follow-up, the visual analogue pain score at rest was 0.14, the thumb opposition was 82%, grip strength 85%, tip pinch 92% and key pinch 79% of the contralateral side. Conclusions: The clinical and functional results of patients with a successful arthrodesis are satisfactory with restoration of good grip and pinch strength. Despite a lack of thumb MP joint flexion, stability allowed force transmission and may be preferred for manual workers. Level of Evidence: Level IV (Therapeutic).
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Legerstee IWF, Shen OY, Kooi K, Hoftiezer YAJ, Eberlin KR, Chen NC. Complications and Unplanned Reoperation After Thumb Metacarpophalangeal Arthrodesis. J Hand Surg Am 2024:S0363-5023(23)00643-3. [PMID: 38180411 DOI: 10.1016/j.jhsa.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024]
Abstract
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.
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Affiliation(s)
- Ingmar W F Legerstee
- Hand and Arm Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA; Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, the Netherlands; Harvard Medical School, Boston, MA.
| | - Oscar Y Shen
- Hand and Arm Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Kevin Kooi
- Hand and Arm Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA; Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands; Movement Sciences, Musculoskeletal Health, Amsterdam UMC, Amsterdam, The Netherlands; Movement Sciences, Musculoskeletal Health, Amsterdam UMC, Amsterdam, The Netherlands
| | - Yannick A J Hoftiezer
- Hand and Arm Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA; Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kyle R Eberlin
- Harvard Medical School, Boston, MA; Department of Plastic, Reconstructive and Hand Surgery, Massachusetts General Hospital, Boston, MA
| | - Neal C Chen
- Hand and Arm Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
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Collins DW, Coutelle NA, Moore A, West W, Simon P, Hess AV. Outcomes of Thumb Metacarpophalangeal Joint Arthrodesis Using the XMCP Intramedullary Interlocking Device. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:6-11. [PMID: 38313612 PMCID: PMC10837174 DOI: 10.1016/j.jhsg.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/29/2023] [Indexed: 02/06/2024] Open
Abstract
Purpose The intramedullary interlocking device for metacarpophalangeal (MCP) joint arthrodesis (XMCP, Extremity Medical, Parsippany, NJ) has been shown to promote union at a precise angle, provide strong fixation without the need for prolonged immobilization, and lower the incidence of hardware irritation and revision surgery. In this study, we evaluated the clinical outcomes of patients undergoing MCP joint arthrodesis with the XMCP system using a retrospective chart review, patient reported outcomes, and radiographic analysis. Methods A retrospective chart review and phone survey was conducted on 57 patients (58 cases) from a single institution between 2017 and 2022. The primary outcome was patient satisfaction, including pre- and postoperative Numeric Rating Scale (NRS) pain scores, Disabilities of Arm Shoulder and Hand (QuickDASH) outcomes, perceived grip strength, and willingness to undergo the procedure again. Secondary outcomes included the need for revision procedures, successful fusion of arthrodesis, and postoperative complications. Results Of the 57 patients who underwent MCP joint arthrodesis of the thumb using the XMCP fusion device, a total of 43 (75%) completed the phone survey. The average age of patients was 67 years with an average clinical follow-up of 9 months (range 1-65 months). Patients who participated in the phone survey questionnaire had an average QuickDASH score of 24.7 ± 20.5. Average perceived NRS scores were 6.2 ± 3.5 and 1.2 ± 2.1 before and after surgery, respectively. Average perceived grip strength of patients was 3 ± 1.3 out of 5. When evaluating for concurrent procedures, there was no statistically significant difference in pre- or postoperative NRS scores. In total, 38 (88%) patients were satisfied with the procedure, and 39 (91%) patients would undergo the procedure again. Conclusion Metacarpophalangeal joint arthrodesis of the thumb with the intramedullary fusion device is reproducible, allows for immediate use without immobilization, has a low number of complications, and provides improved function and pain relief. Level of Evidence Therapeutic III.
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Affiliation(s)
| | | | - Andrew Moore
- Department of Orthopaedics and Sports Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - William West
- Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Peter Simon
- Foundation for Orthopaedic Research and Education, Tampa, FL
| | - Alfred V. Hess
- Florida Orthopaedic Institute, Temple Terrace, FL
- Department of Orthopaedics and Sports Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL
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Dock CC, McGaver RS, McCarthy CK. Long-Term Outcomes in Female Patients With Carpometacarpal Arthroplasty and Metacarpophalangeal Fusion Compared With the Unoperated Side or Carpometacarpal Arthroplasty. J Hand Surg Am 2023:S0363-5023(23)00492-6. [PMID: 37877918 DOI: 10.1016/j.jhsa.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 08/29/2023] [Accepted: 09/13/2023] [Indexed: 10/26/2023]
Abstract
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.
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Affiliation(s)
- Carissa C Dock
- University of Minnesota Medical School, Twin Cities Campus, Minneapolis, MN
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Khatir B, Fréaud O, Petroni G, Pierrart J. Arthroscopic arthrodesis of the thumb metacarpophalangeal joint: An anatomical feasibility study. HAND SURGERY & REHABILITATION 2022; 41:664-668. [PMID: 36038110 DOI: 10.1016/j.hansur.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/26/2022] [Accepted: 08/19/2022] [Indexed: 01/04/2023]
Abstract
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.
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Affiliation(s)
- B Khatir
- Service de chirurgie orthopédique et traumatologique, CHU Avicenne, 125 Rue de Stalingrad, 93000 Bobigny, France.
| | - O Fréaud
- Service de chirurgie orthopédique et traumatologique, CHU Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - G Petroni
- Centre Hospitalier Privé Sainte-Marie, 1 rue Christian Barnard, 95520, Osny, France; Institut Européen de Chirurgie de l'Épaule et de la Main, Polyclinique Saint Côme, 9 Rue Jean-Jacques Bernard, 60200, Compiègne, France
| | - J Pierrart
- Cabinet Archimed, SOS Mains Côte d'opale, Clinique des 2 caps, 80, avenue des Longues Pièces, 62231, Coquelles, France
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Cefalu CA, Blazar PE, Simmons BP, Earp BE. Long-term Outcomes of Silastic Arthroplasty of the Thumb Metacarpophalangeal Joint. Hand (N Y) 2021; 16:632-637. [PMID: 31578890 PMCID: PMC8461196 DOI: 10.1177/1558944719878841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Silastic metacarpophalangeal arthroplasty (SMPA) has proven to be a durable option for end-stage arthritis in the non-thumb digits, while fusion has been the mainstay procedure for the thumb metacarpophalangeal joint (MP). Few studies exist to comment on the viability of thumb MP arthroplasty. This study reports both survival and objective outcomes following SMPA of the thumb. Methods: In an institutional review board-approved retrospective study, we identified 18 patients who underwent thumb SMPA at a tertiary academic center by 3 board-certified hand surgeons. Primary outcome measures were implant survival and post-operative complications. Secondary outcomes measures were quick Disabilities of the Arm, Shoulder, and Hand (quickDASH) scores, brief Michigan Hand Questionnaire (bMHQ), and postoperative pain as rated by the numerical rating scale. Results: Mean quickDASH and bMHQ scores at final follow-up were 35.6 and 70.6, respectively. The most common short-term complication was clinical deformity, followed by instability. The sole long-term complication was an implant dislocation in a previously asymptomatic patient. All patients reported reduction in pain. Three patients were indicated for revision surgery, 2 for persistent instability, and 1 for implant dislocation. Primary survivorship was 83% at mean follow-up of 5.8 years. Conclusions: Thumb SMPA is a viable option for end-stage arthritis. Pain relief in our series was unanimous. Among those that reported persistent symptoms or required revision, a majority had one or more key preoperative risk factors for failure as currently reported in literature. Larger, prospective series are needed to prove superior longevity and functional outcomes of thumb SMPA versus fusion.
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Affiliation(s)
- Charles A. Cefalu
- Harvard Combined Orthopaedic Residency Program, Boston, MA, USA,Charles A. Cefalu, Harvard Combined Orthopaedic Residency Program, 55 Fruit Street, Boston, MA 02114, USA.
| | - Philip E. Blazar
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Barry P. Simmons
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Brandon E. Earp
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Injectable Capsaicin for the Management of Pain Due to Osteoarthritis. Molecules 2021; 26:molecules26040778. [PMID: 33546181 PMCID: PMC7913147 DOI: 10.3390/molecules26040778] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 11/17/2022] Open
Abstract
Capsaicin is a potent agonist of the TRPV1 channel, a transduction channel that is highly expressed in nociceptive fibers (pain fibers) throughout the peripheral nervous system. Given the importance of TRPV1 as one of several transduction channels in nociceptive fibers, much research has been focused on the potential therapeutic benefits of using TRPV1 antagonists for the management of pain. However, an antagonist has two limitations. First, an antagonist in principle generally only affects one receptor. Secondly, most antagonists must have an ongoing presence on the receptor to have an effect. Capsaicin overcomes both liabilities by disrupting peripheral terminals of nociceptive fibers that express TRPV1, and thereby affects all of the potential means of activating that pain fiber (not just TRPV1 function). This disruptive effect is dependent on the dose and can occur within minutes. Thus, unlike a typical receptor antagonist, continued bioavailability at the level of the receptor is not necessary. By disrupting the entire terminal of the TRPV1-expressing nociceptive fiber, capsaicin blocks all the activation mechanisms within that fiber, and not just TRPV1 function. Topical capsaicin, an FDA approved treatment for neuropathic pain, addresses pain from abnormal nociceptor activity in the superficial layers of the skin. Effects after a single administration are evident over a period of weeks to months, but in time are fully reversible. This review focuses on the rationale for using capsaicin by injection for painful conditions such as osteoarthritis (OA) and provides an update on studies completed to date.
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Abstract
Arthritis of the thumb metacarpophalangeal joint can be debilitating whether in isolation or in conjunction with degenerative disease at the adjacent joints. Despite its crucial role in fluid and dexterous motion of the thumb axis, little is known about the isolated incidence of pathology at this joint. Etiologies include primary, posttraumatic, and inflammatory arthritis. For early, isolated degenerative disease, arthroscopic synovectomy has been shown to yield satisfactory results. For more advanced disease, fusion is the benchmark. The literature suggests that increased flexion angles may mitigate development of trapeziometacarpal arthritis. In case of advanced arthropathy of the entire thumb axis, arthroplasty is a viable option to reduce pain, preserve motion, and thus limit progression of adjacent joint disease. Special considerations should be given to the rheumatoid thumb because a select combination of treatments for each deformity is thought to best address the unique pathomechanics.
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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. HAND SURGERY & REHABILITATION 2019; 38:174-178. [PMID: 30818074 DOI: 10.1016/j.hansur.2019.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 01/30/2019] [Accepted: 02/18/2019] [Indexed: 11/21/2022]
Abstract
Arthrodesis of the thumb metacarpophalangeal (MCP) joint usually leads to satisfying results when performed with an open technique. The main complication is adhesion of the extensor tendons that sometimes requires hardware removal associated with tenolysis. The goal of this study was to assess whether a minimally invasive technique could reduce the risk of this complication. Arthrodesis of the thumb MCP was performed using an open technique with a locking plate or compression pins in 12 cases (group I) and using a minimally invasive technique with compression pins or screws in 12 cases, for a total of 24 patients aged 48.9 years on average, among which 15 were women. At the last follow-up, the average pain level was rated at 2/10 in group I and 2.3/10 in group II. The QuickDASH was 40.70/100 in group I and 36.24 in group II, grip strength was 79% of the contralateral side in group I and 51% in group II. Pinch strength was 81% of the contralateral side in group I and 45% in group II. Fusion was achieved in all cases in group I and in 7 of 12 cases in group II. Surgical revision for non-union was needed in 5 cases in group II, with hardware removal and tenolysis performed in 2 cases. The non-unions were observed in non-rheumatoid cases. While the two groups were not identical, arthrodesis of the thumb MCP using a minimally invasive technique with compression pins or screws seems to give satisfying results for rheumatoid cases in which no cartilage remains.
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Metacarpophalangeal joint of the thumb arthrodesis using intramedullary interlocking screws XMCP™. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018. [DOI: 10.1016/j.recote.2018.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Novoa-Parra CN, Montaner-Alonso D, Morales-Rodríguez J. Metacarpophalangeal joint of the thumb arthrodesis using intramedullary interlocking screws XMCP™. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 62:387-391. [PMID: 28882464 DOI: 10.1016/j.recot.2017.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 06/13/2017] [Accepted: 06/21/2017] [Indexed: 11/19/2022] Open
Abstract
The study objective was to assess the results of a thumb metacarpophalangeal joint (MCPJ) arthrodesis using intramedullary interlocking screws at 25°, XMCP ™ (Extremity Medical, Parsippany, NJ). Radiographs evaluated the angle of arthrodesis, time of fusion and fixation of the implant. Clinical and functional outcomes were assessed using the DASH questionnaire and the VAS scale. Any complications found during surgery or the follow-up period were noted. We studied 9 patients. The mean follow-up was 27.6 months. Patients showed clinical and radiological evidence of fusion in an average of 8 weeks, the angle of fusion was 25°. There were no complications and no implant had to be removed. The XMCP™ system provides a reliable method for MCPJ arthrodesis for several indications and can be used with other procedures in the complex hand.
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Affiliation(s)
- C N Novoa-Parra
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Dr. Peset, Valencia, España.
| | - D Montaner-Alonso
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Dr. Peset, Valencia, España; Universidad de Valencia, Valencia, España
| | - J Morales-Rodríguez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Dr. Peset, Valencia, España
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Renfree KJ, Lara D. Incidence of implant-related complications after arthrodesis of 30 thumb metacarpophalangeal joints with tension-band wires. J Hand Surg Eur Vol 2017; 42:523-524. [PMID: 27083197 DOI: 10.1177/1753193416641631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- K J Renfree
- Department of Orthopedics, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - D Lara
- Department of Orthopedics, Mayo Clinic Hospital, Phoenix, AZ, USA
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Kermarrec G, Paulos R, Le Viet D. Surgical reconstruction of an unstable rheumatoid thumb deformity. A case report. ACTA ACUST UNITED AC 2015; 34:201-4. [PMID: 26184650 DOI: 10.1016/j.main.2015.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 01/25/2015] [Accepted: 02/08/2015] [Indexed: 10/23/2022]
Abstract
The thumb is frequently impaired in rheumatoid arthritis. This leads to major disability in affected patients. Through a clinical case, we describe a reconstructive strategy for a three-joint adduction thumb deformity that caused instability of the interphalangeal and metacarpophalangeal joints, without cartilaginous lesion. Ulnar collateral ligament destruction was treated by a bone-ligament-bone graft at the interphalangeal joint and by a Littler ligamentoplasty at the metacarpophalangeal joint. The trapeziometacarpal lesion was treated by trapeziectomy in combination with suspension ligamentoplasty. Clinical and radiological assessments at 22 months of follow-up revealed good outcomes. This technique is a new option to include in the reconstructive treatment for thumb instability, particularly when caused by rheumatoid arthritis.
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Affiliation(s)
- G Kermarrec
- Institut de la main, clinique Jouvet, 6, square Jouvenet, 75016 Paris, France.
| | - R Paulos
- Institut de la main, clinique Jouvet, 6, square Jouvenet, 75016 Paris, France.
| | - D Le Viet
- Institut de la main, clinique Jouvet, 6, square Jouvenet, 75016 Paris, France.
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Abstract
BACKGROUND A variety of metacarpophalangeal joint (MCPJ) arthrodesis techniques have been described for the treatment of symptomatic arthritis and instability of the thumb MCPJ including K wire fixation, tension-band arthrodesis, plate fixation, intramedullary screw, and other intramedullary devices. This study presents a retrospective review of one surgeon's initial series of patients undergoing thumb MCP arthrodesis using an intramedullary compression device with a fixed angle of 25°. METHODS A retrospective chart and radiographic review of patients treated for thumb MCP arthrodesis using the intramedullary device was performed. Final radiographs were evaluated for arthrodesis angle, bony fusion, and implant fixation. Any complication found during surgery or the follow-up period was noted. RESULTS In this study, 17 patients were reviewed. Indications for surgery were osteoarthritis (five patients), rheumatoid arthritis (three patients), MCP instability alone (seven patients), and post-traumatic conditions (two patients). Of these, 12 patients had a simultaneous trapeziometacarpal (TMC) soft tissue arthroplasty. Mean follow-up was 4.9 months. All 17 patients had clinical and radiographic evidence of fusion at an average of 7.9 weeks, with an average fusion angle of 24.4°. There were no hardware complications, no infections, no revisions, and no indications for hardware removal. DISCUSSION Our study results indicate the technique promotes rapid union at a precise angle, provides strong fixation that does not require prolonged immobilization, does not cause hardware irritation, and can be used in conjunction with other procedures including TMC arthroplasty when MCP arthrodesis is indicated for joint instability.
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Affiliation(s)
- Jacqueline C. Vanderzanden
- Department of Orthopedic Surgery and Rehabilitation, University of Iowa, Iowa City, IA 52242 USA ,New England Orthopedics, Baystate Medical Center, 300 Birnie Ave, Suite 201, Springfield, MA 01107 USA
| | - Brian D. Adams
- Department of Orthopedic Surgery and Rehabilitation, University of Iowa, Iowa City, IA 52242 USA
| | - Justin J. Guan
- Department of Orthopedic Surgery and Rehabilitation, University of Iowa, Iowa City, IA 52242 USA ,Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA 52242 USA
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Rigó IZ, Røkkum M. Not all non-rheumatoid patients are satisfied with thumb metacarpophalangeal joint arthrodesis. J Plast Surg Hand Surg 2013; 47:144-6. [PMID: 23402550 DOI: 10.3109/2000656x.2012.742020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Arthrodesis of the thumb metacarpophalangeal (MP) joint exhibits good results in rheumatoid patients but is controversial in post-traumatic conditions. This study evaluated the subjective outcome after thumb MP joint arthrodesis in chronic injuries and non-rheumatoid degenerative disorders. Forty-six patients were evaluated retrospectively with a mean follow-up of 4.1 years (range 1.5-6.5). Both the Quick DASH score (mean 18.6; range 0-72.7) and Visual Analogue Scales (satisfaction, pain, stiffness, and impairment of ADL; mean 3.2, 3.0, 3.0, and 2.5; range 0-9.6, 0-9.1, 0-9.8, and 0-9.6, respectively) showed wide variations. Twelve patients regretted the operation and 37 experienced difficulties with one or more specific activities. Multiple regression analyses indicated that elderly patients with painless instability are the best candidates for thumb MP joint arthrodesis. In young patients with excessively painful thumb MP joints and involvement in Workers' Compensation Board claims, but without advanced degenerative changes, this study recommends avoiding arthrodesis and considering alternative treatment modalities. The importance of adequate preoperative information about the realistic expectations after arthrodesis of the thumb MP joint is emphasised.
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Affiliation(s)
- István Z Rigó
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.
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