Carpometacarpal Arthrodesis: Indications and Techniques

Outcome of Trapeziectomy and Ligament Reconstruction and Tendon Interposition for Patients Aged Less Than 56 Years: A Retrospective Study With a Minimum 5-Year Follow-Up

PURPOSE

The purpose of this study was to determine the long-term consequences of trapeziectomy and ligament reconstruction and tendon interposition (LRTI) for trapeziometacarpal osteoarthritis in patients aged less than 56 years.

METHODS

A retrospective study was performed to investigate the outcome of trapeziectomy and LRTI with a follow-up period of greater than 5 years in patients aged less than 56 years at the time of surgery. Patients completed the Disabilities of Arm, Shoulder, and Hand (DASH), the Patient-Rated Wrist Evaluation (PRWE), and a 10-point visual analog score for pain (VAS). Objective assessments included thumb opposition, palmar and radial abduction angles, and grip, lateral key, and thumb tip pinch strengths. Radiographic assessments of the thumb carpometacarpal joint were performed in three planes, and the trapezial space and trapezial space to metacarpal height ratios were calculated.

RESULTS

Between January 2005 and December 2017, 105 patients were treated. Forty-eight patients with 58 thumbs returned for review. The mean patient age at the time of surgery was 52.5 years, and 96% of the patients were women. The mean follow-up period from surgery was 11 years. The mean VAS score was 1. A significant association was found between younger age at the time of surgery and increased proximal migration of the metacarpal, between high VAS pain scores and high PRWE and DASH scores, weak grip, lateral key pinch and thumb tip pinch strength, and Kapandji score, and between the follow-up period and increasing VAS pain, PRWE, and DASH scores.

CONCLUSIONS

Trapeziectomy and LRTI are effective procedures for patients aged less than 56 years. The benefits of surgery should be balanced against the deterioration in the outcome measures of DASH and PRWE and increasing VAS scores with increasing intervals from surgery.

TYPE OF STUDY/LEVEL EVIDENCE

Therapeutic IV.

Basal thumb arthritis surgery: complications and its management

The management of complications after surgery for basal thumb arthritis is sometimes challenging, and there are no clear recommendations on how to evaluate and manage patients with residual symptoms. The aim of the present article was to review the most common complications after surgery for basal thumb arthritis, with an emphasis on resection arthroplasty, joint replacement and joint fusion. In addition, possible management strategies for the different types of complications will be highlighted.

Minimally invasive arthroscopy-assisted arthrodesis for thumb carpometacarpal osteoarthritis

INTRODUCTION

Arthrodesis is a reliable surgical procedure for treatment of thumb carpometacarpal (CMC) osteoarthritis that provides hand strength and pain relief. Locking plate fixation is a common technique that provides rigid fixation and a high rate of bone union; however, it requires extensive surgical exploration of the first metacarpal and trapezium. Here, we report the surgical outcome of minimally invasive arthroscopy-assisted thumb CMC arthrodesis that preserves soft tissue supplying the blood flow to the bones.

MATERIALS AND METHODS

Nine thumbs of nine patients who underwent arthroscopy-assisted thumb CMC arthrodesis were retrospectively analysed (mean postoperative follow-up, 19.7 months). We investigated the time from surgery to bone union, grip strength, pinch strength (pulp and key), range of motion (ROM) of the thumb, visual analogue scale (VAS) score for pain, Disabilities of Arm, Shoulder, and Hand (DASH) score, and Hand20 questionnaire score preoperatively and at the final follow-up.

RESULTS

Bone union was observed in eight of the nine patients. The mean time to bone union was 2.9 months (range 8 weeks-9 months). Although grip strength changed from 24.0 kg preoperatively to 25.8 kg at the final follow-up (not significant), the pulp pinch strength and key pinch strength significantly increased from 2.3 kg and 3.7 kg preoperatively to 3.8 kg and 5.6 kg at the final follow-up, respectively. No significant change occurred in the thumb ROM. The DASH score, Hand20 questionnaire score, and VAS score for pain significantly improved from 29.8, 42.2, and 78.4 preoperatively to 12.4, 11.2, and 13.2 at the final follow-up, respectively. Non-union was observed in one patient. No other complications were observed.

CONCLUSIONS

Arthroscopy-assisted arthrodesis is a valuable procedure for thumb CMC osteoarthritis. However, the learning curve for this procedure must be overcome before the operative time can be shortened and successful bone union and satisfactory outcomes achieved.

Staple Technology for Fracture Fixation and Joint Arthrodesis

The use of staple technology in the upper extremity has continued to evolve with the development of shape-memory alloys (SMAs) such as Nitinol that display superelastic properties that can be exploited for persistent compression. Clinical and biomechanical studies support the use of SMA staples for upper extremity fracture fixation and joint arthrodesis. To optimize biomechanical strength and clinical outcomes, it is recommended to place two staples, if possible, at the site of interest as well as to trough the staples to prevent hardware prominence.

First Dorsal Metacarpal Artery-pedicled Second Metacarpal Vascularized Bone Graft for Nonunion after Thumb Carpometacarpal Arthrodesis

Arthrodesis is a reliable surgical procedure for treating thumb carpometacarpal osteoarthritis. However, the most frequent and problematic complication of arthrodesis is nonunion. Although postarthrodesis-related nonunion is a common complication, the indications and results of revision procedures for this pathological condition have not been well documented. A 59-year-old man underwent arthrodesis for thumb carpometacarpal osteoarthritis, which resulted in painful nonunion 7 months after the surgery. We performed revision surgery for this pathological condition, using first dorsal metacarpal artery-pedicled second metacarpal vascularized bone graft. This method resulted in successful bone union and pain relief. First dorsal metacarpal artery-pedicled second metacarpal vascularized bone grafting could be an alternative method for nonunion, which is a common complication after thumb carpometacarpal arthrodesis.