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Hozack BA, Liss FE, Fram B, Rivlin M, Ilyas AM, Jones CM. Optimal Position of the Bone Anchor for the Internal Brace Suspensionplasty Technique for Thumb Basal Joint Arthroplasty. J Hand Surg Am 2024; 49:380.e1-380.e6. [PMID: 36100487 DOI: 10.1016/j.jhsa.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 06/29/2022] [Accepted: 08/05/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Ligament reconstruction and tendon interposition is a common technique for thumb basal joint arthroplasty. Recently, a variation of this technique, a suture suspensionplasty, has been introduced. The goal of our study was to assess the optimal position of the bone anchor in the thumb metacarpal. We hypothesized that an anchor placed in the radial aspect of the thumb metacarpal base would provide improved stability and resist subsidence more effectively than an ulnar-based thumb anchor. METHODS Eight fresh-frozen cadaver arms were imaged fluoroscopically in anteroposterior and lateral views centered over the thumb carpometacarpal joint before and after trapeziectomy and after the placement of radial-based and ulnar-based bone anchors. The intermetacarpal angle between the thumb and index metacarpals was measured on all images after the application of a standard force. Radial abduction, opposition, subsidence, palmar abduction, and adduction were measured. Subsidence was calculated as the percentage loss of the trapezial space. RESULTS Both radially and ulnarly placed internal brace constructs allowed more radial abduction, opposition, and palmar abduction than the pretrapeziectomy constructs. They both also reduced subsidence by approximately 20% to 29% compared with the posttrapeziectomy constructs. Comparing radial to ulnar constructs, motion and subsidence were similar. CONCLUSIONS There was immediate stability of the thumb with respect to axial load and subsidence after anchor placement, and this was independent of the anchor position. The position of the bone anchor in the thumb metacarpal base did not affect the range of motion. Although the device can limit subsidence, it does not appear to restrict any range of motion of the thumb, irrespective of anchor position. CLINICAL RELEVANCE This cadaver study can help hand surgeons understand the effect of positioning of bone anchors when performing a specific suture suspensionplasty technique.
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Affiliation(s)
- Bryan A Hozack
- The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA.
| | - Frederic E Liss
- The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Brianna Fram
- The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Michael Rivlin
- The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Asif M Ilyas
- The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA
| | - Christopher M Jones
- The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA
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Tovar-Bazaga M, Pérez-Cuesta Llaneras M, Badia A. Arthroscopic Hemitrapeziectomy: Is an Internal Brace Worth It? Hand (N Y) 2024:15589447241231301. [PMID: 38380812 DOI: 10.1177/15589447241231301] [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] [Indexed: 02/22/2024]
Abstract
BACKGROUND This article's purpose was to analyze clinical results obtained with thumb carpometacarpal (CMC) arthroscopic hemitrapeziectomy with temporary suspension with a Kirschner wire (K-wire). METHODS Seventy thumb CMC arthroscopic hemitrapeziectomies with a mean age of 59 and 18 months of follow-up were performed in our center during a 13-year period. All of them followed the same protocol. Surgical technique is described. RESULTS All patients were arthroscopically classified as Badia's III stage. No tendon interposition was used, and a K-wire was temporarily implanted for 5.1 weeks. Mean postsurgical Visual Analogue Scale of 1.6, Kapandji Opposition Score of 8.1, grip strength of 42.2 lbs, lateral pinch of 9.5 lbs, tip-to-tip pinch of 4.2 lbs and tripod pinch of 7.8 lbs were measured. All previous active workers resumed their previous job. CONCLUSIONS We conclude that thumb CMC arthroscopic hemitrapeziectomy with temporary suspension with K-wire reaches good results in terms of pain reduction, strength, and functionality, without the necessity of an internal brace which increases risks of a second metacarpal fracture.
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Affiliation(s)
- Miguel Tovar-Bazaga
- Department of Orthopaedic and Traumatology Surgery, IIS-Fundación Jiménez Díaz, Madrid, Spain
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Shinya Y, Ikeguchi R, Noguchi T, Ando M, Yoshimoto K, Sakamoto D, Iwai T, Matsuda S. Radiographic Evaluation after Arthroscopic Partial Trapeziectomy with Suture-button Suspensionplasty for Thumb Carpometacarpal Arthritis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4983. [PMID: 37180981 PMCID: PMC10171570 DOI: 10.1097/gox.0000000000004983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/17/2023] [Indexed: 05/16/2023]
Abstract
Arthroscopic partial trapeziectomy with suture-button suspensionplasty was developed for the surgical treatment of thumb carpometacarpal arthritis. However, the relationship between clinical results and radiographic evidence is unclear. Methods The authors retrospectively reviewed 33 consecutive patients who underwent arthroscopic partial trapeziectomy with suture-button suspensionplasty for thumb carpometacarpal arthritis between 2016 and 2021. Clinical and radiographic outcomes were recorded, and the correlations between them were evaluated. Results The average patient age at surgery was 69 years. Patient radiologic evidence was Eaton stage Ⅱ in three thumbs, Ⅲ in 25 thumbs, and Ⅳ in five thumbs. The average trapezial space ratio (TSR) was 0.36 immediately after the operation but declined to 0.32 after 6 months. In contrast, the average joint subluxation was reduced to 0.005 immediately after the operation compared with 0.28 before, and was maintained at 0.04 at final follow-up. A statically significant correlation was detected between grip strength and TSR (P = 0.03), and between pinch strength and TSR (P = 0.02). A significant correlation was detected between TSR and trapezium height (P = 0.0215), which remained after partial trapeziectomy. No correlation was detected between rope position and other clinical or radiographic scores. Conclusions Suture-button can have an effect on the medialization of the first metacarpal base. Excessive trapeziectomy can result in functional deficiency of the thumb through metacarpal subsidence, which potentially causes loss of grip and pinch strength.
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Affiliation(s)
- Yuki Shinya
- From the Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | - Ryosuke Ikeguchi
- From the Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | - Takashi Noguchi
- From the Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | - Maki Ando
- From the Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | - Koichi Yoshimoto
- From the Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | - Daichi Sakamoto
- From the Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | - Terunobu Iwai
- From the Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- From the Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
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Natural History of Metacarpal Subsidence following Trapeziectomy and Its Relationship to Clinical Outcomes. Plast Reconstr Surg 2023; 151:432e-440e. [PMID: 36730472 DOI: 10.1097/prs.0000000000009921] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
METHODS An institutional review board-approved retrospective review of patients who underwent trapeziectomy and ligament reconstruction and tendon interposition (LRTI) was conducted. Patient demographics, visual analogue scale pain scores, grip strength, pinch strengths, and radial and palmar abduction were collected. The trapezial space ratio (TSR) was measured by the scaphometacarpal distance divided by the length of the capitate. Subsidence [(postoperative TSR - preoperative TSR)/preoperative TSR] was measured and classified as severe (≥70%) or mild to moderate (<70%). Median rate of subsidence increase was calculated. Conolly-Rath scores were used to evaluate the proportion of good outcomes in each group. RESULTS A total of 141 trapeziectomies with LRTI were included. Subsidence increased 6.7% (5.4% to 23.0%) per week before 16 weeks and 0.3% (0.1% to 0.8%) per week thereafter. Visual analogue scale pain scores were not significantly different between patients with severe or mild to moderate subsidence ( P = 0.25) 16 weeks after thumb mobilization. The proportion of good outcomes was comparable between the two groups ( P = 0.12). There was no correlation between subsidence and pain (ρ = -0.20; P = 0.24), grip (ρ = -0.02; P = 0.93), key (ρ = -0.13; P = 0.62), tripod (ρ = 0.16; P = 0.71), or index tip pinch strengths (ρ = -0.28; P = 0.43) or radial (ρ = -0.03; P = 0.92) or palmar (ρ = -0.15; P = 0.61) abduction. CONCLUSIONS Subsidence occurs in all patients after trapeziectomy and LRTI, stabilizing 16 weeks after mobilization. Degree of subsidence does not correlate with postoperative outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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Trapeziectomy with suture-button suspensionplasty versus ligament reconstruction and tendon interposition: a randomized controlled trial. HAND SURGERY & REHABILITATION 2021; 41:59-64. [PMID: 34728434 DOI: 10.1016/j.hansur.2021.10.315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/21/2021] [Accepted: 10/02/2021] [Indexed: 11/24/2022]
Abstract
The purpose of the present study was to compare the results of patients operated with trapeziectomy and ligament reconstruction and tendon interposition (LRTI) using flexor carpi radialis tendon versus trapeziectomy followed by suspension of the first metacarpal to the second metacarpal using a Mini TightRope® suture button (suture button suspension: SBS). A single-center prospective randomized controlled trial was performed, comparing 37 patients with SBS and 39 with LRTI. All surgeries were performed by the same fellowship-trained hand surgeon. Patients were assessed by an independent observer at 40 months' follow-up. Pre- and postoperative strength, trapezial space ratio (TSR), range of motion, QuickDASH and visual analogue pain score were recorded. Both procedures improved functional parameters of pain, key strength, tip strength and grip strength while maintaining range of motion, without significant differences. In the SBS group, TSR decreased by 17%, compared to 28% in the LRTI group. The mean operative time was shorter in SBS (63 vs 91 minutes; p < 0.0001), as was immobilization time (2 vs 6 weeks; p < 0.0001), and patients resumed normal activity sooner (10 vs 12 week; p = 0.0138) and required less physical therapy (19.3 vs 13.1 weeks; p < 0.0001). We believe that our results are related to the hypothesis suggested by biomechanical studies that revealed better initial load bearing profile and maintenance of trapezial space following serial loading in cadaver models.
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Cavit A, Civan O, Özcanli H. Technical trick in suture-button suspensionplasty for the treatment of thumb carpometacarpal arthritis. HANDCHIR MIKROCHIR P 2021; 54:87-91. [PMID: 33525035 DOI: 10.1055/a-1344-8846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Suture-button suspensionplasty has been popularized in the treatment of thumb carpometacarpal (CMC) arthritis in recent years. The surgical technique of this method was well defined previously. The most challenging and important part of this technique is the tensioning of the suture-button system to preserve first metacarpal height after trapeziectomy. In present study, we would like to present a technical trick about adjusting the tension while performing suspensionplasty using suture-button device in thumb CMC joint osteoarthritis. In the original technique, trapeziectomy is performed prior to fixation and tensioning of suture-button system. However, it is quite difficult to recreate the original trapezial space, since first metacarpal subsides after trapeziectomy. The trick in our technique is that trapezium remains in its anatomic position up to the end of the operation. Thus, we do not need to make effort to adjust the thumb ray height and use fluoroscopic imaging to ensure its position. In conclusion, we believe that our technique simplifies the most challenging part of the operation, shortens the operation time, preserves the original first ray height and diminishes the exposure of ionizing radiation as it reduces the need for fluoroscopy.
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Affiliation(s)
- Ali Cavit
- Haydarpasa Numune Training & Research Hospital, Department of Orthopaedics & Traumatology, Hand Surgery Clinic
| | - Osman Civan
- Akdeniz University Faculty of Medicine, Department of Orthopaedics & Traumatology
| | - Haluk Özcanli
- Akdeniz University Faculty of Medicine, Department of Orthopaedics & Traumatology
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Ferrão AM, Morais B, Marques N, Nóbrega J, Monteiro J, Jorge JT, Teixeira F. Trapeziectomy and Suture-Button Suspensionplasty for Basilar Thumb Arthritis: Is It Enough to Prevent First Ray Subsidence? J Hand Microsurg 2020; 15:23-30. [PMID: 36761051 PMCID: PMC9904981 DOI: 10.1055/s-0040-1721169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Introduction Trapeziectomy and suture-button suspensionplasty (SBS) are a novel option to treat end-stage trapeziometacarpal (TMC) osteoarthritis. Our purpose is to evaluate our outcomes with this technique and in this setting, with a minimum of 18 months of follow-up. Materials and Methods Twenty-eight patients were included, operated between 2016 and 2018. We recorded demographic data, preoperative Eaton stage, follow-up and operative times. The patients completed the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire and tip pinch, key pinch, and grip strength were measured. First metacarpal subsidence was calculated, and postoperative complications were documented. Results The average follow-up was 34 months. The mean QuickDASH was 32 at the final follow-up. The average strength results were 20 kg for grip, 3.6 kg for tip pinch, and 4.2 kg for key pinch. The rate of first ray subsidence was 10.7%. We encountered three complications: a hardware intolerance, a second metacarpal fracture, and a suture rupture. There was one reoperation to remove an implant. Conclusion Trapeziectomy and SBS functional results are similar to other techniques, with less subsidence of the first ray and allowing for early mobilization and fast recovery. This procedure is a safe and promising option in the treatment of TMC osteoarthritis, with good medium-term outcomes.
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Affiliation(s)
- Ana Moreira Ferrão
- Department of Orthopedic Surgery and Traumatology, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal,Address for correspondence Ana Moreira Ferrão, MD Department of Orthopedic Surgery and Traumatology, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa CentralRua da Beneficência n. 8, 1069-166 LisboaPortugal
| | - Bruno Morais
- Department of Orthopedic Surgery and Traumatology, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Nuno Marques
- Department of Orthopedic Surgery and Traumatology, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - João Nóbrega
- Department of Orthopedic Surgery and Traumatology, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - José Monteiro
- Department of Orthopedic Surgery and Traumatology, Centro Hospitalar do Oeste, Hospital de Torres Vedras, Torres Vedras, Portugal
| | - João Torrinha Jorge
- Department of Orthopedic Surgery and Traumatology, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Frederico Teixeira
- Department of Orthopedic Surgery and Traumatology, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
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