Arthroscopic Assisted Treatment of Thumb Metacarpal Base Articular Fractures

Abstract

Fracture of the base of the thumb metacarpal (M1) is a common finding in hand trauma. Closed reduction and K-wire fixation and open reductioneinternal fixation are traditional treatments of choice. The arthroscopic assisted technique has been introduced to improve intra-articular fragment reduction and to preserve fragment vascularization and capsular and ligamentous integrity along with joint stability. Indications for arthroscopic assistance are all types of intra-articular fractures or pending malunions involving the base of M1 and/or the trapezium. The aim of this article is to describe the surgical technique used in managing articular fractures of the base of M1, with arthroscopic assistance. Our experience with this technique confirms the advantages of a minimally invasive method that provides articular reduction under direct vision, with limited soft-tissue damage, and allows early rehabilitation (from day 1 after surgery). This technique is extremely valuable for high-demand patients such as manual workers or athletes. The relative disadvantage of the technique is its technical difficulty, which requires experience with small-joint arthroscopy.

Arthroscopic Assisted Treatment of Combined Trapezium and Bennett Fracture-Dislocation

“…However, the first international publication was made in 1997, in which 4 patients with Bennett fracture-dislocations were treated by arthroscopy 32. More recently Marcovici et al 16 described the technical details of arthroscopic assistance to articular fractures of the thumb metacarpal base.…”

“…Fluoroscopy is often used to confirm the needles' positions before the insertion of the arthroscope. 16,17 Fluoroscopy also shows the amount of preliminary reduction of the dislocation and fragment displacement, following the ligamentotaxis provided by thumb distraction. The arthroscope is introduced with the same orientation as the needles and switched between the portals following the "box concept" to achieve complete vision of…”

“…Arthroscopic assessment is performed as described by Marcovici et al16 The box concept of the CMC-1j (Fig. 4) is applied to confirm the proper positioning of all the portals 16,30.…”

“…Arthroscopic assessment is performed as described by Marcovici et al16 The box concept of the CMC-1j (Fig. 4) is applied to confirm the proper positioning of all the portals 16,30. The main working portals are the 1R, located radial to the Abductor Pollicis Longs tendon, and the 1U, located ulnar to the Pollicis Brevis Extensor tendon, within the first dorsal compartment 16,30–36.…”

“…The dorsal distal portal (D2) lies just distal of the dorsal intermetacarpal. The box concept adapted from “Arthroscopic Assisted Treatment of Thumb Metacarpal Base Articular Fractures“ by Marcovici et al16…”