Trapezio-metacarpal arthrodesis: procedure and results

Abstract

The high prevalence of trapezio-metacarpal joint (TMJ) osteoarthritis leads to develop techniques to improve surgical outcomes when conservative treatment has failed. We have evaluated 18 patients with Eaton III TMJ osteoarthritis, who underwent an arthrodesis. Using a dorsal-radial curved shaped skin incision the TMJ was exposed through the space between the abductor pollicis longus and the extensor pollicis brevis muscles. The articular capsule was divided and the TMJ was opened. Neat curettage was then performed in both joint surfaces by removing all the articular cartilage until some cancellous bone hints appeared underneath. The joint was then fixed in the optimal position by a 1.6 mm Kirschner wire and a 1.1 mm guide wire. A cannulated drill for the guide wire was used and matched to a cannulated lag screw. Then, a cylinder-shaped cancellous bone autograft harvested from the distal radius by a percutaneous approach was applied in the hole by drilling backwards in order to spread the bone about onto the hole walls. The joint was then definitively fixed by the cannulated lag screw. The K wires were removed by that time. DASH score changed from an average of 68 in the preoperative assessment to 39.4 at the end of the evolution time. The evolution of pain has decreased from 9.2 points preoperatively to 3.9 points in the postoperative using the visual analogue scale. In terms of mobility, it has decreased from 4 points preoperatively to 3.9 postoperatively, 14 patients got opposition of the thumb to the fifth finger, two of them to the head of the fifth metacarpal bone, one patient to the fourth finger, and one to the third. This slight decrease of mobility had no effect on performing activities of daily life, as expressed by the patients. The grip strength increased from 17 to 21.7 kg and the thumb opposition from 7.8 to 11.2 kg. All patients, except one, would have the operation again after knowing the final results. This patient said that results did not meet previous expectations. On the radiographic evaluation, consolidation has been achieved in 17 patients. When thumb carpo-metacarpal arthrodesis is indicated, the procedure provides a reliable and lasting treatment with satisfactory results. The development of new implants and the possibility of introducing autologous graft percutaneously as is described using this technique leads to improve the results.

Addition of an Oblique Interfragmentary Screw to T-plate Fixation Decreases Nonunion Rate in Trapeziometacarpal Arthrodesis

“…As documented above, other techniques, such as the use of a single oblique lag screw or the use of T-plate fixation, resulted in nonunion rates between 6% and 26%. 3,16,18,22,23 We had had complete fusion of all 22 TMAs. It is possible that there is increased stability of the construct or possibly a compressive force of the oblique interfragmentary screw when added to the T-plate.…”

“…Another commonly used technique is a lag screw to provide interfragmentary compression and assist in bone fusion. Galan et al 22 studied the use of an oblique cannulated lag screw in TMAs with a distal radius bone graft. They found a 6% nonunion rate (1 of 18 patients).…”

“…[10][11][12][13][14][15] These techniques, however, may result in symptomatic or radiographic nonunion which has been reported in the literature at a rate of 6% to 26%. 3,10,[16][17][18][19][20][21][22][23] In this study, we did not identify any patients with nonunion, which we hypothesize is due to the addition of an oblique interfragmentary screw to a T-plate. Similar studies have investigated nonunion rates using simple plate fixation for TMAs.…”

“…[10][11][12][13][14][15] One concern with TMA is the rate of nonunion. Previous studies report a 6% to 18% rate of symptomatic nonunion 3,10,[16][17][18][19][20][21][22][23] and a 7% to 26% rate of radiographic nonunion. 16,23 The purpose of this study was to evaluate symptomatic and radiographic nonunion rates with the addition of an oblique interfragmentary screw to T-plate fixation.…”

Cross-Shaped Bone Grafting and Locking Plate Fixation for Arthrodesis of the Trapeziometacarpal Joint: Surgical Technique and Early Mobilization

“…To date, only two studies have demonstrated model-ing of the bone graft for arthrodesis of the trapeziometacarpal joint. Galan et al 18) harvested a cylinder-shaped bone graft from the distal radius and fitted this to the same defect made at the joint. After surgery, the affected thumb was immobilized for 6 weeks and 17 of 18 (94%) patients obtained bony union.…”