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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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Finger LE, Hamaker MC, Singh-Varma A, Goitz RJ, Kaufmann RA, Fowler JR. Comparison of Fusion Rates/Complications Between Different Types of Thumb Metacarpophalangeal Fusion Techniques. Hand (N Y) 2024:15589447241235343. [PMID: 38516828 DOI: 10.1177/15589447241235343] [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: 03/23/2024]
Abstract
BACKGROUND Thumb metacarpophalangeal (MP) fusion is generally successful; however, complications have been reported to occur in 0% to 30% of cases, whereas nonunion rates vary by method but, overall, are reported to occur in 0% to 15% of cases. Many fixation techniques have been described, but there is no consensus on the optimal fusion technique. Our goal was to compare complication and union rates of different thumb MP arthrodesis techniques. METHODS We performed a retrospective review of patients who underwent primary thumb MP fusion between 2000 and 2022. Patients who underwent revision fusion, fusion for infection, or amputation were excluded. Fusions of MP joints of other fingers were also excluded. Data collection consisted of demographic data, complications, time to fusion, rate of delayed union and rate of nonunion. Five different fusion constructs were evaluated during our study period: staples, Kirschner wires (K-wires), cerclage, K-wires with cerclage, and intramedullary screw. RESULTS Forty-seven patients underwent fusion with staples, 16 with K-wires, 14 with cerclage, 9 with K-wires and cerclage, and 6 with an intramedullary screw. The individual complication and nonunion rates differed significantly among the groups with the intramedullary screw group having a statistically higher rate of nonunion (P = .004). Furthermore, smoking, diabetes, and being overweight were associated with nonunions. CONCLUSION Union rates were significantly lower in patients treated with an intramedullary screw and those who are smokers, diabetics, and/or overweight. Caution should be exercised when using intramedullary screw fixation for MP fusion, especially in patients with these comorbidities.
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Affiliation(s)
- Logan E Finger
- Department of Orthopaedic Surgery, University of Pittsburgh, PA, USA
| | - Max C Hamaker
- Department of Orthopaedic Surgery, University of Pittsburgh, PA, USA
| | - Anya Singh-Varma
- Department of Orthopaedic Surgery, University of Pittsburgh, PA, USA
| | - Robert J Goitz
- Department of Orthopaedic Surgery, University of Pittsburgh, PA, USA
| | - Robert A Kaufmann
- Department of Orthopaedic Surgery, University of Pittsburgh, PA, USA
| | - John R Fowler
- Department of Orthopaedic Surgery, University of Pittsburgh, PA, USA
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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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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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Management of the Metacarpophalangeal and Scaphotrapeziotrapezoidal Joints in Patients with Thumb Trapeziometacarpal Arthrosis. Hand Clin 2022; 38:241-247. [PMID: 35465941 DOI: 10.1016/j.hcl.2021.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Basilar thumb osteoarthritis at the trapeziometacarpal joint is the second most common location of osteoarthritis in the hand. Arthritis and instability of the thumb MCP joint can be quite debilitating, given the crucial role the joint plays in thumb dexterity. Advanced basilar thumb osteoarthritis often leads to collapse of the first ray with compensatory hyperextension of the thumb metacarpophalangeal (MCP) joint and is accompanied by arthritis in the scaphotrapezialtrapezoid joint. Here the authors discuss the management of MCP hyperextension and scaphotrapezoidal osteoarthritis in the setting of basilar thumb osteoarthritis.
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Summer T, Erdmann J, Wüstner-Hofmann MC. [Indications and Techniques for Joint Fusion of osteoarthritic Finger Joints]. HANDCHIR MIKROCHIR P 2021; 53:454-461. [PMID: 34583406 DOI: 10.1055/a-1560-2780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The following article, by presenting patients' cases, provides an overview of arthrodesis indications and techniques of osteoarthritic finger joints.
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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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8
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Degeorge B, Chiche L, Coulet B, Lazerges C, Chammas M. Metacarpophalangeal joint instability in trapeziometacarpal osteoarthritis: A systematic review. HAND SURGERY & REHABILITATION 2020; 40S:S126-S134. [PMID: 33378715 DOI: 10.1016/j.hansur.2020.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/30/2020] [Accepted: 05/05/2020] [Indexed: 11/28/2022]
Abstract
Thumb metacarpophalangeal instability is commonly found in conjunction with trapeziometacarpal osteoarthritis. If not corrected, it can have detrimental effects on the outcome. The authors describe the two types of metacarpophalangeal deformities - hyperextension and valgus - their pathophysiology and the surgical repair techniques available to surgeons. An algorithm for treating this instability is presented.
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Affiliation(s)
- B Degeorge
- Département de chirurgie orthopédique, unité de chirurgie du membre supérieur, de la main et des nerfs périphériques, CHU Lapeyronie, 191, avenue du Doyen Gaston Giraud, 34295 Montpellier, France.
| | - L Chiche
- Département de chirurgie orthopédique, unité de chirurgie du membre supérieur, de la main et des nerfs périphériques, CHU Lapeyronie, 191, avenue du Doyen Gaston Giraud, 34295 Montpellier, France
| | - B Coulet
- Département de chirurgie orthopédique, unité de chirurgie du membre supérieur, de la main et des nerfs périphériques, CHU Lapeyronie, 191, avenue du Doyen Gaston Giraud, 34295 Montpellier, France
| | - C Lazerges
- Département de chirurgie orthopédique, unité de chirurgie du membre supérieur, de la main et des nerfs périphériques, CHU Lapeyronie, 191, avenue du Doyen Gaston Giraud, 34295 Montpellier, France
| | - M Chammas
- Département de chirurgie orthopédique, unité de chirurgie du membre supérieur, de la main et des nerfs périphériques, CHU Lapeyronie, 191, avenue du Doyen Gaston Giraud, 34295 Montpellier, France
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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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Lutsky KF, Edelman D, Lebowitz C, Matzon JL, Beredjiklian PK. Union Rates and Complications After Thumb Metacarpophalangeal Fusion. Hand (N Y) 2019; 14:803-807. [PMID: 29989437 PMCID: PMC6900684 DOI: 10.1177/1558944718784025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Fusion of the thumb metacarpophalangeal joint (MPJ) can be performed using tension band wiring (TBW) or plate and screw (PS) fixation. This study evaluated results and complications using these techniques. Methods: A retrospective review of patients who underwent thumb MPJ fusion at our institution from 2010 to 2016 was performed. Patients with >1 year follow-up were included. Demographic information, indication for fusion, time to fusion, and complications were collected. Final radiographs were examined and alignment measured. Results: There were 56 thumbs in 53 patients (42 women and 11 men) including 12 TBW and 44 PS. The mean age was 60.9 years, and follow-up was 32.4 months. Twenty-eight of 44 plates were nonlocking, and 16 were locking. Of the locking plates, 7 of 26 used all locking screws, and 9 of 26 had a combination of locked and nonlocked screws. The mean flexion angle for TBW was 16.5° and PS was 12.8°. The mean coronal angle for TBW patients was 4.0° ulnar and PS was 2.5° ulnar. The overall union rate was 95%. There were 12 complications, 9 in the PS group. The TBW complications were painful hardware requiring removal. Eight complications in the PS group occurred in patients with locked plates. Five of the delayed or nonunions occurred in patients with locked plates and 4 of these were in plates with all screws locked. Conclusion: Complications using PS or TBW are not infrequent. Alignment with both techniques is similar, but use of locked plates specifically increases the rate of delayed or nonunions. We do not recommend routine use of locked plates for fusion of the thumb MPJ.
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Affiliation(s)
- Kevin F. Lutsky
- Thomas Jefferson University,
Philadelphia, PA, USA,Kevin F. Lutsky, Department of Hand &
Upper Extremity Surgery, The Rothman Institute, Thomas Jefferson University, 925
Chestnut Street, 5th floor, Philadelphia, PA 19107, USA.
| | | | - Cory Lebowitz
- Rowan University School of Medicine,
Philadelphia, PA, USA
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Langer MF, Oeckenpöhler S, Spies CK, Grünert JG, Breiter S, Glasbrenner J, Wieskötter B. [Dorsal plate arthrodesis of the thumb metacarpophalangeal joint]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2019; 32:47-57. [PMID: 30806716 DOI: 10.1007/s00064-019-0592-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 01/21/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Elimination of pain or instability by arthrodesis of the thumb joint in functional position by dorsal plateosteosynthesis. INDICATIONS Painful primary or secondary arthrosis of the thumb, nonreconstructable ulnar, radial or palmar instability, posttraumatic dislocation, defect injuries, bone tumors in the region of the thumb metacarpophalangeal joint. CONTRAINDICATIONS Local infection of the thumb metacarpophalangeal joint area. SURGICAL TECHNIQUE Dorsal approach to the thumb metacarpophalangeal (MP) joint, splitting of the extensor aponeurosis between the extensor pollicis longus and extensor pollicis brevis tendon. Opening of the anterior capsule and separation of the collateral ligaments, open up the joint, narrow concave and convex joint surface resections, adjustment of the arthrodesis position in 10-20° flexion and K‑wire transfixation, dorsal plateosteosynthesis, fine adjustment of the flexion, axis and pronation position. Closure of the capsule and the periosteal gliding tissue over the plate, reconstruction of the extensor aponeurosis. POSTOPERATIVE MANAGEMENT Splint for 3 weeks. Full load after 6-8 weeks. RESULTS The dorsal plate arthrodesis of the thumb MP joint is a reliable surgical method with very good functional results.
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Affiliation(s)
- M F Langer
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstr. 1, 48149, Münster, Deutschland.
| | - S Oeckenpöhler
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstr. 1, 48149, Münster, Deutschland
| | - C K Spies
- Handchirurgie, Vulpiusklinik, Bad Rappenau, Deutschland
| | - J G Grünert
- Klinik für Hand‑, Plastische und Wiederherstellungschirurgie, Kantonsspital Sankt Gallen, Gallen, Schweiz
| | - S Breiter
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstr. 1, 48149, Münster, Deutschland
| | - J Glasbrenner
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstr. 1, 48149, Münster, Deutschland
| | - B Wieskötter
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstr. 1, 48149, Münster, Deutschland
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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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13
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Karl Spies C, Langer M, Hahn P, Peter Müller L, Unglaub F. The Treatment of Primary Arthritis of the Finger and Thumb Joint. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:269-275. [PMID: 29739493 PMCID: PMC5954171 DOI: 10.3238/arztebl.2018.0269] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 08/15/2017] [Accepted: 01/31/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Primary finger and thumb joint arthritis is common, with a markedly rising prevalence from age 50 onward. As the population as a whole ages, the need for effective, stage-appropriate treatment of this condition is increasing. METHODS This review is based on pertinent publications retrieved by a selective search in the PubMed and Cochrane Library databases. RESULTS Pain on movement and morning stiffness are commonly reported symptoms. Thorough physical examination and plain x-rays are mandatory. In the early stages of primary finger and thumb joint arthritis, a conservative, multimodal treatment approach involving the use of splints, physiotherapy, and non-steroidal anti-inflammatory drugs can be helpful. The intraarticular injection of hyaluronic acid or cortisone seems to relieve pain in the short term, but its long-term efficacy in primary finger and thumb joint arthritis is questionable. Arthrodesis (joint fusion) is a reliable surgical treatment option for arthritis of the metacarpophalangeal and interphalangeal joints of the thumb. For mobility-preserving surgery of the metacarpophalangeal joints of the second through fifth fingers, silicone implant arthroplasty remains the gold standard. Symptomatic, advanced arthritis of the distal interphalangeal joint is most effectively treated with arthrodesis. CONCLUSION The efficacy of conservative treatment has been documented in high-quality clinical trials, while that of surgical treatment has not. The various surgical methods have yielded benefits in routine clinical use, but these remain to be assessed in randomized and controlled trials.
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Affiliation(s)
| | - Martin Langer
- Department of Trauma, Hand, and Plastic Surgery, Münster University Hospital, Münster
| | - Peter Hahn
- Department of Hand Surgery, Vulpius Hospital, Bad Rappenau
| | - Lars Peter Müller
- Department of Orthopedics and Trauma Surgery, Cologne University Hospital, Cologne
| | - Frank Unglaub
- Department of Hand Surgery, Vulpius Hospital, Bad Rappenau
- Medical Faculty Mannheim, University of Heidelberg, Mannheim
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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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15
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Jørgensen RW, Brorson S, Jensen CH. Metacarpophalangeal Joint Arthrodesis of the Thumb - Minimum of Eight Months Follow-up. Open Orthop J 2017; 10:741-745. [PMID: 28217198 PMCID: PMC5299560 DOI: 10.2174/1874325001610010741] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/20/2016] [Accepted: 12/02/2016] [Indexed: 11/22/2022] Open
Abstract
Background: Disorders of the thumb metacarpophalangeal (MCP) joint can lead to significant loss of function and pain. Thumb MCP arthrodesis following traumatic injuries is inadequately described and recent studies have questioned the outcome of this treatment. Purpose: The purpose of this study was to report outcome and disability following thumb MCP joint arthrodesis in the treatment of chronic instability after traumatic injuries. Methods: A retrospective review of 26 patients operated on with MCP joint arthrodesis, median follow-up 42 months (8-104months). Subjective outcome was assessed using the disabilities of the Arm, Shoulder, and Hand-questionnaire (DASH). In addition, patient satisfaction, pain, stiffness, and impairment of activities of daily living were assessed on a Visual Analogue Scale (VAS) followed by a question stating whether they would undergo the same procedure again. Results: Two patients (7.7%) needed re-operation due to nonunion. Four patients (15.4%) needed hardware removal. Median DASH-score was 18 (25-75% range 6-47), with lower DASH scores being better. Scores were significantly worse in gender and age matched individuals (p<0.05). Median VAS for pain was 3.7 (range 0-8). More than 50% of patients reported mild, moderate or severe pain, but all patients reported that they were willing to undergo the same procedure again. Conclusion: Our data suggest, that patients with post-traumatic thumb injuries managed with thumb MCP joint arthrodesis perform worse than gender and age matched individuals. Many lived with pain, but all reported that they were willing to undergo the same procedure again. We suggest that the disability scale by the National Board of Industrial Injuries should be reconsidered for patients operated on with thumb MCP arthrodesis.
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Affiliation(s)
| | - Stig Brorson
- Orthopedic Department, Herlev Hospital, 2730 Herlev, Denmark
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Abstract
Arthrodesis and arthroplasty are surgical options used for the management of pain, stiffness, deformity, and instability related to arthritis and traumatic injury of the small joints of the hand. Arthrodesis and arthroplasty come with a risk of postoperative infection. Superficial soft tissue infections can often be managed with oral antibiotics alone. Deep infections and osteomyelitis frequently require removal of hardware in addition to antibiotics and may require surgical revision once the infection is cleared. Selection of the most appropriate revision technique depends on the underlying cause of the initial failure, patients' functional and outcome needs, and surgeon preference.
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Avery DM, Caggiano NM, Matullo KS. Ulnar collateral ligament injuries of the thumb: a comprehensive review. Orthop Clin North Am 2015; 46:281-92. [PMID: 25771322 DOI: 10.1016/j.ocl.2014.11.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Injuries to the thumb ulnar collateral ligament (UCL) are common. Failure to address the ensuing laxity of the metacarpophalangeal joint can lead to compromised grip and pinch, pain, and ultimately osteoarthritis. Instability to valgus stress with the lack of a firm end point is a strong indicator of complete rupture of the UCL. Nonoperative treatment is reserved for incomplete ruptures of the thumb UCL. Operative intervention is typically performed for complete ruptures. Repair of acute ruptures and reconstruction for chronic injuries yield excellent results. Complications are rare and most patients show preservation of motion, key pinch, and grip strength.
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Affiliation(s)
- Daniel M Avery
- Department of Orthopaedic Surgery, St. Luke's University Hospital, 801 Ostrum Street, PPH-2, Bethlehem, PA 18015, USA
| | - Nicholas M Caggiano
- Department of Orthopaedic Surgery, St. Luke's University Hospital, 801 Ostrum Street, PPH-2, Bethlehem, PA 18015, USA
| | - Kristofer S Matullo
- Division of Hand Surgery, Department of Orthopaedic Surgery, St. Luke's University Health Network, Bethlehem, PA 18015, USA.
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Berger AJ, Meals RA. Management of osteoarthrosis of the thumb joints. J Hand Surg Am 2015; 40:843-50. [PMID: 25754790 DOI: 10.1016/j.jhsa.2014.11.026] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 11/17/2014] [Accepted: 11/19/2014] [Indexed: 02/02/2023]
Abstract
We present current concepts and evidence to optimize diagnosis and management of osteoarthritis in the thumb joints. Numerous options and controversies exist for surgical treatment of carpometacarpal joint arthritis. Fewer options exist for metacarpophalangeal joint arthritis. Surgical treatment for interphalangeal arthritis is mainly arthrodesis.
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Affiliation(s)
- Aaron J Berger
- Division of Plastic Surgery, Florida International University College of Medicine & Miami Children's Hospital, Miami, FL
| | - Roy A Meals
- Department of Orthopedic Surgery, University of California at Los Angeles, Los Angeles, CA.
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Douglass N, Yao J. Nuts and bolts: dimensions of commonly utilized screws in upper extremity surgery. J Hand Surg Am 2015; 40:368-82. [PMID: 25617959 DOI: 10.1016/j.jhsa.2014.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 11/12/2014] [Indexed: 02/02/2023]
Abstract
A plethora of screw designs and sizes are available from multiple companies for use in upper extremity surgery. Knowing the dimensions of screws is critical in the treatment of bone of varying dimensions for fractures, osteotomies, or arthrodeses. Although many screws are named by their major thread diameter, this is not always true. Because of this confusing nomenclature and vast number of options, we sought to review the most commonly used screws and codify their dimensions into a readily available article and reference chart. This article highlights the basic dimensions of commonly used headless screws, stand-alone lag screws, non-locking and locking screws for plating, and biocomposite screws. Commonly described treatments using these screws include fixation of elbow, wrist, carpal, metacarpal, and phalangeal fractures and osteotomies, as well as arthrodeses of upper extremity joints. This article and its tables are by no means exhaustive of all commercially available implants. The focus is on the most commonly used implants in the United States as of 2014.
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Affiliation(s)
| | - Jeffrey Yao
- Stanford University Medical Center, Redwood City, CA.
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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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Falci SGM, Rodrigues DC, Marchiori EC, Brancher G, Makyama A, Fernandes Moreira RW. Assessment of the fixation of mandibular symphysis fractures using conical cannulated screws: mechanical and photoelastic tests. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:174-80. [PMID: 24906943 DOI: 10.1016/j.oooo.2014.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 02/26/2014] [Accepted: 03/17/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study was to use mechanical and photoelastic tests to compare the performance of cannulated screws with other fixation methods in mandibular symphysis fractures. STUDY DESIGN Ten polyurethane mandibles were allocated to each group and fixed as follows: group PRP, 2 perpendicular miniplates; group PLL, 1 miniplate and 1 plate, parallel; and group CS, 2 cannulated screws. Vertical linear loading tests were performed. The differences between mean values were analyzed with the Tukey test. The photoelastic test was carried out using a polariscope. RESULTS The results revealed differences between the CS and PRP groups at 1, 3, 5, and 10 millimeters of displacement. The photoelastic test confirmed higher stress concentration in all groups close to the mandibular base, whereas the CS group showed it throughout the region assessed. CONCLUSIONS Conical cannulated screws performed well in mechanical and photoelastic tests.
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Affiliation(s)
- Saulo Gabriel Moreira Falci
- Oral and Maxillofacial Surgery Section, Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil.
| | - Danillo Costa Rodrigues
- Oral and Maxillofacial Surgery Section, Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | | | - Giulia Brancher
- Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Andréia Makyama
- Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Roger William Fernandes Moreira
- Oral and Maxillofacial Surgery Section, Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
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Abstract
This is a surgical technique for arthrodesis of the thumb metacarpophalangeal joint using a low-profile plate. Using the principles of tension band fixation and interfragmentary compression, a high rate of fusion is achieved with a low incidence of complications. The technique is versatile allowing fixation at any desired position. It can be used in porotic bone and avoids the need for postoperative immobilization.
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Huffman R, Rayan GM. THUMB METACARPOPHALANGEAL ARTHRODESIS WITH LOCAL BONE GRAFTING. ACTA ACUST UNITED AC 2011; 16:55-61. [DOI: 10.1142/s0218810411005072] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 09/30/2010] [Accepted: 10/16/2010] [Indexed: 11/18/2022]
Abstract
A restrospective study identified 47 thumb MP joints in 41 patients who underwent arthrodeses using cup and cone osteotomy secured with Kirschner-wire fixation and augmented with local bone graft from the thumb metacarpal. Union rate was 96% averaging 6.8 weeks. Two patients had nonunion; 6.3 year follow-up of 15 thumbs showed improvement of or no pain. MHQ scores were 56.5 in the operative hand and 66.7 in the contralateral hand. Thumb MP arthrodesis augmented with local bone graft negates the morbidity of obtaining distant graft. It is a safe and effective technique that provides excellent pain relief with an acceptable union rate.
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Affiliation(s)
- Rebel Huffman
- INTEGRIS Baptist Medical Center, Oklahoma University Health Sciences Center, Oklahoma City, OK 73112, USA
| | - Ghazi M. Rayan
- INTEGRIS Baptist Medical Center, Oklahoma University Health Sciences Center, Oklahoma City, OK 73112, USA
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Rasmussen C, Roos S, Boeckstyns M. Low-profile plate fixation in arthrodesis of the first metacarpophalangeal joint. J Hand Surg Eur Vol 2011; 36:509-13. [PMID: 21490033 DOI: 10.1177/1753193411404325] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Fifty-one consecutive arthrodeses (46 patients) of the first metacarpophalangeal joint were retrospectively reviewed, after fixation with a Leibinger low-profile titanium plate, using a cup-and-cone technique. Primary bone union was achieved in 98%. Three cases required removal of the plate and one case a tenolysis. Follow-up time was 13-92 months (mean 52). There was no correlation between patient satisfaction and position of fusion. We conclude that this technique gives a high rate of union, a short period of immobilization and rehabilitation, and a reliable position at the site of fusion.
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Affiliation(s)
- C Rasmussen
- Gentofte University Hospital, Department of Hand Surgery, Hellerup, Denmark.
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Abstract
Degenerative joint disease affecting the thumb metacarpophalangeal and interphalangeal joints is a debilitating condition, which can significantly restrict activities of daily living. Conservative measures to address symptoms include oral anti-inflammatory medications, activity modification and splinting, and intraarticular corticosteroid injections. Surgical interventions include arthroscopic synovectomy, arthroplasty, and finally arthrodesis of the affected articulations. Although short-term results from synovectomy and arthroplasty seem promising, long-term data are not yet available. Arthrodesis of the metacarpophalangeal and interphalangeal joints yields a stable yet functional thumb with reliably good pain relief.
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Affiliation(s)
- Eon K Shin
- Thomas Jefferson University Hospital, The Philadelphia Hand Center, P.C., 834 Chestnut Street, Suite G114, Philadelphia, PA 19107, USA.
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Bicknell RT, MacDermid J, Roth JH. Assessment of thumb metacarpophalangeal joint arthrodesis using a single longitudinal K-wire. J Hand Surg Am 2007; 32:677-84. [PMID: 17482008 DOI: 10.1016/j.jhsa.2007.02.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2006] [Revised: 02/14/2007] [Accepted: 02/15/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate retrospectively the functional and radiographic outcome of patients who had a thumb metacarpophalangeal joint arthrodesis with a single longitudinal K-wire. METHODS We performed a retrospective review of 27 patients who had a thumb metacarpophalangeal joint arthrodesis with a single longitudinal K-wire. Outcomes were assessed using self-reported measures (Patient-Rated Wrist/Hand Evaluation; AUSCAN Osteoarthritis Hand Index; Disabilities of the Arm, Shoulder and Hand questionnaire; Short Form-36 General Health questionnaire), measured physical impairments (range of motion, strength, manual dexterity), and radiographic review. RESULTS Patient-rated outcome scores indicated mild pain, difficulty with specific and usual tasks, and minimal concern with hand appearance. Most physical impairment measures were not significantly different from the side not surgically treated, and patient satisfaction was high. There was a slight decrease in tripod pinch strength, manual dexterity, interphalangeal joint flexion, handspan, and thumb opposition compared with the contralateral side. The overall complication rate was 11% (3 complications). Twenty-five patients (89%) were able to return to their previous occupations. There were no radiographic malunions or nonunions. Radiographic evidence of degenerative changes was present in 20% of patients at the carpometacarpal joint and 30% of patients at the interphalangeal joint. CONCLUSIONS Our technique of performing a thumb metacarpophalangeal joint arthrodesis with a single longitudinal K-wire is effective, with high overall patient satisfaction and a relatively low complication rate, despite small losses of strength, manual dexterity, and motion. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Ryan T Bicknell
- Department of Surgery, University of Western Ontario, London, Ontario, Canada
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Abstract
PURPOSE OF REVIEW Arthrodesis of the thumb carpometacarpal, metacarpophalangeal, and interphalangeal joints are well-established options in the management of arthritis, instability, and/or deformity. This review includes a general review of the indications and technique of arthrodesis and recent review of the literature. RECENT FINDINGS New literature has focused on the role of arthrodesis in managing carpometacarpal arthritis and compared its results with ligament reconstruction and tendon interposition. However, no conclusive evidence demonstrates the superiority of arthrodesis. Several new articles have demonstrated good long-term results of carpometacarpal arthrodesis. A new report on complications associated with plate and screw fixation for carpometacarpal arthritis has been published, leading the authors to conclude that k-wire fixation was a better option. A technique of metacarpophalangeal joint arthrodesis using a cannulated screw has been recently published with good success. Moreover, a cup-in-cone technique of reaming surfaces of the thumb metacarpophalangeal joint to maximize bone contact surface area has been described. Other authors have reiterated and reinforced the success of some of the more standard techniques including Herbert screws for interphalangeal joint arthrodeses. SUMMARY Thumb arthrodesis of the carpometacarpal, metacarpophalangeal, and interphalangeal joints maintains a significant role in the management of deformity and arthritis. Better comparison studies are necessary in evaluating arthrodesis of the carpometacarpal joint versus arthroplasty. New fixation techniques for metacarpophalangeal joint arthrodesis are promising. Standard fixation for interphalangeal joint fusion has been reiterated. Successful arthrodesis can lead to excellent patient outcomes and function.
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Affiliation(s)
- Marco Rizzo
- Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27710, USA.
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Proubasta I, Lamas C, Trullols L, Itarte J. Arthrodesis of the metacarpophalangeal joint of the thumb using a Herbert screw. Tech Hand Up Extrem Surg 2006; 10:73-8. [PMID: 16783209 DOI: 10.1097/00130911-200606000-00004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We describe a technique for thumb metacarpophalangeal joint arthrodesis by using a Herbert screw. This method of fixation helps in avoiding some of the potential problems associated with wire fixation, tension-band arthrodesis, or plate fixation. Therefore, it eliminates the risk of pin track infection, pin breakage, and painful protrusion under the skin requiring metalwork removal.
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Affiliation(s)
- Ignacio Proubasta
- GHand Unit, Orthopaedic Department, Hospital Sant, Pau Barcelona, Spain.
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Abstract
The human thumb assumes 50% of the workload of the human hand, and is therefore the most important digit. As such, the thumb has a propensity for the development of osteoarthritis. Moreover, the thumb is also often diseased, in anywhere from 68% to 80%of patients who have rheumatoid arthritis. Much attention over the years has been given to the carpalmetacarpal joint of the thumb, whereas the metacarpophalangeal (MP) joint of the thumb remains largely unstudied. The purpose of this article is to review the etiology of thumb MP joint arthritis, and discuss the different treatment options of this condition.
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Affiliation(s)
- Charles S Day
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, E/CC2, Boston, MA 02215, USA.
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