63: Trapeziometacarpal Fusion

Published on 17/04/2015 by admin

Filed under Surgery

Last modified 22/04/2025

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Procedure 63 Trapeziometacarpal Fusion

imageSee Video 47: Fusion of Thumb Carpometacarpal Joint

Procedure

Evidence

Hartigan BJ, Stern PJ, Kiefhaber TR. Thumb carpometacarpal osteoarthritis: arthrodesis compared with ligament reconstruction and tendon interposition. J Bone Joint Surg [Am]. 2001;83:1470-1478.

The authors retrospectively reviewed 109 patients (141 thumbs) younger than 60 years who were treated with either trapeziometacarpal arthrodesis or trapeziectomy with ligament reconstruction and tendon interposition. Fifty-nine patients (82 thumbs) were available to complete a questionnaire and examination with an average follow-up of 69 months. The arthrodesis group available for follow-up included 29 patients (44 thumbs), whereas the trapeziectomy with LRTI group included 30 patients (38 thumbs). Both groups were similar with regard to age, gender, hand dominance, and duration of follow-up. Additional patients in both groups were available to complete a questionnaire. Their results showed no significant difference with regard to pain, function, and satisfaction. The arthrodesis group had significantly stronger lateral pinch and chuck pinch, although grip strength did not differ. The LRTI group had significantly better range of motion with opposition and the ability to flatten the hand. There was a higher complication rate in the arthrodesis group, with nonunion the most common complication. Despite this, pain improved in all nonunions, and all were satisfied with the outcome. The authors concluded that both procedures had similar results with regard to pain, function, and satisfaction despite minimal differences in strength and motion. (Level III evidence)

Kenniston JA, Bozentka DJ. Treatment of advanced carpometacarpal joint disease: arthrodesis. Hand Clin.. 2008;24:285-294.

The authors present a review of carpometacarpal arthritis and its various treatment options, with special attention to arthrodesis. They include a detailed operative technique, discuss associated complications, and review the results reported in the literature over the past 40 years. They conclude that multiple surgical options are available for those patients who fail nonoperative management. These techniques are largely based on clinical symptoms, radiographic staging, and surgeon and patient preference. Arthrodesis remains an excellent option for patients with isolated CMC arthritis who require a pain-free and strong thumb. (Level III evidence)

Taylor EJ, Deari K, D’Arcy JC, Bonnici AV. A comparison of fusion, trapeziectomy and Silastic replacement for the treatment of osteoarthritis of the trapeziometacarpal joint. J Hand Surg [Br]. 2005;30:45-49.

The authors retrospectively reviewed the outcomes of three surgical treatments for osteoarthritis of the trapeziometacarpal joint. A total of 83 operations were performed (36 fusions, 25 trapeziectomies with [22] or without [3] ligament reconstruction, and 22 silicone trapezial replacements) with average follow-up between 33 and 42 months. The authors evaluated patient satisfaction, pain reduction, range of motion, tip and key pinch, and complication rates. They reported no significant difference in clinical outcomes among the three groups but noted a higher complication and reoperation rate in the fusion group. (Level III evidence)