Correction of a Hyperextension Deformity at the Metacarpophalangeal Joint by Arthroplasty for Osteoarthritis of the Thumb Carpometacarpal Joint Followed by External Fixator: A Case Series

This review describes the different possibilities for arthroplasties at the proximal interphalangeal joint, thumb carpometacarpal joint, distal radioulnar joint, metacarpophalangeal joint and the wrist. For each joint, the indication for arthroplasty is explained, the surgical technique with the suitable implant is described and a brief summary of the outcomes reported in the literature is given.

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Description and Clinical Assessment of the Bone Block Tendon Interposition Technique for the Management of Thumb Carpometacarpal Joint Osteoarthritis

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835518500510 ◽

2018 ◽

Vol 23 (04) ◽

pp. 515-519

Author(s):

Diego F. Rincon Cardozo ◽

Wynston J. Alvarez Martinez ◽

Jhon F. Castañeda Lopez ◽

Fredy A. Angarita Maldonado ◽

Juliana A. Rojas Neira ◽

...

Keyword(s):

Case Series ◽

Functional Results ◽

Interference Screw ◽

Pinch Strength ◽

Bone Block ◽

Dash Score ◽

Carpometacarpal Joint ◽

Thumb Carpometacarpal Joint ◽

Thumb Carpometacarpal ◽

And Function

Background: Pellegrini’s surgical technique is the most useful for thumb carpometacarpal joint osteoarthritis. The purpose of this paper is to describe the technique of a modified version using a bone block in the tunnel through which the flexor carpi radialis tendon is passed (BBTI). Methods: Case series of patients diagnosed with osteoarthritis of the thumb carpometacarpal joint, in stage II or higher based on Eaton’s classification, that were intervened using the BBTI technique for a 2-year period. Grip and pinch strength, range of motion, and 1–2 metacarpal angle were evaluated. Pain and function were measured using the visual analogue scale and the Disabilities of the Arm, Shoulder and Hand (DASH) scale. Results: The study included 16 cases in 14 patients (11 women and 3 men), with an average age of 55.7 ± 7.1 years. Encouraging results were obtained, with an average DASH score of 24.3 ± 17.9 and a minimum VAS pain score. A total of 58% showed a grip strength of over 80% and the postoperative movement was equivalent to the contralateral limb. No cases of infection were reported, and only two minor complications were observed. Conclusions: The BBTI technique is a surgical option that incorporates an interference screw, offering good functional results for managing osteoarthritis of the thumb carpometacarpal joint, with a similar complication rate to that of the original technique.

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Modified Eaton-Littler's Reconstruction for Traumatic Thumb Carpometacarpal Joint Instability: Operative Technique and Clinical Outcomes

Journal of Wrist Surgery ◽

10.1055/s-0037-1607423 ◽

2017 ◽

Vol 07 (03) ◽

pp. 191-198 ◽

Cited By ~ 1

Author(s):

Karthikeyan Iyengar ◽

William Loh ◽

Hosam Matar

Keyword(s):

Clinical Outcomes ◽

Outcome Measures ◽

Joint Instability ◽

Case Series ◽

Strength Analysis ◽

Carpometacarpal Joint ◽

Thumb Carpometacarpal Joint ◽

Thumb Carpometacarpal ◽

Cmc Joint

Background Injuries to thumb carpometacarpal joint ligaments lead to instability. Eaton-Littler's ligament reconstruction traditionally uses a strip of flexor carpi radialis to stabilize the CMC joint. Study Description We have modified this technique to reproduce the direction of active action of the anterior oblique ligament by reconstructing both the volar and dorsoradial ligaments. In this prospective study, we evaluated patients with confirmed traumatic thumb CMC joint instability who underwent modified Eaton-Littler's reconstruction. Strength analysis, Michigan Hand Outcome Questionnaire, QuickDASH, and subjective outcome measures were collected pre- and postoperatively with minimum 3 years of follow-up. Eleven patients were included in the final analysis, with mean age of 29 years (range: 16–52) and average follow-up of 6.2 years (range: 3–11). There was a statistically significant improvement in all outcome measures. Clinical Relevance Our modified technique helps to simultaneously address both volar and dorsal ligaments and yields satisfactory clinical outcomes at medium term follow-up. Level of Evidence Level IV, case series.

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EVALUATION OF THE FIRST METACARPAL PROXIMAL FACET INCLINATION AS A PROGNOSTIC PREDICTOR FOLLOWING ARTHROPLASTY FOR OSTEOARTHRITIS OF THE THUMB CARPOMETACARPAL JOINT

Hand Surgery ◽

10.1142/s0218810413500135 ◽

2013 ◽

Vol 18 (01) ◽

pp. 69-72 ◽

Cited By ~ 1

Author(s):

Ichiro Tonogai ◽

Yoshitaka Hamada ◽

Naohito Hibino

Keyword(s):

Radiological Finding ◽

Metacarpophalangeal Joint ◽

Carpometacarpal Joint ◽

Prognostic Predictor ◽

Thumb Carpometacarpal Joint ◽

Carpometacarpal Joints ◽

Radiographic Measurements ◽

Poor Outcomes ◽

Thumb Carpometacarpal

We have retrospectively reviewed 17 thumbs in 16 patients with osteoarthritis of the thumb carpometacarpal joints, for which arthroplasty was performed using Kaarela's method. Postoperatively, three thumbs in two patients had poor outcomes; both patients had a sharp slope of the base of the first metacarpal. Serial radiographic measurements suggested that this sharp slope affected the adducted position of the first metacarpal, and led to the appearance of a metacarpophalangeal joint hyperextension deformity of the thumb. This radiological finding could be a prognostic predictor after surgery for osteoarthritis of the thumb carpometacarpal joint.

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Outcomes of denervation, joint lavage and capsular imbrication for painful thumb carpometacarpal joint osteoarthritis

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193416632149 ◽

2016 ◽

Vol 41 (9) ◽

pp. 904-909 ◽

Cited By ~ 10

Author(s):

D. Ehrl ◽

H. C. Erne ◽

P. N. Broer ◽

C. Metz ◽

E. Falter

Keyword(s):

Case Series ◽

Good Alternative ◽

Carpometacarpal Joint ◽

Level Of Evidence ◽

Thumb Carpometacarpal Joint ◽

Recovery Times ◽

Surgical Options ◽

Thumb Carpometacarpal ◽

Joint Lavage

Pain reduction remains the main aim in the treatment of thumb carpometacarpal joint osteoarthritis. We performed a retrospective analysis of a case series of patients with symptomatic thumb carpometacarpal joint arthritis treated with denervation, joint lavage and capsular imbrication. A total of 60 patients participated in this study. Follow-up, including a clinical examination, was performed on 37 patients at a mean of 46 months (range 12 to 81); an additional 23 patients were followed-up by telephone at a mean of 52 months (range 14 to 93) post-operatively. The patients assessed in person showed a significant decrease in pain and a significant improvement in thumb function. The information gathered by telephone gave similar results. The findings of our study indicate that the presented treatment approach could be a good alternative to more invasive surgical options in patients with earlier stages of thumb carpometacarpal joint osteoarthritis. Advantages include the low rate of complications and invasiveness, as well as short recovery times. Level of evidence: IV

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