Capitolunate Instability and Clinical Outcomes after Resection of the STT Joint in CMC Joint Arthritis

2015 ◽  
Vol 04 (S 02) ◽  
Author(s):  
Mark Ross ◽  
David Gilpin ◽  
Susan Peters ◽  
Bradley Gilpin ◽  
Gregory Couzens
Keyword(s):  
Clinical Outcomes ◽  
Joint Arthritis ◽  
Cmc Joint

scholarly journals Immediate weight-bearing after locking plate fixation of the Ludloff osteotomy

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Steven Neufeld ◽  
John Marcel
Keyword(s):  
Clinical Outcomes ◽  
Hallux Valgus ◽  
Locking Plate ◽  
Weight Bearing ◽  
Loss Of Correction ◽  
Function Index ◽  
Foot Function ◽  
Anatomic Locking Plate ◽  
Joint Arthritis ◽  
With Screws

Category: Bunion Introduction/Purpose: One of the more common and versatile osteotomies to correct moderate hallux valgus deformities is the Ludloff osteotomy. This oblique osteotomy is typically stabilized with screws and patients kept non-weight bearing until healed. Complications include malunion, nonunion and loss of correction, which can occur due to poor compliance with non- weight bearing protocols. Elderly, obese and physically weak patients can have difficulty remaining non-weight bearing. A novel anatomic-locking plate and fixation method was developed that allows immediate weight bearing after a Ludloff osteotomy. We analyzed the results of a consecutive cohort of patients who underwent a Ludloff osteotomy stabilized with this method. The cohort included all patients presenting with a moderate to severe hallux valgus deformities. Complications, radiographic & clinical outcomes were studied. Methods: In this IRB approved retrospective cohort study, we analyzed clinical & radiographic data of all Ludloff osteotomies performed between 2010 and 2015. Preoperative and postoperative data included Foot Function Index, intermetatarsal & hallux valgus angles, complications, callus formation & clinical outcomes. 395 feet in 350 patients were examined. 6 patients (2.1%) were male. 43 feet were excluded due to incomplete films and 21 were excluded due to screw fixation only; requiring restricted post- operative weightbearing protocols. Three surgeons performed the surgeries and review/analyses conducted by a senior orthopedic resident, uninvolved with the care of any of the patients. Indications included symptomatic hallux valgus deformities (intramedullary angle greater than 10°), failure of conservative treatment and normal preoperative range of motion. Exclusion criteria included 1st tarsometatarsal joint arthritis/instability, peripheral neuropathy, vascular disease and 1st metatarsophalangeal joint arthritis. Preoperative and postoperative radiographs were weightbearing. Patients discharged when comfortable in normal shoes. Results: At an average of 8 months postop (2 - 43 months), there was an average hallux valgus (HVA) correction angle correction of 7.6° (p<.0001) and intermetatarsal angle (IMA) correction of 21° from initial to final radiographs. Patients were discharged when comfortable in normal shoes. In the 15 feet (4.6%) who formed hypertrophic callus, there was loss of IMA of 2.3° (p<.0001) and HVA of 4.6° (p<.0001). Superficial wound infection or mild cellulitis was noted in 16 feet (4.9°); no deep infections. 15 (4.6%) feet had hardware removal due to prominent and/or broken screws. These were in older women with thin feet. There was only 1 nonunion & 8 mal-unions. An average foot function index (in 70 patients) of 9.5/100 indicated low pain and disability. Conclusion: The data from this large series of patients (395 osteotomies) supports the use of an immediate weight-bearing protocol for Ludloff osteotomies fixed with anatomic locking plates, including patients with osteopenic bone. All patients were allowed activities and weight bearing as tolerated during the post-operative period. There were relatively few complications including loss of correction or nonunion. Patients and surgeons can expect healing and complication rates similar to osteotomies fixed with screws and a non-weight-bearing post-operative protocol. Furthermore, because of the increased stability imparted by the anatomic locking plate, it would be a good option for revision bunion surgery.

scholarly journals Complications with the Use of Artelon in Thumb CMC Joint Arthritis

Hand ◽  
2011 ◽  
Vol 6 (3) ◽  
pp. 282-286 ◽  
Author(s):  
Sylvan Clarke ◽  
William Hagberg ◽  
Robert A. Kaufmann ◽  
Aaron Grand ◽  
Ronit Wollstein
Keyword(s):  
Joint Arthritis ◽  
Cmc Joint

Cell-Enriched Lipoaspirate Arthroplasty: A Novel Approach to First Carpometacarpal Joint Arthritis

Hand Surgery ◽  
2015 ◽  
Vol 20 (03) ◽  
pp. 479-481 ◽  
Author(s):  
Stefan Bohr ◽  
Hans Oliver Rennekampff ◽  
Norbert Pallua
Keyword(s):  
Treated Patient ◽  
Minimal Invasive ◽  
Invasive Technique ◽  
Carpometacarpal Joint ◽  
Novel Approach ◽  
Basal Joint ◽  
The Cost ◽  
Joint Arthritis ◽  
Cmc Joint

We report a novel, minimal invasive technique for the treatment of symptomatic arthritis of the carpometacarpal (CMC) joint of the thumb, here termed Cell-Enriched Liposaspirate Arthroplasty (CELA). For CELA, autologous fat tissue was harvested using standard liposuction technique followed by an extra-corporal cellular enrichment step. Finally, 1 ml of cell-enriched lipoaspirate was injected into the CMC-joint. Following CELA, the treated patient became pain free within five weeks with a follow-up of 12 months. We conclude that CELA performed on selected cases of arthritis of finger joints such as the basal joint of the thumb has the potential to greatly reduce or delay the necessity for more invasive procedures which tend to improve symptoms of pain at the cost of grip strength and range-of-motion.

Surgical Treatment for Thumb CMC Joint Arthritis

2013 ◽  
Vol 9 (2) ◽  
pp. 113-118
Author(s):  
Brian Gander ◽  
Ronit Wollstein
Keyword(s):  
Surgical Treatment ◽  
Joint Arthritis ◽  
Cmc Joint

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

2017 ◽  
Vol 07 (03) ◽  
pp. 191-198 ◽  
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.

scholarly journals Clinical Outcomes of Volar Oblique Ligament Reconstruction in Thumb Basal Joint Arthritis

Hand ◽  
2016 ◽  
Vol 11 (1_suppl) ◽  
pp. 10S-11S
Author(s):  
Jin-woo Kang ◽  
Yong-Suk Lee ◽  
Seun-Han Shin ◽  
Yang-Guk Chung
Keyword(s):  
Clinical Outcomes ◽  
Ligament Reconstruction ◽  
Basal Joint ◽  
Joint Arthritis

scholarly journals 208 First and Second Metacarpal Arthrodesis - Salvage Procedure for Failed Thumb Carpometacarpal Joint Arthritis Surgery

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
G Manoharan ◽  
J Edakalathur ◽  
S Pickard
Keyword(s):  
Literature Search ◽  
Ligament Reconstruction ◽  
Salvage Procedure ◽  
Carpometacarpal Joint ◽  
Thumb Carpometacarpal Joint ◽  
Primary Procedure ◽  
Surgical Options ◽  
Thumb Carpometacarpal ◽  
Joint Arthritis ◽  
Cmc Joint

Abstract Aim There are various surgical options for the management of thumb carpometacarpal joint (CMCJ) arthritis. These include first metacarpal osteotomy, trapeziectomy with or without ligament reconstruction, CMCJ arthrodesis and arthroplasty. However, if these operations fail, the options for salvage are limited. The authors aim to offer ‘first and second metacarpal arthrodesis (FSMA)’ as a salvage procedure for failed first CMC joint surgeries. The authors also reviewed the literature on FSMA. Method Literature search Operative Technique Results Literature search Conclusions FSMA is a good salvage option for failed surgical treatment of thumb CMCJ arthritis. FSMA can also be utilised as a primary procedure for various indications.

scholarly journals Functional outcome of ligament reconstruction tendon interposition for basal joint arthritis of thumb

2017 ◽  
Vol 3 (3) ◽  
pp. 492
Author(s):  
Saranjeet Singh Jagdev ◽  
Subodh Kumar Pathak ◽  
Nisheet Dave ◽  
Abhijeet Salunke
Keyword(s):  
Ligament Reconstruction ◽  
Advanced Disease ◽  
Pinch Strength ◽  
Dash Score ◽  
Care Hospital ◽  
Strength Gain ◽  
Basal Joint ◽  
Tendon Interposition ◽  
Joint Arthritis ◽  
Cmc Joint

<p><strong>Background:</strong> Thumb carpometacarpal osteoarthritis is a common disease, affecting up to 11% and 53% of men and women in their 50s respectively, which leads to pain, stiffness, weakness of the CMC joint. Patients with advanced disease have multiple surgical options including ligament reconstruction with tendon interposition, resection arthroplasty, silicone implantation, or total joint arthroplasty. The aim of study was to evaluate results of LRTI for CMC joint arthritis.<strong><em> </em></strong></p><p><strong>Methods:</strong> This is a series of 29 patients operated in a tertiary care hospital. All patients included in the study were seen in the outpatient and identified to have basal joint arthritis according to their clinical presentation and classified on the basis of radiologic appearance. Trapeziectomy with ligament reconstruction with tendon interposition was done for patients with advanced disease. All the patients were followed up and assessed for function and disability using DASH score.</p><p><strong>Results:</strong> Average duration of follow up was 36 months with average tip pinch strength gain was 75%, key pinch strength gain 80% , grip strength gain 80 % of other limb. Significant Improvement in active 1<sup>st</sup> web space angle was seen with average of 19.5 degree. Average DASH score was 4.14. Nobody had extreme pain, 3 had mild pain and 2 had moderate pain.<strong> </strong></p><p><strong>Conclusions</strong>: Based on our observation of DASH scores, the results have remained encouraging in most of the cases with restoration of normal anatomy to provide a stable and functional thumb. The success of LRTI in treating trapeziometacarpal arthritis has withstood the test of time.<strong></strong></p>

Osteoarthritis of the Thumb Basilar Joint

2020 ◽  
Author(s):  
Andrew J Straszewski ◽  
Jennifer Moriatis Wolf
Keyword(s):  
Treatment Options ◽  
Treatment Modalities ◽  
Hand Osteoarthritis ◽  
Lower Complication ◽  
Lower Complication Rate ◽  
The Many ◽  
Thumb Carpometacarpal ◽  
Tendon Interposition ◽  
Joint Arthritis ◽  
Cmc Joint

Osteoarthritis of the thumb basilar joint is a common pathology treated by hand surgeons, and this is the leading cause of degenerative pain in the hand. Multi-factorial etiologies, including occupational stresses, gender, hormone milieu, and altered biomechanics, may play roles in the development of thumb carpometacarpal (CMC) joint arthritis.  Patients present with aching pain, synovitis, weakened pinch and grip, and in late disease, adduction deformity and web space contracture. Physical examination and plain radiography are the mainstay of diagnosis, with little utility for advanced imaging.  A multitude of options exists for conservative treatment: physical therapy, splinting, anti-inflammatories, and injections.  With the failure of conservative therapies, surgical management is dictated by disease severity and provider preference.   The thumb CMC joint hosts a variety of treatment options that have evolved over time: arthroscopy, osteotomy, arthrodesis, trapeziectomy alone, or with combinations of ligament reconstruction and tendon interposition.  No superiority has been shown amongst the many base of thumb treatment modalities, though trapeziectomy alone demonstrates a lower complication rate. This review contains 5 tables, 3 figures, and 61 references. Keywords: hand osteoarthritis, base of thumb, anatomy, arthroplasty, silicone, arthrodesis, tendon reconstruction, biomechanics, tendon interposition, outcomes

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