Bone Tunnel Orientation in Suspension Arthroplasty of the Thumb Carpometacarpal Joint: An Anatomical Cadaver Study

Hand ◽  
2020 ◽  
pp. 155894471989713
Author(s):  
Leon van Bömmel ◽  
Sören Könneker ◽  
Lena Sonnow ◽  
Nicco Krezdorn ◽  
Andreas Schmiedl ◽  
...  
Keyword(s):  
Drill Hole ◽  
Cadaver Study ◽  
Bone Tunnel ◽  
Joint Surface ◽  
Carpometacarpal Joint ◽  
Thumb Carpometacarpal Joint ◽  
Common Technique ◽  
Thumb Carpometacarpal ◽  
Cadaveric Model ◽  
Ulnar Tunnel

Background: Ligament suspension after trapeziectomy is a common technique in patients with osteoarthrosis. In this study, we set out to determine whether the orientation of the bone tunnel in the first metacarpal base affects the intraoperative position of the first metacarpal after surgery. Methods: Trapeziectomy and Epping procedure were performed in 32 cadaver hands. A drill hole was placed in the base of the first metacarpal, leaving a radial to ulnar tunnel parallel to the joint surface or a diagonal bone tunnel from the radiodorsal surface to the ulnar joint surface of the first metacarpal. Positioning of the first metacarpal was studied via radiography. Results: The distance between the first metacarpal and the scaphoid after suspension arthroplasty was 9.5 ± 2.6 mm when using the parallel radioulnar bone tunnel and 10.9 ± 2.3 mm when using the diagonal bone tunnel. Suspension of the first metacarpal was 33% higher with the diagonal bone tunnel compared with when using the parallel bone tunnel (displacement of 2.8 ± 2.0 mm vs 4.2 ± 2.0 mm). Conclusions: Higher suspension of the first metacarpal after trapeziectomy can be significantly achieved in our cadaveric model when using ligament suspension of the flexor carpi radialis tendon passed from the ulnar joint surface to the dorsum of the metacarpal. Our results have to be determined via clinical examination. To date, we prefer the diagonal bone tunnel when performing ligament suspension arthroplasty.

scholarly journals The Effect of Thumb Immobilization on Fractures of the Hook of the Hamate: A Cadaver Study

Hand ◽  
2018 ◽  
Vol 15 (3) ◽  
pp. 365-370
Author(s):  
Jacob J. Triplet ◽  
Harris Gellman ◽  
David Clause ◽  
Nicholas M. Halikis
Keyword(s):  
Nonoperative Management ◽  
Cadaver Study ◽  
Fracture Site ◽  
Transverse Carpal Ligament ◽  
Carpometacarpal Joint ◽  
Cast Immobilization ◽  
Fracture Fragment ◽  
Thumb Carpometacarpal Joint ◽  
Thumb Carpometacarpal ◽  
Fracture Motion

Background: Fractures of the hook of the hamate are rare. Nonoperative management has historically been immobilization in a short arm cast (SAC) without thumb immobilization with a high reported incidence of nonunion. The high prevalence of nonunion following nonoperative treatment may be secondary to motion at the fracture site. The transverse carpal ligament’s attachment to the hook of the hamate results in movement at the fracture site during thumb motion. Methods: A cadaveric study using 8 fresh frozen cadaver arms amputated at the mid-humeral level was performed. Computed tomography (CT) imaging was used to assess the bony anatomy and assure no preexisting fractures were present. Osteotomy of the hook of the hamate was performed through a skin incision proximal to the hook of the hamate and the transverse carpal ligament. Each arm was then mounted in a jig designed to hold and stabilize the arm and hand in supination. CT scans were performed without cast immobilization with the thumb in extension and abduction, with SAC without thumb carpometacarpal joint immobilization, and SAC with thumb carpometacarpal joint immobilization. Results: Motion of the fractured hook of the hamate was found to occur in all noncasted specimens, greatest with base fractures. SAC without thumb immobilization had little to no effect in eliminating fracture motion. SAC including the thumb reduced fracture motion in all specimens. Conclusions: Previous poor experience with nonoperative management of fractures of the hook of the hamate may be partially due to inability to adequately immobilize the fracture fragment. Fracture motion of the hamate hook occurs during thumb movement, likely from traction on the fracture fragment by the transverse carpal ligament.

scholarly journals Combination Therapy Involving Ear Cartilage Transfer and Suture-Button Suspension Arthroplasty for Symptomatic Thumb Carpometacarpal Joint Arthritis

2019 ◽  
Vol 08 (02) ◽  
pp. 157-160
Author(s):  
Satoshi Usami ◽  
Kohei Inami
Keyword(s):  
Combination Therapy ◽  
Metacarpal Bone ◽  
Joint Surface ◽  
Carpometacarpal Joint ◽  
Short Term ◽  
Thumb Carpometacarpal Joint ◽  
Suture Button ◽  
Ear Cartilage ◽  
Thumb Carpometacarpal ◽  
Joint Arthritis

AbstractWe describe the short-term outcomes of combination therapy involving ear cartilage transfer and suture-button suspension arthroplasty for the treatment of symptomatic thumb carpometacarpal joint arthritis. The concept is to reduce joint arthritis by separate independent approaches, which are renewing the damaged joint surface of the trapezium and first metacarpal bone suspension. Autologous ear cartilage is a desirable material for joint resurfacing arthroplasty without postoperative synovitis or infection, and it is expected to prevent bone impingement or recurrent joint arthritis when postoperative suture-button slack or failure unfortunately occurs.

Arthroplasty in the hand: what works and what doesn’t?

2021 ◽  
pp. 175319342110177
Author(s):  
Daniel B. Herren ◽  
Hajime Ishikawa ◽  
Marco Rizzo ◽  
Mark Ross ◽  
Michael Solomons
Keyword(s):  
Surgical Technique ◽  
Metacarpophalangeal Joint ◽  
Distal Radioulnar Joint ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Carpometacarpal Joint ◽  
Thumb Carpometacarpal Joint ◽  
Radioulnar Joint ◽  
What Works ◽  
Thumb Carpometacarpal

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.

Modeling of the stress state of the thumb carpometacarpal joint

2013 ◽  
Vol 48 (4) ◽  
pp. 439-449
Author(s):  
G. M. Anferov ◽  
I. G. Goryacheva ◽  
A. N. Lyubicheva ◽  
I. A. Soldatenkov ◽  
Fong-Chin Su ◽  
...  
Keyword(s):  
Stress State ◽  
Carpometacarpal Joint ◽  
Thumb Carpometacarpal Joint ◽  
Thumb Carpometacarpal

Surface Anatomy of the Thumb Carpometacarpal Joint

2011 ◽  
Vol 36 (8) ◽  
pp. 26-27
Author(s):  
Christopher Got ◽  
Eni Halilaj ◽  
Amy L. Ladd ◽  
Arnold-Peter C. Weiss ◽  
Joseph J. Crisco
Keyword(s):  
Carpometacarpal Joint ◽  
Thumb Carpometacarpal Joint ◽  
Surface Anatomy ◽  
Thumb Carpometacarpal

Imaging and management of thumb carpometacarpal joint osteoarthritis

2014 ◽  
Vol 44 (2) ◽  
pp. 165-177 ◽  
Author(s):  
David M. Melville ◽  
Mihra S. Taljanovic ◽  
Luke R. Scalcione ◽  
Joseph M. Eble ◽  
Lana H. Gimber ◽  
...  
Keyword(s):  
Carpometacarpal Joint ◽  
Thumb Carpometacarpal Joint ◽  
Thumb Carpometacarpal

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

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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