Arthrodesis of the trapeziometacarpal joint.
Over a 10-year period, 32 trapeziometacarpal (TM) joint fusions were performed in 29 patients, and reviewed. Pin fixation with tension band wiring was used in 14 cases, screws in eight cases, a plate in six cases, K-wires in three cases and staple fixation in one case. None was bone grafted. Splinting was applied for 4 to 5 weeks. There were four cases of delayed union (more than 2 months) and four cases of non-union requiring re-operation (12.5%). The average follow-up was 6 years and 7 months. Grip (26.5 kg) and pinch (4.9 kg) strength were respectively 7% and 18% less than the normal contralateral side. In bilateral osteoarthritis, grip and pinch were stronger than the contralateral side. Joint angulations measured on X-ray films showed for the peritrapezial joint an 18 degrees arc in flexion-extension (a reduction of 64% compared to the contralateral side) and 11 degrees of arc in abduction-adduction (a reduction of 72%). MP joint mobility increased in extension (160%), in flexion (23%), in abduction (120%), in adduction (157%). Despite the marked decrease in motion, subjective functional complaints were minimal. 78.1% of the patients were fully satisfied, 15.6% partly satisfied, and 6.3% dissatisfied. Pain was absent in 50% of the cases and very mild in 40.7%. Three patients complained of discomfort. Eight patients were noted to have osteoarthritic changes in the scaphotrapezial joint.
Division of Plastic and Reconstructive Surgery, Hôpital Cantonal Universitaire, Geneva, Switzerland.
A
A
Chamay
F
F
Piaget-Morerod
D000328:Adult; D000368:Aged; D001168:Arthritis / Q000601:surgery*; D001174:Arthrodesis / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D001864:Bone Wires / Q000009:adverse effects; D002348:Carpal Bones / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006225:Hand / Q000502:physiology; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D013933:Thumb / Q000503:physiopathology / Q000601:surgery*; D014955:Wrist Joint / Q000503:physiopathology / Q000601:surgery*