title: A biomechanical comparison of four methods of fixation of the trapeziometacarpal joint.
abstract: Four methods of internal fixation for trapeziometacarpal arthrodesis were evaluated for biomechanical stability under axial compression, torsion, and cantilever bending in either flexion-extension or radial-ulnar deviation. The techniques tested included crossed Kirschner wires, cerclage wiring, cup and cone with a single oblique Kirschner wire, and a tension band technique that has not previously been reported. Results reported included stiffness (load/deformation) of the construct and toggle (displacement without load applied, after cyclic loading). The tension band and cerclage techniques provided greater construct stiffnesses in axial loading than crossed Kirschner wire or cup-and-cone fixation, and toggle was significantly lower than for specimens fixed by the cup-and-cone technique. In torsion the tension band technique produced fixation that was significantly stiffer than cup-and-cone fixation. In cantilever bending the differences between fixation systems were not significant, except between cerclage and cup-and-cone techniques in flexion-extension. On the basis of our results in a biomechanical model, the tension band technique offers superior fixation in torsion, the cerclage technique in flexion-extension, and both in axial loading.
authors.affiliation: Department of Orthopaedics, University of Washington, Seattle 98125.
authors.forename: E A
authors.initials: EA
authors.lastname: Stokel
authors.forename: A F
authors.initials: AF
authors.lastname: Tencer
authors.forename: H L
authors.initials: HL
authors.lastname: Driscoll
authors.forename: T E
authors.initials: TE
authors.lastname: Trumble
mesh_terms: D001174:Arthrodesis / Q000379:methods*; D001696:Biomechanical Phenomena; D006801:Humans; D016268:Internal Fixators; D013933:Thumb / Q000601:surgery*; D014955:Wrist Joint / Q000601:surgery*