title: Bilateral thumb metacarpophalangeal joint fusions for severe hyperextension deformities in conjunction with carpometacarpal joint reconstructions.
abstract: BACKGROUND
  Hyperextension of the first metacarpophalangeal (MCP) joint and adduction of the first web space of the hand are features of advanced stages of carpometacarpal (CMC) joint arthrosis. Restoration of mechanical efficiency in such patients requires stabilization of both the CMC and MCP joints. This study describes a patient with bilateral secondary hyperextension of the MCP joint greater than 50° who displayed good functional outcome following staged bilateral MCP joint arthrodesis with simultaneous CMC joint reconstruction.
  
  
  METHODS
  Excision of trapezium, formation of a Weilby sling utilising flexor carpi radialis, and insertion of a Swanson's prosthesis forms the basis of CMC joint reconstruction. Fusion of the MCP joint involved placement of longitudinal K-wires and tension band wiring. The patient underwent an initial right-sided procedure in 2008 and subsequently elected for the same procedure on the contralateral side 26 months later. Good functional improvement was achieved with a pre and postoperative DASH score of 49 and 8 respectively. Follow-up and radiological imaging at 34 months from her initial surgery confirmed good positions of the prostheses and solid MCP joint fusions. The patient developed postoperative interphalangeal joint pain, which responded to steroid injection.
  
  
  CONCLUSIONS
  There is currently limited evidence available addressing the management of severe hyperextension deformity greater than 50° of the MCP joint in the presence of CMC joint arthrosis. Staged bilateral fusion of the MCP joint and simultaneous CMC joint reconstruction in this case illustrates good, reproducible functional results and patient satisfaction with reduced postoperative return to function.
authors.affiliation: Department of Trauma and Orthopaedics, University College Hospital, 250 Euston Road, London, NW1 2PG, UK.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Tsang
authors.forename: Alistair R
authors.initials: AR
authors.lastname: Hunter
authors.forename: Elliot D
authors.initials: ED
authors.lastname: Sorene
mesh_terms: D000368:Aged; D001174:Arthrodesis; D001864:Bone Wires; D052737:Carpometacarpal Joints / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008662:Metacarpophalangeal Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017060:Patient Satisfaction; D011859:Radiography; D016059:Range of Motion, Articular; D013933:Thumb / Q000000981:diagnostic imaging / Q000601:surgery*; D051222:Trapezium Bone / Q000000981:diagnostic imaging / Q000601:surgery*