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Kim, Shin, Jeon, and Cha: Metacarpal Extension Osteotomy for Mild Thumb Carpometacarpal Arthritis: Retrospective Long-Term Outcomes
Original Article

Journal of the Korean Orthopaedic Association 2015; 50(6): 520-526.

Published online: 29 December 2015

DOI: https://doi.org/10.4055/jkoa.2015.50.6.520

Metacarpal Extension Osteotomy for Mild Thumb Carpometacarpal Arthritis: Retrospective Long-Term Outcomes

Dong Kyu Kim, M.D.*, Hyun Dae Shin, M.D., Ph.D., Je Hyung Jeon, M.D., Soo Min Cha, M.D.

*Madison Hospital, Cheonan, Korea.

Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea.

Correspondence to: Soo Min Cha, M.D. Department of Orthopedic Surgery, Chungnam National University School of Medicine, 266 Munhwa-ro, Jung-gu, Daejeon 35015, Korea. TEL: +82-42-280-7340, FAX: +82-42-252-7098, csm9827@hanmail.net

Received 26 May 2015       Revised 29 July 2015       Accepted 12 August 2015

Copyright © 2015 by The Korean Orthopaedic Association

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We report clinical and radiologic outcomes after metacarpal extension osteotomy for mild osteoarthritis of the thumb carpometacarpal joint.

Materials and Methods

From 1999 to 2008, 11 patients were diagnosed with mild thumb carpometacarpal arthritis (Eaton stage I, II), and extension osteotomies were performed. Of these, seven patients with at least 6 years follow-up were analyzed retrospectively. Male to female ratio was 2:5, and mean age at time of surgery was 38.9 years old. Symptom onset period was a mean of 11.2 months. Two patients were I, and five patients were II in Eaton stage. Preoperative visual analogue scale (VAS) and disabilities of the arm, shoulder and hand scale (DASH) scores were 3.7 points (3-4 points), and 40.1 points (32-51 points). Radial abduction was 38.5° (30°-45°), and volar abduction was 42.1° (40°-45°). Grip strengths and pinch powers, compared with the normal contralateral side were 82% (64%-90%) and 72% (40%-100%), respectively.

Results

The mean follow-up period was 8.5 years, and all patients except one maintained their occupational activity during the follow-up period. Final VAS and DASH scores were 0.7 points (0-2 points) and 11.7 points (8-16 points), respectively, and were statistically significant. Volar abduction, grip strengths, and pinch power were improved to 45° (40°-50°), 92.3% (73%-117%), and 94.4% (75%-117%) with statistical significances. In five patients, Eaton stages did not change, and two patients advanced to the next stage (stage I to II in one patient, stage II to III in one patient).

Conclusion

Among the various treatment options for mild thumb carpometacarpal arthritis, metacarpal extension osteotomy may be considered as an effective treatment.

Keywords: thumb, carpometacarpal joints, osteotomy

Figures and Tables

Figure 1

(A) We performed near-circumferential access around the metacarpal, 1 cm distal to the carpometacarpal joint, in anticipation of the osteotomy. After first sawing at the proximal line, a secondary osteotomy was added at the distal line with an angle of 30°, then the wedge-shaped bone was removed. (B) Retrograde fixation using two 1.4-mm K-wires was performed under compressive force, closing the osteotomized area.

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Figure 2

(A, B) Preoperative simple radiographs of a 41-year-old female (case 7), with Eaton stage I. (C) A postoperative radiograph. (D, E) Ten-year follow-up radiographs showed Eaton stage II status; overall clinical evaluations were 'satisfactory.'

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Table 1

Basic Demographic Data and Radiologic Status at The time of Surgery

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Table 2

Preoperative Clinical Evaluation

jkoa-50-520-i002

VAS, visual analogue scale; DASH, disabilities of the arm, shoulder and hand scale.

Table 3

Clinical and Radiologic Evaluation at Final FU

jkoa-50-520-i003

FU, follow-up; DASH, disabilities of the arm, shoulder and hand scale.

Notes

CONFLICTS OF INTEREST The authors have nothing to disclose.

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