Evaluation of Anti-Subsidence Effect of Abductor Pollicis Longus Suspensionplasty in Carpometacarpal Arthritis of the Thumb

Jung Woo Park; Hyun Dae Shin; Soo Min Cha

doi:10.12790/jkssh.2017.22.2.81

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Park, Shin, and Cha: Evaluation of Anti-Subsidence Effect of Abductor Pollicis Longus Suspensionplasty in Carpometacarpal Arthritis of the Thumb

Original Article

Journal of the Korean Society for Surgery of the Hand 2017; 22(2): 81-88.

Published online: 22 June 2017

DOI: https://doi.org/10.12790/jkssh.2017.22.2.81

Evaluation of Anti-Subsidence Effect of Abductor Pollicis Longus Suspensionplasty in Carpometacarpal Arthritis of the Thumb

Jung Woo Park, Hyun Dae Shin, Soo Min Cha

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

Correspondence to: Hyun Dae Shin. Department of Orthopaedic Surgery, Chungnam National University School of Medicine, 266 Munhwa-ro, Jung-gu, Daejeon 35015, Korea. TEL: +82-42-338-2480, FAX: +82-42-338-2482, hyunsd@cnu.ac.kr

Received 21 December 2016 Revised 2 February 2017 Accepted 12 February 2017

(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/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the anti-subsidence effect of suspensionplasty using abductor pollicis longus (APL) tendon in carpometacarpal (CMC) arthritis of the thumb.

Methods

From June 2009 to May 2016, hematoma distraction arthroplasty (HDA; group A, 10 cases) and HDA with suspensionplasty using APL tendon (group B, 7 cases) were performed in total 17 patients with CMC arthritis. The K-wire was fixed from 1st metacarpal to 2nd metacarpal in both group to maintain the empty space for 6 weeks until the fibrous tissue fill the space. We measured the preoperative trapezium space height with picture archiving and communication (PACS) system and compare the height with that was measured postoperatively. Additionally the subsidence rate checked sequentially with follow-up plain radiography.

Results

The subsidence ratios (subsidence/trapezium height) were average 33.2% in group A and 31.4% in group B. There is no statistical difference between two groups. Six weeks after pin removal almost of subsidence occurred, and then from 3 months after surgery to 6 months after surgery, few subsidence was occurred and it is average only 8% of total subsidence. The trial of distraction the empty space when perform the Kirschner wire (K-wire) fixation, it does not influence the prevention of subsidence. Between distraction height and subsidence, there was no statistical relevance.

Conclusion

Although suspensionplasty was known as one of methods to prevent the subsidence, it is thought to be not very helpful method to prevent subsidence of thumb in CMC arthritis.

Keywords: Thumb, Carpometacarpal joint, Arthritis

Figures and Tables

Fig. 1

Surgical method. (A) Trapezium excision, (B) half tendon of abductor pollicis longus (APL) harvested, (C) APL pass the empty space through the stab incision of flexor carpi radialis tendon, and (D) postoperative plain radiography.

Fig. 2

Measurement method of trapezial height. Measure the trapezial height from scaphoid distal pole to 1st metacarpal base in posteroanterior view perpendicular manner to scaphoid distal pole.

Fig. 3

A 47-year-old female with carpometacarpal (CMC) arthritis of thumb. Hematoma distraction arthroplasty was performed. Six weeks after pin removal, almost of subsidence occurred. From then, subsidence progress slowly. (A) Preoperative, (B) postoperative, (C) 3 months follow-up, and (D) 6 months follow-up radiography. The measurement of space height was 9.33 mm. (E) There was also CMC arthritis in the thumb of contralateral hand. The space height was 10.81 mm.

Fig. 4

The chart of serial measurement of trapezial space height. Through 6 weeks after pin removal, subsidence progress rapidly. Few subsidence has occurred since then. Preop, preoperative; Postop, postoperative.

Table 1

Demographic patient data

Table 2

The average value of radiologic measurement in total 17 cases

Values are presented as average (range). There is no statistical difference between two groups in radiologic parameters by analysis with Mann-Whitney U-test.

^*Preoperative.

Table 3

Influence of traction maneuver to prevent subsidence

The analysis was done with Spearman and Kendall's tau-b test. The distraction height (postoperative fixation height–preoperative trapezial height) does not influence the subsidence ratio or subsidence.

Notes

^{CONFLICT OF INTEREST} No potential conflict of interest relevant to this article was reported.

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