Partial Trapeziectomy and Suture-Button Suspensionplasty for the Treatment of Thumb Carpometacarpal Joint Arthritis

Dongmin Kim; Jong Woong Park; Ji Hun Park; In Cheul Choi

doi:10.12790/ahm.2018.23.1.12

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Kim, Park, Park, and Choi: Partial Trapeziectomy and Suture-Button Suspensionplasty for the Treatment of Thumb Carpometacarpal Joint Arthritis

Hand

Archives of Hand and Microsurgery 2018; 23(1): 12-19.

Published online: 2 March 2018

DOI: https://doi.org/10.12790/ahm.2018.23.1.12

Partial Trapeziectomy and Suture-Button Suspensionplasty for the Treatment of Thumb Carpometacarpal Joint Arthritis

Dongmin Kim¹, Jong Woong Park², Ji Hun Park², In Cheul Choi³

¹Department of Orthopaedic Surgery, Armed Forces Capital Hospital, Seongnam, Korea.

²Department of Orthopaedic Surgery, Korea University Anam Hospital, Seoul, Korea.

³Department of Orthopaedic Surgery, Barunsesang Hospital, Seongnam, Korea.

Corresponding author: In Cheul Choi. Department of Orthopaedic Surgery, Barunsesang Hospital, 5 Yatap-ro 75beon-gil, Bundang-gu, Seongnam 13497, Korea. TEL: +82-1577-3175, FAX: +82-31-709-2075, indolldr@hanmail.net

Received 6 November 2017 Revised 9 January 2018 Accepted 10 January 2018

Korean Society for Surgery of the Hand, Korean Society for Microsurgery, and Korean Society for Surgery of the Peripheral Nerve

(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

Our goal was to investigate the clinical results of partial trapeziectomy and suspensionplasty with suture button for the thumb basal joint osteoarthritis.

Methods

A prospective study was performed for patients who have been undergone partial trapeziectomy and suspensionplasty by a suture button fixation for Eaton stage II or III osteoarthritis. Clinical outcome measures included visual analogue scale (VAS) for pain, Quick disabilities of the arm, shoulder, and hand (DASH), pinch and grip power, and thumb movement. Radiographic measurements and complication were recorded. A p-value <0.05 was considered statistically significant.

Results

Total number of the patients was nine, which included 8 females and 1 male. Average age at the time of surgery was 61.2±5.1 years old, and average duration of the follow-up period was 19 months (6–46 months). This procedure was carried out for dominant hand in 6 cases and non-dominant hand in 3 cases. In the early clinical outcomes at the postoperative 10 weeks, VAS measurement demonstrated statistically significant difference. Other clinical parameters; however, did not show as statistical significance at the postoperative 10 weeks. In addition, there was statistical significance in VAS, Quick DASH, grip and thumb range of motion, except pinch power at the last follow-up day. Serial radiographic change was shown during total follow-up period.

Conclusion

Partial trapeziectomy and suspensionplasty using suture button revealed improved clinical outcomes and return to early daily activity by permitting early thumb motion. So this surgical procedure can be a good option for thumb basal joint osteoarthritis.

Keywords: Thumb basal joint, Osteoarthritis, Partial trapeziectomy, Suspensionplasty, Suture button

Figures and Tables

Fig. 1

(A) Skin incision is carried out over thumb basal joint, and then only the distal “horns” of the trapezial saddle and any peripheral osteophytes is resected. (B) K-wire was introduced through the first and second metacarpal bone as a proper positioning of the thumb, (C) First generation TightRope (Arthrex, Naples, FL, USA) is disassembled. (D) Bone tunnel is made using a 1.2 mm K-wire. (E) The TightRope is reassembled from the second metacarpal. (F) After the procedure, short arm thumb spica splint is applied lastly.

Fig. 2

(A) Eaton stage II arthritic change at the thumb basal joint is identified on plain radiograph (arrow), (B) immediate postoperative plain radiograph, (C) thumb movement at postoperative 10 weeks, (D) plain radiograph at postoperative 3 years, (E) full thumb motion was noted as much as contralateral side at postoperative 3 years.

Fig. 3

(A) Immediate postoperative hand plain radiograph, but implant irritation was noted, finally implant removal was carried out at postoperative 1 year. (B) There was no significant subsidence on plain radiograph at postoperative 4 months after implant removal.

Table 1

Early clinical outcomes after partial trapeziectomy and suture-button suspensionplasty

Values are presented as mean±standard deviation.

VAS: visual analog scale, DASH: disabilities of the arm, shoulder, and hand.

^*Statistically significant difference (p<0.05). ^†Compared with healthy contralateral side.

Table 2

Last clinical outcomes after partial trapeziectomy and suture-button suspensionplasty

Values are presented as mean±standard deviation.

VAS: visual analog scale, DASH: disabilities of the arm, shoulder, and hand.

^*Statistically significant difference (p<0.05). ^†Compared with healthy contralateral side.

Table 3

Serial change of the trapezial space ratio after partial trapeziectomy and suture-button suspensionplasty

^*This values are trapezial space ratio (TSR^†) on the plain radiographs. ^†TSR is calculated by dividing the trapezial space height by the length of the first proximal phalanx.

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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