Arthrodesis of the trapeziometacarpal joint for basal joint osteoarthritis of the thumb: the importance of obtaining osseous union

Abstract

Introduction: In the surgical treatment of osteoarthritis of the basal joint of the thumb, several options are available. The carpometacarpal arthrodesis should provide stability, strength and resolution of pain. There is however some controversy on the outcome.

Materials and methods: In a retrospective study we reviewed 34 carpometacarpal joint fusions (26 men, eight women; mean age 48 years). Two techniques of fixation have been used: staples (16x) and K-wires (18x). The follow-up was 5.2 years.

Results: The nonunion rate was 39%. Only 60% of the patients was satisfied. The DASH score was 32 (standard deviation 18). Key pinch force was reduced with 27% of the opposite side. Range of motion was slightly reduced: 6 degrees in the interphalangeal joint, 19 degrees in the metacarpophalangeal joint. When fusion was obtained patients' satisfaction increased to 88%.

Conclusion: Patient satisfaction was low and nonunion rate was high. Better results are obtained in cases with osseous union. More solid fixations, perhaps with addition of bone grafts have to be considered.