Arthrodesis of small joints, illustrated by the carpometacarpal joint of the thumb

Abstract

Objective: Elimination of pain, impairment of function, and loss of power due to basal joint osteoarthritis of the thumb.

Indications: Idiopathic or posttraumatic osteoarthritis of the basal joint of the thumb. The technique is equally suitable for arthrodesis of the first tarsometatarsal joint or the first metatarsophalangeal joint following a failed Keller-Brandes operation or failed prosthesis.

Contraindications: Total or subtotal resection of the trapezium. Osteoarthritis of the distal scaphoid joint (triscaphoid joint).

Surgical technique: Technique for a stable fixation of small joints, illustrated by arthrodesis of the carpometacarpal joint of the thumb. A plate is bent distally and used as a washer for a small-fragment compression screw, crossing the former joint space and the inserted bone graft. Additional compression is achieved by asymmetric drilling of the proximal screw (asymmetric insertion principle).

Postoperative management: Plaster splint for 5 days, then early functional treatment.

Results: In a clinical trial, 16 patients with idiopathic basal joint osteoarthritis of the thumb (18 joints) were followed up for an average of 6 years postoperatively. The main objective of the operation, namely, pain relief, was achieved in all cases. Only one case required revision due to nonunion.