Trapeziometacarpal Joint Arthrodesis Using a Cannulated Compression Screw and Locking Plate Construct

Abstract

Background: Trapeziometacarpal (TMC) arthrodesis is an established surgical option for the treatment of basal joint osteoarthritis. It has traditionally been indicated in younger, higher demand patients who would benefit from the increased strength afforded by a stable thumb base. Trapeziometacarpal arthrodesis has a higher reported complication rate than other treatment options, including nonunion and symptomatic hardware. Description of Technique: We describe a novel construct for TMC joint arthrodesis using a cannulated headless screw to compress the arthrodesis site and a low-profile locking plate to neutralize the considerable musculotendinous forces crossing the joint. Patients and Methods: We performed a retrospective review of 10 patients treated with this fusion construct between June 2019 and February 2021. Results: The average patient age was 56.5 years; 7 patients were female and 3 were male. The mean pain score, on a 0 to 10 point scale, decreased from 7.2 preoperatively to 1.6 at final postoperative follow-up. All patients achieved bony union; none underwent removal of hardware. Conclusions: Given the high reported rate of nonunion following TMC arthrodesis in the literature, improvements in surgical technique are needed. In a small cohort of patients, we report favorable outcomes with a new technique for TMC arthrodesis.

Keywords: arthrodesis; basal joint; osteoarthritis; thumb carpometacarpal (CMC) joint; trapeziometacarpal arthritis.

Fig. 1.

Illustrative case example of a 53-year-old woman with TMC arthritis who underwent arthrodesis: (a) preoperative radiographs showing osteoarthritis, (b) intraoperative fluoroscopy demonstrating the fusion construct, and (c, d) final postoperative radiographs and CT scan demonstrating bony fusion at 12 weeks. TMC trapeziometacarpal, CT computed tomography.

Fig. 2.

Illustrative case example of a 49-year-old woman with right TMC arthritis who underwent arthrodesis: (a) preoperative radiographs showing degenerative changes, (b) intraoperative fluoroscopic images, and (c) final postoperative radiographs at 12 weeks showing bony fusion. TMC trapeziometacarpal.

Fig. 3.

Clinical photographs after TMC arthrodesis: (a) thumb flexion is preserved through the MCP joint, with slightly decreased pronation; (b) thumb radial abduction is maintained; and, however, (c) patients are unable to place the hand flat against a surface due to the slight palmar abduction of the TMC joint fusion. The * indicates the fused side in all of the photographs. MCP metacarpophalangeal, TMC trapeziometacarpal.