Management of a Traumatic Collapse of the First Carpometacarpal Joint After Trapeziectomy With Suture Suspensionplasty: A Case Report

Abstract

Arthritis of the first carpometacarpal (CMC) joint is a common pathology hand surgeons encounter. Treatment begins with conservative measures, but when they fail, surgery is a viable option for providing relief to patients. The most widely used surgical technique is CMC arthroplasty with ligament reconstruction and tendon interposition (LRTI). However, more novel techniques such as trapeziectomy with suspensionplasty are gaining popularity. When surgical measures fail, it is important to identify the mechanism of failure and proper treatment options. There are multiple options for revision surgery at the surgeon's disposal, with no consensus on a superior technique. This case illustrates a patient with painful subsidence secondary to a traumatic collapse of the first CMC joint eight months status post suspensionplasty with trapeziectomy. After conservative measures failed to provide relief, it was decided that a surgical revision was appropriate. The surgeon chose to move forward with suture button suspensionplasty, as it has multiple advantages over LRTI. In the short-term follow-up after revision, the patient experienced improvements in pain and range of motion, along with radiographic evidence of proper alignment of the first metacarpal without subsidence. Regarding the treatment of a case such as this, the authors believe this case should serve as a reference that may be used by future physicians when deciding which surgical technique to employ for the revision of a traumatically collapsed first CMC joint after trapeziectomy with CMC joint suspensionplasty.

Keywords: revision arthroplasty; suture button suspensionplasty; thumb carpometacarpal arthritis; thumb cmc arthroplasty; traumatic arthroplasty failure.

Figure 1. Posteroanterior radiograph of the right hand demonstrating moderate osteoarthritis of the first carpometacarpal joint as evidenced by decreased joint space, osteophytes, and subluxation.

Figure 2. Intraoperative posteroanterior radiograph of the right hand demonstrating the absence of the trapezium after trapeziectomy with proper alignment of the first metacarpal.

Figure 3. Posteroanterior radiograph of the right hand demonstrating a complete collapse of the first carpometacarpal joint. There is marked subsidence of the first metacarpal.

Figure 4. Intraoperative posteroanterior radiograph of the right hand demonstrating proper alignment of the first metacarpal. The hardware is intact and positioned properly.

Figure 5. Posteroanterior radiograph of the right hand at one week post first carpometacarpal joint arthroplasty revision surgery with suture button suspensionplasty. Maintenance of the metacarpal suspension with a proper alignment of the first metacarpal can be seen.