Cross-Shaped Bone Grafting and Locking Plate Fixation for Arthrodesis of the Trapeziometacarpal Joint: Surgical Technique and Early Mobilization.

Abstract

The trapeziometacarpal joint is the second most common site of osteoarthritis in the hand and the most frequent one to require surgery. Arthrodesis of the trapeziometacarpal joint is recognized as one of the valuable technique but unfortunately there has been wide variation in the union rate. The purpose of this study was to evaluate a new arthrodesis technique involving a cross-shaped bone graft and locking plate fixation. Eleven male patients diagnosed as Eaton's stage III osteoarthritis of the trapeziometacarpal join were treated in our institute. The mean patient age was 62 years (range 50 to 80 years). At the day after surgery, physical therapy was started and free use of the hand was permitted. Patients showed radiographic evidence of trapeziometacarpal joint union after an average postoperative period of 8.3 weeks (range 6-12 weeks). The VAS pain score significantly decreased from 7.2 points preoperatively to 0.4 points after surgery. Mean side pinch strength increased significantly from 3.8 kg (53% compared to unaffected side) prior to surgery to 6.2 kg (86%). The DASH score improved from 38.6 (range 34.1-43.2) preoperatively to 17.0 (6.8-22.7) postoperatively. These data suggested that our technique is a successful procedure for the trapeziometacarpal joint arthrodesis. Cross-shaped bone grafts have the advantages of restoring thumb length and providing internal stabilization, especially for rotational force. No complications arose at the bone harvest site of the iliac crest. The procedure seems to be technically demanding, particularly for adapting the bone graft to perfectly match the shape of the defect.