Abstract
BackgroundA variety of metacarpophalangeal joint (MCPJ) arthrodesis techniques have been described for the treatment of symptomatic arthritis and instability of the thumb MCPJ including K wire fixation, tension-band arthrodesis, plate fixation, intramedullary screw, and other intramedullary devices. This study presents a retrospective review of one surgeon's initial series of patients undergoing thumb MCP arthrodesis using an intramedullary compression device with a fixed angle of 25°.MethodsA retrospective chart and radiographic review of patients treated for thumb MCP arthrodesis using the intramedullary device was performed. Final radiographs were evaluated for arthrodesis angle, bony fusion, and implant fixation. Any complication found during surgery or the follow-up period was noted.ResultsIn this study, 17 patients were reviewed. Indications for surgery were osteoarthritis (five patients), rheumatoid arthritis (three patients), MCP instability alone (seven patients), and post-traumatic conditions (two patients). Of these, 12 patients had a simultaneous trapeziometacarpal (TMC) soft tissue arthroplasty. Mean follow-up was 4.9 months. All 17 patients had clinical and radiographic evidence of fusion at an average of 7.9 weeks, with an average fusion angle of 24.4°. There were no hardware complications, no infections, no revisions, and no indications for hardware removal.DiscussionOur study results indicate the technique promotes rapid union at a precise angle, provides strong fixation that does not require prolonged immobilization, does not cause hardware irritation, and can be used in conjunction with other procedures including TMC arthroplasty when MCP arthrodesis is indicated for joint instability.
Highlights
Our study results indicate the technique promotes rapid union at a precise angle, provides strong fixation that does not require prolonged immobilization, does not cause hardware irritation, and can be used in conjunction with other procedures including TMC arthroplasty when MCP arthrodesis is indicated for joint instability
Symptomatic osteoarthritis of the thumb metacarpophalangeal joint (MCPJ) is far less common than that of the trapeziometacarpal joint (TMCJ) [7]; MCPJ instability associated with TMC arthritis and rheumatoid arthritis affecting the MCPJ are common indications for MCP arthrodesis [1]
Final radiographs were evaluated for arthrodesis angle based on the lateral view, bony fusion, and implant fixation based on the lateral, PA, and oblique views, with fusion judged as bone bridging across the fusion site [6]
Summary
Symptomatic osteoarthritis of the thumb metacarpophalangeal joint (MCPJ) is far less common than that of the trapeziometacarpal joint (TMCJ) [7]; MCPJ instability associated with TMC arthritis and rheumatoid arthritis affecting the MCPJ are common indications for MCP arthrodesis [1]. A variety of metacarpophalangeal joint (MCPJ) arthrodesis techniques have been described for the treatment of symptomatic arthritis and instability of the thumb MCPJ including K wire fixation, tension-band arthrodesis, plate fixation, intramedullary screw, and other intramedullary devices. This study presents a retrospective review of one surgeon's initial series of patients undergoing thumb MCP arthrodesis using an intramedullary compression device with a fixed angle of 25°. Methods A retrospective chart and radiographic review of patients treated for thumb MCP arthrodesis using the intramedullary device was performed. Indications for surgery were osteoarthritis (five patients), rheumatoid arthritis (three patients), MCP instability alone (seven patients), and post-traumatic conditions (two patients). All 17 patients had clinical and radiographic evidence of fusion at an average of 7.9 weeks, with an average fusion angle of 24.4°
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