Posttraumatic trapeziometacarpal joint instability in a child — A case report

Abstract

Good hand function requires pain-free stability of the thumb. The thumb determines prehension in the hand. Opposition, the most important type of prehension, occurs at the trapeziometacarpal (TMC) joint. Instability of the TMC joint is mostly caused by osteoarthritis or rheumatoid arthritis. The clinical management of TMC joint traumatic injuries with instability requires a clear understanding of the anatomy and function of the TMC joint. Surgical intervention is typically used when conservative therapy is unable to retard the progression of instability. Surgery is especially considered when the instability is associated with uncontrollable pain and a loss of function. The authors report a case of a 12-year-old female patient presented with trauma who developed a posttraumatic TMC joint instability. We report the case of a 12-year-old girl who sustained a left thumb injury. On examination, left thumb showed instability on TMC joint. The contralateral TMC joint was stable. General examination showed some joint laxity. The patient was treated with a thumb spica cast but the application of a thumb spica was unsuccessful in the resolution of pain and instability of the TMC joint. The Mini-Tightrope™ (Arthrex, Naples, FL) for suspension of the thumb metacarpal was used as an adjunct and stabilizer of the TMC joint. Surgery was done under fluoroscopy to verify the construct and check the position of suspension of the thumb metacarpal. Post-operatively, wear a thumb spica cast for 3 weeks, where gentle grip strengthening exercises was commenced. At 6 weeks, she was encouraged to progress to medium activities and at 9 weeks to all activities without restriction, including sports. This procedure resulted in very good outcomes, with no instability, no pain and almost no scars. Posttraumatic instability of the TMC joint are rarely reported, especially in children. Surgical treatment is used to restore stability and prevent subluxation dislocation of the TMC joint while preserving mobility. New technology (as the Mini-Tightrope™) has the potential to greatly impact the medical field because it may lead to a greater quality of life, decreased pain, or increased function for our patients. This was of special importance in this case because it allows us to stabilize the TMC joint without harming the growth physis. The Mini Tight Rope technique for the TMC joint relieves pain, restores stability while preserves physis and preserves functional range of motion in children.