Premiers résultats de l’arthrodèse scapho-métacarpienne au moyen d’une greffe osseuse structurelle comme traitement de sauvetage des échecs de la trapézectomie

Abstract

Treatment of symptomatic thumb base instability after multiple surgical procedures for thumb base arthritis including trapeziectomy remains a challenging problem. We hypothesized a scaphometacarpal arthrodesis with iliac bone graft to be an acceptable definitive salvage procedure for persistent pain and impaired strength after multiple procedures on the TMC joint. Three patients were revised with a scaphometacarpal arthrodesis in our department. They all underwent three to four procedures on the trapeziometacarpal (TMC) joint prior to the salvage procedure. The indication was persistent pain and loss of strength not responding to conservative therapy. An arthrodesis was performed using an autologous iliac bone block to fill the void after trapeziectomy. The construct was fixed with a 1.5-mm T-plate (DepuySynthes). Patients were immobilized with a thumb spica for eight weeks and a removable night splint was used afterwards. Clinical and radiological evaluation was performed 1 year postoperative. After 1 year, two out of three patients were satisfied with the result. Mean opposition decreased from 8 to 7. Mean retropulsion remained 1. Mean precision pinch increased from 1.5 to 2.6 kg. Mean grip strength increased from 3.3 to 10.5 kg. Bony incorporation of the bone graft was seen on CT in two out of three patients. Patients that remain symptomatic after multiple surgeries on the TMC joint are a difficult problem without a straightforward solution. Different procedures have been proposed as a salvage procedure after residual instability of the thumb but they all have their limitations. We performed a scaphometacarpal arthrodesis with iliac bone graft in three patients with acceptable outcomes. Pain was well tolerated and strength increased after 1 year follow-up. Although this procedure is no first-choice treatment, scaphometacarpal arthrodesis with iliac bone graft might provide for an acceptable and definitive treatment for painful residual instability after multiple procedures on the TMC joint. Scaphometacarpal arthrodesis with iliac bone graft is a new technique for symptomatic thumb base instability and can be used as a salvage procedure with acceptable outcomes in patients not responding to conservative therapy.