Technical Section: Technical Tutorial, Notes and Tips

Abstract

Hyperextension of the thumb metacarpophalangeal joint affects a diverse population of patients. This includes those with cerebral palsy, degenerative or inflammatory arthritides, or following hand trauma. The abnormal movement may result in decreased pinch-grip strength, sesamoid-metacarpal or metacarpophalangeal joint arthritis, or an adduction deformity of the thumb. Sesamoid arthrodesis is indicated to improve function and relieve pain, and is considered superior to metacarpophalangeal joint arthrodesis. Capsuloplasty and capsulodesis have also been described as surgical techniques capable of correcting metacarpophalangeal joint hyperextension.1,2 Sesamoid fusion by interosseous wire suture, as first described by Zancolli, has gained widespread favour and was previously the technique of choice for the senior author (HPG).3 However, this technique can be both cumbersome and time consuming, and there is the inherent risk of potential damage to the extensor mechanism. We describe a new technique involving a modified Mitek® anchor. The device is re-threaded with an interosseous wire, which allows controlled compression between the sesamoid bone and metacarpal.