Metacarpophalangeal Joint Arthrodesis Research Articles

Outcomes of Arthrodesis of the Metacarpophalangeal Joint of the Thumb for Sequelae of Collateral Ligament Injuries: A Series of 18 Cases with 6-Year Follow-Up.

Background: Untreated or insufficiently treated collateral ligament injuries of the thumb metacarpophalangeal (MP) joint can lead to instability or even osteoarthritis. Arthrodesis is one of the treatment options available for the treatment of the sequelae of collateral ligament injuries. The objective of our study was to evaluate the radiological, clinical and functional outcomes of MP joint arthrodesis performed for sequelae of collateral ligament injuries. Methods: We conducted a retrospective, single-centre study and reviewed the files of patients who had a thumb MP joint arthrodesis following a collateral ligament injury between 2011 and 2019. We collected patient's demographic data and the results of the radiological and clinical examinations. Results: Eighteen patients were included in the study. The average age was of 53.6 years and the time between injury to arthrodesis averaged 7 years. Four patients (22%) had nonunion. In the remaining 14 patients with solid union at an average of 72 months follow-up, the visual analogue pain score at rest was 0.14, the thumb opposition was 82%, grip strength 85%, tip pinch 92% and key pinch 79% of the contralateral side. Conclusions: The clinical and functional results of patients with a successful arthrodesis are satisfactory with restoration of good grip and pinch strength. Despite a lack of thumb MP joint flexion, stability allowed force transmission and may be preferred for manual workers. Level of Evidence: Level IV (Therapeutic).

Complications and Unplanned Reoperation After Thumb Metacarpophalangeal Arthrodesis

Arthrodesis of the metacarpophalangeal (MCP) joint of the thumb is a common procedure to treat arthritis or instability. Studies reporting hardware complications and nonunion rates after thumb MCP joint arthrodesis report on small sample sizes. We aimed to describe the hardware complication rate, the nonunion rate, and the number of thumbs that achieve union among patients undergoing thumb MCP joint arthrodesis. A database spanning 5 urban hospitals in a single metropolitan region in the United States was searched for patients who underwent thumb MCP joint arthrodesis between January 1, 2004 and January 1, 2020. After reviewing patient records, we identified 122 thumbs that underwent MCP joint arthrodesis and had a minimum follow-up of 90 days. The primary outcome was unplanned reoperation after hardware complications and nonunion. Second, the number of thumbs that achieved radiographic union was reported for the tension band and screw fixation arthrodesis group. Twenty-two (18%) out of 122 thumbs had hardware complications after thumb MCP joint arthrodesis, and 11 (9%) out of 122 thumbs developed a nonunion. Patients who underwent screw fixation arthrodesis had no events of hardware complications and subsequent hardware removal. The nonunion rate was 9/65 (14%) in the tension band arthrodesis group and 2 (4%) of 45 in the screw fixation arthrodesis group. Of the thumbs that had available radiographs to assess the healing of the arthrodesis, 34 (81%) of 42 were radiographically united in the tension band arthrodesis group and 29 (91%) of 32 in the screw fixation group. Our data suggest that screw fixation has fewer hardware complications and a lower reoperation rate than tension band arthrodesis. Prognosis IV.

Trending the Incidence of 1st MTP Joint Arthrodesis in the Past Decade

Category: Bunion Introduction/Purpose: Arthrodesis of the first metacarpophalangeal joint (MTPJ) is frequently performed for the most common conditions affecting the great toe, hallux rigidus and hallux valgus. However, there is no detailed depiction of the procedural incidence in recent years. We hypothesize that stratified incidences of patients undergoing this procedure in the last decade has risen. Methods: The Truven MarketScan database was queried to identify patients who underwent 1st MTPJ arthrodesis from January 2009 to December 2019 based on CPT coding. Population estimates from the US Census Bureau were used to calculate the annual incidence of 1st MTPJ arthrodesis. Volume and incidence were estimated for annual sums, gender, age subgroups, and four statistical geographical regions of the U.S. Results: In total, 184,016 1st MTPJ arthrodesis procedures were identified in the database from 2009 to 2019. Annual volumes have increased significantly by 70.8%, from 12,125 to 20,710 total procedures nationwide. Procedural incidence reported per 1,000,000 people significantly increased by 58.7%, at 63.8 in 2019. Growth in incidence was demonstrated in males and females of all defined age subgroups. Incidence stratified by region rose in all regions except for the Northeast, where a -0.5% change between 2010 and 2019 was noted, albeit insignificant. Conclusion: The epidemiology of 1st MTPJ arthrodesis has yet to be clarified in recent years. We have found that the annual volumes and incidence of 1st MTP arthrodesis has increased in the past decade. Growth in incidence was demonstrated in both sexes of all age cohorts as well as regionally in the United States. Identifying current trends in procedural incidences can help provide orthopedic surgeons with insight into temporal and quantitative changes in the field.

Réimplantation du pouce après une ischémie prolongée et une exposition à des températures extrêmement chaudes : ces facteurs ont-ils une influence significative sur les résultats finaux ?

Historically, it has been stipulated that the success of replantation of amputations depends, among other factors, on the ischaemia time and temperature. For amputations involving the digits, replantation should take place in lees than 12 hours for warm ischaemia and lees than 24 hours for cold ischaemia Short report letter. We report a unique replantation of a completely amputated thumb following prolonged ischaemia time and hot weather exposure of about 40 °C. This is a case of a 30-year old, otherwise healthy non-smoker male who sustained an electrical saw injury to his left thumb. He was referred to our hospital 23 hours following the initial injury and only after having visited 3 different hospitals. At surgery, the wound was thoroughly irrigated and debrided and adequate shortening of the first metacarpal and proximal phalanx of the amputated thumb was performed. This was followed by first metacarpophalangeal joint arthrodesis using k-wires. The princeps pollicis artery was exposed and repaired and this was followed by repair of both the extensors and flexors. However, it was noted that the flexor pollicis longus was completely retracted proximally necessitating release of the carpal tunnel. The procedure was completed by reconstruction of the venous anastomosis, and exposure and repair of the digital nerves. Finally, a good wash was done and the skin was closed. The patient was placed on routine antibiotics and pentoxifylline. In our case, however, replantation was carried out with excellent final results, although the ischaemia time was 23 hours and the temperature was 40 °C. Mulders et al. described in their study that shorter ischaemia time is associated with successful replantation that replantation of parts of the hand should still be performed even if the ischemia time was prolonged (Lin et al., 2010). We also agree with Yu et al. in their meta-analysis that there was no significant association between ischaemia time and survival rate (Yu et al., 2015). Indeed, one may argue the role of leeching in the salvage of the replanted thumb. In our opinion, however, the decision to resort to such therapy was significant as rapid resolution and re-perfusion started to take place following its initiation. The authors believe that the hand is a crucial part of the body, and if possible, replantation should always be attempted.

Metacarpophalangeal Joint Arthrodesis of the Thumb - Minimum of Eight Months Follow-up.

Background:Disorders of the thumb metacarpophalangeal (MCP) joint can lead to significant loss of function and pain. Thumb MCP arthrodesis following traumatic injuries is inadequately described and recent studies have questioned the outcome of this treatment.Purpose:The purpose of this study was to report outcome and disability following thumb MCP joint arthrodesis in the treatment of chronic instability after traumatic injuries.Methods:A retrospective review of 26 patients operated on with MCP joint arthrodesis, median follow-up 42 months (8-104months). Subjective outcome was assessed using the disabilities of the Arm, Shoulder, and Hand-questionnaire (DASH). In addition, patient satisfaction, pain, stiffness, and impairment of activities of daily living were assessed on a Visual Analogue Scale (VAS) followed by a question stating whether they would undergo the same procedure again.Results:Two patients (7.7%) needed re-operation due to nonunion. Four patients (15.4%) needed hardware removal. Median DASH-score was 18 (25-75% range 6-47), with lower DASH scores being better. Scores were significantly worse in gender and age matched individuals (p<0.05). Median VAS for pain was 3.7 (range 0-8). More than 50% of patients reported mild, moderate or severe pain, but all patients reported that they were willing to undergo the same procedure again.Conclusion:Our data suggest, that patients with post-traumatic thumb injuries managed with thumb MCP joint arthrodesis perform worse than gender and age matched individuals. Many lived with pain, but all reported that they were willing to undergo the same procedure again. We suggest that the disability scale by the National Board of Industrial Injuries should be reconsidered for patients operated on with thumb MCP arthrodesis.

Not all non-rheumatoid patients are satisfied with thumb metacarpophalangeal joint arthrodesis

Arthrodesis of the thumb metacarpophalangeal (MP) joint exhibits good results in rheumatoid patients but is controversial in post-traumatic conditions. This study evaluated the subjective outcome after thumb MP joint arthrodesis in chronic injuries and non-rheumatoid degenerative disorders. Forty-six patients were evaluated retrospectively with a mean follow-up of 4.1 years (range 1.5–6.5). Both the Quick DASH score (mean 18.6; range 0–72.7) and Visual Analogue Scales (satisfaction, pain, stiffness, and impairment of ADL; mean 3.2, 3.0, 3.0, and 2.5; range 0–9.6, 0–9.1, 0–9.8, and 0–9.6, respectively) showed wide variations. Twelve patients regretted the operation and 37 experienced difficulties with one or more specific activities. Multiple regression analyses indicated that elderly patients with painless instability are the best candidates for thumb MP joint arthrodesis. In young patients with excessively painful thumb MP joints and involvement in Workers' Compensation Board claims, but without advanced degenerative changes, this study recommends avoiding arthrodesis and considering alternative treatment modalities. The importance of adequate preoperative information about the realistic expectations after arthrodesis of the thumb MP joint is emphasised.

BILATERAL THUMB METACARPOPHALANGEAL JOINT FUSIONS FOR SEVERE HYPEREXTENSION DEFORMITIES IN CONJUNCTION WITH CARPOMETACARPAL JOINT RECONSTRUCTIONS

Hyperextension of the first metacarpophalangeal (MCP) joint and adduction of the first web space of the hand are features of advanced stages of carpometacarpal (CMC) joint arthrosis. Restoration of mechanical efficiency in such patients requires stabilization of both the CMC and MCP joints. This study describes a patient with bilateral secondary hyperextension of the MCP joint greater than 50° who displayed good functional outcome following staged bilateral MCP joint arthrodesis with simultaneous CMC joint reconstruction. Excision of trapezium, formation of a Weilby sling utilising flexor carpi radialis, and insertion of a Swanson's prosthesis forms the basis of CMC joint reconstruction. Fusion of the MCP joint involved placement of longitudinal K-wires and tension band wiring. The patient underwent an initial right-sided procedure in 2008 and subsequently elected for the same procedure on the contralateral side 26 months later. Good functional improvement was achieved with a pre and postoperative DASH score of 49 and 8 respectively. Follow-up and radiological imaging at 34 months from her initial surgery confirmed good positions of the prostheses and solid MCP joint fusions. The patient developed postoperative interphalangeal joint pain, which responded to steroid injection. There is currently limited evidence available addressing the management of severe hyperextension deformity greater than 50° of the MCP joint in the presence of CMC joint arthrosis. Staged bilateral fusion of the MCP joint and simultaneous CMC joint reconstruction in this case illustrates good, reproducible functional results and patient satisfaction with reduced postoperative return to function.

Journal of Hand Surgery

Long-term outcomes of closed reduction and percutaneous pinning for the treatment of distal radius fractures. Glickel SZ, Catalano LW, Raia FJ, Barron OA, Grabow R, Chia B. J Hand Surg Am. 2008;33:1700–1705.

Assessment of Thumb Metacarpophalangeal Joint Arthrodesis Using a Single Longitudinal K-Wire

To evaluate retrospectively the functional and radiographic outcome of patients who had a thumb metacarpophalangeal joint arthrodesis with a single longitudinal K-wire. We performed a retrospective review of 27 patients who had a thumb metacarpophalangeal joint arthrodesis with a single longitudinal K-wire. Outcomes were assessed using self-reported measures (Patient-Rated Wrist/Hand Evaluation; AUSCAN Osteoarthritis Hand Index; Disabilities of the Arm, Shoulder and Hand questionnaire; Short Form-36 General Health questionnaire), measured physical impairments (range of motion, strength, manual dexterity), and radiographic review. Patient-rated outcome scores indicated mild pain, difficulty with specific and usual tasks, and minimal concern with hand appearance. Most physical impairment measures were not significantly different from the side not surgically treated, and patient satisfaction was high. There was a slight decrease in tripod pinch strength, manual dexterity, interphalangeal joint flexion, handspan, and thumb opposition compared with the contralateral side. The overall complication rate was 11% (3 complications). Twenty-five patients (89%) were able to return to their previous occupations. There were no radiographic malunions or nonunions. Radiographic evidence of degenerative changes was present in 20% of patients at the carpometacarpal joint and 30% of patients at the interphalangeal joint. Our technique of performing a thumb metacarpophalangeal joint arthrodesis with a single longitudinal K-wire is effective, with high overall patient satisfaction and a relatively low complication rate, despite small losses of strength, manual dexterity, and motion. Therapeutic IV.

Conversion of a Ring Finger Metacarpophalangeal Joint Arthrodesis to Arthroplasty: A Case Report

This case report presents the conversion of a ring finger metacarpophalangeal joint arthrodesis to arthroplasty, using a pyrocarbon implant. The patient sought a conversion secondary to poor grip strength and inability to perform basic tasks in his job with the Marine Corps. Three months after surgery he had a stable joint and a 50% increase in grip strength.

Arthrodesis of the Metacarpophalangeal Joint of the Thumb Using a Herbert Screw

We describe a technique for thumb metacarpophalangeal joint arthrodesis by using a Herbert screw. This method of fixation helps in avoiding some of the potential problems associated with wire fixation, tension-band arthrodesis, or plate fixation. Therefore, it eliminates the risk of pin track infection, pin breakage, and painful protrusion under the skin requiring metalwork removal.

Thumb Arthrodesis

Arthrodesis of the thumb carpometacarpal, metacarpophalangeal, and interphalangeal joints are well-established options in the management of arthritis, instability, and/or deformity. This review includes a general review of the indications and technique of arthrodesis and recent review of the literature. New literature has focused on the role of arthrodesis in managing carpometacarpal arthritis and compared its results with ligament reconstruction and tendon interposition. However, no conclusive evidence demonstrates the superiority of arthrodesis. Several new articles have demonstrated good long-term results of carpometacarpal arthrodesis. A new report on complications associated with plate and screw fixation for carpometacarpal arthritis has been published, leading the authors to conclude that k-wire fixation was a better option. A technique of metacarpophalangeal joint arthrodesis using a cannulated screw has been recently published with good success. Moreover, a cup-in-cone technique of reaming surfaces of the thumb metacarpophalangeal joint to maximize bone contact surface area has been described. Other authors have reiterated and reinforced the success of some of the more standard techniques including Herbert screws for interphalangeal joint arthrodeses. Thumb arthrodesis of the carpometacarpal, metacarpophalangeal, and interphalangeal joints maintains a significant role in the management of deformity and arthritis. Better comparison studies are necessary in evaluating arthrodesis of the carpometacarpal joint versus arthroplasty. New fixation techniques for metacarpophalangeal joint arthrodesis are promising. Standard fixation for interphalangeal joint fusion has been reiterated. Successful arthrodesis can lead to excellent patient outcomes and function.

Technical Section: Technical Tutorial, Notes and Tips

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.

AnIn VitroBiomechanical Comparison of a Prototype Intramedullary Pin‐Plate with a Dynamic Compression Plate for Equine Metacarpophalangeal Arthrodesis

To compare the biomechanical properties of a prototype intramedullary pin-plate (IMPP) implant specifically designed for equine metacarpophalangeal (MCP) arthrodesis with a dynamic compression plate (DCP) system. In vitro biomechanical testing of paired cadaveric equine forelimbs with a simulated traumatic disruption of the suspensory apparatus, stabilized by one of two methods for MCP arthrodesis. Twenty-one pairs of adult equine cadaveric forelimbs. Each forelimb had the distal sesamoidean ligaments severed to create a disrupted suspensory apparatus. For each forelimb pair, the MCP joint was stabilized with the IMPP in one limb, and a DCP in the other limb. Seven matching limb pairs were tested in axial compression in a single cycle to failure, 7 matching limb pairs were tested in torsion in a single cycle to failure, and 7 matching limb pairs were fatigued tested in axial compression. Mean test variable values for each method were compared using a paired t-test within each group. Significance was set at P<.05. The mean yield load, yield stiffness, and failure load (axial compression, torsional loading) was significantly greater for the IMPP compared with the DCP system. Mean cycles to failure for axial compression was significantly greater for the IMPP compared with the DCP system. Significance in all tests was P<.0001. The IMPP was superior to the DCP system in resisting the biomechanical forces most likely to cause failure of MCP joint arthrodesis. The IMPP implant should be considered for MCP arthrodesis in horses with traumatic disruption of the suspensory apparatus. The specific design of the IMPP implant may facilitate equine MCP arthrodesis and avoid convalescent complications related to cyclic fatigue.

Motion and morphology of the thumb metacarpophalangeal joint

Purpose: To determine the variability in the flexion/extension motion of the thumb metacarpophalangeal (MCP) joint in a normal volunteer population and to determine any correlation between the shape of the thumb metacarpal head, gender, age, thumb interphalangeal (IP) joint range of motion (ROM), and thumb MCP joint ROM in a population of fresh-frozen cadaver arms. Methods: The ROM of the thumb MCP joints of 100 volunteers (200 thumbs) was measured. The thumb MCP joints of 70 fresh-frozen cadaver arms were examined. Posteroanterior and lateral radiographs were taken of 64 MCP joints. Passive flexion and extension at the MCP and IP joints were measured with a standard goniometer starting at neutral (0°) with the metacarpal, proximal, and distal phalanges axially aligned. The distance from the volar to the dorsal edge of the articular surface (A) and the radius of curvature of the articular surface (r) of the metacarpal head were measured on the lateral view. The shape of the metacarpal head was given a value using the A/r ratio. Regression analysis was used to determine the correlation between the head shape and joint motion. The thumbs were categorized into a round group (A/r ratio > 1.7) or a flat group (A/r ratio of < 1.7) to facilitate statistical analysis. Results: The volunteer population mean thumb MCP maximum flexion was 77° nge, 40°–126°). Range of motion in hyperextension varied from 0° to 72°, with a mean of 35°. Total ROM was from 55° to 176°, with a mean of 110°. In the cadaver population studied the average MCP joint ROM was 94° (mean flexion, 70°; mean extension, 24°). The A/r ratio had a range of 1.1 to 2.2. There were 37 round and 27 flat thumb metacarpal heads. Regression analysis showed a significant correlation between metacarpal head shape and ROM; MCP joints with rounder metacarpal heads had greater motion. Round and flat metacarpal heads had significantly different motion arcs averaging 106° and 77°, respectively. Female gender was associated both with significantly greater MCP joint ROM (99° women/87° men) and a significantly higher incidence of round metacarpal heads (66% of women/36% of men). No significant correlation existed between specimen age, MCP, and/or IP joint ROM. Conclusions: There is a wide range in the magnitude of the thumb MCP joint ROM and the normal shape (round vs flat) of the thumb metacarpal head. A rounder thumb metacarpal head has greater thumb MCP joint ROM than a flatter thumb metacarpal head. Clinically we have found this information helpful in predicting posttraumatic recovery of thumb MCP joint ROM and selecting candidates for and predicting patient satisfaction with thumb MCP joint arthrodesis.

Thumb metacarpophalangeal joint arthrodesis using the AO 3.0-mm cannulated screw: surgical technique.

A technique for metacarpophalangeal joint arthrodesis of the thumb using the 3.0-mm AO cannulated screw is described. Advantages of this technique include its relative simplicity and accuracy, solid fixation, and high union rate.

Treatment of spastic thumb-in-palm deformity: A modified extensor pollicis longus tendon rerouting

Fourteen patients (15 hands) with spastic thumb-in-palm deformities were treated with a modified technique of extensor pollicis longus tendon rerouting. Twelve patients obtained satisfactory correction of their deformities. Although functional improvement was not always anticipated, it was achieved to some degree in 12 patients. Extensor pollicis longus tendon rerouting can provide satisfactory correction of severe thumb-in-palm deformity especially when combined with other procedures such as metacarpophalangeal joint arthrodesis and thumb intrinsic muscle release. The modified rerouting technique can be done with a single incision and allows easy adjustment of tension.