Trapeziometacarpal Joint Arthrodesis Using a Cannulated Compression Screw and Locking Plate Construct.

Background: Trapeziometacarpal (TMC) arthrodesis is an established surgical option for the treatment of basal joint osteoarthritis. It has traditionally been indicated in younger, higher demand patients who would benefit from the increased strength afforded by a stable thumb base. Trapeziometacarpal arthrodesis has a higher reported complication rate than other treatment options, including nonunion and symptomatic hardware. Description of Technique: We describe a novel construct for TMC joint arthrodesis using a cannulated headless screw to compress the arthrodesis site and a low-profile locking plate to neutralize the considerable musculotendinous forces crossing the joint. Patients and Methods: We performed a retrospective review of 10 patients treated with this fusion construct between June 2019 and February 2021. Results: The average patient age was 56.5 years; 7 patients were female and 3 were male. The mean pain score, on a 0 to 10 point scale, decreased from 7.2 preoperatively to 1.6 at final postoperative follow-up. All patients achieved bony union; none underwent removal of hardware. Conclusions: Given the high reported rate of nonunion following TMC arthrodesis in the literature, improvements in surgical technique are needed. In a small cohort of patients, we report favorable outcomes with a new technique for TMC arthrodesis.

Patient satisfaction with the CMC controller: A cohort study.

STUDY DESIGN: Cohort study. INTRODUCTION: The evidence specific to understanding patient satisfaction, preference and the effects on occupational performance using a CMC orthosis is sparse. PURPOSE OF THE STUDY: The main purpose of this study was to determine patient satisfaction, aspects of the orthotic preference, and the effect on pain and function of the CMC Controller Plus neoprene orthotic device. METHODS: This research was conducted at two outpatient clinics located in Pennsylvania and Florida during 2019. The subjects of this study included any individuals referred to one of two participating hand therapy facilities with either a primary or secondary diagnosis of thumb CMC joint arthritis or present with this diagnosis as a comorbidity. The CMC Controller Plus orthosis (Hely & Weber) was provided to each patient by the treating therapist at no cost to the patient after the patient agreed to take part in the study. None of the patients received hand therapy treatment for the CMC pain; the only intervention provided was the CMC Controller Plus. RESULTS: The CMC Controller Plus orthosis improved the patients' functional status and reduced their pain. The effect size for the change in function was large (1.29) compared to the effect size for the reduction in pain which approached moderate at 0.49. DISCUSSION: The CMC Controller Plus orthosis improved the patient's functional status by 52% and reduced their pain by 29%. CONCLUSION: The results were both statistically and clinically significant.

Analysis on anatomy and biomechanics of ligaments in carpometacarpal joints of the thumb and clinical significance / 医用生物力学

Objective To study the anatomic and biomechanical characteristics of the dorsal radial ligament and anterior oblique ligament in carpometacarpal (CPC) joints of the thumb, so as to provide references for ligament repair. Methods Forty fresh hand specimens of adult male cadavers were dissected to make specimen of trapezium bone- ligament-the first metacarpal bone, of which 20 cases retained the dorsal radial ligament and 20 cases retained the anterior oblique ligament, respectively. The ligaments were tested on the biomechanical testing machine, and their length, width, thickness, the maximum load, elastic modulus and elongation rate were measured and calculated. Results For the dorsal radial ligament and anterior oblique ligament, their maximum load was (213.5±72.4) and (168.7±35.2) N, their elastic modulus was (17.2±6.7) and (9.3±2.5) N/mm2, their elongation rate was (116.2±21.3)% and (92.7±22.4)%, respectively. The maximum load, elastic modulus and elongation of the dorsal radial ligament were larger than that of the anterior oblique ligament. Conclusions In the capsular ligament in CPC joints of the thumb, the dorsal radial ligament has a higher stiffness and stronger toughness, which plays an important role in maintaining the stability of the joint. The stiffness of the anterior oblique ligament is smaller, the toughness is poor, which is easy to be damaged. The anterior oblique ligament is suggested to be reconstructed firstly to treat arthritis of CMC joints, and material whose elastic modulus and elongation rate is similar with the dorsal radial ligament should be selected.

Analysis on anatomy and biomechanics of ligaments in carpometacarpal joints of the thumb and its clinical significance / 医用生物力学

Objective To study the anatomic and biomechanical characteristics of the dorsal radial ligament and anterior oblique ligament in carpometacarpal (CPC) joints of the thumb,so as to provide references for ligament repair.Methods Forty fresh hand specimens of adult male cadavers were dissected to make specimen of trapezium bone-ligament-the first metacarpal bone,of which 20 cases retained the dorsal radial ligament and 20 cases retained the anterior oblique ligament,respectively.The ligaments were tested on biomechanical testing machine,and their length,width,thickness,the maximum load,elastic modulus and elongation rate were measured and calculated.Results For the dorsal radial ligament and anterior oblique ligament,their maximum load was (213.5 ±72.4) and (168.7 ±35.2) N,their elastic modulus was (17.2 ±6.7) and (9.3 ±2.5) MPa,their elongation rate was (116.2 ± 21.3) ％ and (92.7 ± 22.4) ％,respectively.The maximum load,elastic modulus and elongation of the dorsal radial ligament were larger than those of the anterior oblique ligament.Conclusions For the capsular ligament in CPC joints of the thumb,the dorsal radial ligament has a higher stiffness and stronger toughness,which plays an important role in maintaining stability of the joint.The anterior obligue ligament is easy to be damaged due to its smaller stiffness and poor toughness.The anterior oblique ligament is suggested to be reconstructed firstly to treat arthritis of CMC joints,and materials whose elastic modulus and elongation rate are similar with the dorsal radial ligament should be selected.

Analysis on anatomy and biomechanics of ligaments in carpometacarpal joints of the thumb and its clinical significance / 医用生物力学

Objective To study the anatomic and biomechanical characteristics of the dorsal radial ligament and anterior oblique ligament in carpometacarpal (CPC) joints of the thumb,so as to provide references for ligament repair.Methods Forty fresh hand specimens of adult male cadavers were dissected to make specimen of trapezium bone-ligament-the first metacarpal bone,of which 20 cases retained the dorsal radial ligament and 20 cases retained the anterior oblique ligament,respectively.The ligaments were tested on biomechanical testing machine,and their length,width,thickness,the maximum load,elastic modulus and elongation rate were measured and calculated.Results For the dorsal radial ligament and anterior oblique ligament,their maximum load was (213.5 ±72.4) and (168.7 ±35.2) N,their elastic modulus was (17.2 ±6.7) and (9.3 ±2.5) MPa,their elongation rate was (116.2 ± 21.3) ％ and (92.7 ± 22.4) ％,respectively.The maximum load,elastic modulus and elongation of the dorsal radial ligament were larger than those of the anterior oblique ligament.Conclusions For the capsular ligament in CPC joints of the thumb,the dorsal radial ligament has a higher stiffness and stronger toughness,which plays an important role in maintaining stability of the joint.The anterior obligue ligament is easy to be damaged due to its smaller stiffness and poor toughness.The anterior oblique ligament is suggested to be reconstructed firstly to treat arthritis of CMC joints,and materials whose elastic modulus and elongation rate are similar with the dorsal radial ligament should be selected.

Analysis on anatomy and biomechanics of ligaments in carpometacarpal joints of the thumb and its clinical significance / 医用生物力学

Objective To study the anatomic and biomechanical characteristics of the dorsal radial ligament and anterior oblique ligament in carpometacarpal (CPC) joints of the thumb,so as to provide references for ligament repair.Methods Forty fresh hand specimens of adult male cadavers were dissected to make specimen of trapezium bone-ligament-the first metacarpal bone,of which 20 cases retained the dorsal radial ligament and 20 cases retained the anterior oblique ligament,respectively.The ligaments were tested on biomechanical testing machine,and their length,width,thickness,the maximum load,elastic modulus and elongation rate were measured and calculated.Results For the dorsal radial ligament and anterior oblique ligament,their maximum load was (213.5 ±72.4) and (168.7 ±35.2) N,their elastic modulus was (17.2 ±6.7) and (9.3 ±2.5) MPa,their elongation rate was (116.2 ± 21.3) ％ and (92.7 ± 22.4) ％,respectively.The maximum load,elastic modulus and elongation of the dorsal radial ligament were larger than those of the anterior oblique ligament.Conclusions For the capsular ligament in CPC joints of the thumb,the dorsal radial ligament has a higher stiffness and stronger toughness,which plays an important role in maintaining stability of the joint.The anterior obligue ligament is easy to be damaged due to its smaller stiffness and poor toughness.The anterior oblique ligament is suggested to be reconstructed firstly to treat arthritis of CMC joints,and materials whose elastic modulus and elongation rate are similar with the dorsal radial ligament should be selected.

Painful thumb carpometacarpal joint osteoarthritis: Results of a novel treatment approach.

BACKGROUND: Pain reduction as well as preservation and improvement in range of motion remain the main aims in the treatment of thumb carpometacarpal (CMC) osteoarthritis (OA). We performed a retrospective outcome analysis of patients with symptomatic stage II-III thumb CMC joint arthritis treated with denervation, joint lavage and capsular imbrication. METHODS: 73 patients with stage II to III OA of the thumb CMC-joint underwent the described technique. A total of 42 patients complied with follow-up assessment and were included in this study. Mean follow-up was 41.2 (range 12-81) months. RESULTS: Mean operative time was 28.4 (±6.5) minutes. The follow-up assessments showed a significant decrease in pain (preoperative Numerical Rating Scale (NRS): 7.5 - postoperative NRS: 1.1) (p < 0.0001) and a significant improvement in function of the thumb (preoperative DASH-Score: 46.8; Cooney-Wrist-Score: 35.4; Krimmer-Wrist-Score: 38.3 - postoperative DASH-Score: 18.1; Cooney-Wrist-Score: 73.7; Krimmer-Wrist-Score: 80.0) (p < 0.0001). CONCLUSION: The findings of our study indicate that the presented treatment approach could be a good alternative to more invasive surgical options in patients with stage II-III CMC OA of the thumb, without impairing more invasive surgical options like trapeziectomy or arthroplasty for the future.

Outcomes of denervation, joint lavage and capsular imbrication for painful thumb carpometacarpal joint osteoarthritis.

Pain reduction remains the main aim in the treatment of thumb carpometacarpal joint osteoarthritis. We performed a retrospective analysis of a case series of patients with symptomatic thumb carpometacarpal joint arthritis treated with denervation, joint lavage and capsular imbrication. A total of 60 patients participated in this study. Follow-up, including a clinical examination, was performed on 37 patients at a mean of 46 months (range 12 to 81); an additional 23 patients were followed-up by telephone at a mean of 52 months (range 14 to 93) post-operatively. The patients assessed in person showed a significant decrease in pain and a significant improvement in thumb function. The information gathered by telephone gave similar results. The findings of our study indicate that the presented treatment approach could be a good alternative to more invasive surgical options in patients with earlier stages of thumb carpometacarpal joint osteoarthritis. Advantages include the low rate of complications and invasiveness, as well as short recovery times. LEVEL OF EVIDENCE: IV.