Modified Burton and Pellegrini procedure for trapezium excision, ligament reconstruction and interposition arthroplasty of the tendon of flexor Carpi radialis.

GOAL OF SURGERY

Relieve of pain and increased stability at the base of 1st metacarpal.

INDICATIONS

Painful degenerative and inflammatory arthritis in trapeziometacarpal joint (TMCJ).

CONTRAINDICATIONS

Patients not willing to undergo lengthy intensive postoperative rehabilitation. Rheumatoid arthritis (relative).

POSITIONING AND ANAESTHESIA

Supine. Hand table. General or regional anaesthesia.

SURGICAL TECHNIQUE

Modification of the Burton-Pelligrini operation by using half of the flexor carpi radialis for interposition between base of 1st metacarpal and scaphoid. Stabilization with a Kirschner wire. In the presence of scaphotrapezoid arthritis an arthrodesis of this joint is performed for better pain control.

POSTOPERATIVE MANAGEMENT

Immobilization in a below elbow cast for 6 weeks. Then active physiotherapy, night splint for another 6 weeks.

POSSIBLE COMPLICATIONS

Fracture while drilling the base of the 1st metacarpus, migration of Kirschner wires, injury to the radial artery and cutaneous nerves.

RESULTS

Out of 15 patients 12 (14 thumbs) were followed for at least 6 months. In 11 patients the shape of the hand was normal and 10 patients were satisfied with the result of the operation. Complications included: twice postoperative migration of Kirschner wires, and once intraoperative tearing of the tendon which had to be sutured.