[Arthrodesis of the trapeziometacarpal joint].

OBJECTIVE

Bony fusion of the trapeziometacarpal joint.

INDICATIONS

High demands concerning stability and strength of the thumb in primary or secondary osteoarthritis (e.g., posttraumatic osteoarthritis following injuries to the carpometacarpal joint of the thumb); instability in the absence of osteoarthritis due to malformations, ligamentous laxicity, and joint hypermobility; malformations; improvement of hand function in neurological disorders; salvage procedure after carpometacarpal arthroplasty provided bone stock is sufficient.

CONTRAINDICATIONS

Osteoarthritis or stiffness of adjacent joints, activities demanding maximal mobility of the thumb, insufficient bone stock.

SURGICAL TECHNIQUE

Resection of the articular surfaces of the trapeziometacarpal joint via a dorsal approach. After temporary K‑wire transfixation, application of a dorsal T‑shaped plate (fixed angled or not), replacement of the K‑wire with a lag screw.

POSTOPERATIVE MANAGEMENT

Immobilization for 8 weeks (radial below-elbow cast including the thumb metacarpophalangeal joint); standard radiographs on second postoperative day and after 8 weeks; removal of stitches after 2 weeks; with bony healing after removal of the cast, guided exercises to increase strength and mobility; full loading for manual tasks after 3 months.

RESULTS

With regards to strength, stability, and pain reduction, results are rated as good and excellent with a high degree of patient satisfaction. Disadvantages are implant-related complications and nonhealing of the fusion in an average of 13% of patients. Nevertheless, the procedure is still indicated in young manual workers who tolerate some limitations of mobility.