[Revision of failed resection arthroplasty of the CMC-1 joint using a costochondral graft].

OBJECTIVE

To correct and prevent the proximalisation of the 1st ray by safe stabilisation using an autologous costochondral graft. Reduction of pain and maintaining good pinch and grip strength while preserving the important opposition of the thumb.

INDICATIONS

Painful proximalisation of the 1st ray after failed trapeziectomy with contact between the base of the 1st metacarpal and the trapezoid or scaphoid.

CONTRAINDICATIONS

Painful conditions following trapeziectomy for other causes.

SURGICAL TECHNIQUE

Perioperative antibiotic prophylaxis is required. Extension of the previous incision and exposure of the sensitive radial branches and the radial artery. Longitudinal incision of the capsule and excision of the scar from the trapezium cavity. Dissection of the scar tissue directly around the metacarpal 1 base. After longitudinal resection of the oblique trapezoid surface, insertion of a suture anchor into the scaphoid joint surface close to the trapezoid. Removal of an approximately 2 cm long piece of rib cartilage from the middle costal arch. Insertion of the costochondral graft into the trapezium space and fixation with the suture anchor. Stable capsule closure. Suction drain. Skin suture. Thumb-forearm splint.

POSTOPERATIVE MANAGEMENT

Postoperative immobilisation of the carpometacarpal (CMC)-1 joint for 4 weeks in medium abduction position. In case of uneventful wound healing also with a well-fitting orthosis. Afterwards independent movement exercises and exercises in warm water. Hand therapy only in case of difficult mobilisation at the earliest 2 months after surgery.

RESULTS

From 2015-2018, 18 patients underwent surgery using this technique. The follow-up was at least 2 years after surgery. Of the 15 patients available for follow-up, 93% were classified as good and improved according to the Conolly-Rath score.