Arch Hand Microsurg.  2024 Jun;29(2):96-104. 10.12790/ahm.24.0011.

Arthrodesis for Eaton-Littler stage III degenerative trapeziometacarpal arthritis: a retrospective comparative study of fixation methods

• Lee JK
• Oh CH
• Ahn WY
• Lee SW
• Kang S
• Han SH

• KMID: 2556359
• DOI: http://doi.org/10.12790/ahm.24.0011

Abstract

Purpose
This study compared clinical outcomes depending on the fixation modality in patients who underwent arthrodesis surgery for Eaton-Littler stage III trapeziometacarpal (TM) joint arthritis between 2009 and 2022.
Methods
In total, 39 patients with 44 hands (five patients had surgery on both hands) were selected. Depending on the operative fixation instruments, patients were divided into two groups: group 1, surgery with 25-gauge interosseous wiring and Kirschner wire or headless screw fixation; group 2, surgery with only multiple headless screws for fixation. Bone union was achieved at 62 days after surgery in group 1 and 75 days in group 2 (p=0.165).
Results
The preoperative mean visual analogue scores improved during the postoperative outpatient follow-up period in both groups (group 1, from 4.0 preoperatively to 1.0 at the final follow-up; group 2, from 5.0 preoperatively to 2.0 at the final follow-up). Mean grip strength and pinch strength increased after surgery. One patient (4.8%) experienced nonunion in group 1, whereas nonunion occurred in four patients (17.4%) in group 2. This difference was not statistically significant. Four patients in group 1 and no patients in group 2 underwent fixation instrument removal after sound union.
Conclusion
Adequate stability can be achieved during arthrodesis by combining interosseous wiring and other implants or multiple headless compression screws, resulting in successful outcomes for patients with Eaton-Littler stage III degenerative TM arthritis.

Keyword

Arthritis; Trapeziometacarpal joints; Carpometacarpal joints; Thumb arthrodesis; Fusion; Interosseous wiring; Headless compression screw

Figure

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  Fig. 1. (A) Trapeziometacarpal joint incision. (B) The incision between the abductor pollicis longus and extensor pollicis brevis, and joint exposure. (C) Resection of the metacarpal base and trapezium articular surfaces. (D) Target arthrodesis angle with 30° to 40º palmar abduction and 20°-30º radial abduction. (E) Insertion of healthy cancellous bone from resected bone into gaps.

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  Fig. 2. (A) Interosseous wiring was added using 16-gauge needles drilled across the trapezium and the base of the first metacarpal bone, and two 25-gauge steel wires were passed through the needles. (B) Secure fixation was achieved by tensioning the interosseous wire, and transaxial Kirschner wires were fixed.

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  Fig. 3. (A, B) Arthrodesis with one interosseous wiring and two Kirschner wires. (C, D) Arthrodesis with one headless compression screw and one interosseous wire. (E, F) Arthrodesis with two or three headless compression screws. (G) A satisfactory postoperative range of motion was obtained in the thumb. All fixation methods mentioned above also obtained a satisfactory postoperative range of motion of the thumb.

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  Fig. 4. A 49-year-old female patient showed nonunion at a 1-year postoperative evaluation. However, no additional surgery was performed because the pain showed improvement compared to preoperative status. The satisfaction score was 5 points.

Reference

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