N Maffulli1, A Irwin, R B Chesney. 1. Department of Orthopaedic Surgery, University of Aberdeen Medical School, Polwarth Building Foresterhill, AB25 2ZD, Aberdeen, Scotland.
Abstract
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.
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.
Authors: Min J Park; Greg Lichtman; Jennifer B Christian; Jennifer Weintraub; James Chang; Vincent R Hentz; Amy L Ladd; Jeffrey Yao Journal: Hand (N Y) Date: 2008-06-05