[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.