Thomas Pillukat1, Wolfram Heitzmann2, Karlheinz Kalb2, Joachim Windolf3, Jörg van Schoonhoven2. 1. Klinik für Handchirurgie, Von Guttenbergstr. 11, 97616, Bad Neustadt an der Saale, Deutschland. thomas.pillukat@campus-nes.de. 2. Klinik für Handchirurgie, Von Guttenbergstr. 11, 97616, Bad Neustadt an der Saale, Deutschland. 3. Klinik für Unfall- und Handchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland.
Abstract
OBJECTIVE: Resuspension of the first metacarpal bone using the extensor carpi radialis longus muscle tendon. Prevention of contact between the first metacarpal bone and adjacent bones (scaphoid, trapezoideum, second metacarpal bone). Preservation of motion. INDICATIONS: Pain after preceeding resectional arthroplasty due to proximalisation of the first ray. Radiologically demonstrated contact between the base of the first metacarpal bone and adjacent bones (scaphoid, trapezoideum, second metacarpal bone). Instability of the first ray at the site of the suspension. CONTRAINDICATIONS: Proven specific reasons: neuropathical complaints and dysaesthesia in the region supplied by the superficial branch of the radial nerve, tendinitis of the flexor carpi radialis tendon etc. SURGICAL TECHNIQUE: Distalisation of the first ray after mobilisation and debridement at the base of the first metacarpal bone with resection of scar tissue, Resection of the pre-existing tendon plasty and contouring the base of the first metacarpal bone with removal of osteophytes. Interposition of tendon material between the base of the first and second metacarpal bones. POSTOPERATIVE MANAGEMENT: Immobilisation in a forearm cast including the thumb metacarpophalangeal joint for 6 weeks. RESULTS: Of 21 patients treated using this procedure, 15 (13 women, 2 men, average age 59 (51-70) years) were evaluated retrospectively on average 4 (2-10) years postoperatively. Opposition of the thumb was nearly normal. Grip strength and strength of pinch grip did not differ significantly from the contralateral side. Pain at rest and exercise (evaluated by a visual analogue scale from 0-10) was postoperatively significantly reduced. On plain X‑rays the distance between the base of the first metacarpal bone and the distal scaphoid pole was significantly increased as a sign of a successful distalisation. Ultimately, 12 patients postoperatively returned to work, 10 to their original occupation. No patient required additional procedures.
OBJECTIVE: Resuspension of the first metacarpal bone using the extensor carpi radialis longus muscle tendon. Prevention of contact between the first metacarpal bone and adjacent bones (scaphoid, trapezoideum, second metacarpal bone). Preservation of motion. INDICATIONS: Pain after preceeding resectional arthroplasty due to proximalisation of the first ray. Radiologically demonstrated contact between the base of the first metacarpal bone and adjacent bones (scaphoid, trapezoideum, second metacarpal bone). Instability of the first ray at the site of the suspension. CONTRAINDICATIONS: Proven specific reasons: neuropathical complaints and dysaesthesia in the region supplied by the superficial branch of the radial nerve, tendinitis of the flexor carpi radialis tendon etc. SURGICAL TECHNIQUE: Distalisation of the first ray after mobilisation and debridement at the base of the first metacarpal bone with resection of scar tissue, Resection of the pre-existing tendon plasty and contouring the base of the first metacarpal bone with removal of osteophytes. Interposition of tendon material between the base of the first and second metacarpal bones. POSTOPERATIVE MANAGEMENT: Immobilisation in a forearm cast including the thumb metacarpophalangeal joint for 6 weeks. RESULTS: Of 21 patients treated using this procedure, 15 (13 women, 2 men, average age 59 (51-70) years) were evaluated retrospectively on average 4 (2-10) years postoperatively. Opposition of the thumb was nearly normal. Grip strength and strength of pinch grip did not differ significantly from the contralateral side. Pain at rest and exercise (evaluated by a visual analogue scale from 0-10) was postoperatively significantly reduced. On plain X‑rays the distance between the base of the first metacarpal bone and the distal scaphoid pole was significantly increased as a sign of a successful distalisation. Ultimately, 12 patients postoperatively returned to work, 10 to their original occupation. No patient required additional procedures.