Arthrodesis of the trapeziometacarpal joint.

ABSTRACT

Over a 10-year period, 32 trapeziometacarpal (TM) joint fusions were performed in 29 patients, and reviewed. Pin fixation with tension band wiring was used in 14 cases, screws in eight cases, a plate in six cases, K-wires in three cases and staple fixation in one case. None was bone grafted. Splinting was applied for 4 to 5 weeks. There were four cases of delayed union (more than 2 months) and four cases of non-union requiring re-operation (12.5%). The average follow-up was 6 years and 7 months. Grip (26.5 kg) and pinch (4.9 kg) strength were respectively 7% and 18% less than the normal contralateral side. In bilateral osteoarthritis, grip and pinch were stronger than the contralateral side. Joint angulations measured on X-ray films showed for the peritrapezial joint an 18 degrees arc in flexion-extension (a reduction of 64% compared to the contralateral side) and 11 degrees of arc in abduction-adduction (a reduction of 72%). MP joint mobility increased in extension (160%), in flexion (23%), in abduction (120%), in adduction (157%). Despite the marked decrease in motion, subjective functional complaints were minimal. 78.1% of the patients were fully satisfied, 15.6% partly satisfied, and 6.3% dissatisfied. Pain was absent in 50% of the cases and very mild in 40.7%. Three patients complained of discomfort. Eight patients were noted to have osteoarthritic changes in the scaphotrapezial joint.