Outcomes of First Metacarpal Extension Osteotomy for Base of Thumb Arthritis.

BACKGROUND: First metacarpal extension osteotomy (FMEO) aims to correct the adduction deformity associated with thumb arthritis, as well as improve the congruity at the first carpometacarpal (FCMC) joint. However, the benefits of this procedure are currently unclear. The purpose of this study is to investigate the outcomes of FMEO in the treatment of FCMC joint arthritis. METHODS: Electronic databases were searched systematically for original data studies in the English language reporting outcomes following FMEO for base of thumb arthritis. Data were extracted from the text, tables, and figures of publications and meta-analyzed where possible. RESULTS: Ten publications comprising 211 thumbs were included. FMEO was associated with an improvement in pain relief and patient-reported functional outcomes, however meta-analysis showed no significant long-term improvement in grip strength or lateral pinch grip. Although there was disease progression in one third of patients after FMEO, most did not require further procedures. Outcomes following secondary procedures was not analyzed in the literature. FMEO produced a range of minor complications, however, major complications were rare. CONCLUSIONS: The available evidence suggests FMEO does not improve grip or pinch strength. However, it may have a role in analgesia and improvement in functional outcomes. Further studies should compare outcomes of FMEO to continued nonoperative treatment, or other surgical options including arthroscopy or ligamentous reconstruction.

Flexor Synovectomy as an Adjunct to Carpal Tunnel Release in Primary Carpal Tunnel Syndrome: A Meta-Analysis.

Background: Carpal tunnel release (CTR) aims to achieve surgical decompression of the median nerve for the treatment of carpal tunnel syndrome (CTS). Flexor tenosynovectomy (FS) has been carried out as an adjunct to routine CTR, on the basis that chronic flexor tenosynovitis has been implicated as an etiological factor in idiopathic CTS. However, the benefits of this additional procedure remains unclear. As such, we aimed to compare functional outcomes, nerve function and complication rates from CTR with and without FS. Methods: A systematic review of published literature was performed for original data English language studies comparing outcomes of CTR with and without FS in the treatment of primary CTS. Mean weighted differences and their 95% confidence interval were used for analysis. Results: Three studies comprising 292 wrists were included. Meta-analysis showed no improvement in post-operative grip strength, symptom severity score, functional status score, median nerve motor latency or major complications with FS. Recurrence rate was not reported in the 3 selected articles. Conclusions: The available evidence suggests FS is an unnecessary adjunct which provides no benefit to CTR, and should not be used routinely to treat primary CTS. Larger studies are needed to validate our findings. FS may have a role in recurrent or secondary CTS.