AUCTORES
Globalize your Research
Research Article | DOI: https://doi.org/10.31579/2692-9406/117
1 Senior Consultant, Assistant Professor of Orthopaedics, 1st Department of Orthopaedics, Athens General HospitalG. Gennimatas, Athens, Greece.
2 Professor of Orthopaedic Surgery,Faculty of Medicine, University of Thessalia, Larissa, Greece.
*Corresponding Author: Konstantinos C Xarchas, Senior Consultant, Assistant Professor of Orthopaedics, 1st Department of Orthopaedics, Athens General Hospital G. Gennimatas, Athens, Greece
Citation: Konstantinos C Xarchas, Zoe Dailiana (2022) A new combination of surgical techniques for the treatment of 1st carpometacarpal joint arthritis, J. Biomedical Research and Clinical Reviews. 7(1) DOI: 10.31579/2692-9406/117
Copyright: © 2022 Konstantinos C Xarchas. This is an open-access article distributed under the terms of The Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 25 March 2022 | Accepted: 25 April 2022 | Published: 18 May 2022
Keywords: surgical techniques; carpometacarpal; arthritis
Up till now, many different techniques have been used for the treatmentof 1st carpometacarpal (cmc) joint arthritis. Here we present a new combination of well- known techniques and surgical approaches that gave excellent results in a five year follow up.
Surgical techniques used for the treatment of 1st cmc joint arthritis include 1st cmc joint arthrodesis [1],1st metacarpal osteotomy [2],excisionof the trapezium with tendon interposition (known as the anchovy procedure) [3], excisionof the trapezium with ligamentreconstruction, tendon interposition (LRTI) [4], hematoma distraction arthroplasty (HDA) [5] and implant replacement [6].
We present a combination of hematoma distraction technique with interposition of a spacer from the distal part of the flexor carpi radialis tendon.Furthermore, the surgical approach used is a combination of Wagner approach for treatment of fractures of the base of the first metacarpal (Bennet etc.) [7] with the Trance FCR approach to the distal radius [8]. The former gives an excellent and more or less safe view for excision of the trapezium while the latter is equally efficient for lifting a small part of the distal flexor carpi radialis tendon. As an alternative, the longitudinal part of the incision can be replacedby a smaller one, positioned more centrally on the palmar surface of the wrist so that a Palmaris longustendon graft can be taken and used as a spacer insteadof the FCR tendon. Both incisions can be used for simultaneous carpal tunnel decompression if needed.
During a time period of 12 years 20 patients suffering of 1st cmc joint arthritis have been treated with the technique we present.The mean follow-up time was 5 years (3-6).There were 13 women and 5 men (2 bilateral operations) all of them above their 40th year of age (40-82) All of them had an excellent pain relief and an improvement of their graspingability of about 40%. This was below the healthy hand, but all patients were satisfied. Traumatic neuroma of a small branch of the radial nerve in one patient, was the only complication met and was treated by surgical exploration and cauterization. The stumps were then embedded in the radius.
Surgical Technique and Follow Up
Under general anesthesia and an arm tourniquet the upper limb is preppedand draped. A curved skin incision aroundthe base of the first metacarpal is extended proximally on the line of the tendon of the flexorcarpi radialis (Figure1).
Attention is then givento preserve the sensory radialnerve and it branches that may need to be carefully dissected. The longitudinal part of the incision is deepened throughthe fcr and the radial artery is usually not met (figure 2).
The trapeziumis then excised-most of the times in one piece (Figure 3)
taking care that the distal part of the fcr remainsintact. The 1st metacarpal is then distracted and stabilized to the secondone with a k-wire. Appropriate metacarpal distraction is verified with the c-arm(Figure 4)
and attention is then turnedback to the fcr tendon.A longitudinal stripe of about 1/3 of the tendon’swidth and 1/3 of its length is removed underdirect vision, turnedinto a small ball with the use of an absorbable suture and put into the gap produced by the trapezium excision (Figure 5).
Finally,skin is closed and the hand put in a thumb spicapopsplint.Sutures are removed two, whereas the pin and spica six weeks postoperatively.A careful physiotherapy program is then commenced and the hand left
The method that we present offers an effective and safe approach for treatment of the first carpometacarpal jointarthritis of the hand.Low rate of complicationsand adequate pain relief,with improved graspingability of the hand, confirm its usefulness and we therefore propose it.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
