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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Volar plate retensioning after trapeziectomy and ligament recosntruction tendon interposition in basal thumb arthritis with hyperextension metacarpophalangeal instability

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  • presenting/speaker Enrico Carità - Clinica San Francesco, Ospedale Volta Mantovana, Verona, Italy
  • Alberto Donadelli - Clinica San Francesco, Verona, Italy
  • Landino Cugola - Clinica San Francesco, Verona, Italy

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-875

doi: 10.3205/19ifssh1085, urn:nbn:de:0183-19ifssh10858

Published: February 6, 2020

© 2020 Carità et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Hyperextension instability of the metacarpophalangeal (MCP) joint of the thumb leads to malfunction and bad outcomes of basal thumb arthritis surgical treatment. Loss of metacarpal height after trapeziectomy and ligament reconstruction tendon interposition (LRTI) can get MCP instability worse. Various techniques have been used to address this hyperextension depending on its severity.

In this study the authors describe their experience with the use of a volar capsular flap fixed with suture-anchor to the neck of first metacarpal bone to restore normal extension in grade 3 instability during basal thumb arthritis surgery.

Methods: From January of 2013 to January of 2018 12 thumb of 10 patients affected by basal thumb arthritis and MCP hyperextension were treated in the same time by trapeziectomy and (LRTI) and volar capsular retensioning. All cases were evaluated pre and post-operatively with VAS, ROM, MCF hyperestension, Jamar and Pinch Test, personal satisfaction and DASH scores with an average follow-up of 39 months (min 6 - Max 62). MCP arthritis was a contra-indication for this technique.

Results and Conclusions: 11 of 12 reported relief from pain, no hyperestension and improvement grip and pinch strength. At the follow-up there was an average reduction of pain from 8,2 to 2,1 VAS. MCF extension was from -10 to 5°; 9 of 10 patients were very satisfied with the results and were able to return to the precedent activities better than before. Improvement of DASH scores was detected. Radiographic controls revealed reduction of scaphoid-metacarpal height from 20 to 50% at follow-up.

We believe that volar plate retensioning is a good way to improve stability of metacarpophalangeal joint preserving motion in alternative to arthrodesis and simultaneous trapeziectomy and LRTI and volar plate retensioning is an appropriate way to treat basal thumb arthritis associated to Z deformity improving functional and subjective outcomes.