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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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Biomechanical Comparison of Trapeziectomy and Suture button suspension-plasty versus Trapeziectomy and FCR ligamentous reconstruction for Thumb Carpometacarpal Arthritis

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  • presenting/speaker Monica Ramirez - Universidad Industrial de Santander, Hospital Universitario de Santander, Department of Plastic Surgery, Bucaramanga, Santander, Colombia
  • Ben Zellner - Medical College of Wisconsin, Department of Hand Surgery, Wauwatosa, WI, United States
  • Samita Goyal - Medical College of Wisconsin, Department of Plastic Surgery, Wauwatosa, WI, United States
  • Mei Wang - Medical College of Wisconsin, Department of Orthopedic Surgery, Wauwatosa, WI, United States
  • Cameron Best - Medical College of Wisconsin, Department of Orthopedic Surgery, Wauwatosa, WI, United States
  • Hani Matloub - Medical College of Wisconsin, Department of Plastic Surgery, Wauwatosa, WI, United States

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. DocIFSSH19-656

doi: 10.3205/19ifssh1089, urn:nbn:de:0183-19ifssh10898

Published: February 6, 2020

© 2020 Ramirez 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

Text

Objectives/Interrogation: Osteoarthritis of the trapezio metacarpal joint is common and disabling. Several procedures have documented success in treating pain and instability. Central to the majority of the treatment is trapeziectomy.

Our objective was to compare the results of suture button (SB) suspension-plasty and FCR tendon ligamentous reconstruction after trapeziectomy under cyclical loading of a mechanical model designed to simulate lateral pinch of the thumb and index finger.

Methods: 18 fresh-frozen below elbow cadaver specimens were used, they were randomly assigned in two groups: 9 underwent trapeziectomy and suture button and 9 trapeziectomy and FCR suspension procedure.

Scapho-metacarpal distance was measured using fluoroscopy before and after trapeziectomy, and either type of reconstruction and biomechanical testing which was conducted on a servo hydraulic load frame (Bionix Landmark, MTS, Eden Prairies, MN) to simulate lateral pinch. Fixed amount of weights were tied to the sutures connecting the tendons of flexor pollicis longus (FPL, 300g), adductor pollicis (AdP, 150g), and abductor pollicis longus (APL, 200g).

Results and Conclusions: The mean scapho-metacarpal distance pre-trapeziectomy for the FCR reconstruction group (n=9) was 11.13 mm with a standard deviation of 2.18 mm. The average post-trapeziectomy space for the FCR specimens (n=9) was 8.38 mm with a standard deviation of 1.63mm. This difference was statistically significant (p=0.0006).

The mean scapho-metacarpal distance pre-trapeziectomy for the Suture button group (n=9) was 9.3 mm with a standard deviation of 2.87 mm. The average post-trapeziectomy space for the SB specimens (n=9) was 6.63 mm with a standard deviation of 3.07 mm. This difference was statistically significant (p=0.0022).

For the matched pairs, the post testing subsidence was 2.66 mm (SD 2.04) for the SB specimens (n=9) and 2.74 mm (SD 1.68) for the FCR specimens. This was statistically insignificant (p=.53).

Biomechanical testing indicates there is statistically significant subsidence after trapeziectomy and either FCR reconstruction or Suture Button reconstruction. However, when both procedures are compared, there is no statistically significant difference in the subsidence (p=0.53) between Trapeziectomy and FCR and Trapeziectomy and SB suspension.

Suture button suspension shows biomechanical results that are comparable to FCR interposition.