gms | German Medical Science

Objectives/Interrogation: The aim of this study was to evaluate the clinical, functional and radiographic benefits of the postoperative immobilization after trapeziectomy with ligament reconstruction and tendon interposition according to Burton-Pellegrini technique.

Methods: A randomized prospective 2:1 study comprised of a sample population of 15 individuals was performed, excluding those who had previous surgeries of this joint and those who do not present the adequate follow-up. Post-operative splinting for a length of 4-6 weeks was performed in 5 patients and not in the remaining 10. The gender, age, laterality and the hand dominance were ascertained. The following parameters were evaluated preoperatively, in the period of 4 to 6 weeks and at 3 and 6 months: Visual Analog Scale (VAS) for pain, QuickDASH, grip strength, palmar and lateral pinch strength. The Dorsal Subluxation of the first metacarpal and the scaphometacarpal distance were measured. The comparison of evolutionary pattern between groups was made by a Repeated Measures Analysis of Variance (rANOVA), assuming Greenhouse-Geiser correction due to an absence of sphericity. Statistically significant value was considered for p <0.050.

Results and Conclusions: All subjects were female, with a median age of 60.5 years (interquartile range of 10.0 years), with no statistically significant differences between groups (p = 0.662). Follow-up for both groups revealed a favorable evolution for all the considered variables (p<0.050). When comparing groups, considering age, dominant hand involvement and Eaton's classification as confounders, only the VAS measured at rest and lateral pinch strength revealed statistically significant measureable differences (p=0.011 and p=0.013), both favoring early motion. The surgical technique according to Burton-Pellegrini's original description includes a 4-week immobilization period with subsequent onset of active motion, with additional protective splinting ranging from 2 to 4 weeks. In this study, up to 6 months after surgery, immobilization between 4 and 6 weeks did not prove to be superior to immediate motion, in regards of pain management, functional development, grip, palmar and lateral pinch strength. Also with regard to imaging parameters, there was no benefit in the use of splint. Although this result may question the true usefulness of splinting in the postoperative surgical treatment of basal thumb arthritis, it will be necessary to include more patients, as well as a longer follow-up to confirm the results obtained.