Arthrodesis of the Thumb Metacarpophalangeal Joint With Plate Fixation

Abstract

This is a surgical technique for arthrodesis of the thumb metacarpophalangeal joint using a low-profile plate. Using the principles of tension band fixation and interfragmentary compression, a high rate of fusion is achieved with a low incidence of complications. The technique is versatile allowing fixation at any desired position. It can be used in porotic bone and avoids the need for postoperative immobilization.

Management of Osteoarthrosis of the Thumb Joints

“…Techniques include K-wire fixation, 67 tension band wiring, 68 bone screws, 69,70 and plate fixation. 71 The ideal position of MCP fixation is approximately 5 to 20 flexion with approximately 15 internal rotation. 72e74…”

Long-term Outcomes of Silastic Arthroplasty of the Thumb Metacarpophalangeal Joint

“…Of more recent, plate fixation with or without compression has also had proven success. In 2012, Rao 22 reported on 30 patients using a dorsal spanning plate with transarticular compression screw fixation. Average time to union was 11.8 weeks and at 1-year follow-up there were no reported instances of infection or symptomatic hardware.…”

Union Rates and Complications After Thumb Metacarpophalangeal Fusion

“…Fusion has generally been felt to be a reliable procedure in stabilizing the thumb MPJ and relieving pain. While several techniques have been described, [2][3][4][8][9][10][11][12][13] we have favored performing MPJ fusion by using either TBW or PS. The results of our study demonstrate that the rate of complications using these techniques is relatively high.…”

“…Aside from taking special care to minimize the prominence of the ends of the K-wires and tension wires, the higher removal rate with TBW compared with PS seems unavoidable. 4,5 Unlike rigidly fixed plates, K-wires have a tendency to back out of bone, which could potentially explain this discrepancy.…”

“…1 Multiple surgical techniques have been described to fuse the thumb MPJ including tension band wiring (TBW), intramedullary devices, and plate and screw (PS) fixation. [2][3][4][8][9][10][11][12][13] Generally, these reports have yielded high rates of fusion (ranging from 85-100%) and relatively low rates of complications regardless of technique (though complication rates as high as 30% have been reported). 6 Each has advantages and disadvantages, and at our institution, we typically use either TBW or PS.…”