Trapeziometacarpal arthrodesis using a combination of. We will be providing unlimited waivers of publication charges for accepted articles related to covid19. Visualization is performed through the posterior portal in a, b, and d and through the anterior portal in c. Especially trapeziectomy with or without interpositional tendon arthroplasty is popular. Stable and wellaligned placement of tibial components during primary total knee arthroplasty is challenging in patients with bone defects.
Thumb cmc carpalmetacarpal joint osteoarthritis and cmc excisional arthroplasty with fascia lata graft clare k. The thumb is placed in the position of a clenched fist in which the distal phalanx of the thumb comfortably rests on the middle phalanx of the index finger with a fully clenched fist. Thumb carpometacarpal arthroplasty the thumb carpometacarpal joint, or cmc joint, is a very common place for arthritis to occur, especially in women. Mahoney history and clinical presentation an 18yearold varsity field hockey player presented with pain in the base of her right thumb. Among surgical methods for advanced trapeziometacarpal arthrosis, arthrodesis may benefit highdemand patients such as laborers because it preserves the osseous foundation of the thumb. Trapeziometacarpal arthrodesis or trapeziectomy with. There has been considerable controversy regarding the procedure of choice for treatment of any given stage of osteoarthritis of the thumb carpometacarpal joint. Intermediate options include complete or partial trapezial excision with or without interposition of a cushioningstabilizing material auto source, allo source, synthetic source. Option to convert easily from internal fixation procedure to subtalar fusion. Multiple procedures available to treat carpometacarpal. A removable handbased splint is fabricated to support the new joint while allowingthe wrist, tip of thumb and possibly second joint of thumb to move freely. The vast majority of patients treated in multiple series in the literature with seemingly widely. Results demonstrate that arthroscopic hemitrapeziectomy and capsular shrinkage for first carpometacarpal arthritis is an effective technique that provides high patient satisfaction, a functional painfree thumb, and a reliable rate of return to activity.
Thumb cmc joint arthrodesis orthopaedicsone articles. This is supplemented by tensionband wiring from the acromion to the neck of the humerus and a muscle. Because of its relative instability, this joint is a frequent site for osteoarthritis. The instratek cmc cable fix is a suture button implant designed to stabilize the thumb metacarpal following removal or partial resection of the trapezium trapezium excision. Articular fractures of the base of the 1 st metacarpal, also known as bennett fractures, are relatively common finger fractures. Figure 1 arthrodesis of the trapeziometacarpal joint. Shoulder arthrodesis is an uncommon salvage procedure that is most commonly performed in patients with intractable instability or paralytic disorders of the upper extremity. The family of swivelock tenodesis implants is designed to support a multitude of proximal biceps tenodesis techniques and maximize or efficiency. Surgical treatment of trapeziometacarpal joint osteoarthritis. Forked eyelets are also available for an allarthroscopic approach. Osteoarthritis of the trapeziometacarpal joint tmj. Snomedct term arthrodesis of elbow procedure concept id. Surgical treatment for arthritic thumb cmc joints is predictably successful.
A joint is comprised of two bones, each covered with cartilage. A technique for isolated arthrodesis of the second. As all joint fractures, finger fractures must be operated on as soon as they are displaced. Tarsometatarsal iii arthrodesis with the round plug joint excision technique. The primary goals of a triple arthrodesis are to relieve pain from arthritic, deformed, or unstable joints. This invaluable 2 dvd set is the perfect companion to the textbook, minimally invasive spine fusion.
Indications discuss indications and more general concerns. Rehabilitation after trapeziometacarpal arthroplasty. A true surgeons guide to navigating the operating room. Trapeziometacarpal osteoarthritis, also known as osteoarthritis at the base of the thumb or as rhizarthrosis, is a reparitive joint disease affecting the first carpometacarpal joint cmc1. As cartilage is removed from the tn, nc, and cc joints to achieve fusion, all necrotic portions of the navicular are excised and replaced with structural autologous iliac crest bone. Cervical arthrodesis is a surgical procedure that joins selected bones in the cervical spine. This study aims to determine the union rate and key strength following arthrodesis using a chevron osteotomy and plate fixation. We are committed to sharing findings related to covid19 as quickly and safely as possible. Pdf the surgical technique and clinical results for. The carpometacarpal joint cmc has a unique anatomic configuration that allows vital motion and hand function. Alapsta anterolateral arthroscopic posterior subtalar arthrodesis of left hindfoot in a patient with severe idiopathic subtalar arthritis.
Arthodesis principles orthopaedic surgery elearning. There are multiple surgical techniques for arthrodesis of the cmc joint. Anew technique of shoulder fusion is presented using a posterior approach. Minimally invasive thumb carpometacarpal joint arthrodesis. Include any exams preformed under anesthesia positioning describe and provide or photos to illustrate p. This study was designed to directly compare the clinical results of two common surgical procedures for this condition, trapeziometacarpal arthrodesis and trapezial excision with ligament reconstruction and tendon. Crossshaped bone grafting and locking plate fixation for. It is a safe and reliable procedure, provided that the surgical technique is carefully followed. Thumb cmc arthroplasty is a treatment option for thumb arthritis, a type of osteoarthritis found at the carpometacarpal cmc joint located at the base of the thumb. To assess the longterm results of trapeziometacarpal arthrodesis using a quadrangular plate, regarding clinical, radiological and functional outcomes, as well as development of complications. Trapeziometacarpal joint tmj osteoarthritis oa, or rhizarthrosis, is a disabling condition of the hand that causes pain, stiffness and weakness, resulting in impaired hand function, strength and dexterity fig. The surgery can be performed using a rightsided or a leftsided approach.
Despite the availability of numerous surgical options, none has been definitively proven to be superior. The cmc joint gives the thumb a wide range of motion up, down, and across the palm, as well the ability to pinch. These hand fractures compromise the function of the trapezometacarpal joint, which is the main joint of the thumb. Because hypermobility of the first tarsometatarsal joint is considered to be causal for hallux valgus disease, fusion of the tarsometatarsal joint is an upcoming surgical procedure. Hallux interphalangeal joint arthrodesis and jones tendon transfer. Comparison of arthrodesis and metallic hemiarthroplasty of the. We have evaluated 18 patients with eaton iii tmj osteoarthritis, who underwent an arthrodesis. Despite the development of new and increasingly stable fixation devices. Bennetts fractures arthroscopic and percutaneous screw technique joseph f. A cast or splint which immobilizes the wrist and thumb is worn. The indications for arthroscopic ankle arthrodesis are for treatment of end stage ankle arthritis in those patients who have failed non operative treatments. The thumb carpometacarpal cmc joint is one of the most common sites of arthritis in the hand. Surgical view of a left ankle arthrodesis in supine position. The surgical technique is a modified burtontype arthroplasty and has been previously described in detail 4.
Arthroscopic ankle and subtalar arthrodesis indications and. Surgical technique view video the patient is positioned supine on the operating table with the arm extended on a hand table. Modifications to the burton arthroplasty in our surgical technique included the use of a mini mitek suture anchor to secure the slip of fcr grants this study received funding from the midamerica orthopaedic. Literature supporting the use of trapeziometacarpal tmc arthrodesis in the treatment of osteoarthritis oa of this joint is unclear. Restoration of shoulder function with shoulder fusion.
A multitude of methods appear to offer similar end results, although some methods definitely involve more surgical work and perhaps greater patient risk. All these factors have made arthroscopic surgery, our first choice technique for ankle and subtalar arthrodesis. Treatment of advanced carpometacarpal joint disease. The advantage of this technique is an avoidance of a shortening of the third ray during the procedure. We present a surgical technique for tarsometatarsal joint arthrodesis using a trephine to resect the articular surfaces and a dowel plug of an autogenous calcaneal graft with locking plate fixation. Articles tomaino orthopaedic care exceptional care. Surgical technique hindfoot endoscopic technique unlike the technique originally proposed by tasto,1 using anterolateral and posterolateral portals and placing the patient in the lateral decubitus position, we perform arthroscopic subtalar arthrodesis using posterior endoscopic portals following a. Arthrex tarsometatarsal iii arthrodesis with the round. Perinavicular arthrodesis as treatment of advanced. Thumb surgery using carpometacarpal joint fixation system.
The surgical technique and clinical results for trapeziometacarpal arthrodesis using locking plate fixation in women 50 years or older article pdf available in plastic and reconstructive surgery. Debilitating joint pain at the thumb can also be managed quite successfully with nonoperative methods, such as bracing, exercise regimen, medications, and injections, but sometimes the pain. Trapezium excision and suture suspensionplasty tess for. Unlike the technique originally proposed by tasto, 1 using anterolateral and posterolateral portals and placing the patient in the lateral decubitus position, we perform arthroscopic subtalar arthrodesis using posterior endoscopic portals following a similar technique as originally described by van dijk et al. After removal of the articular cartilage, a rush pin is introduced from the spine of the scapula, through the glenoid into the medullary canal of the humerus. Long term results of surgical intervention for osteoarthritis of the trapeziometacarpal joint comparison of resection arthroplasty, trapeziectomy with tendon interposition and trapeziometacarpal arthrodesis e. Arthrodesis is often indicated for a young active male or manual worker who needs a strong pinch more than fine motion of the thumb, especially for stage ii to iv and posttraumatic oa. Foot and ankle fusions indications and surgical techniques. Surgical pathologies of the cervical spine have commonly been addressed through anterior and posterior approaches. This surgery is recommended if you have osteoarthritis at the carpalmetacarpal cmc, or basal, joint at the base of your thumb. Unfortunately this predisposes the thumb joint to a degenerative painful condition also known as basal. Therefore, we performed a randomized clinical trial comparing trapeziectomy, with ligament reconstruction and tendon. From 2005 to 2015, 70 patients were treated at our institution for primary osteoarthrosis of thumb carpometacarpal joint performing a trapeziometacarpal arthrodesis. Patients who have significant ankle deformity associated with their ankle arthritis may not be appropriate for the arthroscopic technique and may best be treated with an open technique.
Arthrodesis of the thumb carpometacarpal joint using a. Principles of arthrodesis introduction most reliable operation for pain or instability where stiffness does not seriously affect function, e. First carpometacarpal arthroplasty with ligamentous. Osteoarthritis at that location can cause pain, joint instability. This joint is formed by the trapezium bone of the wrist and the first metacarpal bone of the thumb. Arthrodesis definition of arthrodesis by medical dictionary. Arthroscopic subtalar arthrodesis has proved to offer at least similar results to open techniques, and it may achieve higher rates of fusion and lower complication rates than open techniques when compared directly. Thumb cmc carpalmetacarpal joint osteoarthritis and. Osteoarthritis of the carpometacarpal thumb joint this booklet has been written to provide you with information about your thumb arthritis and give you a better understanding of your thumb joint, why you experience pain, and how you can manage your symptoms. It is the second most common degenerative disease of the hand, after distal interphalangeal joint oa. Shoulder arthrodesis is indicated for brachial plexus injury, failed prosthetic arthroplasty, reconstruction after tumor resection, chronic infection, and refractory instability and pseudoparalysis of the shoulder secondary to combined rotator cuff and deltoid muscle dysfunction.
This procedure involves a combined dorsal approach to the talonavicular tn and naviculocuneiform nc and lateral approach to the calcaneocuboid cc joints. Despite this, in 1939, takagi described an arthroscopic technique for the ankle joint in a. The trapeziometacarpal joint is the second most common site of osteoarthritis in the hand and the most frequent one to require surgery. Arthrodesis of the thumb carpometacarpal joint using a quadrangular plate. Anterolateral arthroscopic posterior subtalar arthrodesis. Arthrodesis of the trapeziometacarpal joint using a.
Essential foot and ankle surgical techniques a multidisciplinary. A triple arthrodesis consists of the surgical fusion of the talocalcaneal tc, talonavicular tn, and calcaneocuboid cc joints in the foot. Implants are available with suture eyelets or closed eyelets for surgeons who prefer a whipstitching technique. Numerous surgical techniques, including trapeziectomy, arthroplasty and arthrodesis have been reported 1,2. We report here a new option of surgical treatment for trapeziometacarpal osteoarthritis. The high prevalence of trapeziometacarpal joint tmj osteoarthritis leads to develop techniques to improve surgical outcomes when conservative treatment has failed. Hallux valgus disease is a common deformity of the forefoot. After surgery, your forearm and hand will be in a large bandage and plaster splint.
Arthrodesis of the trapeziometacarpal joint is recognized as one of the valuable technique but unfortunately there has been wide variation in the union rate. This unique book is a focused and comprehensive presentation of common fusion procedures arthrodesis for the foot and ankle, including patient selection. Metal block augmentation for bone defects of the medial. Arthroscopic hemitrapeziectomy for first carpometacarpal. Several techniques for shoulder arthrodesis have been described over the past century. Arthroscopic ankle and subtalar arthrodesis indications. Arthroscopic ankle and subtalar arthrodesis induces less trauma to the soft tisues and this translates in a lower complication rate, a shorter hospital stay, an early mobilization and a higher success rate. Germany presents the round plug technique for tmt 3 arthrodesis. The thumb is suspended by chinese finger traps with 5 pounds of counter traction, which forces the wrist into ulnar deviation.
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