J Korean Soc Surg Hand.  2017 Jun;22(2):81-88. 10.12790/jkssh.2017.22.2.81.

Evaluation of Anti-Subsidence Effect of Abductor Pollicis Longus Suspensionplasty in Carpometacarpal Arthritis of the Thumb

• Park JW
• Shin HD
• Cha SM

• KMID: 2383799
• DOI: http://doi.org/10.12790/jkssh.2017.22.2.81

Abstract

PURPOSE
To evaluate the anti-subsidence effect of suspensionplasty using abductor pollicis longus (APL) tendon in carpometacarpal (CMC) arthritis of the thumb.
METHODS
From June 2009 to May 2016, hematoma distraction arthroplasty (HDA; group A, 10 cases) and HDA with suspensionplasty using APL tendon (group B, 7 cases) were performed in total 17 patients with CMC arthritis. The K-wire was fixed from 1st metacarpal to 2nd metacarpal in both group to maintain the empty space for 6 weeks until the fibrous tissue fill the space. We measured the preoperative trapezium space height with picture archiving and communication (PACS) system and compare the height with that was measured postoperatively. Additionally the subsidence rate checked sequentially with follow-up plain radiography.
RESULTS
The subsidence ratios (subsidence/trapezium height) were average 33.2% in group A and 31.4% in group B. There is no statistical difference between two groups. Six weeks after pin removal almost of subsidence occurred, and then from 3 months after surgery to 6 months after surgery, few subsidence was occurred and it is average only 8% of total subsidence. The trial of distraction the empty space when perform the Kirschner wire (K-wire) fixation, it does not influence the prevention of subsidence. Between distraction height and subsidence, there was no statistical relevance.
CONCLUSION
Although suspensionplasty was known as one of methods to prevent the subsidence, it is thought to be not very helpful method to prevent subsidence of thumb in CMC arthritis.

Keyword

Thumb; Carpometacarpal joint; Arthritis

MeSH Terms

Arthritis*
Arthroplasty
Carpometacarpal Joints
Follow-Up Studies
Hematoma
Humans
Methods
Radiography
Tendons
Thumb*

Figure

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  Fig. 1 Surgical method. (A) Trapezium excision, (B) half tendon of abductor pollicis longus (APL) harvested, (C) APL pass the empty space through the stab incision of flexor carpi radialis tendon, and (D) postoperative plain radiography.

• 

  Fig. 2 Measurement method of trapezial height. Measure the trapezial height from scaphoid distal pole to 1st metacarpal base in posteroanterior view perpendicular manner to scaphoid distal pole.

• 

  Fig. 3 A 47-year-old female with carpometacarpal (CMC) arthritis of thumb. Hematoma distraction arthroplasty was performed. Six weeks after pin removal, almost of subsidence occurred. From then, subsidence progress slowly. (A) Preoperative, (B) postoperative, (C) 3 months follow-up, and (D) 6 months follow-up radiography. The measurement of space height was 9.33 mm. (E) There was also CMC arthritis in the thumb of contralateral hand. The space height was 10.81 mm.

• 

  Fig. 4 The chart of serial measurement of trapezial space height. Through 6 weeks after pin removal, subsidence progress rapidly. Few subsidence has occurred since then. Preop, preoperative; Postop, postoperative.

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