Effect of intraoperative hand-grip position on surgical outcome of thumb carpometacarpal arthrodesis
Abstract Background A variety of surgical techniques had been developed over the past few decades for treating thumb carpometacarpal joint (CMCJ) osteoarthritis (OA). However, there are currently no accepted consensus on the ideal treatment for thumb CMCJ OA. Arthrodesis was one of the widely popula...
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| Format: | Article |
| Language: | English |
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BMC
2023-12-01
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| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13018-023-04423-y |
| _version_ | 1797397859445768192 |
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| author | Kai-Xing Alvin Lee I.-Ting Chung Wei-Chih Wang Chen-Wei Yeh Tsung-Yu Ho Cheng-En Hsu Yung-Cheng Chiu |
| author_facet | Kai-Xing Alvin Lee I.-Ting Chung Wei-Chih Wang Chen-Wei Yeh Tsung-Yu Ho Cheng-En Hsu Yung-Cheng Chiu |
| author_sort | Kai-Xing Alvin Lee |
| collection | DOAJ |
| description | Abstract Background A variety of surgical techniques had been developed over the past few decades for treating thumb carpometacarpal joint (CMCJ) osteoarthritis (OA). However, there are currently no accepted consensus on the ideal treatment for thumb CMCJ OA. Arthrodesis was one of the widely popular treatment methods; however, studies have showed that non-union rates were as high as 50%, with higher complications such as osteoarthritis of neighbouring joints and higher revision surgeries required as compared to other surgical methods. Patients with arthrodesis were also reported to have decreased thumb range of motion and loss of opponens function. Currently, there are numerous intraoperative positioning techniques for arthrodesis which could be confusing for young surgeons. With recent developments of fixation plates and better understanding of the wrist anatomy, this retrospective review aimed to evaluate the efficacy of our intraoperative hand-grip positioning method for arthrodesis of thumb CMCJ OA. What are the postoperative functional outcomes of (1) T-hook plates and (2) our intraoperative hand-grip positioning method for Eaton III thumb CMCJ OA arthrodesis by evaluating pain visual analogue scale (VAS) score, Disabilities of the Arm, Shoulder and Hand questionnaires (DASH), Mayo Wrist scores, capability of thumb opposition (Kapandji score), and comparing pre- and postoperative grip and pinch strength? Methods Twenty patients with CMCJ OA underwent arthrodesis using our intraoperative hand-grip positioning method and T-hook plates and screws (Acumed, USA). Patients were evaluated preoperatively and at 1, 3, 6 and 12 months postoperatively. Radiologic assessment including fusion evaluation, evaluation of radial and palmar abduction angles was done on hand X-rays. Results Twenty patients with a minimum follow-up duration of 12 months were included in this study. 100% fusion rate was achieved with only 1 case of complication involving radial sensory nerve neuropathy which was resolved after removal of implant and neurolysis. Significant improvement in pain and Mayo Wrist scores were noted 3 months postoperatively, whilst DASH score exhibited significant improvements after 6 months of follow-up (p < 0.05). Even though there were no significant differences observed between preoperative and postoperative grip strength, pinch strength and Kapandji scores, positive recovery trends were noted for all parameters with these functions surpassing preoperative levels after 12 months of follow-up. Significant improvements on hand X-rays were also noted for both postoperative radial and palmar abduction angles. Conclusions There is currently no consensus on the ideal treatment method for thumb CMCJ OA. In this study, we would like to propose a simple intraoperative hand-grip positioning method with T-hook plates for arthrodesis. As seen from our results, our technique was able to provide satisfactory and replicable postoperative results and thus we would like to propose our hand-grip positioning method with T-hook plates fixation for subsequent treatment of patients with Eaton stage III thumb CMCJ OA. |
| first_indexed | 2024-03-09T01:16:18Z |
| format | Article |
| id | doaj.art-1b732d30baf54ff6b90829cd39d2a8c5 |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-03-09T01:16:18Z |
| publishDate | 2023-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-1b732d30baf54ff6b90829cd39d2a8c52023-12-10T12:26:08ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2023-12-011811810.1186/s13018-023-04423-yEffect of intraoperative hand-grip position on surgical outcome of thumb carpometacarpal arthrodesisKai-Xing Alvin Lee0I.-Ting Chung1Wei-Chih Wang2Chen-Wei Yeh3Tsung-Yu Ho4Cheng-En Hsu5Yung-Cheng Chiu6School of Medicine, China Medical UniversitySchool of Medicine, China Medical UniversityDepartment of Orthopaedics Surgery, China Medical University Hsinchu HospitalSchool of Medicine, China Medical UniversitySchool of Medicine, China Medical UniversitySports Recreation and Health Management Continuing Studies-Bachelor’s Degree Completion Program, Tunghai UniversitySchool of Medicine, China Medical UniversityAbstract Background A variety of surgical techniques had been developed over the past few decades for treating thumb carpometacarpal joint (CMCJ) osteoarthritis (OA). However, there are currently no accepted consensus on the ideal treatment for thumb CMCJ OA. Arthrodesis was one of the widely popular treatment methods; however, studies have showed that non-union rates were as high as 50%, with higher complications such as osteoarthritis of neighbouring joints and higher revision surgeries required as compared to other surgical methods. Patients with arthrodesis were also reported to have decreased thumb range of motion and loss of opponens function. Currently, there are numerous intraoperative positioning techniques for arthrodesis which could be confusing for young surgeons. With recent developments of fixation plates and better understanding of the wrist anatomy, this retrospective review aimed to evaluate the efficacy of our intraoperative hand-grip positioning method for arthrodesis of thumb CMCJ OA. What are the postoperative functional outcomes of (1) T-hook plates and (2) our intraoperative hand-grip positioning method for Eaton III thumb CMCJ OA arthrodesis by evaluating pain visual analogue scale (VAS) score, Disabilities of the Arm, Shoulder and Hand questionnaires (DASH), Mayo Wrist scores, capability of thumb opposition (Kapandji score), and comparing pre- and postoperative grip and pinch strength? Methods Twenty patients with CMCJ OA underwent arthrodesis using our intraoperative hand-grip positioning method and T-hook plates and screws (Acumed, USA). Patients were evaluated preoperatively and at 1, 3, 6 and 12 months postoperatively. Radiologic assessment including fusion evaluation, evaluation of radial and palmar abduction angles was done on hand X-rays. Results Twenty patients with a minimum follow-up duration of 12 months were included in this study. 100% fusion rate was achieved with only 1 case of complication involving radial sensory nerve neuropathy which was resolved after removal of implant and neurolysis. Significant improvement in pain and Mayo Wrist scores were noted 3 months postoperatively, whilst DASH score exhibited significant improvements after 6 months of follow-up (p < 0.05). Even though there were no significant differences observed between preoperative and postoperative grip strength, pinch strength and Kapandji scores, positive recovery trends were noted for all parameters with these functions surpassing preoperative levels after 12 months of follow-up. Significant improvements on hand X-rays were also noted for both postoperative radial and palmar abduction angles. Conclusions There is currently no consensus on the ideal treatment method for thumb CMCJ OA. In this study, we would like to propose a simple intraoperative hand-grip positioning method with T-hook plates for arthrodesis. As seen from our results, our technique was able to provide satisfactory and replicable postoperative results and thus we would like to propose our hand-grip positioning method with T-hook plates fixation for subsequent treatment of patients with Eaton stage III thumb CMCJ OA.https://doi.org/10.1186/s13018-023-04423-yThumb carpometacarpal jointOsteoarthritisArthrodesisT-hook plate |
| spellingShingle | Kai-Xing Alvin Lee I.-Ting Chung Wei-Chih Wang Chen-Wei Yeh Tsung-Yu Ho Cheng-En Hsu Yung-Cheng Chiu Effect of intraoperative hand-grip position on surgical outcome of thumb carpometacarpal arthrodesis Journal of Orthopaedic Surgery and Research Thumb carpometacarpal joint Osteoarthritis Arthrodesis T-hook plate |
| title | Effect of intraoperative hand-grip position on surgical outcome of thumb carpometacarpal arthrodesis |
| title_full | Effect of intraoperative hand-grip position on surgical outcome of thumb carpometacarpal arthrodesis |
| title_fullStr | Effect of intraoperative hand-grip position on surgical outcome of thumb carpometacarpal arthrodesis |
| title_full_unstemmed | Effect of intraoperative hand-grip position on surgical outcome of thumb carpometacarpal arthrodesis |
| title_short | Effect of intraoperative hand-grip position on surgical outcome of thumb carpometacarpal arthrodesis |
| title_sort | effect of intraoperative hand grip position on surgical outcome of thumb carpometacarpal arthrodesis |
| topic | Thumb carpometacarpal joint Osteoarthritis Arthrodesis T-hook plate |
| url | https://doi.org/10.1186/s13018-023-04423-y |
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