The Results of Carpometacarpal Joint Arthrodesis of the Osteoarthritic Thumb in Younger Patients Using Memory Staples

Fusion of the trapeziometacarpal joint is a good pain-relieving procedure in young and active individuals with symptomatic isolated arthritis of the thumb base.[1] Many techniques have been proposed, but it is accepted that arthrodesis may be protracted and difficult to achieve. Indeed, failure of fixation is well-recognized and nonunion rates of up to 39% are described in the literature.[2] We began using memory staples to revise nonunions and hardware failures associated with T-plates (as pictured in [Fig. 1]) and quickly began extending their use to include primary fusions due to encouraging results.

Fig. 1 Failed locking T-plate and nonunion, revised successfully with two memory staples.

We conducted a review of 14 consecutive cases performed since 2012 using memory staples, of which three were revisions of failed T-plate and 11 were primary fusions. All cases were performed under regional anaesthesia with a tourniquet. A dorsal approach was used between abductor pollicis longus (APL) and extensor pollicis brevis (EPB). The joint was excised with an oscillating saw with minimal bony excision to preserve thumb height. Opposing cancellous bony surfaces were held with a temporary k-wire in a “neutral” position, ensuring not to extend the thumb and testing the position against the table-top. Drill holes were positioned using a jig, and guide pegs inserted, measured and checked. Staples were then inserted. The k-wire was removed after the first staple and a second staple was subsequently placed. Clinical images of this sequence are shown in [Fig. 2].

Fig. 2 Surgical technique.

Postoperatively, the patients were immobilized in a plaster slab for 2 weeks and a thermoplastic “made to measure” splint for a further 4 weeks, allowing early protected mobilization.

Thirteen males and one female underwent the procedure, with a mean age of 57 (range 27–64). All underwent regular high-demand activities and were therefore not felt to be suitable for trapeziectomy or prosthetic arthroplasty. All cases united successfully with a mean time to union of 70 days. No reoperations were noted at a mean follow-up of 28 months. We feel that the compressive effect of the staples across the whole of the fusion site leads to a superior environment for union to occur. Obtaining this osseous union can be difficult, but it is important for patient satisfaction.[3] Using this technique has proved to be the most reliable and predictable method for the senior author than other previous methods, including locking T-plates.

Other fixation methods such as k-wires and tension band wiring have been described, but these may have associated soft-tissue complications along with significant risks of nonunion.[2] We feel that use of memory staples leads to quick and reliable union in trapeziometacarpal fusion. Having a relatively short follow-up period, subsequent procedures may be required for adjacent segment disease; however, we would expect this to be in line with other methods of fusion. We would recommend the use of this method for achieving union and patient satisfaction in trapeziometacarpal fusion.

Publication History

Article published online:
17 September 2020

• References

• 1 Hayashi M, Uchiyama S, Nakamura K, Itsubo T, Momose T, Kato H. Arthrodesis of the carpometacarpal joint of the thumb with plate fixation and bone grafting: a retrospective review. J Orthop Sci 2015; 20 (02) 302-306
• 2 De Smet L, Van Meir N, Verhoeven N, Degreef I. Is there still a place for arthrodesis in the surgical treatment of basal joint osteoarthritis of the thumb?. Acta Orthop Belg 2010; 76 (06) 719-724
• 3 De Smet L, Vaes F, Van Den Broecke J. Arthrodesis of the trapeziometacarpal joint for basal joint osteoarthritis of the thumb: the importance of obtaining osseous union. Chir Main 2005; 24 (05) 222-224