Results of arthroplasty of the Carpometacarpal Joint of the Thumb: А case series

Arthrosis of the carpometacarpal joint of the thumb is extremely relevant, as it affects up to 15% of the adult population, critically limiting the grasping function of the hand and fine motor skills. In the conditions of the aging society and the growing load on the hands (gadgets, work), the disease leads to early disability, requiring the development of new methods of treatment in addition to standard surgery.The article presents an original and simple method for treatment of arthrosis of the carpometacarpal joint of the thumb, stage III-IV disease.Surgical treatment was performed in 9 patients on 13 hands. The age of patients ranged from 48 to 64 years (mean 58 years). The clinical picture in all patients was typical for rhizarthrosis. The X-ray picture corresponded to stage III-IV rhizarthrosis. All patients underwent hematoma and distraction arthroplasty, entire trapeziectomy, distraction and fixation of the first metacarpal bone in a position of slight “overcorrection” with K-wire or a compression-distraction rod external fixation device. The results of treatment were studied in 8 patients (11 hands) from 2 months to 8 years after surgery (on average 3 years). 7 patients (10 hands) had no pain both at rest and during daily work. Moderate pain was observed in one patient in the immediate postoperative period (2 months after surgery). The opposition of the thumb to the fifth finger was restored in 6 patients (9 hands), in two patients (2 hands) opposition was possible to the fourth finger. The ability to reach the projection of the fifth metacarpal head with active flexion of the thumb was restored in the same proportion. Active radial abduction-adduction of the thumb was completely restored in all 8 patients. 7 patients (10 hands) were “very satisfied” with the results of the operation, one (1 hand) was “not completely satisfied.” Absolutely all patients who underwent surgery returned to performing their previous domestic and professional duties in full. Follow-up X-rays showed clear proximal displacement of the base of the first metacarpal bone and narrowing of the gap between the first metacarpal and scaphoid bones. Conclusions. Trapeziectomy with fibrous tissue interposition is a simple and minimally traumatic method for treating stage III-IV rhizarthrosis. To create the necessary space between the first metacarpal and scaphoid and for postoperative fixation, it is advisable to use a compression-distraction rod external fixation device. Keywords:thumb, arthrosis, carpometacarpal joint, trapeziectomy, hematoma and distraction arthroplasty.