Survival and Long-Term Outcomes of Thumb Metacarpal Extension Osteotomy for Symptomatic Carpometacarpal Laxity and Early Basal Joint Arthritis

J Hand Surg Am. 2018 Aug;43(8):772.e1-772.e7. doi: 10.1016/j.jhsa.2018.01.005. Epub 2018 Mar 2.

Abstract

Purpose: To evaluate the survival and long-term outcomes of thumb metacarpal extension osteotomy for early carpometacarpal (CMC) arthritis.

Methods: Patients who underwent a thumb extension osteotomy between years 2000 and 2011 were identified. Patient demographics, complications, and reoperations were recorded. The Kaplan-Meier survival analysis was used with subsequent CMC surgery defined as failure. Patients who had undergone surgery 10 years or more before the study date underwent radiographic assessment, grip and pinch strength testing, and completed the Patient Rated Wrist/Hand Evaluation (PRWHE) and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaires.

Results: Thirty-two procedures in 7 males and 21 females were performed (mean age, 44.8 y). There were no cases of nonunion. Nine of 32 thumbs developed pin site erythema and were treated with oral antibiotics. Two thumbs developed osteomyelitis. Seven of 32 thumbs (22%) required reoperation. The Kaplan-Meier analysis indicated a 70% probability that patients who have this procedure will not require additional CMC surgery up to 14 years. Seven patients with a mean follow-up of 12.3 years (minimum 10 y) returned for clinical evaluation. The mean PRWHE and QuickDASH scores were 32.1 and 27.7, respectively. Examination revealed 124% pinch and 98% grip strength relative to the preoperative values. One thumb did not progress from stage II disease; 2 thumbs progressed from stage I to stage II; 1 thumb progressed from stage II to stage III; 1 thumb progressed from stage II to stage IV; 1 thumb did not have disease progression at the CMC joint, but developed scaphotrapeziotrapezoidal arthritis.

Conclusions: Although reoperation rates and superficial infections with the described method of fixation were relatively high, thumb metacarpal osteotomy provides some degree of pain relief and improvement of function. This procedure may have utility as a temporizing measure in younger patients as it does not compromise future reconstructive procedures.

Type of study/level of evidence: Therapeutic IV.

Keywords: Arthritis; basal joint; metacarpal extension osteotomy; thumb.

MeSH terms

  • Adult
  • Arthritis / diagnostic imaging
  • Arthritis / physiopathology
  • Arthritis / surgery*
  • Carpometacarpal Joints / diagnostic imaging
  • Carpometacarpal Joints / physiopathology
  • Carpometacarpal Joints / surgery*
  • Disability Evaluation
  • Disease Progression
  • Erythema / etiology
  • Erythema / therapy
  • Female
  • Follow-Up Studies
  • Hand Strength / physiology
  • Humans
  • Male
  • Metacarpal Bones / surgery
  • Middle Aged
  • Osteomyelitis / etiology
  • Osteomyelitis / therapy
  • Osteotomy / adverse effects
  • Osteotomy / methods*
  • Patient Reported Outcome Measures
  • Postoperative Complications
  • Reoperation / statistics & numerical data
  • Retrospective Studies
  • Thumb / diagnostic imaging
  • Thumb / physiopathology
  • Thumb / surgery*
  • Young Adult