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Hyperextension deformities play little part in outcome of trapeziectomy, study finds
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BOSTON — Hyperextension deformities of the metacarpophalangeal joint measuring less than or equal to 30° do not necessarily impact the outcome of trapeziectomy for thumb base osteoarthritis, according to a study presented here.
The results were presented by Tim R. C. Davis, FRCS, CHM, at the 2010 Annual Meeting of the American Society for Surgery of the Hand.
Davis also noted that metacarpophalangeal (MCP) hyperextension deformities measuring greater than 30° can be improved by capsulodesis with a bone anchor, but this may not improve the clinical outcome for hyperextensions of less than 45°.
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“Much is written and talked about on the optimal treatment of trapeziometacarpal osteoarthritis at the base of the thumb,” Davis said. “In comparison, there is very little written about the management of an associated hyperextension deformity of the [MCP] joint.”
Various treatments
Davis’s team prospectively recruited 297 thumbs with painful trapeziometacarpal osteoarthritis in two cohorts from 1992 to 2005. One hundred and twenty-five thumbs were treated with trapeziectomy alone, 55 were treated with palmaris longus interposition, and 115 were treated with flexor carpi radialis ligament reconstruction and tendon interposition.
Reportedly, 101 thumbs had no preoperative hyperextension of the MCP, with 168 displaying a hyperextension deformity of less than 30° and 28 displaying deformity of greater than 30°. The team treated nine with temporary K-wire insertion, six by MCP fusion, five by sesamoid bone tethering to the MC head with a lag screw and 11 by palmar capsulodesis using a bone anchor.
Davis reported that eight of the 28 MCP joints with hyperextension of greater than 30° were left untreated. All of the thumbs were prospectively assessed preoperatively and at 1 year, with the effect of MCP hyperextension on pain and key and tip pinch being measured.
No significant differences
Davis’s team found no significant differences in the 1-year pain levels and key and tip pinch strengths between the thumbs with no preoperative MCP hyperextension and those with untreated MCP hyperextension of less than or equal to 30°.
Thumbs with MCP hyperextension of more than 30° saw reduced deformity — from a mean of 48° to a mean of 16° after 1 year — with the use of capsulodesis, but Davis reported no significant differences in the 1-year pain levels and key and tip pinch strengths between the untreated group and those treated with capsulodesis.
“We feel that hyperextension deformities of 30° or less do not influence the outcome of a trapeziectomy, and probably require no treatment,” Davis concluded.
Reference:
Davis, TR, Poulter R. Thumb metacarpophalangeal joint hyperextension deformity: Its treatment and its influence on the outcome of trapeziectomy. Paper 2. Presented at the 2010 Annual Meeting of the American Society for Surgery of the Hand. October 7-9, 2010. Boston, Mass.
Dr. Davis brought to our attention a current problem that has not been addressed sufficiently in the literature … this excellent work is a worthwhile contribution to the literature. The challenge for this study is the multitude of surgical techniques utilized and inconsistency using K-wire fixation and their possible influence on hyperextension.
— Ghazi M. Rayan, MD
American Society for Surgery of the Hand Moderator
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