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Modified Imbriglia CMC Arthroplasty: Preliminary Report on 15 Cases

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ABSTRACT

Imbriglia’s carpometacarpal (CMC) arthroplasty consists of one-quarter to one-third distal trapezectomy, imbrication of the CMC capsule to the flexor carpi radialis, and transfer of the extensor pollicis brevis to the flexor side of the proximal phalanx. The modification to Imbriglia’s arthroplasty involves imbricating the ulnar most slip of the abductor pollicis longus to the flexor carpi radialis and using the remaining tendon as an “anchovie,” and reefing the other slips of the abductor pollicis longus to give the metacarpal an abduction vector.

Between January 2001 and January 2003, 15 modified Imbriglia CMC arthroplasties were performed in 14 patients (1 male and 13 females). All CMC joints were classified as Eaton grade II or III. The male patient had bilateral CMC arthroplasties. Nine of 14 patients had workers’ compensation insurance. Eight were dominant and 7 were nondominant.

Postoperative care consisted of a thumb spica splint for 2 weeks until suture removal. A removable thumb spica splint was worn for 4 weeks, with exercises of the metacarpophalangeal and distal interphalangeal joints twice in the morning, afternoon, and evening. All 14 charts were reviewed and patients were re-evaluated regarding residual pain, CMC subluxation, hyperextension deformity of the metacarpophalangeal, return to original job, grip strength, pinch strength, injury to the radial sensory nerve, and overall satisfaction with the procedure.

Three of 15 cases had minimal residual pain. No patient experienced subluxation of the metacarpal on the residual trapezium or hyperextension of the metacarpophalangeal joint. All 9 workers’ compensation patients returned to their original job without modification. Grip and pinch strength on the operated side was stronger than the nonoperated side in those patients who had arthritis on the opposite side (7/15). Grip and pinch strength remained lower than the opposite side if no arthritis was noted in the carpometacarpal (7/15). The bilateral patient had stronger strength on both sides. All patients stated they would repeat the procedure.

The modified Imbriglia CMC arthroplasty provides excellent preliminary results in Eaton grade II and III arthritis.