A new concept for thumb basal joint arthrodesis: the V-shaped osteotomy

Nonunion is a common complication after trapeziometacarpal joint arthrodesis. Classically, arthrodesis involves the apposition of the trapezium to the metacarpal after excision of the diseased joint surfaces producing either a cone-in-cup configuration or 2 opposing flat surfaces. With these techniques, it is difficult to achieve good coaptation of the bony surfaces in the desired angle of arthrodesis. Additional bone grafting is often required. We describe a new technique to shape the trapeziometacarpal joint surfaces that provides inherent stability, a larger contact area, and that allows easy positioning of the thumb in the ideal position for fusion.