Nonunion after trapeziometacarpal arthrodesis: comparison between K-wire and internal fixation

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Osteoarthritis Treatment

Background:

• Trapeziometacarpal (TMC) joint osteoarthritis is a common cause of hand pain and disability.
• Surgical intervention, including TMC arthrodesis, is considered for advanced cases unresponsive to conservative management.

Purpose of the Study:

• To evaluate the clinical outcomes and union rates of TMC arthrodesis for osteoarthritis.
• To compare the efficacy of different fixation methods used in TMC arthrodesis.

Main Methods:

• Retrospective review of 63 TMC arthrodeses in 57 patients with osteoarthritis.
• Fixation methods included K-wires, plates, headless compression screws, and memory staples.
• Patient demographics, follow-up duration, fixation type, union rates, and Disabilities of the Arm, Shoulder and Hand (DASH) scores were analyzed.

Main Results:

• The overall non-union rate was 11%.
• K-wire fixation was associated with a 20% non-union rate, while staples and screws achieved 100% union.
• Higher DASH scores were observed in non-union cases compared to united cases (66.7 vs. 21.9).

Conclusions:

• TMC arthrodesis for osteoarthritis can yield good clinical outcomes, particularly when bone union is achieved.
• Fixation with staples or screws is recommended due to superior union rates compared to K-wires.
• The senior author has ceased using K-wires for TMC arthrodesis fixation due to high non-union rates.